Risk of childhood injury: predictors of mothers' perceptions.

BACKGROUND AND OBJECTIVES: Safety education often targets parental risk perception. Predictors of risk perception, however, are not well known, thus limiting the feasibility of effective safety education. Accordingly, in this study, a range of predictors of maternal risk perception were examined. METHODS: A random sample of 870 mothers in northern Sweden was included in the study. Three different questionnaires, with scenarios of a burn injury, a bicycle injury in the home environment, and a bicycle injury in traffic, were completed by the subjects. Multiple linear regression models tested the possible influence of causal attributions, normative beliefs, and sociodemographic and behaviour-related variables on mothers' risk perception. RESULTS: Only 14-23% of the variance in mothers' risk perception could be explained by the multivariate models. Causal attribution to the child was found to be the most important predictor of maternal risk perception. CONCLUSION: Present theoretical models give few clues about how to design educational models that might influence risk perception. To make safety education more effective, other modifiable factors that influence parental safety behaviour, such as subjective norms and self-efficacy, might be better targets.

Pen injection and change in metabolic control and quality of life in insulin dependent diabetes mellitus.

A second follow-up of metabolic control and quality of life in insulin dependent diabetes mellitus (IDDM) patients who had switched 3 years before from syringe to multiple pen injection treatment, was carried out. A total of 73 consecutive outpatients were enrolled in the initial follow-up study in 1988, 1 year after their changeover to insulin pen, with their metabolic control and quality of life examined. The present study concerns the reexamination of 65 of them in 1990. Their HbA(1c) level was recorded yearly, already from 1987, on. After an enhancement of metabolic control in 1988, exhibited primarily by patients with fewer syringe injections before pen treatment, control up to 1990 was found to have regressed to about baseline level or to have gradually declined. Patients who perceived their ability to self-test blood glucose to have decreased exhibited the least satisfactory course of metabolic control. This is seen to indicate that maintaining self-testing in multiple injection insulin treatment is a very real challenge to this regimen.

Disease course and prognosis in rheumatoid arthritis: an interdisciplinary prospective longitudinal study.

A three-year follow-up of individuals with rheumatoid arthritis was performed. The overall aim was to examine the change in functional status and psychological well-being. Possible determinants of prognosis with regard to future functional disability, pain and wellbeing, were explored by both univariate and multiple regression analyses. Functional disability, pain and well-being were fairly stable over the 3-year period. Progress of RA disease was most strongly related to initial function and age and only to a minor extent to the psychological well-being.

Pharmacological intervention in older patients with rheumatoid arthritis. Quality of life aspects.

Despite the rather pessimistic outlook regarding the long term effects of pharmacological treatment of patients with rheumatoid arthritis (RA), there is no doubt that drug interventions can affect quality of life (QOL). The disease has a significant impact upon physical, psychological and social function, and QOL optimisation should cover all these dimensions. Swelling of joints and pain are important manifestations in assessing RA since these may result in sleep disturbances as well as depressed mood. This might be particularly significant for older persons with RA. Outcome parameters of RA can be divided into short, intermediate and long term. The long term results are quite disappointing with regard to disability and premature death. However, more intermediate outcome measures related to QOL might improve after pharmacological interventions. Patient preferences and expectations with regard to the outcome of pharmacological interventions are important parameters to assess. When assessing older patients with RA with QOL instruments, it is recommended that questionnaires are fairly short and easy to complete. Adverse effects of pharmacological interventions are important factors to monitor in QOL assessment in older patients with reduced remaining life span.

Change in quality of life along with type 1 diabetes.

