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1.
Haemophilia ; 21(5): 598-604, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25684356

ABSTRACT

Illness representations of chronic patients are important to explain adherence and preventive behaviours. However, it is unclear if the patient's objective health status may influence illness representations and perceived adherence. This study explored if health status and socio-demographic characteristics influence illness representations and perceived adherence in haemophilic patients. Fifty patients (25 on-demand and 25 on prophylaxis) ageing from 13-73, completed the Illness Perceptions Questionnaire-Revised and the Morisky Medication Adherence Scale. Patients' cognitive illness representations were influenced by type of treatment, haemophilia severity, presence of inhibitor and co-morbidity. Perceived chronicity was influenced by patient's age (P = 0.021). Perceived adherence was not influenced by the health status, but was affected by the relationship status (P = 0.048). Perceived adherence was predicted by perceived chronicity (ß = 0.412; P = 0.003) and by emotions (ß = -0.308; P = 0.023). Patient's health status seems to affect cognitive illness representations but not perceived adherence. Perceived chronicity and negative emotions, which affected perceived adherence, were not influenced by the health status. Physician-patient communication addressing perceived chronicity and emotions rather than patients' health status may influence patient's adherence. Psycho-educational groups could be offered to promote patient's well-being and adjustment to haemophilia, and improve adherence.


Subject(s)
Hemophilia A/drug therapy , Medication Adherence , Adolescent , Adult , Aged , Demography , Health Status , Humans , Middle Aged , Pilot Projects , Risk Factors , Young Adult
2.
Child Care Health Dev ; 36(4): 539-48, 2010 Jul.
Article in English | MEDLINE | ID: mdl-19735270

ABSTRACT

BACKGROUND: The aim of the study was to explore the illness experience of individuals affected by phenylketonuria (PKU) and its differences in different patient age groups. METHODS: A qualitative-interpretative methodology was used through in-depth interviews. Textual data were explored using the principles of grounded theory. RESULTS: Forty-seven patients participated in the study, aged from 10 to >25 years old. The results suggested the age-related PKU experience: (1) a paradox, either to feel normal but isolated from the social context, or to be different while participating in the convivial aspects of the social being; and (2) the need for education about the disease tailored to the individual and growing needs. Specific themes seem to characterize each age range. CONCLUSIONS: This study constitutes a first attempt at understanding PKU from a non-medical-biological perspective.


Subject(s)
Feeding Behavior/psychology , Health Knowledge, Attitudes, Practice , Phenylketonurias/psychology , Adaptation, Psychological , Adolescent , Adult , Age Factors , Attitude to Health , Child , Female , Humans , Male , Qualitative Research , Young Adult
3.
J Psychosom Obstet Gynaecol ; 27(3): 127-30, 2006 Sep.
Article in English | MEDLINE | ID: mdl-17214446

ABSTRACT

The aim of the study was to verify in the context of prenatal diagnosis if the communicative style in consultations is modified in relation to the seriousness of the diagnosis. Videoed consultations after executing amniocentesis and ultra-sound scanning of II level were included in the study with the consent of participants. Only visits with Italian speaking couples without psychiatric problems were analyzed for the study. Selected visits were grouped into "low" (L, minor anomalies) and "high" (H, serious anomalies) visits. A modified version of the RIAS tailored for the specific context was used in the analysis. 27 visits, respectively 13 H and 14 L, were studied. Analysis of the communicative structure of the consultations did not show significant differences between the two groups. The communication during the consultation seems to be mostly influenced by a highly disease-centered model that is not dependent on the content of the consultation itself. Only emotional exchanges showed a marginally significant decrease in the H visits (t = 1.995, p = 0.057), suggesting the probable difficulty of the disease-centered model to manage emotional items during a highly dramatic consultation. Due to the exploratory nature of the study, further research is needed to test the preliminary results.


Subject(s)
Communication , Fetal Diseases/diagnosis , Fetal Diseases/psychology , Physician-Patient Relations , Prenatal Diagnosis/psychology , Amniocentesis/psychology , Emotions/physiology , Female , Humans , Italy , Observer Variation , Pilot Projects , Pregnancy , Severity of Illness Index , Ultrasonography, Prenatal/psychology , Videotape Recording/methods
4.
Support Care Cancer ; 13(1): 18-25, 2005 Jan.
Article in English | MEDLINE | ID: mdl-15480810

ABSTRACT

GOAL OF WORK: The aim of this study was to explore the physicians' internal representation of the doctor-patient relationship in the dramatic field of the patient with pain. METHODS: Using an open narrative format, 151 physicians were asked to "Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain". The narrations were examined in accordance with a clinical-interpretive method. MAIN RESULTS: Three "perspectives of observation" were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the "depersonalization" of pain. In the professional perspective, the narrative concerns the patient as a "person" and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives. CONCLUSIONS: The professional perspective seemed to be the only place in which physicians could "stop", a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.


