Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder (PTSD) in women as a result of their labor and delivery experiences, and identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Four to six weeks postpartum, telephone interviews were conducted with participants (n = 499) and explored the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables were not found to contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = .351, p <.0001) and the perception of inadequate intrapartum care (beta = .319, p <.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder following childbirth is an under-recognized phenomenon. Women who experienced both a high level of obstetric intervention and were dissatisfied with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. Such findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the psychological care provided to birthing women.

No description available.

BACKGROUND AND PURPOSE OF RESEARCH: Nigeria’s National Health Insurance Scheme (NHIS) was setup to secure universal access to affordable quality care. However, after 11yrs, and despite launching different programs, NHIS coverage is still less than 3% nationally, and out-of-pocket payments (OOP) remain the major health financing mechanism. The reasons for the low level of enrollment in NHIS are not well understood. Quality of care may be a factor in enrolment. This study compares technical and perceived quality of care between NHIS enrollees and the uninsured, using diabetes as a tracer condition. It also compares OOP and generic prescription patterns by health insurance enrollment status. METHODS: We conducted a cross sectional clinic-based intercept study. Subjects were adult diabetes patients recruited from 10 NHIS accredited hospitals in Abuja, Nigeria. Data collection included survey and chart review, covering technical aspects of quality – performance of eye and feet exam and HbA1c request; perception of quality, generic medication prescribing pattern and OOP. We performed logistic regression analysis to evaluate the effect of NHIS enrollment status on the technical quality of care, perceived quality of care, generic prescribing and OOP. RESULTS: Out of 455 participants, 149 (33%) were NHIS enrollees, 10 (2%) were enrolled in private health insurance and 296 (65%) had no insurance. After adjusting for correlated data and controlling for facility, BMI, chronic disease score, age, sex, and education, patients under NHIS coverage were 0.85 times less likely to have eye exam (Cl=0.4–1.8), 0.98 times less likely to have feet exam (Cl= 0.4–2.2), and 0.98 times less likely to have A1c test requested (Cl= 0.7–1.3), compared to those without insurance. These findings were not statistically significant at alpha=0.05. On the other hand, compared to the uninsured, NHIS covered patients perceived care to be worse even though they spent significantly less, 56% (Cl=45%–69%) in OOP in public hospitals. DISCUSSION/CONCLUSION: Perception of care quality under the NHIS could be a contributory factor to the reluctance of prospective enrollees. To advance towards the goal of universal health coverage, NHIS must strengthen policy to overcome identified barriers such as medication stock outs and wait times at the facility level.

Musculoskeletal complaints are one of the most common reasons for visits to medical and chiropractic professionals in the United States, and spine-related symptoms in particular comprise the largest share of these complaints. Spine-related conditions increase as people age, having implications for rising disability and consequent spending by Medicare and Medicaid on increased health services use and long-term services and support. Chiropractic is one type of treatment used by older adults with these types of health problems. Covered by Medicare since 1972, chiropractic spinal manipulation is allowed for the express purpose to arrest the progression of functional decline or restore and possibly improve patient function. No studies, however, have examined whether chiropractic use by Medicare beneficiaries has indeed arrested functional decline, delayed disability, or restored health. The purpose of this dissertation research is to examine the comparative effectiveness of chiropractic use relative to no treatment and alternative medical care on the health and functional trajectories of community-dwelling older adults. I also examine the comparative effect of chiropractic on satisfaction with care. This is accomplished through the use of two longitudinal surveys with representative Medicare populations linked to Medicare provider claims. The first analysis examines the long-term comparative effect of chiropractic relative to no use and alternative care on functional decline, self-rated health decline, and the onset of additional depressive symptoms in a cohort of older Medicare beneficiaries, both with and without back conditions. The second study examines the effect of chiropractic compared to medical only episodes of care on health and functional decline in an older adult population with uncomplicated back conditions over a two-year period. The third and final study examines the comparative effect of chiropractic relative to medical care only on one-year changes in function, self-rated health, and satisfaction with care in a nationally representative age-eligible Medicare population with spine-related musculoskeletal conditions. Study results suggest that chiropractic has a consistently protective effect when compared to routine alternative medical care against decline in function among older adults with spine-related conditions, both over the long-term and the short-term. Chiropractic also has a comparative protective effect against decline in self-rated health in the short-term, but has no differential effect on the onset of depressive symptoms either in the short-term or long-term . Medicare beneficiaries using chiropractic for spine-related health conditions are relatively more satisfied than those using medical care only with the information provided to them about their condition, and with follow-up care provided after the initial visit. This research is the first of its kind to examine the comparative effectiveness of chiropractic relative to other usual sources of care for Medicare beneficiaries, in general and specifically among those with spine-related conditions, finding that chiropractic use has a comparatively beneficial effect on function, health, and satisfaction with care. The results have important policy implications for clinicians, patients, and Medicare because of the potential to shift clinical practice away from technologically intense and expensive treatments toward therapies like chiropractic spinal manipulation that demonstrate a comparative advantage in preserving health and function among older adults.

