Differences In Perception Of Symptoms Research Articles

Psychosocial Support for People with Ulcerative Colitis and Irritable Bowel Syndrome: A Feasibility Study on Need, Focus and Viability

Ulcerative colitis (UC) and irritable bowel syndrome (IBS) are associated with high somatic symptom burden, reduced quality of life, and increased psychological distress. The subjective burden, the wish of many patients, and the involvement of psychological processes in symptom perception justify the development of psychosocial support services. We aimed to evaluate need, content and feasibility of such an offer. We included patients with both UC and RDS in order to identify disease-specific and trans-diagnostic aspects for psychosocial interventions. We conducted telephone interviews with adult patients with UC or IBS using a standardized interview guide. We used numerical rating scales and open-ended questions to assess burden of and coping with the disease, disease-related expectations and anxiety, satisfaction with care, support and information needs, and preferences regarding support programs. We calculated descriptive metrics for quantitative variables as well as diagnosis-specific group comparisons. The answers to the open questions were summarised and counted in close accordance with the participants' statements. N=35 patients (UC: n = 15; IBS: n=20) participated (age: M=40.80, SD=14.56; 71% female). In both groups, patients showed a medium level of disease burden, with higher rates for IBS. Both groups reported disease-related anxiety, with higher levels in patients with IBS. Disease-related expectations did not differ between groups. Patients with IBS showed low satisfaction with care and felt less informed about their disease than patients with UC. Both groups indicated a high motivation of participating in a psychological support program and named illness-related expectations and illness anxiety as important components of such. The results confirm an increased need for psychosocial support and the relevance of disease-related expectations and anxiety for both diseases. Differences in symptom perception and care satisfaction indicate the importance of disease-specific elements in psychosocial therapy programs. The results demonstrate the high need for psychosocial support of patients with UC and IBS and indicate the feasibility of a psychosocial therapy program.

The Relationship Between Post-Traumatic Stress Disorder and Self-Management Behaviors in World Trade Center Workers with Asthma

Comorbid posttraumatic stress disorder (PTSD) is highly prevalent and associated with increased morbidity among World Trade Center (WTC) rescue and recovery workers with asthma. However, the potential behavioral pathways underlying this relationship remain unclear. To evaluate whether PTSD is associated with lower adherence to asthma self-management behaviors among WTC workers with asthma. We used data from a prospective cohort of WTC workers with a physician diagnosis of asthma who were prescribed controller medications. Presence of comorbid PTSD was determined based on structured clinical interviews. Asthma self-management behaviors included medication adherence, inhaler technique, use of action plans, and trigger avoidance. We conducted unadjusted and multiple regression analyses to evaluate the association of PTSD with asthma self-management. Overall, 30% of 276 WTC workers with asthma had comorbid PTSD. Posttraumatic stress disorder was associated with worse asthma control and poorer quality of life. However,PTSD was not significantly associated with medicationadherence (odds ratio [OR] -0.15; 95% confidence interval [CI] -0.5 to 0.2), inhaler technique (OR -0.12; 95% CI-0.7 to 0.5), use of action plans (OR 0.8; 95% CI 0.4 to 1.8), or trigger avoidance (OR 0.9; 95% CI 0.4 to 1.8). We did not find significant differences in key asthma self-management behaviors between WTC workers with and without PTSD. These results suggest that other mechanisms, such as differences in symptom perception or inflammatory pathways, may explain the association between PTSD and increased asthma morbidity.

Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia.

