Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

Objective
To determine health-related quality of life (HRQOL), psychological distress, physical function, and self efficacy in persons waiting for lower-limb joint replacement surgery.

Methods
A total of 214 patients on a waiting list for unilateral primary total knee or hip replacement at a large Australian public teaching hospital completed questionnaires after entry to the list. HRQOL and psychological distress were compared with available population norms.

Results
Average HRQOL was extremely poor (mean ± SD 0.39 ± 0.24) and much lower (>2 SD) than the population norm. Near death-equivalent HRQOL or worse than death-equivalent HRQOL were reported by 15% of participants. High or very high psychological distress was up to 5 times more prevalent in the waiting list sample (relative risk 5.4 for participants ages 75 years and older; 95% confidence interval 3.3, 9.0). Women had significantly lower HRQOL, self efficacy, and physical function scores than men. After adjusting for age and sex, significant socioeconomic disparities were also found. Participants who received the lowest income had the poorest HRQOL; those with the least education or the lowest income had the highest psychological distress. Low self efficacy was moderately associated with poor HRQOL (r = 0.49, P < 0.001) and more strongly associated with high psychological distress (r = -0.55, P < 0.001).

Conclusion
Patients waiting for joint replacement have very poor HRQOL and high psychological distress, especially women and those from lower socioeconomic backgrounds. Lengthy waiting lists mean patients can experience extended and potentially avoidable morbidity. Interventions to address psychological distress and self efficacy could reduce this burden and should target women and lower socioeconomic groups.

Quality of life and depression among older patients waiting for joint replacement surgery

Purpose: Older patients waiting for joint replacement surgery in many western countries experience lengthy waits for their surgery. Although these patients suffer with mobility problems the nature of the disability associated with waiting for surgery is unclear. The purpose of this study was to determine health-related quality of life and symptoms of depression in persons waiting for their initial orthopaedic consultation following referral for total knee or total hip replacement surgery.

Methods: All patients who were waiting for an initial orthopaedic consultation for lower-limb joint replacement as at 25 August 2005 were surveyed. Participants were mailed questionnaires concerning demographic information, medical history, health-related quality of life (the Assessment of Quality of Life (AQoL) instrument), and symptoms of depression (Center for Epidemiologic Studies – Depression (CES-D) Scale).

Results: The 84 respondents (response rate 64%) had a mean age of 68.3 (SD 11.5 years), and 60% or respondents were women. Respondents reported an average of 1.6 (SD 0.9) medical conditions, and 85% reported osteoarthritis.} The average health-related quality of life was low (mean AQoL 0.38; SD 0.27), and near death-equivalent or worse than death-equivalent health-related quality of life (AQoL<0.1 of a maximum possible 1.0) was reported by 23% of the participants.The mean depression scale score was 16.5 (SD 11.1), and symptoms of depression (CES-D>16 of a maximum possible 60) were reported by 35% of the sample. There was a strong correlation between health-related quality of life and depression (r=–0.6).

Conclusions: Almost a third of patients waiting to see an orthopaedic surgeon about joint replacement surgery for their hip or knee had symptoms of depression. Geriatric rehabilitation services often provide interventions to these patients. The very poor quality of life reported suggests that more than exercise and strengthening will be needed to reduce disability.

Senses of waiting among Tibetan nomads

Ethnographic vignettes on how Tibetan nomads move describe a modality of waiting that is attuned to the rhythms and syncopations of movement through pastures and the life-cycle. Such waiting complements moving and is in time. How waiting is experienced reveals an important facet of one's synchronicity with time and place.

Like a volcano waiting to erupt : The Australian Yiddish writer Pinchas Goldhar (1901-1947)

 Biographical essay outlining the tragic career of the Australian Yiddish writer Pinchas Goldhar.

