WorldWideScience

Sample records for chronic medical conditions

  1. Medical Transport of Children with Complex Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Carlos F. Lerner

    2012-01-01

    Full Text Available One of the most notable trends in child health has been the increase in the number of children with special health care needs, including those with complex chronic conditions. Care of these children accounts for a growing fraction of health care resources. We examine recent developments in health care, especially with regard to medical transport and prehospital care, that have emerged to adapt to this remarkable demographic trend. One such development is the focus on care coordination, including the dissemination of the patient-centered medical home concept. In the prehospital setting, the need for greater coordination has catalyzed the development of the emergency information form. Training programs for prehospital providers now incorporate specific modules for children with complex conditions. Another notable trend is the shift to a family-centered model of care. We explore efforts toward regionalization of care, including the development of specialized pediatric transport teams, and conclude with recommendations for a research agenda.

  2. Medical errors in hospitalized pediatric trauma patients with chronic health conditions

    Directory of Open Access Journals (Sweden)

    Xiaotong Liu

    2014-01-01

    Full Text Available Objective: This study compares medical errors in pediatric trauma patients with and without chronic conditions. Methods: The 2009 Kids’ Inpatient Database, which included 123,303 trauma discharges, was analyzed. Medical errors were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The medical error rates per 100 discharges and per 1000 hospital days were calculated and compared between inpatients with and without chronic conditions. Results: Pediatric trauma patients with chronic conditions experienced a higher medical error rate compared with patients without chronic conditions: 4.04 (95% confidence interval: 3.75–4.33 versus 1.07 (95% confidence interval: 0.98–1.16 per 100 discharges. The rate of medical error differed by type of chronic condition. After controlling for confounding factors, the presence of a chronic condition increased the adjusted odds ratio of medical error by 37% if one chronic condition existed (adjusted odds ratio: 1.37, 95% confidence interval: 1.21–1.5, and 69% if more than one chronic condition existed (adjusted odds ratio: 1.69, 95% confidence interval: 1.48–1.53. In the adjusted model, length of stay had the strongest association with medical error, but the adjusted odds ratio for chronic conditions and medical error remained significantly elevated even when accounting for the length of stay, suggesting that medical complexity has a role in medical error. Higher adjusted odds ratios were seen in other subgroups. Conclusion: Chronic conditions are associated with significantly higher rate of medical errors in pediatric trauma patients. Future research should evaluate interventions or guidelines for reducing the risk of medical errors in pediatric trauma patients with chronic conditions.

  3. Modelling Estimates of Norovirus Disease in Patients with Chronic Medical Conditions

    OpenAIRE

    Thomas Verstraeten; Baoguo Jiang; John G Weil; Lin, Jennifer H.

    2016-01-01

    Background The burden of disease due to norovirus infection has been well described in the general United States population, but studies of norovirus occurrence among persons with chronic medical conditions have been limited mostly to the immunocompromised. We assessed the impact of norovirus gastroenteritis on health care utilization in US subjects with a range of chronic medical conditions. Methods We performed a retrospective cohort study using MarketScan data from July 2002 to December 20...

  4. The impact of parents’ chronic medical condition on children

    NARCIS (Netherlands)

    Sieh, D.S.

    2012-01-01

    The results of this research suggests that latency-aged and adolescent children generally cope well with the parent’s chronic disease. In terms of parent attachment, coping skills, and salivary cortisol, adolescents with a chronically ill parent have similar scores as those who do not have a chronic

  5. Adherence to Medication Regimens among Low-Income Patients with Multiple Comorbid Chronic Conditions

    Science.gov (United States)

    Mishra, Shiraz I.; Gioia, Deborah; Childress, Saltanat; Barnet, Beth; Webster, Ramothea L.

    2011-01-01

    This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These…

  6. Chronic medical conditions among jail detainees in residential psychiatric treatment: a latent class analysis.

    Science.gov (United States)

    Swartz, James A

    2011-08-01

    Studies of incarcerates with serious mental illnesses have found elevated rates of chronic medical conditions such as asthma and diabetes, and of infectious diseases such as tuberculosis compared with general population rates. This study explored the pattern of chronic medical conditions in a sample of adult detainees in psychiatric treatment in a large urban jail to develop a clinical profile encompassing the full range of medical conditions. A total of 431 male and female detainees were sampled with certainty from admissions to a residential psychiatric treatment program (overall recruitment rate = 67%). Interviews used the World Mental Health version of the Composite International Diagnostic Interview to assess psychiatric and substance use disorders per DSM-IV criteria and chronic medical conditions. Latent class analysis was conducted using 17 medical conditions as class indicators, yielding a 3-class model composed of: a latent class with a high to intermediate probability of multiple medical conditions (HMC; 12.5% of the sample); an intermediate class with a lower probability of having a smaller number of medical conditions (MMC; 43.2%); and a class with a low probability of any medical condition (44.3%). Those in the HMC class were more likely to report respiratory problems, severe headaches, musculoskeletal pain, hypertension, and arthritis, have greater functional impairment, and have a higher number of co-occurring psychiatric disorders. Being older (50+ years) and female were associated with higher odds of being in the HMC or MMC classes. The policy implications for providing medical care to incarcerates with complex mixtures of medical conditions and psychiatric disorders are considered.

  7. Liposuction for chronic medical diseases and noncosmetic conditions: review of the literature

    Directory of Open Access Journals (Sweden)

    Hamdy Abuelhassan El-Khatib

    2015-03-01

    Full Text Available The purpose of this systematic literature review was to evaluate the safety of liposuction techniques and to identify the cosmetic and noncosmetic application of liposuction. Liposuction can be used to improve the quality-of-life in patients with disabling medical conditions in addition to its use for cosmetic rejuvenation. An online search of the Cochrane Library, MEDLINE, Embase, and SciELO were conducted. Forty-seven original articles reported from 1982 to February 2014 were included in this review. The articles reported on the use as well as the limitations of liposuction for treatment of noncosmetic and disabling medical conditions. The criteria used for selection of articles were: large sample size and originality. The case reports were excluded. There was a broad agreement about the applicability and the efficacy of the liposuction for treatment of these chronic medical conditions, such as multiple systemic lipomatosis, dercum's disease, chronic lymphedema, and axillary hyperhidrosis. Literatures review confirmed that Liposuction technique has provided significant and stable cure for these chronic medical conditions. Liposuction is the most frequent esthetic procedure for adipose tissue reduction and treatment of lipedema worldwide. Apart from esthetic indications, liposuction can also be used to treat chronic medical diseases and noncosmetic conditions.

  8. Mediators for internalizing problems in adolescents of parents with chronic medical condition

    NARCIS (Netherlands)

    D.S. Sieh; F.J. Oort; J.M.A. Visser-Meily; A.M. Meijer

    2014-01-01

    Parents’ chronic medical condition (CMC) is related to internalizing problem behavior in adolescents. Following the transactional stress and coping (TSC) model of Hocking and Lochman, our study examines whether the effect of illness and demographic parameters on the child’s internalizing problems is

  9. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients

    Science.gov (United States)

    Dhamane, Amol D; Schwab, Phil; Hopson, Sari; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

    2017-01-01

    Background Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications. Objective The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. Methods COPD patients were identified using a large administrative claims database. Selected patients were 40–89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC <0.8) to mCOPD and non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. Results A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38–1.78, all P<0.01). Conclusion Adherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to m

  10. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

    Science.gov (United States)

    Fattori, A.; Neri, L.; Aguglia, E.; Bellomo, A.; Bisogno, A.; Camerino, D.; Carpiniello, B.; Cassin, A.; Costa, G.; De Fazio, P.; Di Sciascio, G.; Favaretto, G.; Fraticelli, C.; Giannelli, R.; Leone, S.; Maniscalco, T.; Marchesi, C.; Mauri, M.; Mencacci, C.; Polselli, G.; Quartesan, R.; Risso, F.; Sciaretta, A.; Vaggi, M.; Vender, S.; Viora, U.

    2015-01-01

    Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p < 0.01; SF-12 MCS: 59.4% versus 74.3%, p < 0.01). The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions. PMID:26557692

  11. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

    Directory of Open Access Journals (Sweden)

    A. Fattori

    2015-01-01

    Full Text Available Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N=1717 with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p<0.01; SF-12 MCS: 59.4% versus 74.3%, p<0.01. The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers’ quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

  12. Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy

    DEFF Research Database (Denmark)

    Lauridsen, M M; Poulsen, L; Rasmussen, C K

    2016-01-01

    diagnostic test battery in cirrhosis is often the Continuous Reaction Time (CRT) and the Portosystemic Encephalopathy (PSE) tests but the effect on these of other medical conditions is not known. We aimed to examine the effects of common chronic (non-cirrhosis) medical conditions on the CRT and PSE tests. We...... and reaction time stability and the PSE test, which is a paper-pencil test battery consisting of 5 subtests. We found that a high fraction of the patients with HF (8/15, 0.002) or COPD (7/15, p = 0.006) had pathological CRT test results; and COPD patients also frequently had an abnormal PSE test result (6...

  13. PERSONAL ATTITUDES, PERCEIVED SOCIAL NORMS, AND HEALTH RISK BEHAVIOR AMONG FEMALE ADOLESCENTS WITH CHRONIC MEDICAL CONDITIONS

    Science.gov (United States)

    Kunz, Jennifer Hauser; Greenley, Rachel Neff; Mussatto, Kathleen A.; Roth-Wojcicki, Betsy; Miller, Tami; Freeman, Mary Ellen; Lerand, Sarah

    2015-01-01

    Purpose To examine whether perceived peer/parent norms or personal beliefs about adolescent substance use influence substance use among female adolescents with chronic medical conditions. Methods 68 females reported on substance use, personal beliefs, and perceived peer/parent norms. Results Personal beliefs and perceived peer/parent norms were associated with adolescent’s current and future substance use. Although perceived peer norms accounted for variance in current substance use, only personal beliefs accounted for variance in future alcohol use. Conclusions Targeting perceived peer norms may be effective for intervention efforts among adolescents endorsing current substance use, whereas alcohol use prevention efforts should target personal beliefs. PMID:23524992

  14. Vaccination of adolescents with chronic medical conditions: Special considerations and strategies for enhancing uptake

    Science.gov (United States)

    Hofstetter, Annika M; LaRussa, Philip; Rosenthal, Susan L

    2015-01-01

    Adolescents with chronic medical conditions (CMCs), a growing population worldwide, possess a wide array of preventive health care needs. Vaccination is strongly recommended for the vast majority of these adolescents given their increased risk of vaccine preventable infection and associated complications. Not only should they receive routine vaccines, but some also require additional vaccines. Despite these guidelines, evidence suggests that adolescents with CMCs often fail to receive needed vaccines. Many factors contribute to this under-immunization, including lack of knowledge among parents and providers and suboptimal coordination of primary and subspecialty care. This review describes current vaccination recommendations for these adolescents as well as recent data related to infection risk, vaccine efficacy and safety, vaccination coverage, and the unique multilevel factors impacting uptake in this population. It also discusses strategies for improving coverage levels and reducing missed vaccination opportunities, with a particular focus on technology-based interventions. PMID:26212313

  15. Chronic Medical Conditions and Negative Affect; Racial Variation in Reciprocal Associations

    Directory of Open Access Journals (Sweden)

    Shervin Assari

    2016-08-01

    Full Text Available Background: Black-White health paradox can be defined as a lower frequency of depression despite a higher prevalence of economic and social adversities as well as chronic medical conditions (CMC among American Blacks compared to American Whites. Based on this paradox, the CMC - depressive symptoms link is expected to be weaker among Blacks and Whites. We conducted a 10 year longitudinal study to compare Blacks and Whites for bidirectional associations between number of CMC and negative affect.Methods: We used data from the MIDUS (Midlife in the United States, a nationally representative longitudinal study of American adults. A total number of 7,108 individuals with age range 25 to 75 (N = 7,108 were followed for 10 years from 1995 to 2004. Age, gender, and socioeconomic status (education and income measured at baseline were controls. Negative affect and chronic medical conditions were measured at baseline and end of follow up. Race was the moderator. Linear regression analysis was used to test the moderating effect of race on the reciprocal associations between CMC and negative affect, net of covariates.Results: In the pooled sample, while baseline CMC was predictive of an increase in negative affect over time, baseline negative affect was also predictive of an increase in CMC. We found interactions between race and baseline CMC on change in depressive symptoms, as well as race with negative affect on CMC change. Conclusion: Blacks and Whites differ in reciprocal links between CMC and negative affect over time. This finding replicates recent studies on differential links between psychosocial outcomes and physical health based on race. Findings may help us better understand how Black - White health paradox develops across mid and later life.

  16. The contribution of negative reproductive experiences and chronic medical conditions to depression and pain among Israeli women.

    Science.gov (United States)

    Sarid, Orly; Segal-Engelchin, Dorit; Cwikel, Julie

    2012-01-01

    This study of 302 Israeli women sought to investigate the associations among stressful reproductive experiences (e.g. fertility problems, abortions, and traumatic births), chronic medical conditions, pain, and depression. The specific aims of the study were to examine (1) the effect of stressful reproductive experiences, chronic medical conditions, and pain on depressive symptoms and (2) the effect of stressful reproductive experiences, chronic medical conditions, and depressive symptoms on pain. Our findings corroborate with previous studies demonstrating that depression and pain are two interrelated, but different phenomena, which have both common and distinct risk factors. The findings are discussed in the light of stress and adaptation theories that point to the long-term effects of stressful life events on emotional and physiological aspects such as depression and pain.

  17. Anti-hypertensive medications and cardiovascular events in older adults with multiple chronic conditions.

    Directory of Open Access Journals (Sweden)

    Mary E Tinetti

    Full Text Available Randomized trials of anti-hypertensive treatment demonstrating reduced risk of cardiovascular events in older adults included participants with less comorbidity than clinical populations. Whether these results generalize to all older adults, most of whom have multiple chronic conditions, is uncertain.To determine the association between anti-hypertensive medications and CV events and mortality in a nationally representative population of older adults.Competing risk analysis with propensity score adjustment and matching in the Medicare Current Beneficiary Survey cohort over three-year follow-up through 2010.4,961 community-living participants with hypertension.Anti-hypertensive medication intensity, based on standardized daily dose for each anti-hypertensive medication class participants used.Cardiovascular events (myocardial infarction, unstable angina, cardiac revascularization, stroke, and hospitalizations for heart failure and mortality.Of 4,961 participants, 14.1% received no anti-hypertensives; 54.6% received moderate, and 31.3% received high, anti-hypertensive intensity. During follow-up, 1,247 participants (25.1% experienced cardiovascular events; 837 participants (16.9% died. Of deaths, 430 (51.4% occurred in participants who experienced cardiovascular events during follow-up. In the propensity score adjusted cohort, after adjusting for propensity score and other covariates, neither moderate (adjusted hazard ratio, 1.08 [95% CI, 0.89-1.32] nor high (1.16 [0.94-1.43] anti-hypertensive intensity was associated with experiencing cardiovascular events. The hazard ratio for death among all participants was 0.79 [0.65-0.97] in the moderate, and 0.72 [0.58-0.91] in the high intensity groups compared with those receiving no anti-hypertensives. Among participants who experienced cardiovascular events, the hazard ratio for death was 0.65 [0.48-0.87] and 0.58 [0.42-0.80] in the moderate and high intensity groups, respectively. Results were similar

  18. Predicting declines in physical function in persons with multiple chronic medical conditions: What we can learn from the medical problem list

    Directory of Open Access Journals (Sweden)

    Bayliss Martha S

    2004-09-01

    Full Text Available Abstract Background Primary care physicians are caring for increasing numbers of persons with comorbid chronic illness. Longitudinal information on health outcomes associated with specific chronic conditions may be particularly relevant in caring for these populations. Our objective was to assess the effect of certain comorbid conditions on physical well being over time in a population of persons with chronic medical conditions; and to compare these effects to that of hypertension alone. Methods We conducted a secondary analysis of 4-year longitudinal data from the Medical Outcomes Study. A heterogeneous population of 1574 patients with either hypertension alone (referent or one or more of the following conditions: diabetes, coronary artery disease, congestive heart failure, respiratory illness, musculoskeletal conditions and/or depression were recruited from primary and specialty (endocrinology, cardiology or mental health practices within HMO and fee-for-service settings in three U.S. cities. We measured categorical change (worse vs. same/better in the SF-36® Health Survey physical component summary score (PCS over 4 years. We used logistic regression analysis to determine significant differences in longitudinal change in PCS between patients with hypertension alone and those with other comorbid conditions and linear regression analysis to assess the contribution of the explanatory variables. Results Specific diagnoses of CHF, diabetes and/or chronic respiratory disease; or 4 or more chronic conditions, were predictive of a clinically significant decline in PCS. Conclusions Clinical recognition of these specific chronic conditions or 4 or more of a list of chronic conditions may provide an opportunity for proactive clinical decision making to maximize physical functioning in these populations.

  19. Personal attitudes, perceived social norms, and health-risk behavior among female adolescents with chronic medical conditions.

    Science.gov (United States)

    Kunz, Jennifer H; Greenley, Rachel N; Mussatto, Kathleen A; Roth-Wojcicki, Betsy; Miller, Tami; Freeman, Mary E; Lerand, Sarah

    2014-07-01

    To examine whether perceived peer/parent norms or personal beliefs about adolescent substance use influence substance use among female adolescents with chronic medical conditions. Sixty-eight females reported on substance use, personal beliefs, and perceived peer/parent norms. Personal beliefs and perceived peer/parent norms were associated with adolescent's current and future substance use. Although perceived peer norms accounted for variance in current substance use, only personal beliefs accounted for variance in future alcohol use. Targeting perceived peer norms may be effective for intervention efforts among adolescents endorsing current substance use, whereas alcohol use prevention efforts should target personal beliefs.

  20. Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

    DEFF Research Database (Denmark)

    Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne;

    2011-01-01

    As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...... with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems....

  1. Racial and Ethnic Disparities in Influenza Vaccination among Adults with Chronic Medical Conditions Vary by Age in the United States

    Science.gov (United States)

    Lu, Degan; Qiao, Yanru; Brown, Natalie E.; Wang, Junling

    2017-01-01

    Background People living with chronic health conditions exhibit higher risk for developing severe complications from influenza according to the Centers for Diseases Control and Prevention. Although racial and ethnic disparities in influenza vaccination have been documented, it has not been comprehensively determined whether similar disparities are present among the adult population with at least one such condition. Objective To study if racial and ethnic disparities in relation to influenza vaccination are present in adults suffering from at least one chronic condition and if such inequalities differ between age groups. Methods The Medical Expenditure Panel Survey (2011–2012) was used to study the adult population (age ≥18) who had at least one chronic health condition. Baseline differences in population traits across racial and ethnic groups were identified using a chi-square test. This was conducted among various age groups. In addition, survey logistic regression was utilized to produce odds ratios of receiving influenza vaccination annually between racial and ethnic groups. Results The total sample consisted of 15,499 adults living with at least one chronic health condition. The numbers of non-Hispanic whites (whites), non-Hispanic blacks (blacks), and Hispanics were 8,658, 3,585, and 3,256, respectively. Whites (59.93%) were found to have a higher likelihood of self-reporting their receipt of the influenza vaccine in comparison to the black (48.54%) and Hispanic (48.65%) groups (Pinfluenza vaccine coverage than the white population (59.22%, 77.89) (both P0.05). After controlling for patient characteristics, the difference in influenza vaccine coverage between whites and the minority groups were no longer significant for adults aged 50–64 years. However, the difference were still statistically significant for those aged ≥65 years. Conclusions In the United States, there are significant disparities in influenza vaccination by race and ethnicity for

  2. Short report : Chronic medical conditions and life satisfaction in the elderly

    NARCIS (Netherlands)

    Jelicic, M; Kempen, GIJM

    1999-01-01

    The aim of this study was to examine the effect of chronic disease on life satisfaction in community dwelling elderly. A total of 5279 research participants, mean age 69.57 (SD = 8.04) yrs, were asked to judge their life satisfaction on the Seven Point Satisfaction Rating Scale. They were also admin

  3. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: is the whole greater than the sum of its parts?

    OpenAIRE

    Wee, HL; Cheung, YB; Li, SC; Fong, KY; Thumboo, J

    2005-01-01

    Abstract Background Diabetes mellitus (DM) is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1) evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL) (which could be additive, synergistic or subtractive); (2) to determine the extent to which the SF-6D (a single-index preference measure)...

  4. Chronic Condition Data Warehouse

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS Chronic Condition Data Warehouse (CCW) provides researchers with Medicare and Medicaid beneficiary, claims, and assessment data linked by beneficiary across...

  5. Chronic Conditions Dashboard

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS Chronic Conditions Dashboard presents statistical views of information on the prevalence, utilization and Medicare spending for Medicare beneficiaries with...

  6. Chronic Conditions PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Chronic Conditions PUFs are aggregated files in which each record is a profile or cell defined by the characteristics of Medicare beneficiaries. A profile is...

  7. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: Is the whole greater than the sum of its parts?

    Directory of Open Access Journals (Sweden)

    Fong Kok-Yong

    2005-01-01

    Full Text Available Abstract Background Diabetes mellitus (DM is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1 evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL (which could be additive, synergistic or subtractive; (2 to determine the extent to which the SF-6D (a single-index preference measure captures the multidimensional information provided by the SF-36 (a profile measure. Methods Using data from a cross-sectional, population-based survey of Chinese, Malay and Indians in Singapore, we developed 9 separate multiple linear regression models, with each SF-36 scale or SF-6D index score being the dependent variable for one model. The influence of DM and a second chronic medical condition (hypertension (HTN, heart disease (HD, musculoskeletal illnesses (MS and their interactions were studied after adjusting for the influence of potential confounding variables. Results Among 5,224 subjects, the prevalence of DM, HTN, HD and MS were 5.9%, 10.7%, 2.4% and 26.6% respectively. DM lowered SF-36 scores by more than 2 points on 3 SF-36 scales and lowered SF-6D scores by 0.03 points. Subjects with DM and HTN, DM and HD or DM and MS experienced further lowering of SF-36 scores exceeding 2 points on at least 6 scales and further lowering of SF-6D scores by 0.05, 0.08 and 0.10 points respectively. Generally, DM and co-existing medical conditions exerted additive effects on HRQoL, with the exception of DM and heart disease, where a subtractive effect was noted. SF-6D index scores generally reflected the patterns of influence of DM and chronic medical conditions on SF-36 scores. Conclusion DM and chronic medical conditions generally reduced HRQoL in this multiethnic general population in an additive, rather than synergistic or subtractive fashion. In this study, the SF

  8. Factors Affecting the Readiness of Medical Doctors and Patients with Chronic Conditions toward the Usage of Smartphones in the Saudi Arabian Healthcare Sector

    OpenAIRE

    Bassam M Al-Mahadeen

    2015-01-01

    Numerous studies have reported the rapid increase in the number of individuals who use smartphones. However, smartphones appear to be increasingly used by healthcare workers, particularly physicians and nurses. Therefore, this study aims to investigate the readiness of medical doctors and patients with chronic conditions in using and adopting smartphones for communication. This study employs the Technology Acceptance Model to examine the behavior of people in using smartphones from the perspe...

  9. Defining and Measuring Chronic Conditions

    Centers for Disease Control (CDC) Podcasts

    2013-05-20

    This podcast is an interview with Dr. Anand Parekh, U.S. Department of Health and Human Services Deputy Assistant Secretary for Health, and Dr. Samuel Posner, Preventing Chronic Disease Editor in Chief, about the definition and burden of multiple chronic conditions in the United States.  Created: 5/20/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/20/2013.

  10. Chronic Conditions among Medicare Beneficiaries

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data used in the chronic condition reports are based upon CMS administrative enrollment and claims data for Medicare beneficiaries enrolled in the...

  11. Medical marijuana use for chronic pain: risks and benefits.

    Science.gov (United States)

    Greenwell, Garth T

    2012-01-01

    Questions from patients about medical marijuana use for chronic pain are becoming more common. The information in this report will help patients understand the potential risks and benefits of using this substance for painful conditions.

  12. Interstitial Cystitis/Painful Bladder Syndrome and Associated Medical Conditions With an Emphasis on Irritable Bowel Syndrome, Fibromyalgia and Chronic Fatigue Syndrome

    DEFF Research Database (Denmark)

    Nickel, J.C.; Tripp, D.A.; Pontari, M.;

    2010-01-01

    Purpose: We characterized and compared the impact of clinical phenotypic associations between interstitial cystitis/painful bladder syndrome and controls in relation to potentially related conditions, particularly irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. Materials and ...

  13. Diurnal and twenty-four hour patterning of human diseases: acute and chronic common and uncommon medical conditions.

    Science.gov (United States)

    Smolensky, Michael H; Portaluppi, Francesco; Manfredini, Roberto; Hermida, Ramon C; Tiseo, Ruana; Sackett-Lundeen, Linda L; Haus, Erhard L

    2015-06-01

    The symptom intensity and mortality of human diseases, conditions, and syndromes exhibit diurnal or 24 h patterning, e.g., skin: atopic dermatitis, urticaria, psoriasis, and palmar hyperhidrosis; gastrointestinal: esophageal reflux, peptic ulcer (including perforation and hemorrhage), cyclic vomiting syndrome, biliary colic, hepatic variceal hemorrhage, and proctalgia fugax; infection: susceptibility, fever, and mortality; neural: frontal, parietal, temporal, and occipital lobe seizures, Parkinson's and Alzheimer's disease, hereditary progressive dystonia, and pain (cancer, post-surgical, diabetic neuropathic and foot ulcer, tooth caries, burning mouth and temporomandibular syndromes, fibromyalgia, sciatica, intervertebral vacuum phenomenon, multiple sclerosis muscle spasm, and migraine, tension, cluster, hypnic, and paroxysmal hemicranial headache); renal: colic and nocturnal enuresis and polyuria; ocular: bulbar conjunctival redness, keratoconjunctivitis sicca, intraocular pressure and anterior ischemic optic neuropathy, and recurrent corneal erosion syndrome; psychiatric/behavioral: major and seasonal affective depressive disorders, bipolar disorder, parasuicide and suicide, dementia-associated agitation, and addictive alcohol, tobacco, and heroin cravings and withdrawal phenomena; plus autoimmune and musculoskeletal: rheumatoid arthritis, osteoarthritis, axial spondylarthritis, gout, Sjögren's syndrome, and systemic lupus erythematosus. Knowledge of these and other 24 h patterns of human pathophysiology informs research of their underlying circadian and other endogenous mechanisms, external temporal triggers, and more effective patient care entailing clinical chronopreventive and chronotherapeutic strategies.

  14. Prevalence of chronic conditions – Musculoskeletal Conditions

    OpenAIRE

    Ireland and Northern Ireland Population Health Observatory (INIsPHO)

    2012-01-01

    IPH has estimated and forecast the number of adults with MSCs for the years 2010, 2015 and 2020. In the Republic of Ireland, the data are based on the Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007 . The data describe the number of people who report that they have experienced doctor-diagnosed MSC in the previous 12 months:     Lower back pain or any other chronic back condition     Rheumatoid arthritis (inflammation of the joints)     Ost...

  15. Chronic Condition Public Use File (PUF)

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Chronic Conditions Public Use Files (PUF) with information from Medicare claims. The CMS Chronic Conditions PUF is an aggregated file in...

  16. Chronic Condition Clusters and Polypharmacy among Adults

    Directory of Open Access Journals (Sweden)

    Ami Vyas

    2012-01-01

    Full Text Available Objective. The primary objective of the study was to estimate the rates of polypharmacy among individuals with multimorbidity defined as chronic condition clusters and examine their associations with polypharmacy. Methods. Cross-sectional analysis of 10,528 individuals of age above 21, with at least one physical condition in cardiometabolic (diabetes or heart disease or hypertension, musculoskeletal (arthritis or osteoporosis, and respiratory (chronic obstructive pulmonary disease (COPD or asthma clusters from the 2009 Medical Expenditure Panel Survey. Chi-square tests and logistic regressions were performed to analyze the association between polypharmacy and multimorbidity. Results. Polypharmacy rates varied from a low of 7.2% among those with respiratory cluster to a high of 64.1% among those with all three disease clusters. Among those with two or more disease clusters, the rates varied from 28.3% for musculoskeletal and respiratory clusters to 41.8% for those with cardiometabolic and respiratory clusters. Individual with cardiometabolic conditions alone or in combination with other disease clusters were more likely to have polypharmacy. Compared to those with musculoskeletal and respiratory conditions, those with cardiometabolic and respiratory conditions had 1.68 times higher likelihood of polypharmacy. Conclusions. Rates of polypharmacy differed by specific disease clusters. Individuals with cardiometabolic condition were particularly at high risk of polypharmacy, suggesting greater surveillance for adverse drug interaction in this group.

  17. Interstitial Cystitis/Painful Bladder Syndrome and Associated Medical Conditions With an Emphasis on Irritable Bowel Syndrome, Fibromyalgia and Chronic Fatigue Syndrome

    DEFF Research Database (Denmark)

    Nickel, J.C.; Tripp, D.A.; Pontari, M.

    2010-01-01

    Purpose: We characterized and compared the impact of clinical phenotypic associations between interstitial cystitis/painful bladder syndrome and controls in relation to potentially related conditions, particularly irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. Materials...... validated questionnaires focused on symptoms, suffering/coping and behavioral/social factors. Results: Questionnaires were completed by 205 patients with interstitial cystitis/painful bladder syndrome and 117 controls matched for age. Prevalence of selfreported associated condition diagnosis in interstitial...... cystitis/painful bladder syndrome vs controls was irritable bowel syndrome 38.6% vs 5.2%, fibromyalgia 17.7% vs 2.6% and chronic fatigue syndrome 9.5% vs 1.7% (all p

  18. A situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM): an IMB model based approach to understanding and intervening in engagement in care for chronic medical conditions.

    Science.gov (United States)

    Rivet Amico, K

    2011-10-01

    A sizable portion of adults living with chronic medical conditions (CMCs) delay initiation of care or maintain it inconsistently, which has tremendous personal and public costs. However, few explanatory models with high yield for intervention development and implementation have been proposed to date that would help to characterize and support care use for CMCs. A situated Information, Motivation, Behavioral Skills model of Care Initiation and Maintenance (sIMB-CIM) is presented here as an application of the IMB model to medical care use for CMCs. An example of a sIMB model for characterizing and intervening to support maintenance in HIV-care is provided.

  19. Multiple chronic conditions and life expectancy

    DEFF Research Database (Denmark)

    DuGoff, Eva H; Canudas-Romo, Vladimir; Buttorff, Christine

    2014-01-01

    condition. A 67-year-old individual with no chronic conditions will live on average 22.6 additional years. A 67-year-old individual with 5 chronic conditions and ≥10 chronic conditions will live 7.7 fewer years and 17.6 fewer years, respectively. The average marginal decline in life expectancy is 1.8 years...... and increasing numbers of comorbid conditions. CONCLUSIONS: Social Security and Medicare actuaries should account for the growing number of beneficiaries with multiple chronic conditions when determining population projections and trust fund solvency....

  20. Medical management of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Dhiraj Yadav; Jonathan E. Clain

    2003-01-01

    慢性胰腺炎的临床表现包括疼痛、脂肪泻和糖尿病.在西方国家,慢性胰腺炎最常见的病因是酗酒.70%以上的病人在就诊时有疼痛的临床表现,而且,这些患者中又有75%以上会在几年之后出现疼痛减轻或完全消失.对于所有的慢性胰腺炎的病人来说,均应排除非胰源性疼痛和胆道梗阻、胰腺假性囊肿等胰腺局部并发症.应建议所有慢性胰腺炎病人戒烟、戒酒.阿片类镇痛剂仅应用于治疗疼痛严重的病人.尽管有报道认为胰酶替代治疗有助于止痛,但是,对于已经确诊的慢性胰腺炎病人来说,该疗法无效.激素类药物进行腹腔神经丛阻滞术可能有助于病人度过剧烈疼痛期.顽固性疼痛是进行胰液引流或胰腺切除的适应证.建议应用适量胰酶替代联合(或不联合)制酸剂治疗营养不良.慢性胰腺炎导致的糖尿病与原发性糖尿病的治疗原则相似.%The clinical presentation of chronic pancreatitis includes pain, steatorrhea and diabetes. The most common etiology in the western world is excess alcohol use. Pain is present in >70% patients at presentation and decreases in intensity or resolves over several years in up to 75% of patients. Non-pancreatic causes of pain and local complications, chiefly pseudocysts and biliary obstruction should be excluded in all patients. All patients should be advised to abstain from alcohol and smoking and opiates should be used only to control severe exacerbations of pain. Although pancreatic enzyme replacement is reported to be useful in the management of pancreatic pain, it is of little or no benefit in patients with established chronic pancreatitis. Celiac plexus block using steroids may be helpful to tide patients over an episode of severe pain. Intractable pain is an indication for surgery that includes pancreatic drainage procedure or pancreatic resection. For control of malabsorption, adequate pancreatic enzyme replacement with or

  1. Adjusting to Chronic Health Conditions.

    Science.gov (United States)

    Helgeson, Vicki S; Zajdel, Melissa

    2017-01-03

    Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

  2. Catalog of 199 register-based definitions of chronic conditions

    DEFF Research Database (Denmark)

    Hvidberg, Michael F; Johnsen, Søren P; Glümer, Charlotte

    2016-01-01

    definitions were proposed based on record linkage between multiple registers, including registers of prescribed drugs and use of general practitioners' services. CONCLUSIONS THIS STUDY PROVIDED A CATALOG OF REGISTER-BASED DEFINITIONS FOR CHRONIC CONDITIONS FOR USE IN HEALTHCARE PLANNING AND RESEARCH, WHICH IS......INTRODUCTION: The aim of the current study was to present and discuss a broad range of register-based definitions of chronic conditions for use in register research, as well as the challenges and pitfalls when defining chronic conditions by the use of registers. MATERIALS AND METHODS......: The definitions were defined based on information from nationwide Danish public healthcare registers. Medical and epidemiological specialists identified and grouped relevant diagnosis codes that covered chronic conditions, using the International Classification System version 10 (ICD-10). Where relevant...

  3. Multiple Chronic Conditions Among Medicare Beneficiaries...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Individuals with multiple chronic conditions (MCC) present many challenges to the health care system, such as effective coordination of care and cost containment. To...

  4. Integration of healthcare rehabilitation in chronic conditions

    Directory of Open Access Journals (Sweden)

    Anne Frølich

    2010-02-01

    Full Text Available Introduction: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. Description of care practice: Four multidisciplinary rehabilitation intervention programmes, one for each chronic condition: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. Conclusion and discussion: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.

  5. Prevalence of chronic conditions in Australia.

    Directory of Open Access Journals (Sweden)

    Christopher Harrison

    Full Text Available OBJECTIVES: To estimate prevalence of chronic conditions among patients seeing a general practitioner (GP, patients attending general practice at least once in a year, and the Australian population. DESIGN SETTING AND PARTICIPANTS: A sub-study of the BEACH (Bettering the Evaluation and Care of Health program, a continuous national study of general practice activity conducted between July 2008 and May 2009. Each of 290 GPs provided data for about 30 consecutive patients (total 8,707 indicating diagnosed chronic conditions, using their knowledge of the patient, patient self-report, and patient's health record. MAIN OUTCOME MEASURES: Estimates of prevalence of chronic conditions among patients surveyed, adjusted prevalence in patients who attended general practice at least once that year, and national population prevalence. RESULTS: Two-thirds (66.3% of patients surveyed had at least one chronic condition: most prevalent being hypertension (26.6%, hyperlipidaemia (18.5%, osteoarthritis (17.8%, depression (13.7%, gastro-oesophageal reflux disease (11.6%, asthma (9.5% and Type 2 diabetes (8.3%. For patients who attended general practice at least once, we estimated 58.8% had at least one chronic condition. After further adjustment we estimated 50.8% of the Australian population had at least one chronic condition: hypertension (17.4%, hyperlipidaemia (12.7%, osteoarthritis (11.1%, depression (10.5% and asthma (8.0% being most prevalent. CONCLUSIONS: This study used GPs to gather information from their knowledge, the patient, and health records, to provide prevalence estimates that overcome weaknesses of studies using patient self-report or health record audit alone. Our results facilitate examination of primary care resource use in management of chronic conditions and measurement of prevalence of multimorbidity in Australia.

  6. The Near Earth Asteroid Medical Conditions List

    Science.gov (United States)

    Barr, Yael R.; Watkins, S. D.

    2011-01-01

    Purpose: The Exploration Medical Capability (ExMC) element is one of six elements within NASA s Human Research Program (HRP) and is responsible for addressing the risk of "the inability to adequately recognize or treat an ill or injured crewmember" for exploration-class missions. The Near Earth Asteroid (NEA) Medical Conditions List, constructed by ExMC, is the first step in addressing the above-mentioned risk for the 13-month long NEA mission. The NEA mission is being designed by NASA's Human Space Flight Architecture Team (HAT). The purpose of the conditions list is to serve as an evidence-based foundation for determining which medical conditions could affect a crewmember during the NEA mission, which of those conditions would be of concern and require treatment, and for which conditions a gap in knowledge or technology development exists. This information is used to focus research efforts and technology development to ensure that the appropriate medical capabilities are available for exploration-class missions. Scope and Approach: The NEA Medical Conditions List is part of a broader Space Medicine Exploration Medical Conditions List (SMEMCL), which incorporates various exploration-class design reference missions (DRMs). The conditions list contains 85 medical conditions which could occur during space flight and which are derived from several sources: Long-Term Surveillance of Astronaut Health (LSAH) in-flight occurrence data, The Space Shuttle (STS) Medical Checklist, The International Space Station (ISS) Medical Checklist, and subject matter expert opinion. Each medical condition listed has been assigned a clinical priority and a clinical priority rationale based on incidence, consequence, and mitigation capability. Implementation: The conditions list is a "living document" and as such, new conditions can be added to the list, and the priority of conditions on the list can be adjusted as the DRM changes, and as screening, diagnosis, or treatment capabilities

  7. The Prevalence of Fibromyalgia in Other Chronic Pain Conditions

    Directory of Open Access Journals (Sweden)

    Muhammad B. Yunus

    2012-01-01

    Full Text Available Central sensitivity syndromes (CSS include fibromyalgia syndrome (FMS, irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS. CSS are mutually associated. In this paper, prevalence of FMS among other members of CSS has been described. An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example, rheumatoid arthritis, systemic lupus, ankylosing spondylitis, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild.

  8. The prevalence of fibromyalgia in other chronic pain conditions.

    Science.gov (United States)

    Yunus, Muhammad B

    2012-01-01

    Central sensitivity syndromes (CSS) include fibromyalgia syndrome (FMS), irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS). CSS are mutually associated. In this paper, prevalence of FMS among other members of CSS has been described. An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example, rheumatoid arthritis, systemic lupus, ankylosing spondylitis, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild.

  9. Implementing a patient-led service for chronic conditions.

    Science.gov (United States)

    Pope, Denise; Tipler, Sue; Kirwan, John; Hewlett, Sarah

    Many chronic conditions with fluctuating levels of disease activity are traditionally managed by lifelong regular medical reviews. However, this means appointments do not always coincide with patient need, while the volume of reviews makes it difficult to respond quickly to requests for help. Research in rheumatoid arthritis suggests that hospital-initiated reviews can be replaced by patient-initiated reviews, supported by nurse-led initiatives.

  10. Complementary and alternative medications for chronic pelvic pain.

    Science.gov (United States)

    Leong, Fah Che

    2014-09-01

    Chronic pelvic pain is common, but rarely cured, thus patients seek both second opinions and alternative means of controlling their pain. Complementary and alternative medicine accounts for 11.2% of out-of-pocket medical expenditures for adults for all conditions in the United States. Although there are many treatments, rigorous testing and well-done randomized studies are lacking. Dietary changes and physical modalities such as physical therapy have often been included in the category of alternative medicine, but their use is now considered mainstream. This article concentrates on other sources of alternative and complementary medicine, such as dietary supplementation and acupuncture.

  11. Care of Adult Refugees with Chronic Conditions.

    Science.gov (United States)

    Terasaki, Genji; Ahrenholz, Nicole Chow; Haider, Mahri Z

    2015-09-01

    Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees.

  12. Individualized Health Care Plans: Supporting Children With Chronic Conditions in the Classroom

    Science.gov (United States)

    Hopkins, Amanda F.; Hughes, Mary-alayne

    2016-01-01

    Due to the major advances in technology and the sciences, advances in the medical treatment options for children with chronic conditions are being made at an astonishing rate. In the health care field, "children with chronic conditions" is a generic phrase that typically refers to children with physical, developmental, behavioral, or…

  13. Integration of healthcare rehabilitation in chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne; Høst, Dorte; Schnor, Helle;

    2010-01-01

    INTRODUCTION: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and prov......INTRODUCTION: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies......, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities-Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen-collaborated on a quality improvement project focusing on integration and implementation...

  14. The Space Medicine Exploration Medical Condition List

    Science.gov (United States)

    Watkins, Sharmi; Barr, Yael; Kerstman, Eric

    2011-01-01

    Exploration Medical Capability (ExMC) is an element of NASA s Human Research Program (HRP). ExMC's goal is to address the risk of the "Inability to Adequately Recognize or Treat an Ill or Injured Crewmember." This poster highlights the approach ExMC has taken to address this risk. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to define the set of medical conditions that are most likely to occur during exploration space flight missions. The list was derived from the International Space Station Medical Checklist, the Shuttle Medical Checklist, in-flight occurrence data from the Lifetime Surveillance of Astronaut Health, and NASA subject matter experts. The list of conditions was further prioritized for eight specific design reference missions with the assistance of the ExMC Advisory Group. The purpose of the SMEMCL is to serve as an evidence-based foundation for the conditions that could affect a crewmember during flight. This information is used to ensure that the appropriate medical capabilities are available for exploration missions.

  15. The healthy learner model for student chronic condition management--part I.

    Science.gov (United States)

    Erickson, Cecelia DuPlessis; Splett, Patricia L; Mullett, Sara Stoltzfus; Heiman, Mary Bielski

    2006-12-01

    A significant number of children have chronic health conditions that interfere with normal activities, including school attendance and active participation in the learning process. Management of students' chronic conditions is complex and requires an integrated system. Models to improve chronic disease management have been developed for the medical system and public health. Programs that address specific chronic disease management or coordinate school health services have been implemented in schools. Lacking is a comprehensive, integrated model that links schools, students, parents, health care, and other community providers. The Healthy Learner Model for chronic condition management identifies seven elements for creating, implementing, and sustaining an efficient and effective, comprehensive community-based system for improving the management of chronic conditions for school children. It has provided the framework for successful chronic condition management in an urban school district and is proposed for replication in other districts and communities.

  16. Oriental Medical Treatment of chronic Acalculous Cholecystitis

    Directory of Open Access Journals (Sweden)

    Hae-Yeon Lee

    2004-12-01

    Full Text Available Chronic acalculous cholecystitis gets possession of about 12 to 13 percent of patients with chronic cholecystitis. Pathologically it is characterised by chronic inflammation and thickening of the gallbladder wall but doesn't come across stones. Clinical symptoms are vague and include abdominal discomfort and distension, nausea, flatulence and intolerance of fatty foods. A patient on chronic acalculous cholecystitis diagnosed from his clinical symtoms and abdominal ultrasonogram was treated by Geonbihwan, acupuncture and herbal acupuncture. Satisfactory symptomatic improvement was achieved and findings of abdominal ultrasonogram came also normal.

  17. [Medical certification of chronic fatigue syndrome].

    Science.gov (United States)

    Hausotter, W

    2015-03-01

    Chronic fatigue or chronic fatigue syndrome (CFS) is not a new disease, yet in recent years it has become increasingly important as an evaluation problem. It coincides with the well-known clinical picture of neurasthenia, shows extensive overlap with symptoms of depression and, finally, to the current concept of "burnout". Regarding the etiology there is fierce controversy between the representatives of a somatic and a psychological etiology. As reviewers you will be guided by the assessment criteria for somatoform disorders, especially because objectified findings are lacking. CFS can be independently encoded as neurological diagnosis G 93.3 according to ICD-10, although never objectified neurological deficits were detected, as well as neurasthenia F 48.0 or accompanying physical symptoms as somatization disorder F 45.0.

