Improvement In Several Dimensions Research Articles

Readability and understandability of instruments for collecting patient-generated data (PGD).

e18534 Background: PGD are crucial to inform and optimize cancer care. These may include patient-reported outcomes measures (PROMs), patient-reported experience measures (PREMS), or patient preferences information (PPI). The increasing use of PGD has led to the need for the adaptation of instruments to different languages and cultures. Recent data has brought attention to the additional need to consider patients’ ability to understand written information included in PROMs. Low health literacy is associated with higher risk for quality-of-life deterioration and generates disparities, including underrepresentation in cancer research. Aiming at improving equity and representation, we evaluated readability and understandability of nine French-language PROMs that are currently used in a contemporary cohort of breast cancer survivors. Methods: Readability of PROMs was assessed using the Flesh Reading Ease Score (FRES), the Gunning’s Fog Index (FOG), and the FRY graphics (yielding a mean score representing the n. of school years required to understand the respective text). Readability was considered ideal if mean score ≤6th grade level and acceptable if between 6-8th grade. Understandability was evaluated using the Patient Education Materials Assessment Tool (PEMAT, range 0-100%, higher scores corresponding to easier understandability) and defined as ideal if PEMAT ≥ 80%. Plain-language best practice was met if both readability and understandability were ideal. The Evaluative Linguistic Framework for Questionnaires (ELF-Q) provided additional qualitative elements to assess understandability. Two native French speakers, including a patient representative, independently evaluated each PROM. An additional independent assessment was requested if discordance. Results: None of the 9 PROMs evaluated had ideal readability scores, and only 1 had an acceptable score. Understandability ranged from 55-91%, and only 3 PROMs had ideal scores. None of the instruments met the definition of plain-language best practice. ELF-Q identified points for improvement in several dimensions of the PROMs (Table). Conclusions: The use of comprehensive linguistic and cultural frameworks during the development and translation of self-reported PGD instruments may improve experience and engagement of patients with lower literacy and foster equity and representation in cancer cohort studies. [Table: see text]

Does Heavy-Resistance Training Improve Mobility and Perception of Quality of Life in Older Women?

Simple SummaryHeavy-resistance training can offer physicians a viable option for improving functional performance, helping their patients stay independent, active and healthy. The present results clearly demonstrate that circuit weight training is as effective as traditional resistance training for improving functional mobility but is more effective in stimulating positive perception of health-related quality-of-life adaptations in older women.Regular physical exercise has shown great benefits in preventing age-related functional losses and in improving the perception of health-related quality of life (HRQoL) in older people. To optimize these benefits, it would be interesting to evaluate what type of exercise is better. Therefore, the purpose of this study was to assess the effects of heavy-resistance training on mobility and HRQoL in older women. Forty healthy, untrained older women (60–75 years) were randomly assigned to three groups: circuit resistance training (CRT, n = 15), traditional resistance training (TRT, n = 15) or the control group (CG, n = 10). During the 12-week training period, both experimental groups performed training with heavy loads, twice a week. Before and after the training period, the Timed Up and Go test, as a proxy of mobility, and the perception of HRQoL were evaluated. TRT and CRT resulted in a statistically significant improvement in the Timed Up and Go test (−5.4 and −10.3%, respectively; p < 0.05), but only the improvement after CRT was significantly greater than changes in the CG (p < 0.001). Only CRT elicited improvements in several dimensions of the perception of the HRQoL questionnaire, such as: physical functioning (13%, p < 0.001), general health (8.1%; p = 0.048), vitality (17.7%; p < 0.001), role emotional (6.7%; p = 0.044) and physical component summary (6.3%; p = 0.001). The change in the CRT group was greater than in the CG (p < 0.001) in the physical functioning score. The present findings show that CRT might be a time- (and hence cost-) effective alternative to trigger multiple positive functional and psychological adaptations in older women.