‘Waiting-to-see’ if the baby will come : findings from a qualitative study in Kafa Zone, Ethiopia

Background: Much of the quantitative research on maternal mortality in developing countries focuses on the need for health service interventions such as skilled attendants at birth and emergency obstetric and newborn care. A growing number of studies document the need for a more comprehensive perspective and include the macrostructural, that is, the social, cultural, economic and political determinants of health.
Objectives: To examine the salient aspects of birth at home and variables that influence decision making around transfer to a health facility during prolonged/obstructed labor.
Methods: Ethnography using participant observation and semi-structured interviews was conducted in 2007. A total of 56 mothers in Kafa Zone were selected: 20 in-depth interviews with women who gave birth at home; four who gave birth in a health facility; and 32 during antenatal care. Interviews were also conducted with health staff from Bonga Hospital and 15 health centers or health posts. Analysis followed a process of data reduction, data display and conclusion drawing/verification with the data organized around key themes.
Results: Most women gave birth at home assisted by their neighbor, mother, mother-in-law, or husband. It is likely women who gave birth at home feel ‘safe’ because that is where birth normally takes place and where they feel supported by close relatives and neighbors. Prolonged labor or ‘waiting-to-see’ if the baby would come was somewhat normalized and resulted in considerable delays to seeking assistance. Women felt it was ‘unsafe’ to go to a health facility because of the very real possibility that they would die on the way.
Conclusion: The findings highlight the importance of educating the local communities to recognize pregnancy related risks and to develop and implement appropriate responses, especially early referral, as communities play an important mobilizing role to health services.

Hospital hero: a game for reducing stress and anxiety of children while waiting in emergency room

This report tells a story which started as an idea that came to us to fight the battle-cry feeling commonly known as stress and anxiety. Before creating the solution of the idea, we first need to understand the feelings underneath and its effects on our well-being. Throughout the course of our lives, we experience states of weakness and fear. These feelings can arise, for instance, while we are in an emergency room. Needless to say, how much it would have imaginable effects on children, who are unfamiliar to such environments. We ran through a serious of scenarios to find the most suitable solution, among them the study of interaction with positive expressions by Dr. Baldwin, proved to be a valued resource. It was reduced due to its length and to be suitable to our public audience. The game was then created in order to reduce or even eliminate the stress and anxiety of children. Since the game was initially released, some modifications had been made but the original idea - interaction with positive expressions – remained. When the time came, we asked children to play one of the two versions of the game while waiting in the emergency room. This not only created a diversion for them but also a learning experience as it displayed some hospital equipment. The difference between the two versions is that one provides expressions, while the other does not. After all our hard work, we felt rewarded because the project proved its worth and we would see that in the expressions on children’s faces while they played. Most importantly, their anxiety level numbers were significantly reduced during that short period of time.

Opinion of hepatic transplant waiting list patients regarding split liver transplantation

Background. Split liver transplantation (SLT) increases organ supply for hepatic transplantation. Long-term patient survival and complication rates seem to be equivalent between orthotopic liver transplantation (OLT) and SLT. There are controversies among transplant physicians due to an ethical dilemma between benefiting individual needs or those of society. Barshes and Goss (Am J Transplant 5:2047, 2005) demonstrated that the majority of adult liver transplant candidates are favorable to SLT. The aim of our study was to evaluate the opinions of patients at a Brazilian university hospital regarding SLT.Materials and Methods. A questionnaire with 14 questions was applied to 50 patients included in a hepatic transplant waiting list regarding SLT.Results. The overall attitudes of 66% of the participants were classified as utilitarian, 31% were classified as self-preserving, and 3% were undecided. Ninety-one percent of patients would be willing to share even if their expected survival after SLT was shorter than that with OLT. For 77% of patients, children must have priority over adults. However, 83% were unaware of the donors for pediatric transplantations.Conclusions. SLT is a consistent solution for organ demand despite controversies among transplant physicians. The present study demonstrated that most patients were favorable to SLT. In conclusion, attitudes toward graft sharing are not barriers to SLT.