Determinants of patients' expectations about total knee arthroplasty outcomes

Knee osteoarthritis (OA) is the most prevalent form of arthritis in the US, affecting approximately 37% of adults. Approximately 300,000 total knee arthroplasty (TKA) procedures take place in the United States each year. Total knee arthroplasty is an elective procedure available to patients as an irreversible treatment after failure of previous medical treatments. Some patients sacrifice quality of life and endure many years of pain before making the decision to undergo total knee replacement. In making their decision, it is therefore imperative for patients to understand the procedure, risks and surgical outcomes to create realistic expectations and increase outcome satisfaction. ^ From 2004-2007, 236 OA patients who underwent TKA participated in the PEAKS (Patient Expectations About Knee Surgery) study, an observational longitudinal cohort study, completed baseline and 6 month follow-up questionnaires after the surgery. We performed a secondary data analysis of the PEAKS study to: (1) determine the specific presurgical patient characteristics associated with patients’ presurgical expectations of time to functional recovery; and (2) determine the association between presurgical expectations of time to functional recovery and postsurgical patient capabilities (6 months after TKA). We utilized the WOMAC to measure knee pain and function, the SF-36 to measure health-related quality of life, and the DASS and MOS-SSS to measure psychosocial quality of life variables. Expectation and capability measures were generated from panel of experts. A list of 10 activities was used for this analysis to measure functional expectations and postoperative functional capabilities. ^ The final cohort consisted of 236 individuals, was predominately White with 154 women and 82 men. The mean age was 65 years. Patients were optimistic about their time to functional recovery. Expectation time of being able to perform the list activities per patient had a median of less than 3 months. Patients who expected to be able to perform the functional activities by 3 months had better knee function, less pain and better overall health-related quality of life. Despite expectation differences, all patients showed significant improvement 6 months after surgery. Participant expectation of time to functional recovery was not an independent predictor of capability to perform functional activities at 6 months. Better presurgical patient characteristics were, however, associated with a higher likelihood of being able to perform all activities at 6 months. ^ This study gave us initial insight on the relationship between presurgical patient characteristics and their expectations of functional recovery after total knee replacement. Future studies clarifying the relationship between patient presurgical characteristics and postsurgical functional capabilities are needed.^

Women physicians' specialty choices

Three hypotheses have been offered to explain the historical specialty selection by women physicians. They are: (1) women choose the specialty for which the training requirements and working conditions interfere least with their commitments to marriage and children; (2) women tend to select the more "feminine" specialties such as pediatrics and psychiatry, and to avoid the "masculine" fields such as surgery; and (3) women have been deliberately excluded from male-dominated fields such as surgery. While the above hypotheses may be true to a greater or lesser degree, none of them has been adequately tested.^ The major study hypotheses are as follows: (1) female physicians' choice of specialty is influenced by the following reasons: (a) family responsibilities; (b) sex role expectations; and (c) sex discrimination; (2) female physicians' choice of specialty is also influenced by their age and ethnicity; and (3) the primary reasons for choosing a given specialty vary by type of specialty.^ The reasons for specialty selection will be explored based on a survey of women graduates of one of the oldest medical schools in the United States, The University of Texas Medical Branch (UTMB) in Galveston, Texas (n = 930). The survey response rate was 75.3% (700 respondents).^ The results for the first study hypothesis showed that fewer than 14% of the respondents agreed that sex role expectations, sex discrimination and family responsibilities played a role in their choice of specialty. Fifty nine percent of the respondents disagreed with the idea that sex role expectations influenced specialty selection and 64% disagreed that family responsibilities had an effect on the selection of their specialty. Around half (49%) were uncertain of the influence of sex discrimination. It was concluded that sex discrimination, sex role expectations and family responsibilities did not have a major impact on specialty selection.^ With respect to the second hypothesis, age was significant in Internal Medicine, Obstetrics/Gynecology and Psychiatry. Women physicians in Internal Medicine and Obstetrics/Gynecology were significantly younger (less than 45 years old) while physicians in Psychiatry were significantly older (45 years or older) than other specialties studied.^ The third hypothesis was confirmed: the reasons for choosing a given specialty varied by specialty.^ Respondents' comments written on the survey provided insight into other possible reasons for specialty selection including exploration of the role of mentoring and job satisfaction.^ The retrospective cross-sectional study design used in this study does not adequately capture the fact that different reasons may be given for the choice of specialty at different points in time, e.g., as the time of choosing a residency program versus several years into the future.^ In conclusion, approaches that explore the range of reasons that women elect to enter and stay within a given specialty must be explored to gain richer understanding of the complex and dynamic nature of women physicians' professional lives. (Abstract shortened by UMI.) ^

