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Satisfaction of psychotic patients with care and its value to predict outcomes
- J.M. Vermeulen, N.F. Schirmbeck, M.J. van Tricht, L. de Haan
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- Journal:
- European Psychiatry / Volume 47 / January 2018
- Published online by Cambridge University Press:
- 01 January 2020, pp. 60-66
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- Article
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Background
A key indicator of quality of treatment from the patient's perspective is expressed by satisfaction with care. Our aim was to (i) explore satisfaction and its relation to clinical outcome measures; and (ii) explore the predictive value of satisfaction for the course of outcomes over three years.
MethodsData of 654 patients with a non-affective psychosis included in a naturalistic longitudinal cohort study were analyzed. We included 506 males and 148 females with a mean age of 30.47 (SD 7.24) from The Netherlands. Satisfaction was measured with the self-rating Client Satisfaction Questionnaire-8. A wide range of interviewer-rated (e.g., Positive and Negative Symptom Scale) and self-rated (e.g., World Health Organization Quality of Life); outcomes of low, intermediate and high satisfied patients were compared using ANOVA, Chi2 or Kruskal–Wallis tests. The predictive value of satisfaction level on clinical outcomes after three years was tested using regression models.
ResultsSatisfaction levels were low (19.4%), intermediate (48.9%) or high (31.7%). High satisfied patients showed significantly better interviewer-rated outcomes, e.g., less severe psychotic symptoms, and self-rated outcomes, e.g., better quality of life, compared to patients with intermediate or low satisfaction. Higher levels of satisfaction with care at baseline predicted a reduction of positive symptoms three years later (B=–.09, P-value=.013).
ConclusionsSatisfaction of patients with psychosis is a valuable monitoring measure since high satisfied patients show more favorable outcomes ranging from psychopathological symptoms to quality of life. Further research into explanations of lower levels of satisfaction is commendable in order to improve outcomes.
16 - Androgens in male senescence
- Edited by E. Nieschlag, Westfälische Wilhelms-Universität Münster, Germany, H. M. Behre, Westfälische Wilhelms-Universität Münster, Germany
- Assisted by S. Nieschlag
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- Book:
- Testosterone
- Published online:
- 18 January 2010
- Print publication:
- 01 April 2004, pp 497-542
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Summary
Introduction
“Andropause”, defined as the male equivalent of the menopause, which in women signals the end of reproductive life and a near total cessation of sex steroid production by the gonads, does not exist. Indeed, aging in healthy men is normally not accompanied by abrupt or drastic alterations of gonadal function, and androgen production as well as fertility can be largely preserved until very old age.
The limited data available suggests that aging has no major influence on sperm quality and fertilizing capacity (Nieschlag et al. 1982; Rolf et al. 1996), changes in semen parameters being essentially limited to a decrease of ejaculate volume and sperm motility (Rolf et al. 1996). Moreover, a decreased ejaculatory frequency, as observed in elderly men (Rolf et al. 1996), might account for at least part of these age-related changes, but may also mask more subtle changes in spermatogenetic activity (Cooper et al. 1993). Serum inhibin B, a marker of Sertoli cell function and spermatogenesis, was shown to be relatively well maintained in healthy elderly men, albeit at the cost of clearly increased FSH stimulation that compensates for an age-related regression of Sertoli cell mass and function (Mahmoud et al. 2000).
As to hormonal testicular function, it is now well established that mean serum testosterone levels decrease progressively in healthy elderly men, notwithstanding considerable inter-individual variability in the extent of the changes (Vermeulen 1991). Well over 20% of otherwise healthy men over 60 years of age present with subnormal testosterone levels compared to serum levels in young adults.
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