Physicians' and patients' views of problems of compliance with diabetes regimens.

Thirty noninsulin-dependent diabetic patients and 30 residents in internal medicine at Cleveland Metropolitan General Hospital were surveyed regarding their perceptions of the difficulties of complying with diabetic regimens. Three main components of compliance were investigated (medication, diet, and urine testing), and each component was broken down into three separate tasks. Physicians and patients rated the components on a scale of 0 to 10. For each of the three components, physicians rated compliance tasks as more difficult than did the patients. In addition, statistically significant differences were found in the difficulty ratings given separate tasks within each component of compliance. Finally, a statistically significant interaction reflected differences in difficulty ratings of patients compared with those of physicians for the various tasks associated with dietary compliance. Results indicated that physicians and diabetic patients differ in their perceptions of compliance difficulties. It would appear that either physicians were overestimating the difficulty that diabetic patients experience with various tasks or that patients underestimated (or underreported) their difficulty. Possible sources of these differences and their implications for patient and physician education are discussed.

Sexual dysfunction in diabetes. A survey of physicians' responses to patients' problems.

Results of this study suggest that physicians generally attend more to the sexual functioning of male diabetic patients than to that of female diabetic patients. Additionally, they view the men as more troubled than the women by sexual dysfunction. These physicians also were more likely to refer a male diabetic patient for further evaluation or treatment of the sexual dysfunction. Given the incidence of sexual dysfunction within the diabetic population, primary care physicians should actively involve themselves in the identification of such problems in both their male and female diabetic patients.

Preferences for treatment approaches in medical care. College students versus diabetic outpatients.

Preferences for degree of involvement in health care of 47 low-income, inner city, outpatient diabetic patients were measured by the Health Opinion Survey (HOS). These scores were compared with those of three normative groups of college students. Significant differences were found between the samples on each HOS subscale and the total HOS (all P values less than 0.001). Implications of these differences for health care providers are discussed.

Variables affecting the relationship between depression and attribution of outcomes.

The current study investigated the influence of the interpersonal context on the relationship between depression and attribution of outcomes. Since attributions of success and failure are frequently considered to be influenced by self-serving biases, it was anticipated that Ss' knowledge that their attributions would be observed by a peer in their presence would influence the relationship between depression and attribution. Male and female Ss (N = 229) passed or failed an identity-relevant or non-identity-relevant task. Half were told their attributions would be observed by a peer with whom they were paired in the experiment (observation condition) and half believed their attributions would only be seen anonymously at a later time by the E (nonobservation group). Results for Ss who performed the identity-relevant word task were supportive of the hypothesis that the relationship between depression and ability attributions is stronger under observation conditions than under nonobservation conditions. The findings were discussed in the context of an interactional viewpoint of depression.

Urinary tract infections due to Candida albicans.

Infection of the urinary tract due to Candida albicans is an uncommon but well-described complication of modern therapeutics. Despite the rarity of this infection, culture of properly collected urine yielding C. albicans requires an explanation. The significance of systemic factors in the defense of the urinary tract against candidal infection is unknown, but secretions from the prostate gland in men and from periurethral glands in women have been reported to be fungistatic. In addition, growth of Candida at sites on mucous membranes may be suppressed by other normal flora. Conditions that predispose to candiduria include diabetes mellitus, antibiotic and corticosteroid therapy, as well as factors such as local physiology and disturbance of urine flow. Lower urinary tract candidiasis is usually the result of a retrograde infection, while renal parenchymal infection most often follows candidemia. In addition to asymptomatic candiduria, recognized clinical forms of candidal urinary tract infections include bladder infection, renal parenchymal infection, and infections associated with fungus ball formation. Unfortunately, clinical criteria alone are insufficient to distinguish reliably among these clinical types. If the urine is found to contain candidal organisms, the condition of the patient should be considered for determination of appropriate therapy. When infection is thought to be confined to the bladder, patients without indwelling bladder catheters should be considered for flucytosine therapy. For patients requiring indwelling bladder catheterization, irrigation with amphotericin B is usually successful. Although flucytosine alone may be useful for renal parenchymal candidal infection, iv amphotericin B alone or the combination of amphotericin B and flucytosine is indicated when systemic candidiasis cannot be excluded.

Outpatients' attributions of the causes of their psychological problems.

The purpose of this study was to investigate whether mental health outpatients' attributions of the causes of their psychological problems are associated with their treatment expectations. Results indicated that higher ratings for internal causation of problems were associated with longer perceived duration of problems, higher ratings of problem severity, and a greater number of appointments predicted as being necessary to provide the help needed. External attribution ratings were not significantly associated with ratings of problem duration or predicted number of appointments. Higher external attribution ratings were associated with higher ratings of perceived severity, a finding opposite that of previous research. The value of independently considering internal and external attributions of the causes of psychological problems are discussed.

Repression-sensitization and response to the implicit cue requirements of a social situation.

It was hypothesized that in an experiment that used verbal recall of threatening statements, repressors would reproduce significantly more of the threatening statements than would sensitizers when the implicit social cue requirement implied the desirability of attending to such statements. SSs were 20 female repressors, as defined by scores on the Repression-Sensitization scale. Ss first heard and then reproduced from memory either a control paragraph or a paragraph intended to imply the desirability of attending to the threatening stimuli. Next, all Ss wer read 20 statements, half of which were intended to be threatening and half of which were nonthreatening. After the Ss had heard all 20 statements, they reproduced from memory as many as they could. Results indicated that when the implicit social cue requirements implied the desirability of attending to the threatening statements, male repressors reproduced more of the statements than did other Ss in accord with predictions. In contrast, female repressors who were exposed to the implicit social due requirements that implied the desirability of attending to the threatening statements reproduced fewer of the statements than did other Ss.

Attitudes and perception of attitude changes within the interdisciplinary staff of an evening mental health clinic.

A study was made of the attitudes of a multidisciplinary staff of an evening mental health clinic. The focus of the clinic is on short-term treatment, and one of the main purposes of the study was to investigate the reactions of staff members to this type of treatment orientation. Results indicated that staff members, when considered as a whole felt that their confidence in their short-term treatment skills and their belief in the effectiveness of a short-term, interdisciplinary treatment center increased over the course of the first year the clinic was open. These results were not consistent across disciplines, and possible reasons for this inconsistency were discussed.