A 10-year follow-up study of psychosocial factors affecting couples after infertility treatment.

BACKGROUND: Little is known about the long-term course taken in life by couples who had undergone medically assisted reproduction (MAR). The aim of this study was to find out in a large sample whether, in comparison with parents, involuntarily childless couples have a different subjective perception of overall and specific quality of life over a period of >10 years. METHODS: Between 1994 and 1997, 564 couples participated in the initial Heidelberg Fertility Consultation Service study of psychosocial aspects of infertility. In March 2008, a follow-up questionnaire was sent to all of these couples. Both partners were asked about the current status of their desire for a child and their satisfaction with life, their self-esteem, partnership, sexuality and career, as well as their current attitude towards the MAR they had undergone and experience of the process. RESULTS: The final sample consisted of 148 couples and 60 women (response rate: 41% of the women and 31% of the men contacted). Fifty-nine percent of the women had at least one genetically related child, 11% had a foster or adopted child and 30% remained childless. Comparisons of psychological variables between parents and childless couples were done for the 148 couples only. Post-MAR parents indicated significantly higher self-esteem than childless couples (P < 0.01) and were more inclined to go through the infertility treatment again than childless couples (P < 0.001 for women, P < 0.05 for men). Positive aspects of infertility were seen more often by childless couples than by parents (P < 0.001). Childless women reported more occupational satisfaction than mothers (P < 0.01), while no such difference was identified in the male partners. Concerning overall life satisfaction, satisfaction with friendships and the partnership, and sexual satisfaction there were no statistically significant differences between childless women/men and mothers/fathers. CONCLUSIONS: Overall, our 10-year follow-up survey indicated good psychological adjustment both in childless couples and in post-MAR parents. A decline of sexual satisfaction in childless couples (often reported in the literature) was not observed in this large sample. Quality of life in the long-term can safely be said to be high, both in the definitively childless couples and the post-MAR parents. These findings should be integrated into the information and counselling for would-be parents prior to infertility treatment. A major limitation of this study is that the majority of women and men from the initial study did not respond in our follow-up study.

Validation of a German version of the P-QOL Questionnaire.

OBJECTIVE: The objective of this study was to validate the German version of the prolapse quality-of-life questionnaire (P-QOL). METHODS: The P-QOL questionnaire was translated into German and administered to women recruited from two gynecological outpatient clinics and seven gynecological practices. All women were examined in supine position using the Pelvic Organ Prolapse Quantification System of the International Continence Society. The validity was assessed by comparing symptom scores and quality-of-life scores between symptomatic and asymptomatic women. RESULTS: According to the English study, 140 symptomatic and 75 asymptomatic women were included. The total scores for each P-QOL domain were significantly different between symptomatic and asymptomatic women (p < 0.001). Seven symptom regarding questions showed significant differences (p < 0.05). CONCLUSION: The German version of P-QOL is a valid, reliable, and easily comprehensible instrument to assess quality of life and symptoms in German-speaking patients with urogenital prolapse.

Psychosocial characteristics of women and men attending infertility counselling.

BACKGROUND: Little is known about the psychosocial characteristics of infertile couples seeking psychological help. This study describes couples attending infertility counselling. METHODS: Questionnaires pertaining to socio-demographic factors, motives for wanting a child, lay aetiology of their infertility, dimensions of life and partnership satisfaction, and a complaints list were completed by 974 women and 906 men. Of those who indicated an openness to counselling, almost half actually attended infertility counselling, and two groups, 'no counselling' (358 women and 292 male partners) and 'taking up counselling' (275 women and 243 male partners), were therefore compared. RESULTS: More couples with stressful life events were found in the counselling group. For women taking up counselling, psychological distress, in the form of suffering from childlessness and depression as well as subjective excessive demand (as a potential cause for infertility), was higher in comparison to women not counselled. The higher distress for men in the counselling group was indicated by relative dissatisfaction with partnership and sexuality and by accentuating the women's depression. CONCLUSIONS: Infertile couples seeking psychological help are characterized by high levels of psychological distress, primarily in women. The women's distress seems to be more important for attending infertility counselling than that of the men.

Psychosocial characteristics of infertile couples: a study by the 'Heidelberg Fertility Consultation Service'.