  18. Medical cannabis and chronic opioid therapy.

    Science.gov (United States)

    Reisfield, Gary M

    2010-12-01

    Fourteen states and the District of Columbia have legalized the use of cannabis for medical purposes. A small, high-quality literature supports the efficacy of medical cannabis for the treatment of neuropathic pain. The smoked botanical product, however, is associated with a number of adverse medical and psychiatric consequences. Furthermore, experimental data indicate that acute use of cannabis results in impairment of every important metric related to the safe operation of a motor vehicle. Epidemiological data show associations between recent cannabis use and both psychomotor impairment and motor vehicle crashes, associations that are strengthened by the concomitant use of alcohol and other central nervous system depressants. Finally, data from pain clinics reveals an unusually high prevalence of cannabis use in nearly all age groups and an association between cannabis use and opioid and other substance misuse. Based on available data and expert opinion, concomitant use of cannabis and opioids is an absolute contraindication to the operation of a motor vehicle. In patients who use cannabis and are prescribed opioids, heightened vigilance for opioid- and other substance-related problems is warranted. It is appropriate to refrain from prescribing opioids to individuals using medical cannabis if there is reasonable suspicion that the combination will pose a risk to the patient or others.

  19. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey.

    Science.gov (United States)

    Johnson, Lorraine; Wilcox, Spencer; Mankoff, Jennifer; Stricker, Raphael B

    2014-01-01

    Overview. The Centers for Disease Control and Prevention (CDC) health-related quality of life (HRQoL) indicators are widely used in the general population to determine the burden of disease, identify health needs, and direct public health policy. These indicators also allow the burden of illness to be compared across different diseases. Although Lyme disease has recently been acknowledged as a major health threat in the USA with more than 300,000 new cases per year, no comprehensive assessment of the health burden of this tickborne disease is available. This study assesses the HRQoL of patients with chronic Lyme disease (CLD) and compares the severity of CLD to other chronic conditions. Methods. Of 5,357 subjects who responded to an online survey, 3,090 were selected for the study. Respondents were characterized as having CLD if they were clinically diagnosed with Lyme disease and had persisting symptoms lasting more than 6 months following antibiotic treatment. HRQoL of CLD patients was assessed using the CDC 9-item metric. The HRQoL analysis for CLD was compared to published analyses for the general population and other chronic illnesses using standard statistical methods. Results. Compared to the general population and patients with other chronic diseases reviewed here, patients with CLD reported significantly lower health quality status, more bad mental and physical health days, a significant symptom disease burden, and greater activity limitations. They also reported impairment in their ability to work, increased utilization of healthcare services, and greater out of pocket medical costs. Conclusions. CLD patients have significantly impaired HRQoL and greater healthcare utilization compared to the general population and patients with other chronic diseases. The heavy burden of illness associated with CLD highlights the need for earlier diagnosis and innovative treatment approaches that may reduce the burden of illness and concomitant costs posed by this

  20. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey

    Science.gov (United States)

    Johnson, Lorraine; Wilcox, Spencer; Mankoff, Jennifer

    2014-01-01

    Overview. The Centers for Disease Control and Prevention (CDC) health-related quality of life (HRQoL) indicators are widely used in the general population to determine the burden of disease, identify health needs, and direct public health policy. These indicators also allow the burden of illness to be compared across different diseases. Although Lyme disease has recently been acknowledged as a major health threat in the USA with more than 300,000 new cases per year, no comprehensive assessment of the health burden of this tickborne disease is available. This study assesses the HRQoL of patients with chronic Lyme disease (CLD) and compares the severity of CLD to other chronic conditions. Methods. Of 5,357 subjects who responded to an online survey, 3,090 were selected for the study. Respondents were characterized as having CLD if they were clinically diagnosed with Lyme disease and had persisting symptoms lasting more than 6 months following antibiotic treatment. HRQoL of CLD patients was assessed using the CDC 9-item metric. The HRQoL analysis for CLD was compared to published analyses for the general population and other chronic illnesses using standard statistical methods. Results. Compared to the general population and patients with other chronic diseases reviewed here, patients with CLD reported significantly lower health quality status, more bad mental and physical health days, a significant symptom disease burden, and greater activity limitations. They also reported impairment in their ability to work, increased utilization of healthcare services, and greater out of pocket medical costs. Conclusions. CLD patients have significantly impaired HRQoL and greater healthcare utilization compared to the general population and patients with other chronic diseases. The heavy burden of illness associated with CLD highlights the need for earlier diagnosis and innovative treatment approaches that may reduce the burden of illness and concomitant costs posed by this

  1. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey

    Directory of Open Access Journals (Sweden)

    Lorraine Johnson

    2014-03-01

    Full Text Available Overview. The Centers for Disease Control and Prevention (CDC health-related quality of life (HRQoL indicators are widely used in the general population to determine the burden of disease, identify health needs, and direct public health policy. These indicators also allow the burden of illness to be compared across different diseases. Although Lyme disease has recently been acknowledged as a major health threat in the USA with more than 300,000 new cases per year, no comprehensive assessment of the health burden of this tickborne disease is available. This study assesses the HRQoL of patients with chronic Lyme disease (CLD and compares the severity of CLD to other chronic conditions.Methods. Of 5,357 subjects who responded to an online survey, 3,090 were selected for the study. Respondents were characterized as having CLD if they were clinically diagnosed with Lyme disease and had persisting symptoms lasting more than 6 months following antibiotic treatment. HRQoL of CLD patients was assessed using the CDC 9-item metric. The HRQoL analysis for CLD was compared to published analyses for the general population and other chronic illnesses using standard statistical methods.Results. Compared to the general population and patients with other chronic diseases reviewed here, patients with CLD reported significantly lower health quality status, more bad mental and physical health days, a significant symptom disease burden, and greater activity limitations. They also reported impairment in their ability to work, increased utilization of healthcare services, and greater out of pocket medical costs.Conclusions. CLD patients have significantly impaired HRQoL and greater healthcare utilization compared to the general population and patients with other chronic diseases. The heavy burden of illness associated with CLD highlights the need for earlier diagnosis and innovative treatment approaches that may reduce the burden of illness and concomitant costs posed

  2. Patient-Centered Medical Home in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ortiz G

    2011-10-01

    Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

  3. Improving medication adherence of patients with chronic heart failure: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Shah D

    2015-07-01

    Full Text Available Deval Shah,1 Kim Simms,2 Debra J Barksdale,3 Jia-Rong Wu3 1Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, 2Duke University Hospital, Durham, 3School of Nursing, University of North Carolina, Chapel Hill, NC, USA Abstract: Heart failure is a chronic debilitating illness that affects 5.7 million Americans. The financial burden of heart failure in the US toppled $31 billion in 2012, which is one of the highest among all chronic medical conditions. Medication adherence is a major component of heart failure self-care behaviors. Therefore, medication non-adherence is associated with more emergency department visits, frequent rehospitalizations, and higher medical cost. Medication adherence rates have varied from 10% to 98% depending on the definition and measurement used to assess and analyze adherence. Many factors contribute to medication non-adherence such as lack of support, finances, absent of symptoms, cognitive decline, adverse reactions, depression, poor attention span, poor knowledge about medication, multiple medications, difficulty swallowing large pills, and inconveniences of urinary frequency with diuretics. Researchers have explored various strategies such as the use of pharmacists, nurses, telemedicine, and interdisciplinary teams to provide interventions to improve medication adherence in heart failure. Health care providers should continue to provide education, constantly reinforce the importance of taking medication as prescribed, and when feasible, utilize one of the successful evidence-based strategies to increase adherence. Keywords: pharmacy, tele-health, interdisciplinary, registered nurse, interventions

  4. Clinical and Economic Burden of Mental Disorders Among Children With Chronic Physical Conditions, United States, 2008–2013

    OpenAIRE

    Suryavanshi, Manasi S.; Yang, Yi

    2016-01-01

    Introduction The prevalence of chronic physical and mental disorders is increasing among children and adolescents in the United States. In this study, we investigated the association between mental health disorders and chronic physical conditions among children, and we assessed whether having mental disorders is associated with increased health care costs for children with chronic physical conditions, using Medical Expenditure Panel Survey data from 2008 through 2013. Methods Children aged 5 ...

  5. Medication overuse, healthy lifestyle behaviour and stress in chronic headache

    DEFF Research Database (Denmark)

    Westergaard, Maria Lurenda; Glümer, Charlotte; Hansen, Ebba Holme

    2016-01-01

    AIM: This cross-sectional study investigated associations between chronic headache (CH) with and without medication overuse, healthy lifestyle behaviour, and stress. METHODS: Questionnaires were sent to 129,150 adults. Those with headache ≥15 days per month for three months were classified...... as having CH then further described as having medication-overuse headache (MOH) or CH without medication overuse. Associations between headache and daily smoking, physical inactivity, obesity, excessive drinking, illicit drug use, and high stress were analysed by logistic regression. RESULTS: CH...... with and without medication overuse (prevalence 1.8% and 1.6%, respectively) had strong, graded associations with stress. Associations with daily smoking, physical inactivity, and obesity were significant only for MOH. Odds for MOH were highest among people who had all three factors compared to those who had none...

  6. [Ways to optimize working conditions of medical personnel servicing modern hi-tech medical equipment].

    Science.gov (United States)

    Kravchenko, O K

    2007-01-01

    The author analyzed health state of medical personnel through various parameters. Hygienic characteristics of work conditions for medical personnel subjected to physical factors when servicing modern hi-tech medical equipment are presented. Occupational groups at high risk are defined. The article covers main directions in improving work conditions and preserving health for medical personnel in these groups.

  7. Respiratory Conditions Update: Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Karel, Daphne J

    2016-09-01

    Chronic obstructive pulmonary disease (COPD) is defined as persistent airflow limitation due to irritant-induced chronic inflammation. A postbronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio of 0.7 or less is diagnostic in a patient with dyspnea, chronic cough or sputum production, and a history of irritant exposure. Tobacco smoking is the most significant etiology, and smoking cessation is the only intervention shown to slow disease progression. Long-acting beta2-agonists and long-acting muscarinic antagonists are first-line treatments for patients with persistently symptomatic COPD with an FEV1 of 80% or less of predicted. When COPD is uncontrolled with a long-acting bronchodilator, combination therapy with a long-acting muscarinic antagonist-long-acting beta2-agonist or long-acting beta2-agonist-inhaled corticosteroid should be prescribed. Patients with COPD and reduced exercise tolerance should undergo pulmonary rehabilitation and be evaluated for supplemental oxygen therapy. Other treatment options for persistently symptomatic COPD include inhaler triple therapy (ie, long-acting muscarinic antagonist, long-acting beta2-agonist, inhaled corticosteroid), phosphodiesterase type 4 inhibitors, oxygen, and surgical interventions.

  8. Personality characteristics in chronic and non-chronic allergic conditions.

    Science.gov (United States)

    Buske-Kirschbaum, A; Ebrecht, M; Kern, S; Gierens, A; Hellhammer, D H

    2008-07-01

    In psycho-allergological research, the potential relevance of personality factors in the maintenance and exacerbation of atopic symptoms is still a matter of debate. The present study aimed to assess personality dimensions in chronic atopic disease, i.e. atopic dermatitis (AD) and in acute manifestation of atopy (seasonal allergic rhinitis, SAR). Further, the association of a potentially atopy-specific personality profile with atopy-relevant biological stress responses should be evaluated. Subjects suffering from AD (n=36), or SAR (n=20) and non-atopic controls (n=37) were investigated. To determine different personality domains, Spielberger's State-Trait Anxiety Inventory (STAI), the Questionnaire for Competence and Control (FKK) and the Questionnaire for Stress Vulnerability (MESA) were administered. To assess the relation between these personality dimensions and biological stress responses, atopics and non-atopic controls were exposed to a standardized laboratory stressor (Trier Social Stress Test, TSST). Endocrine (cortisol, ACTH), immune (total IgE, leukocyte subsets) and physiological (heart rates) measures were recorded before and after the stress test. When compared to healthy controls, AD and SAR patients showed significantly higher trait anxiety (STAI) and stress vulnerability in situations characterized by failure, job overload and social conflicts (MESA). Moreover, AD subjects scored significantly lower in self-competence and self-efficacy (FKK) as well as in recreation ability (MESA). No difference trait anxiety and stress vulnerability could be detected between AD and SAR subjects. Pearson correlational analyses yielded no significant correlation between the different personality domains and the endocrine, physiological and immunological stress responses. However, stress-induced increase in eosinophil number was significantly correlated with the perceived self-competence/self-efficacy in SAR patients.

  9. Clinical studies on health conditions of medical diagnostic X-ray workers

    Energy Technology Data Exchange (ETDEWEB)

    Liu Liqun

    1984-10-01

    The results of investigations on general health conditions of 2484 medical X-ray workers and 1718 controls were reported. It was shown that the incidences of neurasthenic syndrome, loss of appetite, baldness etc. in X-ray workers were statistically higher than those in controls. Chronic rhinitis, pharyngitis, and paranasal sinusitis also occurred more frequently in the former group. The blood pressure, pulse rate, capillary resistance and past medical history showed no significant difference between these two groups. (Author).

  10. Unintentional Discontinuation of Chronic Medications for Seniors in Nursing Homes

    Science.gov (United States)

    Stall, Nathan M.; Fischer, Hadas D.; Wu, C. Fangyun; Bierman, Arlene S.; Brener, Stacey; Bronskill, Susan; Etchells, Edward; Fernandes, Olavo; Lau, Davina; Mamdani, Muhammad M.; Rochon, Paula; Urbach, David R.; Bell, Chaim M.

    2015-01-01

    Abstract Transitions of care leave patients vulnerable to the unintentional discontinuation of medications with proven efficacy for treating chronic diseases. Older adults residing in nursing homes may be especially susceptible to this preventable adverse event. The effect of large-scale policy changes on improving this practice is unknown. The objective of this study was to analyze the effect of a national medication reconciliation accreditation requirement for nursing homes on rates of unintentional medication discontinuation after hospital discharge. It was a population-based retrospective cohort study that used linked administrative records between 2003 and 2012 of all hospitalizations in Ontario, Canada. We identified nursing home residents aged ≥66 years who had continuous use of ≥1 of the 3 selected medications for chronic disease: levothyroxine, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). In 2008 medication reconciliation became a required practice for accreditation of Canadian nursing homes. The main outcome measures included the proportion of patients who restarted the medication of interest after hospital discharge at 7 days. We also performed a time series analysis to examine the impact of the accreditation requirement on rates of unintentional medication discontinuation. The study included 113,088 adults aged ≥66 years who were nursing home residents, had an acute hospitalization, and were discharged alive to the same nursing home. Overall rates of discontinuation at 7-days after hospital discharge were highest in 2003–2004 for all nursing homes: 23.9% for thyroxine, 26.4% for statins, and 23.9% for PPIs. In most of the cases, these overall rates decreased annually and were lowest in 2011–2012: 4.0% for thyroxine, 10.6% for statins, and 8.3% for PPIs. The time series analysis found that nursing home accreditation did not significantly lower medication discontinuation rates for any of the 3 drug groups. From 2003

  11. Impact of Chronic Conditions on the Cost of Cancer Care...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Impact of Chronic Conditions on the Cost of Cancer Care for Medicaid Beneficiaries, published in Volume 2, Issue 4 of the Medicare...

  12. Medicare Payments, How Much Do Chronic Conditions Matter

    Data.gov (United States)

    U.S. Department of Health & Human Services — There has been a growing interest in understanding the utilization patterns of patients with chronic conditions. Even though there is a lack of standard definition...

  13. Efficacy of medical therapy in treatment of chronic rhinosinusitis.

    Science.gov (United States)

    Young, Lee C; Stow, Nicholas W; Zhou, Lifeng; Douglas, Richard G

    2012-01-01

    Uncomplicated chronic rhinosinusitis (CRS) is generally treated with medical therapy initially and surgery is contemplated only after medical therapy has failed. However, there is considerable variation in the medical treatment regimens used and studies defining their efficacy are few. The aim of this study was to determine the proportion of patients treated medically who responded sufficiently well so that surgery was not required. Subgroup analysis to identify clinical features that predicted a favorable response to medical therapy was also performed. Eighty patients referred to the Otorhinolaryngology Clinic at North Shore Hospital were treated with a standardized medical therapy protocol (oral prednisone for 3 weeks, oral antibiotics and ongoing saline lavage and intranasal budesonide spray). Symptom scores were collected before and after medical therapy. Clinical features such as presence of polyps, asthma, and aspirin hypersensitivity were recorded. Failure of medical therapy was defined as the persistence of significant CRS symptoms, and those patients who failed medical therapy were offered surgery. Follow-up data were available for 72 (90%) patients. Of this group, 52.5%, (95% CI, 42.7%, 62.2%) failed to respond adequately to medical therapy and were offered surgery. The remaining patients (37.5%) were successfully treated with medical therapy and did not require surgery at the time of follow-up. The premedical therapy symptom scores were significantly higher than the postmedical therapy symptom scores (p < 0.01). The symptom scores of those patients postmedical therapy who proceeded to have surgery were significantly higher than the group who responded well to maximum medical therapy (MMT) and did not require surgery (p < 0.0001). There were no significant differences in the proportion of patients with asthma, aspirin sensitivity, or polyps between the groups failing or not failing MMT. In approximately one-third of patients with CRS, medical therapy

  14. Common lung conditions: chronic obstructive pulmonary disease.

    Science.gov (United States)

    Delzell, John E

    2013-06-01

    The etiology of chronic obstructive pulmonary disease (COPD) is chronic lung inflammation. In the United States, this inflammation most commonly is caused by smoking. COPD is diagnosed when an at-risk patient presents with respiratory symptoms and has irreversible airway obstruction indicated by a forced expiratory volume in 1 second/forced vital capacity ratio of less than 0.7. Management goals for COPD include smoking cessation, symptom reduction, exacerbation reduction, hospitalization avoidance, and improvement of quality of life. Stable patients with COPD who remain symptomatic despite using short-acting bronchodilators should start inhaled maintenance drugs to reduce symptoms and exacerbations, avoid hospitalizations, and improve quality of life. A long-acting anticholinergic or a long-acting beta2-agonist (LABA) can be used for initial therapy; these drugs have fewer adverse effects than inhaled corticosteroids (ICS). If patients remain symptomatic despite monotherapy, dual therapy with a long-acting anticholinergic and a LABA, or a LABA and an ICS, may be beneficial. Triple therapy (ie, a long-acting anticholinergic, a LABA, and an ICS) also is used, but it is unclear if triple therapy is superior to dual therapy. Roflumilast, an oral selective inhibitor of phosphodiesterase 4, is used to manage moderate to severe COPD. Continuous oxygen therapy is indicated for patients with COPD who have severe hypoxemia (ie, PaO2 less than 55 mm Hg or an oxygen saturation less than 88% on room air). Nonpharmacologic strategies also are useful to improve patient outcomes. Pulmonary rehabilitation improves dyspnea and quality of life. Pulmonary rehabilitation after an acute exacerbation reduces hospitalizations and mortality, and improves quality of life and exercise capacity. Smoking cessation is the most effective management strategy for reducing morbidity and mortality in patients with COPD. Lung volume reduction surgery, bullectomy, and lung transplantation are

  15. Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders.

    Science.gov (United States)

    Smith, Michael T; Huang, Mary I; Manber, Rachel

    2005-07-01

    Insomnia is a pervasive problem for many patients suffering from medical and psychiatric conditions. Even when the comorbid disorders are successfully treated, insomnia often fails to remit. In addition to compromising quality of life, untreated insomnia may also aggravate and complicate recovery from the comorbid disease. Cognitive behavior therapy for insomnia (CBT-I) has an established efficacy for primary insomnia, but less is known about its efficacy for insomnia occurring in the context of medical and psychiatric conditions. The purpose of this article is to present a rationale for using CBT-I in medical and psychiatric disorders, review the extant outcome literature, highlight considerations for adapting CBT-I procedures in specific populations, and suggest directions for future research. Outcome studies were identified for CBT-I in mixed medical and psychiatric conditions, cancer, chronic pain, HIV, depression, posttraumatic stress disorder, and alcoholism. Other disorders discussed include: bipolar disorder, eating disorders, generalized anxiety, and obsessive compulsive disorder. The available data demonstrate moderate to large treatment effects (Cohen's d, range=0.35-2.2) and indicate that CBT-I is a promising treatment for individuals with medical and psychiatric comorbidity. Although the literature reviewed here is limited by a paucity of randomized, controlled studies, the available data suggest that by improving sleep, CBT-I might also indirectly improve medical and psychological endpoints. This review underscores the need for future research to test the efficacy of adaptations of CBT-I to disease specific conditions and symptoms.

  16. Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are Associated with Medication Adherence.

    Science.gov (United States)

    Krauskopf, Katherine; Federman, Alex D; Kale, Minal S; Sigel, Keith M; Martynenko, Melissa; O'Conor, Rachel; Wolf, Michael S; Leventhal, Howard; Wisnivesky, Juan P

    2015-04-01

    Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self-Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohort of English- and Spanish-speaking adults with COPD from New York and Chicago. Medication adherence was assessed using the Medication Adherence Report Scale. Illness and medication beliefs along CSM domains were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen's d effect sizes) and multiple logistic regression were used to assess the relationship between illness and medication beliefs with adherence. The study included 188 participants (47% Black, 13% Hispanics); 109 (58%) were non-adherent. Non-adherent participants were younger (p < 0.001), more likely to be Black or Hispanic (p = 0.001), to have reported low income (p = 0.02), and had fewer years of formal education (p = 0.002). In unadjusted comparisons, non-adherent participants reported being more concerned about their COPD (p = 0.011; Cohen's d = 0.43), more emotionally affected by the disease (p = 0.001; Cohen's d = 0.54), and had greater concerns about COPD medications (p < 0.001, Cohen's d = 0.81). In adjusted analyses, concerns about COPD medications independently predicted non-adherence (odds ratio: 0.52, 95% confidence interval: 0.36-0.75). In this cohort of urban minority adults, concerns about medications were associated with non-adherence. Future work should explore interventions to influence patient adherence by addressing concerns about the safety profile and long-term effects of COPD medications.

  17. Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are Associated with Medication Adherence

    Science.gov (United States)

    Krauskopf, Katherine; Federman, Alex D; Kale, Minal S; Sigel, Keith M; Martynenko, Melissa; O’Conor, Rachel; Wolf, Michael S; Leventhal, Howard; Wisnivesky, Juan P

    2015-01-01

    Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohort of English- and Spanish-speaking adults with COPD from New York and Chicago. Medication adherence was assessed using the Medication Adherence Report Scale. Illness and medication beliefs along CSM domains were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen’s d effect sizes) and multiple logistic regression were used to assess the relationship between illness and medication beliefs with adherence. The study included 188 participants (47% Black, 13% Hispanics); 109 (58%) were adherent. Non-adherent participants were younger (p<0.001), more likely to be Black or Hispanic (p=0.001), to have reported low income (p=0.02), and had fewer years of formal education (p=0.002). In unadjusted comparisons, non-adherent participants reported being more concerned about their COPD (p=0.011; Cohen’s d=0.43), more emotionally affected by the disease (p=0.001; Cohen’s d=0.54), and had greater concerns about COPD medications (p<0.001, Cohen’s d=0.81). In adjusted analyses, concerns about COPD medications independently predicted non-adherence (odds ratio: 0.52, 95% confidence interval: 0.36–0.75). In this cohort of urban minority adults, concerns about medications were associated with non-adherence. Future work should explore interventions to influence patient adherence by addressing concerns about the safety profile and long-term effects of COPD medications. PMID:24960306

  18. Systematic screening for unsafe driving due to medical conditions: Still debatable

    Directory of Open Access Journals (Sweden)

    Lagarde Emmanuel

    2008-01-01

    Full Text Available Abstract Background Assessing people's ability to drive has become a public health concern in most industrialized countries. Although age itself is not a predictive factor of an increased risk for dangerous driving, the prevalence of medical conditions that may impair driving increases with age. Because the implementation of a screening for unsafe driving due to medical conditions is a public health issue, its usefulness should be judged using standardised criteria already proposed for screening for chronic disease. The aim of this paper is to propose standardised criteria suitable to assess the scientific validity of screening for unsafe driving due to medical conditions, and identify potential issues to be clarified before screening can be implemented and effective. Discussion Using criteria developed for screening for chronic diseases and published studies on driving with medical conditions, we specify six criteria to judge the opportunity of screening for unsafe driving due to medical conditions. This adaptation was needed because of the complexity of the natural history of medical conditions and their potential consequences on driving and road safety. We then illustrate that published studies pleading for or against screening for unsafe driving due to medical conditions fail to provide the needed documentation. Individual criteria were mentioned in 3 to 72% of 36 papers pleading for or against screening. Quantitative estimates of relevant indicators were provided in at most 42% of papers, and some data, such as the definition of an appropriate unsafe driving period were never provided. Summary The standardised framework described in this paper provides a template for assessing the effectiveness (or lack of effectiveness of proposed measures for screening for unsafe driving due to medical conditions. Even if most criteria were mentioned in the published literature pleading for or against such a screening, the failure to find quantitative and

  19. Can eHealth Reduce Medical Expenditures of Chronic Diseases?

    Science.gov (United States)

    Tsuji, Masatsugu; Taher, Sheikh Abu; Kinai, Yusuke

    2015-01-01

    The objective of this research is to evaluate empirically the effectiveness of eHealth in Nishi-aizu Town, Fukushima Prefecture, based on a mail survey to the residents and their receipt data of National Health Insurance from November 2006 to February 2007. The residents were divided into two groups, users and non-users, and sent questionnaires to ask their characteristics or usage of the system. Their medical expenditures paid by National Health Insurance for five years from 2002 to 2006 are examined. The effects were analyzed by comparison of medical expenditures between users and non-users. The interests are focused on four chronic diseases namely heart diseases, high blood pressure, diabetes, and strokes. A regression analysis is employed to estimate the effect of eHealth to users who have these diseases and then calculate the monetary effect of eHealth on reduction of medical expenditures. The results are expected to be valid for establishment of evidence-based policy such as reimbursement from medical insurance to eHealth.

  20. Attachment in medical care: A review of the interpersonal model in chronic disease management.

    Science.gov (United States)

    Jimenez, Xavier F

    2017-03-01

    Objective Patient-physician interaction is continually examined in an era prioritizing patient-centered approaches, yet elaboration beyond aspects of communication and empathy is lacking. Major chronic conditions would benefit tremendously from understanding interpersonal aspects of patient-physician encounters. This review intends to provide a concise introduction to the interpersonal model of attachment theory and how it informs both the patient-physician interaction and medical outcomes in chronic care. Methods A narrative review of the theoretical, neurobiological, epidemiological, investigational, and clinical literature on attachment theory and its impact on medical outcomes was conducted, utilizing a variety of key words as searched on PubMed database. Studies and reviews included were of a variety of sources, including textbooks and peer-reviewed journals. Reports in languages other than English were excluded. Results Measurable, discrete attachment styles and behavioral patterns correlate with poor medical outcomes, including nonadherence in insecure dismissing attachment and care overutilization in insecure preoccupied attachment. Furthermore, insecure dismissing attachment is associated with significant mortality. These variables can be easily assessed, and their effects are reversible, as evidenced by collaborative care outcome data. Discussion Attachment theory is useful a model with application in clinical and investigational aspects of chronic illness care. Implications and guidelines are explored.

  1. Strain-dependent Effects of Acute, Chronic, and Withdrawal from Chronic Nicotine on Fear Conditioning

    OpenAIRE

    Portugal, George S.; Wilkinson, Derek S.; Kenney, Justin W.; Sullivan, Colleen; Gould, Thomas J.

    2011-01-01

    The effects of nicotine on cognitive processes such as learning and memory may play an important role in the addictive liability of tobacco. However, it remains unknown whether genetic variability modulates the effects of nicotine on learning and memory. The present study characterized the effects of acute, chronic, and withdrawal from chronic nicotine administration on fear conditioning, somatic signs, and the elevated plus maze in 8 strains of inbred mice. Strain-dependent effects of acute ...

  2. Chronic Health Conditions Managed by School Nurses. Position Statement. Revised

    Science.gov (United States)

    Morgitan, Judith; Bushmiaer, Margo; DeSisto, Marie C.; Duff, Carolyn; Lambert, C. Patrice; Murphy, M. Kathleen; Roland, Sharon; Selser, Kendra; Wyckoff, Leah; White, Kelly

    2012-01-01

    It is the position of the National Association of School Nurses that students with chronic health conditions have access to a full-time registered professional school nurse (hereinafter referred to as school nurse). School districts should include school nurse positions in their full-time instructional support personnel to provide health services…

  3. Physical fitness and training in chronic childhood conditions

    NARCIS (Netherlands)

    van Brussel, M.

    2008-01-01

    Chapter 1 is a general introduction with background information about physical fitness and training in healthy children and children with a chronic condition. Chapter 2 describes a systematic review on the physical fitness in survivors of acute lymphoblastic leukaemia (ALL). The analysis showed that

  4. Smart medical stocking using memory polymer for chronic venous disorders.

    Science.gov (United States)

    Kumar, Bipin; Hu, Jinlian; Pan, Ning

    2016-01-01

    Proper level of pressure or compression generated by medical stocking or hosiery is the key element for successful treatment or management of chronic venous disorders such as oedema, leg ulcers, etc. However achieving the recommended compression level and, more importantly, sustaining it using stockings has been a major challenge to the health practitioners supervising the treatment. This work aims to investigate and design a smart compression stocking using shape-memory polymer that allows externally controlling the pressure level in the wrapped position on the leg. Based on thermodynamical rubber theories, we first derived several criteria that have to be satisfied simultaneously in order to achieve the controlled pressure adjustment using external heat stimuli. We then presented a case where such a stocking is developed using a blend yarn consists of selected shape-memory polyurethane and nylon filaments. Extensive experimental work has also been conducted to demonstrate the feasibility and explore the influencing factors involved.

  5. Medical Conditions Differentially Affect the Development of IADL Disability: Implications for Medical Care and Research.

    Science.gov (United States)

    Furner, Sylvia E.; And Others

    1995-01-01

    Determined independent effects of nine self-reported medical conditions on the likelihood of developing specific instrumental activities of daily living (IADLs) disabilities at three points in time. Various medical conditions differentially affect each specific IADL disability, and each IADL disability has its own set of predictors, which, in…

  6. Concordance of Chronic Conditions in Older Mexican American Couples

    Directory of Open Access Journals (Sweden)

    Jim P. Stimpson, PhD

    2005-07-01

    Full Text Available Introduction There is substantial evidence that marriage is beneficial to health, but evidence on whether the health status of one spouse is similar, or concordant, with the other spouse is limited. This study assessed whether a chronic condition of one spouse is a risk factor for the same chronic condition in the other spouse. Methods The study used baseline data from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly on 553 couples (1106 individuals who are representative of approximately 500,000 older (≥65 years Mexican Americans living in the southwestern United States. Logistic regression was used to predict six chronic conditions among couples: heart condition, stroke, hypertension, diabetes, arthritis, and cancer. Analyses were adjusted for age, education, U.S. nativity, blood pressure, body mass index, smoking, and alcohol consumption. Results The wife’s history of hypertension, diabetes, arthritis, and cancer was associated with higher odds that the husband would have these conditions. A history of hypertension, arthritis, and cancer in the husband was associated with higher odds that the wife would have these conditions. Conclusion These results provide preliminary evidence that chronic conditions in one spouse are associated with an increased risk of developing like conditions in the other spouse among older Mexican American couples. We propose that the reciprocal influence that marital partners have on each other may be caused by shared living arrangements and shared health risks. Health promotion activities should target family systems. In particular, health providers should gather health histories not only from patients and their genetic family members but also from spouses.

  7. Medical therapy for chronic obstructive pulmonary disease in 2007.

    Science.gov (United States)

    Ingenito, Edward P

    2007-01-01

    Medical treatment for patients with stable chronic obstructive pulmonary disease (COPD) has evolved significantly over the past 2 decades. Current World Health Organization recommendations suggest a stepwise approach to therapy depending upon disease severity. As-needed use of short-acting bronchodilators is recommended for patients with mild disease. Scheduled dosing of bronchodilators is recommended for patients with more advanced disease. Inhaled beta-agonists and anti-cholinergic agents in combination have proved to be more effective than either agent alone. Long-acting preparations are associated with better disease control and have not been associated with tachyphylaxis. Inhaled corticosteroids are useful for reducing the frequency of exacerbations in patients who experience one or more episodes per year. Oxygen therapy is clearly beneficial in patients with advanced COPD and chronic respiratory failure, and its potential benefits in less severe disease are currently being studied. Pulmonary rehabilitation benefits patients with mild-to-severe disease, although the greatest benefits have been demonstrated in those with moderate COPD. New ultra-long-acting inhaled bronchodilators, phosphodiesterase inhibitors, protease inhibitors, and retinoids intended to promote tissue regeneration are currently being evaluated in clinical trials as future therapeutic agents.

  8. How commonly are known medical conditions associated with autism?

    Science.gov (United States)

    Barton, M; Volkmar, F

    1998-08-01

    Recent research has yielded increasing support for neurobiologic theories of autism. A number of family and twin studies support the role of genetics and have led to wide acceptance of autism as an organically based disorder. Controversy persists, however, over the role of congenital medical conditions in the etiology of autism. Two rather divergent views have emerged. One, advocated by Gillberg and colleagues, proposes that up to 30% of cases of autism are associated with a known medical condition. On the other hand, research by Rutter and colleagues suggests the incidence may be closer to 10%. In this retrospective study records on 211 subjects with autism and other developmental disorders are reviewed to determine the prevalence of associated medical conditions and its variability related to the system used to diagnose autism. Results suggest the prevalence of medical conditions with suspected etiologic relationship with autism varies between 10 and 15%, depending on the diagnostic system employed. Further variability in prevalence rates results from a less strict definition of "medical condition" and yields rates between 25 and 37%. Disparate findings in previous research may stem from variability in both diagnostic system employed and which medical conditions are considered significant in the etiology of autism.

  9. Pillbox use, satisfaction, and effectiveness among persons with chronic health conditions.

    Science.gov (United States)

    Schwartz, Jaclyn K

    2016-08-11

    The purpose of this study was to understand how persons with chronic health conditions use pillboxes, their satisfaction with current devices, and the impact of pillbox use on medication adherence. We used convergent parallel mixed methods approach to explore the experiences of 13 regular, 3 occasional, and 5 non-pillbox users. Medication consumers completed the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0), an interview about their medication routines, and a medication adherence diary to describe their experiences with their pillboxes. Results demonstrated most participants use pillboxes to help manage their medications, and pillbox users tended to have better medication adherence than nonusers. Participants used a variety of pillboxes differing in size, shape, and color. Users reported selecting pillboxes based on their needs in addition to the demands of their habits and medication regimens. Users were generally satisfied with their pillboxes with an average QUEST score of 4.33. However, participants also identified areas for an improved design of pillboxes. Pillboxes can be an effective strategy to improve medication adherence. Improvements in device prescription, training, research, and design are needed to understand the mechanisms and size of effects of this intervention.

  10. Chronic disorders of consciousness following coma: Part one: medical issues.

    Science.gov (United States)

    Luce, John M

    2013-10-01

    Increasing numbers of patients survive traumatic brain injury (TBI) and cardiopulmonary arrest and resuscitation and are admitted to the ICU in coma. Some of these patients become brain dead; others regain consciousness. Still others become vegetative or minimally conscious, conditions called chronic disorders of consciousness and ultimately are cared for outside the ICU. Comatose patients lack the wakefulness and awareness that distinguish consciousness from unconsciousness. Vegetative patients are awake in that they manifest sleep-wake cycles, but they are unaware of their environment and cannot respond to stimuli. Minimally conscious patients are awake, aware to a limited extent, and somewhat responsive. The diagnosis of the vegetative and minimally conscious states has been based largely on their behavioral and pathologic features, and it has been believed that vegetative patients remain in that condition permanently. Nevertheless, EEG and neuroimaging studies suggest that the traditional diagnostic approach is imprecise. Moreover, clinical investigations have revealed that some vegetative patients can become minimally conscious and that some minimally conscious patients can gain increased awareness. Few therapies for patients with chronic disorders of consciousness have been subjected to randomized trials. Furthermore, although a small number of patients have improved neurologically with or without treatment, their overall prognosis for neurologic recovery remains poor.

  11. Update on Medical Management of Clinical Manifestations of Chronic Kidney Disease.

    Science.gov (United States)

    Quimby, Jessica M

    2016-11-01

    Dysregulation of normal kidney functions in chronic kidney disease (CKD) leads to several pathophysiologic abnormalities that have the potential to significantly clinically affect the CKD patient. This article discusses the clinical impact of hypertension, hypokalemia, anemia, dysrexia, nausea/vomiting, and constipation in the CKD patient and therapies for these conditions. These clinical manifestations of disease may not occur in every patient and may also develop later during the progression of disease. Therefore, monitoring for, identifying, and addressing these factors is considered an important part of the medical management of CKD.

  12. Epidemiology of multiple chronic conditions: an international perspective

    Directory of Open Access Journals (Sweden)

    François G. Schellevis

    2013-12-01

    Full Text Available The epidemiology of multimorbidity, or multiple chronic conditions (MCCs, is one of the research priority areas of the U.S. Department of Health and Human Services (HHS by its Strategic Framework on MCCs. A conceptual model addressing methodological issues leading to a valid measurement of the prevalence rates of MCCs has been developed and applied in descriptive epidemiological studies. Comparing these results with those from prevalence studies performed earlier and in other countries is hampered by methodological limitations. Therefore, this paper aims to put the size and patterns of MCCs in the USA, as established within the HHS Strategic Framework on MCCs, in perspective of the findings on the prevalence of MCCs in other countries. General common trends can be observed: increasing prevalence rates with increasing age, and multimorbidity being the rule rather than the exception at old age. Most frequent combinations of chronic diseases include the most frequently occurring single chronic diseases. New descriptive epidemiological studies will probably not provide new results; therefore, future descriptive studies should focus on the prevalence rates of MCCs in subpopulations, statistical clustering of chronic conditions, and the development of the prevalence rates of MCCs over time. The finding of common trends also indicates the necessary transition to a next phase of MCC research, addressing the quality of care of patients with MCCs from an organizational perspective and with respect to the content of care.

  13. Crash Rates of Quebec Drivers with Medical Conditions

    OpenAIRE

    Dow, Jamie; Gaudet, Michel; Turmel, Émilie

    2013-01-01

    Using a databank that combines comprehensive medical data with the driving records of 96% of the drivers in Quebec, odds ratios were calculated for crash risk involving death or serious injury according to the diagnosis of medical conditions traditionally associated with increased crash risk. Results were controlled for age, sex, residence (rural/urban), possession of a professional licence (classes 1 – 4), previous involvement in a crash with injury or death and for the presence of other med...

  14. Sexual dysfunction among Ghanaian men presenting with various medical conditions

    Directory of Open Access Journals (Sweden)

    Quaye Lawrence

    2010-10-01

    Full Text Available Abstract Background Several medical conditions can affect and disrupt human sexuality. The alteration of sexuality in these medical conditions often hinder effective communication and empathy between the patients and their sexual partners because of cultural attitudes, social norms and negative feelings such as anxiety and guilt. Validated and standardized sexual inventories might therefore help resolve this problem. The objective of this cross-sectional study was to obtain data on the prevalence of male sexual dysfunction (SD among Ghanaians with various medical conditions residing in Kumasi. Methods The Golombok Rust Inventory of Sexual Satisfaction (GRISS was administered to 150 Ghanaian men with various medical conditions between 19 and 66 years old (mean ± standard deviation: 40.01 ± 12.32 years domiciled in the Kumasi metropolis. Results Out of the total 150 questionnaires administered, 105 (70.0% men returned the questionnaires. Questionnaires from 3 men were incomplete, leaving 102 complete and evaluable questionnaires, indicating a 68.0% response rate. Of the remaining 102 men, 88.2% were married, 70.6% had attained higher education, 88.2% were non-smokers. Whereas 54.9% were engaged in exercise, 61.8% indulged in alcoholic beverages. The prevalence of the various medical conditions include: diabetes (18%, hypertension (24.5%, migraine (11.8%, ulcer (7.8%, surgery (6.9%, STD (3.9 and others (26.5%. The prevalence of SD among the respondents in the study was 59.8%. The highest prevalence of SD was seen among ulcer patients (100%, followed by patients who have undergone surgery (75%, diabetes (70%, hypertension (50%, STD (50% and the lowest was seen among migraine patients (41.7%. Conclusions SD rate is high among Ghanaian men with medical conditions (about 60% and vary according to the condition and age.

  15. Prevalence and factors associated with behavioral disorders in children with chronic health conditions

    Directory of Open Access Journals (Sweden)

    Budi Santoso Adji

    2010-03-01

    Conclusions Prevalence of behavioral disorders in children with chronic health condition is 37.5%. The duration of illness contributes to the manifestation of behavioral disorders in children with chronic health conditions. [Paediatr Indones. 2010;50:1-5].

  16. Overuse of symptomatic medications among chronic (transformed migraine patients: profile of drug consumption

    Directory of Open Access Journals (Sweden)

    Krymchantowski Abouch Valenty

    2003-01-01

    Full Text Available Chronic daily headache and chronic (transformed migraine (TM patients represent more than one third of the subjects seen in specialized headache centers. Most of these patients may overuse symptomatic medications (SM taken on a daily basis to relieve headache and associated symptoms. The conversion to the daily or near-daily pattern of headache presentation is thought to be related to the medication overuse. The aim of this study was to evaluate the profile of SM consumption among transformed migraine patients attending a tertiary center. One hundred thirty three consecutive patients (22 men and 111 women, ages 17 to 80 with TM and overuse of SM according to the proposed criteria of Silberstein et al (1994, 1996 were prospectively studied. None of the patients were under treatment for other conditions. Among them, 73 (54.9% were using one category of SM, while 55 (41.3% and 5 (3.8% patients were taking simultaneously two and three categories of SM respectively. The categories of overused symptomatic medications varied from simple analgesics to narcotics, triptans and combinations of ergot derivatives and caffeine and of analgesics and caffeine. The average intake per patient per day was of 3 to 4 tablets and mostly of the patients overused simple analgesics (isolated or in combination with other substances (75.2%, caffeine containing drugs (71.4%, drugs containing ergotamine derivatives (26.1%, triptans (alone or combined (15.5%, drugs with narcotics or ansiolitics (13% and anti-inflammatory drugs (3.7%. The mechanisms by which the overuse of symptomatic medications may play a role in this transformation are uncertain but despite of the necessity of controlled trials to demonstrate the real role of such compounds in the development of transformed migraine, this study emphasizes the necessity for more rigorous prescribing guidelines for patients with frequent headaches.

  17. Chronic disease, medications and lifestyle: perceptions from a regional Victorian Aboriginal community

    Directory of Open Access Journals (Sweden)

    Deacon-Crouch M

    2016-09-01

    Full Text Available Background: Poor medication management may contribute to the increased morbidity and mortality of Aboriginal people in Australia. Yet while there is extensive literature about the perceptions of healthcare providers on this issue, there is limited information on the perceptions of Aboriginal people themselves. Objectives: To investigate the perceptions of a group of Aboriginal people attending a Victorian regional Aboriginal Health Service (AHS with diagnosed medical conditions requiring medications, of their lifestyle, disease management and medication usage. Methods: Data was collected through one to one in depth interviews using a semi-structured ‘yarning’ process. Twenty patients were invited to participate in the study and were interviewed by Aboriginal Health Workers in a culturally appropriate manner. The interviews were recorded and transcribed verbatim. The data were analysed using descriptive statistics. Results: Our results show that the majority of participants perceived that changes in lifestyle factors such as diet, exercise, and smoking cessation would help improve their health. Most patients reported having been counselled on their medicines, and while the majority reported adherence and acknowledgement of the efficacy of their medicines, there was a lack of clarity regarding long term maintenance on regimens. Finally, while the majority reported taking over the counter products, some did not see the need to inform their doctor about this, or chose not to. Conclusion: Chronic illness was perceived as common in families and community. Patients relied mostly on their health care professionals as sources for their drug information. Patients may have benefited from further counselling in the area of complementary and other over the counter medicines, as well as on the necessity of maintenance of regimes for chronic disease management. Finally, lifestyle changes such as dietary improvements and smoking cessation were identified as

  18. Oral inflammation and infection, and chronic medical diseases: implications for the elderly.

    Science.gov (United States)

    Scannapieco, Frank A; Cantos, Albert

    2016-10-01

    Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.

