From children to young adults: cystic fibrosis and siblingship: a longitudinal study.

AIM: To compare the results from our previous study in 1994/95 of children with cystic fibrosis (CF) at the age of 6-14 years and their healthy siblings with data from the same participants as young adults in regard to their self-esteem, life satisfaction and attitudes towards the CF siblingship situation. METHODS: Thirty-seven sibling pairs participated. Three instruments were used: The 'As I see myself' self-evaluation questionnaire; the 'Ladder of life', assessing life satisfaction; and the 'Sibling Mirror', reflecting a person's feelings, when one's sibling or oneself has CF. RESULTS: Contrary to 1994/95 study results, the female participants showed no signs of impaired self-esteem. Concerning life satisfaction, women in both groups and the men with CF have lower ratings than a healthy reference group. Individuals with CF look upon themselves today as independent, thoughtful and mature, but remember themselves as being active, spoiled or fussy. Healthy siblings consider themselves diplomatic, responsible, mature, important and loyal but remember themselves as angry, envious and neglected. CONCLUSION: The self-esteem of women in the sibling pairs (whether with CF or healthy sisters) has improved since their childhood. Overall, the results indicate that young adults with CF today are medically well controlled and psychosocially well adapted, albeit aware of their precarious future.

Disease perception and social behaviour in persistent rhinitis: a comparison between patients with allergic and nonallergic rhinitis.

BACKGROUND: Although the understanding of the pathophysiology and pharmacology of rhinitis has increased within recent years, few studies have examined the impact of rhinitis on patients' behaviour. AIM: To compare perennial allergic rhinitis (PAR) and perennial nonallergic rhinitis (PNR) in terms of patients' perception of their disease and its psychosocial concomitants. METHODS: Thirty-one PAR patients and 32 PNR patients responded to a standard symptom list and were interviewed in-depth regarding their complaints and the impact of rhinitis on their daily lives. RESULTS: PAR and PNR patients reported similar somatic and psychosocial complaints. In both disease groups the adverse effects of rhinitis were reported to be substantially limiting, particularly in social contacts, the impact appearing to be more severe in the women. CONCLUSION: Rhinitis has a severe impact on the daily lives of patients, women reporting more severe psychosocial effects. Disease perception and social adjustment appear to not depend appreciably on whether or not an objective diagnosis of rhinitis can be established.

The short-EMBU in East-Germany and Sweden: a cross-national factorial validity extension.

The factorial stability and reliability of the 23-item s(hort)-EMBU previously demonstrated to be satisfactory in samples of students from Greece, Guatemala, Hungary and Italy, were extended with 791 students from East-Germany and Sweden. Previous findings on factorial validity, internal reliability and correlations among scales were replicated. The 23-item form thus continues to be recommended as a reliable functional equivalent to the early 81-item EMBU, when the clinical and/or research context does not adequately permit application of time-consuming test batteries.

A descriptive study of how dentists view their profession and the doctor-patient relationship.

In this article we report on how 64 dentists working in a big city in southern Sweden view their profession. The dentists ranged in age from 30 to 70 years (as it was indicated in intervals of 10 years). Their professional experience ranged from 2 to 44 years (mean, 23 years). We collected their views on the ideal skills of a good dentist by means of a questionnaire. From this material we identified three categories: 1) interpersonal skills; 2) clinical skills; and 3) others, such as self-confidence, stress tolerance, and managerial and administrative skills. Next, they rated the relative importance of a number of listed attributes in dentistry in this order: contact with patients, communication skills, empathy, manual skills, and theory. Finally, they described a number of aspects of their profession. We conclude that the importance of interpersonal skills, as well as stress tolerance and administrative skills, is emphasized by experienced practitioners but that these skills are not focused on in the dental curriculum.

Does the quality of advanced prosthetic dentistry determine patient satisfaction?

In a clinical follow-up study 42 patients were selected from an original sample of 335 individuals who had undergone extensive prosthetic treatment. The selection was done in accordance with a treatment satisfaction measure. The selected patients' appliances were classified in accordance with the California Dental Association (CDA) quality assessment system. Altogether, most of the new reconstructions were rated as satisfactory. The removable partial dentures had a somewhat higher share of non-acceptable appliances according to the CDA criteria. There was an association between the CDA categories and patient satisfaction. Using logistic regression analysis and knowing the CDA rating, we could correctly classify 67% of the patients with regard to the satisfaction measure. The satisfaction measure was modified on the basis of an interview, improving the model to 83% correctly classified. It was concluded that the technical quality of the prosthodontic treatment was associated with patient satisfaction.

Personality factors versus expectations and self-reported symptoms among patients awaiting advanced prosthodontic treatment.

