Inner-city adults with severe reading difficulties: a closer look.

Relatively little is known about the characteristics of inner-city adults who seek assistance from literacy programs. Increased knowledge about this population will enhance the development of more effective programs, as well as policy options. This study describes the characteristics of 280 adults, ages 16 to 63, who came to an adult literacy program that focused on severe reading difficulties. The program, located within a hospital complex in a large, urban area, attracted these individuals through an extensive multimedia outreach effort. Results suggested that the adults who sought help were generally characterized by a vast array of cognitive, academic, and social difficulties. In addition, the extent of these difficulties increased dramatically as literacy level declined. These findings suggest that comprehensive educational, social, and vocational services may be needed to help adults with severe reading difficulties cope with the diverse and severe problems they face.

Patient interest in receiving audiotapes of information presented by their physicians. A survey of patients awaiting treatment in university and private practice settings.

OBJECTIVE: To investigate patient interest in, and willingness to pay for, tape recordings of physicians' explanations and recommendations. DESIGN: Survey. SETTINGS: An outpatient university-based practice and an outpatient private group practice of family physicians. SUBJECTS: A convenience sample of 425 patients. Of the 409 who agreed to complete the survey, 257 (63%) were awaiting treatment in a university practice and 152 (37%) were awaiting treatment in a private practice. RESULTS: Fifty-four percent of respondents believed that a tape would be helpful, 59.1% thought their family would ask to listen to it, and 77.5% said they would play it for family members. If asked to bring a blank tape, 84.5% indicated that they would do so. If recordings were available for purchase, respondents indicated they would be willing to pay a mean of $1.46 for them. CONCLUSIONS: If physicians offer recordings of their explanations and recommendations, patients are likely to want them. Investigations of actual compliance and health outcomes associated with the use of these recordings appear warranted.

Comparative validity of two hearing loss screening questionnaires.

BACKGROUND: Hearing loss is one of the most common of all physical impairments, but physicians seldom screen adults for it, and patients often overlook or deny hearing problems. This study was designed to validate the use of two self-administered hearing loss questionnaires. METHODS: Two self-administered screening questionnaires and a hearing screening evaluation using the Welch Allyn Audioscope 3 instrument were given to 409 consecutive family practice patients over the age of 18 years. Correlational, discriminate, sensitivity, and specificity analyses were conducted on the data. RESULTS: Neither of the existing questionnaires was clinically sensitive enough to be recommended for use. A new tool based on a discriminate function analysis of the existing questionnaires was developed. In contrast, the audioscope proved to be a sensitive screening tool. Of those patients who were identified, 88% did not follow recommendations to obtain further evaluation. CONCLUSIONS: Existing self-administered questionnaires cannot be recommended for use. A controlled clinical study using the newly derived questionnaire, the Smith Hearing Screening, should be conducted.

Prescriptions for saying good-bye: teaching termination to family practice residents.

Physicians terminate doctor-patient relationships at various times during their careers. Preparing physicians for this process should be part of residency training in family practice. This report describes the structured role-playing exercises and physician scripts used to teach termination skills. Evaluation of these teaching methods suggests that residents value termination instruction, prefer participative approaches, and report greater sensitivity to the feelings and issues evoked by termination.

Initial evaluation of a hidden agenda method of teaching the interview.

A structured role-playing method of teaching the biopsychosocial interview using hidden agendas and videotape feedback was developed and evaluated. The teaching method significantly improved medical student interviewing skills as reflected by pre-post scores of 83 third-year students on the Facilitating Response Index. The teaching method is described in detail and recommendations for future research are presented.

Screening depression in primary care: back to the basics with a new tool.

Two depression inventories were used to screen 377 family practice patients. One, the Self-Rating Depression Scale (SDS), assesses major symptomatology; it is the depression inventory most frequently used in family practice. The other, the Depression Adjective Checklist (DACL), assesses mood only and has not been previously reported in the family medicine literature. Forty-one percent of the patients who completed the SDS rated themselves at least mildly depressed; 37% scored in the same range on the DACL. Four percent of the patients scored in the severe depression range on the SDS, while 15% scored in the severe depression range on the DACL. Residents treating these patients, however, failed to diagnose depression in more than 85% of the patients who had rated themselves as at least mildly depressed on either inventory. The residents also failed to diagnose depression in more than 70% of those who had rated themselves as severely depressed. Teaching and research implications are discussed.