  19. Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

    Directory of Open Access Journals (Sweden)

    Mncedisi M. Willie

    2012-02-01

    Full Text Available Background: Prescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full, and includes a select of chronic conditions. Chronic conditions affect people’s lifestyles and require ongoing management over a period of years for long-term survival. Objectives: This study examined the association between prevalence of selected chronic diseases and health service use, in particular visits to general practitioners (GPs by medical scheme members.Method: This was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic disease prevalence, age stratum and scheme size on GP visits per annum.Results: The study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95% CI = 1.008–1.159, as was prevalence of type 2 diabetes (OR = 1.087; 95% CI = 1.027–1.152, whilst prevalence of hyperlipidaemia (OR = 0.92; 95% CI = 0.875–0.97 was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95% CI = 1.017–1.26.Conclusion: This study shows that scheme size, prevalence of chronic diseases such as asthma, type 2 diabetes, hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them.

  20. Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

    Directory of Open Access Journals (Sweden)

    Mncedisi M. Willie

    2012-10-01

    Full Text Available Background: Prescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full, and includes a select of chronic conditions. Chronic conditions affect people’s lifestyles and require ongoing management over a period of years for long-term survival.Objectives: This study examined the association between prevalence of selected chronic diseases and health service use, in particular visits to general practitioners (GPs by medical scheme members.Method: This was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic diseaseprevalence, age stratum and scheme size on GP visits per annum.Results: The study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95% CI = 1.008–1.159, as was prevalence of type 2 diabetes (OR = 1.087; 95% CI = 1.027–1.152, whilst prevalence of hyperlipidaemia (OR = 0.92; 95%CI = 0.875–0.97 was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95% CI = 1.017–1.26.Conclusion: This study shows that scheme size, prevalence of chronic diseases such as asthma, type 2 diabetes, hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them.

  1. Psychosocial predictors of non-adherence to chronic medication: systematic review of longitudinal studies.

    NARCIS (Netherlands)

    Zwikker, H.E.; Bemt, B.J. van den; Vriezekolk, J.E.; Ende, C.H. van den; Dulmen, S. van

    2014-01-01

    Objectives: Several cross-sectional studies suggest that psychosocial factors are associated with non-adherence to chronic preventive maintenance medication (CPMM); however, results from longitudinal associations have not yet been systematically summarized. Therefore, the objective of this study was

  2. Psychosocial predictors of non-adherence to chronic medication: systematic review of longitudinal studies

    NARCIS (Netherlands)

    Zwikker, H.E.; Bemt, B.J.F van den; Vriezekolk, J.E.; Ende, C.H.M. van den; Dulmen, S. van

    2014-01-01

    OBJECTIVES: Several cross-sectional studies suggest that psychosocial factors are associated with non-adherence to chronic preventive maintenance medication (CPMM); however, results from longitudinal associations have not yet been systematically summarized. Therefore, the objective of this study was

  3. Strategies of adherence promotion in the management of pediatric chronic conditions.

    Science.gov (United States)

    Drotar, Dennis

    2013-01-01

    Children and families often have difficulty following prescribed medical treatment for chronic pediatric conditions. Such nonadherence has a significant impact on children's health care outcomes and the costs of their care. This review describes a comprehensive approach to increase treatment adherence in chronic pediatric illnesses and lessen its impact. Key elements of this proposed model of adherence promotion include the following: (1) a core approach to adherence promotion to be implemented by pediatric health care providers; (2) follow-up and ongoing management; and (3) tailoring and targeting specific more intensive family-centered interventions to children and adolescents who demonstrate clinically significant treatment nonadherence or risk for nonadherence. Behavioral specialists have important roles in conducting research on adherence promotion, training health care providers, and delivering services to children and adolescents with clinically significant adherence problems.

  4. Prevalence and impact of disabling chronic conditions in childhood.

    Science.gov (United States)

    Newacheck, P W; Halfon, N

    1998-01-01

    OBJECTIVES: This study provides a current national profile of the prevalence and impact of chronic conditions causing childhood disability. Disability is defined as a long-term reduction in ability to conduct social role activities, such as school or play, because of a chronic physical or mental condition. METHODS: A cross-sectional descriptive analysis was performed on data from 99513 children younger than 18 years who were included in the 1992-1994 National Health Interview Survey. The response rate exceeded 93% during each year. RESULTS: A significant proportion of children, estimated at 6.5% of all US children, experienced some degree of disability. The most common causes of childhood disability were respiratory diseases and mental impairments. Prevalence of disability was higher for older children, boys, and children from low-income and single-parent families. Childhood disability is estimated to result in 66 million restricted activity days annually, including 24 million days lost from school. Furthermore, disability in childhood results in an added 26 million physician contacts and 5 million hospital days annually. CONCLUSIONS: Childhood disability has profound impacts on children, the education system, and the health care system. PMID:9551003

  5. Iterative Design and Usability Testing of the Imhere System for Managing Chronic Conditions and Disability.

    Science.gov (United States)

    Fairman, Andrea D; Yih, Erika T; McCoy, Daniel F; Lopresti, Edmund F; McCue, Michael P; Parmanto, Bambang; Dicianno, Brad E

    2016-01-01

    A novel mobile health platform, Interactive Mobile Health and Rehabilitation (iMHere), is being developed to support wellness and self-management among people with chronic disabilities. The iMHere system currently includes a smartphone app with six modules for use by persons with disabilities and a web portal for use by medical and rehabilitation professionals or other support personnel. Our initial clinical research applying use of this system provides insight into the feasibility of employing iMHere in the development of self-management skills in young adults (ages 18-40 years) with spina bifida (SB) (Dicianno, Fairman, et al., 2015). This article describes the iterative design of the iMHere system including usability testing of both the app modules and clinician portal. Our pilot population of persons with SB fostered the creation of a system appropriate for people with a wide variety of functional abilities and needs. As a result, the system is appropriate for use by persons with various disabilities and chronic conditions, not only SB. In addition, the diversity of professionals and support personnel involved in the care of persons with SB also enabled the design and implementation of the iMHere system to meet the needs of an interdisciplinary team of providers who treat various conditions. The iMHere system has the potential to foster communication and collaboration among members of an interdisciplinary healthcare team, including individuals with chronic conditions and disabilities, for a client-centered approach to support self-management skills.

  6. Depressive symptoms in people with chronic physical conditions: prevalence and risk factors in a Hong Kong community sample

    Directory of Open Access Journals (Sweden)

    Nan Hairong

    2012-11-01

    Full Text Available Abstract Background Depression is predicted to become one of the two most burdensome diseases worldwide by 2020 and is common in people with chronic physical conditions. However, depression is relatively uncommon in Asia. Family support is an important Asian cultural value that we hypothesized could protect people with chronic physical conditions from developing depression. We investigated depressive symptom prevalence and risk factors in a Chinese sample with chronic medical conditions, focusing on the possible protective role of family relationships. Methods Data were obtained from the Hong Kong Jockey Club FAMILY Project cohort study in 2009–2011, which included 6,195 participants (age ≥15 with self-reported chronic conditions. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9. Demographic and lifestyle variables, stressful life events, perceived family support and neighborhood cohesion were assessed. Factors associated with a non-somatic (PHQ-6 depression score were also examined. Results The prevalence of depressive symptoms (PHQ-9 scores ≥5 was 17% in those with one or more chronic conditions, and was more prevalent in women than in men (19.7% vs. 13.9%; p p p  Conclusions Acute life stress and the number of chronic conditions, together with socio-demographic factors, explain most variance in depressive symptoms among chronically ill Chinese individuals. Somatic items in the PHQ-9 increased the depression scores but they did not alter the pattern of predictors. Family support appears to be an important protective factor in Chinese cultures for individuals with chronic conditions.

  7. Parametric estimation of medical care costs under conditions of censoring

    OpenAIRE

    Raikou, Maria; McGuire, Alistair

    2009-01-01

    This paper is concerned with a set of parametric estimators that attempt to provide consistent estimates of average medical care costs under conditions of censoring. The main finding is that incorporation of the inverse of the probability of an individual not being censored in the estimating equations is instrumental in deriving unbiased cost estimates. The success of the approach is dependent on the amount of available information on the cost history process. The value of this information in...

  8. Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature.

    Science.gov (United States)

    Edelstein, Burton L; Ng, Man Wai

    2015-01-01

    An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.

  9. MODELING CHRONIC DISEASE PATIENT FLOWS DIVERTED FROM EMERGENCY DEPARTMENTS TO PATIENT-CENTERED MEDICAL HOMES.

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua; Kumar, Sameer; Britton, Bruce

    Chronic Disease is defined as a long lasting health condition, which can develop and/or worsen over an extended time, but which can also be controlled. The monetary and budgetary toll due to its persistent nature has become unsustainable and requires pressing actions to limit their incidence and burden. This paper demonstrates the utility of the System Dynamics approach to simulate the behavior of key factors involved in the implementation of chronic disease management. We model the patient flow diversion from emergency departments (ED) to patient-centered medical homes (PCMH), with emphasis on the visit rates, as well as the effect of insurance coverage, in an effort to assure continuity of quality care for Asthma patients at lower costs. The model is used as an evaluative method to identify conditions of a maintained health status through adequate policy planning, in terms of resources and capacity. This approach gives decision makers the ability to track the level of implementation of the intervention and generate knowledge about dynamics between population demands and the intervention effectiveness. The functionality of the model is demonstrated through the consideration of hypothetical scenarios executed using sensitivity analysis.

  10. Natural healers: a review of animal assisted therapy and activities as complementary treatment for chronic conditions.

    Science.gov (United States)

    Reed, Reiley; Ferrer, Lilian; Villegas, Natalia

    2012-01-01

    The primary objective of this review is to synthesize the existing literature on the use of animal-assisted therapy and activity (AAT/A) as complementary treatment among people living with chronic disease and to discuss the possible application of this practice among children living with HIV. Relevant databases were searched between March 10 and April 11, 2011, using the words: animal assisted therapy or treatment and chronic conditions or diseases. Thirty-one articles were found and 18 followed the inclusion and exclusion criteria. Research suggests that AAT/A is effective for different patient profiles, particularly children. Interaction with dogs has been found to increase positive behaviors, such as sensitivity and focus, in children with social disabilities. Decreased levels of pain have also been reported among child patients as a result of AAT/A. More research should be done in the area of children living with chronic diseases that require strict adherence to treatment, such as HIV, and on AAT/A's prospective use as an educational tool to teach children about the importance of self-care for their medical conditions.

  11. Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study

    DEFF Research Database (Denmark)

    Wilbrink, Leopoldine A; Teernstra, Onno Pm; Haan, Joost

    2013-01-01

    BACKGROUND: About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled...... in medically intractable, chronic cluster headache patients of high- versus low-amplitude ONS. Primary outcome measure is the mean number of attacks over the last four weeks. After a study period of six months there is an open extension phase of six months. Alongside the randomised trial an economic evaluation...... study is performed. DISCUSSION: The ICON study will show if ONS is an effective preventive therapy for patients suffering medically intractable chronic cluster headache and if there is a difference between high- and low-amplitude stimulation. The innovative design of the study will, for the first time...

  12. [The role of chronic gastritis in past medical history with NSAID administration in patients with osteoarthrosis].

    Science.gov (United States)

    Zak, M Iu

    2014-11-01

    122 patients with osteoarthrosis, who have in the past medical history verified chronic gastritis (50 males and 72 females) at the age from 42 to 64 have been examined. Control group was comprised of 40 patients with osteoarthrosis without gastroduodenal zone pathology in the past medical history. For arthralgia relief patients were prescribed meloxicam (average dose--12.5 - 1.39 mg daily) or nimesulide (average dose--150 ± 14.91 mg daily). As a result of this research it was determined that administration of selective NSAID (meloxicam and nimesulide) in patients with chronic gastritis in the past medical history raised the risk of NSAID gastropathy/dyspepsia 2.9 times (P 0.05) of erosive gastropathy. Patients with chronic gastritis in the past medical history when taking NSAID with the purpose of gastropathy prevention are recommended to undergo gastroprotective therapy.

  13. Behavioral activation therapy for remediating persistent social deficits in medication-responsive chronic depression.

    Science.gov (United States)

    Erickson, Gregory; Hellerstein, David J

    2011-05-01

    The purpose of this article is to explore the use of behavioral activation therapy in patients with medication-responsive chronic depression who continue to experience social and occupational deficits. The classification of chronic depression includes a variety of disorders that are both common and debilitating and that frequently leave patients socially impaired even after remission of mood symptoms. Medication is often only partially effective in remedying these social impairments. As a result, other interventions, including forms of psychotherapy, may be justified as an adjunct to medication to improve residual social impairment. Behavioral activation therapy is one such treatment that may be especially appropriate for such individuals. The authors offer a brief description of behavioral activation therapy and examine how to adapt this therapy for use in patients with medication-responsive chronic depression. Preliminary evidence suggests that the therapy can be easily implemented with few modifications to improve social and occupational difficulties.

  14. Potential therapeutic competition in community-living older adults in the U.S.: use of medications that may adversely affect a coexisting condition.

    Directory of Open Access Journals (Sweden)

    Songprod Jonathan Lorgunpai

    Full Text Available OBJECTIVE: The 75% of older adults with multiple chronic conditions are at risk of therapeutic competition (i.e. treatment for one condition may adversely affect a coexisting condition. The objective was to determine the prevalence of potential therapeutic competition in community-living older adults. METHODS: Cross-sectional descriptive study of a representative sample of 5,815 community-living adults 65 and older in the U.S, enrolled 2007-2009. The 14 most common chronic conditions treated with at least one medication were ascertained from Medicare claims. Medication classes recommended in national disease guidelines for these conditions and used by ≥ 2% of participants were identified from in-person interviews conducted 2008-2010. Criteria for potential therapeutic competition included: 1, well-acknowledged adverse medication effect; 2 mention in disease guidelines; or 3 report in a systematic review or two studies published since 2000. Outcomes included prevalence of situations of potential therapeutic competition and frequency of use of the medication in individuals with and without the competing condition. RESULTS: Of 27 medication classes, 15 (55.5% recommended for one study condition may adversely affect other study conditions. Among 91 possible pairs of study chronic conditions, 25 (27.5% have at least one potential therapeutic competition. Among participants, 1,313 (22.6% received at least one medication that may worsen a coexisting condition; 753 (13% had multiple pairs of such competing conditions. For example, among 846 participants with hypertension and COPD, 16.2% used a nonselective beta-blocker. In only 6 of 37 cases (16.2% of potential therapeutic competition were those with the competing condition less likely to receive the medication than those without the competing condition. CONCLUSIONS: One fifth of older Americans receive medications that may adversely affect coexisting conditions. Determining clinical outcomes in these

  15. Frequency and content analysis of chronic fatigue syndrome in medical text books.

    Science.gov (United States)

    Jason, Leonard A; Paavola, Erin; Porter, Nicole; Morello, Morgan L

    2010-01-01

    Text books are a cornerstone in the training of medical staff and students, and they are an important source of references and reviews for these professionals. The objective of this study was to determine both the quantity and quality of chronic fatigue syndrome (CFS) information included in medical texts. After reviewing 119 medical text books from various medical specialties, we found that 48 (40.3%) of the medical text books included information on CFS. However, among the 129 527 total pages within these medical text books, the CFS content was presented on only 116.3 (0.090%) pages. Other illnesses that are less prevalent, such as multiple sclerosis and Lyme disease, were more frequently represented in medical text books. These findings suggest that the topic ofCFS is underreported in published medical text books.

  16. Child maltreatment: pathway to chronic and long-term conditions?

    Science.gov (United States)

    Taylor, Julie; Bradbury-Jones, Caroline; Lazenbatt, Anne; Soliman, Francesca

    2016-09-01

    The manifesto Start Well, Live Better by the UK Faculty of Public Health (Start Well, Live Better-A Manifesto for the Public's Health. London: UK Faculty of Public Health, 2014) sets out 12 compelling priorities for the protection of people's health. The focus of this document is preventative, calling for a comprehensive strategy to target a wide-ranging set of challenges to public health; however, it fails to mention child maltreatment and its negative impact on long-term health outcomes. In this article, we explore the long-term negative consequences of child maltreatment and how these can be conceptually aligned with four different characteristics of long-term health conditions. We suggest that situating child maltreatment within a long-term conditions framework could have significant advantages and implications for practice, policy and research, by strengthening a commitment across disciplines to apply evidence-based principles linked with policy and evaluation and recognizing the chronic effects of maltreatment to concentrate public, professional and government awareness of the extent and impact of the issue. We argue that a public health approach is the most effective way of focusing preventative efforts on the long-term sequelae of child maltreatment and to foster cooperation in promoting children's rights to grow and develop in a safe and caring environment free from violence and abuse.

  17. Effectiveness of Telephone-Based Health Coaching for Patients with Chronic Conditions: A Randomised Controlled Trial

    Science.gov (United States)

    Dwinger, Sarah; Kriston, Levente; Herbarth, Lutz; Siegmund-Schultze, Elisabeth; Bermejo, Isaac; Matschinger, Herbert; Heider, Dirk; König, Hans-Helmut

    2016-01-01

    Background Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients’ self-management. We aimed to examine the effectiveness of telephone-based health coaching (TBHC) in chronically ill patients. Methods and Findings This prospective, pragmatic randomized controlled trial compares an intervention group (IG) of participants in TBHC to a control group (CG) without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1) multiple conditions (chronic campaign), 2) heart failure (heart failure campaign), or 3) chronic mental illness conditions (mental health campaign) were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses (DDD), frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching (PSM) was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios (HR). Probability of hospital readmission and probability of death were analysed by calculating odds ratios (OR). Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596) in the chronic campaign, of 660 (IG: 338; CG: 322) in the

  18. Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse.

    Science.gov (United States)

    Gómez-Beldarrain, Marian; Carrasco, María; Bilbao, Amaia; García-Moncó, Juan C

    2011-08-01

    Chronic migraine patients are at risk of developing a medication overuse. Brain functional studies in these patients have demonstrated an orbitofrontal hypometabolism, persistent after overuse cessation. Orbitofrontal dysfunction is also present in addiction and thus could predispose migraineurs to medication overuse. The aim of this study was to investigate if orbitofrontal dysfunction can be demonstrated in patients with chronic migraine and medication overuse by performing a systematic neuropsychological evaluation focused on tests that assess frontal lobe function. Second, to establish whether it is related to the outcome of these patients. We prospectively studied 42 chronic migraine patients with medication overuse, 42 episodic migraineurs and 41 controls on a battery of neuropsychological tasks evaluating the orbitofrontal and dorsolateral functioning. Depression, anxiety, and personality traits were also assessed. Chronic migraineurs with medication overuse showed a significant impairment in orbitofrontal task performance and higher depression scores as compared to episodic migraineurs and controls. Dorsolateral dysfunction was present in both groups of migraneurs, who also had higher rates of anxiety as compared to controls. After 1 year of follow-up, migraine patient's outcome was classified according to their medication overuse status. A negative outcome that included persistent or new-onset medication overuse was present in 34% of migraineurs and was associated with baseline poor orbitofrontal task performance, and with mild dorsolateral dysfunction, higher rates of depression, anxiety and neuroticism-anxiety traits. Formal education and years with migraine did not influence outcome. Orbitofrontal dysfunction is present in patients with chronic migraine and medication overuse, and associates with a poor outcome at 1 year of follow-up. Neuropsychological evaluation in migraine may help to detect patients prone to overuse so that appropriate therapeutic

  19. Examining influential factors in providers’ chronic pain treatment decisions: a comparison of physicians and medical students

    OpenAIRE

    2015-01-01

    Background Chronic pain treatment guidelines are unclear and conflicting, which contributes to inconsistent pain care. In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions. The purpose of this study was to examine factors that reportedly influence providers’ chronic pain treatment decisions. A secondary aim was to examine differences across participant training level. Methods Eighty-five participants (35 medical st...

  20. Monitoring the prevalence of chronic conditions: which data should we use?

    Directory of Open Access Journals (Sweden)

    Orueta Juan F

    2012-10-01

    Full Text Available Abstract Background Chronic diseases are an increasing threat to people’s health and to the sustainability of health organisations. Despite the need for routine monitoring systems to assess the impact of chronicity in the population and its evolution over time, currently no single source of information has been identified as suitable for this purpose. Our objective was to describe the prevalence of various chronic conditions estimated using routine data recorded by health professionals: diagnoses on hospital discharge abstracts, and primary care prescriptions and diagnoses. Methods The ICD-9-CM codes for diagnoses and Anatomical Therapeutic Chemical (ATC codes for prescriptions were collected for all patients in the Basque Country over 14 years of age (n=1,964,337 for a 12-month period. We employed a range of different inputs: hospital diagnoses, primary care diagnoses, primary care prescriptions and combinations thereof. Data were collapsed into the morbidity groups specified by the Johns Hopkins Adjusted Clinical Groups (ACGs Case-Mix System. We estimated the prevalence of 12 chronic conditions, comparing the results obtained using the different data sources with each other and also with those of the Basque Health Interview Survey (ESCAV. Using the different combinations of inputs, Standardized Morbidity Ratios (SMRs for the considered diseases were calculated for the list of patients of each general practitioner. The variances of the SMRs were used as a measure of the dispersion of the data and were compared using the Brown-Forsythe test. Results The prevalences calculated using prescription data were higher than those obtained from diagnoses and those from the ESCAV, with two exceptions: malignant neoplasm and migraine. The variances of the SMRs obtained from the combination of all the data sources (hospital diagnoses, and primary care prescriptions and diagnoses were significantly lower than those using only diagnoses. Conclusions The

  1. Accompanying conditions in patients with chronic spontaneous urticaria and urticarial vasculitis: Results of a retrospective study

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    Sevgi Akarsu

    2015-03-01

    Full Text Available Background and Design: Chronic spontaneous urticaria (CSU, the most common form of chronic urticaria, is characterized by spontaneous wheals and/or angioedema lasting longer than six weeks. Urticarial vasculitis (UV is a small vessel vasculitis; but is also included in the various classification systems of chronic urticaria by some authors. The aim of our study was to evaluate the frequency of accompanying conditions, and to compare the demographic, clinical and laboratory features of patients with CSU and UV. Materials and Methods: In this study, the files of CSU (n=146 and UV (n=43 patients who had been hospitalized between January 2010-December 2013 were retrospectively reviewed in terms of demographic data, disease-specific history, accompanying diseases, medications and laboratory findings. Results: When comparing between the two groups for statistical differences, it was found that the frequencies of personal atopy and angioedema were significantly higher in patients with CSU; however, the patients with UV had significantly higher rates for female gender and the presence of systemic symptoms compared to those with CSU. It was determined that the mean values for erythrocyte sedimentation rate and C-reactive protein, as well as the rates of antinuclear antibody positivity and hypocomplementemia were significantly higher in the UV group, compared with those in the CSU group. Accompanying factors were determined as infections, medications, autoimmune diseases and malignities in order of frequency in both CSU and UV groups, but only the frequency of autoimmune diseases was significantly higher in patients with UV group. Conclusion: Although various authors have reported that a large number (up to 40-60% of patients with UV may present only with wheals (clinically indistinguishable from CSU; we assumed that it would be more appropriate to be considered UV as a priority in patients especially who had systemic symptom, autoimmune disease

  2. Multiple Chronic Conditions among Adults Aged 45 and Over: Trends Over the Past 10 Years

    Science.gov (United States)

    ... have more physician visits ( 3 ). Out-of-pocket spending is higher for persons with multiple chronic conditions and has increased in recent years ( 5 ). Chronic disease, and combinations of chronic diseases, affects individuals to varying degrees and may impact an individual's ...

  3. Prevalence of chronic headache with and without medication overuse

    DEFF Research Database (Denmark)

    Westergaard, Maria Lurenda; Glümer, Charlotte; Hansen, Ebba Holme;

    2014-01-01

    with these headaches. This cross-sectional study examined the prevalence of CH in Denmark; possible associations between CH and education, work status, and income; and the health status of people with CH across socioeconomic strata. A total of 129,150 individuals aged ⩾16years were invited to the 2010 Danish National...... medication overuse (⩾20 or ⩾30 defined daily doses per month depending on the drug or drugs) were classified as having MOH. Associations between headache and SEP were analyzed by logistic regression, and associations between headache and health status scores, by linear regression. Physical and mental health...... composite scores (SF-12) were summarized per headache group, stratified by SEP, and compared to the sample mean. Analyses were adjusted for stratified sampling and nonresponse. The response rate was 53.1%. CH prevalence was 3.3% with 53.0% of cases having concurrent medication overuse (MOH prevalence 1...

  4. Supporting Medical Research on Chronic Diseases using Integrated Health Monitoring Platform

    OpenAIRE

    Krukowski, Artur; Vogiatzaki, Emmanouela; Charalambides, Marios; Chouchoulis, Michalis

    2014-01-01

    This paper describes combined experiences in developing e-Health platforms and services with respect of supporting medical research into the causes and relationships among physiological parameters and health problems concerning different chronic diseases, from cardiovascular to stroke, epilepsy, and others. The Personal Health Records (PHR) is presented as new technological approaches aimed at standardizing electronic management of medical information between the patient and its physicians, a...

  5. Dioxins from medical waste incineration: Normal operation and transient conditions.

    Science.gov (United States)

    Chen, Tong; Zhan, Ming-xiu; Yan, Mi; Fu, Jian-ying; Lu, Sheng-yong; Li, Xiao-dong; Yan, Jian-hua; Buekens, Alfons

    2015-07-01

    Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) are key pollutants in waste incineration. At present, incinerator managers and official supervisors focus only on emissions evolving during steady-state operation. Yet, these emissions may considerably be raised during periods of poor combustion, plant shutdown, and especially when starting-up from cold. Until now there were no data on transient emissions from medical (or hospital) waste incineration (MWI). However, MWI is reputed to engender higher emissions than those from municipal solid waste incineration (MSWI). The emission levels in this study recorded for shutdown and start-up, however, were significantly higher: 483 ± 184 ng Nm(-3) (1.47 ± 0.17 ng I-TEQ Nm(-3)) for shutdown and 735 ng Nm(-3) (7.73 ng I-TEQ Nm(-3)) for start-up conditions, respectively. Thus, the average (I-TEQ) concentration during shutdown is 2.6 (3.8) times higher than the average concentration during normal operation, and the average (I-TEQ) concentration during start-up is 4.0 (almost 20) times higher. So monitoring should cover the entire incineration cycle, including start-up, operation and shutdown, rather than optimised operation only. This suggestion is important for medical waste incinerators, as these facilities frequently start up and shut down, because of their small size, or of lacking waste supply. Forthcoming operation should shift towards much longer operating cycles, i.e., a single weekly start-up and shutdown.

  6. Medical Signal-Conditioning and Data-Interface System

    Science.gov (United States)

    Braun, Jeffrey; Jacobus, charles; Booth, Scott; Suarez, Michael; Smith, Derek; Hartnagle, Jeffrey; LePrell, Glenn

    2006-01-01

    A general-purpose portable, wearable electronic signal-conditioning and data-interface system is being developed for medical applications. The system can acquire multiple physiological signals (e.g., electrocardiographic, electroencephalographic, and electromyographic signals) from sensors on the wearer s body, digitize those signals that are received in analog form, preprocess the resulting data, and transmit the data to one or more remote location(s) via a radiocommunication link and/or the Internet. The system includes a computer running data-object-oriented software that can be programmed to configure the system to accept almost any analog or digital input signals from medical devices. The computing hardware and software implement a general-purpose data-routing-and-encapsulation architecture that supports tagging of input data and routing the data in a standardized way through the Internet and other modern packet-switching networks to one or more computer(s) for review by physicians. The architecture supports multiple-site buffering of data for redundancy and reliability, and supports both real-time and slower-than-real-time collection, routing, and viewing of signal data. Routing and viewing stations support insertion of automated analysis routines to aid in encoding, analysis, viewing, and diagnosis.

  7. Unintentional non-adherence to chronic prescription medications: How unintentional is it really?

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    Gadkari Abhijit S

    2012-06-01

    Full Text Available Abstract Background Unintentional non-adherence has been characterized as passively inconsistent medication-taking behavior (forgetfulness or carelessness. Our objectives were to: (1 study the prevalence and predictors of unintentional non-adherence; and (2 explore the interrelationship between intentional and unintentional non-adherence in relation to patients’ medication beliefs. Methods We conducted a cross-sectional survey of adults with asthma, hypertension, diabetes, hyperlipidemia, osteoporosis, or depression from the Harris Interactive Chronic Illness Panel. The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease. They answered three questions on unintentional non-adherence (forgot, ran out, being careless, 11 questions on intentional non-adherence, and three multi-item scales assessing perceived need for medication (k = 10, perceived medication concerns (k = 6, and perceived medication affordability (k = 4. Logistic regression was used to model predictors of each unintentional non-adherence behavior. Baron and Kenny’s regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence. Bootstrapping was employed to confirm the statistical significance of these results. Results For the index disease, 62% forgot to take a medication, 37% had run out of the medication, and 23% were careless about taking the medication. Common multivariate predictors (p  Conclusions For our study sample, unintentional non-adherence does not appear to be random and is predicted by medication beliefs, chronic disease, and sociodemographics. The data suggests that the importance of unintentional non-adherence may lie in its potential prognostic significance for future intentional non-adherence. Health care providers may consider routinely

  8. Oral complementary medicine and alternative practitioner use varies across chronic conditions and attitudes to risk

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    Robert J Adams

    2010-11-01

    Full Text Available Robert J Adams1, Sarah L Appleton1, Antonia Cole2, Tiffany K Gill3, Anne W Taylor3, Catherine L Hill11The Health Observatory, 2Rheumatology Unit, 3Population Research and Outcomes Unit, SA Health, The University of Adelaide Discipline of Medicine, Queen Elizabeth Hospital, Woodville, AustraliaObjectives: To determine whether chronic conditions and patient factors, such as risk perception and decision-making preferences, are associated with complementary medicine and alternative practitioner use in a representative longitudinal population cohort.Participants and setting: Analysis of data from Stage 2 of the North West Adelaide Health Study of 3161 adults who attended a study clinic visit in 2004–2006. The main outcome measures were the medications brought by participants to the study clinic visit, chronic health conditions, attitudes to risk, levels of satisfaction with conventional medicine, and preferred decision-making style.Results: At least one oral complementary medicine was used by 27.9% of participants, and 7.3% were visiting alternative practitioners (naturopath, osteopath. Oral complementary medicine use was significantly associated with arthritis, osteoporosis, and mental health conditions, but not with other chronic conditions. Any pattern of complementary medicine use was generally significantly associated with female gender, age at least 45 years, patient-driven decision-making preferences (odds ratio [OR] 1.38, 95% confidence interval [CI]: 1.08–1.77, and frequent general practitioner visits (>five per year; OR 3.62, 95% CI: 2.13–6.17. Alternative practitioner visitors were younger, with higher levels of education (diploma/trade [OR 1.88, 95% CI: 1.28–2.76], bachelor’s degree [OR 1.77, 95% CI: 1.11–2.82], income > $80,000 (OR 2.28, 95% CI: 1.26–4.11, female gender (OR 3.15, 95% CI: 2.19–4.52, joint pain not diagnosed as arthritis (OR 1.68, 95% CI: 1.17–2.41, moderate to severe depressive symptoms (OR 2.15, 95% CI

  9. Medication overuse as a cause of chronic headache in shunted hydrocephalus patients

    DEFF Research Database (Denmark)

    Willer, Lasse; Jensen, R H; Juhler, M

    2010-01-01

    To highlight the group of hydrocephalus patients known to have a long history of shunt revisions and refractory chronic headache. When a shunt in perfect working order has no effect on headache, other causes of headache should be investigated. In this paper, patients with medication overuse...

  10. Perception and attitudes of medical students toward communication, chronic disease and death

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    Baliram V. Ghodke

    2014-10-01

    Conclusion: Perception of students regarding caring of chronically ill-patients and death related issues needs improvement. We believe that integrating different teaching strategies and training programs regarding this issue should begin at early stages of undergraduate medical curriculum. [Int J Basic Clin Pharmacol 2014; 3(5.000: 854-859

  11. Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

    DEFF Research Database (Denmark)

    Ingebrigtsen, Truls S; Marott, Jacob L; Nordestgaard, Børge G;

    2015-01-01

    OBJECTIVE: We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals...

  12. Integrating the Chronic Care Model into a Novel Medical Student Course

    Science.gov (United States)

    Block, Robert C.; Tran, Bill; McIntosh, Scott

    2011-01-01

    Objective: To determine whether integration of the Chronic Care Model into undergraduate medical education is associated with anticipated use of the Model and whether student perceptions match actual integration of the Model into their community projects. Design: This was a cross-sectional study using qualitative and quantitative data. Setting: A…

  13. Leisure as a Resource for Successful Aging by Older Adults with Chronic Health Conditions

    Science.gov (United States)

    Hutchinson, Susan L.; Nimrod, Galit

    2012-01-01

    Drawing on the model of Selective Optimization with Compensation (SOC) (Baltes & Baltes, 1990), the purpose of this article is to examine leisure-related goals of older adults with chronic conditions and the strategies they use to not only successfully manage their chronic health conditions but live well with them. Semi-structured in-person…

  14. mHealth and the management of chronic conditions in rural areas: a note of caution from southern India.

    Science.gov (United States)

    Nahar, Papreen; Kannuri, Nanda Kishore; Mikkilineni, Sitamma; Murthy, G V S; Phillimore, Peter

    2017-04-01

    This article examines challenges facing implementation of likely mHealth programmes in rural India. Based on fieldwork in Andhra Pradesh in 2014, and taking as exemplars two chronic medical 'conditions' - type 2 diabetes and depression - we look at ways in which people in one rural area currently access medical treatment; we also explore how adults there currently use mobile phones in daily life, to gauge the realistic likelihood of uptake for possible mHealth initiatives. We identify the very different pathways to care for these two medical conditions, and we highlight the importance to the rural population of healthcare outside the formal health system provided by those known as registered medical practitioners (RMP), who despite their title are neither registered nor trained. We also show how limited is the use currently made of very basic mobile phones by the majority of the older adult population in this rural context. Not only may this inhibit mHealth potential in the near future; just as importantly, our data suggest how difficult it may be to identify a clinical partner for patients or their carers for any mHealth application designed to assist the management of chronic ill-health in rural India. Finally, we examine how the promotion of patient 'self-management' may not be as readily translated to a country like India as proponents of mHealth might assume.

  15. The Effects of Chronic Partial Sleep Deprivation on Cognitive Functions of Medical Residents

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    Sara Samadzadeh

    2010-06-01

    Full Text Available "n  "n Objective:Because of on-call responsibilities, many medical residents are subjected to chronic partial sleep deprivation, a form of sleep restriction whereby individuals have chronic patterns of insufficient sleep. It is unclear whether deterioration in cognitive processing skills due to chronic partial sleep deprivation among medical residents would influence educational exposure or patient safety. Method: Twenty-six medical residents were recruited to participate in the study. Participants wore an Actigraph over a period of 5 consecutive days and nights so their sleep pattern could be recorded. Thirteen participants worked on services that forced chronic partial sleep deprivation (<6 hours of sleep per 24h for 5 consecutive days and nights. The other thirteen residents worked on services that permitted regular and adequate sleep patterns. Following the 5-day sleep monitoring period, the participants completed the three following cognitive tasks: (a the Wisconsin Card Sorting Test (WCST to assess abstract reasoning and prefrontal cortex performance; (b the Time Perception Task (TPT to assess time estimation and time reproduction skills; and (c the Iowa Gambling Task (IGT to assess decision-making ability. "nResults: The results of independent samples t-tests found no significant differences between the group who was chronically sleep deprived and the group who rested adequately (all ps > .05. "nConclusion: These results may have emerged for several possible reasons: (a chronic partial sleep deprivation may have a lesser impact on prefrontal cortex function than on other cognitive functions; (b fairly modest chronic sleep restriction may be less harmful than acute and more significant sleep restriction; or (c our research may have suffered from poor statistical power. Future research is recommended.

  16. Latent inhibition in rats neonatally treated chronically with MK-801: differential effects on conditioned taste aversion and conditioned emotional response.

    Science.gov (United States)

    Niikura, Ryo; Nozawa, Takashi; Yamada, Kazuo; Kato, Katsunori; Ichitani, Yukio

    2015-04-15

    Chronic neonatal blockade of N-methyl-d-aspartate (NMDA) receptors produces various abnormal behaviors in adulthood animals. This study investigated the effects of neonatal treatment chronically with MK-801 in rats on the preexposure-induced retardation of CS-US association, i.e. latent inhibition (LI), of two aversive classical conditioning tasks in adulthood. In conditioned taste aversion (CTA) using sucrose taste and LiCl, neonatal chronic MK-801 (0.4 mg/kg twice/day) treatment attenuated the inhibitory effect of sucrose preexposure on the aversive conditioning, although the treatment did not affect CTA conditioning itself. On the other hand, in conditioned emotional response (CER) using tone and electrical foot shock, rats neonatally treated with MK-801 showed the same degree of inhibitory effect of tone preexposure on the aversive conditioning compared with neonatally vehicle-treated rats, and also showed the same level of CER conditioning itself. Thus, the effect of chronic neonatal blockade of NMDA receptors on the LI of classical conditioning in adulthood was differentiated by the task employed. Results suggest that LI of CTA paradigm compared with that of CER is more sensitive to abnormal development after chronic neonatal blockade of NMDA receptors as an index of cognitive/attentional deficits caused by the treatment.

  17. What Features of Smartphone Medication Applications Are Patients with Chronic Diseases and Caregivers Looking for?

    Science.gov (United States)

    Liu, Yisi; Wang, Liuyu; Chang, Polun; Lamb, Karen V; Cui, Yanyan; Wu, Ying

    2016-01-01

    We explored the desired features of medication applications for patients with chronic disease and their caregivers with a questionnaire survey, 50 from patients and 50 from their caregivers. Although the majority of people (75%) are willing to use medication apps, the actual usage rate is quite low (11%). Worrying about privacy of personal information seems to be the main reason of not using applications. The overall score desired for use was 3.29 ± 1.02 (out of 5). Searching medications and diseases and assistance with making doctors' appointments are the most wanted categories. Online shopping for drugs and delivery were the least desired items. The main concerns for people who do not want certain features include: they are not useful, worrying about buying counterfeit drugs and reliability of content. Compared with patients, caregivers seems to be more concerned on nutrition tips for chronic illness, fall detection, and privacy protection (P < 0.05 for all).

  18. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results

    Directory of Open Access Journals (Sweden)

    Sameer Chopra

    2016-01-01

    Full Text Available Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS, met criteria for National Institute of Health (NIH Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP. Median operative time (range: 157 (127–259 min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range were: International Prostate Symptom Score - 14 (1–19; Sexual Health Inventory for Men - 6 (−14–22; and NIH-CPSI total - 23.5 (13–33. Median length of follow-up (range was 34 (24–43 months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively.

  19. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results.

    Science.gov (United States)

    Chopra, Sameer; Satkunasivam, Raj; Aron, Monish

    2016-01-01

    Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), met criteria for National Institute of Health (NIH) Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP). Median operative time (range): 157 (127-259) min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI) score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range) were: International Prostate Symptom Score - 14 (1-19); Sexual Health Inventory for Men - 6 (-14-22); and NIH-CPSI total - 23.5 (13-33). Median length of follow-up (range) was 34 (24-43) months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively.

  20. Private health insurance and quality of life: perspectives of older Australians with multiple chronic conditions.

    Science.gov (United States)

    Jeon, Yun-Hee; Black, Annie; Govett, Janelle; Yen, Laurann; McRae, Ian

    2012-01-01

    A qualitative study was conducted to explore in-depth issues relating to the health costs of chronic illness as identified in a previous study. A key theme that emerged from interviews carried out was the benefits and challenges of private health insurance (PHI) membership, and choices older Australians with multimorbidity make in accessing health services, with and without PHI. This is the focus of this paper. Semistructured interviews were conducted with 40 older people with multiple chronic conditions. Data were analysed using content analysis. Key motivators for maintaining PHI included: fear of an inability to access timely health care; the opportunity to exercise choice in service provider; a belief of being 'better off' both medically and financially, which was often ill-founded; and the core values of self reliance and independence. Most described financial pressure caused by rising PHI premiums as well as other out-of-pocket health related expenses. Many older people who can ill afford PHI still struggle to maintain it, potentially at the cost of their quality of life, based on beliefs about costs of health care that they have never properly assessed. The findings highlight the degree to which people whose resources are constrained are prepared to go to maintain access to private hospital care. Attention should be given to assisting older people to make informed and valid choices of health insurance derived from the facts, rather than being based on fear and assumptions.

  1. Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease.

    Science.gov (United States)

    Risser, Jessica; Jacobson, Terry A; Kripalani, Sunil

    2007-01-01

    Medication nonadherence remains a significant obstacle to achieving improved health outcomes in patients with chronic disease. Self-efficacy, the confidence in one's ability to perform a given task such as taking one's medications, is an important determinant of medication adherence, indicating the need for reliable and valid tools for measuring this construct. This study sought to develop a self-efficacy scale for medication adherence in chronic disease management that can be used in patients with a broad range of literacy skills. The Self-efficacy for Appropriate Medication Use (SEAMS) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. Its psychometric properties were evaluated among 436 patients with coronary heart disease and other comorbid conditions. Reliability was evaluated by measuring internal consistency and test-retest reliability. Principal component factor analysis was performed to evaluate the validity of the SEAMS. Reliability and validity analyses were also performed separately among patients with low and higher literacy levels. The final 13-item scale had good internal consistency reliability (Cronbach's alpha = 0.89). A two-factor solution was found, explaining 52.3% of the scale's variance. The scale performed similarly across literacy levels. The SEAMS is a reliable and valid instrument that may provide a valuable assessment of medication self-efficacy in chronic disease management, and appears appropriate for use in patients with low literacy skills.

  2. Developing a generic, individualised adherence programme for chronic medication users

    Directory of Open Access Journals (Sweden)

    Herborg H

    2008-09-01

    Full Text Available Objective: The scope of this article is to describe the background for and content of an adherence counselling programme with a specific focus on an individualised, multi-dimensional adherence model for patients with a potential adherence problem (a so-called ‘individualised systems model’.Methods: An intervention programme based on WHO’s systems model for adherence was developed for implementation in primary health care and tested in a development project in Danish pharmacies in 2004-2005 in three pharmacies and 4 GP practices by 27 patients. Data were collected from the participants by registration forms, questionnaires, and focus groups. Since the programme was to support patients in the self-management process regarding choice and implementation of medication treatment, various strategies were used and different theoretical assumptions and choices made prior to setting up the study. These strategies include distinguishing between different types of non-adherence, a model for stages of change, self-efficacy, narratives, motivating interviewing strategies and coaching techniques. These strategic and theoretical choices are described in the article. Results: The strategies and theoretical reflections formed the platform for the creation of a counselling programme, which was tested in two forms, a basic and an extended version - provided by either a pharmaconomist or a pharmacist. The result section also describes a toolbox of instruments to enable pharmacy staff and GPs to tailor a counselling programme for patients individually called ‘Safe and effective use of medicines’. Besides, the results include a description of how the WHO-model is transformed into an individualised counselling model.

  3. Chronic health conditions related to quality of life for federal civil servants

    Directory of Open Access Journals (Sweden)

    Luciana Eduardo Fernandes Saraiva

    Full Text Available OBJECTIVE: The aim of this study is to correlate the QOL domains of the civil servants to the type and number of chronic health conditions. METHOD: A transversal, quantitative study, conducted at the Department of Civil Servant Assistance of the Federal University of Rio Grande do Norte with 215 civil servants, during the period from March to May 2011. RESULTS: Among the chronic health conditions studied, there was significant relationship between non-communicable chronic disease and QOL scores, correlating weakly (r <-376; p <0.008 in the other fields. It was found that the greater the number of chronic conditions, the lower the values on the QOL scale. CONCLUSION: The quality of life of civil servants is negatively influenced by chronic health conditions, compromising, in general, their daily work and life activities.