To assess simple questions for identifying patient personality traits among a normal Swedish population and to assess possible relationships between personality and symptoms, attitudes, dental problems, and received dental care, a questionnaire was sent to 489 subjects awaiting prosthodontic treatment (response rate 84.2%). Three personality traits could be identified: "Fearful-depressed" subjects consumed more tranquillisers, were worried and had many symptoms, whilst "Open-minded" were optimistic about treatment, had high expectations and few symptoms. "Control-minded" did not reveal worries and guarded their autonomy. It was concluded that personality indicators were related to clinically relevant factors: salience of teeth, perceptions of problems, dental attendance pattern, expectations and perceptions of symptoms.

Dimensions of satisfaction among prosthodontic patients.

Patient satisfaction with advanced prosthodontic treatment was measured by a questionnaire in five dimensions: attitude towards information; general well-being; economy; function; appearance concerning the number, shape, position and colour of the teeth. The questionnaire was distributed to 380 patients with extensive oral restorative treatment (response rate 88.2%). The levels of satisfaction were generally very high. Only 4% of patients stated with hindsight that they would not have carried through the treatment. The various dimensions were summated into a comprehensive satisfaction measure that displayed adequate discriminatory ability. No weighting of dimensions was possible, but the multidimensional nature of patient satisfaction was confirmed.

Family therapy in poorly controlled juvenile IDDM: effects on diabetic control, self-evaluation and behavioural symptoms.

Diabetic control, behavioural symptoms and self-evaluation were assessed in 25 children with IDDM who were in poor metabolic control (P group), before and subsequent to one of two treatment conditions: family therapy and conventional treatment (C). In addition, data were collected from 12 patients in optimal control (O group). Prior to treatment the patients in poor control were rated higher than those in the O group for symptoms indicating somatization and internalization of conflict and showed a gloomier self-image. The O group patients had fewer behavioural symptoms and a more positive self-image than non-diabetic reference groups. Diabetic control improved after family therapy only. Furthermore, the family therapy group improved on a combined measure of behavioural symptoms and one aspect of self-evaluation (relations to parents and family). The results suggest that IDDM may either interfere with or foster the child's development towards autonomy, depending on family interaction patterns which affect the child's behaviour and self-esteem. Family therapy is a treatment option which can mediate improved diabetic control by changing family relationships to allow for a better balance between parental and self-care of the child with poorly controlled IDDM.

Cooperation between parents in caring for diabetic children: relations to metabolic control and parents' field-dependence-independence.

Aspects of parental interaction were assessed in 20 families with diabetic, insulin-dependent children, using hour-long video-taped interviews, the children being in optimal (O, n = 10) or poor (P, n = 10) metabolic control and showing optimal or poor psychological adaptation. In comparison with the O-group parents, the P-group parents were less appreciative of one another, were less congruent in their attitudes to diabetes care, and appeared not to respect their childrens' independence and integrity; the mothers were discontented with the support given them by their husbands; the children assumed less responsibility for managing their diabetes and seemed less confident during the interview. The results are interpreted in light of an earlier finding that the P-group fathers are more field-dependent (FD) than their wives while the opposite is true for the O-group fathers. With reference to evidence from the cognitive style literature, we suggest that the relatively FD P-group fathers have difficulties in acting as autonomous sources of support to their wives resulting in marital discord and a delayed transition from maternal to self care in their children.

Rehabilitation after coronary bypass surgery: coping strategies predict metabolic improvement and return to work.

Thirty-six consecutive male patients who underwent coronary bypass surgery were investigated before and repeatedly up to 5 years after surgery. We followed the patients' physical capacity, dietary and exercise habits, mood, perception of health and return to work. Discriminant analysis identified four variables from the preoperative interview and the psychological tests which correctly classified 22 out of 24 patients into either metabolic responders--who were characterized by favourable changes in their lipoprotein profile, related to a successful clinical outcome--or non-responders. Responders were found to acknowledge subjective, emotional aspects of their situation whereas non-responders minimised their disease. Six preoperative variables successfully predicted the classification of all but one patient into full-time workers or not, one year after surgery. Full-time workers were more frequent among minimizers. The results suggest that whereas minimising of disease is adaptive in a short-term perspective, acknowledgement may be successful in the long run.

Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy.