Subject(s)
Pain , Physician-Patient Relations , Communication , Humans , Narration , Qualitative Research
5.
Educ Health (Abingdon) ; 15(1): 51-7, 2002.
Article in English | MEDLINE | ID: mdl-14741987

ABSTRACT

INTRODUCTION: A key concept for general practice nowadays is that of patient-centred medicine. In this model the physician's aim is to integrate the patient's experience of illness with the conventional understanding of disease, trying to reconcile the patient's agenda with his/her own. This paper describes a preliminary experience of a CME course on patient-centred medicine in Italy. AIM AND METHODS: The article focuses on a 7 hour course for teaching patient-centred medicine to Italian general practitioners. Assessment of the course was done both in terms of learner satisfaction and efficacy. Learner satisfaction was evaluated by a questionnaire with a 6-point Likert scale and course efficacy by a pre/post-paper-and-pencil test. FINDINGS AND DISCUSSION: The pilot course on patient-centred medicine seems to obtain high satisfaction in participants. Furthermore, an increase in competence with regards to patient-centeredness resulted after the course. The pilot study represents the first Italian CME seminar on patient-centered medicine. Results obtained both in terms of satisfaction and efficacy suggest that the CME course is a valid educational tool. The opportunity to extend the experience to a higher number of participants is therefore recommended.

6.
Support Care Cancer ; 9(5): 390-6, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11497395

ABSTRACT

The purpose of this study was to explore GPs' perspectives on giving bad news during consultations. To this end, 168 GPs were asked to recall, and record on the first page of a questionnaire, an occasion when they had given medically related bad news to a patient. The stories were analysed with a qualitative and interpretative approach. Two axes, each with a semantic polarity, were identified: a relational axis (semantic polarity: escape vs accompanying) and an ethical axis (semantic polarity: the doctor's choice vs the patient's choice). Furthermore, two main topics appeared to be common to almost all the narratives: the need to reassure the patient and the account of the doctor's emotions. Two different relational patterns appear to be described by doctors. A substantial number of GPs implicitly describe a disease- or doctor-centred consultation: in these cases the physicians refer to signs and symptoms, diagnosis and treatments; they decide for themselves whether to tell the truth or not. On the other hand, a smaller number describe consultations that could be defined as patient centred: these doctors consider that their duty of care for the individual ill person is paramount and try to respect the patient's right to decide. In both these relational patterns, GPs feel it is a fundamental professional duty to reassure the patient; furthermore, they feel the most difficult aspect is managing their own emotional responses.


Subject(s)
Attitude of Health Personnel , Ethics, Clinical , Ethics, Medical , Family Practice/standards , Physician-Patient Relations , Truth Disclosure , Adult , Aged , Anecdotes as Topic , Communication Barriers , Female , Humans , Male , Middle Aged , Sensitivity and Specificity , Surveys and Questionnaires
8.
Recenti Prog Med ; 90(1): 9-12, 1999 Jan.
Article in Italian | MEDLINE | ID: mdl-10193157

ABSTRACT

The communication and relationship between doctors and patients has been given increased attention in recent years. There are many different methods by which to collect data on doctor-patient communication and relationship: of these, videorecording seems to have the most advantages. The objective of this article is to describe the method we used to make videorecorded consultations in General Medical Practice in Italy. In particular, the article addresses: 1) the technical feasibility of videorecording consultations; 2) a possible answer to the problem of informed consent both from doctors and from patients. At present, the archives collect 258 videotaped consultations of 14 General Practitioners: about three patients in four (75.9%) did consent to have their consultation recorded; a high range of videorecorded consultations (94.2%) does not present technical problems. In line with published surveys, these recording consultations are an increasingly important method of studying communication and doctor-patient relationship, and of teaching/learning these aspects of medical practice.