  4. Finalizing a measurement framework for the burden of treatment in complex patients with chronic conditions

    Directory of Open Access Journals (Sweden)

    Eton DT

    2015-03-01

    % were coping with multiple chronic conditions. A preliminary conceptual framework using data from the first 32 interviews was evaluated and was modified using narrative data from 18 additional interviews with a racially and socioeconomically diverse sample of patients. The final framework features three overarching themes with associated subthemes. These themes included: 1 work patients must do to care for their health (eg, taking medications, keeping medical appointments, monitoring health; 2 challenges/stressors that exacerbate perceived burden (eg, financial, interpersonal, provider obstacles; and 3 impacts of burden (eg, role limitations, mental exhaustion. All themes and subthemes were subsequently confirmed in focus groups. Conclusion: The final conceptual framework can be used as a foundation for building a patient self-report measure to systematically study treatment burden for research and analytical purposes, as well as to promote meaningful clinic-based dialogue between patients and providers about the challenges inherent in maintaining complex self-management of health. Keywords: treatment burden, conceptual framework, adherence, questionnaire, self-management, multi-morbidity

  5. Validity of Oxygen-Ozone Therapy as Integrated Medication Form in Chronic Inflammatory Diseases.

    Science.gov (United States)

    Bocci, Velio; Zanardia, Iacopo; Valacchi, Giuseppe; Borrelli, Emma; Travagli, Valter

    2015-01-01

    The state-of-the-art of oxygen-ozone therapy is now clarified and all the mechanisms of action of medical ozone are within classical biochemistry and molecular biology. The outcomes of standard treatments in peripheral arterial occlusive disease (PAOD) and dry-form of age-related macular degeneration (AMD) have been compared with the documented therapeutic results achieved with ozonated autohemotherapy (O-AHT). On the other hand, the clinical data of O-AHT on stroke remain indicative. As the cost of O-AHT is almost irrelevant, its application in all public hospitals, especially those of poor Countries, would allow two advantages: the first is for the patient, who will improve her/his conditions, and the second is for Health Authorities burdened with increasing costs. The aim of this paper is to report to clinical scientists that O-AHT is a scientific-based therapeutic approach without side effects. The integration of O-AHT with effective approved drugs is likely to yield the best clinical results in several chronic inflammatory diseases.

  6. ANALYTICAL STUDY OFDENTAL STATUS OFPATIENTSWITH CHRONIC GENERALIZED PERIODONTITIS DENTAL CLINIC OF KRASNOYARSK STATE MEDICAL UNIVERSITY

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    Marugina Tatyana Leonidovna

    2013-05-01

    Full Text Available To make distinct approaches in the diagnosis, treatment and prevention of chronic generalized periodontitis the analysis of case rate of the disease during the period of 2010-2012 years was carried out in the dental clinic of Krasnoyarsk State Medical Academy. In order to divide patients into several groups according to severity of the disease the review of case history of 4390 patients aged 20 to 65 was made. 684 patients (15.6 % were diagnosed with mild degree of the disease, 2608 (59.4% with an average degree and 1908 patients (25% with severe degree of the disease. The low percentage of number of patients with mild degree of the disease is the result of late diagnosis of the disease. During the analysis of the structure of providing periodontal care at the stages of examination, periodontal and surgical help the lack of an objective assessment of the condition ofalveolar mucosa isnoted. Therefore, during the initial examination, we suggest to use Schiller-Pisarev method. As a crucial step in the identification of early forms of periodontal disease is a health education outreach.

  7. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    Science.gov (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population.

  8. Suicide ideation, plans, and attempts among general practice patients with chronic health conditions in Puerto Rico

    Directory of Open Access Journals (Sweden)

    Sarah Huertas

    2011-03-01

    Full Text Available Mildred Vera2,4, María L Reyes-Rabanillo1, Sarah Huertas3, Deborah Juarbe4, Coralee Pérez-Pedrogo4, Aracelis Huertas5, Marisol Peña61Veterans Affairs Caribbean Healthcare System, San Juan, Puerto Rico; 2Department of Health Services Administration, School of Public Health; 3Department of Psychiatry, School of Medicine; 4Center for Evaluation and Sociomedical Research, School of Public Health; 5School of Health Professions; 6Center for Preparedness in Public Health, School of Public Health, Medical Sciences Campus, University of Puerto Rico San Juan, Puerto Rico.Background: Little is known about suicidal ideation among general practice patients in Puerto Rico. In this study we examined the rates, severity, and correlates of suicidal ideation, plans, and attempts among general practice patients with chronic illnesses. This is important in targeting appropriate interventions and management approaches to minimize and prevent suicide.Methods: We screened patients with chronic physical conditions at general practices. Suicidal ideation was assessed with the suicidality module of the Mini International Neuropsychiatric Interview. Major depression was assessed with the Patient Health Questionnaire depression module. The relationship between sociodemographic factors, depression and suicidal ideation was examined with multiple logistic regression analysis. Among the subgroup that acknowledged suicidal ideation, we used multinomial logistic regression analysis to estimate simultaneously the multivariate associations of depression and sociodemographic factors with suicidality risk levels.Results: Of the 2068 patients screened, 15.4% acknowledged recent suicidal ideation. Among this group, 8.6% reported passive ideation, 3.7% active ideation without a plan, and 3.1% active ideation with a plan or attempt. According to multivariate logistic regression, suicidal ideation was higher among patients with moderately severe depression and severe depression than

  9. Self-reports of medication side effects and pain-related activity interference in patients with chronic pain: a longitudinal cohort study.

    Science.gov (United States)

    Martel, Marc O; Finan, Patrick H; Dolman, Andrew J; Subramanian, Subu; Edwards, Robert R; Wasan, Ajay D; Jamison, Robert N

    2015-06-01

    The primary purpose of this study was to examine the association between self-reports of medication side effects and pain-related activity interference in patients with chronic pain. The potential moderators of the association between reports of side effects and pain-related activity interference were also examined. A total of 111 patients with chronic musculoskeletal pain were asked to provide, once a month for a period of 6 months, self-reports of medication use and the presence of any perceived side effects (eg, nausea, dizziness, headaches) associated with their medications. At each of these time points, patients were also asked to provide self-reports of pain intensity, negative affect, and pain-related activity interference. Multilevel modeling analyses revealed that month-to-month increases in perceived medication side effects were associated with heightened pain-related activity interference (P effects were associated with heightened pain-related activity interference even after controlling for the influence of patient demographics, pain intensity, and negative affect. This study provides preliminary evidence that reports of medication side effects are associated with heightened pain-related activity interference in patients with chronic pain beyond the influence of other pain-relevant variables. The implications of our findings for clinical practice and the management of patients with chronic pain conditions are discussed.

  10. The role of corticosteroids and stress in chronic pain conditions.

    Science.gov (United States)

    McEwen, Bruce S; Kalia, Madhu

    2010-10-01

    The relationship between corticosteroids (endogenous and exogenous) and stress is well known, as is the use of steroids as concomitant treatment in pain management during acute inflammation. In the past, steroids have not been considered the first line of treatment in pain management. In this review, we examine new scientific and clinical evidence that demonstrates the direct role that steroids play in the generation and clinical management of chronic pain. We will discuss the new findings demonstrating the fact that steroids and related mediators produce paradoxical effects on pain such as analgesia, hyperalgesia, and even placebo analgesia. In addition, we will examine the physiologic effect of stress, high allostatic load, and idiopathic disease states such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and burnout. The recently observed positive relationship between glutaminergic activity in the insula and clinical pain will be examined in the context of understanding the central role of steroids in chronic pain. The complex role of the hypothalamic-pituitary-adrenal axis in pain will be discussed as well as other heterogeneous forms of chronic pain that involve many components of the central nervous system. Components of the hypothalamic-pituitary-adrenal axis have paradoxical effects on certain types of pain that are dependent on dose and on site (whether peripheral or central) and mode of application. Recent studies on glia have shown that they prolong a state of neuronal hypersensitization in the dorsal root ganglia by releasing growth factors and other substances that act on the immune system. We will discuss the implication of these new findings directly linking pain to steroids, stress, and key higher brain regions in the context of future therapeutic targets.

  11. Causal inference regarding infectious aetiology of chronic conditions: a systematic review.

    Directory of Open Access Journals (Sweden)

    Sofia Orrskog

    Full Text Available BACKGROUND: The global burden of disease has shifted from communicable diseases in children to chronic diseases in adults. This epidemiologic shift varies greatly by region, but in Europe, chronic conditions account for 86% of all deaths, 77% of the disease burden, and up to 80% of health care expenditures. A number of risk factors have been implicated in chronic diseases, such as exposure to infectious agents. A number of associations have been well established while others remain uncertain. METHODS AND FINDINGS: We assessed the body of evidence regarding the infectious aetiology of chronic diseases in the peer-reviewed literature over the last decade. Causality was assessed with three different criteria: First, the total number of associations documented in the literature between each infectious agent and chronic condition; second, the epidemiologic study design (quality of the study; third, evidence for the number of Hill's criteria and Koch's postulates that linked the pathogen with the chronic condition. We identified 3136 publications, of which 148 were included in the analysis. There were a total of 75 different infectious agents and 122 chronic conditions. The evidence was strong for five pathogens, based on study type, strength and number of associations; they accounted for 60% of the associations documented in the literature. They were human immunodeficiency virus, hepatitis C virus, Helicobacter pylori, hepatitis B virus, and Chlamydia pneumoniae and were collectively implicated in the aetiology of 37 different chronic conditions. Other pathogens examined were only associated with very few chronic conditions (≤ 3 and when applying the three different criteria of evidence the strength of the causality was weak. CONCLUSIONS: Prevention and treatment of these five pathogens lend themselves as effective public health intervention entry points. By concentrating research efforts on these promising areas, the human, economic, and societal

  12. 42 CFR 482.22 - Condition of participation: Medical staff.

    Science.gov (United States)

    2010-10-01

    ... medical staff must be composed of doctors of medicine or osteopathy and, in accordance with State law, may... or osteopathy. (3) The responsibility for organization and conduct of the medical staff must be assigned only to an individual doctor of medicine or osteopathy or, when permitted by State law of...

  13. Students With Chronic Conditions: Experiences and Challenges of Regular Education Teachers.

    Science.gov (United States)

    Selekman, Janice

    2016-10-30

    School nurses have observed the increasing prevalence of children with chronic conditions in the school setting; however, little is known about teacher experiences with these children in their regular classrooms. The purpose of this mixed-method study was to describe the experiences and challenges of regular education teachers when they have students with chronic conditions in their classroom and implications for the school nurse. The national sample consisted of regular education teachers. The methodologies consisted of focus groups and an online survey. Seven themes emerged: Teachers want to be informed about their students with chronic conditions, teachers lack information about the conditions, there is a lack of preparation in preteacher education programs about students with chronic conditions, teachers feel frustration and stress in working effectively with these students, teachers shared concerns about their students, teachers are asked to perform health-related tasks for students, and teachers made recommendations of what they need from the school nurse.

  14. Prevalence and Costs of Five Chronic Conditions in Children

    Science.gov (United States)

    Miller, Gabrielle F.; Coffield, Edward; Leroy, Zanie; Wallin, Robin

    2016-01-01

    The objective is to examine the prevalence and health-care costs associated with asthma, epilepsy, hypertension, food allergies, and diabetes in children aged 0-18 years. Prevalence was calculated using 2005-2012 Medical Expenditure Panel Survey (MEPS) data, a population-based, nationally representative sample. Using MEPS, two-part models…

  15. Oral health and medical conditions among Amish children

    Science.gov (United States)

    Harrison, Marc-Allen; Milgrom, Peter

    2017-01-01

    Background: The Amish are a growing population who live a traditional, rural way of life, which makes them less accepting of modernism. Most Amish live in poverty and are detached from modern health care. In addition, the recent change of their lifestyle has been reported, such as consuming a nontraditional diet and the usage of electronic devices. As a result, their lifestyle change may have impacted their oral health. However, since only a single report about oral health among Amish children has been published approximately three decades ago it has not yet been updated. This study describes oral health among Amish children and their medical conditions during visits to a mobile dental unit (MDU). Material and Methods: The dental records of all patients (N=216) who visited a mobile dental unit were reviewed, which covers 1 year from May 20, 2011, the first date of service. The following factors were taken into consideration during the review process: parental perceptions of their children’s oral health care, dental care experiences, and general health information. Results: Fifty-four (27.8%) children, ages 3 to 17, have never received dental treatment before visiting the MDU; the average number of untreated decayed teeth was 6.8. In spite of this, most parents rated their children’s oral health as good or very good (87.7%). The high cost and long distance travel associated with routine, professional dental care makes it difficult for children to maintain good oral hygiene. Our analysis revealed that bleeding disorders were more prevalent among this gene pool compared to the nation at large; however, asthma was less common. Conclusions: There are oral and general health disparities among Amish children. There is a lack of awareness among Amish parents with regard to their children’s oral health. Key words:Amish, child, dental caries, mobile health units. PMID:28298971

  16. Rehabilitation in an individual with chronic arsenic poisoning: medical, psychological, and social implications.

    Science.gov (United States)

    McFall, T L; Richards, J S; Matthews, G

    1998-04-01

    Although arsenic poisoning was a common cause of homicide in the past, it is seldom suspected today; thus there may be serious delays in diagnosis and treatment of arsenic ingestion. Rehabilitation specialists have traditionally dealt with the debilitating consequences of the classic arsenic-induced sensorimotor peripheral neuropathy; however, a knowledge of the presentation of acute toxicity combined with the effects of chronic exposure is essential for proper treatment, particularly in the event of ongoing exposure. This case report demonstrates the wide spectrum of medical complications associated with arsenic poisoning and briefly reviews its pathophysiology and treatment from both the medical and psychosocial perspective.

  17. [The medical perspective towards chronic pain: biomedical model and clinical practice].

    Science.gov (United States)

    Lima, Mônica Angelim Gomes de; Trad, Leny A Bomfim

    2007-11-01

    This study aimed to shed light on the meanings ascribed to chronic pain in medical discourse and clinical practice in two Pain Clinics located in University hospitals in Salvador (Bahia) and São Paulo, Brazil. An ethnographic approach used participant observation and semi-structuralized interviews with attending and managing physicians. Data analysis drew on the clinical models developed by Byron Good and the medical rationalities project formulated by Madel Luz. The meanings emerging from the study were the recognition of chronic pain by biomedicine as a disease rather than a symptom, its invisibility to physicians, and its non-communicability and inevitability. The informants suggested the need for valorization of the human encounter in the clinic, exercise of understanding as opposed to suspicion, and negotiation of sustainable therapeutic projects.

  18. Legal framework conditions for the reprocessing of medical devices.

    Science.gov (United States)

    Großkopf, Volker; Jäkel, Christian

    2008-09-03

    The processing of single-use products is permissible pursuant to medical device law. This is apparent both from the wording of the German Law on Medical Devices and from the purpose and the objectives underpinning the legislative materials. The prerequisite for processing is, however, compliance with the the Joint Recommendation of the Commission for Hospital Hygiene and the Prevention of Infection at the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Products (BfArM).For medical devices in the category "critical C", the RKI/BfArM-recommendation provides that the processor's quality management system must be certified by a body accredited by the Central Authority of the Federal States for Health Protection with regard to Medicinal Products and Medical Devices (Zentralstelle der Länder für Gesundheitsschutz bei Arzneimitteln und Medizinprodukten, ZLG). The certification must be carried out in accordance with EN ISO 13485:2003+AC:2007.On April 4, 2008 the Federal Health Ministry (Bundesministerium für Gesundheit, BMG) presented a progress report on the processing of medical devices. The BMG concludes that the legal framework for the processing of medical devices is sufficient, and that a prohibition on the processing of single-use products is inappropriate.

  19. Measuring financial protection for health in families with chronic conditions in Rural China

    Directory of Open Access Journals (Sweden)

    Jiang Chunhong

    2012-11-01

    Full Text Available Abstract Background As the world’s largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures. Methods We used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient. Results An additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks. Conclusions There is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high

  20. Constipation - prevalence and incidence among medical patients acutely admitted to hospital with a medical condition

    DEFF Research Database (Denmark)

    Noiesen, Eline; Trosborg, Ingelise; Bager, Louise;

    2014-01-01

    To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients.......To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients....

  1. Chronic migraine and medication overuse headache: clarifying the current International Headache Society classification criteria.

    Science.gov (United States)

    Sun-Edelstein, C; Bigal, M E; Rapoport, A M

    2009-04-01

    Despite the recent advances in the understanding and classification of the chronic daily headaches, considerable controversy still exists regarding the classification of individual headaches, including chronic migraine (CM) and medication overuse headache (MOH). The original criteria, published in 2004, were difficult to apply to most patients with these disorders and were subsequently revised, resulting in broader clinical applicability. Nonetheless, they remain a topic of debate, and the revisions to the criteria have further added to the confusion. Even some prominent headache specialists are unsure which criteria to use. We aimed to explain the nature of the controversies surrounding the entities of CM and MOH. A clinical case will be used to illustrate some of the problems faced by clinicians in diagnosing patients with chronic daily headache.

  2. Medication safety and chronic kidney disease in older adults prescribed metformin: a cross-sectional analysis

    OpenAIRE

    Huang, Deborah L.; Abrass, Itamar B; Young, Bessie A.

    2014-01-01

    Background Medication safety in patients with chronic kidney disease (CKD) is a growing concern. This is particularly relevant in older adults due to underlying CKD. Metformin use is contraindicated in patients with abnormal kidney function; however, many patients are potentially prescribed metformin inappropriately. We evaluated the prevalence of CKD among older adults prescribed metformin for type 2 diabetes mellitus using available equations to estimate kidney function and examined demogra...

  3. The cost-effectiveness of managed care regarding chronic medicine prescriptions in a selected medical scheme

    Directory of Open Access Journals (Sweden)

    K. Day

    1998-09-01

    Full Text Available The purpose of the study was to examine the cost-effectiveness of managed care interventions with respect to prescriptions for chronic illness sufferers enrolled with a specific medical scheme. The illnesses included, were epilepsy, hypertension, diabetes and asthma. The managed care interventions applied were a primary discount; the use of preferred provider pharmacies, and drug utilization review. It was concluded that the managed care interventions resulted in some real cost savings.

  4. Quality of life, treatment adherence, and locus of control: multiple family groups for chronic medical illnesses.

    Science.gov (United States)

    López-Larrosa, Silvia

    2013-12-01

    The Multiple Family Groups (MFGs) approach for patients with a chronic medical illness and their families is a structured psychoeducational program that unfolds in six weekly 90-minute sessions. In the MFGs, patients and family members explore new ways to balance illness and nonillness priorities in family life (Steinglass, 1998; Steinglass, 2000 Cuadernos de Terapia Familiar, 44-45, 11; Steinglass, Ostroff, & Steinglass, 2011 Family Process, 50, 393).

  5. Sport climbing with pre-existing cardio-pulmonary medical conditions.

    Science.gov (United States)

    Kuepper, T; Morrison, A; Gieseler, U; Schoeffl, V

    2009-06-01

    Over the past 25 years sport climbing has developed from an elite extreme sport subculture pursued by few into a mainstream recreational sport enjoyed globally by climbers of all ages, climbing abilities, and with pre-existing health conditions. As the demands and grades of climbing difficulty have increased over this period, most scientific literature on sport climbing focused on acute injuries and overuse syndromes, or performance physiology in healthy adult males. The physiological response to sport climbing is more similar to that of resistance training (i.e., body building) rather than a predominantly aerobic sport (i.e., running, cycling), so that heart rate and blood pressure during a climb will be disproportionately high relative to the 'exercise' of climbing, and breathing may be irregular. Therefore this review sought evidence-based recommendations for recreational sport climbing participation by those individuals with pre-existing cardiopulmonary medical conditions including coronary heart disease, chronic heart failure, cardiac dysrhythmia, pulmonary diseases (i.e., asthma) or hypertension. This review defines the criteria that must be fulfilled for safe sport climbing by those with pre-existing cardiopulmonary conditions or those with hypertension.

  6. Exclusion of patients with concomitant chronic conditions in ongoing randomised controlled trials targeting 10 common chronic conditions and registered at ClinicalTrials.gov: a systematic review of registration details

    Science.gov (United States)

    Buffel du Vaure, Céline; Dechartres, Agnès; Battin, Constance; Ravaud, Philippe; Boutron, Isabelle

    2016-01-01

    Objectives To systematically assess registration details of ongoing randomised controlled trials (RCTs) targeting 10 common chronic conditions and registered at ClinicalTrials.gov and to determine the prevalence of (1) trial records excluding patients with concomitant chronic condition(s) and (2) those specifically targeting patients with concomitant chronic conditions. Design Systematic review of trial registration records. Data sources ClinicalTrials.gov register. Study selection All ongoing RCTs registered from 1 January 2014 to 31 January 2015 that assessed an intervention targeting adults with coronary heart disease (CHD), hypertension, heart failure, stroke/transient ischaemic attack, atrial fibrillation, type 2 diabetes, chronic obstructive pulmonary disease, painful condition, depression and dementia with a target sample size ≥100. Data extraction From the trial registration records, 2 researchers independently recorded the trial characteristics and the number of exclusion criteria and determined whether patients with concomitant chronic conditions were excluded or specifically targeted. Results Among 319 ongoing RCTs, despite the high prevalence of the concomitant chronic conditions, patients with these conditions were excluded in 251 trials (79%). For example, although 91% of patients with CHD had a concomitant chronic condition, 69% of trials targeting such patients excluded patients with concomitant chronic condition(s). When considering the co-occurrence of 2 chronic conditions, 31% of patients with chronic pain also had depression, but 58% of the trials targeting patients with chronic pain excluded patients with depression. Only 37 trials (12%) assessed interventions specifically targeting patients with concomitant chronic conditions; 31 (84%) excluded patients with concomitant chronic condition(s). Conclusions Despite widespread multimorbidity, more than three-quarters of ongoing trials assessing interventions for patients with chronic conditions

  7. The Relevance of Value Net Integrator and Shared Infrastructure Business Models in Managing Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Susan Lambert

    2005-11-01

    Full Text Available There is widespread support for chronic condition management (CCM programs that require a multi-disciplinary, care-team approach. Implementation of such programs represents a paradigm shift in primary care service delivery and has significant resource implications for the general practice. Integral to the widespread uptake of care-team based CCM is information collection, storage and dissemination amongst the care-team members. This paper looks to ebusiness models for assistance in understanding the requirements of general practitioners (GPs in providing multi-disciplinary team care to patients with chronic conditions. The role required of GPs in chronic condition management is compared to that of a value net integrator. The essential characteristics of value net integrators are identified and compared to those of GPs providing multi-disciplinary team care to patients with chronic conditions. It is further suggested that a shared infrastructure is required.

  8. Quality of life in individuals with chronic foot conditions: a cross sectional observational study.

    LENUS (Irish Health Repository)

    Groarke, Patrick

    2012-06-01

    Chronic foot conditions have been reported to be a significant cause of impairment and disability to individuals affected. However, studies to date have particularly focussed on patient satisfaction with outcomes following surgery.

  9. Prevalence of multiple chronic conditions in the United States' Medicare population

    Directory of Open Access Journals (Sweden)

    Dean Debbie

    2009-09-01

    Full Text Available Abstract In 2006, the Centers for Medicare & Medicaid Services, which administers the Medicare program in the United States, launched the Chronic Condition Data Warehouse (CCW. The CCW contains all Medicare fee-for-service (FFS institutional and non-institutional claims, nursing home and home health assessment data, and enrollment/eligibility information from January 1, 1999 forward for a random 5% sample of Medicare beneficiaries (and 100% of the Medicare population from 2000 forward. Twenty-one predefined chronic condition indicator variables are coded within the CCW, to facilitate research on chronic conditions. The current article describes this new data source, and the authors demonstrate the utility of the CCW in describing the extent of chronic disease among Medicare beneficiaries. Medicare claims were analyzed to determine the prevalence, utilization, and Medicare program costs for some common and high cost chronic conditions in the Medicare FFS population in 2005. Chronic conditions explored include diabetes, chronic obstructive pulmonary disease (COPD, heart failure, cancer, chronic kidney disease (CKD, and depression. Fifty percent of Medicare FFS beneficiaries were receiving care for one or more of these chronic conditions. The highest prevalence is observed for diabetes, with nearly one-fourth of the Medicare FFS study cohort receiving treatment for this condition (24.3 percent. The annual number of inpatient days during 2005 is highest for CKD (9.51 days and COPD (8.18 days. As the number of chronic conditions increases, the average per beneficiary Medicare payment amount increases dramatically. The annual Medicare payment amounts for a beneficiary with only one of the chronic conditions is $7,172. For those with two conditions, payment jumps to $14,931, and for those with three or more conditions, the annual Medicare payments per beneficiary is $32,498. The CCW data files have tremendous value for health services research. The

  10. Evaluating sociodemographic and medical conditions of patients under home care service

    Directory of Open Access Journals (Sweden)

    Tolga Önder

    2015-09-01

    Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

  11. A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults

    OpenAIRE

    Petitte, Trisha; Mallow, Jennifer; Barnes, Emily; Petrone, Ashley; Barr, Taura; Theeke, Laurie

    2015-01-01

    Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneline...

  12. The Impact of a Telephone-Based Chronic Disease Management Program on Medical Expenditures.

    Science.gov (United States)

    Avery, George; Cook, David; Talens, Sheila

    2016-06-01

    The impact of a payer-provided telephone-based chronic disease management program on medical expenditures was evaluated using claims data from 126,245 members in employer self-ensured health plans (16,224 with a chronic disease in a group enrolled in the self-management program, 13,509 with a chronic disease in a group not participating in the program). A random effects regression model controlling for retrospective risk, age, sex, and diagnosis with a chronic disease was used to determine the impact of program participation on market-adjusted health care expenditures. Further confirmation of results was obtained by an ordinary least squares model comparing market- and risk-adjusted costs to the length of participation in the program. Participation in the program is associated with an average annual savings of $1157.91 per enrolled member in health care expenditures. Savings increase with the length of participation in the program. The results support the use of telephone-based patient self-management of chronic disease as a cost-effective means to reduce health care expenditures in the working-age population. (Population Health Management 2016;19:156-162).

  13. Health Conditions at Periodic Medical Surveillance in Romanian Offshore Workforce

    DEFF Research Database (Denmark)

    Liga, Percsi Letitia; Jensen, Olaf

    2013-01-01

    Drilling activities in Romania have been running for over 150 years. The objective was to estimate the prevalence of the metabolic syndrome and the routine laboratory values in Romanian oil- and gas platform workers. Methods Data from 201 medical examinations in a 3-month period was collected and...

  14. Family routines and rituals in the context of chronic conditions: a review.

    Science.gov (United States)

    Crespo, Carla; Santos, Susana; Canavarro, Maria Cristina; Kielpikowski, Magdalena; Pryor, Jan; Féres-Carneiro, Terezinha

    2013-01-01

    This paper is a systematic review of 39 empirical studies on family routines and rituals in the context of a chronic condition of a family member. The search strategy encompassed a wide spectrum of chronic conditions affecting family members from childhood/adolescence to adulthood. Twenty quantitative, 13 qualitative, 3 mixed-methods, and 3 intervention studies published between 1995 and 2012 were reviewed. A conceptual framework of routines and rituals as key elements of family health was adopted, resulting in three main findings. First, a chronic condition in a family member impacted the frequency and nature of family's routines and rituals. Second, these whole-family interactions held important functions for individuals and families, constituting strategic resources in the condition's management and opportunities for emotional support exchanges, and providing the family with a sense of normalcy amid the challenges posed by chronic conditions. Third, family routines and rituals were linked to positive health and adaptation outcomes for both patients and family members. Implications for future research include the need for the distinction between routines and rituals against a conceptual background, use of validated assessment methods, and empirical examination of predictors of changes in routines and rituals throughout the course of the condition and of the mechanisms linking these family events to positive outcomes. Conclusions support the inclusion of routines and rituals in a family-centered care approach to the understanding and treatment of chronic conditions.

  15. The effect of control and self-medication of chronic gout in a developing country. Outcome after 10 years

    NARCIS (Netherlands)

    Darmawan, John; Rasker, Johannes J.; Nuralim, Hendri

    2003-01-01

    Objective:: We describe a 10 year observation of the effect of control of hyperuricemia compared with self-medication alone in patients with chronic gout. Methods: We studied 299 consecutively self-referred Malayo-Polynesian men with chronic gout, mean age 35 ± 14.3 SD years. Subjects comprised 228

  16. Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study: Rationale and protocol of a randomised trial

    NARCIS (Netherlands)

    Wilbrink, Leopoldine A.; Teernstra, Onno P.M.; Haan, Joost; Zwet, van Erik W.; Evers, Silvia M.A.A.; Spincemaille, Geert H.; Veltink, Peter H.; Mulleners, Wim; Brand, Ronald; Huygen, Frank J.P.M.; Jensen, Rigmor H.; Paemeleire, Koen; Goadsby, Peter J.; Visser-Vandewalle, Veerle; Ferrari, Michel D.

    2013-01-01

    Background: About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled neurom

  17. Prevalence of right-to-left shunts on transcranial Doppler in chronic migraine and medication-overuse headache

    DEFF Research Database (Denmark)

    Guo, Song; Shalchian, Sarvnaz; Gérard, Pascale;

    2014-01-01

    BACKGROUND: It was suggested that right-to-left shunt (RLS) may be highly prevalent in chronic migraine (CM) patients, indicating that patent foramen ovale (PFO) might be an aggravating and chronifying factor of migraine. Since a high proportion of chronic migraineurs also have medication...

  18. Improving Preclinic Preparation for Patients with Chronic Conditions in Quito, Ecuador: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    K. Rodriguez

    2015-01-01

    Full Text Available Objectives. As in many settings, patients in community health centers in Ecuador do not complete previsit forms or receive assistance to identify questions and concerns they would like to address in brief clinic visits with physicians. We examined the comparative effectiveness of providing (1 a previsit form to complete; (2 a previsit form along with assistance in completing the form; and (3 usual care. Methods. Parallel, three-arm randomized controlled trial in two health centers serving indigent to low-income communities in Quito, Ecuador, among 199 adult patients who took medications for at least one chronic condition. Outcome measures were self-reported satisfaction with the visit, confidence in asking questions, and extent to which patients’ objectives were met. Results. Patients who received assistance in completing a previsit form were more than twice as likely as participants in usual care to report achieving everything they wanted during their visit (AOR 2.2, P=0.039. There were no differences in any outcomes between the groups who received the previsit form with no assistance and usual care. Conclusions. For high-quality patient-centered primary care, it is important to develop and test innovative and scalable interventions for patients and physicians to make the best use of limited clinic time.

  19. Evaluation of dense collagen matrices as medicated wound dressing for the treatment of cutaneous chronic wounds.

    Science.gov (United States)

    Helary, Christophe; Abed, Aicha; Mosser, Gervaise; Louedec, Liliane; Letourneur, Didier; Coradin, Thibaud; Giraud-Guille, Marie Madeleine; Meddahi-Pellé, Anne

    2015-02-01

    Cutaneous chronic wounds are characterized by an impaired wound healing which may lead to infection and amputation. When current treatments are not effective enough, the application of wound dressings is required. To date, no ideal biomaterial is available. In this study, highly dense collagen matrices have been evaluated as novel medicated wound dressings for the treatment of chronic wounds. For this purpose, the structure, mechanical properties, swelling ability and in vivo stability of matrices concentrated from 5 to 40 mg mL(-1) were tested. The matrix stiffness increased with the collagen concentration and was associated with the fibril density and thickness. Increased collagen concentration also enhanced the material resistance against accelerated digestion by collagenase. After subcutaneous implantation in rats, dense collagen matrices exhibited high stability without any degradation after 15 days. The absence of macrophages and neutrophils evidenced their biocompatibility. Subsequently, dense matrices at 40 mg mL(-1) were evaluated as drug delivery system for ampicillin release. More concentrated matrices exhibited the best swelling abilities and could absorb 20 times their dry weight in water, allowing for an efficient antibiotic loading from their dried form. They released efficient doses of antibiotics that inhibited the bacterial growth of Staphylococcus Aureus over 3 days. In parallel, they show no cytotoxicity towards human fibroblasts. These results show that dense collagen matrices are promising materials to develop medicated wound dressings for the treatment of chronic wounds.

  20. Pharmaceutical care and home delivery of medication to patients with chronic myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Begoña San José Ruiz

    2015-01-01

    Full Text Available Objectives: To describe the implementation of a new model face to face and remote pharmaceutical care with home delivery of tyronsine kinase inhibitors medicines for patients with chronic myeloid leukemia. Methods: Patients with chronic myeloid leukemia were selected to start this new model of care. Four characteristics were taken into account for the choice: chronicity of the disease, frequency of doctor visits, pharmaceutical care value and conservation of tyronsine kinase inhibitors medicines at room temperature. Results: Out of 68 patients with chronic myeloid leukemia and treated with tyronsine kinase inhibitors, 42 were selected due to the frequency of their hematologist visits. An introductory letter and a questionnaire about their preferences were sent to these patients.Sixteen of them expressed their desire to participate. The legal department designed a confidentiality contract, as well as a model of informed consent. A logistic distribution model based on defined routes and timetables was established. Prior to inclusion, pharmaceutical care was performed in a face to face consultation and the communication way was established for the followings remote consultations. Home delivery had a monthly cost of 13.2 € (including VAT per patient. All the patients who started this program continue in it. To date, 5 deliveries per patient have been conducted Conclusions: It is possible to establish an alternative model of pharmaceutical care with home delivery of medication, keeping the pharmacist-patient relationship, avoiding travel, ensuring the confidentiality and rationalizing the stocks

  1. Comorbidity of Mental Health Problems and Chronic Health Conditions in Children.

    Science.gov (United States)

    Combs-Orme, Terri; Heflinger, Craig Anne; Simpkins, Celeste G.

    2002-01-01

    A study compared Medicaid children with and without serious mental health problems (n=965) using parent reports of global health status, physical functioning, and general health perceptions. Children with more serious mental health problems were significantly more likely to have chronic health conditions. The number of conditions also predicted…

  2. Let's talk about medication: concordance in rating medication adherence among multimorbid patients and their general practitioners

    NARCIS (Netherlands)

    Ose, D.; Mahler, C.; Vogel, I.; Ludt, S.; Szecsenyi, J.; Freund, T.

    2012-01-01

    BACKGROUND: Medication adherence can be essential for improving health outcomes. Patients with multiple chronic conditions, often receiving multiple medications, are at higher risk for medication nonadherence. Previous research has focused on concordance between patients and providers about which me

  3. FEATURES OF THE CHRONIC PAIN SYNDROME IN PATIENTS WITH RHEUMATOID ARTHRITIS AND MEDICAL DIAGNOSTIC TACTICS

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    M. A. Gromova

    2016-01-01

    medical tactics for rheumatoid arthritis patients with a chronic pain syndrome in therapeutic practice based on pain strength gradation, assessment of chronic pain syndrome variations, definition of anxiety and depression signs. All this allows to validate consultation of medical specialists and to differentiate treatment. Conclusions. The integrated approach to diagnostics of a chronic pain syndrome for rheumatoid arthritis allows to estimate pain strengths in dynamics of disease development, to reveal existence of pain variations, anxiety and depression. It enables usage of patient maintenance tactics and increases efficiency of treatment in therapeutic practice. 

  4. Temporomandibular chronic dislocation: The long-standing condition

    Science.gov (United States)

    Puche-Torres, Miguel; Iglesias-Gimilio, Maria-Eugenia

    2016-01-01

    Background The temporomandibular joint (TMJ) dislocation can be categorised into three groups: acute, habitual or recurrent and long-standing. The long-standing or protracted lower jaw dislocation refers to a condition that persists for more than one month without reduction. There are a great variety of methods for its treatment, from the manual or non-surgical, to surgical ones like the indirect approach (conservative surgical approach) and direct approach (open joint). Additional procedures in unsuccessful cases may include extra-articular orthognathic techniques to correct a malocclusion until joint replacement. Material and Methods We report four new cases with a minimum of 6 weeks dislocation who were seen since 1995 to 2015 in the Maxillofacial Department of the Clínico Hospital (Valencia, Spain), in which the mean age was 57.5 years. Most of them were bilateral and the gender was predominantly female. Additionally, we have reviewed the related literature. Results All of the cases were successfully treated and half of them required open surgery. Conclusions The report confirms the difficulty of the treatment and reaffirms the necessity to bear in mind the wide variety of methods available for the treatment of this pathology. We stress the difficulties associated with managing the treatment and of suggesting new guidelines. The best option still remains not to delay the diagnostic and to select the appropriate initial treatment. Key words:Temporomandibular luxation, TMJ dislocation, protracted dislocation, long-standing dislocation. PMID:27694782

  5. [Economic burden for patients with chronic myelogenous leukemia--healthcare economics and medical governance of cancer].

    Science.gov (United States)

    Kodama, Yuko; Kami, Masahiro

    2010-04-01

    Due to the recent economic downturn, the economic burden of cancer patients has been further worsened. Specifically for chronic myelogenous leukemia patients, their annual income has decreased by 1, 500, 000 yen from 2000 to 2008, while the cost of their medications has increased from 1,000,000 yen to 1,200,000 yen due the advent of the new drug, Glivec, which was approved in 2001. The scores for psychological burden have increased 30% over the past 8 years before Glivec became available. The economic crisis among cancer patients is a consequence of structural problems with many anticancer drugs and cancer treatment. Especially, problems involving the cost of medical care and the system of drug pricing should be resolved by thorough discussion not only with cancer patients but also with the entire population. Discussion on the medical expense burden for CML patients has flourished through patients' spontaneous activities and information disclosure to a wider population through the internet. This methodology will be significant in establishing medical governance in cancer treatment in Japan.

  6. A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults.

    Science.gov (United States)

    Petitte, Trisha; Mallow, Jennifer; Barnes, Emily; Petrone, Ashley; Barr, Taura; Theeke, Laurie

    Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.

  7. Motivating medical students to learn basic science concepts using chronic myeloid leukemia as an integration theme

    Directory of Open Access Journals (Sweden)

    Sara Teresinha Olalla Saad

    2015-02-01

    Full Text Available Objective: To report on the use of chronic myeloid leukemia as a theme of basic clinical integration for first year medical students to motivate and enable in-depth understanding of the basic sciences of the future physician. Methods: During the past thirteen years we have reviewed and updated the curriculum of the medical school of the Universidade Estadual de Campinas. The main objective of the new curriculum is to teach the students how to learn to learn. Since then, a case of chronic myeloid leukemia has been introduced to first year medical students and discussed in horizontal integration with all themes taught during a molecular and cell biology course. Cell structure and components, protein, chromosomes, gene organization, proliferation, cell cycle, apoptosis, signaling and so on are all themes approached during this course. At the end of every topic approached, the students prepare in advance the corresponding topic of clinical cases chosen randomly during the class, which are then presented by them. During the final class, a paper regarding mutations in the abl gene that cause resistance to tyrosine kinase inhibitors is discussed. After each class, three tests are solved in an interactive evaluation. Results: The course has been successful since its beginning, 13 years ago. Great motivation of those who participated in the course was observed. There were less than 20% absences in the classes. At least three (and as many as nine students every year were interested in starting research training in the field of hematology. At the end of each class, an interactive evaluation was performed and more than 70% of the answers were correct in each evaluation. Moreover, for the final evaluation, the students summarized, in a written report, the molecular and therapeutic basis of chronic myeloid leukemia, with scores ranging from 0 to 10. Considering all 13 years, a median of 78% of the class scored above 5 (min 74%-max 85%, and a median of 67

  8. Environmental Determinants of Chronic Disease and Medical Approaches: Recognition, Avoidance, Supportive Therapy, and Detoxification

    Directory of Open Access Journals (Sweden)

    Margaret E. Sears

    2012-01-01

    Full Text Available The World Health Organization warns that chronic, noncommunicable diseases are rapidly becoming epidemic worldwide. Escalating rates of neurocognitive, metabolic, autoimmune and cardiovascular diseases cannot be ascribed only to genetics, lifestyle, and nutrition; early life and ongoing exposures, and bioaccumulated toxicants may also cause chronic disease. Contributors to ill health are summarized from multiple perspectives—biological effects of classes of toxicants, mechanisms of toxicity, and a synthesis of toxic contributors to major diseases. Healthcare practitioners have wide-ranging roles in addressing environmental factors in policy and public health and clinical practice. Public health initiatives include risk recognition and chemical assessment then exposure reduction, remediation, monitoring, and avoidance. The complex web of disease and environmental contributors is amenable to some straightforward clinical approaches addressing multiple toxicants. Widely applicable strategies include nutrition and supplements to counter toxic effects and to support metabolism; as well as exercise and sweating, and possibly medication to enhance excretion. Addressing environmental health and contributors to chronic disease has broad implications for society, with large potential benefits from improved health and productivity.

  9. Efficacy of serial medical surveillance for chronic beryllium disease in a beryllium machining plant.

    Science.gov (United States)

    Newman, L S; Mroz, M M; Maier, L A; Daniloff, E M; Balkissoon, R

    2001-03-01

    There is limited information on the use of the blood beryllium lymphocyte proliferation test (BeLPT) at regular intervals in medical surveillance. Employees of a beryllium machining plant were screened with the BeLPT biennially, and new employees were screened within 3 months of hire. Of 235 employees screened from 1995 to 1997, a total of 15 (6.4%) had confirmed abnormal BeLPT results indicating beryllium sensitization; nine of these employees were diagnosed with chronic beryllium disease. Four of the 15 cases were diagnosed within 3 months of first exposure. When 187 of the 235 employees participated in biennial screening in 1997 to 1999, seven more had developed beryllium sensitization or chronic beryllium disease, increasing the overall rate to 9.4% (22 of 235). The blood BeLPT should be used serially in beryllium disease surveillance to capture new or missed cases of sensitization and disease. Beryllium sensitization and chronic beryllium disease can occur within 50 days of first exposure in modern industry.

  10. Microbial biofilms: impact on the pathogenesis of periodontitis, cystic fibrosis, chronic wounds and medical device-related infections.

    Science.gov (United States)

    Mihai, Mara Madalina; Holban, Alina Maria; Giurcaneanu, Calin; Popa, Liliana Gabriela; Oanea, Raluca Mihaela; Lazar, Veronica; Chifiriuc, Mariana Carmen; Popa, Marcela; Popa, Mircea Ioan

    2015-01-01

    The majority of chronic infections are associated with mono- or polymicrobial biofilms, having a significant impact on the patients' quality of life and survival rates. Although the use of medical devices revolutionized health care services and significantly improved patient outcomes, it also led to complications associated with biofilms and to the emergence of multidrug resistant bacteria. Immunocompromised patients, institutionalized or hospitalized individuals, elderly people are at greater risk due to life-threatening septic complications, but immunocompetent individuals with predisposing genetic or acquired diseases can also be affected, almost any body part being able to shelter persistent biofilms. Moreover, chronic biofilm-related infections can lead to the occurrence of systemic diseases, as in the case of chronic periodontitis, linked to atherosclerosis, cardiovascular disease and diabetes. The more researchers discover, new unknown issues add up to the complexity of biofilm infections, in which microbial species establish relationships of cooperation and competition, and elaborate phenotypic differentiation into functional, adapted communities. Their interaction with the host's immune system or with therapeutic agents contributes to the complex puzzle that still misses a lot of pieces. In this comprehensive review we aimed to highlight the microbial composition, developmental stages, architecture and properties of medical biofilms, as well as the diagnostic tools used in the management of biofilm related infections. Also, we present recently acquired knowledge on the etiopathogenesis, diagnosis and treatment of four chronic diseases associated with biofilm development in tissues (chronic periodontitis, chronic lung infection in cystic fibrosis, chronic wounds) and artificial substrata (medical devices-related infections).

  11. Advancing medical-surgical nursing practice: improving management of the changing patient condition.

    Science.gov (United States)

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

    Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

  12. Continuity of care for children with complex chronic health conditions: parents' perspectives

    Directory of Open Access Journals (Sweden)

    Shaw Nicola

    2009-12-01

    Full Text Available Abstract Background Continuity of care has been explored largely from academic and service provider perspectives, and in relation to adult patient/client groups. We interviewed parents of children with complex chronic health conditions to examine how their experiences and perceptions of continuity of care fit with these perspectives; and to identify the salient factors in the experience of, and factors contributing to, continuity in this population. Methods Parents of 47 elementary school-aged children with spina bifida, Down syndrome, attention-deficit/hyperactivity disorder, Duchenne muscular dystrophy or cystic fibrosis participated in semi-structured interviews. Parents described and mapped the pattern of their interactions with service providers over time in all domains relevant to their child's health, well-being, and development (medical, rehabilitational, educational, and social supportive services, with particular attention paid to their perceptions of connectedness or coherency in these interactions. Verbatim transcripts were analyzed thematically using a framework approach to impose structure regarding parents' perspectives on continuity of care. Results Existing academic concepts of relational, informational and management continuity were all discernable in parents' narratives. A thorough knowledge of the child on the part of service providers emerged as extremely important to parents; such knowledge was underpinned by continuity of personal relationships, principally, and also by written information. For this population, notions of continuity extend to the full range of service providers these children and families need to achieve optimal health status, and are not limited to physicians and nurses. Communication among providers was seen as integral to perceived continuity. Compartmentalization of services and information led to parents assuming a necessary, though at times, uncomfortable, coordinating role. Geographic factors

  13. [Medical activities under adverse conditions. Memisa Medicus Mundi].