BACKGROUND: The aim of the study was to identify differences in psychological characteristics between couples with fertility disorders, especially idiopathic infertility, and a representative sample. MATERIAL AND METHODS: A total of 564 couples was examined using psychological questionnaires pertaining to sociodemographic factors, motives for wanting a child, dimensions of life satisfaction and couple relationships, physical and psychic complaints, and a personality inventory. RESULTS: Specific to our sample was the high educational level of the couples, and the large number with idiopathic infertility (27% of all diagnoses). There were no remarkable differences in psychological variables between the infertile couples and a representative sample, except that the infertile women showed higher scores on the depression and anxiety scales. Couples with idiopathic infertility showed no remarkable differences in the questionnaire variables compared with couples with other medical diagnoses of infertility. CONCLUSIONS: A typical psychological profile for infertile couples could not be identified using standardized psychometric rating methods. This may be an effect of the specific characteristics of our sample. For some couples, the infertility crisis can be seen as a cumulative trauma, which indicates that these couples have a marked need for infertility counselling.

[Music therapy for chronic headaches. Evaluation of music therapeutic groups for patients suffering from chronic headaches]. / Musiktherapie bei chronischen Kopfschmerzen. Evaluation musiktherapeutischer Gruppen für Kopfschmerzpatienten.

PROBLEM: This paper presents a new approach to music therapeutic treatments. We developed a short time treatment ( 8 group sessions) for patients suffering from chronic headaches. The multimodal concept of this headache treatment and particularly the effect of a sound trance on headache patients are explained and evaluated in this paper. METHODS: An evaluation study was done with 34 patients, who belonged to four therapy groups. In order to evaluate this treatment the patients were interviewed and had to fill out several self-rating scales about pain and some psychological variables (e. g. depression) before, directly after and 6-12 months after the treatment. This treatment group (n=26) was compared to a small waiting group (n=9). A case study elucidated the psycho-social anamnesis, and the process and outcome of the music therapy. RESULTS: The case study shows that the sound trance caused a loss of the affect control or at least reduced it. This experience enabled the patients to develop creative solutions, which resulted in a pain relief 6-12 month later. The comparison of the statistic means directly before and after the treatment did not reveal many therapeutic effects. Yet, 6-12 months later many patients reported less days at which they suffered from headaches; and they also significantly improved their ability of pain control. CONCLUSION: The results indicate that music therapy groups are more successful than a waiting group. The study's results agree with numerous other psychological evaluation studies and shows once more that music therapists working with patients suffering from chronic headaches are able to achieve successful results particularly long-dated. Thus, creative therapeutic approaches supplement the medical treatment, as they help the patients to develop an adaptive way of coping their pain. Yet, it will need further research to confirm the benefit of music therapy for patients suffering from chronic pain.

A multidisciplinary cross-sectional study on solvent-related health effects in painters compared with construction workers.

OBJECTIVES: The main aim of the study was to examine possible solvent-associated effects on the nervous system in currently employed painters. Special attention was paid to evaluate subtle health effects. MATERIALS AND METHODS: A total of 401 painters and 209 construction workers without solvent exposure with at least 10 years of professional experience were subjected to a clinical, neurological, psychiatric, neuropsychological and neurophysiological examination. For personal medical and occupational history, standardized questionnaires were used. A quantitative rating of exposure was obtained by expert rating of the respective occupational history without knowledge of the individual test results. RESULTS: There was no excess of somatic disorders or solvent-associated adverse effects on the nervous system. No distinct effects of solvent exposure on nerve conduction velocities (NCV) or cognition were found. Discrete NCV deficits in painters were not considered a sign of subclinical polyneuropathy. Painters, however, reported an excess of specific symptoms that could be assigned to "mood and behaviour". The differences between specific and non-specific questionnaire outcomes on the one hand and the positive correlation between chronic exposure index and symptom scores on the other hand support the hypothesis of solvent-induced effects. Because data is lacking on past solvent exposure, it is not possible to relate these effects to current exposure limits. CONCLUSIONS: Currently employed painters differ from controls not exposed to solvents with respect to the frequency of certain symptoms in mood and behaviour. These symptoms are related to life-long solvent exposure rather than to current exposure. At present, the issue of time course and reversibility or irreversibility of these symptoms cannot be answered. The predictive value for subsequent neuropsychiatric morbidity remains to be elucidated in follow-up studies.

[Confounding of occupational cancer risk in epidemiological studies due to ignorance of smoking data as exemplified by bladder and lung cancer in painters]. / Die Fehleinschätzung beruflicher Krebsrisiken in epidemiologischen Studien durch Unkenntnis des Raucherstatus am Beispiel von Harnblasen und Lungenkrebs der Baumaler.

