The factor structure of coping strategies in hemophilia.

The purpose of the present study was to analyze the factor structure of the Coping Strategies Questionnaire (CSQ). In order to find factors that are reproducible across samples and to evaluate their relationship to pain, disability, and depressive mood, the subjects used were a group of 224 patients with congenital coagulation defects. Factor analysis identified 4 factors in the Coping Strategies Questionnaire that could be categorized as Distraction, Pain Control, Reinterpreting Pain Sensations, and Catastrophizing. There were positive correlations between pain and Catastrophizing (p < 0.005) and between disability and Catastrophizing (p < 0.005). There was also a relationship between Catastrophizing and emotional well-being indicating that the lower the feeling of well-being, the greater the use of Catastrophizing strategies. The present results confirm that a 4- to 5-factor solution gives reasonable reproducibility across samples and methods.

Clinician's ability to identify caries risk subjects.

The clinician's ability to identify caries risk children without saliva tests was studied in five health care centers. 77 examiners predicted, after the annual check-up and treatment, whether, during the following 12 months, the child would develop new dentinal caries lesions to be filled. 7917 children aged 5-16 yr were included. Only information routinely available at clinical examinations was used. In general, the overall sensitivity was 44% and specificity 90%. Some clinicians were able to identify the caries risk children with high sensitivity and specificity figures.

Coping strategies, pain, and disability in patients with hemophilia and related disorders.

OBJECTIVE: To analyze the use of various coping strategies in homogeneous groups of patients with hemophilia and von Willebrand's disease and to investigate the relationship between the state of the disease, the use of coping strategies, and management of the disease. METHODS: The coping strategies measured by the Coping Strategies Questionnaire were analyzed in 3 homogeneous groups of 224 patients. Psychosocial well-being (PWB) measured by the Rand 36-item Health Survey 1.0 was used as an indicator of management of the disease. The pain factor consisted of the following variables: pain intensity, use of analgesics, Functional Disability Index, and physical activity level. RESULTS: The groups of patients differed significantly only in the use of the catastrophizing strategy (CAT). In all pain groups, distraction was the most commonly used coping strategy. A significant interaction effect of pain factor and age on PWB (P = 0.04) was found. The mediating function of the CAT strategy was confirmed by the series of regression analyses. CONCLUSION: The coping strategy profile in hemophilia was found to be similar to those in other chronic pain states. The use of the strategies does not depend on the severity of the disease. We confirmed the role of age and the use of the CAT strategy as, respectively, moderator and mediator in the pattern of relationships between the clinical state of the disease and psychosocial well-being.

Caries experience and treatment need among adults responding to an invitation for dental examination and treatment in two Karelian communities in Russia.

This study was planned and conducted by the Health Authorities of Karelia in the Russian Federation and the Faculty of Dentistry, University of Kuopio, Finland. The aim of the study was to analyze caries experience and treatment need among adults who responded to an invitation for dental examination and offered free dental treatment in two communities in Karelia. A total of 227 adults aged 30-72 years from 2 rural communities were examined clinically in accordance with WHO criteria by a team of Finnish dental specialists. The participants represented two major ethnic groups (Fenno-Ugrians, 68%; Slavs, 32%). The mean DMFT and DMFS were 15.8 and 58.8, respectively. Among dentate subjects (n = 225) 88% had at least one carious tooth and 80% had one or more filled or crowned teeth. Altogether, 34% of the subjects needed extraction(s), and 83% needed restorative treatment. The main finding of the study was that with regard to caries experience, oral health was quite good compared with that found in Finland and the UK.

Empirically derived classification of coagulation disorders in 224 patients.

BACKGROUND: It is not known whether the current molecular classification of blood coagulation disorders into severe (0-1%), moderate (1-5%) and mild (5-40% factor activity remaining) corresponds to the actual clinical situation or is in the patients best interest. METHODS: A questionnaire-based study of 244 patients. Principal factor analysis was used to create a set of variables for classification, which was performed using K-means algorithm. The main variables were use of prophylactic treatment during the last five years and during the last 12 months, home treatment, bleeding, surgery, antibody inhibitors, use of cold medication, pain, use of analgesics, functional disability and physical activity level. RESULTS: The first five variables of the main outcome measures loaded to a factor reflecting bleeding (bleeding factor) and the last four to a pain factor; both factors produced a 3-cluster solution with severe, moderate and mild bleeding or pain. Overlap between the molecular, bleeding and pain classifications was not extensive. Only 16% of 81 patients with severe coagulation factor deficiency had severe musculoskeletal pain and disability. Furthermore, only 28.6% of the patients with severe von Willebrand's disease actually had a severe bleeding disorder. CONCLUSIONS: Molecular classification does not correlate very well with the severity of disease as reflected in bleeding and pain. This is due to better prognosis for patients on modern medical management. Appropriate patient classification is a basis for defining and managing patients' clinical problems.