Subject(s)
Family Practice , Office Visits , Physician-Patient Relations , Videotape Recording , Adult , Communication , Family Practice/statistics & numerical data , Female , Humans , Italy , Male , Middle Aged , Office Visits/statistics & numerical data , Patient Selection
9.
Ann Ital Med Int ; 13(1): 56-64, 1998.
Article in Italian | MEDLINE | ID: mdl-9642844

ABSTRACT

The dominant model in medical practice today has been defined as the "disease-centered" model. In the past few years, it has been attacked for oversimplifying the problems of illness because it assumes disease to be fully accounted for by deviations from the norm of measurable biological variables. This article describes a patient-centered model that integrates the traditional understanding of disease with each patient's experience of illness. The transformed clinical method involves three major changes: 1) new tasks for the consultation: the patient-centered method focuses on disease and on four principal dimensions of the patients, i.e., their ideas about the illness, their feelings and fears, the impact of their problems on their lives, their expectations about what should be done; 2) new strategies to obtain these objectives: new interviewing skills and communication techniques, e.g., attentive listening; open questions; 3) new modes of teaching and learning, e.g., the use of role-playing and videotaping. Research has shown that patient-centered medicine enables better clinical results to be obtained and is associated with increased patient and physician satisfaction.


Subject(s)
Patient Care Planning , Patient-Centered Care , Evidence-Based Medicine , Humans , Italy , Patient Care Planning/organization & administration , Patient Care Planning/standards , Patient-Centered Care/organization & administration , Patient-Centered Care/standards
10.
Biol Psychiatry ; 40(5): 398-402, 1996 Sep 01.
Article in English | MEDLINE | ID: mdl-8874841

ABSTRACT

Twelve patients with obsessive-compulsive disorder were studied after the administration of a mixture of amino acids devoid of tryptophan (TRP) or a mixture containing all the essential amino acids, in a double-blind, crossover design. The TRP-free mixture caused a marked depletion of plasma TRP. After TRP decrease, mean ratings of obsessions and compulsions, measured by Visual Analogue Scales (VAS) ratings, did not worsen. In contrast with other reports in literature, TRP depletion also failed to alter mood in our subjects.


Subject(s)
Obsessive-Compulsive Disorder/metabolism , Tryptophan/deficiency , Adult , Affect , Amino Acids/pharmacology , Amino Acids, Essential/pharmacology , Cross-Over Studies , Double-Blind Method , Female , Humans , Male , Obsessive-Compulsive Disorder/psychology , Psychiatric Status Rating Scales , Tryptophan/metabolism
11.
Life Sci ; 58(26): 2389-95, 1996 May 24.
Article in English | MEDLINE | ID: mdl-8691983

ABSTRACT

After an overnight fast, 5 male healthy subjects ingested increasing amounts of a solution containing a fixed proportion of seven essential amino acids (L-isoleucine, 13.3%; L-leucine, 21.0%; L-lysine, 15.2%; L-methionine, 21.0%; L-threonine, 9.5%; L-tryptophan, 4.8% and L-valine, 15.2%) and lacking phenylalanine and tyrosine. The solutions caused a rapid fall in plasma phenylalanine and tyrosine which was proportional to the total amount of amino acids ingested. Following the highest dose administered (31.5 g) plasma phenylalanine and tyrosine fell to a minimum of, respectively, 12.7% and 29.8% the initial levels and remained markedly reduced at 6 hours after treatment. The decrease of tyrosine and phenylalanine levels was associated with a decrease of systolic and diastolic arterial pressure.


Subject(s)
Phenylalanine/blood , Tyrosine/blood , Adult , Blood Pressure , Catecholamines/metabolism , Humans , Male
13.
Physiol Behav ; 54(6): 1235-7, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8295969

ABSTRACT

Female Wistar rats, weekly injected with estradiol valerate after ovariectomy, were trained to cause a sexual contact with a potent male by operating a lever. Contact-response latencies, which vary according to the nature of the sexual contact, were measured as an index of the female's sexual motivation. In these experimental conditions the administration of a tryptophan-free amino acid mixture, which has been proved to decrease brain serotonin and to enhance male mounting behavior, failed to modify the sexual motivation of the female rats.


