Factors affecting disability in patients attending the internal medicine departments of general hospitals

Fatigue and disability in elderly patients with chronic obstructive pulmonary disease (COPD)

The purpose of this study was to describe the prevalence and severity of fatigue and to investigate relationships between fatigue, and disability in elderly COPD patients. This descriptive and analytical study was conducted on 98 patients. Three instruments were used: Personal information form (PIF), visual analog scale for fatigue (VAS-F) and brief disability questionnaire (BDQ). The statistical analyses were used in order to evaluate the data: Student's t-test, Kruskall-Wallis test, Pearson correlation coefficient calculation and logistic regression analysis. All of patients in the sample experienced fatigue. The level of fatigue and disability experienced by the patients with COPD was high, their energy level was low. It was determined that as COPD patients' fatigue increases their disability also increases, that there are relationships between fatigue and marital status and that there are relationships between disability and gender. Furthermore, in this study significant differences were found in COPD patients' VAS-F and BDQ scores for some symptoms of COPD, such as dyspnea, fatigue, cough and sputum. The results of the study indicated that high levels of fatigue are experienced which impacts on patients' functional condition and needs to be professionally assessed managed.

Enabling a survey of primary care to measure the health care experiences of adults with disabilities

PURPOSE

To enable an existing survey on primary care so that it can be used to assess the healthcare experiences reported by adults living with disabilities, and to evaluate its properties.

METHODS

Mixed-methods study. We first identified content areas for measurement as compared to the items in the existing instrument and then developed new candidate items. Cognitive testing was conducted in English and Spanish. After revisions to the primary care instrument based on the cognitive testing results, the draft-enabled instrument was field-tested by mail with telephone follow-up, in English and Spanish.

RESULTS

Consumer focus groups and a technical expert panel identified eight content areas in primary care that are particularly important to maximise function and well-being of people of with disabilities. Cognitive testing also revealed serious problems with several items in the existing survey when answered by or about people with disabilities. Field testing yielded 1086 surveys, of which 40% were completed by a proxy respondent. Learning disabilities were reported by 38% of respondents. Item non-response for revised and new questions was less than 4%.

CONCLUSIONS

It is feasible to enable a survey of primary care and its administration. Survey administration instructions should be modified to accommodate proxy respondents. The screener item to identify people with mobility impairments on walking a distance should be replaced with walking for 6 min. Adding questions from the American Community Survey about functional ability will allow survey sponsors to identify respondents with various limitations, and to compare their experiences to those of people with no limitations. Careful development and testing of the items with input from interested parties throughout the design and testing stages yielded a survey with good psychometric properties and content validity in multiple languages. Health delivery systems can use the survey data to identify clinical processes needing improvement to provide high quality care for people with disabilities.

Mental health problems of Army personnel seen in medical outpatient clinics in Greece

OBJECTIVE

The problem of the underdiagnosis and inadequate treatment of mental disorders in people who visit health services has been studied in Greece as well as in other countries. There is not, however, enough research data for military personnel. The purpose of the present study is to assess the psychiatric morbidity of military personnel referred to outpatient clinics for physical problems.

METHOD

Two hundred twenty-two (222) males serving in the Army, aged 21.9 +/- 2.8 years, were examined when they visited the outpatient clinics of a General Military Hospital of a border area of Greece. They gave information concerning demographic data, completed the General Health Questionnaire (GHQ-28), and were assessed by the psychiatric interview M.I.N.I. (Mini International Neuropsychiatric Interview).

RESULTS

Eighty-two out of 222 individuals (36.9%) were classified as GHQ cases. Enlisted men and personnel with chronic physical disabilities were classified more often as cases than were professionals and physically able military men. Those referred for fractures had fewer psychiatric problems than those referred for other reasons. The most common diagnoses were anxiety disorders, major depressive episode, and alcohol abuse.

CONCLUSIONS

A large number of military personnel present undiagnosed psychological problems despite attempts in the last few years by army services to develop mechanisms of timely diagnosis and treatment of psychiatric cases. Measures for the improvement of this situation are discussed.

Disability in schizophrenia: clinical correlates and prediction over 1-year follow-up

Schizophrenia may cause disability leading to restrictions on many domains of daily life such as hygiene, self-management, vocational and leisure activities, and family and social relationships. The aim of this study was to assess the level of disability with the Brief Disability Questionnaire (BDQ), developed by the World Health Organization, and to identify the clinical correlates and predictors of disability during a 1-year follow-up period in 382 patients with schizophrenia. All patients were assessed at the beginning of the study, and 168 (44%) of them were re-evaluated after 1 year. Total disability scores of the patients with schizophrenia were significantly decreased at follow-up. Female patients seemed to be more disabled than males. Disability showed a positive correlation with the total, positive symptoms and negative symptoms scores on the Brief Psychiatric Rating Scale, as well as scores on the UKU Side Effects Rating Scale. Patients with the disorganized subtype of schizophrenia and residual symptoms were more disabled than patients with other subtype diagnoses. Negative symptoms and duration of untreated psychosis were significant predictors of disability after 1 year. Early-onset schizophrenia had a twofold increased risk for developing disability. Disability in schizophrenia is a clinical phenomenon closely linked to negative symptoms and poor outcome.