INTERVENCIÓN EDUCATIVA CON CABALLOS PARA UN ADOLESCENTE CON TRASTORNO POR DÉFICIT DE ATENCIÓN CON HIPERACTIVIDAD

El presente artículo evalúa el impacto que ha tenido una intervención educativa asistida con caballos en el desarrollo positivo del autoconcepto de un adolescente con trastorno por déficit de atención con hiperactividad (TDAH). Diversos autores dicen que el autoconcepto se va construyendo por los propios éxitos y fracasos a lo largo del desarrollo personal y, por lo tanto, plantean que es dinámico, ya que cambia con la experiencia. Esta es una intervención realizada a un adolescente con TDAH y con una alta autopercepción de fracaso personal que presentaba dificultades de comportamiento en el entorno escolar, familiar y social. Como complemento a toda la labor realizada durante su etapa escolar, se les propuso a la escuela y a la familia que participara en un programa educativo con caballos. El objetivo de este artículo es mostrar la eficacia del programa de intervención. La metodología es un estudio de caso único, donde se administraron diversas escalas de autoconcepto y de afrontamiento de problemas, las cuales se complementaron con entrevistas e instrumentos de observación. Los resultados obtenidos permiten observar una mejora amplia en varias dimensiones del autoconcepto (laboral, emocional, familiar y física), alcanzando unos percentiles dentro de la media general de la población. También se observa una mejora en la dimensión social y en la académica aunque están por debajo de la media general poblacional. Igualmente las estrategias de afrontamiento de problemas han mejorado. En consecuencia, su comportamiento también, según lo expresa su entorno social. Por lo tanto se concluye que esta alternativa educativa ha sido efectiva.

Fostering Global Competence through Short-Term Study Abroad

The article summarizes the effects of an eight week short term study abroad program four weeks in the U nited S tates and four weeks in Germany on students’ global competence. Students’ global competence was measured with the Global Competence Aptitude Assessment (GCAA) before and after the eight week summer program. Data was collected from three summer programs and a total of 42 students participa ted in the study. The results indicate that students made statistically significant improvements in several dimensions of global competence but also statistically declined in one area. Suggestions for possible curricular and programmatic changes were made that may be put into place to provide more opportunities for the development of global competence in future iterations of this summer study abroad program.

Telephone Follow-Up by Nurse After Total Knee Arthroplasty: Results of a Randomized Clinical Trial.

Because of shorter hospitalizations, patients now have to take responsibility for their recovery period at a very early stage. We evaluated the effects of structured, nurse-managed telephone follow-up (TFU) after discharge from the hospital following total knee arthroplasty (TKA). The design was a single-center, unblinded, parallel-group randomized clinical trial. The primary outcome was self-reported physical function according to the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Secondary outcomes were stiffness and pain according to the WOMAC Index; health-related quality of life, measured with the Medical Outcomes Study Short Form (SF-36); general self-efficacy, measured with the General Self-Efficacy Scale; and number of acute visits to the orthopaedic outpatient clinic. In total, 117 patients were randomized to 2 groups: an intervention group receiving TFU 4 and 14 days after discharge in addition to conventional treatment, and a control group receiving conventional treatment. The TFUs were structured by key subjects for health status, as defined by the VIPS model (the Swedish acronym for the concepts of Well-being, Integrity, Prevention, and Safety). The effect was measured 1 and 3 months postsurgery. No significant effects on physical function in the disease-specific WOMAC Index were identified. However, significant differences in scores were identified in favor of the intervention group on general self-efficacy (p = .014) and physical function (p = .031), measured with the Medical Outcomes Study Short Form 1 month after TKA, but this effect was not seen at 3 months. A positive improvement in several dimensions of health status and health-related quality of life was identified in favor of the intervention group, but patients who had TFU had more unscheduled visits to the outpatient clinic. Telephone follow-up did not improve physical function compared with conventional treatment, as measured with the WOMAC Index. A short-term effect was identified, improving general self-efficacy and physical function as dimensions of health-related quality of life.

Strength Training Improves Body Image and Physical Activity Behaviors Among Midlife and Older Rural Women

The effect of strength training on body image is understudied. The Strong Women Program, a 10-week, twice weekly strength-training program, was provided by Extension agents to 341 older rural women (62±12 years); changes in body image and other psychosocial variables were evaluated. Paired-sample t-test analyses were conducted to assess mean differences pre- to post-program. Strength training was associated with significant improvements in several dimensions of body image, health-related quality of life, and physical activity behaviors, satisfaction, and comfort among rural aging women—an often underserved population that stands to benefit considerably from similar programs.