STUDY OBJECTIVE: To evaluate the effect of family therapy on childhood obesity. DESIGN: Clinical trial. One year follow-up. SETTING: Referral from school after screening. PARTICIPANTS: Of 1774 children (aged 10 to 11), screened for obesity, 44 obese children were divided into two treatment groups. In an untreated control group of 50 obese children, screened in the same manner, body mass index (BMI) values were recorded twice, at 10 to 11 and at 14 years of age. INTERVENTION: Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months, while one of the groups also received family therapy. RESULTS: At the 1-year follow-up, when the children were 14 years of age, intention-to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children. The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment, and less than in the control group (P = .04 and P = .02, respectively). Moreover, mean BMI was significantly lower in the family therapy group than in the control group (P < .05), and the family therapy group also had fewer children with BMI > 30 than the control group (P = .02). The reduction of triceps, subscapular, and suprailiac skinfold thicknesses, expressed as percentages of the initial values, was significantly greater in the family therapy group than in the conventional treatment group (P = .03, P = .005 and P = .002, respectively), and their physical fitness was significantly better (P < .05). CONCLUSIONS: Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age.

Diabetic children and their parents: personality correlates of metabolic control.

Test measures of field-dependence-independence and impulsiveness-control were obtained from two groups of diabetic children and their parents, the children being in optimal (O, n = 12) or poor (P. n = 27) metabolic control and, according to the judgment of clinicians, showing optimal or poor psychological adaptation. Children of the O-group scored lower in impulsiveness and higher in realistic functioning than those of the P-group. Differences which parallelled these were found between the two groups of fathers. The P-group fathers were decidedly more field-dependent than their wives, while the opposite was found for the O-group. Group differences of the kind obtained were seen as possible determinants of disturbed family interaction or emotional stress in the child in the P-group and of autonomy and self-reliance in the child in the O-group. It is concluded that the role of fathers of diabetic children has been underestimated.

Weight loss after gastroplasty: psychological sequelae in relation to clinical and metabolic observations.

Twenty-one grossly obese patients were studied before and repeatedly after gastroplasty. Eighteen months after surgery, three groups of patients were identified which had similar preoperative weights but showed significantly different patterns of weight loss. About one third of the patients were considered unsuccessful (less than 20% weight loss). Psychological assessment, using the meta-contrast technique, showed that signs of regressive defense and of immature identity decreased postoperatively. Mild to moderate depressive reactions were found in two thirds of the patients postoperatively and were significantly more frequent among the successful patients. Acute depressive episodes, severe enough to require professional intervention, occurred in four patients, three of whom belonged to the successful group. No correlation could be found between surgical complications or metabolic alterations after gastroplasty and postoperative depression, implying that these factors do not primarily influence the patient's postoperative psychological status. Rather, we suggest that the marked weight loss as such leads to problems of adaptation which in turn may trigger depressive reactions.

Relation of mobility-fixity to the interpretation of pictorial stimuli.

A group of 61 students who had previously (in 1986) been classified by Hansson, Rydén, and Johnsson in terms of perceptual fixity-mobility using a "free" Rod-and-Frame Test, were investigated regarding their interpretations of a nonfigurative stimulus shown repetitively at short exposure-times, and their characterization of two pictures each portraying two soldiers in intensive interaction--one man apparently attacking the other in the first picture and apparently rescuing or taking care of the other man in the second. Mobile subjects on the free Rod-and-Frame Test reported a larger number of different interpretations of the nonfigurative stimulus and construed it more frequently in terms of human themes than did the fixed subjects; in rating the pictures of soldiers, they used more extreme and complex characteristics. It appeared that, when confronted with ambiguous stimuli, the mobile individual moves both "horizontally", as it were, along the surface of objective reality, and "vertically", from present to past realities, thus conjoining subjective-emotional and objective-analytic aspects of perception. This interpretation agrees with Werner's model of mobility-fixity which implies that the mobile individual operates on different developmental levels of perceptual functioning.

Relationship between differentiation and integration of self and nonself: an investigation in terms of modes of perceptual adaptation.

Differentiation and integration of self- and nonself-aspects of perception were investigated as features of the process of adapting to a spiral aftereffect (SAE) induced with massed trials. The cessation of the SAE at each trial was assumed to indicate that self-aspects of perception had been differentiated from nonself-aspects, changes in SAE duration over trials being considered to represent the integration of these aspects. Degree and stability of self-nonself-differentiation, reflected in the level and persistence of field-dependence measured on a serial version of the Rod and Frame Test, varied between individuals (N = 129). The results suggest that persistent field-independence requires both self- and nonself-aspects of perception to be adequately and continuously represented in an integrative process which is oriented towards stimulus-proximity, self-aspects of perception being successively replaced by nonself-aspects.

Field-dependence/independence: ability in relation to mobility-fixity.

