Romanian version of SDM-Q-9 validation in Internal Medicine and Cardiology setting: a multicentric cross-sectional study.

BACKGROUND: Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients' point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9. MATERIAL AND METHODS: A multicentric cross-sectional study was performed comprising eight recruitment centers. The sample consisted of in- and outpatients who referred to Hospital Units for treatment for atrial fibrillation or collagen diseases. Furthermore, patients who were members of Autoimmune Disease Patient Society were able to participate via an online survey. All participants completed the Romanian translated SDM-Q-9. RESULTS: Altogether, 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The Romanian version had good internal consistency (Cronbach α coefficient of 0.96.) Corrected item correlations were good ranging from 0.64 to 0.89 with low corrected item correlations for item 1 and item 7. PCA found a one-factorial solution (similar with previous reports) but the first item had the lowest loading. CONCLUSION: SDM-Q-9 is a useful tool for evaluation and improvement in health care that was validated in Romania and can be used in clinical setting in this country.

Cerebral vascular aging: extending the concept of pulse wave encephalopathy through capillaries to the cerebral veins.

The recent concept of pulse wave encephalopathy helps understanding the cerebral venous remodeling in aging. This so-called periventricular venous collagenosis is an expected mechanical consequence of the age-related changes in arterial pulsations and the mechanical fatigue of vascular smooth muscles. Unlike arteriolar mechanical stress, venular mechanical stress depends on both the blood pulse wave amplitude and the mechanical properties of the environment tissue. Thereby, there is a preferential periventricular location of venous collagenosis and a mechanistic link between venous collagenosis and foci of white matter rarefaction or leukoaraiosis. The recent concept of pulse wave encephalopathy also helps understanding the widening of retinal venules, the "mirror" of cerebral venules, in various manifestations of pulse wave encephalopathy, including progressive leukoara�osis, lacunar and hemorrhagic "pulse wave" strokes, and dementia. Indeed, the age-related chronic increase in arterial pulsations explains subsequent arteriolar myogenic "fatigue", marked attenuation in the arteriolar myogenic tone and abnormal penetration of the insufficiently dampened arterial pulse wave into the venules. Thus, retinal venular widening, a biomarker of advanced pulse wave encephalopathy, is also increasingly recognized as a biomarker for high cardiovascular risk. All these data support a shift in the concept of chronic cerebrovascular disease, from the classical model which is restricted to steno-occlusive cerebrovascular diseases to an enlarged model which would include the pulse wave encephalopathy concept. Thereby, preventing damage to the cerebral microvasculature by an undampened arterial pulse wave will become a logical target for the prevention and treatment of late-onset cognitive decline.

The relationship between frequency and intensity of fears and a collagen condition.

Encouraged by the positive relationship between joint laxity and panic anxiety, our objective in this study was to compare widespread cultural fears in subjects with and without joint hypermobility syndrome and to assess whether this relationship is sustained for common fears as well. A sample consisting of 1,305 subjects from a rural town were assessed for joint hypermobility syndrome using Beighton's criteria. We assessed fear intensity and frequency using a modified version of the Fear Survey Schedule (FSS-III). Intense fears, defined with a score of 3-4, were compared between hypermobile and nonhypermobile subjects. The analysis was carried out separately for men and women. Nonparametric analysis was applied throughout. Joint hypermobility syndrome was found in 19.9% (141) of women and 6.9% (41) of men. Concerning the fear survey, when we compared the groups with and without joint hypermobility, the mean total scores for both genders were significantly higher for the hypermobile group. When we analyzed each item individually, 43 out of the 44 most severe fears in women and 36 out of the 39 in men, scores were significantly higher in the hypermobile group. We found significant differences between subjects with and without joint hypermobility when assessing specific fears, reinforcing the hypothesis that intensity of fears is greater in subjects with joint hypermobility syndrome. These results show that the association of joint laxity and phobic anxiety is sustained for intense fears and might represent a susceptibility factor for these anxiety conditions.

Del estrés a las psicodermatosis: breve guía para comprender la etiopatogenia de las dermatosis inducidas por el estrés / From stress to psychodermatosis: a brief guide to understand the etiopathogenesis of stress-induced dermatoses

La psico-neuro-inmuno-endocrino-dermatología es una especialidad relativamente nueva dentro de la medicina, que emparenta la parte psíquica y el estrés con diversas ramas de la medicina como son la neurología, endocrinología, dermatología e inmunología. En este artículo se trata de explicar, en forma breve y clara, la etiopatogenia de las dermatosis inducidas por el estrés, desde que el estímulo es captado en el sistema nervioso central hasta el desarrollo de la dermatosis

Del estrés a las psicodermatosis: breve guía para comprender la etiopatogenia de las dermatosis inducidas por el estrés / From stress to psychodermatosis: a brief guide to understand the etiopathogenesis of stress-induced dermatoses

La psico-neuro-inmuno-endocrino-dermatología es una especialidad relativamente nueva dentro de la medicina, que emparenta la parte psíquica y el estrés con diversas ramas de la medicina como son la neurología, endocrinología, dermatología e inmunología. En este artículo se trata de explicar, en forma breve y clara, la etiopatogenia de las dermatosis inducidas por el estrés, desde que el estímulo es captado en el sistema nervioso central hasta el desarrollo de la dermatosis (AU)

[Relationship between the experience of steroids side effects and noncompliance with oral steroids treatment in collagen disease patients].