Subject(s)
Amino Acids/administration & dosage , Serotonin/physiology , Sexual Behavior, Animal/physiology , Tryptophan/deficiency , Amino Acids/metabolism , Animals , Appetitive Behavior/physiology , Copulation/physiology , Female , Male , Rats , Rats, Wistar , Reaction Time/physiology , Tryptophan/metabolism
14.
Recenti Prog Med ; 83(4): 213-7, 1992 Apr.
Article in Italian | MEDLINE | ID: mdl-1626116

ABSTRACT

The ingestion of an amino acid mixture lacking tryptophan causes a rapid fall of plasma tryptophan in healthy subjects. This is because amino acids elicit protein synthesis and endogenous tryptophan is incorporated into new proteins. If protein synthesis is the mechanism through which tryptophan-free solution decrease blood tryptophan, it may be interesting to study tryptophan levels after a tryptophan-free mixture in subjects with impaired protein synthesis. In the present paper we show that in 27 cirrhotics the administration of a tryptophan-free solution caused a fall of total plasma tryptophan that began significantly later than in 14 control subjects, the delay being significantly proportional to the severity of the disease. The difference between control and cirrhotic subjects was due to the bound fraction of plasma tryptophan. The diagnostic and clinical usefulness of our findings are discussed.


Subject(s)
Amino Acids/administration & dosage , Liver Cirrhosis/therapy , Tryptophan , Analysis of Variance , Chromatography, High Pressure Liquid , Drug Combinations , Drug Evaluation , Female , Humans , Liver Cirrhosis/blood , Liver Cirrhosis/epidemiology , Male , Time Factors , Tryptophan/blood
15.
Percept Mot Skills ; 72(3 Pt 1): 895-8, 1991 Jun.
Article in English | MEDLINE | ID: mdl-1891327

ABSTRACT

The effects of a tryptophan-free amino acid mixture on Poggendorff illusion, corner Poggendorff illusion, and attention were investigated with 12 male subjects who ingested either a balanced amino acid mixture or a tryptophan-free mixture, the latter known to cause a marked depletion of brain tryptophan and serotonin. No significant difference between the two mixtures on the perceptual illusions was found.


Subject(s)
Attention/physiology , Figural Aftereffect/physiology , Optical Illusions/physiology , Orientation/physiology , Pattern Recognition, Visual/physiology , Tryptophan/physiology , Adult , Discrimination Learning/physiology , Humans , Male , Neural Inhibition/physiology , Serotonin/physiology
16.
Life Sci ; 48(5): 409-18, 1991.
Article in English | MEDLINE | ID: mdl-1992283

ABSTRACT

In healthy subjects the administration of an amino acid mixture devoid of tryptophan causes a marked decrease of plasma tryptophan. This is because amino acid mixtures induce protein synthesis and tryptophan in blood is incorporated into newly synthesized proteins. We hypothesized that a tryptophan-free mixture could differently affect plasma tryptophan levels in subjects with an impaired protein synthesis such as chronic liver patients. We studied tryptophan levels after a tryptophan-free amino acid solution in controls and cirrhotics fasting 12 hours. Plasma total tryptophan fell to 91% of the initial level 60 minutes after the administration of the diet, to 71% after 120, and to 50% after 210' in controls. In cirrhotics the solution caused a decrease of plasma tryptophan that began significantly later than in controls, the delay being proportional to the severity of the disease. Cirrhotics were subdivided into two groups in accordance to the Pugh modification of the Child-Turcotte criteria. Total plasma tryptophan was 100% of base line levels after 60', 88% after 120', and 65% after 210' in less severe clinical condition; total plasma tryptophan was 102% of base line levels after 60', 98% after 120', and 75% after 210' in more severe clinical condition.


Subject(s)
Amino Acids/pharmacology , Liver Cirrhosis/blood , Tryptophan/blood , Adult , Bilirubin/blood , Dietary Proteins/administration & dosage , Female , Humans , Male , Middle Aged , Platelet Count , Prothrombin/analysis , Serum Albumin/analysis
17.
Life Sci ; 49(15): 1121-8, 1991.
Article in English | MEDLINE | ID: mdl-1895873

ABSTRACT

The hypothesis that incorporation of tryptophan (TRY) into proteins is the mechanism underlying the decrease in plasma and tissue TRY levels after a TRY-free amino acid mixture was investigated. Rats fasted 15 hours were pretreated with saline or with the protein synthesis inhibitor cycloheximide (CHEX) and treated with saline or a TRY-free amino acid mixture. In a first experiment, in saline pretreated rats the TRY-free mixture caused a decrease of 49% in total plasma TRY, of 64% in free plasma TRY, of 66% in brain TRY and of 42% in liver TRY. After 5 mg/kg of CHEX the same TRY-free diet caused a decrease of 5% in total plasma TRY, 14% in free plasma TRY, 18% in brain TRY and 9% in liver TRY. In a second experiment, the TRY-free diet caused a 43% decrease of total plasma TRY in saline pretreated animals and a decrease of 15%, 6% and 2% respectively after the pretreatment with 0.3, 1.0 and 5.0 mg/kg of CHEX. In brain TRY, the TRY-free diet caused a 62% decrease in saline pretreated rats and a decrease of 38%, 20% and 19% respectively after the pretreatment with 0.3, 1.0 and 5.0 mg/kg of CHEX. Since 5.0 mg/kg of CHEX almost completely block protein synthesis and since doses of CHEX from 0.3 to 5.0 mg/kg cause a dose-dependent inhibition of protein synthesis, our data support the hypothesis that protein synthesis is the mechanism through which TRY-free mixtures decrease TRY levels.