In response to the presence of health disparities among a diverse population of older adults, creating culturally competent health care services has emerged as a possible method to help reduce and eventually eliminate inequalities in health care. However, little information exists concerning the effectiveness of cultural competence, and even less is known about how culturally competent clients perceive their providers to be. This dissertation examined a number of indicators related to cultural competence, including the predictors of client-provider racial/ethnic concordance, client perceptions of the interpersonal sensitivity of their health care providers, and the overall satisfaction with care reported by older Non-Hispanic White, African American/Black, Hispanic/Latino, and Asian American adults. In order to accomplish these aims, three related studies were conducted, all drawing on data from the Commonwealth Fund 2001 Health Care Quality Survey. The first study focused on the factors that predicted racial/ethnic concordance between clients and their health care providers. The second study examined several factors that can affect the clients’ perception of their providers’ interpersonal sensitivity, including client-provider racial/ethnic concordance. The third and final analysis utilized the outcome variables from the two previous studies, in addition to the client-level variables, to determine which factors predicted satisfaction with care received. The results show that the factors that predicted client-provider racial/ethnic concordance and perceived interpersonal sensitivity varied across the four groups. In addition, perceived interpersonal sensitivity was a significant predictor of satisfaction with care for all four of the groups. The findings from this dissertation contribute to a broader understanding of racial/ethnic differences in client-provider racial/ethnic concordance, perceptions of interpersonal sensitivity, and overall satisfaction with care among older adults from racially and ethnically diverse backgrounds.