The aim of this study was to recurrently follow quality of life in type 1 diabetes patients who have switched from syringe to multiple pen injection treatment. The insulin pen is a simpler automatically preset device for self-injection. Seventy-three consecutive outpatients were initially examined in 1988, 66 of whom were re-examined in 1990. Quality of life was defined as perceived well-being and life satisfaction, globally as well as within key domains and functions. Various status and retrospective change ratings were repeatedly performed by patients and significant others. For a great majority, quality of life status was fairly stable between 1988 and 1990. Nine subjects with recent incidences of severe socio-medical complications accounted for a great deal (41%) of the decline in composite quality of life status recorded. Future-orientation and the conduct of the multiple regimen declined in the major fairly stable patient group as well. Contrary to the change-in-status outcome referred to, the direct retrospective change ratings in 1990 indicated a certain continuing consistent improvement over the last 2 years. It was minor, though, in comparison with the preceding enhancement attributed to the pen. In spite of the divergent mean outcome, the disparate change parameters correlated. The self-rated life quality trends were corroborated by ratings by significant others. To a certain extent, the mean change bias may reflect coping strategies released by and adopted against the strain of the illness. Probably, these primarily coloured the more sensitive direct retrospective change ratings. Some bias may also be due to a lack of sensitivity of the status ratings. However, the differential change assessments may also tease out and illustrate two separate, equally valid, patient perspectives, one on their current situation and another one on how it has changed. The diabetes illness appears reasonably stable in a majority of the subjects over the study interval. There seem to be some remaining satisfactory quality of life effects of the pen therapy. The study underscores the benefit of undertaking combined retro-/prospective and sufficiently longitudinal analyses with simultaneous dual rating operations, to get the most nuanced overview.

Type II diabetes and quality of life: a review of the literature.

In this review, an attempt was made to describe how non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) affects the life of the ill person. Patients are affected by and cope with this complex disease in different ways, depending on its severity and complications. Influences on well-being therefore also vary--from none to major deterioration. A substantial proportion of patients are primarily affected with fatigue, anxiety, and depression. Deteriorations in cognitive function have also been documented, although diverging evidence exists. Some negative social circumstances have also been noted. Social support, particularly specific support, appears to be helpful, although self-efficacy and health practices seem to be as important. Resistance to compliance with diabetes regimens together with reactions to the demands for increased levels of physical activity are often seen. Systematic focused studies examining how patients and significant others perceive the impact of the disease in retrospect are still awaited. There is a great need for more research on type II diabetes; broad prospective longitudinal follow-up studies monitoring natural disease progression, as well as examining the predictive significance of quality of life, would be welcome.

Rheumatoid arthritis, coping and well-being. Cross-sectional sub-group comparisons and correlational analyses.

A study was performed on 169 women and 53 men with a clinical diagnosis of rheumatoid arthritis (RA). This is a chronic disabling disease with no known cure and therefore the outcome of treatment has increasingly become focused upon assessment of well-being rather than more clinical parameters. We studied the relationship between clinical manifestation, self assessed functional disability and coping, on one hand, and well-being, on the other. Severity of RA disease was hypothesised to be negatively related while utilisation of various coping strategies, was deemed positively to well-being. The most mentioned coping strategies in the study group were problem oriented. With increasing severity of the RA disease we observed less acceptance and control. Well-being consistently decreased with increasing severity of RA, both with regard to clinical severity and functional disability status. Significant trends were seen with regard to security, future orientation, endurance, indolence and loneliness. Bivariate analysis between coping strategies and well-being revealed generally low correlations. Individuals accepting the illness displayed less guilt and tension and more endurance. Those who had decided to live an active life showed a more positive belief in the future and less indolence. The study outcome underscores the significance of well-being and coping (psychosocial factors) in RA, which should be considered and not neglected in clinical practice.

Assessment of quality of life in rheumatoid arthritis: methods and implications.

During the last decade, self-report of health status and quality of life has gained increasing credibility and acceptance in studies of individuals with rheumatoid arthritis (RA). According to a number of reports, the new self-assessment instruments offer an excellent complement to the more traditional clinical outcome measurements. In the absence of a cure for RA and the use of potentially toxic drugs, quality-of-life assessment seems to have an important place in clinical drug trials. The most commonly used quality of life or health status instruments in studies of RA seem to perform well and give reliable and valid information. A common concern, however, with these instruments is that there appears to be a lack of questionnaires which allow satisfaction with various aspects of quality of life to be expressed. Many instruments focus on negative aspects of quality of life, although quality of life for most individuals is related to something positive. There is no perfect instrument applicable for all situations, but the selection of an instrument depends on the specific purpose of a particular study. Psychological interventions are more likely to affect people's emotions and well-being, whereas a drug intervention might more dramatically affect physical function. It appears, however, reasonable to assume that effects of drug intervention on quality of life should be measured with a longer perspective, such as after at least 6 months' observation. The field is still in a phase of methodological and theoretical development which is also reflected in the few numbers of published studies concerning the effect of drug interventions on quality of life of patients with RA.

Coping behaviour and degree of discrepancy between retrospective and prospective self-ratings of change in quality of life in type 1 diabetes mellitus.