    Science.gov (United States)

    Spanjer, J M

    1992-05-01

    The largest medical missionary organization in the Netherlands is Memisa Medicus Mundi. It has been in operation since 1984 when the organization Memisa, founded in 1925 by 2 doctors from Rotterdam and a priest, merged with Medicus Mundi Nederland. 130 of its doctors work in 80 programs mostly in English-speaking Third World countries. The regional representative for East Africa, worst affected by AIDS, related that a number of doctors work in hospitals where more than 1/2 of patients suffer from AIDS. Many doctors do not want to go to Africa because of the AIDS stigma and the lack of professional challenge of caring mainly for victims of 1 disease. Yet increasingly more foreign doctors are needed, as native doctors are often infected themselves. 1992 World Health Organizations data indicate that 1 out of 40 adult Africans is infected with the human immunodeficiency virus (HIV). In major East African cities the proportion reaches 30% of the adult population. A 1991 visit to Uganda, Tanzania, and Malawi revealed the spectacle of empty villages or inhabited only by children and old people. In Malawi there is 1 doctor for 40,000 people and 1 bed for 600 inhabitants whose average age is 49.3 years for men and 57.2 years for women. The doctors working there stressed prevention, and 1 of them got embroiled in a conflict with the Catholic archbishop because of handing out condoms. Nonetheless, sensitive topics such as sterilization, caesarean section, abortion, euthanasia, and contraception have been addressed to educate the people, since prevention takes precedence over treatment.

  14. Inhaler Costs and Medication Nonadherence Among Seniors With Chronic Pulmonary Disease

    Science.gov (United States)

    Rogers, William H.; Safran, Dana Gelb; Wilson, Ira B.

    2010-01-01

    Background: Chronic pulmonary diseases (CPDs) such as asthma and COPD are associated with particularly high rates of cost-related medication nonadherence (CRN), but the degree to which inhaler costs contribute to this is not known. Here, we examine the relationship between inhaler-specific out-of-pocket costs and CRN in CPD. Methods: Using data obtained in 2006 in a national stratified random sample (N = 16,072) of community-dwelling Medicare beneficiaries aged ≥ 65 years, we used logistic regression to examine the relationship between inhaled medications, various types of out-of-pocket costs, and CRN in persons with CPD. Results: The prevalence of CRN in Medicare recipients with CPD using inhalers was 31%. In multivariate models, the odds that respondents with CPD using inhalers would report CRN was 1.43 (95% CI, 1.21-1.69) compared with respondents without CPD who were not using inhalers. Adjustment for out-of-pocket inhaler costs—but not adjustment for total medication costs or non-inhaler costs—eliminated this excess risk of CRN (OR, 0.95; 95% CI, 0.71-1.28). Patients paying > $20 per month for inhalers were at significantly higher risk for CRN compared with those who had no out-of-pocket inhaler costs. Conclusions: Individuals with CPD and high out-of-pocket inhaler costs are at increased risk for CRN relative to individuals on other medications. Physicians should be aware that inhalers can pose a particularly high risk of medication nonadherence for some patients. PMID:20418367

  15. Factors associated with collaboration among agencies serving children with complex chronic conditions.

    Science.gov (United States)

    Nageswaran, Savithri; Golden, Shannon L; Easterling, Douglas; O'Shea, T Michael; Hansen, William B; Ip, Edward H

    2013-11-01

    Our objective was to identify agency-level factors that increase collaborative relationships between agencies that serve children with complex chronic conditions (CCC). We hypothesized that an agency will collaborate with more partners in the network if the agency had a coordinator and participated in a community coalition. We surveyed representatives of 63 agencies that serve children with CCC in Forsyth County, North Carolina about their agencies' collaborations with other agencies. We used social network analytical methods and exponential random graph analysis to identify factors associated with collaboration among agencies. The unit of analysis was the collaborative tie (n = 3,658) between agencies in the network. Agencies participating in a community coalition were 1.5 times more likely to report collaboration than agencies that did not participate in a coalition. Presence of a coordinator in an agency was not associated with the number of collaborative relationships. Agencies in existence for a longer duration (≥11 vs. ≤10 years; adjusted odds ratio (aOR): 2.1) and those with a higher proportion of CCC clientele (aOR: 2.1 and 1.6 for 11-30 % and ≥31 % compared to ≤10 %) had greater collaboration. Care coordination agencies and pediatric practices reported more collaborative relationships than subspecialty clinics, home-health agencies, durable medical equipment companies, educational programs and family-support services. Collaborative relationships between agencies that serve children with CCC are increased by coalition participation, longer existence and higher CCC clientele. Future studies should evaluate whether interventions to improve collaborations among agencies will improve clinical outcomes of children with CCC.

  16. Returning persons with a medical condition to their home country : still a contentious issue

    NARCIS (Netherlands)

    Flegar, Veronika

    2015-01-01

    Deportation of persons with a medical condition: the Dutch National ombudsman criticizes the immigration authorities of the Netherlands for an insufficiently clear evaluation of the medical resources available in the country of origin. At the same time, Judge Pinto de Albuquerque points to the meage

  17. Innovations in preventing and managing chronic conditions: what's working in the real world?

    Science.gov (United States)

    Cassil, Alwyn

    2010-06-01

    Wellness and prevention strategies are fast becoming a standard feature of employer-based health benefits in hopes of countering rapidly rising health care costs that drive higher insurance premiums. At the same time, payers and health care providers are experimenting with how to improve care coordination for high-cost patients with multiple chronic conditions, an ongoing challenge in the fragmented U.S. health care system. Promoting health and wellness and improving the care of people with chronic conditions offer promise in helping to improve the value of health care and control costs, according to experts at a Center for Studying Health System Change (HSC) conference titled, Innovations in Preventing and Managing Chronic Conditions: What's Working in the Real World? Panelists explored how effective employer-sponsored wellness and prevention initiatives focus on health improvement as a business strategy and foster work and community environments that help people lower risk factors--smoking, diet, lack of exercise--that lead to disease. Panelists also discussed various models--centered on strong primary care-to improve care for people with chronic conditions.

  18. Motivational Factors in Discussing Sexual Health with Young People with Chronic Conditions or Disabilities

    Science.gov (United States)

    Van der Stege, Heleen A.; Hilberink, Sander R.; Visser, Adriaan P.; Van Staa, AnneLoes

    2014-01-01

    The objective of this study was to identify determinants of professionals' intention to use the new board game SeCZ TaLK to facilitate sexual health discussions with young people with chronic health conditions and disabilities, and to gauge whether intention led to actual use. A cross-sectional web-based survey of 336 professionals before they…

  19. Association of Mental Disorders With Subsequent Chronic Physical Conditions : World Mental Health Surveys From 17 Countries

    NARCIS (Netherlands)

    Scott, Kate M.; Lim, Carmen; Al-Hamzawi, Ali; Alonso, Jordi; Bruffaerts, Ronny; Caldas-de-Almeida, Jose Miguel; Florescu, Silvia; de Girolamo, Giovanni; Hu, Chiyi; de Jonge, Peter; Kawakami, Norito; Elena Medina-Mora, Maria; Moskalewicz, Jacek; Navarro-Mateu, Fernando; O'Neill, Siobhan; Piazza, Marina; Posada-Villa, Jose; Torres, Yolanda; Kessler, Ronald C.

    2016-01-01

    IMPORTANCE It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less cl

  20. Association of Mental Disorders With Subsequent Chronic Physical Conditions World Mental Health Surveys From 17 Countries

    NARCIS (Netherlands)

    Scott, Kate M.; Lim, Carmen; Al-Hamzawi, Ali; Alonso, Jordi; Bruffaerts, Ronny; Caldas-de-Almeida, Jose Miguel; Florescu, Silvia; de Girolamo, Giovanni; Hu, Chiyi; de Jonge, Peter; Kawakami, Norito; Elena Medina-Mora, Maria; Moskalewicz, Jacek; Navarro-Mateu, Fernando; O'Neill, Siobhan; Piazza, Marina; Posada-Villa, Jose; Torres, Yolanda; Kessler, Ronald C.

    2016-01-01

    IMPORTANCE It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less cl

  1. Information Behavior of People Diagnosed with a Chronic Serious Health Condition: A Longitudinal Study

    Science.gov (United States)

    St. Jean, Beth Lenore

    2012-01-01

    This study consisted of a longitudinal investigation into the information behavior of people diagnosed with a particular chronic serious health condition, type 2 diabetes. This study sought to identify the factors that motivate or impede the information seeking and use of these individuals and to discover how these factors and their influences…

  2. The road to independence: Lived experiences of youth with chronic conditions and their parents compared

    NARCIS (Netherlands)

    M.A.C. Peeters (Mariëlle A.C.); S.R. Hilberink (Sander); A.L. van Staa (AnneLoes)

    2014-01-01

    markdownabstract__Abstract__ PURPOSE: To gain insight into the development of young persons with chronic conditions towards independence by comparing their lived experiences to those of their parents. METHODS: Semi-structured interviews were held with 16 young persons (7 males, 9 females; 15-22 yea

  3. Keeping Older Adults with Vision Loss Safe: Chronic Conditions and Comorbidities that Influence Functional Mobility

    Science.gov (United States)

    Riddering, Anne T.

    2008-01-01

    Age-related macular degeneration (AMD) is a leading cause of vision loss in Americans aged 60 and older. The loss of central vision from AMD can decrease visual acuity, contrast sensitivity, glare sensitivity, color discrimination, and the ability to adapt to changes in lighting conditions. Older adults with vision loss often have other chronic,…

  4. Prevalence of Chronic Health Conditions in Children With Intellectual Disability : A Systematic Literature Review

    NARCIS (Netherlands)

    Oeseburg, Barth; Dijkstra, Geke J.; Groothoff, Johan W.; Reijneveld, Sijmen A.; Jansen, Danielle E. M. C.

    2011-01-01

    A systematic review of the prevalence rates of chronic health conditions in populations of children with intellectual disability was provided. We identified 2,994 relevant studies by searching Medline, Cinahl, and PsycINFO databases from 1996 to 2008. We included the 31 studies that had sufficient m

  5. Using online health communities to deliver patient-centered care to people with chronic conditions

    NARCIS (Netherlands)

    Eijk, M. van der; Faber, M.J.; Aarts, J.W.M.; Kremer, J.A.M.; Munneke, M.; Bloem, B.R.

    2013-01-01

    BACKGROUND: Our health care system faces major threats as the number of people with multiple chronic conditions rises dramatically. OBJECTIVE: To study the use of Online Health Communities (OHCs) as a tool to facilitate high-quality and affordable health care for future generations. METHODS: OHCs ar

  6. Psychological functioning of siblings in families of children with chronic health conditions: A meta-analysis

    NARCIS (Netherlands)

    Vermaes, I.P.R.; Susante, A.M.J. van; Bakel, H.J.A. van

    2012-01-01

    Objective: The aim of this meta-analysis was to provide an up-to-date review of the literature to enhance our understanding of how chronic health conditions (CHCs) affect siblings, both positively and negatively. Methods: PsycINFO and Medline were systematically searched. Inclusion criteria were as

  7. Adolescents' Perceptions of Chronic Self-Concept, Peer Relations, and Learning Conditions

    Science.gov (United States)

    Liu, Weiping; Eckert, Thomas

    2014-01-01

    Based on Lewin's Field Theory, Bronfenbrenner's Bioecological Systems Theory and social network analysis, the authors collected data from 405 Chinese adolescents about their peer relations, chronic self-concept levels and learning condition variables through questionnaire distributing, and from their teachers about their annual average…

  8. Personalized Coaching Systems to support healthy behavior in people with chronic conditions

    NARCIS (Netherlands)

    Hermens, H.; Akker, op den H.; Tabak, M.; Wijsman, J.; Vollenbroek, M.

    2014-01-01

    Chronic conditions cannot be cured but daily behavior has a major effect on the severity of secondary problems and quality of life. Changing behavior however requires intensive support in daily life, which is not feasible with a human coach. A new coaching approach – so-called Personal Coaching Syst

  9. Motivational factors in discussing sexual health with young people with chronic conditions or disabilities

    NARCIS (Netherlands)

    Stege, H.A. van der; Hilberink, S.R.; Visser, A.P.; Staa, A.L. van

    2014-01-01

    The objective of this study was to identify determinants of professionals’ intention to use the new board game SeCZ TaLK to facilitate sexual health discussions with young people with chronic health conditions and disabilities, and to gauge whether intention led to actual use. A cross-sectional web-

  10. Iterative Design and Usability Testing of the iMHere System for Managing Chronic Conditions and Disability

    Directory of Open Access Journals (Sweden)

    Andrea D. Fairman

    2016-07-01

    Full Text Available A novel mobile health platform, Interactive Mobile Health and Rehabilitation (iMHere, is being developed to support wellness and self-management among people with chronic disabilities. The iMHere system currently includes a smartphone app with six modules for use by persons with disabilities and a web portal for use by medical and rehabilitation professionals or other support personnel. Our initial clinical research applying use of this system provides insight into the feasibility of employing iMHere in the development of self-management skills in young adults (ages 18-40 years with spina bifida (Dicianno, Fairman, McCue, Parmanto, Yih, et al., 2015. This article is focused on describing the iterative design of the iMHere system including usability testing of both the app modules and clinician portal. Our pilot population of persons with spina bifida fostered the creation of a system appropriate for people with a wide variety of functional abilities and needs. As a result, the system is appropriate for use by persons with various disabilities and chronic conditions, not only spina bifida. In addition, the diversity of professionals and support personnel involved in the care of persons with spina bifida (SB also enabled the design and implementation of the iMHere system to meet the needs of an interdisciplinary team of providers who treat various conditions. The iMHere system has the potential to foster communication and collaboration among members of an interdisciplinary healthcare team, including individuals with chronic conditions and disabilities, for client-centered approach to support self-management skills.

  11. Factors that lessen the burden of treatment in complex patients with chronic conditions: a qualitative study

    Directory of Open Access Journals (Sweden)

    Ridgeway JL

    2014-03-01

    Full Text Available Jennifer L Ridgeway,1,2 Jason S Egginton,1,2 Kristina Tiedje,3 Mark Linzer,4,5 Deborah Boehm,4 Sara Poplau,6 Djenane Ramalho de Oliveira,7 Laura Odell,8 Victor M Montori,2,9 David T Eton1,2 1The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 2Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; 3Department of Anthropology, Université Lumière Lyon 2, Lyon, France; 4Division of General Internal Medicine, Hennepin County Medical Center, 5University of Minnesota Medical School, 6Minneapolis Medical Research Foundation, Minneapolis, MN, USA; 7Department of Social Pharmacy, Universidade Federal de Minas Gerais, Brazil; 8Pharmacy Services, 9Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA Purpose: Patients with multiple chronic conditions (multimorbidity often require ongoing treatment and complex self-care. This workload and its impact on patient functioning and well-being are, together, known as treatment burden. This study reports on factors that patients with multimorbidity draw on to lessen perceptions of treatment burden. Patients and methods: Interviews (n=50 and focus groups (n=4 groups, five to eight participants per group were conducted with patients receiving care in a large academic medical center or an urban safety-net hospital. Interview data were analyzed using qualitative framework analysis methods, and themes and subthemes were used to identify factors that mitigate burden. Focus groups were held to confirm these findings and clarify any new issues. This study was part of a larger program to develop a patient-reported measure of treatment burden. Results: Five major themes emerged from the interview data. These included: 1 problem-focused strategies, like routinizing self-care, enlisting support of others, planning for the future, and using technology; 2 emotion-focused coping strategies, like

  12. Effect of antipsychotic medication on overall life satisfaction among individuals with chronic schizophrenia: findings from the NIMH CATIE study.

    Science.gov (United States)

    Fervaha, Gagan; Agid, Ofer; Takeuchi, Hiroyoshi; Foussias, George; Remington, Gary

    2014-07-01

    The field of schizophrenia is redefining optimal outcome, moving beyond clinical remission to a more comprehensive model including functional recovery and improved subjective well-being. Although numerous studies have evaluated subjective outcomes within the domain of subjective quality of life in patients with schizophrenia, less is known about global evaluations of subjective well-being. This study examined the effects of antipsychotic medication on overall life satisfaction in patients with chronic schizophrenia. Data were drawn from the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study, where participants with a DSM-IV diagnosis of schizophrenia were randomized to receive olanzapine, perphenazine, quetiapine, risperidone or ziprasidone under double-blind conditions (N=753). The primary outcome measure was prospective change in subjectively evaluated overall life satisfaction scores following 12 months of antipsychotic treatment. Psychopathology, medication side effects and functional status were also evaluated, among other variables. Patients experienced modest improvements in overall life satisfaction (d=0.22, p0.05). Change in severity of positive, negative, and depressive symptoms as well as functional status each demonstrated a small, albeit statistically significant, association with change in life satisfaction (r=0.10-0.21, p׳slife satisfaction scores (explained variance satisfaction with life. Clinicians should be aware that these two domains are not inextricably linked.

  13. ENDOSCOPIC AND HISTOPATHOLOGIC CHANGES IN CHILDREN WITH CHRONIC DYSPEPSIA IN A RURAL MEDICAL COLLEGE HOSPITAL IN MELMARUVATHUR- TAMILNADU

    OpenAIRE

    Padma K; Sumathi S.; Dinakaran Nagendram; Kannan C

    2016-01-01

    INTRODUCTION Chronic pain abdomen and dyspepsia is the most common presenting symptoms in the Paediatric Outpatient Department (OPD) after respiratory illnesses. It is increasing alarmingly both in the paediatric and adult population. We, therefore carried out a cross-sectional study among children with chronic dyspepsia aged between 5 to 15 years attending Paediatric OPD in a rural medical college hospital, Melmaruvathur, Tamilnadu, South India. OBJECTIVE To evaluate the ga...

  14. Chronic inflammatory diseases are stimulated by current lifestyle: how diet, stress levels and medication prevent our body from recovering

    Directory of Open Access Journals (Sweden)

    Bosma-den Boer Margarethe M

    2012-04-01

    Full Text Available Abstract Serhan and colleagues introduced the term "Resoleomics" in 1996 as the process of inflammation resolution. The major discovery of Serhan's work is that onset to conclusion of an inflammation is a controlled process of the immune system (IS and not simply the consequence of an extinguished or "exhausted" immune reaction. Resoleomics can be considered as the evolutionary mechanism of restoring homeostatic balances after injury, inflammation and infection. Under normal circumstances, Resoleomics should be able to conclude inflammatory responses. Considering the modern pandemic increase of chronic medical and psychiatric illnesses involving chronic inflammation, it has become apparent that Resoleomics is not fulfilling its potential resolving capacity. We suggest that recent drastic changes in lifestyle, including diet and psycho-emotional stress, are responsible for inflammation and for disturbances in Resoleomics. In addition, current interventions, like chronic use of anti-inflammatory medication, suppress Resoleomics. These new lifestyle factors, including the use of medication, should be considered health hazards, as they are capable of long-term or chronic activation of the central stress axes. The IS is designed to produce solutions for fast, intensive hazards, not to cope with long-term, chronic stimulation. The never-ending stress factors of recent lifestyle changes have pushed the IS and the central stress system into a constant state of activity, leading to chronically unresolved inflammation and increased vulnerability for chronic disease. Our hypothesis is that modern diet, increased psycho-emotional stress and chronic use of anti-inflammatory medication disrupt the natural process of inflammation resolution ie Resoleomics.

  15. Reduced intensity conditioning is superior to nonmyeloablative conditioning for older chronic myelogenous leukemia patients undergoing hematopoietic cell transplant during the tyrosine kinase inhibitor era

    DEFF Research Database (Denmark)

    Warlick, Erica; Ahn, Kwang Woo; Pedersen, Tanya L;

    2012-01-01

    Tyrosine kinase inhibitors (TKIs) and reduced intensity conditioning (RIC)/nonmyeloablative (NMA) conditioning hematopoietic cell transplants (HCTs) have changed the therapeutic strategy for chronic myelogenous leukemia (CML) patients. We analyzed post-HCT outcomes of 306 CML patients reported to...

  16. Medical Nutrition Therapy based on Nutrition Intervention for a Patient with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Seo, Seung Hee

    2014-07-01

    Chronic obstructive pulmonary disease (COPD) is a major cause of disability, and according to statistics from the World Health Organization, COPD is the fourth leading cause of death overall in the face of decades, and expected to be increased. In 2005, the reported prevalence of COPD in Korea was 17.2% of adults over the age of 45. Malnutrition is a common problem in papatients with COPD. And several nutritional intervention studies showed a significant improvement in physical and functional outcomes. According to the results of previous studies, the nutritional support is important. This is a case report of a patient with COPD who was introduced to a proper diet through nutrition education based on the medical nutrition therapy protocol for COPD.

  17. Sedentary Behavior in People with and without a Chronic Health Condition: How Much, What and When?

    Directory of Open Access Journals (Sweden)

    Coralie English

    2016-08-01

    Full Text Available Purpose: To describe sedentary behaviors (duration, bouts and context in people with and without a chronic health condition. Methods: Design: Secondary analysis of two cross-sectional studies. Participants: People with stable chronic obstructive pulmonary disease (COPD (n = 24, male:female 18:6 and their spousal carers (n = 24, 6:18; stroke survivors (n = 24, 16:8 and age- and sex-matched healthy adults (n = 19, 11:8. Level of physiological impairment was measured with post-bronchodilator spirometry (FEV1 %predicted for people with COPD, and walking speed for people with stroke. Outcomes: Participants were monitored over seven days (triaxial accelerometer, Sensewear armband to obtain objective data on daily sedentary time, and prolonged sedentary bouts (≥ 30 min. During the monitoring period, a 24-hour use of time recall instrument was administered by telephone interview to explore the context of sedentary activities (e.g. television, computer or reading. Sedentary time was quantified using accelerometry and recall data, and group differences were explored. Linear regression examined associations between physiological impairment and sedentary time. Results: Participant groups were similar in terms of age (COPD 75 ± 8, carers 70 ± 11, stroke 69 ± 10, healthy 73 ± 7 years and body mass index (COPD 28 ± 4, carers 27 ± 4, stroke 31 ± 4, healthy 26 ± 4 kg.m–2. The healthy group had the lowest sedentary time (45% of waking hours, followed by the carer (54%, stroke (60% and COPD (62% groups (p < 0.0001. Level of physiological impairment was an independent predictor of waking sedentary time (p = 0.001. Conclusions: People with a chronic health condition spent more time sedentary than those without a chronic condition, and there were small but clear differences between groups in the types of activities undertaken during sedentary periods. The study findings may aid in the design of targeted interventions to decrease sedentary time in people

  18. Development and description of measurement properties of an instrument to assess treatment burden among patients with multiple chronic conditions

    Directory of Open Access Journals (Sweden)

    Tran Viet-Thi

    2012-07-01

    Full Text Available Abstract Background Patients experience an increasing treatment burden related to everything they do to take care of their health: visits to the doctor, medical tests, treatment management and lifestyle changes. This treatment burden could affect treatment adherence, quality of life and outcomes. We aimed to develop and validate an instrument for measuring treatment burden for patients with multiple chronic conditions. Methods Items were derived from a literature review and qualitative semistructured interviews with patients. The instrument was then validated in a sample of patients with chronic conditions recruited in hospitals and general practitioner clinics in France. Factor analysis was used to examine the questionnaire structure. Construct validity was studied by the relationships between the instrument's global score, the Treatment Satisfaction Questionnaire for Medication (TSQM scores and the complexity of treatment as assessed by patients and physicians. Agreement between patients and physicians was appraised. Reliability was determined by a test-retest method. Results A sample of 502 patients completed the Treatment Burden Questionnaire (TBQ, which consisted of 7 items (2 of which had 4 subitems defined after 22 interviews with patients. The questionnaire showed a unidimensional structure. The Cronbach's α was 0.89. The instrument's global score was negatively correlated with TSQM scores (rs = -0.41 to -0.53 and positively correlated with the complexity of treatment (rs = 0.16 to 0.40. Agreement between patients and physicians (n = 396 was weak (intraclass correlation coefficient 0.38 (95% confidence interval 0.29 to 0.47. Reliability of the retest (n = 211 patients was 0.76 (0.67 to 0.83. Conclusions This study provides the first valid and reliable instrument assessing the treatment burden for patients across any disease or treatment context. This instrument could help in the development of treatment strategies that are both

  19. Models of care for late-life depression of the medically ill: examples from chronic obstructive pulmonary disease and stroke.

    Science.gov (United States)

    Avari, Jimmy N; Alexopoulos, George S

    2015-05-01

    Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically, or acutely medically ill older adults. The Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. The addition of problem-solving training enables patients to use resources available to them and hopefully improve their outcomes. Ecosystem-focused therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with poststroke depression (PSD) and targets five areas, part of the "psychosocial storm" originating from the patient's sudden disability and the resulting change in the patient's needs and family's life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.

  20. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Special medical record requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR...

  1. Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

    Directory of Open Access Journals (Sweden)

    Lauren Lapointe-Shaw

    Full Text Available BACKGROUND: Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices. METHODS: We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI, angiotensin-converting enzyme (ACE inhibitor or angiotensin receptor blocker (ARB following hospital admission from April 1(st 2008-March 31(st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class. RESULTS: The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47% for PPIs, $162 thousand (17% for ACE inhibitors and $14 thousand (4% for ARBs over the year following discharge. INTERPRETATION: In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

  2. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis.

    Science.gov (United States)

    Hoffmeister, A; Mayerle, J; Beglinger, C; Büchler, M W; Bufler, P; Dathe, K; Fölsch, U R; Friess, H; Izbicki, J; Kahl, S; Klar, E; Keller, J; Knoefel, W T; Layer, P; Loehr, M; Meier, R; Riemann, J F; Rünzi, M; Schmid, R M; Schreyer, A; Tribl, B; Werner, J; Witt, H; Mössner, J; Lerch, M M

    2015-12-01

    Chronic pancreatitis is a disease of the pancreas in which recurrent inflammatory episodes result in replacement of pancreatic parenchyma by fibrous connective tissue. This fibrotic reorganization of the pancreas leads to a progressive exocrine and endocrine pancreatic insufficiency. In addition, characteristic complications arise, such as pseudocysts, pancreatic duct obstructions, duodenal obstruction, vascular complications, obstruction of the bile ducts, malnutrition and pain syndrome. Pain presents as the main symptom of patients with chronic pancreatitis. Chronic pancreatitis is a risk factor for pancreatic carcinoma. Chronic pancreatitis significantly reduces the quality of life and the life expectancy of affected patients. These guidelines were researched and compiled by 74 representatives from 11 learned societies and their intention is to serve evidence-based professional training as well as continuing education. On this basis they shall improve the medical care of affected patients in both the inpatient and outpatient sector. Chronic pancreatitis requires an adequate diagnostic workup and systematic management, given its severity, frequency, chronicity, and negative impact on the quality of life and life expectancy.

  3. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Yang P

    2016-10-01

    Full Text Available Ping Yang, Na Chen, Rong-Rong Wang, Lu Li, Sai-Ping Jiang Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Background: With the increasing incidence rate of chronic kidney disease (CKD, inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure.Objective: The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients.Methods: A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified.Results: Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56, contraindicated (n=46, and cautiously used medicines (n=161 accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056. Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%, cardiovascular drugs (n=61, 23.19%, and antimicrobial drugs (n=55, 20.91% represented the top three medicine categories in CKD patients.Conclusion: The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. Keywords: inappropriateness of

  4. Factors associated with a patient-centered medical home among children with behavioral health conditions.

    Science.gov (United States)

    Knapp, Caprice; Woodworth, Lindsey; Fernandez-Baca, Daniel; Baron-Lee, Jacqueline; Thompson, Lindsay; Hinojosa, Melanie

    2013-11-01

    At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities.

  5. Recommendations for the medical management of chronic venous disease: The role of Micronized Purified Flavanoid Fraction (MPFF).

    Science.gov (United States)

    Bush, Ronald; Comerota, Anthony; Meissner, Mark; Raffetto, Joseph D; Hahn, Steven R; Freeman, Katherine

    2017-04-01

    Scope A systematic review of the clinical literature concerning medical management of chronic venous disease with the venoactive therapy Micronized Purified Flavonoid Fraction was conducted in addition to an investigation of the hemodynamics and mechanism of chronic venous disease. Methods The systematic review of the literature focused on the use of Micronized Purified Flavonoid Fraction (diosmin) which has recently become available in the US, in the management of chronic venous disease. The primary goal was to assess the level of evidence of the role of Micronized Purified Flavonoid Fraction in the healing of ulcers, and secondarily on the improvement of the symptoms of chronic venous disease such as edema. An initial search of Medline, Cochrane Database for Systematic Reviews and Google Scholar databases was conducted. The references of articles obtained in the primary search, including a Cochrane review of phlebotonics for venous insufficiency, were reviewed for additional studies. Studies were included if patients had a diagnosis of chronic venous disease documented with Doppler and Impedance Plethysmography. Studies excluded were those that had patients with arterial insufficiency (Ankle Brachial Index chronic venous disease patients because of its favorable safety profile. The Working Group for chronic venous disease concurs with previous guidance by the International European Society for Vascular Surgery in 2015 which recommended the use of Micronized Purified Flavonoid Fraction for the healing of venous ulcers, alone and adjunctive to compression therapy, and for the reduction in symptoms of chronic venous disease such as edema.

  6. The Interface between Substance Abuse and Chronic Pain Management in Primary Care: A Curriculum for Medical Residents

    Science.gov (United States)

    Gunderson, Erik W.; Coffin, Phillip O.; Chang, Nancy; Polydorou, Soteri; Levin, Frances R.

    2009-01-01

    Objectives: To develop and assess a housestaff curriculum on opioid and other substance abuse among patients with chronic noncancer pain (CNCP). Methods: The two-hour, case-based curriculum delivered to small groups of medical housestaff sought to improve assessment and management of opioid-treated CNCP patients, including those with a substance…

  7. Diet and Exercise Adherence and Practices among Medically Underserved Patients with Chronic Disease: Variation across Four Ethnic Groups

    Science.gov (United States)

    Orzech, Kathryn M.; Vivian, James; Huebner Torres, Cristina; Armin, Julie; Shaw, Susan J.

    2013-01-01

    Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative ("n" = 71) and quantitative ("n" = 297) data collected in a 4-year, multimethod study…

  8. Conditions for successful reflective use of portfolios in undergraduate medical education

    OpenAIRE

    Driessen, Erik W; Van Tartwijk, Jan; Overeem, Karlijn; Vermunt, Jan D; Vleuten, C.P.M. van der

    2005-01-01

    AIM: Portfolios are often used as an instrument with which to stimulate students to reflect on their experiences. Research has shown that working with portfolios does not automatically stimulate reflection. In this study we addressed the question: What are the conditions for successful reflective use of portfolios in undergraduate medical education? METHODOLOGY/RESEARCH DESIGN: We designed a portfolio that was aimed at stimulating reflection in early undergraduate medical education, using exp...

  9. Personality Traits in College Students and Caregiving for a Relative with a Chronic Health Condition

    Directory of Open Access Journals (Sweden)

    Michael A. Trujillo

    2016-01-01

    Full Text Available The purpose of this study was to investigate among college students the relationship between personality traits and willingness to care for a relative with a chronic health condition. 329 undergraduate students completed an online questionnaire. Hierarchical multiple regressions found that after controlling for demographics personality traits explained 10% of the variance in willingness to provide emotional care, 7% in instrumental care, and 7% in nursing care. Within these models, greater empathy was uniquely associated with willingness to provide emotional, instrumental, and nursing care for a family member in the future. Similarly, participants with high agreeableness were more willing to provide emotional care, and participant older age was a unique predictor of instrumental care. The results can help shape research on interventions that incorporate perspective taking, motivational interviewing, and training in life skills as a means of boosting college students’ willingness to provide care for a relative with a chronic health condition.

  10. Personality Traits in College Students and Caregiving for a Relative with a Chronic Health Condition.

    Science.gov (United States)

    Trujillo, Michael A; Perrin, Paul B; Elnasseh, Aaliah; Pierce, Bradford S; Mickens, Melody

    2016-01-01

    The purpose of this study was to investigate among college students the relationship between personality traits and willingness to care for a relative with a chronic health condition. 329 undergraduate students completed an online questionnaire. Hierarchical multiple regressions found that after controlling for demographics personality traits explained 10% of the variance in willingness to provide emotional care, 7% in instrumental care, and 7% in nursing care. Within these models, greater empathy was uniquely associated with willingness to provide emotional, instrumental, and nursing care for a family member in the future. Similarly, participants with high agreeableness were more willing to provide emotional care, and participant older age was a unique predictor of instrumental care. The results can help shape research on interventions that incorporate perspective taking, motivational interviewing, and training in life skills as a means of boosting college students' willingness to provide care for a relative with a chronic health condition.

  11. Chronic Conditions, Workplace Safety, And Job Demands Contribute To Absenteeism And Job Performance.

    Science.gov (United States)

    Jinnett, Kimberly; Schwatka, Natalie; Tenney, Liliana; Brockbank, Claire V S; Newman, Lee S

    2017-02-01

    An aging workforce, increased prevalence of chronic health conditions, and the potential for longer working lives have both societal and economic implications. We analyzed the combined impact of workplace safety, employee health, and job demands (work task difficulty) on worker absence and job performance. The study sample consisted of 16,926 employees who participated in a worksite wellness program offered by a workers' compensation insurer to their employers-314 large, midsize, and small businesses in Colorado across multiple industries. We found that both workplace safety and employees' chronic health conditions contributed to absenteeism and job performance, but their impact was influenced by the physical and cognitive difficulty of the job. If employers want to reduce health-related productivity losses, they should take an integrated approach to mitigate job-related injuries, promote employee health, and improve the fit between a worker's duties and abilities.

  12. The effect of acceptance training on psychological and physical health outcomes in elders with chronic conditions.

    Science.gov (United States)

    McDonald, Patricia E; Zauszniewski, Jaclene A; Bekhet, Abir K; DeHelian, Laura; Morris, Diana L

    2011-12-01

    This pilot trial investigated the short and long-term effects of Acceptance Training (ACT) intervention on acceptance, perceived health, functional status, anxiety, and depression in elders with chronic conditions living in retirement communities (RCs). The ACT intervention combined Rational Emotive Behavior Therapy with music, relaxation, and guided imagery during six weekly 2-hour sessions. Face-to-face interviews were conducted with 16 African-American and 46 White elders across four data collection points in six randomly selected RCs using well-established measures of perceived health, functional status, anxiety, and depression, and a measure of acceptance of chronic conditions adapted from a previous measure of acceptance of diabetes. While changes were found in perceived health, functional status, anxiety, and depression, the most significant changes occurred in the elders' acceptance of chronic conditions immediately after the intervention (t = -2.62, p < .02), and these changes persisted for 6 and 12 weeks (t's = -2.74, -3.32, p's < .01), respectively. Although a 40% attrition rate reduced the sample size from 62 (N = 62) to 37 (N = 37), the significant increases in acceptance over time provide initial evidence for the fidelity of the ACT intervention.

  13. Expectations outpace reality: physicians' use of care management tools for patients with chronic conditions.

    Science.gov (United States)

    Carrier, Emily; Reschovsky, James

    2009-12-01

    Use of care management tools--such as group visits or patient registries--varies widely among primary care physicians whose practices care for patients with four common chronic conditions--asthma, diabetes, congestive heart failure and depression--according to a new national study by the Center for Studying Health System Change (HSC). For example, less than a third of these primary care physicians in 2008 reported their practices use nurse managers to coordinate care, and only four in 10 were in practices using registries to keep track of patients with chronic conditions. Physicians also used care management tools for patients with some chronic conditions but not others. Practice size and setting were strongly related to the likelihood that physicians used care management tools, with solo and smaller group practices least likely to use care management tools. The findings suggest that, along with experimenting with financial incentives for primary care physicians to adopt care management tools, policy makers might consider developing community-level care management resources, such as nurse managers, that could be shared among smaller physician practices.

  14. Automating and estimating glomerular filtration rate for dosing medications and staging chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Trinkley KE

    2014-05-01

    Full Text Available Katy E Trinkley,1 S Michelle Nikels,2 Robert L Page II,1 Melanie S Joy11Skaggs School of Pharmacy and Pharmaceutical Sciences, 2School of Medicine, University of Colorado, Aurora, CO, USA Objective: The purpose of this paper is to serve as a review for primary care providers on the bedside methods for estimating glomerular filtration rate (GFR for dosing and chronic kidney disease (CKD staging and to discuss how automated health information technologies (HIT can enhance clinical documentation of staging and reduce medication errors in patients with CKD.Methods: A nonsystematic search of PubMed (through March 2013 was conducted to determine the optimal approach to estimate GFR for dosing and CKD staging and to identify examples of how automated HITs can improve health outcomes in patients with CKD. Papers known to the authors were included, as were scientific statements. Articles were chosen based on the judgment of the authors.Results: Drug-dosing decisions should be based on the method used in the published studies and package labeling that have been determined to be safe, which is most often the Cockcroft–Gault formula unadjusted for body weight. Although Modification of Diet in Renal Disease is more commonly used in practice for staging, the CKD–Epidemiology Collaboration (CKD–EPI equation is the most accurate formula for estimating the CKD staging, especially at higher GFR values. Automated HITs offer a solution to the complexity of determining which equation to use for a given clinical scenario. HITs can educate providers on which formula to use and how to apply the formula in a given clinical situation, ultimately improving appropriate medication and medical management in CKD patients.Conclusion: Appropriate estimation of GFR is key to optimal health outcomes. HITs assist clinicians in both choosing the most appropriate GFR estimation formula and in applying the results of the GFR estimation in practice. Key limitations of the

  15. Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse?

    Directory of Open Access Journals (Sweden)

    Piette JD

    2011-04-01

    Full Text Available John D Piette1, Ann Marie Rosland1, Maria J Silveira1, Rodney Hayward1, Colleen A McHorney21Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; 2US Outcomes Research, Merck and Co, Inc, North Wales, PA, USAAbstract: A national internet survey was conducted between March and April 2009 among 27,302 US participants in the Harris Interactive Chronic Illness Panel. Respondents reported behaviors related to cost-related medication non-adherence (CRN and the impacts of medication costs on other aspects of their daily lives. Among respondents aged 40–64 and looking for work, 66% reported CRN in 2008, and 41% did not fill a prescription due to cost pressures. More than half of respondents aged 40–64 and nearly two-thirds of those in this group who were looking for work or disabled reported other impacts of medication costs, such as cutting back on basic needs or increasing credit card debt. More than one-third of respondents aged 65+ who were working or looking for work reported CRN. Regardless of age or employment status, roughly half of respondents reporting medication cost hardship said that these problems had become more frequent in 2008 than before the economic recession. These data show that many chronically ill patients, particularly those looking for work or disabled, reported greater medication cost problems since the economic crisis began. Given links between CRN and worse health, the financial downturn may have had significant health consequences for adults with chronic illness.Keywords: medication adherence, cost-of-care, access to care, chronic disease

  16. Chronic Pain

    Science.gov (United States)

    ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

  17. Responsiveness of five condition-specific and generic outcome assessment instruments for chronic pain

    Directory of Open Access Journals (Sweden)

    Verra Martin L

    2008-04-01

    Full Text Available Abstract Background Changes of health and quality-of-life in chronic conditions are mostly small and require specific and sensitive instruments. The aim of this study was to determine and compare responsiveness, i.e. the sensitivity to change of five outcome instruments for effect measurement in chronic pain. Methods In a prospective cohort study, 273 chronic pain patients were assessed on the Numeric Rating Scale (NRS for pain, the Short Form 36 (SF-36, the Multidimensional Pain Inventory (MPI, the Hospital Anxiety and Depression Scale (HADS, and the Coping Strategies Questionnaire (CSQ. Responsiveness was quantified by effect size (ES and standardized response mean (SRM before and after a four week in-patient interdisciplinary pain program and compared by the modified Jacknife test. Results The MPI measured pain more responsively than the SF-36 (ES: 0.85 vs 0.72, p = 0.053; SRM: 0.72 vs 0.60, p = 0.027 and the pain NRS (ES: 0.85 vs 0.62, p Conclusion The MPI was most responsive in all comparable domains followed by the SF-36. The pain-specific MPI and the generic SF-36 can be recommended for comprehensive and specific bio-psycho-social effect measurement of health and quality-of-life in chronic pain.

  18. The Bodies Politic: Chronic Health Conditions and Voter Turnout in the 2008 Election.

    Science.gov (United States)

    Gollust, Sarah E; Rahn, Wendy M

    2015-12-01

    Health policy researchers often evaluate the social and economic consequences of chronic illness, but rarely have they considered the implications of chronic illness on one important form of political participation: voting. However, if chronic illnesses--already unequally distributed in society--are associated with differential rates of voter turnout, then these inequalities in democratic representation could, in turn, produce further health inequity. In this study, we use data from eight states from the 2009 Behavioral Risk Factor Surveillance Survey to examine the associations between having diagnoses of five chronic conditions and turnout in the 2008 US presidential election. After adjusting for sociodemographic characteristics and some health-related confounding factors, we find that individuals with cancer diagnoses are more likely to vote, while those with heart disease diagnoses are less likely to vote. These associations differ by race and educational status; notably, African Americans and those with lower education with cancer are even more likely to turn out to vote than whites and those with more education with cancer. We discuss the implications of our findings in the context of health social movements and the role of health organizations in shaping political processes, important directions for the study of health politics.

  19. Chronic intermittent heroin produces locomotor sensitization and long-lasting enhancement of conditioned reinforcement.

    Science.gov (United States)

    Morrison, J; Thornton, V; Ranaldi, R

    2011-09-01

    In a previous study we showed that chronic intermittent heroin in rats enhanced responding with conditioned reinforcement and reversal learning of a conditioned magazine approach task when tested three days after the heroin treatment. Whether or not this enhanced appetitive learning persists after a protracted withdrawal period remains unknown and constitutes the aim of the present study. Forty-eight male Long Evans rats were each exposed to positive pairings of a light stimulus and food for 4 consecutive daily sessions. Then, two groups of rats received saline and two groups received heroin (2 mg/kg) injections before placement in activity monitors for 9 consecutive daily sessions. This was followed by testing in operant conditioning chambers where one lever produced the light stimulus previously paired with food and another no stimulus. For one saline and one heroin group this testing occurred after 2 days of withdrawal while for the other saline and heroin groups it occurred after 30 days of withdrawal. The results indicate that animals treated with heroin displayed progressively and significantly greater locomotor activity across sessions while animals treated with saline displayed locomotor activity that remained low and stable across sessions. In addition, the heroin groups in each withdrawal condition displayed significantly enhanced responding with conditioned reinforcement compared to their respective saline control groups. These results demonstrate that chronic intermittent heroin enhances appetitive learning for natural reinforcers and motivational processes and that this effect persists even after 30-days of withdrawal.

  20. Chronic cocaine pretreatment facilitates Pavlovian sexual conditioning in male Japanese quail.

    Science.gov (United States)

    Levens, Neil; Akins, Chana K

    2004-11-01

    Repeated drug exposure that results in behavioral sensitization has been shown to enhance sex-seeking behaviors in rats as well as facilitate Pavlovian excitatory and inhibitory conditioning. In the present experiment, male Japanese quail were given repeated presentations of cocaine (10 mg/kg, i.p.) that resulted in increased locomotor activity relative to saline. After a 10-day withdrawal period, subjects received sexual conditioning trials that consisted of presentation of an object conditioned stimulus (CS) followed by sexual reinforcement. Results showed that birds that previously received chronic cocaine demonstrated more conditioned approach behavior to the CS object, a shorter latency to copulate with a female, and made more cloacal contacts (copulatory behavior) during sexual reinforcement than saline-treated birds. The findings suggest that chronic cocaine later facilitates Pavlovian conditioning in a sexual behavior paradigm. This may be the result of cocaine facilitating learning via the dopaminergic system. The findings are discussed in the context of the incentive sensitization theory and possible neuronal mechanisms.

