Verbesserung der gesundheitsbezogenen Lebensqualität von Schielpatientinnen und -patienten durch Schieloperationen

Ziel der vorliegenden Studie war die Erfassung der Erwartungen, Lebensqualität sowie des Angst- und Depressionsniveaus von erwachsenen Patientinnen und Patienten, die sich an der Universitäts-Augenklinik Bonn einer Schieloperation unterzogen. Diese Variablen sollten als mögliche Einflussfaktoren auf die postoperative Lebensqualität und die Zufriedenheit mit dem operativen Eingriff untersucht werden. Weiterhin wurde untersucht, welche Variablen einen Einfluss auf die Erwartungen an die Operation haben. Zu diesem Zwecke wurden etablierte Strabismus-spezifische Fragebögen aus der englischen Sprache ins Deutsche übersetzt und die Anwendbarkeit der neu übersetzten Fragebögen im klinischen Kontext überprüft. Es wurden 59 Patientinnen und Patienten eingeschlossen, die sich zur präoperativen orthoptischen Untersuchung vorstellten. Durch die Schieloperation zeigte sich eine erhebliche Verkleinerung des Schielwinkels und eine Verringerung der Doppelbilder. Es konnte kein signifikanter Unterschied zwischen den erwarteten und den tatsächlich wahrgenommenen Veränderungen durch die Operation festgestellt werden. Im Prä-post-Vergleich verbesserten sich Lebensqualität wie auch Angst- und Depressionslevel. Die Zufriedenheit mit der Operation war insgesamt hoch. Es zeigte sich, dass ein Zusammenhang zwischen geringerem postoperativen Schielwinkel sowie geringerem postoperativen Diplopieausmaß und höherer postoperativer Zufriedenheit vorlag, während Alter, Geschlecht, Erwartungen, Angst- und Depressionslevel keinen Einfluss hatten. In Bezug auf die Lebensqualität nach der Operation konnte gezeigt werden, dass das postoperative Diplopieausmaß signifikant mit der postoperativen Lebensqualität zusammenhing und die übrigen Variablen – auch die psychosozialen – keinen Einfluss hatten. Der präoperative Schielwinkel und das Depressionslevel gingen mit höheren Erwartungen an das Ergebnis der Schieloperation einher; andere Faktoren zeigten sich nicht als signifikante Einflussgröße. Insgesamt konnte in unserer Studie gezeigt werden, dass sich psychosoziale Lebensaspekte von Patientinnen und Patienten mit Strabismus nach entsprechender operativer Korrektur verbessern und dass die Verwendung Strabismus-spezifischer psychosozialer Fragebögen zur Messung hiervon im klinischen Alltag praktikabel und auch für die zukünftige Verwendung und Testung größerer Stichproben geeignet ist

Adolescent mothers' perceptions of reproductive health services in the Garankuwa area of South Africa

The estimated number of babies born to adolescents younger than 16 in the Republic of South Africa (RSA) is approximately 17 000 (Mwaba 2000:30). These figures imply far reaching health, obstetric and social implications for the adolescent mothers, their babies,and their families, including their extended families. This exploratory quantitative survey attempted to identify which factors prevented adolescent mothers (aged 19 or younger at the birth of their babies) from using ontraceptive, emergency contraceptive and termination of pregnancy (TOP) services in the Garankuwa area of the RSA. All these services are provided free of charge at government hospitals and clinics throughout the RSA.Health Studie

Adolescent mothers' utilisation of reproductive health services in the Gauteng Province of the Republic of South Africa

A financial grant was received from the World Health Organization (WHO) during 1998 to establish whether adolescent mothers (aged 19 or younger at the birth of their babies) utilized contraceptive, emergency contraceptive and termination of pregnancy (TOP) services in the Republic of South Africa (RSA). This report refers to data obtained from 111 questionnaires completed by dolescent mothers between January 2000 and May 2000 in the Gauteng Province; 61 in the Pretoria and 50 in the Garankuwa areas, and excluding the 12 completed questionnaires used foi pretesting the research instrument. The biographic data of the 111 adolescent mothers indicated that the minority were married, employed or earned sufficient income to care for themselves and their babies. However, the minority used contraceptives prior to conception, none used emergency contraceptives or termination of pregnancy (TOP) services. The minority attended ante-natal clinics five or more times during their pregnancies, and a negligible number indicated that they had ever been treated for sexually transmitted diseases (STDs). These findings indicate that the 111 adolescent mothers in Gauteng who participated in this survey did not make optimum use of the available reproductive health (RH) care services. Education about sex, pregnancy and contraceptives should commence at the age of 10, but no later than the age of 12 as the majority of respondents did not have the necessary knowledge to make informed decisions about their futures. The accessibility of contraceptive, emergency contraceptive , s and TOP services for adolescents should be investigated in .< \ v specific areas and attempts made to enhance such accessi- \ ; bility. This might necessitate offering these services over weeker| ds or during evenings when school girls could attend without fear of meeting their mothers, aunts or teachers at these clinicsHealth Studie

Identifying bereaved subjects at risk of complicated grief: Predictive value of questionnaire items in a cohort study