Quality of life and metabolic control were examined in 74 adults with Type 1 diabetes mellitus in 1988. Sixty-six of the persons were followed up in 1990 with the aim of studying more closely the subgroup that showed a 'major' discrepancy between 'retrospective' and 'prospective' quality of life change ratings. 'Prospective' quality of life change was defined as the difference in assessed quality of life status between 1990 and 1988. 'Retrospective' quality of life change was assessed directly by subjects in 1990 covering the same time period. Data on quality of life, well-being, sociodemographics and metabolic control were collected on both occasions. Recent life-change events and long-term complications were also recorded in 1990. Subjects with 'major' discrepancy reported greater retrospective quality of life improvement, higher quality of life, and greater well-being, as well as lesser occurrence of negative and greater occurrence of positive recent life-change events, than did those with 'minor' discrepancy, despite their exhibiting poorer metabolic control and a higher prevalence of incipient nephropathy. The results are discussed in terms of possible coping and defence strategies.

Severity of rheumatoid arthritis, function and quality of life: sub-group comparisons.

The main purpose of this study was to explore whether people with more severe rheumatoid arthritis, as diagnosed by increasing functional disability, also exhibit a poorer quality of life, being more negatively affected by the disease, than individuals with less severe rheumatoid arthritis. A cross-sectional survey was carried out on 169 females and 53 males with rheumatoid arthritis (RA). Functional status was measured according to the Stanford Health Assessment Questionnaire (HAQ), overall ill-health was assessed by the Sickness Impact Profile (SIP) and the quality of life assessment was performed using a generic quality of life assessment package (QLsc). The severity of RA, as measured by HAQ, correlated both with changes due to disease and the quality of life status, and with SIP. The intrusion of the disease appeared to be greatest within the physical life domain, followed by the psychological and social domains. Correlations between the physical, psychological and social life domains were high. Although the relationship between the various life domains is complex, the present study confirms a significant relation between physical and psycho-social dysfunction.

Precursors of repeated short-term sick-leave: an empirical review of some background, job and well-being characteristics.

The aim of the study was to search for bivariate associations between on the one hand samples of background, job-related and well-being characteristics, and on the other hand longitudinally recorded sick-leave in individuals with repeated short-term sick-leave. Out of altogether 123 subjects included, 113 self-rated their well-being at the onset of, and 88 also after, a supportive programme. The well-being rating covered experience of treatment by other people, reservation, loneliness, inferiority, tension, vulnerability, guilt, security and indolence. Socio-demographic and job-related characteristics and attitudes were registered and declared at the initial contact. Correlations between these separate sets of independent variables, and sick-leave occasions and days in each of the two years following the contact were computed. There was an almost complete lack of covariation between background variables and sick-leave. Neither did job-related characteristics correlate. Only an expressed wish for a job change was vaguely associated with more absence days, but not with more spells. In striking contrast, a convincing consistent longitudinal pattern between self-rated well-being and sick-leave behaviour emerged. The poorer the well-being, the greater the subsequent sick-leave. Yet, a major part of the sick-leave variance remained unexplained. Accordingly, other etiological factors may still interact with well-being in the comprehensive setting behind the sick-leave behaviour.(ABSTRACT TRUNCATED AT 250 WORDS)

Quality of life: status and change (QLsc) reliability, validity and sensitivity of a generic assessment approach tailored for diabetes.

The aim was to review the psychometric properties of a generic strategy for assessing status and change in quality of life (QLsc) partly tailored for patients with insulin-dependent diabetes mellitus. Quality of life was defined as perceived well-being and life satisfaction, globally as well as within key domains and functions. The strategy has been developed iteratively and, thereby, proven psychometrically satisfactory across groups and settings. Seventy-three consecutive outpatients were examined in 1988, after a period on multiple injection treatment by insulin pen; 66 were re-examined in 1990. In 1988 and 1990, perceived well-being and life domain status were self-rated. Life domain changes attributed to pen treatment were rated retrospectively in 1988 and subsequent general changes over 2 years rated similarly in 1990. Shortened parallel ratings were performed by significant others. Series of cross-sectional and longitudinal analyses yielded convincing reliability, validity and sensitivity evidence of various kinds for all ratings, irrespective of rater-self or significant other. As expected, a consistent correlational pattern emerged between status self-ratings, suggesting 'the better/worse off' in one sense, the 'better/worse off' in other senses assessed. Moreover, congruent change linkages, suggesting 'the greater change for the better/worse' according to the one type, the 'greater change for the better/worse' according to the other one, were also salient. Fourteen persons with less congruence in the disparate, but parallel change rating parameters appeared to be in a critical disease phase, applying reaction formation or denial like defence mechanisms. In conclusion, the entire cohesive strategy also functioned well in the current setting. It may probably be applied in search for other vulnerable sub-groups and in analyses of coping strategies. It offers rich analytic options especially in evaluational contexts. The study outcome may stimulate development of methodology within this field.