Previous authors have pointed out that, while the classic Rod-and-Frame Test (RFT) yields a measure of ability to perform field-independently, it is unsuitable for identifying stylistic preference, such as mobility-fixity within the field-dependence/independence dimension. To relate mobility-fixity and ability aspects of field-dependence/independence, we compared data obtained from two versions of the test: one with a "free" instruction, on which the subjects were invited to adjust the rod to any position(s) they preferred on each of 10 trials and a process-oriented version (RFT-P), involving 20 trials with the standard instruction but with a constant rod-and-frame configuration, making possible analysis of the process of adaptation. Mobility versus fixity was defined in terms of more or less frequent changes of rod positions and choice of a high or a low proportion of nongeometrical positions in the RFT-Free. 38 female and 23 male university students completed first the RFT-Free and thereafter the RFT-Process. Women were more field-dependent than men throughout the RFT-Process trials; there were no differences between the sexes over trials or in choice of positions in the RFT-Free. Compared with field-dependent subjects, field-independent subjects more often changed rod positions in the RFT-Free and preferred nongeometrical positions somewhat more. Among field-independent subjects, those with consistently low deviations in RFT-Process more often preferred a variety of nongeometrical positions in RFT-Free than did those with gradually increasing deviations. We conclude that field-independence is associated with mobility and field-dependence with fixity, as defined by the RFT-Free variables, and that a prerequisite for high mobility is a relative stability of field-independence as reflected on the RFT-Process. Theoretical implications of this conclusion are discussed.

Differentiation of back pain patients using a pain questionnaire.

A specially designed pain questionnaire was administered to 52 consecutive out-patients referred to an orthopaedic clinic of a general hospital over a two week period because of pain in the lower back. A clinical evaluation, based on the patients' markings on 'pain drawings', and on the degree of compatibility between their reported pain symptoms and the results of physical examinations, led to the classification of 21 cases (40%) as psychogenic. The answers of these patients to the questionnaire differed in several aspects from those of the remaining 60%. Pain was more severe, multiform and enduring, and had a more pervasive influence on their life situation; they included a higher frequency of family problems, changes of employment, stress experienced at work, sleeping problems, and 'specialist shopping'. Without being aware of which patients were classified as psychogenic cases, the orthopaedic surgeons made less auspicious prognoses for these patients and also found the questionnaire more helpful in evaluating them. When asked to rate the intensity of the patients' pain, the surgeons, unlike the patients, avoided extreme ratings. Comparing the two scales used (a six-step verbal scale and a 10 cm graphic rating scale (GRS) for rating pain intensity, patients found the GRS to be more meaningful. The words occupied different relative positions on the verbal scale and the GRS, and their position on the GRS fluctuated according to whether they denoted general pain or pain during attacks. The findings suggest that the questionnaire is a useful screening tool for identifying patients requiring further psychological evaluation.

Weight reduction after gastroplasty: the predictive value of surgical, metabolic, and psychological variables.

Twenty-one grossly obese patients (mean body weight 126 kg, range 93-190 kg) were treated with gastroplasty ad modum Gomez. Eighteen months after surgery the average weight loss was 30.4 kg (range 1-71 kg); about 80 per cent of this weight loss represented loss of body fat. Mean weight loss of the entire programme, including preoperative weight reduction was 34.4 kg (range 1-71 kg). Dilation of the pouch and/or channel occurred in 14 patients and was generally discovered 6-12 months after operation. The wide range in weight reduction could not be unequivocally attributed to technical-surgical factors. Although the patients with the least weight reduction had all developed channel dilation, several patients with excellent weight loss also showed dilation of the pouch and/or channel. An extensive psychological investigation performed before surgery demonstrated more signs of sensitivity and denial in the unsuccessful patients; the successful ones were more dependent and tended to live in a supportive social environment. The unsuccessful patients were younger and their estimated alcohol consumption was higher. A number of morphological and biochemical variables including body weight, fat cell size, and variables reflecting thyroid function, lipid and glucose metabolism, and adipose tissue metabolism were not related to subsequent weight loss.

Selective resistance to approach: a precursor to fear responses to an alarm call in great tit nestlings Parus major.

The reactions of 10-day-old great tit nestlings to 3 auditory stimuli were studied. The stimuli, presented on a series of feeding occasions, were (1) the species' "sweet" alarm call, (2) a song strophe of the great tit, and (3) a song strophe of the tree-creeper (Certhia familiaris). In contrast to earlier findings in studies of older nestlings, these younger nestlings did not respond to the alarm call with cessation of begging. However, a significant differential effect of the alarm call was demonstrated when the conditioning rates for the nestling' begging response to each of the 3 stimuli were determined. Thus, conditioning was significant slower to the alarm call than to the other stimuli. The results agree with the general conception that responses to species-specific calls develop gradually during early ontogenesis. Thus fear responses to the alarm call, such as cessation of begging and "freezing," which are elicited in newly fledged young, are preceded by weaker aversive tendencies that are not obvious from observations of the nestlings' behavior in nature. It is suggested that the nestlings' exposure to contrasting auditory stimulation-their own begging call and the parental feeding call-constitutes the experiential base for withdrawal responses to the "sweet" call.