The impact of biopsychosocial factors on quality of life: women with primary biliary cirrhosis on waiting list and post liver transplantation.

OBJECTIVES: Primary biliary cirrhosis (PBC) is the second most common reason for liver transplants among women in the USA. While survival rates are high, there is evidence of persistent problems post-transplant. This study aimed to identify significant contributors to quality of life (QOL) for women with PBC on waiting list (WL) and post-transplant (PT) and compare QOL in each group with US population norms. DESIGN: A cross-sectional, two-group study design was used. METHODS: WL and PT participants were recruited through medical centres and on-line. QOL was measured by the Short Form-36 and an indicator of Social QOL created for this study. A biopsychosocial model incorporating demographic, biomedical, psychological, and sociological factors guided choice of variables affecting QOL. Analyses examined (1) all factors for differences between WL and PT groups, (2) association between factors and QOL outcomes within each group, (3) multivariate regression of QOL on factors in the model for the sample as a whole, and (4) comparison of QOL outcomes with national norms. RESULTS: One hundred women with PBC participated in the study, 25 on WL and 75 PT. Group comparisons showed improvement for PT participants in most biomedical and psychological variables and in QOL outcomes. QOL was related to many, but not all, of the variables in the model. In multivariate analysis, Fatigue, Depression, Coping, and Education - but not Transplant Status - were identified as indicators of QOL. Physical QOL improved significantly after 5 years PT, when it was no longer worse than national norms. Mental QOL remained worse than national norms despite distance in time from transplant. CONCLUSIONS: The model proved useful in identifying a range of factors that contributed to QOL for women with PBC before and after transplant. Recommendations were made for clinical practice to improve QOL through a combination of treatment and self-management.

Fatigue as a major predictor of quality of life in women with autoimmune liver disease: the case of primary biliary cirrhosis.

OBJECTIVES: Fatigue is a nearly universal symptom of many chronic diseases, yet it is often poorly understood and underappreciated as a factor in quality of life (QOL). Generally, clinicians have relied on subjective measures of fatigue, if they consider it at all. This study uses well-validated instruments to examine fatigue as a predictor of QOL in women with primary biliary cirrhosis (PBC), an autoimmune, chronic liver disease. METHODS: Eighty-one women with PBC completed a survey that included measures of fatigue (Fatigue Impact Scale) and QOL (SF-36) as well as demographic variables (age, education) and medical information (symptoms, stage of illness, time since diagnosis). QOL results for the sample were compared with those of a nationally normed U.S. population. Bivariate and multivariate analyses were conducted to identify contributors to variation in QOL. RESULTS: Compared with national norms, QOL for this PBC population was significantly impaired. When all variables with bivariate significance in relation to QOL were included in multivariate analyses, results showed fatigue to be the primary predictor of QOL, including all 8 QOL scales and the 2 summary scales. Regression results, dominated by fatigue, explain 25-59% of the variance in QOL. CONCLUSIONS: Fatigue has profound effects on every aspect of life for women with PBC-physical, social, emotional, and psychological. The results lead to recommendations for health care providers to assess fatigue in their patients with PBC and to take steps, where warranted, to mitigate its effects.

A tool for measuring physician readiness to manage intimate partner violence.

BACKGROUND: Intimate partner (domestic) violence (IPV) is a common problem in medical practice that is associated with adverse health outcomes. There are widespread calls to improve IPV education for physicians, but there are few valid, reliable, easily available, and comprehensive measures of physician IPV knowledge, attitudes, and practices that can be used to assess training effectiveness. METHODS: In 2002, expert consensus and previous surveys were used to develop a new survey-based IPV self-assessment tool that included more information on current IPV knowledge and practices than previous tools. The draft tool was evaluated using standard psychometric techniques in a group of 166 physicians in 2002, revised, and then retested in a second group of 67 physicians on three occasions in 2003 and 2004. Analyses were conducted in 2005. RESULTS: The draft IPV survey tool demonstrated good internal consistency reliability, with Cronbach's alpha >/=0.65 for ten final scales. The developed scales were closely correlated with theoretical constructs and predictive of self-reported behaviors. On repeat testing, a revised version of the tool was found to have good stability of psychometric properties in a different physician population (Cronbach's alpha>/=0.65, and internal correlations as predicted), good correlation with measured office IPV practices, and stable results in this population over 12 months. CONCLUSIONS: The final version of this instrument, named the PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey) tool, is a 15-minute survey that is a comprehensive and reliable measure of physician preparedness to manage IPV patients. This tool is publicly available and can be used to measure the effectiveness of IPV educational programs.