Subject(s)
Amino Acids/administration & dosage , Brain/drug effects , Cycloheximide/pharmacology , Liver/drug effects , Protein Synthesis Inhibitors/pharmacology , Tryptophan/metabolism , Animals , Brain/metabolism , Diet , Dose-Response Relationship, Drug , Liver/metabolism , Male , Random Allocation , Rats , Rats, Inbred Strains , Tryptophan/blood
18.
Percept Mot Skills ; 70(2): 531-9, 1990 Apr.
Article in English | MEDLINE | ID: mdl-2342851

ABSTRACT

The effects of a tryptophan-free amino acid mixture on tilt aftereffect, movement aftereffect, and the Mueller-Lyer illusion were studied. 12 male subjects ingested either a balanced amino acid mixture or a tryptophan-free mixture which causes a marked depletion of brain tryptophan and serotonin. The tryptophan-free mixture significantly increased the strength of tilt aftereffect but had no effect on movement aftereffect or the Mueller-Lyer illusion. These results were discussed with reference to the pharmacological activity of serotonin and its influence on the strength of lateral inhibition in mammalian brains.


Subject(s)
Figural Aftereffect/physiology , Illusions/physiology , Optical Illusions/physiology , Orientation/physiology , Serotonin/physiology , Tryptophan/deficiency , Adult , Attention/physiology , Brain/physiology , Humans , Male , Motion Perception/physiology
19.
Life Sci ; 44(14): 971-6, 1989.
Article in English | MEDLINE | ID: mdl-2467158

ABSTRACT

Rats fasted 15 hours were treated p.o. with increasing amounts (660 and 1320 mg/kg body weight) of a mixture containing a fixed proportion of seven essential amino acids (L-phenylalanine 13.6%, L-leucine 6.0%, L-isoleucine 12.1%, L-methionine 12.1%, L-lysine 30.3%, L-threonine 10.6%, L-valine 15.2%) and lacking tryptophan. The mixtures produced a dose-response decrease of free (by 34% after the lower dose and by 58% after the higher dose of the mixture) and total (by 10 and 31%) plasma tryptophan and of brain tryptophan (by 38 and 65%), serotonin (by 17 and 41%) and 5-hydroxyindole acetic acid (by 21 and 49%). The mechanisms of these changes are discussed.


Subject(s)
Amino Acids/pharmacology , Brain/metabolism , Serotonin/metabolism , Tryptophan/blood , Amino Acids/administration & dosage , Animals , Brain/drug effects , Hydroxyindoleacetic Acid/metabolism , Male , Rats , Rats, Inbred Strains , Tryptophan/metabolism
20.
Life Sci ; 42(16): 1551-6, 1988.
Article in English | MEDLINE | ID: mdl-3352467

ABSTRACT

Male healthy subjects, fasting 12 hours, ingested increasing amounts of a mixture containing a fixed proportion of seven essential amino acids (L-isoleucine 11.5%, L-leucine 18.0%, L-lysine 13.1%, L-methionine 18.0%, L-phenylalanine 18.0%, L-threonine 8.2%, L-valine 13.1%) and lacking tryptophan. The diets produced a rapid fall in plasma tryptophan which was proportional to the total amount of the amino acids ingested. Following the highest dose administered (36.6 g) plasma tryptophan fell to a minimum of about 35% the initial level and remained markedly reduced at 6 hours after treatment. The mechanism of this decrease and its potential clinical relevance are discussed.


Subject(s)
Amino Acids, Essential/administration & dosage , Dietary Proteins/pharmacology , Tryptophan/blood , Adult , Dietary Proteins/administration & dosage , Dose-Response Relationship, Drug , Humans , Male , Middle Aged , Random Allocation , Tryptophan/administration & dosage
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