Vocational rehabilitation outcomes of veterans with substance use disorders in a partial hospitalization program.

The authors examined factors that influenced the employment rates of 529 veterans with severe alcohol and other substance use disorders who were being treated at an addictions partial hospitalization program. The employment rate was significantly higher for veterans who completed the hospitalization program, participated in a Veterans Industries work-for-pay program, and received drug-free supportive housing.

Sexuality in persons with lower extremity amputations.

PURPOSE: There is a paucity of information regarding sexual functioning in persons with lower extremity amputations. The purpose of this study was to describe sexual and psychological functioning and health status in persons with lower extremity amputation. METHODS: Self-report surveys assessed sexual functioning (Derogatis Inventory), depression (Beck Depression Inventory, anxiety (State-Trait Anxiety Inventory), and health status (Health Status Questionnaire) in a convenience sample of 30 men with lower extremity amputations. Mean age of the participants was 57 years (range 32-79). Mean duration since amputation was 23 months (range 3-634 months). Twenty one subjects (70%) had trans-tibial and seven subjects (23%) had trans-femoral amputations. RESULTS: A majority of subjects were experiencing problems in several domains of sexual functioning. Fifty three percent (n = 16) of the subjects were engaged in sexual intercourse or oral sex at least once a month. Twenty seven percent (n = 8) were masturbating at least once a month. Nineteen subjects (63%) reported orgasmic problems and 67% were experiencing erectile difficulties. Despite these problems, interest in sex was high in over 90% of the subjects. There was no evidence of increased prevalence of depression or anxiety in these subjects when compared to other outpatient adult populations. CONCLUSIONS: Sexual problems were common in the subjects studied. Despite these problems, interest in sex remained high. Few investigations have been directed toward identifying the psychological and social factors that may contribute to these problems and more research with a larger population is needed in this area.

Prospective study of fatigue in localized prostate cancer patients undergoing radiotherapy.

The objectives were to (1) prospectively evaluate fatigue utilizing validated instruments in patients with localized prostate cancer, and (2) examine the relationships between fatigue, depression, quality of life, and sleep disturbance. The instruments used included: Piper Fatigue Scale, Beck Depression Inventory, Epworth Sleepiness Scale, and Functional Assessment of Cancer Therapy for Prostate Scale. Data on cancer stage, prostate specific antigen levels, hematocrit, patient's body weight and radiation dosage were recorded. Patients were evaluated preradiotherapy, middle of radiotherapy, completion of radiotherapy, and at 4-5 weeks follow-up. Thirty-six veterans with localized prostate cancer were studied. Mean age was 66.9 years (range 55-79). Duration of treatment was 7-8 weeks. Univariate procedure and Wilcoxon Signed Rank-test were used to examine changes in pretreatment scores for each of the three subsequent study periods. To adjust for multiple comparisons Bonferroni test was used. Spearman Correlations were calculated among parameters. No significant changes were noted in mean scores of hematocrit and body weight during the study period. On the Piper Fatigue Scale, adjusted for multiple comparisons, the median scores were significantly higher at completion of radiotherapy as compared with preradiotherapy values. Three patients (8%) were experienced fatigue according to Piper Fatigue Scale before treatment as compared to nine patients (25%) at completion of radiotherapy. On Prostate Cancer Specific and Physical Well Being subscales of the Functional Assessment for Prostate Cancer Therapy, the scores were significantly lower at middle and completion of radiotherapy than at pretreatment. At preradiotherapy, middle of radiotherapy, completion of radiotherapy and follow-up evaluation, patients scoring higher on the Piper Fatigue Scale were more likely to report a poorer quality of Physical Well Being on Functional Assessment of Cancer Therapy for Prostates. No significant changes were noted in the Beck Depression Inventory and Epworth Sleepiness Scale scores during treatment. Eight patients scored 10 or more on the Beck Depression Inventory before starting radiotherapy, suggesting depressive symptomatology. Of these, only seven patients scored 10 or more at completion of treatment. The incidence of fatigue is lower in our study than in previously published data. A relationship exists between fatigue scores and physical well being subscale scores. Higher scores on the Piper Fatigue Scale at the completion of radiotherapy, as well as no changes on depression and sleepiness scales, suggest that fatigue may not be the result of depression or sleep disturbance. Based upon our previous work, we propose that the physical expression of fatigue may be secondary to a decline in neuromuscular efficiency and enhanced muscle fatigue.

Neuromuscular fatigue in prostate cancer patients undergoing radiation therapy.

OBJECTIVE: To determine the etiology of fatigue in prostate cancer patients undergoing radiation therapy (RT). METHODS: Thirteen prescreened men (60 to 76 years in age, 58 to 130 kg in body weight) were evaluated for neuromuscular fatigue (NMF) of the tibialis anterior (TA) muscle, cardiopulmonary fatigue (CPF), and psychological-subjective fatigue (PSF) at 1 to 2 weeks before RT (Pre), at the end of 8 weeks of RT (RT), and at 5 to 6 weeks after completion of RT (Post). OUTCOME MEASURES: For NMF, the TA muscle was fatigued by sustained isometric contraction at 80% of maximum voluntary contraction for 60 seconds on a force dynamometer. Neuromuscular efficiency (NME) expressed as a ratio of isometric force (in Newtons) and respective integrated electromyograms were measured. For CPF, stress testing was performed on a treadmill using the modified Bruce protocol. Piper Fatigue Scale, Beck Depression Inventory, and Epworth Sleepiness Scale were administered to evaluate PSF. DATA ANALYSIS: Paired t tests, single factor analysis of variance, and nonparametric analysis. RESULTS: At RT, there was a significant decline in NME of TA at the beginning (18.4%, p < .01) and the end (29.2%, p < .001) of sustained muscle contraction for 60 seconds. Post values were lower but nonsignificant in comparison with Pre values. NME recovered within 5 to 6 weeks after RT. No abnormalities were detected in CPF or PSF. No correlation was found between the decline in NME and psychological status of the patients. CONCLUSION: Results provide definitive evidence of transient decline in NME in prostate cancer patients at the completion of RT. The effect seems to be specific for neuromuscular performance alone and is independent of the cardiovascular or psychological status of the patients.