  1. Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study

    Directory of Open Access Journals (Sweden)

    Eton DT

    2012-08-01

    Full Text Available David T Eton,1 Djenane Ramalho de Oliveira,2,3 Jason S Egginton,1 Jennifer L Ridgeway,1 Laura Odell,4 Carl R May,5 Victor M Montori1,61Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; 2College of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 3Medication Therapy Management Program, Fairview Pharmacy Services LLC, Minneapolis, MN, USA; 4Pharmacy Services, Mayo Clinic, Rochester, MN, USA; 5Faculty of Health Sciences, University of Southampton, Southampton, UK; 6Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USABackground: Burden of treatment refers to the workload of health care as well as its impact on patient functioning and well-being. We set out to build a conceptual framework of issues descriptive of burden of treatment from the perspective of the complex patient, as a first step in the development of a new patient-reported measure.Methods: We conducted semistructured interviews with patients seeking medication therapy management services at a large, academic medical center. All patients had a complex regimen of self-care (including polypharmacy, and were coping with one or more chronic health conditions. We used framework analysis to identify and code themes and subthemes. A conceptual framework of burden of treatment was outlined from emergent themes and subthemes.Results: Thirty-two patients (20 female, 12 male, age 26–85 years were interviewed. Three broad themes of burden of treatment emerged including: the work patients must do to care for their health; problem-focused strategies and tools to facilitate the work of self-care; and factors that exacerbate the burden felt. The latter theme encompasses six subthemes including challenges with taking medication, emotional problems with others, role and activity limitations, financial challenges, confusion about medical information, and health care delivery obstacles

  2. Concentration- and age-dependent effects of chronic caffeine on contextual fear conditioning in C57BL/6J mice.

    Science.gov (United States)

    Poole, Rachel L; Braak, David; Gould, Thomas J

    2016-02-01

    Chronic caffeine exerts negligible effects on learning and memory in normal adults, but it is unknown whether this is also true for children and adolescents. The hippocampus, a brain region important for learning and memory, undergoes extensive structural and functional modifications during pre-adolescence and adolescence. As a result, chronic caffeine may have differential effects on hippocampus-dependent learning in pre-adolescents and adolescents compared with adults. Here, we characterized the effects of chronic caffeine and withdrawal from chronic caffeine on hippocampus-dependent (contextual) and hippocampus-independent (cued) fear conditioning in pre-adolescent, adolescent, and adult mice. The results indicate that chronic exposure to caffeine during pre-adolescence and adolescence enhances or impairs contextual conditioning depending on concentration, yet has no effect on cued conditioning. In contrast, withdrawal from chronic caffeine impairs contextual conditioning in pre-adolescent mice only. No changes in learning were seen for adult mice for either the chronic caffeine or withdrawal conditions. These findings support the hypothesis that chronic exposure to caffeine during pre-adolescence and adolescence can alter learning and memory and as changes were only seen in hippocampus-dependent learning, which suggests that the developing hippocampus may be sensitive to the effects of caffeine.

  3. Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials

    OpenAIRE

    Ling Jun Kong; Romy Lauche; Petra Klose; Jiang Hui Bu; Xiao Cun Yang; Chao Qing Guo; Gustav Dobos; Ying Wu Cheng

    2016-01-01

    Several studies reported that Tai Chi showed potential effects for chronic pain, but its role remains controversial. This review assessed the evidence regarding the effects of Tai Chi for chronic pain conditions. 18 randomized controlled trials were included in our review. The aggregated results have indicated that Tai Chi showed positive evidence on immediate relief of chronic pain from osteoarthritis (standardized mean difference [SMD], −0.54; 95% confidence intervals [CI], −0.77 to −0.30; ...

  4. Using a Clinical Knowledge Base to Assess Comorbidity Interrelatedness Among Patients with Multiple Chronic Conditions

    Science.gov (United States)

    Zulman, Donna M.; Martins, Susana B.; Liu, Yan; Tu, Samson W.; Hoffman, Brian B.; Asch, Steven M.; Goldstein, Mary K.

    2015-01-01

    Decision support tools increasingly integrate clinical knowledge such as medication indications and contraindications with electronic health record (EHR) data to support clinical care and patient safety. The availability of this encoded information and patient data provides an opportunity to develop measures of clinical decision complexity that may be of value for quality improvement and research efforts. We investigated the feasibility of using encoded clinical knowledge and EHR data to develop a measure of comorbidity interrelatedness (the degree to which patients’ co-occurring conditions interact to generate clinical complexity). Using a common clinical scenario—decisions about blood pressure medications in patients with hypertension—we quantified comorbidity interrelatedness by calculating the number of indications and contraindications to blood pressure medications that are generated by patients’ comorbidities (e.g., diabetes, gout, depression). We examined properties of comorbidity interrelatedness using data from a decision support system for hypertension in the Veterans Affairs Health Care System. PMID:26958279

  5. Chronic inflammatory demyelinating polyradiculoneuropathy: diagnostic and therapeutic challenges for a treatable condition.

    Science.gov (United States)

    Vallat, Jean-Michel; Sommer, Claudia; Magy, Laurent

    2010-04-01

    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic neuropathy of supposed immune origin. Understanding of its pathophysiology has recently improved, although its causes remain unclear. The classic presentation of CIDP includes sensory and motor symptoms in the distal and proximal segments of the four limbs with areflexia, evolving over more than 8 weeks. Raised protein concentrations in CSF and heterogeneous slowing of nerve conduction are typical of the condition. In addition to this usual phenotype, distribution of symptoms, disease course, and disability can be heterogeneous, leading to underdiagnosis of the disorder. Diagnosis is sometimes challenging and can require use of imaging and nerve biopsy. Steroids and intravenous immunoglobulin are effective, and plasma exchange can be helpful as rescue therapy. The usefulness of immunosuppressants needs to be established. The identification of specific diagnostic markers and new therapeutic strategies with conventional or targeted immunotherapy are needed to improve the outlook for patients with CIDP.

  6. Comparative assessment of the effectiveness of modern neuroprotectors in conditions of experimental chronic cerebral ischemia

    Directory of Open Access Journals (Sweden)

    A. V. Demchenko

    2015-04-01

    Full Text Available Modern pharmacological influence on the pathological changes in cerebral ischemia is actual task of the modern neurology. Aim. To make a comparative assessment of the effectiveness of modern neuroprotectors in conditions of experimental chronic cerebral ischemia. Methods and results. Experimental study of the neuroprotective effects of the citicoline, cortexin and tiocetam on the cognitive functions on the model of the chronic cerebral ischemia was conducted on 75 white rats. Biochemical, immunoassay, pharmacological, statistical methods were used. Conclusion. Obtained results showed citicoline, cortexin and tiocetam ability to positively influence on the molecular-biochemical changes in the brain cortex with ischemia. This resulted in the glutathione-dependent enzymes activity increase, recover of the thiol-disulfide system balance, nitrotyrosine concentration decrease, improvement of the cognitive function in the experimental animals.

  7. A Research of Stress over Medical Employees which is Caused by Job Conditions in Sivas

    Directory of Open Access Journals (Sweden)

    Cüneyt Tokmak

    2011-03-01

    Full Text Available Stress that almost everybody can experience in their lifetime is a state of discomfort which is caused by several components and which can influence the quality of life in a negative way. Especially the complications in the job conditions that are faced by the employees can be sources of stress. In this study, it is aimed to reveal whether the job conditions cause stress over health employees or not. It is also aimed to discover whether the effect of job conditions on employees alter depending on diverse criteria (gender, age, organization, income level, marital status. In this study, field survey method is used and a questionnaire is applied over a total of 456 people who work for private and public medical establishments in Sivas. As a result, it is revealed that job conditions cause a medium level stress and employees working for private medical establishments face less stress in comparison to the employees working for public establishments.

  8. Report of chronic myeloid leukemia from Indira Gandhi Institute of Medical Sciences, Regional Cancer Center, 2002-2009.

    Science.gov (United States)

    Prasad, Rajiv Ranjan; Singh, Pritanjali

    2013-07-01

    Indira Gandhi Institute of Medical Sciences, Regional Cancer Center was established in 1993. It's one of the main Health-Care Institution in the state of Bihar. The data of 205 patients was presented in the ICON meeting and 98% of patients were diagnosed in chronic phase. Complete hematological response was seen in 91% of patients in 3 months. A total of 197 (96%) patients were alive at the time of analysis of which 179 (87%) were still in chronic phase with hematological remission.

  9. Air conditioning a vaccine laboratory. [Connaught Medical Research Laboratory, Toronto, Canada

    Energy Technology Data Exchange (ETDEWEB)

    Ross J.

    1976-05-01

    In 1974, the new Bacterial Vaccine Building of Connaught Medical Research Laboratories, Toronto, Canada, was opened to produce such vaccines as pertussis, typhoid, paratyphoids, and cholera and such toxoids as staphylococcus, diphtheria, and tetanus. It also produces other medicinal products. The layout of the complex and the air conditioning system necessary in all zones are described and schematically shown. (MCW)

  10. Academic and Family Conditions Associated with Intrinsic Academic Motivation in Japanese Medical Students: A Pilot Study

    Science.gov (United States)

    Tanaka, Masaaki; Watanabea, Yasuyoshi

    2012-01-01

    Objective: Intrinsic academic motivation is one of the most important psychological concepts in education, and it is related to academic outcomes in medical students. This study examined the relationships between academic and family conditions and intrinsic academic motivation. Design: Cross-sectional design. Setting: The study group consisted of…

  11. Epidemiology of Autism Spectrum Disorder in Portugal: Prevalence, Clinical Characterization, and Medical Conditions

    Science.gov (United States)

    Oliveira, Guiomar; Ataide, Assuncao; Marques, Carla; Miguel, Teresa S.; Coutinho, Ana Margarida; Mota-Vieira, Luisa; Goncalves, Esmeralda; Lopes, Nazare Mendes; Rodrigues, Vitor; Carmona da Mota, Henrique; Vicente, Astrid Moura

    2007-01-01

    The objective of this study was to estimate the prevalence of autistic spectrum disorder (ASD) and identify its clinical characterization, and medical conditions in a paediatric population in Portugal. A school survey was conducted in elementary schools, targeting 332 808 school-aged children in the mainland and 10 910 in the Azores islands.…

  12. Chronic Health Conditions as a Risk Factor for Falls among the Community-Dwelling US Older Adults: A Zero-Inflated Regression Modeling Approach

    Directory of Open Access Journals (Sweden)

    Yoshita Paliwal

    2017-01-01

    Full Text Available Falls are an important health concern among older adults due to age-related changes in the body. Having a medical history of chronic health condition may pose even higher risk of falling. Only few studies have assessed a number of chronic health conditions as risk factor for falls over a large nationally representative sample of US older adults. In this study, Behavioral Risk Factor Surveillance System (BRFSS 2014 participants aged 65 years and older (n = 159,336 were evaluated. It was found that 29.7% (n=44,550 of the sample experienced at least one fall and 16.3% (n=20,444 experienced more than one fall in the past 12 months. According to the study findings, having a medical history of stroke, CKD, arthritis, depression, and diabetes independently predict the risk of first-time falling as well as the risk of recurrent falling in older adult population while controlling for other factors. On the other hand, having a medical history of the heart attack, angina, asthma, and COPD did not predict the risk of first-time falling, but did predict the risk of recurrent falling after experiencing the first fall in this population.

  13. Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication.

    Science.gov (United States)

    Nikulina, Valentina; Guarino, Honoria; Acosta, Michelle C; Marsch, Lisa A; Syckes, Cassandra; Moore, Sarah K; Portenoy, Russell K; Cruciani, Ricardo A; Turk, Dennis C; Rosenblum, Andrew

    2016-08-01

    During long-term opioid therapy for chronic noncancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report, and biofluid screening. This study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive-behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated patients with chronic pain who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely nonsignificant. In conclusion, concordance between patient and provider reports of AMTB among patients with chronic pain prescribed opioid medication varied by provider level of training.

  14. Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish healthcare system

    Science.gov (United States)

    Angulo-Pueyo, Ester; Ridao-López, Manuel; Martínez-Lizaga, Natalia; García-Armesto, Sandra; Peiró, Salvador; Bernal-Delgado, Enrique

    2017-01-01

    Objectives Potentially avoidable hospitalisations have been used as a proxy for primary care quality. We aimed to analyse the ecological association between contextual and systemic factors featured in the Spanish healthcare system and the variation in potentially avoidable hospitalisations for a number of chronic conditions. Methods A cross-section ecological study based on the linkage of administrative data sources from virtually all healthcare areas (n=202) and autonomous communities (n=16) composing the Spanish National Health System was performed. Potentially avoidable hospitalisations in chronic conditions were defined using the Spanish validation of the Agency for Health Research and Quality (AHRQ) preventable quality indicators. Using 2012 data, the ecological association between potentially avoidable hospitalisations and factors featuring healthcare areas and autonomous communities was tested using multilevel negative binomial regression. Results In 2012, 151 468 admissions were flagged as potentially avoidable in Spain. After adjusting for differences in age, sex and burden of disease, the only variable associated with the outcome was hospitalisation intensity for any cause in previous years (incidence risk ratio 1.19 (95% CI 1.13 to 1.26)). The autonomous community of residence explained a negligible part of the residual unexplained variation (variance 0.01 (SE 0.008)). Primary care supply and activity did not show any association. Conclusions The findings suggest that the variation in potentially avoidable hospitalisations in chronic conditions at the healthcare area level is a reflection of how intensively hospitals are used in a healthcare area for any cause, rather than of primary care characteristics. Whether other non-studied features at the healthcare area level or primary care level could explain the observed variation remains uncertain. PMID:28237952

  15. The importance of assessing for abuse and neglect in children with chronic health conditions referred for neuropsychological evaluation.

    Science.gov (United States)

    Olson, Katie; Jacobson, Kristin K

    2014-01-01

    Chronic childhood illnesses have been demonstrated to negatively impact family functioning by introducing new or additive stress on all members of the family system, as well as by increasing financial burden and social isolation. Although these factors have not necessarily been shown to have a direct causal effect on increased rates of abuse in children with chronic illnesses, these children have nonetheless been demonstrated to be at greater risk for neglect and physical and sexual abuse. Children with chronic health care needs are increasingly likely to be referred for neuropsychological evaluation. Thorough assessment of maltreatment would be a valuable addition to all neuropsychological evaluations of children presenting with chronic health conditions.

  16. Secondary prevention of chronic health conditions in patients with multimorbidity: what can physiotherapists do?

    Directory of Open Access Journals (Sweden)

    Sarah Dennis

    2016-04-01

    Full Text Available Multimorbidity is the co-occurrence of two or more diseases in an individual without a defining index disease [1,2]. In developed countries, the prevalence of multimorbidity has been estimated from both general practice and population data [3,4]. Data from general practices in Scotland found that 23% of patients had multimorbidity [3], whereas the prevalence of multimorbidity in Québec, Canada, was 46–51% in the general practice population and 10–13% in the general population aged over 24 years [4]. Australian data indicate that almost 40% of people aged over 44 years have multimorbidity, and this proportion increases to around 50% of those aged 65–74 years and to 70% of those aged 85 and over [5]. Data from a study of Australian general practice activity reported prevalence estimates for the most common combinations of chronic conditions [6]. Of the 12 most common combinations, the majority included conditions that can be positively impacted by physiotherapy interventions, such as low back pain [7], arthritis [8], chronic obstructive pulmonary disease [9], cardiac disease [10] and type 2 diabetes [11]. However, for some of these conditions, the uptake and access to physiotherapy interventions was suboptimal, especially in the primary care setting, due to poor referral from general practitioners (GPs [12,13] and/or restricted access to physiotherapy associated with workforce shortages, as well as high cost to the patient for private consultation. Journal of Comorbidity 2016;6(2:50–52

  17. Unique genetic loci identified for emotional behavior in control and chronic stress conditions.

    Directory of Open Access Journals (Sweden)

    Kimberly AK Carhuatanta

    2014-10-01

    Full Text Available An individual’s genetic background affects their emotional behavior and response to stress. Although studies have been conducted to identify genetic predictors for emotional behavior or stress response, it remains unknown how prior stress history alters the interaction between an individual’s genome and their emotional behavior. Therefore, the purpose of this study is to identify chromosomal regions that affect emotional behavior and are sensitive to stress exposure. We utilized the BXD behavioral genetics mouse model to identify chromosomal regions that predict fear learning and emotional behavior following exposure to a control or chronic stress environment. 62 BXD recombinant inbred strains and C57BL/6 and DBA/2 parental strains underwent behavioral testing including a classical fear conditioning paradigm and the elevated plus maze. Distinct quantitative trait loci (QTLs were identified for emotional learning, anxiety and locomotion in control and chronic stress populations. Candidate genes, including those with already known functions in learning and stress were found to reside within the identified QTLs. Our data suggest that chronic stress history reveals novel genetic predictors of emotional behavior.

  18. Twenty-five additional cases of trisomy 9 mosaic: Birth information, medical conditions, and developmental status.

    Science.gov (United States)

    Bruns, Deborah A; Campbell, Emily

    2015-05-01

    Limited literature exists on children and adults diagnosed with the mosaic form of trisomy 9. Data from the Tracking Rare Incidence Syndromes (TRIS) project has provided physical characteristics and medical conditions for 14 individuals. This article provides TRIS Survey results of 25 additional cases at two data points (birth and survey completion) as well as developmental status. Results confirmed a number of phenotypic features and medical conditions. In addition, a number of cardiac anomalies were reported along with feeding and respiratory difficulties in the immediate postnatal period. In addition, developmental status data indicated a range in functioning level up to skills in the 36 and 48-month range. Strengths were also noted across the sample in language and communication, fine motor and social-emotional development. Implications for professionals caring for children with this genetic condition are offered.

  19. Processes of Metastudy: A Study of Psychosocial Adaptation to Childhood Chronic Health Conditions

    Directory of Open Access Journals (Sweden)

    David B. Nichola

    2006-03-01

    Full Text Available Metastudy introduces a systematically aggregated interpretive portrayal of a body of literature, based on saturation and the synthesis of findings. In this metastudy, the authors examined qualitative studies addressing psychosocial adaptation to childhood chronic health conditions, published over a 30-year period (1970–2000. They describe metastudy processes, including study identification, strategies for study search and retrieval, adjudication of difference in study design and rigor, and analysis of findings. They also illustrate metastudy components through examples drawn from this project and discuss implications for practice and recommendations.

  20. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

    DEFF Research Database (Denmark)

    Melloni, Chiara; Cornel, Jan H; Hafley, Gail

    2016-01-01

    AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS...... disease vs. normal/mild chronic kidney disease were estimated. Platelet reactivity at 30 days was assessed in a subset of patients (n = 1947). The majority of patients were in the normal/mild chronic kidney disease group (67%), followed by moderate chronic kidney disease (29%) and severe chronic kidney.......26; 95% confidence interval 1.09-1.46; severe vs. normal/mild: hazard ratio 1.60; 95% confidence interval 1.25-2.04). Platelet reactivity was lower in patients treated with prasugrel compared with clopidogrel, across all three chronic kidney disease stages. CONCLUSIONS: Among medically managed acute...

  1. Screening for pre-malignant conditions in the oral cavity of chronic tobacco chewers

    Directory of Open Access Journals (Sweden)

    Priyanka Mahawar, Shweta Anand, Umesh Sinha, Madhav Bansal, Sanjay Dixit

    2011-01-01

    Full Text Available Oral cancer is a major health problem in tobacco users all over the world. It is one of the ten most common cancers in the world. Oral cancer is almost always preceded by some type of precancerous lesion. The precancerous lesions can be detected upto 15years, prior to their change to an invasive carcinoma. It usually affects between the ages of 15 and 40 years. It may be triggered by factors like frequency and duration of tobacco consumption, alcohol, poor oral hygiene etc. This study was conducted primarily to screen chronic tobacco chewers for the presence of oral pre-malignant conditions and secondly to educate them about the hazards of tobacco and motivate them to quit the habit. This was a cross sectional study conducted at Badi gawaltoli area of Indore. Tobacco chewers using tobacco for more than 5yrs were included in the study. Chronic tobacco chewers were screened for oral pre-malignant lesions followed by an educational intervention about the harmful effects of tobacco. Two follow ups were made to motivate them to quit the habit and to get treatment for their lesions. An open ended semi-structured questionnaire was administered to chronic tobacco chewers to assess their habit of tobacco chewing, smoking, their knowledge regarding lesions in their mouth, hazards of tobacco and any cessation efforts. Among the 80 identified chronic tobacco chewers, 60 were males and 20 were females. Lesions such as leukoplakia, erythroplakia and oral sub-mucosal fibrosis were found in 10 females (50% and 24 males (40%.

  2. 慢性胰腺炎的内科治疗%Medical treatment of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    赖雅敏; 钱家鸣

    2011-01-01

    慢性胰腺炎(chronic pancreatitis,CP)是由于胰腺炎症导致胰腺组织不可逆的毁损,最终将导致胰腺内、外分泌功能的部分或全部丧失.CP治疗目标是减轻疼痛,改善胰腺脂肪泻及营养不良,治疗糖尿病等并发症,保持或改善病人生活质量等.缓解疼痛是最常见的临床问题,补充胰酶和适当使用镇痛药物是常用治疗方法.胰酶制剂能显著改善脂肪泻,而其使用剂量和使用方法非常重要.近年来内镜治疗的进步令人鼓舞,方法包括胰腺括约肌切开术,支架置入术和体外震波碎石术等.内镜技术的进步为CP病人提供了新的治疗希望,但长期疗效仍有待随访.此外,在生活方式上,戒烟酒对CP病人很可能有益,而低脂饮食因为可能导致脂溶性维生素的缺乏而不被推荐.%Chronic pancreatitis (CP) is an ongoing inflamatory disorder characterized by irreversible destruction of the pancreas associated with disabling chronic pain and permanent loss of exocrine and endocrine function. The treatment of patients with CP revolves around control of pain, diabetes and steatorrhea. Pain relief is the most common and most difficult problem. The initial approach should consist of non-opioid analgesics and supplementation with pancreatic enzymes containing high amounts of proteases. Enzymes significantly reduce fat excretion and stool frequency and improve fat absorption. Dosing and timing are important. Although the medical treatment of CP is frustrating in most cases and the role of pancreatic enzyme replacement therapy and anti-oxidants is uncertain,the benefit of pancreatic endotherapy for CP is encouraging. The modalities includepancreatic sphincterotomy, stenting and ESWL to break large calculi. With growing expertise in endoscopic techniques, refinements in equipment and promising results from uncontrolled studies, patients should be offered opportunities of endoscopic therapy before subjecting them to surgical treatment

  3. Chronic hepatitis C: Treat or wait? Medical decision making in clinical practice

    Institute of Scientific and Technical Information of China (English)

    Claus Niederau; Dietrich Hüppe; Elmar Zehnter; Bernd M(o)ller; Renate Heyne; Stefan Christensen; Rainer Pfaff

    2012-01-01

    AIM:To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not.METHODS:This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α2a/ribavirin,involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings).A structured questionnaire had to be answered prior to the treatment decision,which included demographic data,information about the personal life situation of the patients,anamnesis and symptomatology of hepatitis C,virological data,laboratory data and data on concomitant diseases.A second part of the study analyzes patients treated with pegylated interferon α2a.All questionnaires included reasons against treatment mentioned by the physician.RESULTS:Overall treatment uptake was 45%.By multivariate analysis,genotype 1/4/5/6,HCV-RNA ≤ 520 000 IU/mL,normal alanine aminotransferase (ALT),platelets ≤ 142 500/μL,age > 56 years,female gender,infection length > 12.5 years,concomitant diseases,human immunodeficiency virus co-infection,liver biopsy not performed,care in private practice,asymptomatic disease,and unemployment were factors associated with reduced treatment rate.Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems.Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.CONCLUSION:Some reasons against treatment were medically based whereas others were related to fears,socio-economical problems,and information deficits both on the side of physicians and patients.

  4. The association between optimal lifestyle adherence and short-term incidence of chronic conditions among employees.

    Science.gov (United States)

    Pronk, Nicolaas P; Lowry, Marcia; Kottke, Thomas E; Austin, Erin; Gallagher, Jason; Katz, Abigail

    2010-12-01

    "Optimal lifestyle," comprising abstinence from smoking, adequate physical activity, eating 5 servings of fruits and vegetables each day, and consuming limited or no alcohol, is associated with low risk of chronic disease when unselected populations are observed for long periods of time. It is unclear whether these same associations are present when observation is limited to employed individuals followed for a brief period of time. The purpose of this investigation was to study the association between adherence to optimal lifestyle and the incidence of chronic conditions among employees over a 2-year period. Logistic regression was used to assess the association between employees' (N  = 6848) adherence to optimal lifestyle and the incidence of diabetes, heart disease, cancer, hypertension, high cholesterol, and back pain during a 2-year period. All data were self-reported. Adherence to any 3 components of the optimal lifestyle was associated with a significantly lower near-term incidence of diabetes (odds ratio [OR] =  0.56; 95% confidence interval [CI] = 0.31-0.97) and back pain (OR = 0.69; 95% CI = 0.53-0.92). Adherence to all 4 optimal lifestyle components was significantly associated with lower near-term incidence of back pain (OR = 0.44; 95% CI = 0.26-0.76). Physical activity was associated with significantly lower near-term incidence risk of heart disease (OR = 0.60; 95% CI = 0.38-0.95), high cholesterol (OR = 0.80; 95% CI = 0.66-0.99), and diabetes (OR = 0.51; 95% CI = 0.30-0.86). Adherence to optimal lifestyle, in particular adequate physical activity, is associated with lower near-term risk of developing several chronic conditions. Employers and payers should consider this fact when formulating policy or allocating resources for health care and health promotion.

  5. Assessing behavioural effects of chronic HPA axis activation using conditional CRH-overexpressing mice.

    Science.gov (United States)

    Dedic, Nina; Touma, Chadi; Romanowski, Cristoph P; Schieven, Marcel; Kühne, Claudia; Ableitner, Martin; Lu, Ailing; Holsboer, Florian; Wurst, Wolfgang; Kimura, Mayumi; Deussing, Jan M

    2012-07-01

    The corticotropin-releasing hormone (CRH) and its cognate receptors have been implicated in the pathophysiology of stress-related disorders. Hypersecretion of central CRH and elevated glucocorticoid levels, as a consequence of impaired feedback control, have been shown to accompany mood and anxiety disorders. However, a clear discrimination of direct effects of centrally hypersecreted CRH from those resulting from HPA axis activation has been difficult. Applying a conditional strategy, we have generated two conditional CRH-overexpressing mouse lines: CRH-COE ( Del ) mice overexpress CRH throughout the body, while CRH-COE ( APit ) mice selectively overexpress CRH in the anterior and intermediate lobe of the pituitary. Both mouse lines show increased basal plasma corticosterone levels and consequently develop signs of Cushing's syndrome. However, while mice ubiquitously overexpressing CRH exhibited increased anxiety-related behaviour, overexpression of CRH in the pituitary did not produce alterations in emotional behaviour. These results suggest that chronic hypercorticosteroidism alone is not sufficient to alter anxiety-related behaviour but rather that central CRH hyperdrive on its own or in combination with elevated glucocorticoids is responsible for the increase in anxiety-related behaviour. In conclusion, the generated mouse lines represent valuable animal models to study the consequences of chronic CRH overproduction and HPA axis activation.

  6. Uterine metabolism of the pregnant rabbit under chronic steady-state conditions

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, R.L.; Gilbert, M.; Block, S.M.; Battaglia, F.C.

    1986-05-01

    The study of uterine metabolism in pregnancy under chronic steady-state conditions has been confined to large mammals and, more recently, to the guinea pig. The pregnant rabbit is of interest because of its short gestation and large litter size. We developed an indirect approach involving retrograde catheterization of the uterine venous drainage, permitting measurement of both uterine metabolic quotients and uterine uptakes. Radioactive microspheres were used to measure blood flow. A large lactate and ammonia efflux from the uterus was found. In the fed state, ketogenic substrates were taken up in small amounts. However, during starvation a significant increase in ketoacid uptake was observed with a concurrent fall in acetate uptake. There was a large glucose/oxygen quotient across the uterus, but the glucose plus lactate/oxygen quotient was comparable to that found in the sheep and guinea pig (0.6 +/- 0.1). It is apparent that in all three species studied under chronic steady-state conditions (sheep, guinea pig, and rabbit) there is a large glucose uptake associated with a net lactate production, and fuels other than glucose and lactate must be used by the uterus.

  7. A background to acupuncture and its use in chronic painful musculoskeletal conditions.

    Science.gov (United States)

    White, Peter

    2006-09-01

    This article gives a brief description of the origins of acupuncture and describes some of the underlying philosophy behind this treatment and attempts to place it in context of the traditional Chinese medicine genre within which acupuncture is set. The article then explains the difference between traditional and Western style acupuncture and explains how point selection is made. The use of acupuncture is steadily increasing for a variety of reasons, it is a very safe intervention particularly when compared to conventional treatment and its lack of serious side effects might in part account for some of its popularity. The science behind acupuncture is also explored in terms of its underlying mechanisms and includes pain gate, endogenous opioids, diffuse noxious inhibitory control, serotonin and bioelectricity as possible explanations. The efficacy of acupuncture for a range of chronic musculoskeletal conditions is then explored and it is concluded that acupuncture has a place in the treatment of chronic musculoskeletal pain and in particular osteo-arthritis (OA). Where degenerative conditions are involved, acupuncture clearly cannot provide a 'cure' but can provide symptomatic relief, often over a prolonged period.

  8. Working with Students in the Medication Era: Do We All Have to Know How to Diagnose and Treat Mental Conditions?

    Science.gov (United States)

    Alishio, Kip

    2005-01-01

    A marked increase in the number of college students on medications for depression, attention deficit disorder, and other conditions may have intimidated counselors and educators into believing that they all need to be medical experts. The widespread practice of medicalizing behavior and experience contrasts dramatically with the approach in which…

  9. Extrahepatic manifestations of chronic hepatitis C virus infection:297 cases from a tertiary medical center in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    Cheng Zhaojing; Zhou Baotong; Shi Xiaochun; Zhang Yao; Zhang Lifan; Chen Limeng; Liu Xiaoqing

    2014-01-01

    Background Chronic hepatitis C virus (HCV) infection can affect multiple organ systems and cause a variety of extrahepatic manifestations (EMs).We sought to assess the constituent ratio of EMs in Chinese patients with chronic HCV infection and identify the clinical and biological factors associated with EM.Methods The medical records of 297 patients with chronic HCV infection were analyzed and demographic and epidemiological information was collected.The diagnosis of chronic HCV infection was based on positive anti-HCV combined with a positive HCV-RNA or at least two times of elevated aminotransferases attributable to HCV infection.Patients with HBV and/or HIV coinfection,autoimmune hepatitis,and history of alcohol abuse were excluded.Results Sixty-two percent (184/297) of the patients had at least one EM,including fatigue (29.4%),type 2 diabetes mellitus (28.2%),renal involvement (12.5%),lymphadenopathy (9.6%),fever (9.4%),thyroid dysfunction (8.1%),and arthralgia (7.4%).Neuropathy,sicca syndrome,B-cell lymphoma,Raynaud's phenomenon,and lichen planus were rare.The mean age of patients with EM was older compared with those without EM.Conclusions EMs were common in Chinese patients with chronic HCV infection,particularly fatigue,type 2 diabetes,renal impairment,lymphadenophy,fever,and thyroid dysfunction.Older age was associated with EMs.

  10. Can Chronic Pain Patients Be Adequately Treated Using Generic Pain Medications to the Exclusion of Brand-Name Ones?

    Science.gov (United States)

    Candido, Kenneth D; Chiweshe, Joseph; Anantamongkol, Utchariya; Knezevic, Nebojsa Nick

    2016-01-01

    According to the Food and Drug Administration (FDA) reports, approximately 8 in 10 prescriptions filled in the United States are for generic medications, with an expectation that this number will increase over the next few years. The impetus for this emphasis on generics is the cost disparity between them and brand-name products. The use of FDA-approved generic drugs saved 158 billion dollars in 2010 alone. In the current health care climate, there is continually increasing pressure for prescribers to write for generic alternative medications, occasionally at the expense of best clinical practices. This creates a conflict wherein both physicians and patients may find brand-name medications clinically superior but nevertheless choose generic ones. The issue of generic versus brand medications is a key component of the discussion of health payers, physicians and their patients. This review evaluates some of the important medications in the armamentarium of pain physicians that are frequently used in the management of chronic pain, and that are currently at the forefront of this issue, including Opana (oxymorphone; Endo Pharmaceuticals, Inc., Malvern, PA), Gralise (gabapentin; Depomed, Newark, CA), and Horizant (gabapentin enacarbil; XenoPort, Santa Clara, CA) that are each available in generic forms as well. We also discuss the use of Lyrica (pregabalin; Pfizer, New York, NY), which is currently unavailable as generic medication, and Cymbalta (duloxetine; Eli Lilly, Indianapolis, IN), which has been recently FDA approved to be available in a generic form. It is clear that the use of generic medications results in large financial savings for the cost of prescriptions on a national scale. However, cost-analysis is only part of the equation when treating chronic pain patients and undervalues the relationships of enhanced compliance due to single-daily dosing and stable and reliable pharmacokinetics associated with extended-duration preparations using either retentive

  11. New strategies in the assessment of psychological factors affecting medical conditions.

    Science.gov (United States)

    Sirri, Laura; Fabbri, Stefania; Fava, Giovanni A; Sonino, Nicoletta

    2007-12-01

    In this article, we examine research that may lead to a better assessment of psychological factors affecting medical conditions. We performed a review of the psychosomatic literature using both Medline and manual searches. We selected papers that were judged to be relevant to new strategies of assessment, with particular reference to the use of the Diagnostic Criteria for Psychosomatic Research. We assessed 8 areas concerned with the assessment of psychological factors in the setting of medical disease: hypochondriasis, disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, irritable mood, and Type A behavior. A new subclassification of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-V]; not yet published) category of psychological factors affecting physical conditions appears to be feasible and may provide the clinician with better tools for identifying psychological distress.

  12. Chronic pelvic pain syndrome: reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand.

    Science.gov (United States)

    Anderson, Rodney U; Harvey, Richard H; Wise, David; Nevin Smith, J; Nathanson, Brian H; Sawyer, Tim

    2015-03-01

    This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

  13. ENDOSCOPIC AND HISTOPATHOLOGIC CHANGES IN CHILDREN WITH CHRONIC DYSPEPSIA IN A RURAL MEDICAL COLLEGE HOSPITAL IN MELMARUVATHUR- TAMILNADU

    Directory of Open Access Journals (Sweden)

    Padma K

    2016-09-01

    Full Text Available INTRODUCTION Chronic pain abdomen and dyspepsia is the most common presenting symptoms in the Paediatric Outpatient Department (OPD after respiratory illnesses. It is increasing alarmingly both in the paediatric and adult population. We, therefore carried out a cross-sectional study among children with chronic dyspepsia aged between 5 to 15 years attending Paediatric OPD in a rural medical college hospital, Melmaruvathur, Tamilnadu, South India. OBJECTIVE To evaluate the gastroduodenal morbidity in children presenting to the paediatric department of a rural medical college hospital with chronic dyspeptic symptoms. METHODS Forty six children between the age group of 5 to 15 years with chronic dyspeptic symptoms of at least one month duration were evaluated for their symptom profile, epidemiological profile, nutritional status, endoscopic appearance and histopathological changes. Data analysis was done using SPSS version 18. RESULTS Of the 46 children studied, 43% were between the age group of 5-10 years and 70% were female children. Pain abdomen lasting for more than at least one month was the most common finding (93% observed. Other common symptoms in the order of decreasing frequency were early satiety (87%, poor appetite (76%, nausea (57% and not thriving (57%. History of loss of appetite was significantly associated with chronic dyspepsia with an odds ratio of 68.9394 and 95% confidence interval 26.62 to 178.54, p value of <0.0001. Most of the children belonged to lower income group predominantly of a rural background. 33 (72% children had under nutrition as per IAP classification. 10 (30% Grade I, 15 (45% Grade II and eight (24% had Grade III malnutrition. 26 children (57% had abnormal endoscopic findings. Antral mucosal biopsy done showed chronic lymphocytic gastritis in 44 (96% cases. 38 of these 44 (86% were H. pylori positive. H. pylori positivity in chronic dyspepsia was highly statistically significant with a p value of 0

  14. Medical costs and lost productivity from health conditions at volatile organic compound-contaminated Superfund sites

    Energy Technology Data Exchange (ETDEWEB)

    Lybarger, J.A.; Spengler, R.F.; Brown, D.R. [Agency for Toxic Substances and Disease Registry, Atlanta, GA (United States). Div. of Health Studies; Lee, R.; Vogt, D.P. [Oak Ridge National Lab., TN (United States)]|[Joint Inst. for Energy and Environment, Oak Ridge, TN (United States); Perhac, R.M. Jr. [Univ. of Tennessee, Knoxville, TN (United States)]|[Joint Inst. for Energy and Environment, Oak Ridge, TN (United States)

    1998-10-01

    This paper estimates the health costs at Superfund sites for conditions associated with volatile organic compounds (VOCs) in drinking water. Health conditions were identified from published literature and registry information as occurring at excess rates in VOC-exposed populations. These health conditions were: (1) some categories of birth defects, (2) urinary tract disorders, (3) diabetes, (4) eczema and skin conditions, (5) anemia, (6) speech and hearing impairments in children under 10 years of age, and (7) stroke. Excess rates were used to estimate the excess number of cases occurring among the total population living within one-half mile of 258 Superfund sites. These sites had evidence of completed human exposure pathways for VOCs in drinking water. For each type of medical condition, an individual`s expected medical costs, long-term care costs, and lost work time due to illness or premature mortality were estimated. Costs were calculated to be approximately $330 million per year, in the absence of any remediation or public health intervention programs. The results indicate the general magnitude of the economic burden associated with a limited number of contaminants at a portion of all Superfund sites, thus suggesting that the burden would be greater than that estimated in this study if all contaminants at all Superfund sites could be taken into account.

  15. Associations between lifetime traumatic events and subsequent chronic physical conditions: a cross-national, cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Kate M Scott

    Full Text Available BACKGROUND: Associations between lifetime traumatic event (LTE exposures and subsequent physical ill-health are well established but it has remained unclear whether these are explained by PTSD or other mental disorders. This study examined this question and investigated whether associations varied by type and number of LTEs, across physical condition outcomes, or across countries. METHODS: Cross-sectional, face-to-face household surveys of adults (18+ were conducted in 14 countries (n = 38, 051. The Composite International Diagnostic Interview assessed lifetime LTEs and DSM-IV mental disorders. Chronic physical conditions were ascertained by self-report of physician's diagnosis and year of diagnosis or onset. Survival analyses estimated associations between the number and type of LTEs with the subsequent onset of 11 physical conditions, with and without adjustment for mental disorders. FINDINGS: A dose-response association was found between increasing number of LTEs and odds of any physical condition onset (OR 1.5 [95% CI: 1.4-1.5] for 1 LTE; 2.1 [2.0-2.3] for 5+ LTEs, independent of all mental disorders. Associations did not vary greatly by type of LTE (except for combat and other war experience, nor across countries. A history of 1 LTE was associated with 7/11 of the physical conditions (ORs 1.3 [1.2-1.5] to 1.7 [1.4-2.0] and a history of 5+ LTEs was associated with 9/11 physical conditions (ORs 1.8 [1.3-2.4] to 3.6 [2.0-6.5], the exceptions being cancer and stroke. CONCLUSIONS: Traumatic events are associated with adverse downstream effects on physical health, independent of PTSD and other mental disorders. Although the associations are modest they have public health implications due to the high prevalence of traumatic events and the range of common physical conditions affected. The effects of traumatic stress are a concern for all medical professionals and researchers, not just mental health specialists.

  16. Enterococcus and Streptococcus spp. associated with chronic and self-medicated urinary tract infections in Vietnam

    Directory of Open Access Journals (Sweden)

    Poulsen Louise

    2012-11-01

    Full Text Available Abstract Background Urinary tract infections (UTI are one of the most common infections among women worldwide. E. coli often causes more than 75% of acute uncomplicated UTI, however, little is known about how recurrent UTIs and indiscriminate use of antimicrobials affect the aetiology of UTIs. This study aimed to establish the aetiology of UTI in a population of recurrent and self-medicated patients referred from pharmacies to a hospital in Hanoi, Vietnam and to describe genotypes and antimicrobial susceptibility of the associated bacterial pathogens. The aetiology of bacterial pathogens associated with UTI (defined as ≥ 104 CFU/ml urine was established by phenotypic and molecular methods. Enterococcus faecalis isolates were typed by Multi Locus Sequence Typing (MLST, Pulsed-Field Gel Electrophoresis (PFGE and antimicrobial susceptibility testing. Methods Urine samples from 276 patients suffering symptoms of urinary tract infection were collected and cultured on Flexicult agar® allowing for detection of the most common urine pathogens. Patients were interviewed about underlying diseases, duration of symptoms, earlier episodes of UTI, number of episodes diagnosed by doctors and treatment in relation to UTI. All tentative E. faecalis and E. faecium isolates were identified to species level by PCR, 16S rRNA and partial sequencing of the groEL gene. E. faecalis isolates were further characterized by Multi Locus Sequence Typing and antimicrobial susceptibility testing. Results Mean age of 49 patients was 48 yrs (range was 11–86 yrs and included 94% women. On average, patients reported to have suffered from UTI for 348 days (range 3 days-10 years, and experienced 2.7 UTIs during the previous year. Cephalosporins were reported the second drug of choice in treatment of UTI at the hospital. E. faecalis (55.1%, E. coli (12.2% and Streptococcus gallolyticus subsp. pasteurianus (8.2% were main bacterial pathogens. MIC testing of E. faecalis showed

  17. The Experience of Older Women Living with Loneliness and Chronic Conditions in Appalachia.

    Science.gov (United States)

    Theeke, Laurie A; Mallow, Jennifer; Gianni, Chelsea; Legg, Kacie; Glass, Christy

    2015-04-01

    This phenomenological qualitative study explored the experience of living with loneliness and multiple chronic conditions for rural older women in Appalachia. The study took place in 2012 in Northern West Virginia. Participants were 14 older women who were chronically ill, community dwelling, and lonely (Score of 40 or higher on the Revised 20-item UCLA Loneliness Scale). Thematic content analysis revealed four categories that contained thirteen themes: (a) negative emotions of loneliness, which included themes of sadness, disconnection, fear, anger, and worry; (b) positive emotions when not lonely, which included themes of joy with others and pride in self; (c) loss of independence and loneliness, which included themes of functional decline contributes to loneliness, burden, and gratitude for help; and (d) ways of managing loneliness, which included remembering holidays and happier moments, staying busy, and getting out. The study contributes new knowledge about the experience of anger, fear, and worry when lonely. These emotions have not extensively been identified as significant to loneliness. Future studies exploring the links between loneliness and anger, fear, worry, and negative physical health outcomes could enhance knowledge of mechanisms by which loneliness contributes to health decline. Additionally, knowing that positive emotions such as joy are described as being linked to less lonely times could inform future work that aims to diminish loneliness and enhance positive emotional states. Finally, understanding that functional impairment is described as contributing to loneliness in this population reinforces the need to assess for and address functional limitations.

  18. An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions

    Science.gov (United States)

    Bourn, Scott; Skoufalos, Alexis; Beck, Eric H.; Castillo, Daniel J.