<p>Abstract</p> <p>Background</p> <p>Bereavement is a condition which most people experience several times during their lives. A small but noteworthy proportion of bereaved individuals experience a syndrome of prolonged psychological distress in relation to bereavement. The aim of the study was to develop a clinical tool to identify bereaved individuals who had a prognosis of complicated grief and to propose a model for a screening tool to identify those at risk of complicated grief applicable among bereaved patients in general practice and palliative care.</p> <p>Methods</p> <p>We examined the responses of 276 newly bereaved individuals to a variety of standardised and ad hoc questionnaire items eight weeks post loss. Inventory of Complicated Grief (ICG-R) was used as a gold standard of distress at six months after bereavement. Receiver operating characteristic (ROC) curves analysis was performed for all scales and items regarding ICG-R score. Sensitivity, specificity and area under curve (AUC) were calculated for scales and items with the most promising ROC curve analyses.</p> <p>Results</p> <p>Beck's Depression Inventory (BDI) was the scale with the highest AUC (0.83) and adding a single item question ('Even while my relative was dying, I felt a sense of purpose in my life') gave a sensitivity of 80% and specificity of 75%. The positive/negative predictive values for this combination of questions were 70% and 85%, respectively. With this screening tool bereaved people could be categorized into three groups where group 1 had 7%, group 2 had 23% and group 3 had 64% propensity of suffering from complicated grief six months post loss.</p> <p>Conclusions</p> <p>This study shows that the BDI in combination with a single item question eight weeks post loss may be used for clinical screening for risk of developing complicated grief after six months. The feasibility and clinical implications of the screening tool has to be tested in a clinical setting.</p

Lymphotoxin expression in human and murine renal allografts

The kidney is the most frequently transplanted solid organ. Recruitment of inflammatory cells, ranging from diffuse to nodular accumulations with defined microarchitecture, is a hallmark of acute and chronic renal allograft injury. Lymphotoxins (LTs) mediate the communication of lymphocytes and stromal cells and play a pivotal role in chronic inflammation and formation of lymphoid tissue. The aim of this study was to assess the expression of members of the LT system in acute rejection (AR) and chronic renal allograft injury such as transplant glomerulopathy (TG) and interstitial fibrosis/tubular atrophy (IFTA). We investigated differentially regulated components in transcriptomes of human renal allograft biopsies. By microarray analysis, we found the upregulation of LT beta, LIGHT, HVEM and TNF receptors 1 and 2 in AR and IFTA in human renal allograft biopsies. In addition, there was clear evidence for the activation of the NF kappa B pathway, most likely a consequence of LT beta receptor stimulation. In human renal allograft biopsies with transplant glomerulopathy (TG) two distinct transcriptional patterns of LT activation were revealed. By quantitative RT-PCR robust upregulation of LTa, LT beta and LIGHT was shown in biopsies with borderline lesions and AR. Immunohistochemistry revealed expression of LT beta in tubular epithelial cells and inflammatory infiltrates in transplant biopsies with AR and IFTA. Finally, activation of LT signaling was reproduced in a murine model of renal transplantation with AR. In summary, our results indicate a potential role of the LT system in acute renal allograft rejection and chronic transplant injury. Activation of the LT system in allograft rejection in rodents indicates a species independent mechanism. The functional role of the LT system in acute renal allograft rejection and chronic injury remains to be determined

Contraceptive practices of women in Northern Tshwane, Gauteng Province

Despite the availability of free contraceptives in the Republic of South Africa (RSA), unwanted and unintended pregnancies continue to pose challenges to reproductive health services. Structuredinterviews were conducted with 83 women in the Northern Tshwane area of the Gauteng Province about their contraceptive practices. All the participants couldgain more knowledge about the effective use ofmodern contraceptives. Knowledge about emergency contraceptives was extremely limited. Although most participants knew about legalised termination of pregnancy services in the RSA, they didnot know how to access these services. The recommendations address ways in which contraceptive services could be improved. Keywords: adolescents\' contraceptive use; emergency contraception; contraception; termination of pregnancy Health SA Gesondheid Vol. 9 (4) 2004: pp. 42-5

Altruistic nondirected kidney donation: attitudes, characteristics and ethical implications

Purpose of reviewAltruistic nondirected kidney donation involves a person donating one of their kidneys to an unknown recipient. The donor's mental health and motives are frequently questioned. We want to highlight this topic and also encourage discussions about ethical implications.Recent findingsThe main topics are the mental health of altruistic nondirected kidney donors and the general attitude towards the practice of this form of donation as well as the willingness of the public to donate this way. Soliciting organ donation via social networks or financial support is debated extensively in the media.SummaryThere is a lack of studies on altruistic nondirected kidney donation. Most studies focus on related donors. Studies with larger samples should be performed on altruistic nondirected kidney donors to learn more about their motives and assess their mental health

Implementing strabismus-specific psychosocial questionnaires in everyday clinical practice: mental health and quality of life in the context of strabismus surgery

Background Strabismus can have a great negative impact on the quality of life and the well-being of affected patients. In the past, these aspects were often neglected and, compared with somatic functioning, placed in the background. The aim of our study is to elicit factors influencing satisfaction with strabismus surgery, quality of life and expectations of surgery in order to better predict who will benefit the most and who may need further support.Methods We made a selection of suitable questionnaires to assess psychosocial aspects of strabismus and decided for Adult Strabismus 20 Questionnaire, Amblyopia and Strabismus Questionnaire, Diplopia Questionnaire, Expectations of Strabismus Surgery Questionnaire and Hospital Anxiety and Depression Scale. We then translated these measures (if not available in German). The patients filled out these forms as part of their preoperative orthoptic and ophthalmological assessment as well as approximately 3 months after strabismus surgery.Results We enrolled 59 patients in this study. Postoperative strabismus-related quality of life was higher after surgery and anxiety and depression levels were lower. Satisfaction with surgery was lower with higher postoperative angle and diplopia; the latter was also a determinant of lower postoperative quality of life. Higher expectations of strabismus surgery were present with higher depression levels and higher preoperative strabismus angle.Conclusion Our data indicate that strabismus surgery may cause a significant improvement in several psychosocial domains. There is evidence that psychosocial factors can have significant impact on expectations with surgery. Hence, it is important to consider mental health aspects of this disease in order to treat patients in the best possible way