The aim of this study was to compare the symptomatology, palliative care outcomes, therapeutic procedures, diagnostic tests, and pharmacological treatments for people with dementia (PWD) and without dementia (PW/OD) admitted to Spanish nursing homes. Design: This was a cross-sectional study which is part of a long-term prospective follow-up of elderly people performed in nursing homes to measure end-of-life care processes. Participants: 107 nursing home patients with advanced or terminal chronic diseases were selected according to the criteria of the Palliative Care Spanish Society. Setting: Two trained nurses from each nursing home were responsible for participant selection and data collection. They must have treated the residents and had a minimum seniority of 6 months in the nursing home. Measurements: Sociodemographic data; Edmonton Symptom Assessment Scale; Palliative Care Outcome Scale; and prevalence of diagnostic tests, pharmacological treatments, and therapeutic procedures were evaluated. Results: Pain, fatigue, and nausea were found to be significantly higher in the nondementia group and insomnia, poor appetite, and drowsiness were significantly higher in the dementia group. Patient anxiety, support, feeling that life was worth living, self-worth, and practical matters management were higher in the nondementia group. Regarding drugs, use of corticoids was higher in the nondementia group, while use of anxiolytics was higher in the dementia group. Diagnostic procedures such as urine analysis and X-ray were higher in the dementia group. Conclusions: Differences in symptom perception, diagnostic tests, and pharmacological procedures were found between patients with and without dementia. Specific diagnostic tools need to be developed for patients with dementia.

Sex-Based Differences in Symptom Perception and Care-Seeking Behavior in Acute Stroke.

Lack of early stroke recognition and delays in seeking emergency care by persons experiencing a stroke severely limit acute treatment options. Sparse and sometimes conflicting evidence suggests sex differences in care-seeking behaviors in stroke, stroke knowledge, perceptions of stroke symptoms, and the importance of physical location at the time of stroke and of having a witnessed stroke. To explore specific sex-based differences in stroke presentation and associated care-seeking behaviors. Descriptive study based on a convenience sample of 60 patients with stroke admitted to an academic medical center in Northern California. Impact of the patient's sex on 1) time to presentation (early [≤ 4.5 hours] vs late [> 4.5 hours]); 2) perception of symptoms and clinical signs; 3) stroke knowledge and decision making; 4) physical location at the time of stroke; and 5) bystander presence and assistance with decision making. There was a discrepancy between how patients perceive symptoms and their medical findings on physical examination. Although most patients had at least one sign or symptom associated with nationally used stroke recognition acronyms, both sexes delayed care because they did not perceive their symptoms as urgent. Early-presenting men were more likely to have a higher stroke severity score at admission, receive alteplase, arrive by Emergency Medical Services, and have a witnessed stroke. Both early- and late-presenting women reported more nonfocal symptoms than did men. This study suggests that there are sex-based differences in symptom perception and care-seeking behavior in acute ischemic stroke.

Abstract TP365: Gender Differences in Symptom Perception and Care-Seeking Behavior in Acute Stroke

Background: Evidence suggests gender differences in: care seeking behaviors during stroke; stroke knowledge; perceptions of stroke symptoms; physical location at the time of event and decision making, and the impact of having a witness. Aims: To determine the impact of gender on the time to presentation (greater or equal to 4.5 hours or greater than 4.5 hours), symptom perception and clinical signs, stroke knowledge and decision making, physical location at the time of stroke, and the presence and impact of having a witnessed stroke. Study Design: A descriptive study based on a convenience sample of 60 subjects admitted to an academic medical center for stroke. Methods: Patients were asked a series of questions regarding the care seeking decision process, the role of others in the decision process, physical location at the time of event and the decision to seek care, and general stroke knowledge. They also answered a 28 symptom questionnaire which was compared to medical findings. Results: There were approximately equal number of men and women in the late and early presenting groups. Early presenting men were more likely to: have a higher admission NIHSS score (7.7 vs 4.8), to receive alteplase (71% vs 20%), to arrive by EMS, and have a witnessed stroke compared to early arriving women. Men were more likely to take an active role in the decision making process to seek care, while care seeking decision making in females was more likely to be transferred to nonspousal family members. Both early and late presenting women reported more non-focal symptoms than men. While most patients had at least one sign or symptom associated with national used stroke symptom acronyms, both genders delayed care because they didn’t perceive their symptoms as being urgent. Limitations: Small convenience sample from a single hospital with no control for stroke etiology. Conclusion: More research is needed to better understand the influence of gender on patient perception of stroke and care seeking behaviors.

Long-term breast cancer survivors’ symptoms and morbidity: differences by sexual orientation?