The Impacts of Electricity Sector Reforms in Developing Countries

During the past two-and-a-half decades, a large number of developing and transition countries have introduced varying mixes of institutional reforms into their electricity sectors. The emerging international evidence suggests that the standard reform model—privatization, vertical and horizontal unbundling, and the introduction of performance-based regulatory mechanisms—if implemented correctly, can lead to significant improvements in several dimensions of operating performance.

A Comparison of the Psychological Outcomes of Cosmetic Surgical Procedures

Studies of psychological outcomes of cosmetic surgery generally provide low standards of evidence due to significant methodological limitations and few studies have explored the outcomes of surgery types other than breast reduction or have compared post-operative outcomes for different surgery types. This study therefore aimed to explore the psychological outcomes and post-operative satisfaction of cosmetic surgery and compare the outcomes and satisfaction of participants undergoing different procedures. Surveys were administered to a sample of 142 elective cosmetic surgery patients prior to surgery and six months after surgery. The surveys included standardised measures of body image (appearance evaluation, appearance orientation, body areas satisfaction), self-esteem, and mental health (psychiatric disturbance, anxiety, depression, dysmorphic concerns). The findings revealed high rates of post-operative satisfaction and significant improvements in several dimensions of body image (appearance evaluation and body area satisfaction) and mental health (anxiety, depression, and dysmorphic concerns), but not self-esteem. Breast augmentation patients reported significantly higher improvement on appearance evaluation, significantly higher ratings of how likely they thought it was that they had achieved, or would achieve, what they were looking for in having the procedure, and a trend to report that the overall result of surgery was better than or as expected than rhinoplasty patients. It is recommended that future research clarifies the degree to which self-esteem and indices of mental health improve after cosmetic surgery and fully establishes the impact of different procedures on psychological outcomes. Level of Evidence. Therapeutic Study, Level II.

Dépenses de santé et équité dans l'accès aux services de santé dans les pays en développement

Résumé Au cours des années 2000, la question de la santé a gagné en priorité dans les politiques de développement, ce qui s’est traduit par une forte augmentation des dépenses dans le secteur de la santé. Pour que ces politiques contribuent efficacement à la réduction de la pauvreté il faut non seulement que les dépenses de santé soient efficaces mais aussi que l’équité dans l’accès aux services de santé s’améliore. Cet article vise à apporter une contribution à cette problématique de l’équité en santé dans les pays en développement en considérant le cas de l’accès aux services de santé infantile et maternelle. Nous montrons dans ce cadre que des dépenses publiques de santé plus importantes profitent un peu plus aux pauvres qu’aux riches mais qu’une progression de ces dépenses se traduit au mieux par une amélioration marginale de l’équité de l’accès aux services de santé. Nous montrons également que l’accès aux services de santé est fortement influencé par les caractéristiques socioéconomiques des ménages, et notamment par l’éducation des mères de famille. Une politique de généralisation de l’éducation des filles pourrait ainsi contribuer à améliorer significativement l’accès à la santé pour les pauvres. Nous trouvons enfin que des améliorations de la gouvernance dans plusieurs de ses dimensions pourraient également contribuer de manière très sensible à une distribution de l’accès aux services de santé plus équitable. Classification JEL : I1, I3

Psychological Predictors of Outcome in Vertical Banded Gastroplasty: a 6 Months Prospective Pilot Study

At present, bariatric surgery is the most effective treatment for morbid obesity. Several factors appear to influence the patient's ability to adjust to the postoperative condition, but reliable predictors are lacking. The aim of this study was to assess whether psychological presurgical variables can predict outcome of vertical banded gastroplasty (VBG) in the short term. 38 severely obese patients (6 men and 32 women) underwent laparoscopic VBG. All were assessed prospectively at TO (before surgery) and at T6 (6 months after surgery) with a semi-structured interview and a battery of psychological tests: State Trait Anger Expression Inventory (STAXI), Eating Disorder Inventory (EDI-2), Symptom Checklist 90 (SCL-90), Beck Depression Inventory (BDI), Binge Eating Scale (BES), Body Shape Questionnaire (BSQ), and (only at TO) the Temperament and Character Inventory (TCI). The comparison between TO and T6 found a significant weight loss and an improvement in several dimensions of EDI-2, BDI, and BSQ, together with an increase in the frequency of vomiting. Self-directedness (TCI) and Body Dissatisfaction (EDI-2) appear to be predictors of short-term outcome regarding weight loss. Self-transcendence (TCI) is associated with emerging side-effects. Although larger and longer studies are necessary to confirm these data, Self directedness and Self trascendence emerge as predictors of 6 months clinical and psychological outcome of VBG.