FAMILY MEDICINE RESIDENT SURVEY ON HEALTH PROMOTION (PERSONAL EXPECTATIONS, BEHAVIORS, PERCEIVED SELF-EFFICACY, COGNITIVE ASSESSMENT, OUTCOME EXPECTANCY)

This study was designed to test the theoretical predictors of personal efficacy expectations among family medicine resident physicians for helping their patients change thirteen high risk health behaviors. A survey questionnaire was sent to 781 family medicine residents in the six state south central region. The response rate was 60 percent. The hypothesized relationship between lower levels of difficulty and higher personal efficacy expectations was supported by the data. Effort was a significant predictor of perceived self efficacy for health behaviors considered less difficult to change. Situational support did not prove to be a significant predictor for many of the health behaviors. Rate and pattern of success were consistent and significant predictors of perceived self efficacy for helping patients change all thirteen of the health behaviors. Modeling of effective methods by faculty was a significant predictor of efficacy expectations for several but not all of the behaviors. Personal modeling was a significant predictor of perceived efficacy for helping patients change behaviors related to alcohol misuse and exercise. The respondents personally modeled positive health behaviors more consistently than their older colleagues or the general population.^ The results of this study lend substantially to the usefulness of the cognitive-behavioral theory of perceived self efficacy and provide a mechanism for assessing the predictors of personal efficacy expectations of family medicine resident physicians. The findings are expected to have direct implications for faculty to institute systematic programs of interventions designed to increase residents' perceptions of efficacy in facilitating more positive health behaviors among their patients. ^

A feasibility study for assessing building occupants' indoor air quality expectations compared to nationally recognized standards

Indoor Air Quality (IAQ) can have significant implications for health, productivity, job performance, and operating cost. Professional experience in the field of indoor air quality suggests that high expectations (better than nationally established standards) (American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE)) of workplace indoor air quality lead to increase air quality complaints. To determine whether there is a positive association between expectations and indoor air quality complaints, a one-time descriptive and analytical cross-sectional pilot study was conducted. Area Safety Liaisons (n = 330) at University of Texas Health Science Center – Houston were asked to answer a questionnaire regarding their expectations of four workplace indoor air quality indicators i.e., (temperature, relative humidity, carbon dioxide, and carbon monoxide) and if they experienced and reported indoor air quality problems. A chi-square test for independence was used to evaluate associations among the variables of interest. The response rate was 54% (n = 177). Results did not show significant associations between expectation and indoor air quality. However, a greater proportion of Area Safety Liaisons who expected indoor air quality indicators to be better than the established standard experienced greater indoor air quality problems. Similarly, a slightly higher proportion of Area Liaisons who expected indoor air quality indicators to be better than the standard reported greater indoor air quality complaints. ^ The findings indicated that a greater proportion of Area Safety Liaisons with high expectations (conditions that are beyond what is considered normal and acceptable by ASHRAE) experienced greater indoor air quality discomfort. This result suggests a positive association between high expectations and experienced and reported indoor air quality complaints. Future studies may be able to address whether the frequency of complaints and resulting investigations can be reduced through information and education about what are acceptable conditions.^

Fathering Behavior within the Context of Role Expectations and Marital Satisfaction: Framework for Studying Fathering Behavior

A father’s participation in a child’s life has been regarded as a significant factor in the enhancement of a couple’s relationship. Although the investigations between paternal behavior and marital satisfaction come with mixed results, they clearly link the concepts of maternal and paternal role expectations to paternal behavior, which can be also moderated by earner status, child’s gender, and traditional versus contemporary role expectations. Research needs to focus on examining how individuals’ perceptions of role expectations relate to fathers’ actual parenting behavior. Therefore, a framework that outlines the interaction between and among these variables is developed, as supported by recent literature as a guide for future research directives.