Because little is known about morbidity and symptoms among sexual minority women with breast cancer, that is, lesbian or bisexual-identified women, and women with a preference for a woman partner, we examined differences by sexual orientation in long-term survivors' symptoms and morbidity, considering arm morbidity, systemic therapy side effects, hypertension, and number of comorbidities. From a state cancer registry, we recruited 257 heterosexual and 69 sexual minority women (SMW) with a diagnosis of primary, nonmetastatic breast cancer. To increase the number of SMW, we used convenience recruitment methods and obtained an additional 112 SMW who fit the same eligibility criteria as the registry-derived sample. Using a telephone survey, we collected demographic and self-reported data on arm morbidity and systematic therapy side effects, using the European Organization for Research and Treatment of Cancer Quality of Life scale, QLQ-BR23 and a comorbidity measure developed for breast cancer survivors. Sexual orientation was more strongly associated with arm morbidity and systemic side effects than with high blood pressure and comorbidities. Sexual orientation related indirectly to systemic side effects and arm morbidity through cancer treatments and some demographic factors. Our finding that SMW respond more negatively to certain cancer treatments compared to heterosexual women suggests an opportunity to intervene with education and support for SMW breast cancer survivors for whom these life-saving treatments are necessary. Because breast cancer survivors are at risk for multiple severe and persistent symptoms, assessing such symptoms is an important aspect of survivorship care. Cultural differences in perception of symptoms, communication issues, cultural barriers to reporting of symptoms, and different cultural norms about expressing pain or impairments have been established by studies. Knowledge about differences in impairment and symptoms by sexual orientation will help providers' efforts to provide high quality care to breast cancer survivors and may enhance cancer survivorship.

Effect of Sex on Symptoms Associated With Gastroesophageal Reflux

Previous research suggests that females have a poorer outcome than do males after surgery for gastroesophageal reflux. To evaluate reflux and esophageal symptoms in males and females in a community sample and in patients undergoing antireflux surgery. Face-to-face interview. A South Australian community. Random sample of 2973 individuals from the community and 2153 patients presenting for antireflux surgery. In a random sample of 2973 individuals from the community, the prevalence of reflux and other esophageal symptoms was determined and compared with symptoms in 2153 patients presenting for antireflux surgery. Identical questions were used to assess frequency and severity of heartburn and dysphagia and medication use. Analog scales assessed heartburn and dysphagia (0 indicating no symptoms and 10, severe symptoms). Outcomes for males vs females were compared across both groups. In the community, females were more likely to report heartburn, and when reported, symptom severity was higher. The prevalence of dysphagia was similar for males and females, although females reported higher dysphagia scores for solid foods. A similar proportion of males and females took antireflux medications. Females presenting for antireflux surgery were, on average, 7 years older than males, had a higher body mass index, and had higher heartburn and dysphagia symptom scores. At endoscopy, men were more likely to have ulcerative esophagitis and Barrett esophagus, and at surgery they were less likely to have a hiatal hernia. Significant differences were noted between males and females in the frequency and severity of gastroesophageal reflux-associated symptoms in the community and in patients presenting for surgery. These might reflect differences in symptom perception, which explain previously reported better outcomes in men undergoing antireflux surgery.

Distorted symptom perception in patients with medically unexplained symptoms.

The present study investigated differences in symptom perception between a clinical sample with medically unexplained symptoms (MUS) and a matched healthy control group. Participants (N = 58, 29 patients) were told that they would inhale different gas mixtures that might induce symptoms. Next, they went through 2 subsequent rebreathing trials consisting of a baseline (60 s room air breathing), a rebreathing phase (150 s, which gradually increased ventilation, PCO2 in the blood, and perceived dyspnea), and a recovery phase (150 s, returning to room air breathing). Breathing behavior was continuously monitored, and dyspnea was rated every 10 s. The within-subject correlations between dyspnea on the one hand and end-tidal CO2 and minute ventilation on the other were used to index the degree to which perceived dyspnea was related to specific relevant respiratory changes. The results showed that perceived symptoms were less strongly related to relevant physiological parameters in MUS patients than in healthy persons, specifically when afferent physiological input was relatively weak. This suggests a stronger role for top-down psychological processes in the symptom perception of patients with MUS.