PURPOSE: To analyze the relationship between the experience of side effect and the compliance with oral steroids drug treatment of the patients in Collagen Disease Clinic. METHODS: A questionnaire survey through interview was conducted on 165 outpatients with various collagen disease at Saga Medical School Hospital. RESULTS: 94 patients (57%) had a history of noncompliance to the steroids drug. 49 patients (52.1%) adventitiously had forgotten to take the steroids as ordered and 45 patients (47.9%) intentionally had regulated their steroids dose or had discontinued the steroids drug treatment. Over 80% of the patients had experienced side effects of the steroids. The patients who experienced one or more of the following side effects, osteoporosis, bone fractures, menstrual disorders, moon face, central obesity, alopecia, acnelike eruption, manic-depressive state, and insomnia, intentionally regulated, or discontinued the steroids therapy. In addition, the patients who were not made cognizance about side effects of the steroids by their physicians and nurse tended to noncompliance group. CONCLUSION: To increase the compliance rate with oral steroids drug treatment, we must make conscious efforts to inform the patients on the condition of their medical states, the efficacy of the prescribed drugs, and the side effects and risk concerning discontinuation of the steroids. It is Also necessary to establish "Drug information and counseling day" in outpatient Department.

[Relationship between autoimmune diseases and personality traits in women]. / Relation entre maladies dysimmunitaires et traits de personnalité chez la femme.

The personality traits of 40 women with non organ-specific dysimmune diseases were studied by means of a questionnaire devised to evaluate behavioural components including 48 items divided into 8 different patterns. The patients fell into 3 groups. Group I comprised 20 women with collagen diseases, including systemic lupus erythematosus (n = 8), scleroderma (n = 4), Sharp's syndrome (n = 4), polymyositis (n = 3) and Shulman's syndrome (n = 1). Group II was made of 10 women with either primary (n = 6) or secondary (n = 4) Sjögren's syndrome. Group III consisted of 10 women with vasculitis. Results were compared with those obtained in a control population of 41 women without dysimmune disease. At the time of examination the mean daily dose of prednisone was 10.5 mg. All 40 patients differed from the control group by their unobtrusiveness, self depreciation (P less than 0.01), hyperconformability and excessive kindness (P less than 0.02). Additional traits were a tendency towards contradiction and intolerance in patients with Sjögren's syndrome and a lack of agressiveness combined with a feeling of inferiority in patients with vasculitis. These results confirms that patients with dysimmune disease are psychologically fragile and suggest that the possibility of psychotherapy should be examined in these patients.

The Illness Behavior Assessment Schedule: reliability and validity.

A patient's illness behavior represents an important component of any clinical presentation, and may in itself be pathological. Illness behavior and abnormal illness behavior are not easily evaluated, and considerable disagreement exists as to the criteria for making diagnoses such as "conversion reaction," "hypochondriacal reaction," etc. This paper describes the background, reliability and validity of the Illness Behavior Assessment Schedule (IBAS) which has been developed as a basis for a systematic and standardized approach to illness behavior.

The medical care of psychiatric patients.

Longitudinal and cross-sectional data have demonstrated a high incidence of physical illness among psychiatric patient populations. Problems involved in the treatment of medically ill psychiatric patients include the nonspecificity of psychiatric symptoms, the inadequacy of previous examinations by a nonpsychiatric physician to rule out the possibility of physical disease causing psychiatric symptoms, and the patient's lack of awareness of current or pre-existing physical disease when consulting the psychiatrist. The following review examines nine categories of medical disorders that are known to produce psychiatric symptoms, with discussion of the psychiatric manifestations. Implications for current practice and training are briefly considered.

[Neuropathological aspects of chronic diseases]. / Neuropathologische Aspekte bei chronischen körperlichen Erkrankungen.

Practically all diseases of bodily organs may lead to quantitatively and qualitatively differing alterations of the central and periphal nervous system. These are connected to the basic disease on one side, to compications on the other. The preliminary condition for the appearance of encephalopathies following bodily diseases lies mostly in a disturbance of the blood-brain and blood-liquor barrier. No close correlation exists usually between psychiatric and nervous syndromes and pathomorphological findings. However, the findings are often characteristical, although not specifical. Especially the findings in uraemia, liver diseases, rheumatic and so-called pararheumatic diseases (collagenoses) are discussed.