Knowledge and Expectations of Support People in Prenatal Genetic Counseling Sessions

Prenatal genetic counseling patients have the ability to choose from a myriad of screening and diagnostic testing options, each with intricacies and caveats regarding accuracy and timing. Decisions regarding such testing can be difficult and are often made on the same day that testing is performed. Therefore, it is reasonable to consider that the support people brought to an appointment may have a role in the decision-making process. We aimed to better define this potential role by examining the incoming knowledge and expectations of support people who attended prenatal genetic counseling appointments. Support people were asked to complete a survey at one of seven Houston area prenatal clinics. The survey included questions regarding demographics, relationship to patient, incoming knowledge of the appointment, expectations of decision-making and perceived levels of influence over the decisions that would be made during the counseling session. The majority (79.4%) of the 252 participants were spouses/partners. Overall, there was poor knowledge of the referral indications with only 33.5% of participants correctly identifying the patient’s indication. Participants had even poorer knowledge of testing options that would be offered during the session, as only 17.7% were able to correctly identify testing options that would be discussed during the genetic counseling session. Of participants, just 3.6% said that they did not want to be included in discussions about screening/testing options. Only a few participants thought that they had less influence over decisions related to the pregnancy than over non-pregnancy decisions. Participants who reported feeling like they had a higher level of influence were likely to attend more of the pregnancy-related appointments with the patient. Findings from this study have provided insight into the perspective of support persons and have identified gaps in knowledge that may exist between the patients and the people they choose to bring with them into the genetic counseling session. In addition, this study is a starting point to assess how much the support people think that they impact the decision-making process of prenatal genetic counseling patients versus how much the prenatal patients value the input of the support people.

Relationships among epilepsy self-management, health outcomes, and socioeconomic status

The purpose of this study was to investigate the association between epilepsy self-management and disease control and socio-economic status. Study participants were adult patients at two epilepsy specialty clinics in Houston, Texas that serve demographically and socioeconomically diverse populations. Self-management behaviors- medication, information, safety, seizure, and lifestyle management were tested against emergency room visits, hospitalizations, and seizure occurrence. Overall self-management score was associated with a greater likelihood of hospitalizations over a prior twelve month time frame, but not for three months, and was not associated with seizure occurrence or emergency room visits, at all. Scores on specific self-management behaviors varied in their relationships to the different disease control indicators, over time. Contrary to expectations based on the findings of previous research, higher information management scores were associated with greater likelihood of emergency room visits and hospitalizations, over the study's twelve months. Higher lifestyle management scores were associated with lower likelihood of any emergency room visits, over the preceding twelve months and emergency room visits for the last three months. The positive associations between overall self-management scores and information management behaviors and disease control are contrary to published research. These findings may indicate that those with worse disease control in a prior period employ stronger self-management efforts to better control their epilepsy. Further research is needed to investigate this hypothesis.^

Violencia de género : Descripción y resultados de una investigación sobre mujeres golpeadas

La Cátedra "Fundamentos, Técnicas e Instrumentos de la Exploración Psicológica II" inició en el año 2006 una Investigación titulada: Violencia: Mujer golpeada. Delimitación de estructura psíquica mediante Técnicas Proyectivas. El rastreo bibliográfico nos permitió delimitar dos líneas explicativas que giran alrededor de esta situación, a saber: a) Una correspondiente a la línea psico - socio - económica. b) La otra centrada psicoanalíticamente sobre la estructura y dinámica psíquica de las mujeres que son golpeadas (deslindando las situaciones extremas de la perversión y las que corresponden a las costumbres de tipo cultural). La primera línea no satisface nuestras expectativas, ya que nos dan razones suficientes, pero no necesarias. Se asientan en lo que hemos dado en llamar "Teoría de la escasez" (falta de recursos, de afectos y de red social), pero sabemos que no es necesario que estas "faltas" se encuentren presentes para que una mujer sea golpeada. La segunda línea explicativa en cambio, nos permitió hipotetizar que "algo de la estructura psíquica debía estar en juego." Esto nos llevó a implementar una Batería de Técnicas Proyectivas para investigar estructuras psíquicas, la cual aplicamos a un grupo de casos obtenido de población urbana, de distintas edades, clases sociales y nivel educacional. Obteniendo hasta el momento indicadores que nos hablan de una indefensión yoica. Prevaleciendo las defensas maníacas reveladas como idealización del otro, negación e identificación con el agresor

