Clinical and socioeconomic features of subjects with red cedar asthma. A follow-up study.

A follow-up study of 128 subjects with red cedar asthma was conducted to evaluate the clinical and socioeconomic impact of the disease in determining the working status of the subjects after the diagnosis was made. The results suggest that the severity of asthma is not the main determinant of working status. Comparing the data at diagnosis and at follow-up examination, we found that the persistence of exposure resulted in a deterioration in the asthma despite the use of more medications. Subjects who were working were younger and had a larger number of dependents than the subjects who were not working at the time of the follow-up examination. We conclude that the socioeconomic factors are important in determining the working status of subjects with red cedar asthma. To prevent severe impairment and disability, there should be more economic incentives for these subjects to choose other jobs.

The influence of social, economic, and professional considerations on services offered by dentists to long-term care residents.

Many studies have focused on the disabilities and behavior of the elderly population in an attempt to explain the frequent reports of poor oral health among residents of long-term care (LTC) facilities, but little attention has been given to the experiences and opinions of dentists relating to the problem. This study was conducted to discover how dentists feel about older patients and about working in LTC facilities. A response to a questionnaire was obtained from 334 (55%) of the 603 dentists in Vancouver who treated adults. The responses were subjected to bivariate and multivariate analyses. Three models were constructed from factors that might interest a dentist in attending a patient in a facility; the factors in each model were ranked in order of importance. Interest was associated significantly with lack of concern for time lost in practice, with training in managing medically compromised patients, and with a positive attitude toward elderly patients. Dentists with fewer years in practice were attracted by the economic potential of the service, while the older and busier dentists were less involved because of the disruption to their practice and leisure. Dentists who made home visits also were more likely to be interested. The model based on professional considerations was superior to either the social or economic model in explaining an interest in the service.

Opinions of dentists on the treatment of elderly patients in long-term care facilities.

The high prevalence of disorders in the mouths of elderly residents in long-term care (LTC) facilities suggests that the dental services available to the residents are inadequate. A questionnaire was sent to most of the dentists practicing in Vancouver (British Columbia) to solicit their opinions on treating older patients in LTC facilities, and a response was obtained from 334 (55%). It indicated that 19 percent of the respondents had treated old people within this context, although few of them felt they had been educated adequately for the service. Many reasons were offered to explain the small participation. Most respondents had never been asked to attend a facility. Many felt that it interfered with their practice and leisure, and they were concerned about the limited options available for treatment. Dentists who had attended facilities were motivated by a sense of professional or public responsibility, but they were uneasy about the limited options and about the inadequate space and equipment available. In general, the dentists were not interested in attending an institutionalized geriatric population, and they felt ill-prepared for the service.

Effects of social relationships on survival for women with breast cancer: a prospective study.

In this study we examine the relationship between a woman's social contexts at the time of diagnosis and her chances of having survived breast cancer four years later. A cohort of 133 women were followed prospectively after initial diagnosis and treatment and data were obtained from a questionnaire mailed soon after diagnosis and from hospital charts. Using multivariate methods to examine predictors of survival, two clinical factors, pathologic nodal status and clinical stage of disease, were significantly associated with survival. In addition we found significant and independent effects on survival of: number of supportive friends, number of supportive persons, whether the woman worked, whether she was unmarried, the extent of contact with friends and the size of her social network. Thus, the woman's social context, particularly contexts of friendship and work outside the home, are statistically important for survival. Using existing literature, further data analyses and interviews with some survivors, we speculate on the ways in which social contexts may influence survival and suggest research methods suitable to this question.

Psychosocial and Physical Effects of Adjuvant Chemotherapy: Survey of younger women with breast cancer.

Breast cancer patients younger than 55 completed a questionnaire on psychosocial factors and physical side effects shortly after diagnosis and 9 to 15 months after diagnosis. Those who had used adjuvant chemotherapy were more likely than those who had not to report physical side effects; there was little difference in psychosocial factors. Recent users were more likely than ex-users to report physical side effects, difficulties with domestic chores, and improvement in psychosocial factors.

Plural medicine in Sri Lanka: do Ayurvedic and Western medical practices differ?