Relationship between Inflammatory Biomarkers and Symptom Perception in Patients with Heart Failure

Purpose and Background: Heart failure (HF) is an inflammatory clinical condition in which inflammatory biomarkers are increased. Two of these biomarkers, soluble tumor necrosis factor receptor 1 and 2 (sTNFR1 and sTNFR2), are predictors of hospitalization and mortality in HF. Up to 97% of patients with HF have symptoms that negatively affect daily life. Whether subjective symptom perception is related to objective inflammatory biomarkers is not known in HF. The purpose of this study was to compare mean differences in symptom perception between patients with high and low sTNFR1 and sTNFR2.

Caffeine ingestion and lower urinary tract symptoms in healthy volunteers

To assess lower urinary tract symptoms (LUTS) after caffeine ingestion in healthy volunteers. We conducted a randomized, double-blind, placebo-controlled trial utilizing healthy adult volunteers without urinary tract disease. Caffeine dosage was based on patient weight (equivalent to a 70 kg person taking 200 mg of caffeine twice a day). After a 24-hr washout period, subjects ingested tablets (placebo and drug were identical in appearance) twice a day for 3 days. All participants completed volume-frequency diaries and a post-study symptom questionnaire. Statistical analysis was performed using SAS (version 8.2). Differences voiding frequency and volume were assessed by Wilcoxon rank sum test. The designated level of statistical significance was P < 0.05. During the first day on study medications, patients taking caffeine versus placebo voided a mean of 7.8 versus 6.4 times in a 24-hr period, respectively, P = 0.05. The mean total urine production was 2,004 ml (caffeine) versus 1,643 ml (placebo), P = 0.06, while total fluid ingested was similar (2,246 ml-caffeine, 2,102 ml-placebo, P = 0.46). For the remaining 2 days there was no significant difference between the two arms. The post-study questionnaire revealed no differences in symptom perception between the two groups. In healthy volunteers caffeine appears to produce an initial diuresis, but does not appear to have other significant or sustaining effects on lower urinary symptoms in this 4-day model.

Predictors of differences in symptom perception of older patients and their doctors.

Doctors and their older patients do not necessarily agree on what health problem ought to be treated. Discordance influences diagnostic procedures, patient satisfaction and treatment outcome negatively. The purpose of the present study was to determine the psychosocial factors influencing differences in symptom reports of patients and physicians. A cohort study was carried out in a medical out-patient clinic. A total 141 women and 213 men agreed to give symptom reports while waiting for their doctor's appointment and allowed their treating physician to evaluate symptoms afterwards. Disagreement between patients and physicians on which symptoms triggered the visit appeared in one-third of the cases. This was more likely the longer symptoms existed, the less intensely patients experienced their symptom and the more restricted they felt because of the symptom. Psychosocial factors did not have a significant influence. Independently of psychosocial variables, the different illness concepts of patients and their treating physician influence the subject of the consultation. Doctors and patients were most likely to agree when patients reported their symptoms as being of recent onset and being intense. Symptom intensity and the associated degree of restriction seem to reflect two different conceptual dimensions of symptom evaluation.

Perceptions of chest pain differ by race

Background African American patients are less likely to receive thrombolytic therapy and coronary revascularization than are white patients. Delay and clinical presentation may be keys to understanding differences in care. Objective To determine how symptom recognition and perception influence clinical presentation as a function of race, we characterized symptoms and care-seeking behavior in African American and white patients seen in the ED with chest pain. Methods The prospective study was conducted from April 1999 to September 1999 among patients who were seen in the ED and were admitted or observed in the ED Chest Pain Unit (n = 215). Interviews were conducted within 48 hours with a structured set of questions. Results Thirty-one percent of white patients and 8.9% of African American patients were admitted with a diagnosis of acute myocardial infarction (P =.001). African American patients were as likely as white patients to report “typical” objective symptoms but were more likely to attribute their symptoms to a gastrointestinal source rather than a cardiac source (P =.05). Of those patients with the final diagnosis of myocardial infarction (n = 45), 61% of African American patients attributed symptoms to a gastrointestinal source and 11% to a cardiac source, versus 26% and 33%, respectively, for white patients. The median prehospital delay for African American patients was 263 minutes (interquartile range, 120 to 756 minutes), similar to the 247 minutes for white patients (interquartile range, 101 to 825 minutes, P =.72), despite African American patients (80%) being more likely than white patients (66%) to perceive their symptoms as severe/life-threatening at onset (P =.05). Conclusion Racial differences in symptom perception exist. Although the proportion of objectively defined typical symptoms were similar, self-attribution was more often noncardiac in African American patients than in white patients. Self-attribution, in addition to objective clinical findings, is likely to influence caregiver diagnostic approaches and therefore therapeutic approaches, and merits further study. (Am Heart J 2002;144:51-9.)