Diagnosing depression in primary care: a practical, interdisciplinary review and a call for change.

Because recognizing depression is of critical importance, we have organized a comprehensive review of current literature on medical, psychiatric, and behavioral science to give primary care physicians a brief, practical, and multidisciplinary survey of diagnostic approaches to depression. The review is also designed to help clarify the disparate approaches, definitions, theories, and classifications of depression found in the literature. We emphasize two emerging perspectives important to primary care physicians in their understanding and treatment of depression. The first is a wider view of masked depression, and the second is depressive behavior related to family and cultural systems. Traditional classifications may have limited applicability to the patient families most often seen in primary care. We hope that the paper will serve as a challenge to physicians to combine open and creative observation with inductive reasoning in the creation of a more useful system for classifying depression in primary care.

Alternative treatments for withdrawing the long-term benzodiazepine user: a pilot study.

Anxiolytic therapy with benzodiazepines and their potential for dependence are reviewed. Relaxation training and biofeedback have been used for chemically dependent anxious patients. These techniques have been recommended for benzodiazepine-dependent patients, but not investigated. Previous withdrawal studies offer only limited follow-up data. Stress management treatment was based on a successful case study. Recruitment difficulties were encountered. However, seven patients were randomly assigned to stress management or brief psycho-therapy. All showed improvement, but three of four patients available for 1 year follow-up had returned to pretreatment dependence. These withdrawal difficulties suggest the need for more effective treatments and more adequate follow-up studies.

Hypnoanesthesia in the morbidly obese.

The advent of chemical anesthesia relegated hypnosis to an adjunctive role in patients requiring major operations. Anesthesia can be utilized with acceptable risk in the great majority of patients encountered in modern practice. But an occasional patient will present--such as one with morbid obesity--who needs a surgical procedure and who cannot be safely managed by conventional anesthetic techniques. This report describes our experience with such a patient and illustrates some of the advantages and disadvantages of hypnoanesthesia. The greatest disadvantage is that it is unpredictable. Close cooperation between the patient, hypnotist, anesthesiologist, and surgeon is critical. However, the technique may be utilized to remove very large lesions in selected patients. Hypnoanesthesia is an important alternative for some patients who cannot and should not be managed with conventional anesthetic techniques.

Relaxation training tapes: preferences and effects of gender and background.

Relaxation training tapes vary in voice gender and background, but little has been published regarding the preferences and effects of these parameters. Four classes, totalling 40 male and 36 female undergraduates, listened to parts of two commercially available sets of relaxation tapes. Both sets offered progressive relaxation and autogenic training in a choice of a male or a female voice. One set also provided a musical and environmental background. Tape segments were randomly assigned to the classes and balanced for gender and background. Subjects indicated a preference for the female voices. In addition, there was a significant association between sex of subject and voice gender preference, with males preferring female voices and females preferring male voices. However, the choices of the "best" tapes and actual ratings of relaxation indicated no significant voice-gender preferences associations. Preferences for the facilitating effects of the tapes with musical and environmental backgrounds were reflected in significant preferences for tape sets, tape choices, and relaxation ratings. The clinical implications and limitations of these findings were discussed.

Comparison of response formats for the Depression Adjective Check Lists.

Studied potential checking and response bias on the Depression Adjective Check Lists (DACL) by comparing the scores of 144 college students on three administration formats: True-false, forced-choice, and standard format. The DACL scores on the three formats were interrelated significantly with one another as well as with an independent measure of state depression of college students (CID). Correlations between the number of depressive adjectives checked and the depression score were significant in the true-false format, but not in the standard format. This argues against the use of the true-false format of the DACL. However, in demonstrating only a weak social desirability response bias, and in failing to reveal the existence of a checking bias, the results give further credence to the use of the standard format.