Background factors, long-term complications, quality of life and metabolic control in insulin dependent diabetes.

Sixty-six of 74 adults with Insulin Dependent Diabetes Mellitus (IDDM) examined earlier (1988), were followed up two years later (1990) with the aim of studying the influence of sociodemographic factors, long-term complications and quality of life on metabolic control. It was found that both non-cohabitance and a major discrepancy between quality of life change ratings made prospectively (difference in current QOL ratings made 1990 vs 1988) and retrospectively (assessed in 1990 and covering the same period) were associated with poorer metabolic control, and also that perceived somatic health was linked with better metabolic control. A majority of the persons with a major discrepancy in their quality of life ratings, seen as suggestive of difficulties in their realistically assessing their own life situation, was also found to be non-cohabitant and/or to have incipient nephropathy, indicating these persons to constitute a risk group. In addition, well-regulated subjects were found to rate their bodily health as higher than they did their quality of life, whereas for poorly regulated persons the opposite was the case. The results were seen as pointing to the need of paying special attention clinically to the group of persons characterized here by a major discrepancy in their quality of life change ratings and also as emphasizing the fact that living with IDDM is a balancing act for the individual between satisfying bodily demands to be well-regulated and living in such a way as to perceive quality of life.

Recent life events, gender, and the control of diabetes mellitus.

Sixty-six outpatients with insulin-dependent diabetes mellitus (IDDM) filled in a life event questionnaire reflecting positive and negative life events perceived to have occurred over the past year. The difference in glycosylated hemoglobin (HbA1C) measures obtained before and after the 1-year period in question (Delta-HbA1C) served as a proxy measure of change in metabolic control. Among males, those reporting predominantly negative life events showed poorer metabolic control than those reporting few negative life events or none. Among females, the greater the number of events reported, especially positive ones, the greater the change for the better in HbA1C over the event year studied. These results suggest that life events may be significant to metabolic control in insulin-dependent diabetes. This only becomes apparent, however, when the two genders are analyzed separately, as various relationships found in one sex may be lacking or even opposite to the other sex. The findings also suggest the importance to the diabetic of learning of life events both the relative lack and preponderance of positive as well as negative events.

Change and status in quality of life in patients with rheumatoid arthritis.

Current status in quality of life and deterioration retrospectively attributed to the disease by patients with rheumatoid arthritis (RA) were examined. The study group included 169 female and 53 male patients with probable (n = 70), definite (n = 127) and classical RA (n = 25). In a cross-sectional postal survey the participants self-rated their quality of life according to a generic self-assessment package tailored in part for this study. Shortened parallel ratings by significant others were also performed. The impact of RA on quality of life was pervasive. Heaviest intrusion emerged within the physical life sphere and the behavioural and activity domain, followed by the impact on global life satisfaction and habits. Material, psychological and social life domains were less disrupted. In spite of the pervasive discomfort attributed to the illness, quality of life status was mostly rated as being 'rather good' to 'good'. There was a consistent pattern: the better off currently, the less disturbance from the disease perceived. Higher age and longer duration of RA were significantly correlated to a lower status. In addition, individuals still working rated a higher quality of life and less intrusion of the disease. Self-ratings were corroborated by ratings of significant others. While there was an agreement on the level of the negative impact of the disease, the patients rated their current situation more positively than did significant others. The dual assessment of quality of life status and change appears reasonable and informative as regards rheumatoid arthritis.

War-wounded refugees. Quality of life after 2-3 years in Sweden.

The Medical Center for Refugees in Linköping, Sweden, includes a medical ward for refugees and asylum applicants. It was started in January, 1986 and is financed by the Swedish Immigration Board. Sixty percent of the patients are war-wounded and 40% have diagnoses non-related to war. This article describes a group of 19 refugees who were the war-wounded patients at this ward in June, 1986. In most of them the main medical impairment was amputation. They were followed up in 1988 by interview and self-ratings. The aim was to illuminate their quality of life after 2-3 years in Sweden. Most of them were satisfied with their external living conditions. Their psychological well-being, however, was not so good and they were very occupied by thoughts of their native countries. Their physical handicaps seemed to be of secondary importance.