Citalopram Treatment of Compulsive Shopping

Article AbstractBackground: Treatment with intravenous clomipramine is rapidly effective in some obsessive-compulsive disorder (OCD) patients unresponsive to orally administered serotonin reuptake inhibitors (SRIs). The selective serotonin reuptake inhibitor citalopram is effective for OCD when administered orally. We investigated whether intravenous citalopram would rapidly benefit OCD patients unresponsive to orally administered SRIs. Method: Thirty-nine adult outpatients participated in a 3-week open-label trial of intravenous citalopram. Eligible patients had moderate-to-severe DSM-IV OCD of >=1 year's duration, a baseline Yale-Brown Obsessive Compulsive Scale (YBOCS) score >=25, and no other active Axis I diagnosis and had failed at least 2 adequate oral SRI trials, excluding citalopram. Intravenous citalopram was administered daily for 21 days, followed by oral citalopram until treatment day 84. Intravenous citalopram was started at 20 mg/day and was increased to 40 to 80 mg/day as tolerated. Results: Intravenous citalopram was well tolerated even at higher doses (dropout rate=2.6%). At day 21, 23 (59%) of the 39 patients had YBOCS score decreases of >=25%, of whom 4 had decreases of >=35%. Twenty-seven patients with YBOCS score decreases of >=20% were allowed to continue on treatment with oral citalopram, and by day 84, all had substantial further improvement. All 27 patients also showed significant improvement in several dimensions of quality of life. Conclusion: Intravenous citalopram was safe and rapidly effective in a group of treatment-resistant OCD patients. The early onset of response suggests a means of accelerating OCD symptom relief and predicting response to oral citalopram treatment. Double-blind, double-dummy, placebo-controlled trials of intravenous versus oral citalopram in patients with treatment-resistant OCD are indicated.

Quality of life after balloon angioplasty or stenting for acute myocardial infarction: One-year results from the Stent-PAMI trial

OBJECTIVESThe goal of this study was to compare the impact of primary stenting or percutaneous transluminal coronary angioplasty (PTCA) on health-related quality of life (HRQOL) in patients undergoing direct angioplasty for acute myocardial infarction (AMI).BACKGROUNDPrevious studies have demonstrated that coronary stenting reduces clinical and angiographic restenosis compared with PTCA. However, the impact of stenting on HRQOL from the patient’s perspective remains unknown.METHODSWe administered the Seattle Angina Questionnaire and the Medical Outcomes Study Short-form Survey at 1, 6 and 12 months after initial treatment to all North American patients in the Stent-Primary Angioplasty for Myocardial Infarction trial (Stent-PAMI) (n = 509)—a randomized trial comparing primary stenting to conventional PTCA for patients with AMI.RESULTSAt one month, most HRQOL measures were similar for the two groups, but stent patients reported less bodily pain than PTCA patients (p = 0.03). At six-month follow-up, stenting resulted in significant improvements in several dimensions of HRQOL including reduced anginal frequency and bodily pain as well as improved disease perception (all p ≤ 0.03) and a trend towards better anginal stability (p = 0.056). By 12-month follow-up, however, none of these differences remained statistically significant. These differences in HRQOL were largely explained by the greater need for ischemia-driven target-vessel repeat revascularization procedures in PTCA patients during the first six months (16.0% vs. 6.2%, p < 0.001).CONCLUSIONSIn patients undergoing revascularization for AMI, initial stent placement is associated with improvements in several dimensions of health status during the first six months of follow-up. In the absence of differences in mortality, these findings add to the overall argument in favor of initial stenting in patients treated with mechanical reperfusion for myocardial infarction.