Association between sexual function and marital relationship in patients with ischemic heart disease

Patients with ischemic heart disease [IHD] may report difficulties with sexual function and marital relationship. However, there is a dearth of studies focusing on the association between these aspects in IHD patients. The present study sought to assess the association between sexual function and marital relationship among IHD patients and also test the effect modification of gender, education level, and marital distress on the above association. In this cross-sectional study, 551 patients with IHD were enrolled and their sexual function and marital relationship quality were assessed with the Relation and Sexuality Scale [RSS] and Revised Dyadic Adjustment Scale [RDAS], respectively. Association between marital relationship quality and sexual function was assessed with respect to gender, education level, and marital distress. Most participants [72%] were men at a mean age of 57 +/- 11 [range = 36-80] years. Total sexual function was significantly correlated with total marital quality [r = -0.28], marital consensus [r = -0.17], marital coherence [r = -0.19], marital affection expression [r = -0.22], and marital satisfaction [r = -0.25]. Total marital quality also showed a significant association with sexual fear [r = -0.11]. These associations were moderated by gender, education level, and marital distress level. Among the IHD patients, sexual function and marital relationship quality showed a mild to moderate association. Association between sexual function and marital relationship quality, however, may depend on gender, education level, and marital distress level

Prevention of pregnancy complications in Iran following implementing a national educational program

To determine the impact of a national intervention program on some pregnancy complications in Iran. This multicenter study was conducted in governmental sector in 14 provinces in Iran between 2003 and 2005. Intervention included education of all maternal health care providers including gynecologists, general physicians, and midwifes in the governmental sector. Time interval between the pre- [of 3,978 and 3,958 pregnancies] and post- [3,958 pregnancies] measurements were 18 months. Self reported data on pregnancy complications were registered. Interviews were conducted by trained personnel. Participants were interviewed when admitted for delivery or at the time attending for vaccination of their 2 month infants. The following pregnancy complications were reduced significantly as compared to before intervention: 1] bleeding or spotting, 2] urinary tract complications, 3] blurred vision and severe headache, 4] premature labor pain, 5] anemia, 6] severe vomiting, 7] inappropriate weight gain, 8] endometritis, 9] urinary incontinence, 10] breast abscess or mastitis, 11] wound infection, and 12] bleeding was significantly reduced after intervention, compared to before intervention. Premature rupture of membrane showed a significant increase. These complications did not show a significant change: 1] hypertension, 2] fever and chills, 3] convulsion, shock, and loss of consciousness, and 4] obstetric fistula. National programs may be proved to be largely effective by decreasing some of the pregnancy complications in developing countries

Ethnicity modifies the additive effects of anxiety and drug use disorders on suicidal ideation among black adults in the United States

This study aimed to test if ethnicity moderates the additive effects of lifetime psychiatric disorders on serious suicidal thoughts among a nationally representative sample of Black adults in the United States. For this study, we used data of 5,181 Black adults [3,570 African Americans and 1,621 Caribbean Blacks] who participated in the National Survey of American Life, 2001 2003. Five lifetime psychiatric disorders [i.e., major depressive disorder, general anxiety disorder, post-traumatic stress disorder, alcohol abuse disorder, and drug abuse] were considered as the independent variables. Lifetime serious suicidal ideation was considered as the dependent variable. Logistic regressions were used to determine if ethnicity modifies the effects of each psychiatric disorder on serious suicide ideation. Ethnicity was conceptualized as the possible moderator and socio demographics [i.e., age, gender, education level, employment, marital status and country region] were control variables. Among African Americans, major depressive disorder, general anxiety disorder, post-traumatic stress disorder and alcohol abuse disorder were associated with higher odds of suicidal thoughts. Among Caribbean Blacks, major depressive disorder and drug abuse disorder were associated with higher odds of suicidal thoughts. In the pooled sample, there was a significant interaction between ethnicity and anxiety disorder and a marginally significant interaction between ethnicity and drug abuse. Based on our study, suicidality due to psychiatric disorders among Black adults in the United States may depend on ethnicity. General anxiety disorder seems to be a more important risk factor for suicidal ideation among African Americans while drug abuse may contribute more to the risk of suicidal thoughts among Caribbean Blacks.