Studies on occupational risk factors for cancer are frequently carried out without information on smoking habits. However, the proportion of smokers may vary considerably across occupational groups. Thus it is unclear, whether an observed increased cancer risk in an occupational group is at least partly the result of a higher proportion of smokers in that group. The paper demonstrates the possible extent of such confounding by using hypothetical and empirical examples of studies concerning the lung cancer and bladder cancer risk in painters. A formula for the indirect control of such confounding is applied. Relative risks greater than 1.2 for bladder cancer and 1.3 for lung cancer should thus not be considered solely the result of confounding. The degree of confounding is less than generally assumed. However, the evaluation of this degree remains questionable in case of an interaction between smoking and occupational exposure.

Associations between selected life events and cancer.

This case control study compares 508 women with cancer with 1,563 controls with respect to four different life events as indicators for an increased cancer risk: (1) death of the father during childhood; (2) death of the mother during childhood, both before the age of 16; (3) divorced, separated, or widowed at any time; (4) at least one traumatic World War II experience. The age-adjusted relative risks were 1.10, 1.71, 1.45, and 1.33, respectively. The only variable not showing a significant association with cancer was "death of father." Inferences from the results are limited by the retrospective study design and by the inability to isolate events that are cancer specific from those specific to illness in general.

Psychosocial factors and disease bias in breast cancer patients.

The personality patterns of cancer patients as found in retrospective case-control studies are often suspected to be consequences of the disease. In this study an attempt was made to remove the bias arising from the disease itself by taking into account two indicator variables for the subject's anticipation of the subsequently established diagnosis. Seventy-five women with breast cancer were compared to 75 benign controls, matched in pairs for age and "reason for consultation" (the first indicator). Relative risks of 14 psychosocial scales were estimated in turn by logistic regression analysis for matched sets. The analysis showed 13 scales being positively or negatively related to cancer risk in accordance with the hypotheses. After adjusting for "fear of breast cancer" (the second indicator), five scales showed a significant association. In a previous report on this study, neither indicator variable was accounted for and the associations were generally found to be weaker, suggesting that they were masked by the malignant and benign subjects' differences in their degree of anticipation of a cancer diagnosis. As there were no a priori hypotheses regarding these indicator variables, the statistical significance of the results should be treated with caution.

Psychosocial factors and breast cancer: a critical reevaluation of established hypotheses.

The Bahnson psychosocial risk profile was reexamined for breast cancer screening. The questionnaire was presented to 3,306 women who came to the consultation hour in a hospital for prevention and early detection. It was administered prior to knowledge of the diagnosis. Newly detected breast cancer cases were compared to matched groups of healthy and benign controls on several psychosocial scales. Discrimination between these groups was rather poor, showing the questionnaire's inadequacy to measure factors relevant in discriminating between this study's newly detected cancer cases and controls. Possible explanations for the "poor" results are discussed.

[Psychosocial factors and cancer. A study of 80 women by means of a psychosocial questionnaire (author's transl)]. / Psychosoziale Faktoren und Krebs. Untersuchung von 80 Frauen mit einem psychosozialen Fragebogen.

The psychosocial questionnaire compiled by C. B. Bahnson and M. B. Bahnson and adapted for the German-speaking area was used to question 40 female cancer patients (30 mammary, 6 gastric and 4 pulmonary carcinomata) aged between 36 and 64 years and 40 control subjects selected by the matched pairs method. The cross section examination showed significant differences (p less than or equal to 0.05) between cancer patients and control subjects on single variate examination in 10 individual variables. Discriminant analysis (multivariate examination) revealed a discriminant function of 12 variables which enabled the classification of the entire collective of subjects with 95 percent accuracy in the carcinoma and control groups. Our results confirm largely the hypotheses developed in the USA.

[Prophylaxis in general practice. Aspects of the problems (author's transl)]. / Modell einer Vorsorge in der Allgemeinpraxis. Aspekte ihrer Problematik

For four and a half years prophylactic examinations were carried out quarterly in addition to the statutory early recognition investigations in a general practice. The participation being 42.5% was above the participation rate at the statutory early recognition investigations and showed a marked correlation to age and social stratum, but not to sex. The therapeutic effect, measured by the lowering of the cholesterol level, was compared with data from the literature, our results being below those of the other authors. Then the therapeutic effect was considered from various points of view such as sex, age, social stratum and frequency of participation. The most important result appeared to be that similar investigations are probably necessary once a year at the most on medical grounds, to detect and treat risk factors, which would be of great economic importance.