Norma estándar y variedad rioplatense en instrumentos de gramatización

En el marco de las políticas lingüísticas, el trabajo analiza los discursos sobre el español como lengua estándar subyacentes en los diversos instrumentos de gramatización (Auroux, 1992) destinados a regular los usos lingüísticos en el ámbito hispanoamericano. Postula la hipótesis de que las políticas lingüísticas alentadas desde las Academias de la Lengua y las diversas instancias de difusión del estándar llamado panhispánico acuden al espíritu de unidad y homogeneidad lingüística presente desde los inicios de los discursos sobre el español afectando el prestigio de los estándares regionales. A partir de esta hipótesis, sostiene que las actuales expectativas de homogeneidad e intercomprensibilidad lingüística expresadas tanto en diccionarios, manuales de estilo o gramáticas como en los medios de comunicación olvidan que los estándares regionales paralelos a ese español globalizado no siempre cuentan con una vía de enseñanza formal que los valide y los prestigie frente a la variedad transnacional. Para verificar la plausibilidad de esta hipótesis, analizamos diccionarios de la RAE y Panhispánico de Dudas y manuales escolares de enseñanza de español, entre otros instrumentos; allí identificamos la construcción de las nociones de norma estándar, español transnacional y dialecto

Violencia de género : Descripción y resultados de una investigación sobre mujeres golpeadas

La Cátedra "Fundamentos, Técnicas e Instrumentos de la Exploración Psicológica II" inició en el año 2006 una Investigación titulada: Violencia: Mujer golpeada. Delimitación de estructura psíquica mediante Técnicas Proyectivas. El rastreo bibliográfico nos permitió delimitar dos líneas explicativas que giran alrededor de esta situación, a saber: a) Una correspondiente a la línea psico - socio - económica. b) La otra centrada psicoanalíticamente sobre la estructura y dinámica psíquica de las mujeres que son golpeadas (deslindando las situaciones extremas de la perversión y las que corresponden a las costumbres de tipo cultural). La primera línea no satisface nuestras expectativas, ya que nos dan razones suficientes, pero no necesarias. Se asientan en lo que hemos dado en llamar "Teoría de la escasez" (falta de recursos, de afectos y de red social), pero sabemos que no es necesario que estas "faltas" se encuentren presentes para que una mujer sea golpeada. La segunda línea explicativa en cambio, nos permitió hipotetizar que "algo de la estructura psíquica debía estar en juego." Esto nos llevó a implementar una Batería de Técnicas Proyectivas para investigar estructuras psíquicas, la cual aplicamos a un grupo de casos obtenido de población urbana, de distintas edades, clases sociales y nivel educacional. Obteniendo hasta el momento indicadores que nos hablan de una indefensión yoica. Prevaleciendo las defensas maníacas reveladas como idealización del otro, negación e identificación con el agresor

Norma estándar y variedad rioplatense en instrumentos de gramatización

En el marco de las políticas lingüísticas, el trabajo analiza los discursos sobre el español como lengua estándar subyacentes en los diversos instrumentos de gramatización (Auroux, 1992) destinados a regular los usos lingüísticos en el ámbito hispanoamericano. Postula la hipótesis de que las políticas lingüísticas alentadas desde las Academias de la Lengua y las diversas instancias de difusión del estándar llamado panhispánico acuden al espíritu de unidad y homogeneidad lingüística presente desde los inicios de los discursos sobre el español afectando el prestigio de los estándares regionales. A partir de esta hipótesis, sostiene que las actuales expectativas de homogeneidad e intercomprensibilidad lingüística expresadas tanto en diccionarios, manuales de estilo o gramáticas como en los medios de comunicación olvidan que los estándares regionales paralelos a ese español globalizado no siempre cuentan con una vía de enseñanza formal que los valide y los prestigie frente a la variedad transnacional. Para verificar la plausibilidad de esta hipótesis, analizamos diccionarios de la RAE y Panhispánico de Dudas y manuales escolares de enseñanza de español, entre otros instrumentos; allí identificamos la construcción de las nociones de norma estándar, español transnacional y dialecto

Violencia de género : Descripción y resultados de una investigación sobre mujeres golpeadas

