Testing the factor structure of the Family Quality of Life Survey - 2006.

BACKGROUND: Although the Family Quality of Life Survey - 2006 (FQOLS-2006) is being used in research, there is little evidence to support its hypothesised domain structure. The purpose of this study was to test the domain structure of the survey using confirmatory factor analysis. METHOD: Samples from Australia, Canada, Nigeria and the USA were analysed using structural equation modelling. The data from Australia, Canada and the USA were combined on the assumption that these countries are similar, at least to some degree, in economic development, language and culture. The Nigerian data were analysed on its own. The analysis was undertaken in two phases. First, the hypothesis that each of nine domains of the FQOLS-2006 is a unidimensional construct that can reliably measure the dimensions Importance, Stability, Opportunities, Attainment, Stability and Satisfaction was tested. Second, the hypothesis that family quality of life (FQoL) is a single latent construct represented by the nine domains measured in the FQOLS-2006 was tested. RESULTS: In the first phase of the analysis, the Importance dimension was dropped because of skewness and lack of variance. The Stability dimension did not fit well within the individual domain model in both the Nigerian and the combined three countries' data. When Importance and Stability were excluded, the individual domain models showede good or acceptable fit when error variances of some dimensions were allowed to correlate. In the second phase of the analysis, the overall model, FQoL, represented by the nine domains of the FQOLS-2006 showed good fit in both data sets. CONCLUSIONS: The conceptual model of the FQOLS-2006 was supported with some qualifications. Each domain on the survey can be reliably measured by four dimensions Opportunities, Initiative, Attainment and Satisfaction. The dimensions of Importance and Stability, however, did not fit. Data reported on these dimensions from past and current studies should be interpreted with caution. The construct of FQoL is also reliably measured by the domains of the FQOLS-2006. Further research into the psychometric properties of the survey, particularly from a cross-cultural perspective, is needed.

The prolyl cis/trans isomerase cyclophilin 18 interacts with the tumor suppressor p53 and modifies its functions in cell cycle regulation and apoptosis.

The functional diversity of the tumor suppressor protein p53 is mainly regulated by protein interactions. In this study, we describe a new interaction with the peptidyl-prolyl cis/trans isomerase cyclophilin 18 (Cyp18). The interaction reduced the sequence-specific DNA binding of p53 in vitro, whereas the inhibition of the interaction increased p53-reporter gene activity in vivo. The active site of the folding helper enzyme Cyp18 was directly involved in binding. The proline-rich region (amino acids 64-91) of p53 was most likely responsible for the observed binding because a synthetic peptide comprising amino acids 68-81 of p53 inhibited this interaction, and a p53 variant containing a proline residue at position 72 (p53(P72)) interacted with Cyp18 more effectively than the corresponding p53(R72) variant. Impairment of the Cyp18-p53 interaction induced an accumulation of cells in the G2/M phase of the cell cycle, which was more pronounced when p53(P72) was expressed compared with p53(R72) in an otherwise isogenic cellular background. Moreover, p53-dependent apoptosis was elevated in Cyp18 knockout cells, suggesting an antiapoptotic potential of Cyp18-p53 complexes. Functional in vivo data hint to a possible clinical relevance of the p53-Cyp18 interaction observed.

Family quality of life among families with a member who has an intellectual disability: an exploratory examination of key domains and dimensions of the revised FQOL Survey.

BACKGROUND: The Family Quality of Life Survey (FQOLS-2006) was developed as the result of increased interest in family quality of life (FQOL) among families with a member who has an intellectual disability (ID). The instrument includes nine life domains and six dimensions reflecting the main areas and characteristics of FQOL. The aim of the current study was to provide a descriptive analysis of the domains and dimensions of the survey and to explore their relationship to one another and to global satisfaction. METHOD: A convenience sample of 35 participants with a family member who had ID completed the FQOLS-2006 in a large urban centre in Canada. The data were analysed using descriptive analyses. RESULTS: The findings showed that although participants differentiated between different domains and dimensions, as reflected in their variability, stability was also found. For example, support from others was rated lowest across most dimensions, while family relationships and health of the family were generally rated higher. CONCLUSIONS: The findings strengthen the importance of examining both the overall perception of FQOL as well as the perceptions in individual life domains. Moreover, they highlight the need to examine each life domain according to its various dimensions. In sum, the results call for further examination of the FQOLS-2006 as a useful tool for assessing FQOL and for implementing services based on it.

Quality of life is not only for people served--it is also for staff: the Multi-Focal Approach.

BACKGROUND: To date, little attention has been given to the concept of quality of life around human resources employment programmes for staff working with persons with a dual diagnosis. METHOD: This article describes the implementation of quality of life principles to service provision for people with dual diagnosis and its application to staff training. RESULTS: This type of experiential training facilitated change in staff's attitude to, and treatment of, the people served. CONCLUSION: Human resources development programmes should be based on the same core quality of life principles and domains that guide service delivery on the individual level.

Prostaglandin E1 versus sex therapy in the management of psychogenic erectile dysfunction.