    2017-01-01

    Abstract Although the health care reform movement has brought about positive changes, lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal—higher quality health care and improved population health outcomes at a lower cost. The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients and their caregivers, diminishing positive health outcomes and driving costs ever higher. Long-entrenched acute care-focused treatment and reimbursement paradigms hamper more effective deployment of existing resources to improve the ongoing care of these patients. New models for care coordination during transitions, longitudinal high-risk care management, and unplanned acute episodic care have been conceived and piloted with promising results. Utilizing existing resources, Mobile Integrated Healthcare is an emerging model focused on closing these care gaps by means of a round-the-clock, technologically sophisticated, physician-led interprofessional team to manage care transitions and chronic care services on-site in patients' homes or workplaces. PMID:27563751

  19. Telemedical systems for home monitoring of patients with chronic conditions in rural environment

    Directory of Open Access Journals (Sweden)

    Marcin Maciejewski

    2014-03-01

    Full Text Available This paper describes the requirements and possible implementations of a telemedical system. The idea of remote patient monitoring is a point of interest for researchers in Poland, and is also in high demand in fields such as diabetology, cardiology, and geriatrics, among others. Aging society, medical care costs and many other factors make remote patient care a promising idea for the future. For each and every condition, a specialized type of sensor must be used to allow specific measurements to be performed. Moreover, a local data storage and communication device must be provided for the sensor to be able to relay data to the station. A smart phone can be used perform such tasks. By implementing such remote diagnostic systems it is possible to collect, process, store and present vital medical data that can be used immediately to perform diagnosis, or later as reference for expert systems. The ‘Borboleta’ and ‘SaguiSaúde’ systems already implemented can serve as a base for system analysis. The systems provide necessary functions and can be used as reference. Many factors contribute to the success of the telemedical system, such as ease of access, scalability, safety, platform independence, and many others. For easier implementation and clarity, the system should be divided into independent layers, which will also make it easier to modify and integrate into other medical systems. Making the system easy to use for patients, medical staff, administrators and data managers makes the task of system design especially challenging. One must decide which information is necessary for each type of user and provide them clearly and in an orderly fashion.

  20. Complexity in caring for an ageing heart failure population: concomitant chronic conditions and age related impairments.

    Science.gov (United States)

    De Geest, Sabina; Steeman, Els; Leventhal, Marcia E; Mahrer-Imhof, Romy; Hengartner-Kopp, Beatrice; Conca, Antoinette; Bernasconi, Arlette T; Petry, Heidi; Brunner-La Rocca, Hanspeter

    2004-12-01

    The complexity of caring for the ageing heart failure (HF) population is further complicated by concomitant chronic conditions (i.e., polypharmacy, depression), age related impairments (i.e., hearing, visual and cognitive impairments, impairments in activities of daily living (ADL/IADL), and other issues (e.g., health illiteracy, lack of social support). This paper provides an overview of these risk factors, outlines how they individually and in interplay endanger favourable outcome by putting patients at risk for poor self-management. Moreover, suggestions are made on how these issues could be addressed and integrated in heart failure management by applying gerontological care principles in caring for the ageing heart failure population.

  1. Gorlin-Goltz syndrome--a medical condition requiring a multidisciplinary approach.

    Science.gov (United States)

    Kiwilsza, Małgorzata; Sporniak-Tutak, Katarzyna

    2012-09-01

    Gorlin-Goltz syndrome is a rare genetic condition showing a variable expressiveness. It is inherited in a dominant autosomal way. The strongest characteristic of the disease includes multiple basal cell carcinomas, jaw cysts, palmar and plantar pits, skeletal abnormalities and other developmental defects. Owing to the fact that the condition tends to be a multisystemic disorder, familiarity of various medical specialists with its manifestations may reduce the time necessary for providing a diagnosis. It will also enable them to apply adequate methods of treatment and secondary prevention. In this study, we present symptoms of the disease, its diagnostic methods and currently used treatments. We searched 2 scientific databases: Medline (EBSCO) and Science Direct, for the years 1996 to 2011. In our search of abstracts, key words included nevoid basal cell carcinoma syndrome and Gorlin-Goltz syndrome. We examined 287 studies from Medline and 80 from Science Direct, all published in English. Finally, we decided to use 60 papers, including clinical cases and literature reviews. Patients with Gorlin-Goltz syndrome need particular multidisciplinary medical care. Knowledge of multiple and difficult to diagnose symptoms of the syndrome among professionals of various medical specialties is crucial. The consequences of the disease pose a threat to the health and life of patients. Therefore, an early diagnosis creates an opportunity for effective prevention and treatment of the disorder. Prevention is better than cure.

  2. The analysis of the medical university students’ health condition and lifestyle

    Directory of Open Access Journals (Sweden)

    OLGA KHURS

    2017-01-01

    Full Text Available Introduction: Significant psychophysiological burdens and unhealthy lifestyle constitute the risk factors leading to students’ health deterioration. Purpose: The purpose of the research was the analysis of students’ health condition and lifestyle in medical university. Material and methods: The objects of the research were 100 third year students of the Faculties of General Medicine and Pediatrics of Grodno State Medical University. For the study of students’ orientation on healthy lifestyle, a special scale-type questionnaire was developed and used. Results: According to the respondents’ opinions it has been detected that the basic factors influencing the state of health are the lifestyle and the living conditions. The students activity is evaluated as very low as well as their rational nutrition. The majority of them smoke and drink alcohol. Conclusions: The peculiarities of studying at a medical university accompanied by imbalanced nutrition might lead to the deterioration of health in the students which are doctors to be. The results ought to lead to the optimization of prophylaxis programs and entire alteration of the students’ lifestyles.

  3. The Importance of General Self-Efficacy for the Quality of Life of Adolescents with Chronic Conditions

    NARCIS (Netherlands)

    J.M. Cramm (Jane); M.M.H. Strating (Mathilde); M.E. Roebroeck (Marij); A.P. Nieboer (Anna)

    2013-01-01

    textabstractWe investigated the influence of general self-efficacy perceived by adolescents with chronic conditions and parents on quality of life. This cross-sectional study used the general self-efficacy scale and DISABKIDS condition-generic module to survey adolescents (92/293; 31 %) with type I

  4. Internet-based cognitive behavioral therapy for patients with chronic somatic conditions: a meta-analytic review

    NARCIS (Netherlands)

    Beugen, S. van; Ferwerda, M.; Hoeve, D.; Rovers, M.M.; Koulil, S. van; Middendorp, H. van; Evers, A.W.M.

    2014-01-01

    BACKGROUND: Patients with chronic somatic conditions face unique challenges accessing mental health care outside of their homes due to symptoms and physical limitations. Internet-based cognitive behavioral therapy (ICBT) has shown to be effective for various psychological conditions. The increasing

  5. Rapid review: sinonasal surgery vs. medical therapy for asthma in patients with chronic rhinosinusitis with or without nasal polyps.

    Science.gov (United States)

    de Bruin, Rick Johan Matthies; Hage, Rene; van der Zaag-Loonen, Hester; van Benthem, Peter Paul Germain

    2016-09-01

    The objective of the study was to compare the effect of sinonasal surgery vs. medical treatment on asthma in patients with chronic rhinosinusitis with or without nasal polyps. We executed a PRISMA guidelines-based systematic search of the following databases: PubMed, CENTRAL, Embase, Scopus and CINAHL. The search ran from database inception until 26 Feb 2014. We included controlled clinical trials comparing surgical intervention with medical intervention in patients with chronic rhinosinusitis with or without nasal polyps. We included only English papers. We used a pre-defined data collection form. Two authors independently assessed study quality. We assessed directness of evidence and risk of bias using pre-defined criteria. Our search yielded 2004 original articles, six of which satisfied our inclusion criteria. One article was excluded from further review because no comparison could be made of the subgroup of operated asthmatic patients versus the non-surgical control group. Only one study used objective pulmonary function measurements in asthmatics undergoing sinonasal surgery and therefore had the highest directness of evidence. Also it had a low risk of bias. Patient characteristics, treatments and outcome measures varied across studies, as did the observed effect. Risk of bias was high in most studies. Patient characteristics, treatment and outcome measurement differed across studies, making a comparison of the effects difficult. There is a risk of publication language bias. There is insufficient evidence either for or against sinonasal surgery for asthma control as compared to medical treatment.

  6. Learning to predict and control harmful events: chronic pain and conditioning.

    Science.gov (United States)

    Vlaeyen, Johan W S

    2015-04-01

    Pain is a biologically relevant signal and response to bodily threat, associated with the urge to restore the integrity of the body. Immediate protective responses include increased arousal, selective attention, escape, and facial expressions, followed by recuperative avoidance and safety-seeking behaviors. To facilitate early and effective protection against future bodily threat or injury, learning takes place rapidly. Learning is the observable change in behavior due to events in the internal and external environmental and includes nonassociative (habituation and sensitization) and associative learning (Pavlovian and operant conditioning). Once acquired, these knowledge representations remain stored in memory and may generalize to perceptually or functionally similar events. Moreover, these processes are not just a consequence of pain; they may directly influence pain perception. In contrast to the rapid acquisition of learned responses, their extinction is slow, fragile, context dependent and only occurs through inhibitory processes. Here, we review features of associative forms of learning in humans that contribute to pain, pain-related distress, and disability and discuss promising future directions. Although conditioning has a long and honorable history, a conditioning perspective still might open new windows on novel treatment modalities that facilitate the well-being of individuals with chronic pain.

  7. Living In A Country With A Strong Primary Care System Is Beneficial To People With Chronic Conditions.

    Science.gov (United States)

    Hansen, Johan; Groenewegen, Peter P; Boerma, Wienke G W; Kringos, Dionne S

    2015-09-01

    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries of the European Union, focusing on people's self-rated health status and whether or not they had severe limitations or untreated conditions. We found that people with chronic conditions were more likely to be in good or very good health in countries that had a stronger primary care structure and better coordination of care. People with more than two chronic conditions benefited most: Their self-rated health was higher if they lived in countries with a stronger primary care structure, better continuity of care, and a more comprehensive package of primary care services. In general, while having access to a strong primary care system mattered for people with chronic conditions, the degree to which it mattered differed across specific subgroups (for example, people with primary care-sensitive conditions) and primary care dimensions. Primary care reforms, therefore, should be person centered, addressing the needs of subgroups of patients while also finding a balance between structure and service delivery.

  8. Psychological Stressors and Burden of Medical Conditions in Older Adults: A Psychosomatic Approach

    Directory of Open Access Journals (Sweden)

    Arash Mani

    2009-12-01

    Full Text Available "n  "n  "nObjective: "nIn geriatric practice, the impact of psychological distress on health status has been undermined due to ageism, atypical presentation and less tendency to report negative affect among elderly people. Few studies have examined the impact of psychological stressors on medical burden in older adults. The current study has investigated the correlation of psychological distress and burden of medical conditions in a sample of older people .     "n  "n  "nMethod: A convenient study sample of 120 elderly subjects was recruited from the places where there was greater chance for the elderly people to attend. Data were collected by a trained research assistant using perceived stress scale, cumulative illness rating scale, geriatric depressive scale and a demographic questionnaire.     "n  "n  "nResults: "nOur participants perceived more level of stress than the average for their age. In the current study, the burden of medical condition was significantly correlated with the level of perceived stress(r = .197, p = .044. Moreover, in regression analysis, perceived stress was the strongest predictor for physical health morbidity (R2 =.049, significant f= .03.     "n  "n  "nConclusions: "nThe result of this study suggested that the psychological stressors contribute to poor health outcome in older adults ; the area that is usually overlooked due to ageism and its physiological related changes. The medical practitioners should consider the psychological distress as a part of etiological factors implicating in health morbidity among their aged patients.

  9. Obsessive-compulsive aspects as predictors of poor response to treatments in patients with chronic migraine and medication overuse.

    Science.gov (United States)

    Curone, M; D'Amico, D; Bussone, G

    2012-05-01

    Patients with chronic migraine (CM) and medication overuse (MO) have a high frequency of psychiatric comorbidity or psychopathological traits, the presence of which may have important implications for the course of the CM and the MO, both for response to treatment and possible relapses. Overuse of symptomatic drugs is regarded as one of the most important risk factor for the transformation of episodic migraine into CM and drug-seeking tendency due to fear of headache in chronic migraine patients shares with obsessive-compulsive disorder (OCD) the compulsive quality of the behavior. Aim of this study was to review the clinical history of a sample of CM patients with MO in which an obsessive-compulsive trait was identified, performing a comparison with a sample of patients without obsessive-compulsive trait. We selected 14 patients with positivity to Spectrum Project OBS (obsessive-compulsive disorder) questionnaire and other 14 patients with negativity to the same tool from among a sample of patients who were enrolled in a previous study on the psychopathological profile of patients suffering from CM with MO. According to data obtained from the clinical records referring to the previous 5 years, patients with OBS questionnaire positivity showed a worse clinical course and a tendency to early relapse in MO after symptomatic medication withdrawal. Our results show that the comorbidity of OCD should be always evaluated in patients with CM and MO as it may play a relevant role--particularly if not treated--among the risk factors favoring the progression of episodic migraine to the chronic form, and/or the tendency to a pathological behavior that prompts the overuse of symptomatic medications.

  10. The Relationship Between Burnout Syndrome Among the Medical Staff and Work Conditions in the Polish Healthcare System.

    Science.gov (United States)

    Głębocka, Alicja

    2016-12-31

    Psychologists emphasize that people employed in social service organizations are vulnerable to chronic stress and burnout syndrome caused by a close and unsatisfied interpersonal relationship. However, emotional exhaustion, depersonalization, and a feeling of diminished personal accomplishment can be attributed to other external factors. One of them is poor living and occupational conditions. According to a report by OECD, the healthcare system in Poland is the worst among the member countries. The aim of the present study was to define the relationship between occupational burnout and the rating of the Polish healthcare system among the medical staff. The study included 224 participants. The Maslach Burnout Inventory and the Dehumanized Behavior and the Głębocka and Rużyczka scale of Behavioral Indicators of Patient's Dehumanization were applied. The evaluations of the healthcare system were also collected. The results demonstrate that physicians were the group of most emotionally exhausted and, simultaneously, most life-satisfied persons, while nurses presented the highest level of dehumanization and the lowest level of satisfaction from life achievements. Only did physicians evaluate the healthcare system as a relatively good one. They were also more tolerant of latent dehumanization. A relationship between the dimensions of burnout and the evaluation of healthcare system were observed. The emotionally exhausted or prone to dehumanization persons were more likely to evaluate the Polish healthcare system negatively.

  11. Chronic conditions and sleep problems among adults aged 50 years or over in nine countries: a multi-country study.

    Directory of Open Access Journals (Sweden)

    Ai Koyanagi

    Full Text Available Data on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted.Data on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa conducted between 2011-2012 and 2007-2010 respectively were analyzed.The association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China to 17.0% (Poland. After adjustment for confounders, angina (OR 1.75-2.78, arthritis (OR 1.39-2.46, and depression (OR 1.75-5.12 were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI for 1,2,3, and ≥ 4 chronic conditions was 1.41 (1.09-1.82, 2.55 (1.99-3.27, 3.22 (2.52-4.11, and 7.62 (5.88-9.87 respectively in the overall sample.Identifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies

  12. Does multimorbidity influence the occurrence rates of chronic conditions? A claims data based comparison of expected and observed prevalence rates.

    Directory of Open Access Journals (Sweden)

    Ingmar Schäfer

    Full Text Available OBJECTIVE: Multimorbidity is a complex phenomenon with an almost endless number of possible disease combinations with unclear implications. One important aspect in analyzing the clustering of diseases is to distinguish between random coexistence and statistical dependency. We developed a model to account for random coexistence based on stochastic distribution. We analyzed if the number of diseases of the patients influences the occurrence rates of chronic conditions. METHODS: We analyzed claims data of 121,389 persons aged 65+ using a list of 46 chronic conditions. Expected prevalences were simulated by drawing without replacement from all observed diseases using observed overall prevalences as initial probability weights. To determine if a disease occurs more or less frequently than expected by chance we calculated observed-minus-expected deltas for each disease. We defined clinical relevance as |delta| ≥ 5.0%. 18 conditions were excluded because of a prevalence < 5.0%. RESULTS: We found that (1 two chronic conditions (e.g. hypertension were more frequent than expected in patients with a low number of comorbidities; (2 four conditions (e.g. renal insufficiency were more frequent in patients with many comorbidities; (3 six conditions (e.g. cancer were less frequent with many comorbidities; and (4 16 conditions had an average course of prevalences. CONCLUSION: A growing extent of multimorbidity goes along with a rapid growth of prevalences. This is for the largest part merely a stochastic effect. If we account for this effect we find that only few diseases deviate from the expected prevalence curves. Causes for these deviations are discussed. Our approach also has methodological implications: Naive analyses of multimorbidity might easily be affected by bias, because the prevalence of all chronic conditions necessarily increases with a growing extent of multimorbidity. We should therefore always examine and discuss the stochastic interrelations

  13. Use of complementary and alternative medicines for children with chronic health conditions in Lagos, Nigeria

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    Senbanjo Idowu O

    2008-12-01

    Full Text Available Abstract Background The use of complementary and alternative medicine (CAM is on the increase globally with a high prevalence in children and adults with chronic illnesses. Many studies have evaluated the epidemiology of medicine use for children in developing countries but none has evaluated the use of CAM for children with chronic illnesses. The aim of this study was therefore to determine the prevalence, pattern of use, parental sources of information, perceived benefits, cost, and adverse effects of CAM in children with epilepsy, sickle cell anaemia and asthma in Lagos, Nigeria. Methods Parents of children with epilepsy (122, asthma (78 or sickle cell anaemia (118 who presented consecutively to the paediatric neurology, respiratory and haematology clinics of the Lagos State University Teaching Hospital (LASUTH, Ikeja were interviewed with a structured open- and close-ended questionnaire. The information obtained comprised the demography of both the patients and their parents; past and present treatments received by the patients; the type of CAM, if any, used by the patients; and the sources, cost, benefits and adverse effects of the CAM used. Results A total of 303 CAMs were used by the patients, either alone or in combination witother CAM. CAM was reportedly used by 99 (31% patients (epilepsy -38%, sickle cell anaemia – 36% and asthma – 25%. The majority (84% of these patients were currently using CAM. The use of CAM was stopped six months prior to the study by 16 patients (16%. Biological products were the most frequently used CAMs (58%, followed by alternative medical systems (27% and mind-body interventions (14%. Relations, friends and neighbours had a marked influence on 76% of the parents who used CAM for their children. Eighty-five (86% parents were willing to discuss the use of CAM with their doctors but were not asked. CAM use was associated with adverse reactions in 7.1% of the patients. Conclusion Parental use of CAMs to treat

  14. Medication overuse headache and chronic migraine in a specialized headache centre: field-testing proposed new appendix criteria

    DEFF Research Database (Denmark)

    Zeeberg, P; Olesen, Jes; Jensen, R

    2009-01-01

    The classification subcommittee of the International Headache Society (IHS) has recently suggested revised criteria for medication overuse headache (MOH) and chronic migraine (CM). We field tested these revised criteria by applying them to the headache population at the Danish Headache Centre...... and the possibility of a renewed effect of prophylactic drugs due to medication withdrawal. We therefore recommend the implementation of the appendix criteria for both MOH and CM into the main body of the International Classification of Headache Disorders....... and compared the results with those using the current criteria. For CM we also tested two alternative criteria, one requiring > or = 4 migraine days/month and > or = 15 headache days/month, the second requiring > or = 15 headache days/month and > or = 50% migraine days. We included 969 patients with migraine...

  15. Health Maintenance in Very Old Age : Medical Conditions, Functional Outcome and Nutritional Status

    OpenAIRE

    Dong, Huan-Ji

    2014-01-01

    The overall aim of this thesis was to provide better understanding of the underlying factors related to health maintenance in very old people, with a focus on medical conditions, functional outcome and nutritional status. Data were gathered from the ELSA 85 project (Elderly in Linköping Screening Assessment). The ELSA 85 project was started in 2007 with a population-based survey of 85-year-old individuals (n = 650) residing in Linköping municipality, Sweden. During the study period from 2007 ...

  16. Growth Responses of Fish During Chronic Exposure of Metal Mixture under Laboratory Conditions

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    Saima Naz and Muhammad Javed

    2013-07-01

    Full Text Available Growth responses of five fish species viz. Catla catla, Labeo rohita, Cirrhina mrigala, Ctenopharyngodon idella and Hypophthalmichthys molitrix were determined, separately, under chronic exposure of binary mixture of metals (Zn+Ni at sub-lethal concentrations (1/3rd of LC50 for 12 weeks. Randomized complete block design (RCBD was followed to conduct this research work. The groups (10 fish each of Catla catla, Labeo rohita, Cirrhina mrigala, Ctenopharyngodon idella and Hypophthalmichthys molitrix having almost similar weights were investigated for their growth responses and metals bioaccumulation patterns in their body organs during chronic exposure of Zn+Ni mixture. The bioaccumulation of metals in the fish body organs viz. gills, liver, kidney, fins, bones, muscle and skin were also determined before and after growth trails under the stress of metals mixture. The exposure of fish to sub-lethal concentrations of mixture caused significant impacts on the average wet weight increments of five fish species. Ctenopharyngodon idella and Labeo rohita attained significantly higher weights, followed by that of Hypophthalmichthys molitrix, Cirrhina mrigala and Catla catla. However, the growth of metals mixture exposed fish species was significantly lesser than that of control fish (un-stressed. Significantly variable condition factor values reflected the degree of fish well-beings that correlated directly with fish growth and metal exposure concentration. Any significant change in feed intake, due to stress, is reflected in terms of fish growth showing the impacts of metal mixture on fish growth were either additive or antagonist / synergistic. Accumulation of all the metals in fish body followed the general order: liver>kidney>gills> skin >muscle> fins >bones.

  17. Physical activity as a mediator of the impact of chronic conditions on quality of life in older adults

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    Miller William C

    2007-12-01

    Full Text Available Abstract Background Chronic conditions could negatively affect the quality of life of older adults. This may be partially due to a relative lack of physical activity. We examined whether physical activity mediates the relationship between different chronic conditions and several health outcomes that are important to the quality of life of older adults. Methods The data were taken from the Canadian Community Health Survey (cycle 1.1, a cross-section survey completed in 2001. Only respondents who were 65 years or older were included in our study (N = 22,432. The Health Utilities Index Mark 3 (HUI3 was used to measure overall quality of life, and to measure selected health outcomes (dexterity, mobility, pain, cognition, and emotional wellbeing that are considered to be of importance to the quality of life of older adults. Leisure-time physical activity was assessed by determining weekly energy expenditure (Kcal per week based on the metabolic equivalents of self-reported leisure activities. Linear and logistic regression models were used to determine the mediating effect of leisure-time physical activity while controlling for demographic variables (age and sex, substance use (tobacco use and alcohol consumption, and obesity. Results Having a chronic condition was associated with a relative decrease in health utility scores and a relative increase in mobility limitations, dexterity problems, pain, emotional problems (i.e., decreased happiness, and cognitive limitations. These negative consequences could be partially attributed to a relative lack of physical activity in older adults with a chronic condition (14% mediation for the HUI3 score. The corresponding degree of mediation was 18% for mobility limitations, 5% for pain, and 13% for emotional wellbeing (statistically significant mediation was not observed for the other health attributes. These values varied with respect to the different chronic conditions examined in our study. Conclusion Older

  18. Feasibility of Remote Ischemic Peri-conditioning during Air Medical Transport of STEMI Patients.

    Science.gov (United States)

    Martin-Gill, Christian; Wayne, Max; Guyette, Francis X; Olafiranye, Oladipupo; Toma, Catalin

    2016-01-01

    Remote ischemic peri-conditioning (RIPC) has gained interest as a means of reducing ischemic injury in patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing emergent primary percutaneous coronary intervention (pPCI). We aimed to evaluate the feasibility, process, and patient-related factors related to the delivery of RIPC during air medical transport of STEMI patients to tertiary pPCI centers. We performed a retrospective review of procedural outcomes of a cohort of STEMI patients who received RIPC as part of a clinical protocol in a multi-state air medical service over 16 months (March 2013 to June 2014). Eligible patients were transported to two tertiary PCI centers and received up to four cycles of RIPC by inflating a blood pressure cuff on an upper arm to 200 mmHg for 5 minutes and subsequently deflating the cuff for 5 minutes. Data regarding feasibility, process variables, patient comfort, and occurrence of hypotension were obtained from prehospital records and prospectively completed quality improvement surveys. The primary outcome was whether at least 3 cycles of RIPC were completed by air medical transport crews prior to pPCI. Secondary outcomes included the number of cycles completed prior to pPCI, time spent with the patient prior to transport (bedside time), patient discomfort level, and incidence of hypotension (systolic blood pressure air medical transport for pPCI, without occurrence of prolonged bedside times. The incidence of excessive RIPC-related discomfort or hemodynamic instability is rare. STEMI patients requiring on average >30 minutes transport for pPCI may be the ideal group for RIPC utilization.

  19. Frequent Mental Distress, Chronic Conditions, and Adverse Health Behaviors in the Behavioral Risk Factor Surveillance Survey, Jordan, 2007

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    Mohannad Al-Nsour, MD, MSc

    2013-08-01

    Full Text Available Introduction Recent evidence indicates that chronic diseases and mental illness are associated. In the Middle Eastern country of Jordan, chronic diseases and frequent mental distress (FMD are increasing; however, the capacity for mental health care is limited. The objective of this study was to determine the association between FMD, chronic conditions, and adverse health behaviors in Jordan. Methods The third cycle of the Jordan Behavioral Risk Factor Surveillance Survey (2007 served as the data source for this study. The sample consisted of 3,612 noninstitutionalized Jordanian adults aged 18 years or older. Logistic regression was used to obtain odds ratios for the association between chronic conditions, health behaviors, and FMD adjusted for age, sex, marital status, education, income, and employment. Results In the adjusted models, people with hypertension (adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.6–2.7, high cholesterol (AOR, 2.3; 95% CI, 1.6–3.2, diabetes (AOR, 1.6; 95% CI, 1.1–2.4, and asthma (AOR, 2.2; 95% CI, 1.5–3.1 and smokers (AOR, 1.5; 95% CI, 1.1–2.0 were more likely to have FMD than people without each of these conditions. Adults who reported vigorous physical activity were less likely to have FMD (AOR, 0.6; 95% CI, 0.4–0.9 than their less active counterparts. Conclusions In Jordan, FMD was associated with several chronic conditions. As a result, we suggest additional research to examine the complex relationship between FMD and chronic conditions. More doctors in the primary health care system should be trained in mental health.

  20. Peptide Selank Enhances the Effect of Diazepam in Reducing Anxiety in Unpredictable Chronic Mild Stress Conditions in Rats

    Science.gov (United States)

    Kolomin, Timur; Andreeva, Lyudmila; Bondarenko, Elena; Myasoedov, Nikolay; Slominsky, Petr; Shadrina, Maria

    2017-01-01

    It was shown that the anxiolytic effect of Selank is comparable to that of classical benzodiazepine drugs and that the basis of their mechanism of action may be similar. These data suggest that the presence of Selank may change the action of classical benzodiazepine drugs. To test this hypothesis, we evaluated the anxiolytic activity of Selank and diazepam in rats both under conditions of unpredictable chronic mild stress and in its absence, after the individual and combined administration of these compounds using the elevated plus maze test. We found that, even in the absence of chronic stress, the administration of a course of test substances changed anxiety indicators toward their deterioration, but the changes after the administration of a course of Selank were less pronounced. In conditions of chronic stress, anxiety indicator values after the simultaneous use of diazepam and Selank did not differ from the respective values observed before chronic stress exposure. The data obtained indicate that the individual administration of Selank was the most effective in reducing elevated levels of anxiety, induced by the administration of a course of test substances, whereas the combination of diazepam with Selank was the most effective in reducing anxiety in unpredictable chronic mild stress conditions. PMID:28280289

  1. A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions.

    Science.gov (United States)

    Graham, Christopher D; Gouick, Joanna; Krahé, Charlotte; Gillanders, David

    2016-06-01

    Many have proposed that Acceptance and Commitment Therapy (ACT) may be particularly effective for improving outcomes in chronic disease/long-term conditions, and ACT techniques are now being used clinically. However, reviews of ACT in this context are lacking, and the state of evidence is unclear. This systematic review aimed to: collate all ACT interventions with chronic disease/long-term conditions, evaluate their quality, and comment on efficacy. Ovid MEDLINE, EMBASE and Psych Info were searched. Studies with solely mental health or chronic pain populations were excluded. Study quality was then rated, with a proportion re-rated by a second researcher. Eighteen studies were included: eight were randomised controlled trials (RCTs), four used pre-post designs, and six were case studies. A broad range of applications was observed (e.g. improving quality of life and symptom control, reducing distress) across many diseases/conditions (e.g. HIV, cancer, epilepsy). However, study quality was generally low, and many interventions were of low intensity. The small number of RCTs per application and lower study quality emphasise that ACT is not yet a well-established intervention for chronic disease/long-term conditions. However, there was some promising data supporting certain applications: parenting of children with long-term conditions, seizure-control in epilepsy, psychological flexibility, and possibly disease self-management.

  2. Unconditioned and conditioned muscular responses in patients with chronic back pain and chronic tension-type headaches and in healthy controls.

    Science.gov (United States)

    Klinger, Regine; Matter, Nadia; Kothe, Ralph; Dahme, Bernhard; Hofmann, Ulrich G; Krug, Florian

    2010-07-01

    Muscular tension is assigned an important role in the development and maintenance of chronic pain syndromes. It is seen as a psychophysiological correlate of learned fear and avoidance behavior. Basic theoretical models emphasize classical conditioning of muscular responses as a mechanism of pain chronification. However, the empirical basis for this field is very small. Our aim was to investigate muscular factors in relation to unconditioned and conditioned pain stimuli. An experimental study was conducted using a differential classical conditioning paradigm with 18 patients with chronic back pain (BP) and tension-type headache (TTH), and 18 healthy controls (HC). A high-pitched sound served as the CS+, paired with an intracutaneous electric pain stimulus (US), while a neutral sound was used as the CS-. Simultaneously, integrated surface electromyograms (iEMGs) were recorded for seven muscle sites. Our hypothesis was that the pain patients would demonstrate enhanced conditionability. Baseline values between patients (TTH, BP) and HC showed no significant differences. Although the perception and pain thresholds were balanced, both patient groups revealed a higher number of significant muscular responses to the pain stimulus (UR) than the HC. All participants showed significant conditioned muscular responses, however, the patients displayed a higher number than the healthy controls. Furthermore a significant relation was found between muscular responses and the experience of pain 1day after the experiment. Muscular responses can be learned via classical conditioning. TTH and BP patients revealed a higher number of unconditioned and conditioned responses.

  3. Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions

    OpenAIRE

    Staud,Roland

    2012-01-01

    The intensity of acute and chronic pain depends on interactions between peripheral impulse input and CNS pain mechanisms, including facilitation and inhibition. Whereas tonic pain inhibition is a characteristic of most pain-free individuals, pain facilitation can be detected in many chronic pain patients. The capability to inhibit pain is normally distributed along a wide continuum in the general population and can be used to predict chronic pain. Accumulating evidence suggests that endogenou...

  4. Family history of cancer, personal history of medical conditions and risk of oral cavity cancer in France: the ICARE study.

    OpenAIRE

    Radoï, Loredana; Paget-Bailly, Sophie; Guida, Florence; Cyr, Diane; Menvielle, Gwenn; Schmaus, Annie; Carton, Matthieu; Cénée, Sylvie; Sanchez, Marie; Guizard, Anne-Valérie; Trétarre, Brigitte; Stücker, Isabelle; Luce, Danièle

    2013-01-01

    International audience; BACKGROUND: The aim of this study was to evaluate the role of family history of cancer and personal history of other medical conditions in the aetiology of the oral cavity cancer in France. METHODS: We used data from 689 cases of oral cavity squamous cell carcinoma and 3481 controls included in a population-based case--control study, the ICARE study. Odds-ratios (ORs) associated with family history of cancer and personal medical conditions and their 95% confidence inte...

  5. Contextual factors related to chronic condition in portuguese adolescents: highlights from the HBSC/WHO study

    Directory of Open Access Journals (Sweden)

    Teresa Santos

    2016-01-01

    Full Text Available Abstract Adolescence’s changes may become more pronounced when living with a chronic condition (CC. This study aims to examined the differences in satisfaction with family life, perception of school competence and “pressure with homework” of Portuguese adolescents’ 1 living with CC; 2 how living with CC affects school participation; taking into account age, gender and family socioeconomic status (SES. Five thousand fifty Portuguese adolescents (mean age 14 ± 1.85 of the Health Behaviour in School-aged Children (HBSC/WHO were included. Results showed increased vulnerability in adolescents living with CC, presenting a lower satisfaction with family life and poor school outcomes. Younger boys, having a higher SES and not having CC are significantly associated with satisfaction with family life. Older girls, having a lower SES and living with CC were associated with more stress related to school work. Future interventions should include these features combined with ‘listening’ to adolescents and their needs, allowing their participation in the promotion of personal health.

  6. Self-management of chronic illness: the role of 'habit' versus reflective factors in exercise and medication adherence.

    Science.gov (United States)

    Phillips, L Alison; Cohen, Joshua; Burns, Edith; Abrams, Jessica; Renninger, Steffi

    2016-12-01

    Non-adherence to health behaviors required for chronic illness self-management is pervasive. Advancing health-behavior theory to include behavioral initiation and maintenance factors, including reflective (e.g., belief- and feedback-based) and automatic (e.g., habit-based) mechanisms of adherence to different treatment-related behaviors could improve non-adherence prediction and intervention efforts. To test behavioral initiation and maintenance factors from an extended common sense self-regulation theoretical framework for predicting medication adherence and physical activity among patients with Type 2 diabetes. Patients (n = 133) in an in-person (n = 80) or online (n = 53) version of the study reported treatment-related (1) barriers, (2) beliefs and experiential feedback (reflective mechanisms of treatment-initiation and short-term repetition), and (3) habit strength (automatic mechanism of treatment-maintenance) for taking medication and engaging in regular physical activity at baseline. Behaviors were assessed via self-reports (n = 133) and objectively (electronic monitoring pill bottles, accelerometers; n = 80) in the subsequent month. Treatment-specific barriers and habit strength predicted self-reported and objective adherence for both behaviors. Beliefs were inconsistently related to behavior, even when habits were "weak". Experiential feedback from behavior was not related to adherence. Among patients with Type 2 diabetes diagnosis, medication and physical activity adherence were better predicted by their degree of automatic behavioral repetition than their beliefs/experiences with the treatment-actions. Habit strength should be an intervention target for chronic illness self-management; assessing it in practice settings may effectively detect non-adherence to existing treatment-regimens. However, future research and further refining of CS-SRM theory regarding the processes required for such habit development are needed.

  7. Consequences of success in pediatrics: young adults with disability benefits as a result of chronic conditions since childhood

    NARCIS (Netherlands)

    Verhoof, E.J.A.

    2015-01-01

    The purpose of this EMWAjong study was to evaluate the psychosocial functioning, the emotional well-being and the factors affecting the vocational success and well-being in young adults with a Wajong benefit for a childhood-onset chronic somatic condition while growing up. The study was aimed at you

  8. A realist review: what do nurse led self-management interventions achieve for outpatients with a chronic condition?

    NARCIS (Netherlands)

    Hooft, S.M. van; Been-Dahmen, J.M.J.; Ista, E.; Staa, A. van; Boeije, H.R.

    2016-01-01

    Aim: To examine how nurse-led interventions that support self-management of outpatients with chronic conditions work and in what contexts they work successfully. Background: Self-management could be directed at goals such as quality of life, adherence, or patients’ empowerment. Self-management suppo

  9. An Innovative Mixed Methods Approach to Studying the Online Health Information Seeking Experiences of Adults with Chronic Health Conditions

    Science.gov (United States)

    Mayoh, Joanne; Bond, Carol S.; Todres, Les

    2012-01-01

    This article presents an innovative sequential mixed methods approach to researching the experiences of U.K. adults with chronic health conditions seeking health information online. The use of multiple methods integrated within a single study ensured that the focus of the research was emergent and relevant and ultimately provided a more complete…

  10. The Role of School Health Services in Addressing the Needs of Students with Chronic Health Conditions: A Systematic Review

    Science.gov (United States)

    Leroy, Zanie C.; Wallin, Robin; Lee, Sarah

    2017-01-01

    Children and adolescents in the United States spend many hours in school. Students with chronic health conditions (CHCs) may face lower academic achievement, increased disability, fewer job opportunities, and limited community interactions as they enter adulthood. School health services provide safe and effective management of CHCs, often for…

  11. Sex-based differences in brain alterations across chronic pain conditions.

    Science.gov (United States)

    Gupta, Arpana; Mayer, Emeran A; Fling, Connor; Labus, Jennifer S; Naliboff, Bruce D; Hong, Jui-Yang; Kilpatrick, Lisa A

    2017-01-02

    Common brain mechanisms are thought to play a significant role across a multitude of chronic pain syndromes. In addition, there is strong evidence for the existence of sex differences in the prevalence of chronic pain and in the neurobiology of pain. Thus, it is important to consider sex when developing general principals of pain neurobiology. The goal of the current Mini-Review is to evaluate what is known about sex-specific brain alterations across multiple chronic pain populations. A total of 15 sex difference and 143 single-sex articles were identified from among 412 chronic pain neuroimaging articles. Results from sex difference studies indicate more prominent primary sensorimotor structural and functional alterations in female chronic pain patients compared with male chronic pain patients: differences in the nature and degree of insula alterations, with greater insula reactivity in male patients; differences in the degree of anterior cingulate structural alterations; and differences in emotional-arousal reactivity. Qualitative comparisons of male-specific and female-specific studies appear to be consistent with the results from sex difference studies. Given these differences, mixed-sex studies of chronic pain risk creating biased data or missing important information and single-sex studies have limited generalizability. The advent of large-scale neuroimaging databases will likely aid in building a more comprehensive understanding of sex differences and commonalities in brain mechanisms underlying chronic pain. © 2016 Wiley Periodicals, Inc.

  12. Health-related quality of life as measured with EQ-5D among populations with and without specific chronic conditions: a population-based survey in Shaanxi Province, China.

    Directory of Open Access Journals (Sweden)

    Zhijun Tan

    Full Text Available INTRODUCTION: The aim of this study was to examine health-related quality of life (HRQoL as measured by EQ-5D and to investigate the influence of chronic conditions and other risk factors on HRQoL based on a distributed sample located in Shaanxi Province, China. METHODS: A multi-stage stratified cluster sampling method was performed to select subjects. EQ-5D was employed to measure the HRQoL. The likelihood that individuals with selected chronic diseases would report any problem in the EQ-5D dimensions was calculated and tested relative to that of each of the two reference groups. Multivariable linear regression models were used to investigate factors associated with EQ VAS. RESULTS: The most frequently reported problems involved pain/discomfort (8.8% and anxiety/depression (7.6%. Nearly half of the respondents who reported problems in any of the five dimensions were chronic patients. Higher EQ VAS scores were associated with the male gender, higher level of education, employment, younger age, an urban area of residence, access to free medical service and higher levels of physical activity. Except for anemia, all the selected chronic diseases were indicative of a negative EQ VAS score. The three leading risk factors were cerebrovascular disease, cancer and mental disease. Increases in age, number of chronic conditions and frequency of physical activity were found to have a gradient effect. CONCLUSION: The results of the present work add to the volume of knowledge regarding population health status in this area, apart from the known health status using mortality and morbidity data. Medical, policy, social and individual attention should be given to the management of chronic diseases and improvement of HRQoL. Longitudinal studies must be performed to monitor changes in HRQoL and to permit evaluation of the outcomes of chronic disease intervention programs.

  13. Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Kong, Ling Jun; Lauche, Romy; Klose, Petra; Bu, Jiang Hui; Yang, Xiao Cun; Guo, Chao Qing; Dobos, Gustav; Cheng, Ying Wu

    2016-04-29

    Several studies reported that Tai Chi showed potential effects for chronic pain, but its role remains controversial. This review assessed the evidence regarding the effects of Tai Chi for chronic pain conditions. 18 randomized controlled trials were included in our review. The aggregated results have indicated that Tai Chi showed positive evidence on immediate relief of chronic pain from osteoarthritis (standardized mean difference [SMD], -0.54; 95% confidence intervals [CI], -0.77 to -0.30; P Tai Chi practice for osteoarthritis may be more than 5 weeks. And there were some beneficial evidences regarding the effects of Tai Chi on immediate relief of chronic pain from low back pain (SMD, -0.81; 95% CI, -1.11 to -0.52; P osteoporosis (SMD, -0.83; 95% CI, -1.37 to -0.28; P = 0.003). Therefore, clinicians may consider Tai Chi as a viable complementary and alternative medicine for chronic pain conditions.

  14. Modelling population-level consequences of chronic external gamma irradiation in aquatic invertebrates under laboratory conditions

    Energy Technology Data Exchange (ETDEWEB)

    Lance, Emilie [Laboratoire de modelisation pour l' expertise environnementale (LM2E) Institut de Radioprotection et de Surete Nucleaire (IRSN), PRP-ENV, SERIS, Cadarache (France); Alonzo, Frederic, E-mail: frederic.alonzo@irsn.fr [Laboratoire d' ecotoxicologie des radionucleides (LECO) Institut de Radioprotection et de Surete Nucleaire (IRSN), PRP-ENV, SERIS, Cadarache (France); Garcia-Sanchez, Laurent [Laboratoire de biogeochimie, biodisponibilite et transferts des radionucleides (L2BT) Institut de Radioprotection et de Surete Nucleaire (IRSN), PRP-ENV, SERIS, Cadarache (France); Beaugelin-Seiller, Karine; Garnier-Laplace, Jacqueline [Laboratoire de modelisation pour l' expertise environnementale (LM2E) Institut de Radioprotection et de Surete Nucleaire (IRSN), PRP-ENV, SERIS, Cadarache (France)

    2012-07-01

    We modelled population-level consequences of chronic external gamma irradiation in aquatic invertebrates under laboratory conditions. We used Leslie matrices to combine life-history characteristics (duration of life stages, survival and fecundity rates) and dose rate-response curves for hatching, survival and reproduction fitted on effect data from the FREDERICA database. Changes in net reproductive rate R{sub 0} (offspring per individual) and asymptotic population growth rate {lambda} (dimensionless) were calculated over a range of dose rates in two marine polychaetes (Neanthes arenaceodentata and Ophryotrocha diadema) and a freshwater gastropod (Physa heterostropha). Sensitivities in R{sub 0} and {lambda} to changes in life-history traits were analysed in each species. Results showed that fecundity has the strongest influence on R{sub 0}. A delay in age at first reproduction is most critical for {lambda} independent of the species. Fast growing species were proportionally more sensitive to changes in individual endpoints than slow growing species. Reduction of 10% in population {lambda} were predicted at dose rates of 6918, 5012 and 74,131 {mu}Gy{center_dot}h{sup -1} in N. arenaceodentata, O. diadema and P. heterostropha respectively, resulting from a combination of strong effects on several individual endpoints in each species. These observations made 10%-reduction in {lambda} a poor criterion for population protection. The lowest significant changes in R{sub 0} and {lambda} were respectively predicted at a same dose rate of 1412 {mu}Gy h{sup -1} in N. arenaceodentata, at 760 and 716 {mu}Gy h{sup -1} in O. diadema and at 12,767 and 13,759 {mu}Gy h{sup -1} in P. heterostropha. These values resulted from a combination of slight but significant changes in several measured endpoints and were lower than effective dose rates calculated for the individual level in O. diadema and P. heterostropha. The relevance of the experimental dataset (external irradiation rather

  15. Associations of Self-Reported Periodontal Disease With Metabolic Syndrome and Number of Self-Reported Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Lillian Bensley, PhD

    2011-05-01

    Full Text Available IntroductionIncreasing evidence supports associations between periodontal disease and various chronic conditions. Possible explanations include chronic inflammatory processes, shared pathogens, and shared risk factors, such as smoking and psychosocial stress. The objective of this study was to assess associations of periodontal disease with metabolic syndrome and number of chronic diseases.MethodsAs part of the Washington Adult Health Survey, a household-based cross-sectional study conducted during 2006-2007 among adults aged 25 years or older in Washington State, we collected questionnaire data, blood samples, and anthropometric measures. We used these data to assess associations of periodontal disease with metabolic syndrome and the number of self-reported chronic diseases, controlling for age, sex, annual household income, smoking, and psychosocial stress. We used both complete case and multiple imputation Poisson regression analyses.ResultsIn the adjusted complete case analysis, 1.4 times as many chronic conditions were found among people with severe compared with no periodontal disease, and people with severe periodontal disease were 1.5 times more likely to have metabolic syndrome than people with no periodontal disease. Arthritis and liver disease were individually associated with severe periodontal disease. Results of the multiple imputation analyses were similar.ConclusionThese results suggest that people with severe periodontal disease are likely to have more chronic diseases and are more likely to have metabolic syndrome compared with people without periodontal disease. Research about the effectiveness of periodontal treatment to help prevent or control chronic diseases is needed.