La Cátedra "Fundamentos, Técnicas e Instrumentos de la Exploración Psicológica II" inició en el año 2006 una Investigación titulada: Violencia: Mujer golpeada. Delimitación de estructura psíquica mediante Técnicas Proyectivas. El rastreo bibliográfico nos permitió delimitar dos líneas explicativas que giran alrededor de esta situación, a saber: a) Una correspondiente a la línea psico - socio - económica. b) La otra centrada psicoanalíticamente sobre la estructura y dinámica psíquica de las mujeres que son golpeadas (deslindando las situaciones extremas de la perversión y las que corresponden a las costumbres de tipo cultural). La primera línea no satisface nuestras expectativas, ya que nos dan razones suficientes, pero no necesarias. Se asientan en lo que hemos dado en llamar "Teoría de la escasez" (falta de recursos, de afectos y de red social), pero sabemos que no es necesario que estas "faltas" se encuentren presentes para que una mujer sea golpeada. La segunda línea explicativa en cambio, nos permitió hipotetizar que "algo de la estructura psíquica debía estar en juego." Esto nos llevó a implementar una Batería de Técnicas Proyectivas para investigar estructuras psíquicas, la cual aplicamos a un grupo de casos obtenido de población urbana, de distintas edades, clases sociales y nivel educacional. Obteniendo hasta el momento indicadores que nos hablan de una indefensión yoica. Prevaleciendo las defensas maníacas reveladas como idealización del otro, negación e identificación con el agresor

Norma estándar y variedad rioplatense en instrumentos de gramatización

En el marco de las políticas lingüísticas, el trabajo analiza los discursos sobre el español como lengua estándar subyacentes en los diversos instrumentos de gramatización (Auroux, 1992) destinados a regular los usos lingüísticos en el ámbito hispanoamericano. Postula la hipótesis de que las políticas lingüísticas alentadas desde las Academias de la Lengua y las diversas instancias de difusión del estándar llamado panhispánico acuden al espíritu de unidad y homogeneidad lingüística presente desde los inicios de los discursos sobre el español afectando el prestigio de los estándares regionales. A partir de esta hipótesis, sostiene que las actuales expectativas de homogeneidad e intercomprensibilidad lingüística expresadas tanto en diccionarios, manuales de estilo o gramáticas como en los medios de comunicación olvidan que los estándares regionales paralelos a ese español globalizado no siempre cuentan con una vía de enseñanza formal que los valide y los prestigie frente a la variedad transnacional. Para verificar la plausibilidad de esta hipótesis, analizamos diccionarios de la RAE y Panhispánico de Dudas y manuales escolares de enseñanza de español, entre otros instrumentos; allí identificamos la construcción de las nociones de norma estándar, español transnacional y dialecto

Effects of elevated CO2 on early life history development of the yellowtail kingfish, Seriola lalandi, a large pelagic fish

An increasing number of studies have examined the effects of elevated carbon dioxide (CO2) and ocean acidification on marine fish, yet little is known about the effects on large pelagic fish. We tested the effects of elevated CO2 on the early life history development and behaviour of yellowtail kingfish, Seriola lalandi. Eggs and larvae were reared in current day control (450 µatm) and two elevated CO2 treatments for a total of 6 d, from 12 h post-fertilization until 3 d post-hatching (dph). Elevated CO2 treatments matched projections for the open ocean by the year 2100 under RCP 8.5 (880 µatm CO2) and a higher level (1700 µatm CO2) relevant to upwelling zones where pelagic fish often spawn. There was no effect of elevated CO2 on survival to hatching or 3 dph. Oil globule diameter decreased with an increasing CO2 level, indicating potential effects of elevated CO2 on energy utilization of newly hatched larvae, but other morphometric traits did not differ among treatments. Contrary to expectations, there were no effects of elevated CO2 on larval behaviour. Activity level, startle response, and phototaxis did not differ among treatments. Our results contrast with findings for reef fish, where a wide range of sensory and behavioural effects have been reported. We hypothesize that the absence of behavioural effects in 3 dph yellowtail kingfish is due to the early developmental state of newly hatched pelagic fish. Behavioural effects of high CO2 may not occur until larvae commence branchial acid-base regulation when the gills develop; however, further studies are required to test this hypothesis. Our results suggest that the early stages of kingfish development are tolerant to rising CO2 levels in the ocean.