BACKGROUND: Patient safety strategies highlight patients' own active involvement in ensuring medication safety. A prerequisite for involving patients in their medication therapy is having tools that can assist them in ensuring safe medicine use. Older home-dwelling adults with multiple medications are at high risk for medication-related problems, yet only a few age-specific patient self-administered medication risk screening tools exist. This study aimed to develop, validate, and assess the feasibility of a self-administered medication risk checklist for home-dwelling older adults ≥65 years. MATERIALS AND METHODS: The draft checklist was formed based on a validated practical nurse-administered Drug Related Problem Risk Assessment Tool supplemented with findings from two systematic literature reviews. The content validity of the draft checklist was determined by a three-round Delphi survey with a panel of 19 experts in geriatric care and pharmacotherapy. An agreement of ≥80% was required. A feasibility assessment (i.e. understandability of the items, fill-out time of the checklist) of the content-validated checklist was conducted among older adults ≥65 years (n = 87) visiting community pharmacies (n = 4). Data were analysed using qualitative content analysis. RESULTS: The final validated and feasibility-tested Medication Risk Checklist (LOTTA) for home-dwelling older adults consists of eight items screening the highest priority systemic risks (three items), potentially drug-induced symptoms (one item), adherence, and self-management problems (four items). The checklist proved feasible for self-administration, the mean fill-out time being 6.1 min. CONCLUSIONS: A wide range of potential medication risks related to the medication use process can be identified by patient self-assessment. Screening tools such as LOTTA can enhance early detection of potential medication risks and risk communication between older adults and their healthcare providers. A wider and more integrated use of the checklist could be facilitated by making it electronically available as part of the patient information systems.
Patient safety strategies highlight patients’ own active involvement in ensuring medication safety, which in turn, requires easy-to-use tools to self-assess potential medication risks and communicate them with healthcare providers.This study produced a short, age-specific eight item Medication Risk Checklist (LOTTA) to be self-administered by home-dwelling older adults to identify major systemic risks, potential drug-induced symptoms, adherence, and self-management problems related to medication taking.To facilitate the use of the checklist in early detection of potential medication risks, future studies should focus on converting the LOTTA list into electronic form and pilot its use as an integrated part of the electronic patient information system.
- Klíčová slova
- Medication therapy, older adults, patient safety, primary care, risk screening, self-management,
- MeSH
- bezpečnost pacientů MeSH
- kontrolní seznam * MeSH
- lidé MeSH
- sebezhodnocení (psychologie) * MeSH
- senioři MeSH
- zdravotnický personál MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). OBJECTIVES: To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. METHODS: Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups. RESULTS: Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner. CONCLUSIONS: The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.
- Klíčová slova
- communication, critical care, decision-making, teamwork,
- MeSH
- jednotky intenzivní péče * MeSH
- lékařský personál nemocniční MeSH
- lidé MeSH
- organizační kultura * MeSH
- rozhodování etika MeSH
- sebezhodnocení (psychologie) * MeSH
- teoretické modely MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- validační studie MeSH
OBJECTIVES: This study examines the role of personality in cognitive performance, adherence, and satisfaction with regular cognitive self-monitoring. MATERIALS AND METHODS: One hundred fifty-seven cognitively healthy older adults, age 55+, completed the 44-item Big-Five Inventory and were subsequently engaged in online monthly cognitive monitoring using the Cogstate Brief Battery for up to 35 months (M=14 mo, SD=7 mo). The test measures speed and accuracy in reaction time, visual learning, and working memory tasks. RESULTS: Neuroticism, although not related to cognitive performance overall (P>0.05), was related to a greater increase in accuracy (estimate=0.07, P=0.04) and speed (estimate=-0.09, P=0.03) on One Card Learning. Greater conscientiousness was related to faster overall speed on Detection (estimate=-1.62, P=0.02) and a significant rate of improvement in speed on One Card Learning (estimate=-0.10, P<0.03). No differences in satisfaction or adherence to monthly monitoring as a function of neuroticism or conscientiousness were observed. CONCLUSIONS: Participants volunteering for regular cognitive monitoring may be quite uniform in terms of personality traits, with personality traits playing a relatively minor role in adherence and satisfaction. The more neurotic may exhibit better accuracy and improve in speed with time, whereas the more conscientious may perform faster overall and improve in speed on some tasks, but the effects appear small.
Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from ca 1980 to ca 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca 2002 to ca 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.
- Klíčová slova
- Europe, financial crisis, health inequalities, morbidity, mortality,
- MeSH
- analýza přerušované časové série statistika a číselné údaje MeSH
- disparity zdravotní péče ekonomika statistika a číselné údaje MeSH
- disparity zdravotního stavu MeSH
- dospělí MeSH
- ekonomická recese statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- sebezhodnocení (psychologie) MeSH
- senioři MeSH
- socioekonomické faktory MeSH
- zpráva o sobě MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: Impairment of sleep and circadian rhythm is a typical feature of bipolar disorder (BD). We carried out an exploratory cross-sectional case-control study to extend the knowledge of sleep characteristics in offspring at risk for BD. METHODS: We investigated 42 offspring of bipolar parents (OB) (mean age 12.5 ± 3.2) and 42 sex and age matched comparison offspring of healthy parents. We administered the Pediatric Sleep Questionnaire, the Morningness/Eveningness Questionnaire and The General Behavior Inventory Sleep Subscale (GBISS) to assess circadian preference, and to identify sleep impairment symptoms. In addition, the participants completed 14 days of actigraphy to characterise sleep and wake patterns. The current psychopathology profile was assessed using Kiddie Schedule for Affective Disorders and Schizophrenia. RESULTS: Prevalence of sleep disturbance symptoms was higher among OB than controls (headache after waking up, 17.9% vs. 2.4%, p = 0.03; excessive daytime sleepiness, 38.5% vs. 10.0%, p = 0.004; apparent tiredness at wake-up times, 43.6% vs. 15.0%, p = 0.007 and nightmares, 21.6% vs. 2.4%, p = 0.01), but the differences between groups were not significant after adjusting for current psychopathology. OB had higher GBISS total score (parental version, p < 0.001; self-assessment, p = 0.07) than the controls. OB had higher preference for eveningness than the controls (p = 0.047). According to the actigraphy, OB had longer sleep onset latency (p = 0.048) than the controls. CONCLUSION: Evidence suggests that the offspring of bipolar parents experience sleep disturbance symptoms, which was associated with psychopathology in this study. Prospective longitudinal sleep studies would clarify whether sleep disturbance could be a predictor of mood disorder onset in this high-risk population.