Religious beliefs may reduce the negative effect of psychiatric disorders on age of onset of suicidal ideation among blacks in the United States

To evaluate the possible interaction between religious beliefs and psychiatric disorders among Black Americans. In this study, we used data of 5181 adult Black Americans who had participated in National Survey of American Life [NSAL] from February 2001 to June 2003. Variables such as socio-demographics, religious beliefs, and psychiatric disorders were entered in a Cox regression to determine the possible interaction between psychiatric disorders [0, 1, >/= 2] and the subjective religiosity on age of onset of suicidal thought among the participants. Main outcome was age of the first serious suicidal ideation. A dose-dependent effect of number of psychiatric disorders on suicidal ideation was observed. Psychiatric disorders had a higher impact on age of suicidal ideation among those with low self-reported religiosity. Religious beliefs may buffer the effect of psychiatric disorders on suicidal thought. Blacks who are less religious and suffer psychiatric disorders are at the highest risk for early suicidal ideation

Costs and length of hospitalization following kidney transplantation

We assessed the costs of hospital admissions and length of hospital stay in kidney allograft recipients admitted to our center, in order to rank hospitalization causes in terms of costly and prolonged admissions, to bring to light the respective correlates of costly and prolonged admissions, and to investigate the relationship between costs and length of rehospitalizations. Among rehospitalizations, 83.3% of those due to cerebrovascular accident were costly and 51% of those with graft rejection resulted in prolonged hospital stays. Costly admissions had a high regularity in cases of patients older than 60 years, end-stage renal disease due to diabetes mellitus, graft loss, intensive care unit admission, and hospitalizations accompanied by in death. Prolonged stays were more common in those who were admitted to intensive care unit and those who ultimately died. The Costs showed a significant correlation with the length of rehospitalization [r = 0.626, P = .001]. The strong correlation between the length of hospitalization and posttransplant hospitalization costs means that the former should be curtailed by focusing on such correlates of high-cost admissions as high age and diabetes mellitus as the cause of kidney failure

Marital adjustment in patients on long-term hemodialysis. A case-control study

This study was conducted to compare marital adjustment between patients on long-term hemodialysis and healthy controls and to determine whether the psychological symptoms correlate with marital adjustment in these patients. In a case-control study, 40 patients on long-term hemodialysis and 40 healthy participants were compared for the quality of marital relationship. The Revised Dyadic Adjustment Scale was used for interviews of marital relationship, which includes total marital adjustment and its subscales of marital consensus, affection expression, marital satisfaction, and marital cohesion. Symptoms of anxiety and depression and the Ifudu comorbidity scale were also assessed in the patients group. Marital consensus, affection expression, marital satisfaction, marital cohesion, and the overall marital relationship were significantly poorer in the patients on hemodialysis than in the controls. Also, symptoms of anxiety were more severe among the patients on hemodialysis in comparison with that in the controls. However, this was not the case for symptoms of depression. In the patients on hemodialysis, the severity of anxiety slightly correlated reversely with the total marital relationship score and marital satisfaction subscale. Depression correlated reversely with total marital adjustment, affection expression, marital satisfaction, and marital cohesion. Finally, some marital relationship subscales showed poorer results in men on dialysis, younger patients, and those with higher educational levels. Marital adjustment in patients on hemodialysis, which is linked with depressive symptoms and anxiety, is poorer compared to the healthy controls. This finding shows the necessity of an appropriate family approach for patients on long-term dialysis

Revised dyadic adjustment scale as a reliable tool for assessment of quality of marital relationship in patients on long-term hemodialysis

Although the revised dyadic adjustment scale [RDAS] has been widely used as an indicator of the quality of marital relationship, no report is available on the reliability of this measure in patients on hemodialysis. We examined the internal consistency of the RDAS in a group of Iranian patients undergoing maintenance hemodialysis. A translated Persian version of the RDAS was self-administered to 135 patients. The internal consistency of the RDAS was tested using the Chronbach a coefficient which was 0.898, 0.683, 0.779, 0.827, and 0.836 for the RDAS total score and the dyadic consensus, affective expression, dyadic satisfaction, and dyadic cohesion subdomains, respectively. All of the Chronbach a scores were higher in patients with higher income and education level. Using the RDAS to examine marital relationship quality in patients on hemodialysis, the total score and almost all subscores except for dyadic consensus had adequate internal consistency

Health-related quality of life in chronic obstructive pulmonary disease: are disease-specific and generic quality of life measures correlated?

Generic and disease-specific health-related quality of life [HRQoL] questionnaires are commonly used in subjects with chronic obstructive pulmonary disease [COPD]. However, it is not clear whether generic and disease-specific measures should be used in parallel, as they focus on different aspects of life. This study aimed to investigate the association between two most commonly used generic and disease specific HRQoL measures: Medical Outcomes Study Short Form 36Item [SF-36] and St George's Respiratory Questionnaire [SGRQ]. Materials and In a cross-sectional study, 58 subjects were selected through non-randomized systematic sampling from all COPD patients admitted to the "Respiratory Clinic of Baqiyatallah Hospital" during 2006. Each subject completed both SF-36 and SGRQ forms. Spirometry was also performed for each patient. The correlations between SGRQ total score and its subscores, including symptoms, activity and impacts, and SF-36 total score and its subscores, including physical functioning [PF], role-physical [RP], bodily pain [BP], general health [GH], vitality [VT], social functioning [SF], role-emotional [RE] and mental health [MH], were assessed. No significant correlation was found between the total score or subscores of SF-36 and the total score or subscales of SGRQ [p>0.05]. The generic SF-36 and the disease specific SGRQ questionnaires assess different aspects of HRQoL in COPD patients and each should be used separately. The optimal approach appears to be the application of generic and disease-specific measures together, at least in the research setting. Further studies are recommended with larger sample size