Contexte : Les troubles liés à l’usage des substances psychoactives constituent une priorité de santé publique dans le champ des pathologies chroniques. Les indicateurs de type Patient-Reported Outcomes (PRO) offrent des perspectives complémentaires aux indicateurs classiques pour la mesure de l’état de santé des patients et l’appréciation de la qualité des soins. Objectifs : Étudier les propriétés psychométriques de questionnaires de qualité de vie (QV) et les déterminants de la satisfaction précoce vis-à-vis des soins ambulatoires de patients dépendants aux substances de type alcool ou opiacés. Méthode : Les caractéristiques des patients et des médecins ont été recueillies à l’inclusion dans la cohorte SUBUSQOL. La satisfaction précoce a été mesurée quinze jours après la première consultation et ses déterminants ont été testés dans des modèles de régression linéaires multivariés. Les propriétés psychométriques du questionnaire spécifique Q-LES-Q-SF ont été étudiées au préalable sur un échantillon de patients. Résultats : La version française du Q-LES-Q-SF constitue un outil unidimensionnel robuste et fiable, les items du SF-12 et Q-LES-Q-SF présentent peu ou pas de fonctionnement différentiel selon l’âge, le sexe, le niveau d’éducation et le type d’addiction. Peu de variables recueillies sont associées à la satisfaction. Les patients dépendants à l’alcool se révèlent être plus satisfaits des modalités de contact et du délai de rendez-vous et ceux sans aucun antécédent de prise en charge pour leur dépendance plus satisfaits de leur consultation avec le médecin. Conclusion : Les questionnaires SF-12 et Q-LES-Q-SF peuvent être utilisés dans des populations de patients suivis en ambulatoire pour une dépendance aux substances psychoactives / Context: Of chronic diseases, substance use disorders are a public health priority. Patient-reported outcome indicators (PRO) offer additional insights into the classical indicators used to measure the patient’s health status and appreciation of their quality of care. Objectives: to study the psychometric properties of quality of life instruments and to study the determinants of early outpatient satisfaction with ambulatory care in alcohol- or opiate-dependent patients. Method: Patient and physician characteristics were collected in the SUBUSQOL cohort. Early satisfaction with care was measured fifteen days after the first consultation. The determinants of satisfaction were tested using multivariate linear models of regression. Prior data on the self-reported health status of a sample of alcohol- or opiate-dependent outpatients were used to investigate the psychometric properties of a specific questionnaire, the Q-LES-Q-SF. Results: Our results establish that the French version of the Q-LES-Q-SF is a unidimensional, valid and reliable instrument of self-reported health status assessment for use in care or medical research and that few items of the SF-12 and the Q-LES-Q-SF displayed differential functioning according to age, sex, educational level and type of substance use disorder. Our results show that few variables are associated with the level of patient satisfaction. Alcohol dependence was strongly associated with higher satisfaction with appointment making, and patients with no history of previous care for substance use disorders had a higher level of satisfaction with the doctor consultation. Conclusion: The use of the SF-12 and the Q-LES-Q-SF is recommended for outpatients suffering from substance use disorders

<h1>Abstract</h1><p><strong>Background: </strong>Pain is usually common patients who undergo high-dose treatment in combination with HSCT. Pain is usually associated with side effects as for example mucositis. The purpose of this study was to examine patients’ experiences of pain in relation to stemcellstransplantation. The purpose was also to examine how patients experience that they have been treated by the personnel regarding their pain, and also if the pain relief correspond to the patients expectations.</p><p><strong>Method: </strong>The study is a descriptive, longitudinal study. Eight patients who underwent HSCT were interviewed. The study implemented in three parts, whereof two interviews and one questionnaire. The interview material was analyzed by means of content analysis.</p><p><strong>Results: </strong>The result shows that five of eight patients experienced pain during HSCT treatment. Three of these informants experienced pain in their mouth, their head and in their stomach. This is usually commonly side effects of the treatment. Back pain occurs in two of the patients and this pain hasn’t proceeded during the treatment.</p><p>Three informants did not experience any pain at all during the time of nursing. The result even shows that the all of the informants had experienced a well refutation of the personnel in terms of their pain. All informants reported that it was important to be well pain relieved. Those informants who had pain during their treatment were very satisfied with the pain relief they have got.</p><p><strong> </strong></p><p><strong>Keywords: </strong>stem cell transplantation, oral pain, pain treatment, oral mucositis, satisfaction with care.</p> / <p> </p><h1>Sammanfattning</h1><p><strong>Bakgrund och syfte: </strong>Smärta är vanligt förekommande bland patienter som genomgår högdosbehandling i kombination med HSCT. Smärta är vanligtvis förknippad med biverkningar som t ex mucosit. Syftet med denna studie var att undersöka patienters upplevelse av smärta i samband med stamcellstransplantation. Syftet är även att undersöka hur patienterna upplever att de blir bemötta av personalen angående sin smärta, samt om smärtlindringen motsvarar patientens förväntningar.</p><p><strong>Metod:</strong> Studien är en deskriptiv, longitudinell studie. Åtta patienter som skulle genomgå stamcellstransplantation intervjuades. Studien genomfördes i tre delar, varav två intervjuer och ett frågeformulär. Intervjumaterialet analyserades med innehållsanalys.</p><p><strong>Resultat:</strong> Resultatet visar att fem av åtta patienter upplevde smärta i samband med HSCT. Tre av dessa informanter upplevde smärtor i munnen, huvudet och i magen. Ryggsmärta förekom hos två av informanterna och denna smärta hade inte uppstått i samband med behandlingen. Tre informanter upplevde ingen smärta alls under hela vårdtiden. Resultatet visar även att samtliga informanter upplevt ett bra bemötande av personalen vad gäller deras smärta. Alla informanter uppgav att det var viktigt att vara bra smärtlindrad. De informanter som hade smärta under behandlingen var mycket nöjda med den smärtlindring de fick.</p><p><strong> </strong></p><p><strong>Nyckelord: </strong>stamcellstransplantation, oral smärta, smärtbehandling, oral mucosit, tillfredsställelse med vård.</p>