In Sri Lanka, as in India, two formally structured systems of medicine exist side by side. While Western-style biomedicine is believed to be useful, Ayurvedic medicine is well established and commonly used. Underlying one explanation for the persistence of such plural medical systems is a functional theory, suggesting that each system is used for different treatments, diseases, or for the ideological, linguistic or social characteristics of the physician. In part, Ayurvedic and Western medicine may persist because their practitioners provide distinctly different services. We tested part of this functional explanation by sending trained 'pseudo-patients' to 764 Ayurvedic and allopathic physicians across Sri Lanka. 'Patients' reported symptoms of common cold, diarrhea or back pain, and recorded after leaving the clinic many aspects of history-taking, diagnostic procedures and physician-patient interaction. Medicines prescribed were later analyzed by a laboratory. We found, basically, no significant differences between the medical practices of sampled Ayurvedic and Western-style physicians, with one exception. While both types spend 3-4 min asking four questions and doing two or three physical examination procedures, and while both prescribe, overwhelmingly, only Western medicines, the allopathic physicians give drugs, that, from the point of view of Western medicine, either 'help' or 'harm' and Ayurvedic physicians prescribe 'neutral' medicines. While we have not directly tested the entire functional explanation we suggest that a structural explanation of the persistence of two systems of medicine may be more valid. Ayurvedic and Western medicine continue in Sri Lanka because they, as institutions, are linked to the social, economic and political structure of the society. Thus, survival is based, not on what a physician does in his practice but upon the power of his medical profession to control medical territory.

Factors influencing oral health in long term care facilities.

In a stratified random sample of 41 long term care (LTC) facilities in Vancouver, 653 residents were chosen to investigate oral health needs and demands for treatment. All of the 603 dentists in the same area were questioned to assess their interest in attending the residents of the institutions. The information from each source was reviewed to identify factors influencing the oral health services to this predominantly elderly and medically compromised population. The majority (60%) of the residents were edentulous and they made infrequent demands on dentists. Two-thirds of those interviewed said that there was nothing wrong with their mouths, but most of those who were aware of a problem wanted it treated, preferably within the institution. They complained about loose or uncomfortable dentures most frequently, and many were dissatisfied with previous dental treatment. The oral mucosal lesions seen on examination were usually symptomless and associated with poor hygiene, while structurally defective dentures and deep carious lesions were not uncommon. The responding 334 dentists indicated that they enjoyed treating elderly patients, 19% had attended an LTC facility, usually to provide an emergency service, and 37% were willing to provide this service if asked. Interest, however, in the service was curtailed by pressures from private practice, concerns about inadequate training and the small demand and poor conditions in the facilities. Although the demand for treatment was not extensive from the residents, they did have problems that were not receiving care.

Mandibular dysfunction in an institutionalized and predominantly elderly population.

Oral health problems were identified among 653 residents of 40 long-term care institutions in Vancouver, using a personal interview and a dental examination. Information on jaw function was analysed as part of this investigation to identify associations between the clinical signs of mandibular dysfunction and the complaints of the subjects, their occlusal instability, and the quality of their dentures. The sample population were predominantly female and over 75 years of age, and 42% had some natural teeth. Complaints of jaw dysfunction, usually sore muscles, were heard from 13% of the 488 subjects interviewed. The examination was performed on all of the subjects and revealed that 43% had unstable occlusal contacts, 37% were using loose or unstable dentures, and 20% had one or more clinical signs of jaw dysfunction. Joint noise was the most frequent sign detected and it was heard in a greater percentage of the women than men, while deviation of the mandible during mouth opening was observed with great frequency in the younger age groups. There was no apparent association found between the clinical signs of jaw dysfunction and the complaints of the subjects or the condition of their teeth or dentures. The study demonstrated that complaints and clinical signs of jaw dysfunction, with the exception of joint noises, were uncommon in this population.

A measure of the 'sick' label in psychiatric disorder and physical illness.

Persons with psychotic disorders receive devalued labels. Despite considerable theorizing, the proposition that these labels affect the course of psychotic illness has rarely been subjected to investigation. The lack of an adequate operational measure for the labeling construct has hampered research. The present report describes the development of the Social Response Questionnaire (SRQ), a measure of the 'sick' label which incorporates moralistic attitudes, fear of dangerousness and negative expectations attached to the role of the severely psychiatrically ill. This 32-item scale, a multidimensional measure of informal labeling, which may be administered in a self-report format or to significant others, permits the study of dose-response relationships. The SRQ is internally stable. It also exhibits construct validity. Schizophrenics and persons with affective psychosis label themselves and are labeled by others more harshly than persons with Crohn's disease or normals. While self-percepts and the perceptions of significant others are fairly congruent for normals and persons with a significant physical illness, there is no agreement between the self-ratings of psychotics and their significant others. Psychotic persons view themselves more negatively than Crohn's disease sufferers or normals, but not as negatively as their therapists, families and friends. Potential uses for the SRQ in longitudinal research are addressed.