The treatment for psychogenic erectile dysfunction has been previously managed by non-medical methods consisting of counseling with a psychiatrist, psychologist or sex therapist. The success rate for treatment with counseling has not been uniformly successful. This paper compares the treatment of psychogenic erectile dysfunction using standard sex therapy and self-injection therapy using low-dose PGE1. Fifty men with psychogenic impotence were divided into two groups: standard sex therapy for twelve weeks or treatment using low-dose (2.5 - 5.0 microg) of PGE1. The results showed that men treated with low-dose PGE1 had a 47% improvement of obtaining an unaided erection compared to 58% improvement rate with sex therapy. 69% of patients in the PGE1 group were satisfied with their treatment compared to 75% receiving sex therapy. The frequency of intercourse reported in patient diaries for the two groups was similar (20.5 per month for PGE1 vs 20.0 per month for sex therapy. The reported duration of erection by patients receiving PGE1 therapy was longer than that reported by those receiving sex therapy (35 min vs 10 min). The comparison of the cost of treatment of the two treatment groups reveals that the sex therapy is approximately 25% more expensive than the PGE1 treatment. This pilot study demonstrates that the efficacy of PGE1 was numerically, though not statistically, less than sex therapy in the treatment of psychogenic impotence. The cost per positive outcome with PGE1 treatment is lower than that of sex therapy treatment making PGE1 more cost-effective.

When patients request the impotence pill.

Erectile dysfunction is a common condition affecting men over age 50. With the recent increase in public awareness about available therapies, more and more men are seeking help. Primary care physicians usually can prescribe first-line treatments without acquiring additional equipment or staff. Patients who are not satisfied with oral medication, vacuum devices, injection therapy, or intraurethral suppositories may be referred to a urologist for further treatment. Development of new medical therapies is ongoing, and within the next few years, we expect to see the introduction of more medications for treatment of erectile dysfunction. Some agents act peripherally on the penile circulation and others centrally on the portion of the brain involved in producing erections.

Preventive healthcare in physicians and attorneys.

Physicians make recommendations to their patients on a daily basis regarding tests and procedures. However, no research has evaluated physicians use of similar tests for their own health and well-being. This article reviews a comparison between 55 male physicians and 55 male attorneys of similar age regarding their use of the annual physical examination and routine screening tests. In several areas, the results indicate that physicians do not participate in routine tests and procedures as well as do their legal counterparts. Possible explanations for this physician behavior are included in the discussion segment of the article.

Common urologic disorders. When to treat and when to refer.

Healthcare will continue to see a trend toward fewer referrals to specialists. Consequently, primary care physicians must understand the evaluation and management of the most common urologic disorders. This understanding, coupled with the knowledge of when to refer to a urologist, will enable safe management.

Putting the process of care into practice.

"Putting the process of care into practice" provides an interactive, visual model of outpatient resources and processes. It illustrates an episode of care from a fee-for-service as well as managed care perspective. The Care Process Matrix can be used for planning and staffing, as well as retrospectively to assess appropriate resource use within a practice. It identifies effective strategies for reducing the cost per episode of care and optimizing quality while moving from managing costs to managing the care process. Because of an overbuilt health care system, including an oversupply of physicians, success in the future will require redesigning the process of care and a coherent customer service strategy. The growing complexities of practice will require physicians to focus on several key competencies while outsourcing other functions such as billing and contracting.

Safety and efficacy outcome of mentor alpha-1 inflatable penile prosthesis implantation for impotence treatment.

PURPOSE: We investigated safety and efficacy outcome pertaining to the Mentor Alpha-1, 3-piece inflatable penile prosthesis for impotence treatment. MATERIALS AND METHODS: A 2-phase, multi-institutional, large scale retrospective study, with independently analyzed medical record (phase I) and questionnaire (phase II) data from consecutive eligible patients of 7 physician investigators was performed from March to October 1993. RESULTS: In phase I there were no morbidities of any type in 394 of the 434 patients (90.8%) (mean age 61 years, range 24 to 88) who underwent Alpha-1 implantation (mean followup 22.2 months, range 0.67 to 44.5). The risk of prosthesis malfunction (fluid leak and auto-inflation) was 2.5%. No cylinder aneurysms were reported. A total of 93.1% of Alpha-1 devices was free from explantation (4.4%) or revision surgery (2.5%) for approximately 2 years from the original implant date. Kaplan-Meier actuarial analyses revealed that cumulative survival of the Alpha-1 prostheses at 12, 24 and 36 months was 98 +/- 1%, 93 +/- 2% and 85 +/- 7% until device malfunction, and 91 +/- 2% 83 +/- 4% and 75 +/- 7% until surgical intervention (revision or explantation). In phase II 89% of the men claimed fulfilled expectations with the Alpha-1 prosthesis as impotence treatment. Satisfaction responses 80% or greater were noted with regard to intercourse ability and confidence, and device rigidity and function. Implantation did not result in greater than 80% satisfaction in partner relationships or feelings (as judged by the patient), social or work confidence, or intercourse frequency. Factors adversely affecting satisfaction included partner feelings of dissatisfaction (as judged by the patient), specific physician investigators and need for explantation/revision surgery. CONCLUSIONS: In 1 of the largest multi-institutional implant outcome studies thus far performed, safety and efficacy data concerning the Alpha-1 contemporary inflatable device were found markedly improved over earlier inflatable prostheses and now compare favorably with historical data from noninflatable rod type devices.