Background: It is a well-known phenomenon that nurses and other oncology staff have a tendency to ascribe patients with cancer more problems and suffering than the patients themselves report. Aim: The overall aim of the present thesis was therefore to gain increased knowledge and understanding of dis/agreement between patients with cancer and nurses regarding their perception of patients’ situation and of the importance of patient-nurse dis/agreement in clinical practice. Methods: A prospective comparative design was used. Data were collected from a sample of 90 consecutively recruited patient-nurse pairs. Each pair consisted of a patient with cancer, newly admitted to a ward, and a nurse responsible for that patient’s care. Data were collected from the pairs with corresponding self-administrated questionnaires on two occasions: directly after the admission interview and on the patient’s third day on the ward. Results: At the group level, a distinct pattern was shown in which nurses ascribed the patients more emotional distress, less coping resources and a lower quality of life than the patients themselves reported. In short, the results revealed the following clinical importance of patient-nurse dis/agreement. With respect to how nurses act in relation to their perceptions of patients’ emotional distress, patient-nurse dis/agreement did not seem to be important; with few exceptions, nurses’ implemented care did not differ when it was directed at more as compared to less distressed patients. Further, nurses’ general tendency to overestimate cancer patients’ problems and suffering had no influence on patients’ satisfaction with received care and nurses’ satisfaction with provided care. However, patients cared for by nurses who underestimated their level of depression were less satisfied with those nurses’ care. In addition, the more frequently the nurse had implemented care characterized by a trusting relationship, the higher patients’ and nurses’ satisfaction with received/provided care. Conclusions: Initial patient-nurse dis/agreement concerning patients’ situation appears to be of little significance to nurses’ caring behaviour and to patients’ and nurses’ subsequent evaluation of received and provided care.

Abstract Background: Pain is usually common patients who undergo high-dose treatment in combination with HSCT. Pain is usually associated with side effects as for example mucositis. The purpose of this study was to examine patients’ experiences of pain in relation to stemcellstransplantation. The purpose was also to examine how patients experience that they have been treated by the personnel regarding their pain, and also if the pain relief correspond to the patients expectations. Method: The study is a descriptive, longitudinal study. Eight patients who underwent HSCT were interviewed. The study implemented in three parts, whereof two interviews and one questionnaire. The interview material was analyzed by means of content analysis. Results: The result shows that five of eight patients experienced pain during HSCT treatment. Three of these informants experienced pain in their mouth, their head and in their stomach. This is usually commonly side effects of the treatment. Back pain occurs in two of the patients and this pain hasn’t proceeded during the treatment. Three informants did not experience any pain at all during the time of nursing. The result even shows that the all of the informants had experienced a well refutation of the personnel in terms of their pain. All informants reported that it was important to be well pain relieved. Those informants who had pain during their treatment were very satisfied with the pain relief they have got.   Keywords: stem cell transplantation, oral pain, pain treatment, oral mucositis, satisfaction with care. / Sammanfattning Bakgrund och syfte: Smärta är vanligt förekommande bland patienter som genomgår högdosbehandling i kombination med HSCT. Smärta är vanligtvis förknippad med biverkningar som t ex mucosit. Syftet med denna studie var att undersöka patienters upplevelse av smärta i samband med stamcellstransplantation. Syftet är även att undersöka hur patienterna upplever att de blir bemötta av personalen angående sin smärta, samt om smärtlindringen motsvarar patientens förväntningar. Metod: Studien är en deskriptiv, longitudinell studie. Åtta patienter som skulle genomgå stamcellstransplantation intervjuades. Studien genomfördes i tre delar, varav två intervjuer och ett frågeformulär. Intervjumaterialet analyserades med innehållsanalys. Resultat: Resultatet visar att fem av åtta patienter upplevde smärta i samband med HSCT. Tre av dessa informanter upplevde smärtor i munnen, huvudet och i magen. Ryggsmärta förekom hos två av informanterna och denna smärta hade inte uppstått i samband med behandlingen. Tre informanter upplevde ingen smärta alls under hela vårdtiden. Resultatet visar även att samtliga informanter upplevt ett bra bemötande av personalen vad gäller deras smärta. Alla informanter uppgav att det var viktigt att vara bra smärtlindrad. De informanter som hade smärta under behandlingen var mycket nöjda med den smärtlindring de fick.   Nyckelord: stamcellstransplantation, oral smärta, smärtbehandling, oral mucosit, tillfredsställelse med vård.

