ABSTRACT
OBJECTIVES: To develop a new instrument, the Menopause-specific Quality of Life Scale (MS-QoLS), for Thai women and to study the experience of menopausal aspects in peri- and postmenopausal Thai women. MATERIALS AND METHODS: Item generation was developed from a focus group discussion and in-depth interview, and the content validity index (CVI) was computed, using item relevance ratings by content experts. Items with CVI values higher than 0.7 were selected. The draft questionnaire was tested for language, format and content. The final questionnaire was administered and the construct validity and reliability were then assessed. RESULTS: Fifty-seven peri- and postmenopausal women participated in the focus group discussion and in-depth interview. Sixty-eight items across eight dimensions were generated based on content analysis result. The dimensions included Physical health, Psychological health, Sexual health, Daily activity, Family, Social, Treatment, and Economics. A total of 280 menopausal women were recruited from four collaborative hospitals for psychometric validation. After factor analysis, 22 items remained with six dimensions identified, that is, well-being, emotionality, anxiety/fear, family, social and sexual health. Cronbach's coefficient α of each domain was between 0.61 and 0.83. CONCLUSION: The Thai MS-QoLS was systematically developed and validated for peri- or postmenopausal women. The initial assessment of the questionnaire showed an acceptable level of validity and reliability.
Subject(s)
Menopause , Quality of Life , Adult , Aged , Aged, 80 and over , Female , Health Status Indicators , Hot Flashes , Humans , Menopause/physiology , Menopause/psychology , Middle Aged , Myalgia , Osteoporosis, Postmenopausal , Reproductive Health , Surveys and Questionnaires , Sweating , Thailand , Vaginal DiseasesABSTRACT
Targeted broadband ultraviolet B (UVB) phototherapy as well as 308-nm excimer laser have been reported to significantly improve or clear localized psoriatic plaques within 5 to 10 treatments when medium fluences [i.e. 4-6 multiples of minimal erythema doses (MED)] were used. Our study was conducted to determine the effects of different concentrations of topical 8-methoxypsoralen (8-MOP) cream when used in combination with targeted UV phototherapy with regard to number of treatments and cumulative UV doses to clear localized psoriasis. Ten evaluable patients with stable plaque-type psoriasis completed the study. Three different concentrations of 8-MOP creams (0.001%, 0.01% and 0.1%) were applied prior to irradiation with 4 MEDs of targeted narrowband UVB (NB-UVB), whereas 0.001% 8-MOP cream was used in conjunction with 5 J/cm(2) UVA. All irradiations took place once weekly for 12 weeks. Psoriasis severity index (PSI) score was used to evaluate the efficacy of the treatment. With area-under-the-curve analysis, 0.1% 8-MOP/NB-UVB was superior to other modalities in reducing the PSI scores. The number of treatments and cumulative NB-UVB doses necessary to achieve PSI-95, a 95% reduction in the scores, was also lower in the 0.1% 8-MOP/NB-UVB group, although the differences were not statistically significant. We conclude that topical 8-MOP cream enhances the therapeutic effects of targeted NB-UVB phototherapy without significantly increasing the short-term adverse effects.
Subject(s)
Methoxsalen/administration & dosage , Photosensitizing Agents/administration & dosage , Psoriasis/drug therapy , Psoriasis/radiotherapy , Ultraviolet Therapy/methods , Administration, Topical , Adolescent , Adult , Combined Modality Therapy , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Skin/drug effects , Skin/pathology , Skin/radiation effectsABSTRACT
OBJECTIVE: Patients with medically unexplained symptoms are given diagnoses dependent upon the particular medical specialty consulted--irritable bowel syndrome in gastroenterology, fibromyalgia in rheumatology and others. The purpose of this paper is to establish whether these 13 different syndromes are discrete entities. METHODS: Consecutive new patients in seven outpatient clinics at two general hospitals were recruited. Patients completed questionnaires measuring symptoms and demographic data. Case notes were reviewed to ascertain whether the presenting symptoms were medically explained 3 months after the initial visit. RESULTS: Complete data were available for 550 subjects. With 37 unexplained symptoms included in the model, 30% of the total variance could be explained by one factor using unrotated principal component analysis. When the 13 identified functional syndromes were included, it was evident that functional syndromes could not be assumed to be independent. A two-factor model was the best fit for the present data after rotation. CONCLUSIONS: This study suggests that the existence of distinct functional somatic syndromes (FSSynd) as defined clinically in medicine should be reconsidered.
