Specialty care and education associated with greater disease-specific knowledge but not satisfaction with care for chronic hepatitis C.

BACKGROUND: Little is known about differences among hepatitis C virus (HCV) patients managed by generalists vs. specialists with respect to patient-centred outcomes, such as disease-specific knowledge, health-related quality of life (HRQoL) and satisfaction with care. AIM: To examine selected patient-centred outcomes of HCV-related care provided in primary care, specialty care or both. METHODS: A total of 629 chronic HCV patients completed a survey including an HCV knowledge assessment and validated instruments for satisfaction and HRQoL. Multivariable linear regression was used to compare outcomes between groups. RESULTS: Adjusted total HCV knowledge score was lower among patients who did not attend specialty care (P < 0.01). Primary care and specialty patients did not differ in adjusted general HRQoL or satisfaction. Sixty percent of specialty patients underwent formal HCV education, which was associated with 5% higher knowledge score (P = 0.01). General HRQoL and patient satisfaction did not differ between primary care and specialty groups. Disease-specific knowledge and care satisfaction were independent of mental illness, substance abuse, socio-economic variables, history of antiviral treatment, formal HCV education and duration of time between last visit and survey completion. CONCLUSIONS: Primary care patients with chronic HCV have lower adjusted disease-specific knowledge than specialty patients, but no difference in general HRQoL or patient satisfaction.

Health-related quality of life in Parkinson's disease after pallidotomy and deep brain stimulation.

This study explored the multidimensional outcome of three neurosurgical interventions for Parkinson's disease (PD): pallidotomy (N = 23), pallidal deep brain stimulation (DBS) (N = 9), and thalamic DBS (N = 7). All patients completed the Sickness Impact Profile (SIP) and the Beck Depression Inventory. Pallidotomy patients also completed the Profile of Mood States, the Beck Anxiety Inventory, and a disease-specific quality of life (QOL) measure, the Parkinson's Disease Questionnaire (PDQ-39). Three months after surgery, all neurosurgical groups showed significant improvements in mood and function, including physical, psychosocial, and overall functioning. Pallidal DBS and pallidotomy patients who completed additional QOL measures reported decreased anxiety and tension, increased vigor, improved mobility and ability to perform activities of daily living, and decreased perceived stigma. Psychosocial dysfunction scores from the SIP were related to depressed mood both at baseline (r = .42) and at followup (r = .45), but the physical dysfunction subscale was not related to mood at either time point, suggesting that disruption of social relationships due to PD may have more impact on affective distress than physical symptoms alone. Results suggest that neurosurgical interventions for PD improve disabling PD motor symptoms and also improve several domains of quality of life.

Social and psychological characteristics of HIV-infected women and gay men. HIV Neurobehavioral Research Center (HNRC) Group.

In this paper, we examine social and psychological characteristics of 60 HIV+ women and gay men, matched on age and stage of HIV infection. A discriminant function analysis was performed using measures of life adversity, psychological distress, and psychosocial resources. The best combination of predictors for distinguishing between HIV+ women and gay men was comprised of satisfaction with emotional support, network size, use of avoidant coping, Hamilton depression, and loneliness scores [chi 2(7) = 14.8, p < .05]. Women reported more satisfaction with emotional support, although gay men had larger social networks. Gay men used more avoidant coping and had higher lonelines scores as compared to women, although women reported more depressive symptoms. Utilizing this set of psychosocial variables, we correctly classified 73% of the HIV+ women and 67% of the HIV+ men. These findings suggest the importance of considering subgroup differences in the design of counseling programs for HIV+ individuals.

Stress and depressive symptoms prospectively predict immune change among HIV-seropositive men. HIV Neurobehavioral Research Center Group.

LIFE stress, mood, and other psychosocial factors may help to explain variability in HIV (human immunodeficiency virus) disease progression. Attempts to support this notion empirically have produced mixed findings; several studies report a positive relationship between psychosocial factors and various indicators of disease progression or immune function (e.g., Evans et al. 1992; Goodkin et. al. 1992), whereas others have failed to detect any association (e.g., Perry et. al. 1992).

Identification of psychobiological stressors among HIV-positive women. HIV Neurobehavioral Research Center (HNRC) Group.

This research describes major stressors in the lives of women who have been infected with the human immunodeficiency virus (HIV). Thirty-one HIV antibody positive (HIV+) women infected primarily through heterosexual contact participated in a two hour semi-structured interview detailing the circumstances, context, and consequences of all stressful life events and difficulties experienced within the preceding six months. Qualitative methods of data analyses were utilized (Miles & Huberman, 1984). HIV-related life events and difficulties were classified into primary and secondary stressors based on the stress process model (Pearlin et al., 1981). Problems arising directly from one's seropositivity were defined as primary stressors. Stressful life events and difficulties occurring in other role areas were defined as secondary stressors. Six categories of HIV-related stressors were identified and quantified. Primary stressors were health-related, and included both gynecological problems (e.g., amenorrhea) and general symptoms of HIV infection (e.g., fatigue). Secondary stressors related to child and family (e.g., future guardianship of children), marital/partner relations (e.g., disclosure of HIV+ status), occupation (e.g., arranging time-off for medical appointments), economic problems (e.g., insurance "hassles"), and social network events (e.g., death of friends from AIDS). This research indicates that HIV-positive women are exposed to multiple stressors; some may be viewed as unique to women, whereas others may be considered common to both sexes. Identification of stressors has implications for the design of medical and psychiatric interventions for women.