Survival of rehospitalized kidney allograft recipients

Undergoing transplantation is extremely stressful, and a recipient is likely leave the hospital burdened with fears of an uncertain future. A paucity of knowledge on the long-term survival of rehospitalized kidney transplant recipients is the likely the reason that physicians fail to provide this group of patients with promising information and reassurance about their future. We sought to describe the long-term patient and graft survival after nonfatal rehospitalization in kidney recipients with a normal graft function after discharge. We reviewed the follow-up data [from the time of discharge after first rehospitalization] of 253 kidney transplant recipients who had been discharged from rehospitalization with a normal kidney function [serum creatinine less than 1.6 mg/dL]. Patient and graft survival rates 6 months and 1, 2, and 5 years after discharge were determined. The mean duration of follow-up [from the time of discharge after the first rehospitalization] was 38.9 +/- 11.2 months [range, 6 to 84 months]. The overall patient survival rates were 98%, 97%, 95%, and 93% at 6 months, 1 year, 2 years, and 5 years, respectively. Graft survival rates at these times were 88%, 82%, 77%, and 63%, respectively. After the first posttransplant rehospitalization, 54 patients [21.9%] experienced more hospitalization episodes [mean, 2.6 +/- 2.0 times], while 193 [78.1%] had no further hospitalizations during the follow-up period. Kidney transplant recipients who are rehospitalized should be reassured about favorable chances of survival if discharged with a normal graft function

socioeconomic status and quality of life in patients with chronic obstructive pulmonary disease

The quality of life in patients with chronic obstructive pulmonary disease [COPD] is associated with poor pulmonary function, respiratory symptoms, incapacity to perform daily activities, as well as mental and cognitive disorders. Although there exists some evidence regarding the effect of socioeconomic status on the quality of life in the general population and those with chronic diseases, research is scarce on this issue in COPD patients. This study aimed to investigate the association between income and quality of life in COPD patients. In a case-control study, 131 subjects were selected through systematic sampling from all COPD patients admitted to the pulmonology Clinic of the Baqiyatallah Hospital during the year 2006. Subjects were then divided into three groups based on their household monthly income as follows: group I [n=52], income < 2,000,000 Rials; group II [n=62], income between 2,000,000 and 3,000,000 Rials; and group III [n=17], income > 3,000,000 Rials. The groups were matched with regard to gender, age, educational background, marital status, comorbidity burden, and insurance coverage. Spirometric measures and quality of life [SF-36] were compared between the groups. The overall quality of life and physical health subscale were significantly different between the groups [p < 0.05]. Other parameters of SF-36 including physical functioning, role limitation due to physical problems, bodily pain, social functioning, general mental health, role limitation due to emotional problems, vitality, and mental health exhibited no significant difference between the groups [p > 0.05]. Quality of life and physical function of COPD patients are significantly correlated with their socioeconomic status. Future prospective studies are needed to find potential causative associations between the level of income and life quality in these patients

Family satisfaction from point of view of diabetic and non- diabetic pares

Family satisfaction in subpopulations referred to the endocrine clinic including diabetic and non diabetic patients and their spouses are compared in the present study. This study also assesses the correlation between family satisfaction and variables such as age, sex, educational level, economic status, type of diabetes, duration of the disease, type of therapy and dosage of drugs. A comparison of the frequency of sexual dysfunction between diabetics and non-diabetic pairs was also done. In this case- control study, 400 subjects were selected as simplified non-randomized method from outpatients referred to the Shahre Kord endocrine clinic in 2002. We assigned samples to group I [diabetic patients, n=100], group II [diabetic patients spouses, n=100], group III [non-diabetic patients, n=100] and group IV [non-diabetic patients spouses, n=100]. Groups I and II were similar in sex, socioeconomic status and educational level. GRIMS family relationship questionnaire was used to evaluate family satisfaction. Family satisfaction for diabetics in comparison with non-diabetics [P=0.05], diabetics in comparison with their spouses [P=0.003], and non-diabetics in comparison with their spouses [p=0.002] were significantly less. There was no significant difference between family satisfaction in diabetic and non-diabetic patients spouses [p>0.05]. Relative frequency of sexual dysfunction was 76% and 29% and relative frequency of decreased libido was 32% an 12%, in diabetic and non- diabetic couples, respectively. Family satisfaction was less in patients with diabetes type I and whom using higher dosage of drugs. This study emphasized on the attention to the family as a part of approach to the diabetic patients. According to our results, it is recommended to focus the most attention in this field to the patients with type I diabetes and who consume more amounts of drugs