Is there a specific relationship between asthma and panic disorder?

The objective of the present study was three-fold: (1) to assess the prevalence of PD in asthmatic patients in comparison with non-asthmatic patients; (2) to investigate possible differences in pulmonary function and anxiety symptomatology between asthmatic patients with PD and those without; and (3) to evaluate possible differences in symptom perception during histamine-induced bronchoconstriction between asthmatic patients with PD versus asthmatic controls without PD matched for age, sex and bronchial responsiveness to histamine (PC 20). The study was performed on 123 consecutive patients referred to the lung function laboratory of a university hospital for a histamine challenge test. Firstly, baseline measures for FEV 1, anxiety (ADIS-R, ACQ, BSQ, and STAI) and depression (SDS) were collected. Subsequently, before and during induced bronchoconstriction FEV 1, perceived breathlessness (Borg scale), subjective anxiety (SUDS), and somatic panic symptoms (PAQ) were assessed. The prevalence of PD in asthmatic patients, although higher than in the general population, was very similar to the rate observed in non-asthmatic patients. Baseline level of FEV 1 and bronchial responsiveness to histamine (PC 20) were also not significantly different between asthmatic patients with and without PD. Moreover, in comparison with matched controls, PD cases reported significantly higher levels of perceived breathlessness during induced bronchoconstriction, although their mean fall in FEV 1 was very comparable. It is concluded that the higher prevalence of PD in asthma is non-specific and probably due to selection bias.

Symptom perception: psychological correlates of symptom reporting and illness behavior of women with medically unexplained gynecological symptoms.

Medically unexplained (gynecological) symptoms can be viewed as an indication of the somatization of negative emotions. Most studies regarding psychological correlates of medically unexplained gynecological symptoms have paid attention only to certain personality characteristics of women with these symptoms. In this study the reporting of physical symptoms and the resulting illness behavior is explained in terms of information processing or a perception process, i.e. the process by which people detect and interpret physical sensations as symptoms of illness (symptom perception). Symptom perception is in part determined by environmental characteristics and cognitive and emotional processes, such as variation in daily life, (coping with) emotional threat and the use of cognitive illness schemes. Differences in symptom perception and illness behavior of women with medically unexplained and explained gynecological symptoms, compared to women with medically explained gynecological symptoms and a control group, were established with the help of a questionnaire, containing a number of scales. As expected, women with medically unexplained gynecological symptoms had higher reports of common symptoms and sensations and showed also more other illness behavior than the other two groups. They reported less variation and more threat in daily life than the other two groups. These variables together with the use of illness schemes contributed most to symptom reporting of women with medically unexplained symptoms. It is concluded that defence against threat is probably an important determinant. Suggestions for further research and some practical implications are discussed.

Panic-fear in asthma: a divergence between subjective report and behavioral patterns.

The reported frequency of occurrence of Panic-Fear symptoms during asthmatic attacks varies widely and is related to treatment response independently of the objective severity of asthma. In a previous study, symptom minimizers (Low Panic-Fear) requested few as-needed (PRN) medications and treatments while hospitalized, even on days when significant airway obstruction was present. In contrast symptom emphasizers (High Panic-Fear) requested PRNs frequently, even on days when no airway obstruction was present. In the present study, these behavioral differences toward PRNs occurred despite the similar ability of patients in various Panic-Fear groups to perceive and report changes in airway obstruction. Together these results suggest that specific behavioral strategies, which do not derive from differences in symptom perception, influence the treatment response of asthmatic patients differing in Panic-Fear symptomatology.