A community-based trial of an online intimate partner violence CME program.

BACKGROUND: There is a broad need to improve physician continuing medical education (CME) in the management of intimate partner violence (IPV). However, there are only a few examples of successful IPV CME programs, and none of these are suitable for widespread distribution. DESIGN: Randomized controlled trial beginning in September 2003 and ending in November 2004. Data were analyzed in 2005. SETTING/PARTICIPANTS: Fifty-two primary care physicians in small (fewer than eight physicians), community-based medical offices in Arizona and Missouri. INTERVENTION: Twenty-three physicians completed a minimum of 4 hours of an asynchronous, multi-media, interactive, case-based, online CME program that provided them flexibility in constructing their educational experience ("constructivism"). Control physicians received no CME. MAIN OUTCOME MEASURES: Scores on a standardized self-reported survey, composed of ten scales of IPV knowledge, attitudes, beliefs, and self-reported behaviors (KABB) administered before randomization and repeated at 6 and 12 months following the CME program. RESULTS: Use of the online CME program was associated with a significant improvement in eight of ten KABB outcomes, including physician self-efficacy and reported IPV management practices, over the study period. These measures did not improve in the control group. CONCLUSIONS: The Internet-based CME program was clearly effective in improving long-term individual educational outcomes, including self-reported IPV practices. This type of CME may be an effective and less costly alternative to live IPV training sessions and workshops.

Assessing the success of the WomanKind program: an integrated model of 24-hour health care response to domestic violence.

PURPOSE: The WomanKind program, a non-profit health care based program for for victims of domestic/intimate partner violence (IPV), seeks to enable and motivate health care providers to identify victims of such violence and refer them to WomanKind's in-house services. An evaluation designed to assess client referral to WomanKind services and the impact of health care provider training was carried out. METHODS: Data were collected at three intervals over a 2-year period at 3 intervention and 2 comparison hospitals located in Minneapolis, MN. The focus of data collection efforts was to assess the providers' knowledge, attitudes, beliefs, and behaviors (KABB) concerning identification and referral of victims of IPV. Hospital staff and volunteer advocate training programs also were evaluated. Chart reviews were conducted and client referrals assessed. RESULTS: Providers at WomanKind hospitals demonstrated significantly higher knowledge, attitudes, beliefs and behaviors than those at comparison hospitals throughout the study. During the data collection period, 1719 IPV victims were identified and referred to the WomanKind program, while only 27 IPV victims were referred to trained social workers at the comparison hospitals. Chart reviews indicated that emergency staff at the intervention sites provide documentation of IPV in patient records twice as frequently as emergency staff at the comparison sites. CONCLUSION: This research underscores the efficacy of a well-structured, multidisciplinary effort to deliver services to IPV victims. The results demonstrate that specialized training and on-site client services create a significant positive impact on the KABB of health care providers.

Testing an intimate partner violence assessment icon form with battered migrant and seasonal farmworker women.

A user-friendly assessment form using icons was developed for the Lideres Campesinas de California, Inc., a women farmworker organization in California, for assessing migrant and seasonal farmworker women for abuse. The purpose of this study was to test the reliability and validity of the form. Twenty-five women from the Lideres participated. The form, called the Intimate Partner Violence (IPV) Assessment Icon Form, was designed to be used with literate, semi-literate, and illiterate women. Inter-rater reliability and criterion-related validity of the IPV Assessment Form were found to be adequate for the literate and semi-literate participants. There were not enough illiterate women (n = 2) to include in the analysis. This study also demonstrates that with adequate training, support, and tools, migrant and seasonal farmworker women can work in partnership with researchers to design, develop and conduct research in their own communities.

The mediating roles of perceived social support and resources in the self-efficacy-suicide attempts relation among African American abused women.

The authors examined whether self-efficacy among African American abused women decreased their risk of suicide attempts through the mediating influences of perceived social support from friends, perceived social support from family, and perceived effectiveness for obtaining material resources. The sample consisted of 100 women who presented to a hospital following a suicide attempt and 100 women who presented to the same hospital for nonemergency medical problems. Results revealed that the association between self-efficacy and suicide attempt status was partially accounted for by the mediating roles of perceived social support from friends and family, and perceived effectiveness at obtaining resources. Findings suggest that interventions to increase abused women's self-efficacy should focus on increasing their capacity to obtain social and material resources.