- Klíčová slova
- Actigraphy, Adolescent, Bipolar disorder, Child, High-risk, Offspring, Sleep,
- MeSH
- aktigrafie MeSH
- bipolární porucha patofyziologie psychologie MeSH
- cirkadiánní rytmus MeSH
- dítě postižených rodičů psychologie MeSH
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- poruchy spánku a bdění diagnóza patofyziologie MeSH
- prospektivní studie MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- rodiče psychologie MeSH
- sebezhodnocení (psychologie) MeSH
- studie případů a kontrol MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: The subject of self-rated health status of women in fertile age has not yet been investigated in our country. As our study is longitudinal and the same questions-questionnaire items regarding self-rated health of the monitored women are repeated in each investigation phase, we are able to not only find out which factors are related but also verify how this relationship evolves with their ageing, life situation changes and growing up of their children. SETTING: Research Centre for Toxic Compounds in the Environment, Masaryk University, Brno. METHODS: Pregnant women from the Brno part of ELSPAC study rated their health status for the time period before becoming pregnant, for the first months of pregnancy and for the half of pregnancy. On the four-grade scale of self-reported health status the associations with their personal health-history (from prenatal questionnaires and prenatal and obstetrician health-care network) were investigated. RESULTS: The monitored women rated their pre-pregnancy health-status increasingly worse with increasing age and weight, increasing morbidity, increasing medicine consumption and with increasing number of injuries. Also their parents, siblings and children were more often ill and more often admitted in hospitals as in-patients. These women required more specialized care starting in their childhood, suffered more from infectious diseases, operations, injuries, stresses and break-ups of their original families. Their misunderstanding with parents was occurred with higher frequency, their upbringing was more strict, they suffered from school failures more often, they had problems with the police and premature pregnancies. According to the mothers education, especially the daughters of college educated women felt subjectively worse. Also women with basic level of education, problems at work, financial troubles, those who had many children and less adults in their household rated their health worse. They were also unemployed and dissatisfied with their housing situation. In partner relationships conflicts were present frequently including violence. They also suffered from depression, anxiety, neuroses, phobias and social isolation more often. They also attempted to become pregnant longer than other women and tolerated pregnancy worse. They noted more changes to themselves and experiences more stress. The worse their feelings were during the first months of pregnancy, the higher frequency of pregnancy difficulties, delivery pathologies and post-natal complications were present according to the health-status documentation. CONCLUSION: This paper brings a whole series of original findings of factors associated with self-rated health-status. The socio-economic position in the families of their own had a more substantial influence on the health-status of the monitored women compared to the position in the families where they grew up. The indicators - e.g. stress, social isolation, work, social support, education, income and household created gradients on the health-status scale which were overall highly significant.
- MeSH
- dospělí MeSH
- lidé MeSH
- postoj ke zdraví * MeSH
- průzkumy a dotazníky MeSH
- sebezhodnocení (psychologie) * MeSH
- socioekonomické faktory MeSH
- těhotenství * MeSH
- zdravotní stav * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství * MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
According to a recent literature review on the opioid mechanism in eating disorders, we found that there is increasing reason to re-examine the treatment potential of naltrexone. The endogenous opioid system belongs to the important modulators of food intake. The eating disorders share many traits with substance dependence models. We present two case histories of time-limited naltrexone therapy to show that, in clinical practice, individualized indication may contribute to short-term improvement and to prediction of a different long-term treatment outcome.
- MeSH
- afekt účinky léků MeSH
- alkoholismus komplikace farmakoterapie MeSH
- dospělí MeSH
- lidé MeSH
- naltrexon terapeutické užití MeSH
- narkotika - antagonisté terapeutické užití MeSH
- poruchy příjmu potravy komplikace farmakoterapie MeSH
- sebezhodnocení (psychologie) MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Názvy látek
- naltrexon MeSH
- narkotika - antagonisté MeSH
The aim of this study was to evaluate subjective health status of Łódź adult population and to determine the factors affecting their self-perception of health. The study population consisted of randomly selected 1,056 adults aged 20-74 years from L6di district. Logistic regression model was applied to assess the factors influencing the self-perception of health. More than 30% of study subjects described their health as poor or very poor. There were no statistically significant differences between men and women regarding self-perception of health (p>0.05). Older people more frequently reported their health as poor and very poor compared to those younger than 25 years of age. Four percent of men and 10% of women younger than 25 years of age described their health as poor or very poor whereas in age category 45-54 years that percentage increased to more than 40% (men RR=16.3; p<0.001, women RR=7.5; p<0.001), in 55-64 to 60% (men RR=18.6; p<0.001, women RR=10.0; p<0.001) and for people older than 64 years of age to 60% for men (RR=12.6; p<0.01) and 72% for women (RR=13.4; p<0.001). People with lower educational degree perceived their health as worse compared to those with university diploma (men RR=5.3; p<0.001; women 4.6; p<0.001). The risk of indicating the health as poor or very poor was 3.4 times higher for unemployed men comparing to employed (p<0.001) and 1.5 for unemployed women compared to employed (p>0.05). Men indicating no leisure-time physical activity significantly more frequently described their health as poor or very poor than men with satisfactory level of recreational physical activity (RR=2.2; p<0.01). Current and former smoker men described their health as worse compared to non-smokers (current smokers RR=1.5; p>0.05; former smokers RR=1.8; p>0.05). Preventive programs aimed at improving self-perceived health should concentrate on increasing recreational physical activity and elimination of smoking. Those actions should in particular target people in older age category.