Psychological factors in the long-term prognosis of chronic low back pain patients.

This study appraised the significance of psychological factors in the long-term prognosis of patients with chronic low back pain (LBP). The MMPI ratings of 80 long-term sick-listed LBP patients were set in relation to their disability pension status 6 to 12 years later. The number of elevated scales, in combination with the level of certain scales (HS and HY), proved to be a better predictor than profile patterns, advocated in some studies. Moreover, in a review of prognostic studies, the HS and HY scales appeared most frequently as significant predictors. That result also was confirmed in this study of long-term prediction of overall functional level. The results are discussed in relation to the concepts of pain-fear and sick role.

Severity of disease and quality of life: a comparison in patients with cancer and benign disease.

The aim of our study was to compare the quality of life in patients with malignant and benign diseases. Eighty-nine females and 110 males (mean age 59 years) from the surgical unit at the University Hospital of Linköping were examined. Ninety-five subjects suffering from a gastrointestinal malignancy were compared with 104 non-malignant patients, of which 57 had benign gastrointestinal disorders, 24 endocrine and 23 vascular diseases. Quality of life was defined as perceived well-being and life satisfaction, globally as well as within key domains. Two separate types of self-ratings, a life domain (20 items) and a well-being rating (eleven subscales, each scale with ten items), were performed in the medical ward. The life domain rating covered the subject's own appraisal of his health and psychological circumstances; social network; activities and habits; of a structural domain ('ability to lead a meaningful life') and of his global life satisfaction. The well-being rating focused on emotional experiences (basic mood, security, indolence, loneliness, inferiority, and guilt together with future-orientation) and perceived behaviour (endurance, tension, sociability and attitudes of the environment). The patients who had a gastrointestinal malignancy scored consistently 'lower' than patients with benign diseases. After adjusting for age concerns, most of the significant inter-group differences remained. After adjusting for nutritional state influences (e.g., recent weight loss), differences in global life satisfaction, future-orientation and perceived attitude from the environment were still apparent. This study is contrary to several other studies undertaken in search of expected group differences but none were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Loneliness and alcohol abuse: a review of evidences of an interplay.

This report contains a review of the literature about the interplay between loneliness and the abuse of alcohol. A theoretical discussion based on clinical observations can be dated back to the 1950's. Systematic empirical studies, however, appear sparsely and have mainly been performed during the last decade. Thus, knowledge is still incomplete, but the review indicates that loneliness may be significant at all stages in the course of alcoholism: as a contributing and maintaining factor in the growth of abuse and as an encumbrance in attempts to give it up. Concordant reports demonstrate that alcoholics do feel more lonely than members of most other groups do. In advanced abusers, loneliness is obviously connected with a number of negative characteristics and, together with several of those, directly linked to a poor prognosis. There are, however, no obvious relations to the external social situation (i.e. network) or amount of drinking. Instead, the feeling of loneliness appears to be more connected with a general negative perception about oneself and one's relations to other people and also with a general dissatisfaction with most things in life. The lonely abuser seems likewise resigned and unable to bring himself to change his/her situation. There are also associations with a broad array of psychopathology. In comparison to people with other health problems, the supportive value of the social network of alcoholics appears to be more wavering.

Background, quality of life and metabolic control in patients with insulin-dependent diabetes mellitus.

The interference of background characteristics with quality of life and metabolic control in patients with insulin-dependent diabetes mellitus (IDDM) were examined. Seventy-three consecutive outpatients who switched from syringe injections to multiple pen-injection treatment comprised the study group. Perceived status as well as retrospective changes in quality of life, attributed to the new treatment modality, were assessed at follow-up after 9-13 months. Data on metabolic control (HbA1C) were collected at base-line and follow-up. Sub-group comparisons in life quality and metabolic control were performed with regard to differences in sex, age, cohabitation, onset and duration of IDDM. Most of the background characteristics had no or just minor significance for status and change in the life quality and metabolic control of the patients. Cohabitation, however, was linked to a better life quality status pertaining to different domains and a tendency to better metabolic control. In addition, females reported a slightly better health status and a more healthy life style (i.e. eating, drinking and smoking habits) than did males. Extra treatment attention may therefore be justified for non-cohabiting males.