Subject(s)
Psychophysiologic Disorders/diagnosis , Somatoform Disorders/diagnosis , Cross-Sectional Studies , Diagnosis, Differential , Female , Humans , London/epidemiology , Male , Medicine/statistics & numerical data , Psychophysiologic Disorders/classification , Psychophysiologic Disorders/epidemiology , Somatoform Disorders/classification , Somatoform Disorders/epidemiology , Specialization , SyndromeABSTRACT
OBJECTIVES: This study aimed to estimate the prevalence and risk factors for medically unexplained symptoms across a variety of specialities. METHODS: A cross-sectional survey was conducted at two general hospitals in southeast London between 1995 and 1997. Eight hundred and ninety consecutive new patients from seven outpatient clinics were included. Demographic and clinical characteristic variables were assessed. RESULTS: Five hundred eighty-two (65%) of the subjects surveyed returned completed questionnaires. A final diagnosis was available in 550 (62%). Two hundred twenty-eight (52%) fulfilled criteria for medically unexplained symptoms. The highest prevalence was in the gynecology clinic (66%). After adjustment for confounders, medically unexplained symptoms were associated with being female, younger, and currently employed. Psychiatric morbidity per se was not associated with the presence of medically unexplained symptoms, but was more likely in those complaining of multiple symptoms. Those with medically unexplained symptoms were less disabled, but more likely to use alternative treatment in comparison with those whose symptoms were medically explained. Patients with medically unexplained symptoms were more likely to attribute their illness to physical causes as opposed to lifestyle factors. CONCLUSIONS: Medically unexplained symptoms are common across general/internal medicine and represent the most common diagnosis in some specialities. Medical behavior, training, and management need to take this into account.
Subject(s)
Medicine , Psychophysiologic Disorders/epidemiology , Specialization , Adolescent , Adult , Aged , Epidemiologic Studies , Female , Humans , Male , Middle Aged , Prevalence , Risk FactorsABSTRACT
We assessed risk factors affecting the provisional diagnosis of medically unexplained symptoms made by physicians in new patients, in 526 clinical encounters. Comparisons were made between the doctor's initial assessments regarding the nature of symptoms, and the final diagnosis. Physicians were more likely to err on the side of diagnosing the symptoms as medically explained rather than unexplained. When physicians perceived the interaction with the patient to be positive, they were more likely to make a provisional diagnosis that the symptoms were explained. Conversely, a negative perception of the interaction was associated with an increased likelihood of viewing symptoms as medically unexplained. Physicians should be aware of the effect of their own perceptions on their diagnostic behaviour.
Subject(s)
Diagnosis , Adolescent , Adult , Aged , Clinical Competence/standards , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Physician-Patient Relations , Risk Factors , Sensitivity and Specificity , Surveys and QuestionnairesABSTRACT
We review the concept and importance of functional somatic symptoms and syndromes such as irritable bowel syndrome and chronic fatigue syndrome. On the basis of a literature review, we conclude that a substantial overlap exists between the individual syndromes and that the similarities between them outweigh the differences. Similarities are apparent in case definition, reported symptoms, and in non-symptom association such as patients' sex, outlook, and response to treatment. We conclude that the existing definitions of these syndromes in terms of specific symptoms is of limited value; instead we believe a dimensional classification is likely to be more productive.
Subject(s)
Colonic Diseases, Functional/diagnosis , Fatigue Syndrome, Chronic/diagnosis , Somatoform Disorders/diagnosis , Colonic Diseases, Functional/psychology , Colonic Diseases, Functional/therapy , Combined Modality Therapy , Fatigue Syndrome, Chronic/psychology , Fatigue Syndrome, Chronic/therapy , Humans , Patient Care Team , Prognosis , Sick Role , Somatoform Disorders/psychology , Somatoform Disorders/therapyABSTRACT
The aim of this study was to investigate the interrater reliability of the recognition of medically unexplained symptoms by medical investigators. The casenotes of 56 consecutive secondary care out-patient attenders were examined by three medical investigators. The investigators determined whether the presenting symptoms were medically unexplained (not, probable, or definite) and the results were tested for interrater reliability. The combined kappa for the three investigators was 0.76, indicating substantial agreement. This suggests that casenote examination is a reliable method of determining whether a symptom is medically unexplained.