- MeSH
- ambulantní zařízení MeSH
- cvičení MeSH
- dospělí MeSH
- kouření MeSH
- lidé středního věku MeSH
- lidé MeSH
- městské obyvatelstvo MeSH
- mladý dospělý MeSH
- průřezové studie MeSH
- rozhovory jako téma MeSH
- sebezhodnocení (psychologie) * MeSH
- senioři MeSH
- stupeň vzdělání MeSH
- věkové faktory MeSH
- volnočasové aktivity MeSH
- zdraví - znalosti, postoje, praxe * MeSH
- zdravotní stav * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Polsko MeSH
We examined patterns of trait similarity (assortative mating) in married couples in four cultures, using both self-reports and spouse ratings on versions of the Revised NEO Personality Inventory. There was evidence of a subtle but pervasive perceived contrast bias in the spouse-rating data. However, there was strong agreement across methods of assessment and moderate agreement across cultures in the pattern of results. Most assortment effects were small, but correlations exceeding .40 were seen for a subset of traits, chiefly from the Openness and Agreeableness domains. Except in Russia, where more positive assortment was seen for younger couples, comparisons of younger and older cohorts showed little systematic difference. This suggested that mate selection, rather than convergence over time, accounted for similarity. Future research on personality similarity in dyads can utilize different designs but should assess personality at both domain and the facet levels.
- MeSH
- charakter * MeSH
- dospělí MeSH
- dvojčata psychologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- manželé psychologie MeSH
- manželství psychologie MeSH
- mladý dospělý MeSH
- osobnostní dotazník statistika a číselné údaje MeSH
- psychometrie MeSH
- registrace MeSH
- sebezhodnocení (psychologie) MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srovnání kultur * MeSH
- výběrové chování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Intramural MeSH
- srovnávací studie MeSH
- studie na dvojčatech MeSH
- Geografické názvy
- Česká republika MeSH
- Nizozemsko MeSH
- Rusko MeSH
- Spojené státy americké MeSH
BACKGROUND: The aim of our study was to evaluate the efficacy of electroconvulsive (ECT) and venlafaxine therapy from the patient's point of view. METHODS: We used a retrospective chart review from 22 inpatients who underwent ECT and 22 patients treated with venlafaxine due to resistant unipolar or bipolar depression. We used bilateral ECT in a median of 8 (IQR 7-9.7) sessions and venlafaxine therapy with a median daily dosage of 225 mg (IQR 150-225 mg) for a median of 4 (IQR 4-5) weeks. The main outcome was change in a self-evaluation scale - Short Form of the Beck Depression Inventory (BDI-SF). The response was defined as the decreasing of the BDI-SF score by >or=50%, remission as decreasing of BDI-SF score
- MeSH
- antidepresiva druhé generace terapeutické užití MeSH
- cyklohexanoly terapeutické užití MeSH
- depresivní poruchy psychologie terapie MeSH
- dospělí MeSH
- elektrokonvulzívní terapie psychologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- psychiatrické posuzovací škály MeSH
- retrospektivní studie MeSH
- sebezhodnocení (psychologie) MeSH
- spokojenost pacientů * MeSH
- stupeň závažnosti nemoci MeSH
- venlafaxin hydrochlorid MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Názvy látek
- antidepresiva druhé generace MeSH
- cyklohexanoly MeSH
- venlafaxin hydrochlorid MeSH