Syftet för föreliggande studie var att undersöka olika sätt att organisera primärvårdens om- händertagande av patienter med psykisk ohälsa och hur det påverkar patienters nöjdhet med vården. Studiens frågeställningar syftade att undersöka 1) skillnader i nöjdhet mellan patienter som erbjuds sedvanlig Integrerad Beteendehälsa (IBH) med Brief Interventions (BI) och de som får utökad bedömning med vägledd självhjälp 2) om patienters vardagliga funktion förbättras och om förbättringen har ett samband med deras upplevelse av nöjdhet 3) hur vanligt negativa upplevelser är inom behandlingsmetoderna. Av 41 randomiserade primärvårdspatienter kunde 30 analyseras utifrån deras upplevda nöjdhet inom vården. Båda grupperna var i genomsnitt nöjda med vården och skattade besöken som hjälpsamma. Patienter som efter utökad bedömning fick vägledd självhjälp skattade tidigt i behandlingen högre grad av nöjdhet och den skillnaden kvarstod. Det fanns en signifikant förändring av vardaglig funktion till det bättre för patientgruppen som helhet, men förändringen korrelerade inte signifikant med nöjdhet. Det fanns en tydlig skillnad i antal rapporterade negativa upplevelser. 14 negativa upplevelser rapporterades av patienter som fått Brief Interventions, medan en negativ upplevelse rapporterades av patienterna som fått vägledd självhjälp. Slutsatser från föreliggande studie bekräftar tidigare forskning kring att nöjdhet går att uppfylla med kortare behandlingsinterventioner samt strukturerade behandlingar. / The purpose of the present study was to examine different ways of organizing primary care for patients with general mental disorders, and how the treatment affects the patient’s satisfaction with the care. The study aimed to examine 1) if there is a difference in patient satisfaction between patients offered brief interventions within the primary care behavior health model, and patients offered an extended assessment with guided self help 2) if the patients everyday function improves and correlates with their experience of satisfaction 3) how common adverse events are within the two treatment methods. Out of 41randomized primary care patients, 30 could be analyzed based on their perceived satisfaction in health care. The result showed that both treatment groups were overall satisfied with the care and estimated the care visits as helpful. Patients who received guided self-help estimated a higher degree of satisfaction earlier in the treatment, and the level of satisfaction remained high throughout the treatment. Regarding the patient group as a whole, there was a significant change in everyday function; the patients improved their everyday function although it did not correlate with satisfaction. There was a significant difference in the number of adverse events between the two treatment groups. 14 adverse events were reported from patients who received Brief Interventions and 1 adverse event was reported from a patient who received guided self-help. Conclusions from the present study confirm findings from previous research that it is possible to achieve patient satisfaction with brief treatment interventions and structured treatment plans.