  16. Chronic but not acute antidepresant treatment alters serum zinc/copper ratio under pathological/zinc-deficient conditions in mice.

    Science.gov (United States)

    Mlyniec, K; Ostachowicz, B; Krakowska, A; Reczynski, W; Opoka, W; Nowak, G

    2014-10-01

    Depression is the leading psychiatric disorder with a high risk of morbidity and mortality. Clinical studies report lower serum zinc in depressed patients, suggesting a strong link between zinc and mood disorders. Also copper as an antagonistic element to zinc seems to play a role in depression, where elevated concentration is observed. In the present study we investigated serum copper and zinc concentration after acute or chronic antidepressant (AD) treatment under pathological/zinc-deficient conditions. Zinc deficiency in mice was induced by a special diet administered for 6 weeks (zinc adequate diet - ZnA, contains 33.5 mgZn/kg; zinc deficient diet - ZnD, contains 0.2 mgZn/kg). Animals received acute or chronically saline (control), imipramine, escitalopram, reboxetine or bupropion. To evaluate changes in serum copper and zinc concentrations the total reflection X-ray fluorescence (TXRF) and flame atomic absorption spectrometry (FAAS) was performed. In ZnD animals serum zinc level was reduced after acute ADs treatment (similarly to vehicle treatment), however, as demonstrated in the previous study after chronic ADs administration no differences between both ZnA and ZnD groups were observed. Acute ADs in ZnD animals caused different changes in serum copper concentration with no changes after chronic ADs treatment. The calculated serum Zn/Cu ratio is reduced in ZnD animals (compared to ZnA subjects) treated with saline (acutely or chronically) and in animals treated acutely with ADs. However, chronic treatment with ADs normalized (by escitalopram, reboxetine or bupropion) or increased (by imipramine) this Zn/Cu ratio. Observed in this study normalization of serum Zn/Cu ratio in depression-like conditions by chronic (but not acute) antidepressants suggest that this ratio may be consider as a marker of depression or treatment efficacy.

  17. Self-reported Quality of ADL Task performance in Persons with Chronic Conditions

    DEFF Research Database (Denmark)

    Nielsen, Kristina Tomra; Wæhrens, Eva Ejlersen

    2016-01-01

    Background: Several studies have indicated that persons with chronic diseases perceive problems related to Activities of Daily Living (ADL), including Personal ADL (PADL) and Instrumental ADL (IADL). However, little is known about how persons with chronic diseases perceive the quality of their ADL...... groups with chronic diseases. Method: Persons with various chronic diseases including rheumatic diseases, cancer, chronic obstructive pulmonary disease and schizophrenia were included in the study. Data related to self-reported quality of ADL task performance were collected from 2007-2015 using the ADL...... in relation to selfreported quality of ADL task performance will be investigated both within and between diagnostic groups. Results and conclusion: Data extraction is in progress. We expect the results of the study to show both similarities and differences in relation to self-reported quality of both personal...

  18. Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care

    OpenAIRE

    2011-01-01

    Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need for various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technolog...

  19. Contributions of societal and geographical environments to "chronic Lyme disease": the psychopathogenesis and aporology of a new "medically unexplained symptoms" syndrome.

    Science.gov (United States)

    Sigal, Leonard H; Hassett, Afton L

    2002-08-01

    Lyme disease is a relatively well-described infectious disease with multisystem manifestations. Because of confusion over conflicting reports, anxiety related to vulnerability to disease, and sensationalized and inaccurate lay media coverage, a new syndrome, "chronic Lyme disease," has become established. Chronic Lyme disease is the most recent in a continuing series of "medically unexplained symptoms" syndromes. These syndromes, such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity, meet the need for a societally and morally acceptable explanation for ill-defined symptoms in the absence of objective physical and laboratory findings. We describe factors involved in the psychopathogenesis of chronic Lyme disease and focus on the confusion and insecurity these patients feel, which gives rise to an inability to adequately formulate and articulate their health concerns and to deal adequately with their medical needs, a state of disorganization termed aporia.

  20. Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases

    Directory of Open Access Journals (Sweden)

    Ibáñez-Beroiz Berta

    2011-12-01

    Full Text Available Abstract Background Small area analysis is the most prevalent methodological approach in the study of unwarranted and systematic variation in medical practice at geographical level. Several of its limitations drive researchers to use disease mapping methods -deemed as a valuable alternative. This work aims at exploring these techniques using - as a case of study- the gender differences in rates of hospitalization in elderly patients with chronic diseases. Methods Design and study setting: An empirical study of 538,358 hospitalizations affecting individuals aged over 75, who were admitted due to a chronic condition in 2006, were used to compare Small Area Analysis (SAVA, the Besag-York-Mollie (BYM modelling and the Shared Component Modelling (SCM. Main endpoint: Gender spatial variation was measured, as follows: SAVA estimated gender-specific utilization ratio; BYM estimated the fraction of variance attributable to spatial correlation in each gender; and, SCM estimated the fraction of variance shared by the two genders, and those specific for each one. Results Hospitalization rates due to chronic diseases in the elderly were higher in men (median per area 21.4 per 100 inhabitants, interquartile range: 17.6 to 25.0 than in women (median per area 13.7 per 100, interquartile range: 10.8 to 16.6. Whereas Utilization Ratios showed a similar geographical pattern of variation in both genders, BYM found a high fraction of variation attributable to spatial correlation in both men (71%, CI95%: 50 to 94 and women (62%, CI95%: 45 to 77. In turn, SCM showed that the geographical admission pattern was mainly shared, with just 6% (CI95%: 4 to 8 of variation specific to the women component. Conclusions Whereas SAVA and BYM focused on the magnitude of variation and on allocating where variability cannot be due to chance, SCM signalled discrepant areas where latent factors would differently affect men and women.

  1. Interaction between Chronic Obstructive Pulmonary Disease (COPD) and other important health conditions and measurable air pollution

    Science.gov (United States)

    Blagev, D. P.; Mendoza, D. L.; Rea, S.; Sorensen, J.

    2015-12-01

    Adverse health effects have been associated with urban pollutant exposure arising from close proximity to highly-emitting sources and atmospheric mixing. The relative air pollution exposure dose and time effects on various diseases remains unknown. This study compares the increased risk of health complications when patients are exposed to short term high-levels of air pollution vs. longer term exposure to lower levels of air pollution. We used the electronic medical record of an integrated hospital system based in Utah, Intermountain Healthcare, to identify a cohort of patients with Chronic Obstructive Pulmonary Disease (COPD) who were seen between 2009-2014. We determined patient demographics as well as comorbidity data and healthcare utilization. To determine the approximate air pollution dose and time exposure, we used the Hestia highly-resolved emissions inventory for Salt Lake County, Utah in conjunction with emissions based on the National Emissions Inventory (NEI). Hourly emissions of CO2 and criteria air pollutants were gridded at a 0.002o x 0.002o resolution for the study years. The resulting emissions were transported using the CALPUFF and AERMOD dispersion models to estimate air pollutant concentrations at an hourly 0.002o x 0.002oresolution. Additionally, pollutant concentrations were estimated at each patient's home and work address to estimate exposure. Multivariate analysis adjusting for patient demographics, comorbidities and severity of COPD was performed to determine association between air pollution exposure and the risk of hospitalization or emergency department (ED) visit for COPD exacerbation and an equivalency estimate for air pollution exposure was developed. We noted associations with air pollution levels for each pollutant and hospitalizations and ED visits for COPD and other patient comorbidities. We also present an equivalency estimate for dose of air pollution exposure and health outcomes. This analysis compares the increased risk of

  2. Assessment of medical students’ proficiency in dermatology: Are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States?

    Directory of Open Access Journals (Sweden)

    Catherine A Ulman

    2015-05-01

    Full Text Available This study assessed whether a current medical school curriculum is adequately preparing medical students to diagnose and treat common dermatologic conditions. A 15-item anonymous multiple choice quiz covering fifteen diseases was developed to test students’ ability to diagnose and treat common dermatologic conditions. The quiz also contained five items that assessed students’ confidence in their ability to diagnose common dermatologic conditions, their perception of whether they were receiving adequate training in dermatology, and their preferences for additional training in dermatology. The survey was performed in 2014, and was completed by 85 students (79.4%. Many students (87.6% felt that they received inadequate training in dermatology during medical school. On average, students scored 46.6% on the 15-item quiz. Proficiency at the medical school where the study was performed is considered an overall score of greater than or equal to 70.0%. Students received an average score of 49.9% on the diagnostic items and an average score of 43.2% on the treatment items. The findings of this study suggest that United States medical schools should consider testing their students and assessing whether they are being adequately trained in dermatology. Then schools can decide if they need to re-evaluate the timing and delivery of their current dermatology curriculum, or whether additional curriculum hours or clinical rotations should be assigned for dermatologic training.

  3. The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease.

    Directory of Open Access Journals (Sweden)

    Minal S Kale

    Full Text Available Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD.We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ and Beliefs about Medications Questionnaire (BMQ. Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs.We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001, not be married (p = 0.006, and to have lower income (p<0.001 or education (p<0.001. In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen's d = 0.42, and were more likely to be concerned about their illness ((p = 0.04, Cohen's d = 0.17. In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94. In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37 though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04.In this cohort of urban individuals with COPD, low health literacy was

  4. The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Kale, Minal S.; Federman, Alex D.; Krauskopf, Katherine; Wolf, Michael; O’Conor, Rachel; Martynenko, Melissa; Leventhal, Howard; Wisnivesky, Juan P.

    2015-01-01

    Background Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD. Methods We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ). Unadjusted analyses, with corresponding Cohen’s d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs. Results We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001), not be married (p = 0.006), and to have lower income (p<0.001) or education (p<0.001). In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen’s d = 0.42), and were more likely to be concerned about their illness ((p = 0.04, Cohen’s d = 0.17). In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65–0.94). In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05–1.37) though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82–1.04). Conclusions In this cohort of urban

  5. Ritanserin as add-on medication to neuroleptic therapy for patients with chronic or subchronic schizophrenia

    NARCIS (Netherlands)

    Den Boer, JA; Vahlne, JO; Post, P; Heck, AH; Daubenton, F; Olbrich, R

    2000-01-01

    The effect of ritanserin, a potent 5HT(2A/2C) receptor antagonist, used as an add-on medication to neuroleptic treatmentin patients with schizophrenia, was compared with that of placebo, in an international, double-blind, parallel-group study. Previously established neuroleptic therapy was maintaine

  6. Chronic psychosocial stress causes delayed extinction and exacerbates reinstatement of ethanol-induced conditioned place preference in mice

    OpenAIRE

    Bahi, Amine; Dreyer, Jean-Luc

    2014-01-01

    Objective: Here, we examined the impact of chronic subordinate colony (CSC) exposure on EtOH-CPP extinction, as well as ethanol-induced reinstatement of CPP.Methods: Mice were conditioned with saline or 1.5 g/kg ethanol and were tested in the EtOH-CPP model. In the first experiment, the mice were subjected to 19 days of chronic stress, and EtOH-CPP extinction was assessed during seven daily trials without ethanol injection. In the second experiment and after the EtOH-CPP test, the mice were s...

  7. “Just Advil”: Harm reduction and identity construction in the consumption of Over-The-Counter medication for chronic pain Social Science & Medicine

    Science.gov (United States)

    2015-01-01

    Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medication as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as “just over-the-counter” or “not real pain medication,” sufferers engage in ideological harm reduction, distinguishing themselves from “those people who like taking pain medication” while still seeking relief. Justifying one’s use of OTC medication as minimal and “normal,” regardless of intake, avoids association with the addictive potential of prescription pain

  8. Health-Related Quality of Life Among Adults With Multiple Chronic Conditions in the United States, Behavioral Risk Factor Surveillance System, 2007

    Directory of Open Access Journals (Sweden)

    Han-Yang Chen, MS

    2011-01-01

    Full Text Available IntroductionLittle is known about health-related quality of life (HRQOL among people with multiple chronic conditions. We examined the association between the number of chronic conditions and self-reported HRQOL outcomes among adults in the United States.MethodsWe used data from the Behavioral Risk Factor Surveillance System (BRFSS in 2007 (n = 430,912 to compare 4 HRQOL measures for people with any of 8 chronic conditions. We also assessed the frequency of self-reported physical and mental distress and the number of days activity was limited because of chronic conditions. We estimated prevalence and adjusted odds ratios (AORs and 95% confidence intervals (CIs by using survey logistic regression analyses.ResultsPeople with 3 or more chronic conditions had the highest risk of reporting fair or poor health compared with respondents with no chronic conditions (AOR, 8.7; 95% CI, 8.0-9.4. People with cardiovascular conditions or diabetes had higher risk of reporting poor HRQOL outcomes than those with other chronic conditions. The odds ratios for frequent physical distress were consistently higher than those for frequent mental distress and frequent activity limitations for all conditions.ConclusionStrategies that help clinicians to manage their patients’ chronic conditions may contribute to improved HRQOL among adults. Our findings may help to inform these strategies.

  9. Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire

    Directory of Open Access Journals (Sweden)

    Roy Fox

    2008-12-01

    Full Text Available Roy Fox1, Tara Sampalli1, Jonathan Fox11Nova Scotia Environmental Health Centre, Fall River, NS, CanadaAbstract: The Nova Scotia Environmental Health Centre is a treatment facility for individuals with chronic environmental conditions such as multiple chemical sensitivity, chronic fatigue syndrome, fibromyalgia, chronic respiratory conditions and in some cases chronic pain. The premise of care is to provide a patient-centred multidisciplinary care approach leading to self-management strategies. In order to measure the outcome of the treatment in these complex problems, with overlapping diagnoses, symptoms in many body systems and suspected environmental triggers, a detailed symptoms questionnaire was developed specifically for this patient population and validated. Results from a pilot study in which an abbreviated symptoms questionnaire based on the top reported symptoms captured in previous research was used to measure the efficacy of a multidisciplinary care approach in individuals with multiple chemical sensitivity are presented in this paper. The purpose of this study was to examine the extent, type and patterns of changes over time in the top reported symptoms with treatment measured using the abbreviated symptoms questionnaire. A total of 183 active and 109 discharged patients participated in the study where the health status was measured at different time periods of follow up since the commencement of treatment at the Centre. The findings from this study were successful in generating an initial picture of the nature and type of changes in these symptoms. For instance, symptoms such as difficulty concentrating, sinus conditions and tiredness showed early improvement, within the first 6 months of being in treatment, while others, such as fatigue, hoarseness or loss of voice, took longer while others showed inconsistent changes warranting further enquiry. A controlled longitudinal study is planned to confirm the findings of the pilot study

  10. Improving the external validity of clinical trials: the case of multiple chronic conditions

    Directory of Open Access Journals (Sweden)

    Martin Fortin

    2013-12-01

    Full Text Available The U.S. Department of Health and Human Services vision and strategic framework on multiple chronic conditions (MCCs incorporates recommendations designed to facilitate research that will improve our knowledge about interventions and systems that will benefit individuals with MCCs (or multimorbidity. The evidence base supporting the management of patients with MCCs will be built both through intervention trials specifically designed to address multimorbidity and identification of MCCs in participants across the clinical trial range. This article specifically focuses on issues relating to external validity with specific reference to trials involving patients with MCCs. The exclusion of such patients from clinical trials has been well documented. Randomized control trials (RCTs are considered the “gold standard” of evidence, but may have drawbacks in relation to external validity, particularly in relation to multimorbidity. It may, therefore, be necessary to consider a broader range of research methods that can provide converging evidence on intervention effects to address MCCs. Approaches can also be taken to increase the usefulness of RCTs in general for providing evidence to inform multimorbidity management. Additional improvements to RCTs would include better reporting of inclusion and exclusion criteria and participant characteristics in relation to MCCs. New trials should be considered in terms of how they will add to the existing evidence base and should inform how interventions may work in different settings and patient groups. Research on treatments and interventions for patients with MCCs is badly needed. It is important that this research includes patient-centered measures and that generalizability issues be explicitly addressed.

  11. Medical nutrition therapy in chronic kidney disease; from dialysis to transplant: A case report

    Directory of Open Access Journals (Sweden)

    Gabriela Leal-Escobar

    2016-01-01

    Full Text Available Chronic kidney disease has direct implications in nutritional status, causing anorexia and muscular catabolism. These situations are frequent in kidney renal replacement therapy in which nutritional disorders and inflammatory mechanisms associated with therapy often lead to the development of protein-energy wasting. Nutrition therapy has shown an adequate therapeutic strategy to prevent and treat metabolic alterations, reducing surgical and nutritional complication risks in kidney transplantation patients. The current case reports nutritional intervention on a continuous ambulatory peritoneal dialysis patient who was subsequently prescribed to automatic peritoneal dialysis and, finally, kidney transplant from a living donor.

  12. Knowledge and Adherence to Medications among Palestinian Geriatrics Living with Chronic Diseases in the West Bank and East Jerusalem

    Science.gov (United States)

    Najjar, Anas; Amro, Yazan; Kitaneh, Islam; Abu-Sharar, Salam; Sawalha, Maryam; Jamous, Abrar; Qiq, Muhannad; Makharzeh, Enas; Subb Laban, Bayan; Amro, Wafa; Amro, Ahmad

    2015-01-01

    Background Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics. Methods and Findings We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses. Results A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD=8.58) years and ranged from 60-110 years. The sample comprised 659 (55.3%) females and 533 (44.7%) males. The global knowledge and global adherence scores were (67.57%) and (89.29%), respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1%) and 1088 (91.3%) participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor’s degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value <0.05). Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value <0.05). We found positive correlation between participants’ global adherence and global knowledge (r=0.487 and p-value <0.001). Negative correlation was found between participants’ global knowledge and adherence with age (r= -0.236, p-value <0.001 and r= -0.211 and p-value <0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r= -0.130, p-value <0.001) was predicted

  13. Knowledge and Adherence to Medications among Palestinian Geriatrics Living with Chronic Diseases in the West Bank and East Jerusalem.

    Directory of Open Access Journals (Sweden)

    Anas Najjar

    Full Text Available Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics.We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥ 60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses.A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD = 8.58 years and ranged from 60-110 years. The sample comprised 659 (55.3% females and 533 (44.7% males. The global knowledge and global adherence scores were (67.57% and (89.29%, respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1% and 1088 (91.3% participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor's degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value < 0.05. Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value < 0.05. We found positive correlation between participants' global adherence and global knowledge (r = 0.487 and p-value < 0.001. Negative correlation was found between participants' global knowledge and adherence with age (r = -0.236, p-value < 0.001 and r = -0.211 and p-value < 0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r = -0.130, p-value < 0.001 was predicted.We concluded that patients with a

  14. ACTIVATION MECHANISMS OF GUT-ASSOCIATED LYMPHOID TISSUE UNDER CHRONIC SOCIAL STRESS CONDITIONS

    Directory of Open Access Journals (Sweden)

    A. M. Kamyshnyi

    2015-01-01

    Full Text Available Stress-induced immune disregulation is a risk factor of autoimmune and inflammatory diseases, but, so far, the mechanisms for this effect are not fully known. Expression levels of specific mRNAs were assessed in gut-associated lymphoid tissue (GALT from Wistar rats subjected to chronic social stress (CSS. Gene expression was evaluated for NR3C1, Adrβ2, as well as IL-1β, IL-17α pro-inflammatory cytokines, and Nlrp, an inflammasome gene. Under the CSS conditions, we have shown altered distribution of RORγt +, FoxP3+, LMP2+, XBP1+ lymphocytes in GALT.The experiments were carried out with female Wistar rats aged 5–6 months. Specific mRNA expression for the target genes was determined by means of real-time PCR performed in a CFX96™ thermocycler («BioRadLaboratories, Inc»,USA. Relative levels of a target gene expression were quantified by the ΔΔCt method, being compared with rat GAPDH reference gene expression. Statistical analysis was performed with available «BioRad СFX Manager 3.1» software. Specific monoclonal rat antibodes were used for detection of immunopositive lymphocytes by means of indirect immunofluorescence technique.CSS development leads to decreased levels of mRNA expression for Nr3c1 and Adrβ2-genes in the GALT cells, being accompanied with unidirectional changes, i.e., increased transcription of pro-inflammatory cytokine mRNAs (IL-1β, IL-17α and Nlrp3-inflammasome genes. These changes are accompanied by decreased FoxP3+/RORγt + cell ratio and predominant Th17 differentiation accompanied by suppressor failure. In addition, CSS development was characterized by unidirectional tendency for increasing total number of LMP2+ lymphocytes and reduced ХВР1+ cell population density in lymphoid structures of rat ileum.The events observed in GALT cell populations under CSS conditions are opposing classical paradigm of the stress response. The CSS-associated effects do not promote immunosuppression, however, are able to cause

  15. Chronic post-embolic pulmonary hypertension: a new target for medical therapies?

    Directory of Open Access Journals (Sweden)

    Marion Delcroix

    2013-09-01

    Full Text Available The rationale for the use of pulmonary arterial hypertension-targeted drugs in chronic thromboembolic pulmonary hypertension is based on four bundles of evidence, as follows: 1 the pathobiology of the disease, with a distal component of pre-capillary arteriopathy that is very similar to pulmonary arterial hypertension; 2 the inoperability of some patients, and the persistence or recurrence of pulmonary hypertension after pulmonary endarterectomy in others; 3 the short-term efficacy and safety of pulmonary arterial hypertension-targeted drugs in these patients; and 4 their potential effect on survival. Chronic thromboembolic pulmonary hypertension is essentially a surgical disease, curable by pulmonary endarterectomy, with acceptable procedural mortality in experienced centres. Patient selection for surgery is extremely complex and results in 30–50% of patients considered inoperable. A large clinical experience has been built up with endothelin receptor antagonists and phosphodiesterase-5 inhibitors, while evidence from controlled trials is running far behind schedule. More recently, a randomised controlled trial with the guanylate cyclase stimulator, riociguat, achieved its target and showed haemodynamic, as well as functional, improvements within 4 months of therapy. The place of this therapy in the therapeutic arsenal needs to be further defined, but should be strictly limited to inoperable patients.

  16. Nutritional condition of school age children. Clinic, anthropo-medical and alimentary assessment

    Directory of Open Access Journals (Sweden)

    Alina Esther González Hermida

    2011-04-01

    Full Text Available Background: the study of children´s growth in an appropriate indicator of children health condition and should be used as one of the basis in the practice of preventive medicine. Objective: to determine the nutritional al condition of children of third and sixth grade of elementary schools of Health Area V of Cienfuegos Municipality. Methods: descriptive, observational, cross-sectional and relational study of 445 school age children from 4 elementary schools. A clinic assessment was carried out along with an anthropo-medical evaluation. A qualitative survey was developed to assess the frequency of consumption of different alimentary groups. Results: the relation weight/height in the two genders presents a prevalence of normal weight; undernourishment is more common among females, overweight is more usual among boys and obesity can be found in both genders. The variable weight/age showed one bad-nutrition (for defect among females, there was a prevalence of bad-nutrition for excess in both genders. There were no children with height under the third percentile, with prevalence of boys and girls tall and very tall. Bronchial asthma was the most common disease. Conclusions: Food consumption in general, taking into account frequency and kind of food, is not the appropriate. There is a relation between positive clinical findings and the anthropometric assessment of weight/height.

  17. The social negotiation of fitness for work: tensions in doctor-patient relationships over medical certification of chronic pain.

    Science.gov (United States)

    Wainwright, Elaine; Wainwright, David; Keogh, Edmund; Eccleston, Christopher

    2015-01-01

    The UK government is promoting the health benefits of work, in order to change doctors' and patients' behaviour and reduce sickness absence. The rationale is that many people 'off sick' would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the 'sick note' with the 'fit note' and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies. Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note's focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.

  18. Pain medication and global cognitive functioning in dementia patients with painful conditions

    NARCIS (Netherlands)

    Plooij, B.; Spek, K. van der; Scherder, E.J.

    2012-01-01

    BACKGROUND: Dementia patients are at an increased risk for undertreatment of pain, compared with older people without dementia, suggesting a relationship between pain medication prescription and cognitive functioning. Studies on a possible relationship between pain medication and cognitive functioni

  19. Effect of medical ozone therapy on renal blood flow and renal function of patients with chronic severe hepatitis

    Institute of Scientific and Technical Information of China (English)

    GU Xi-bing; YANG Xiao-juan; ZHU Hong-ying; XU Yue-qin; LIU Xia-ying

    2010-01-01

    Background Medical ozone therapy system was reported to have certain effects on the treatment of severe hepatitis,but its mechanism is not very clear. One of the causes of death of severe hepatitis is complication of renal damage or hepatorenal syndrome. The present study aimed to observe effects of medical ozone therapy system on plasma renin activity (PRA), angiotensin Ⅱ (AⅡ), aldosterone (ALD), renal blood flow and renal function of patients with chronic severe hepatitis and explore mechanisms of medical ozone therapy in the treatment of severe hepatitis.Methods Eighty-five cases with chronic severe hepatitis were randomly divided into ozone therapy group (43 cases)and control group (42 cases). The patients in the ozone therapy group were treated with basic treatments plus ozone therapy system. Basic autohemotherapy was used. One hundred milliliter venous blood was drawn from each patient,and was mixed with 100 ml (35 μg/ml) medical ozone and then was returned the blood to the patient intravenously, once every other day for 20 days. Only the basic treatments were given to the control group. PRA, All, ALD, renal blood flow and damage to renal function of the two groups before treatment and 20 days after treatment were compared. Survival rates were also compared.Results Twenty days after the treatment, in ozone therapy group, PRA was (1.31±0.12) ng·ml-1·h-1, All (111.25±17.35)pg/ml, ALD (251.31 ±22.60) pg/ml, which decreased significantly compared with those before treatment (PRA (2.23±0.13)ng·ml-1 ·h1, AⅡ (155.18±19.13) pg/ml, ALD (405.31±29.88) pg/ml, t=4.67-14.23, P <0.01), also lower than those of control group 20 days after the treatment (PRA (2.02±0.11) ng·ml-1·h-1, All (162.21±15.32) pg/ml, ALD (401.20±35.02) pg/ml,t=4.97-15.61, P <0.01); renal blood flow was (175.15±28.20) ml/min, which increased compared with that before the treatment ((125.68±21.25) ml/min) and was higher than that of control group 20 days after the treatment

  20. Addressing the general medical needs of a patient with an altered mental state.

    Science.gov (United States)

    Boyer, Jenny L; Ginzburg, Harold M; Shah, Parind; Ardoin, Stan

    2008-12-01

    Patients presenting to an Emergency Department with an altered mental state, whether from a psychiatric, medical or surgical condition or a combination of psychiatric and medical or surgical conditions, require more than the usual amount of diagnostic acumen. General medical conditions often appear in the guise of dysfunctional emotions and/or behaviors. Acute and chronic psychosis may mask underlying acute and chronic medical and surgical conditions. As the case of Esmin Green of Brooklyn, New York, illustrates, the failure to identify underlying medical and surgical conditions in delirious, demented, or psychotic patients can prove fatal to the patient and economically costly to the medical center and its employees.

  1. Cannabinoids: Medical implications.

    Science.gov (United States)

    Schrot, Richard J; Hubbard, John R

    2016-01-01

    Herbal cannabis has been used for thousands of years for medical purposes. With elucidation of the chemical structures of tetrahydrocannabinol (THC) and cannabidiol (CBD) and with discovery of the human endocannabinoid system, the medical usefulness of cannabinoids has been more intensively explored. While more randomized clinical trials are needed for some medical conditions, other medical disorders, like chronic cancer and neuropathic pain and certain symptoms of multiple sclerosis, have substantial evidence supporting cannabinoid efficacy. While herbal cannabis has not met rigorous FDA standards for medical approval, specific well-characterized cannabinoids have met those standards. Where medical cannabis is legal, patients typically see a physician who "certifies" that a benefit may result. Physicians must consider important patient selection criteria such as failure of standard medical treatment for a debilitating medical disorder. Medical cannabis patients must be informed about potential adverse effects, such as acute impairment of memory, coordination and judgment, and possible chronic effects, such as cannabis use disorder, cognitive impairment, and chronic bronchitis. In addition, social dysfunction may result at work/school, and there is increased possibility of motor vehicle accidents. Novel ways to manipulate the endocannbinoid system are being explored to maximize benefits of cannabinoid therapy and lessen possible harmful effects.

  2. Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil

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    L.S.C. Coelho

    2014-09-01

    Full Text Available The objective of the present study was to estimate the prevalence of chronic pelvic pain in the community of São Luís, capital of the State of Maranhão, Northeastern Brazil, and to identify independent conditions associated with it. A cross-sectional study was conducted, including a sample of 1470 women older than 14 years predominantly served by the public health system. The interviews were held in the subject's home by trained interviewers not affiliated with the public health services of the municipality. The homes were visited at random according to the city map and the prevalence of the condition was estimated. To identify the associated conditions, the significant variables (P=0.10 were selected and entered in a multivariate analysis model. Data are reported as odds ratio and 95% confidence interval, with the level of significance set at 0.05. The prevalence of chronic pelvic pain was 19.0%. The independent conditions associated with this diagnosis were: dyspareunia (OR=3.94, premenopausal status (OR=2.95, depressive symptoms (OR=2.33, dysmenorrhea (OR=1.77, smoking (OR=1.72, irregular menstrual flow (OR=1.62, and irritative bladder symptoms (OR=1.90. The prevalence of chronic pelvic pain in Sao Luís is high and is associated with the conditions cited above. Guidelines based on prevention and/or early identification of risk factors may reduce the prevalence of chronic pelvic pain in São Luís, Brazil.

  3. A New Measure for Assessing the Physical Activity Behaviors of Persons with Disabilities and Chronic Health Conditions: The Physical Activity and Disability Survey.

    Science.gov (United States)

    Rimmer, James H.; Riley, Barth B.; Rubin, Stephen S.

    2001-01-01

    Assessed the psychometric properties of the Physical Activity and Disability Survey (PADS), which measures physical activity for people with disabilities and chronic health conditions. Cross-sectional and pre-post designs were employed with 103 people who had disabilities and chronic health conditions. Results supported the PADS' reliability and…

  4. DIAGNOSIS AND MEDICAL AND SURGICAL MANAGEMENT OF CHRONIC INFECTIOUS FIBRINOUS PLEURITIS IN AN OKAPI (OKAPIA JOHNSTONI).

    Science.gov (United States)

    Franzen, Dana; Lamberski, Nadine; Zuba, Jeffery; Richardson, G Lynn; Fischer, A T; Rantanen, Norman W

    2015-06-01

    A 10-yr-old female okapi (Okapia johnstoni) at the San Diego Zoo Safari Park was evaluated for intermittent malaise, inappetence, occasional cough, abdominal splinting, and licking at both flanks. Physical examination revealed tachypnea, tachycardia, and fluid sounds on thoracic auscultation. Transthoracic ultrasound showed multiple uniform, anechoic filled structures in the right and left pleural space. Surgical exploration of the thoracic cavity revealed bilateral, mature, fibrous, compartmentalizing adhesions between the visceral and parietal pleura, confirming a diagnosis of chronic, infectious, fibrinous pleuritis. The suspected etiology was occult aspiration pneumonia secondary to historical episodes of regurgitation associated with general anesthesia. Culture of the pleural fluid and fibrous adhesions grew Trueperella (Arcanobacterium) pyogenes, Arcanobacterium haemolyticum, and few Fusobacterium species. Treatment consisted of chest-tube placement to establish drainage, thoracic lavage, unilateral surgical debridement, and long-term antibiotics. The animal made a complete clinical recovery over 7 mo.

  5. Dynamic magnetic resonance imaging in the assessment of chronic medical nephropathies with impaired renal function

    Energy Technology Data Exchange (ETDEWEB)

    Dalla-Palma, L.; Pozzi-Mucelli, R.S.; Cova, M.; Meduri, S. [Dept. of Radiology, University of Trieste (Italy); Panzetta, G.; Galli, G. [Hemodialysis Service, Ospedale Maggiore, Trieste (Italy)

    2000-02-01

    We examined the value of dynamic magnetic resonance imaging (MRI) in chronic renal disease with renal insufficiency. In 33 consecutive patients (21 vascular nephropathy, 12 glomerular nephropathy) MRI was performed using a 1.5-T unit and a body coil, with SE T1-weighted (TR/TE = 600/19 ms) and dynamic TFFE T1-weighted sequences (TR/TE = 12/5 ms, flip angle = 25 ) after manual bolus injection (via a cubital vein) of 0.1 mmol/kg Gd-DTPA-BMA. Morphological evaluation was performed in unblinded fashion by three radiologists, evaluating renal size, cortical thickness, and corticomedullary differentiation. Functional analysis was performed by one reviewer. Time-signal intensity curves, peak intensity value (P), time to peak intensity (T), and the P/T ratio were obtained at the cortex, medulla, and pyelocaliceal system of each kidney. The relationship of these parameters to serum creatinine and with creatinine clearance was investigated. A good correlation between morphological features of the kidneys and serum creatinine values was found. Morphological findings could not distinguish between vascular and glomerular nephropathies. A statistically significant correlation (P <0.01) between cortical P, cortical P/T, medullary P, and serum creatinine and creatinine clearance was found. A significant correlation (P <0.01) was also found between cortical T, medullary P/T, T of the excretory system, and creatinine clearance. The cortical T value was significantly higher (P <0.01) in vascular nephropathy than in glomerular nephropathy. Thus in patients with chronic renal failure dynamic MRI shows both morphological and functional changes. Morphological changes are correlated with the degree of renal insufficiency and not with the type of nephropathy; the functional changes seem to differ in vascular from glomerular nephropathies. (orig.)

  6. Cardiovascular safety of new inhaled medications for asthma and chronic obstructive pulmonary disease: a critical review from pharmacist perspective

    Directory of Open Access Journals (Sweden)

    Kwang Choon Yee

    2016-06-01

    Full Text Available Individuals with chronic respiratory disorder often have cardiovascular comorbidities and are more vulnerable to adverse effects from medication. Inhaler medications are effective in managing many respiratory diseases, but some have concern about its potential cardiovascular effect from long-term therapy and inappropriate use of these drugs. In the past few years, new members of inhaled long-acting beta-2 agonists and anticholinergics have become available. Based on the published data we reviewed, the adverse cardiovascular effects of these drugs are relatively low, and largely comparable to existing agents. However, most of the studies have very strict selection criteria for subjects, with limited study periods. Therefore, some level of concern remains with the clinical use of these agents, often in patients with substantial cardiovascular or other comorbidities, and are likely to use these drug for very long periods. Perhaps the monitoring of therapeutic efficacy and toxicity by laboratory methods needs to be further explored. [Int J Res Med Sci 2016; 4(6.000: 1814-1829

  7. Helping a boy with chronic medical problems get on friendly terms with his body and puberty.

    Science.gov (United States)

    Todd, Victoria

    2012-01-01

    "My mom wants me to shave off my facial hair, but I like it. I think it makes me look mature," said sixteen-year-old Alex as he proudly stroked the crop of hairs sprouting from his chin. I was speechless. Why? Because for years I had heard about all the medical things that were wrong with Alex's body. Then, when puberty arrived, his distress about his changing body was intense. So how did psychoanalysis help him get on friendly terms with body changes, even enjoying signs of growing up? We shall see.

  8. Emergency Medical Treatment Needs: Chronic and Acute Exposure to Hazardous Materials.

    Science.gov (United States)

    1982-06-01

    1979, a chlorine gas release resulting from a freight train derailment in Mississauga, Canada, led to the evacuation of nearly 250,000 residents of that...ZNO3ETHYLTIO3-, HYDROCHLORIDE 9 Ni - ACRTANILIDE9 4’ - CLORO -Z-I IETHYLI 2-1PYRROLIDINYL )ETHYL )AHIHO -, DINYOROCHLORIDE 10 Ni - ACETAHILIDE9 2%*6-DCLRO-Z...aldehyde The following medical procedures should be made o Appearance and odor: Colorless liquid or gas with a available to each employee who is exposed to

  9. 离退休老年人群慢性病用药情况调查和分析%Analysis of Chronic Disease Medication in Particular Elderly Population

    Institute of Scientific and Technical Information of China (English)

    王建斌; 张革; 李勇; 吴建波

    2014-01-01

    Objective To summarize experience relating to medication for chronic diseases among retired cadres. Methods A total of 150 elderly residents were chosen to determine their health conditions,categories of medicine for major chronic diseases,non-treatment,drug abuse and rates of adverse drug reactions,respectively. Results The incidence of chronic diseases in elderly people was 100%,126 people took medicine chronically,5. 1 types of medicine were taken per patient,and Adverse Drug Reaction( ADR)rate was nearly 3. 5%. Conclusion The army veteran cadres should follow the rational principle of druguse. Regular expert assessment is beneficial for elders. In addition,drug abuse and incorrect treatment should be forbidden to reduce the risk of adverse drug reac-tion or other negative responses.%目的:通过对一组离退休老年人群慢性病患病及用药情况的调查,总结老年人群慢性病用药经验。方法查阅患者健康档案,统计150名60岁以上离退休老年人群慢性病患病情况、用药品种、主要慢性病用药情况、未用药和超适应症用药情况及用药不良反应发生率。结果慢性病患病率达100%。长期服药126例(84.0%),人均服药5.1种,其中1~5种71例(56.4%),6~10种42例(33.3%),11种以上者13例(10.3%),最多达21种。药物不良反应发生率3.5%。结论老年人多患慢性病,长期服药种类多,严格遵循老年人群用药原则,合理用药,定期专家综合评估,避免用药误区和无指征用药可降低药物不良反应的发生。

  10. Health Disparities in Nonreligious and Religious Older Adults in the United States: A Descriptive Epidemiology of 16 Common Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Alexandra C.H. Nowakowski

    2017-01-01

    Full Text Available In this paper, we compute prevalence estimates for nonreligious and religious people in relation to 16 common chronic conditions in contemporary American society. Using survey data from the National Social Life, Health, and Aging Project, we speak to current debates concerning potential relationships between religion, nonreligion and health in older adult populations with two key findings. First, we show no consistent relationships between religion or nonreligion and chronic condition prevalence. Second, we demonstrate race, sex, and class variations within nonreligious people’s health outcomes consistent with patterns noted in previous analyses of religious populations. In conclusion, we draw out implications for future research concerning the importance of (1 using caution when interpreting correlations between religion (i.e., a privileged social location and health; (2 developing intersectional approaches to religion, nonreligion, and health; and (3 building a diverse base of scholarship concerning nonreligion and health.

  11. The Debrisoft(®) Monofilament Debridement Pad for Use in Acute or Chronic Wounds: A NICE Medical Technology Guidance.

    Science.gov (United States)

    Meads, Catherine; Lovato, Eleonora; Longworth, Louise

    2015-12-01

    As part of its Medical Technology Evaluation Programme, the National Institute for Health and Care Excellence (NICE) invited a manufacturer to provide clinical and economic evidence for the evaluation of the Debrisoft(®) monofilament debridement pad for use in acute or chronic wounds. The University of Birmingham and Brunel University, acting as a consortium, was commissioned to act as an External Assessment Centre (EAC) for NICE, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance issued. The sponsor submitted a simple cost analysis to estimate the costs of using Debrisoft(®) to debride wounds compared with saline and gauze, hydrogel and larvae. Separate analyses were conducted for applications in home and applications in a clinic setting. The analysis took an UK National Health Service (NHS) perspective. It incorporated the costs of the technologies and supplementary technologies (such as dressings) and the costs of their application by a district nurse. The sponsor concluded that Debrisoft(®) was cost saving relative to the comparators. The EAC made amendments to the sponsor analysis to correct for errors and to reflect alternative assumptions. Debrisoft(®) remained cost saving in most analyses and savings ranged from £77 to £222 per patient compared with hydrogel, from £97 to £347 compared with saline and gauze, and from £180 to £484 compared with larvae depending on the assumptions included in the analysis and whether debridement took place in a home or clinic setting. All analyses were severely limited by the available data on effectiveness, in particular a lack of comparative studies and that the effectiveness data for the comparators came from studies reporting different clinical endpoints compared with Debrisoft(®). The Medical Technologies Advisory Committee made a positive recommendation for adoption of Debrisoft(®) and this has been published

  12. Meeting the Challenge of Chronic Conditions in a Sustainable Manner: Building on the AHC Learning.

    Science.gov (United States)

    Delgado, Pedro

    2016-01-01

    The Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease (AHC) set out to achieve three aims: to create a patient- and family-centred approach to manage chronic diseases; to build a network of organizational, regional and provincial teams to share evidence-informed, systems-level solutions and work together to develop, implement and sustain improvement initiatives; and to promote the sustainability of the participating health systems. Important elements of all three aims were achieved and the synthesis provides a meaningful contribution to systems working to improve chronic care. This paper explores those achievements as well as some of the areas for improvement, including replicability, expanded outcome measurement, greater detail around patient and family engagement, increased focus on specific outcomes and processes, and further articulation of lessons learned and recommendations.

  13. Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators.

    Science.gov (United States)

    Ehrlich, Carolyn; Kendall, Elizabeth; Muenchberger, Heidi

    2012-08-01

    People with complex chronic conditions frequently need to navigate their own way through and around a fragmented and siloed health care system. Care coordination is a defining principle of primary care and is frequently proposed as a solution to this problem. However, care coordination requires more time and effort than primary care physicians alone have the capacity to deliver. Although registered nurses (RNs) are skilled team members who can be included in the delivery of coordinated patient care, any model of care coordination that involves RNs needs to fit within the existing health care delivery system. In this study, which used qualitative techniques based on grounded theory and included face-to-face interviews and open coding and theoretical sampling until data saturation was achieved, and which was one component of a larger action research study, we aimed to gain an understanding of the difference between usual chronic condition care and the work of chronic condition care coordination. The researchers interviewed general practitioners and RNs from various general practice sites who were actively coordinating care. Four unique processes were found to define care coordination implementation, namely: (1) moving beyond usual practice by spanning boundaries; (2) relationship-based care; (3) agreed roles and routines among relevant parties; and (4) committing to chronic condition care coordination. The findings suggested that existing professional and organisational cultures required negotiation before care coordination could be integrated into existing contexts. The challenge, however, seems to be in acknowledging and overcoming professional practice boundaries that define existing care through reflective practice and shared resourcing.

  14. Trends, productivity losses, and associated medical conditions among toxoplasmosis deaths in the United States, 2000-2010.

    Science.gov (United States)

    Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank

    2014-11-01

    Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000-2010. A matched case-control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups.

  15. Forging partnerships between rural women with chronic conditions and their health care providers.

    Science.gov (United States)

    Cudney, Shirley; Weinert, Clarann; Kinion, Elizabeth

    2011-03-01

    Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

  16. Management of adaptation of graduates of medical schools to conditions of independent professional activity: research and optimization

    Directory of Open Access Journals (Sweden)

    Erugina M.V.

    2014-03-01

    Full Text Available The Objective: research of regularities of adaptation of graduates of medical schools to conditions of independent professional activity and justification of the directions of optimization of management by this process. Material and Methods. Object of research included functioning of system of adaptation of graduates of medical schools to conditions of independent professional activity. Are carried out: The study of reports of the Saratov region for 2006-2012, documentation of 16 treatment-and-prophylactic medical organizations and 84 responses on graduates of Saratov State Medical University n.a. V. I. Razumovsky; anonymous retrospective questioning of 164 doctors after professional retraining at the faculty of professional development; expert questionnaire of 15 persons of the faculty of organizational chairs have been carried out. Results. In the work "complex adaptation factor"; dynamics of level of social and psychological, psychophysiological, organizational and professional indicators of adaptation of graduates to conditions of independent professional activity; the characteristic of "lagging behind" doctors; purposes of management of adaptation, importance of stages of its organizational support have been established. The ways to evaluate the success of individual adaptation and management of this process have been worked out, which are designed on the basis of the corresponding authorized optimization technology. Conclusion. Results of the conducted research allowed to expand idea of adaptation of graduates of medical schools to conditions of independent professional activity and to solve a number of applied problems of its optimization.

  17. Behaviour change and social blinkers? The role of sociology in trials of self-management behaviour in chronic conditions.

    Science.gov (United States)

    Ong, Bie Nio; Rogers, Anne; Kennedy, Anne; Bower, Peter; Sanders, Tom; Morden, Andrew; Cheraghi-Sohi, Sudeh; Richardson, Jane C; Stevenson, Fiona

    2014-02-01

    Individual-focused self-management interventions are one response to both an ageing society and the purported increase in chronic conditions. They tend to draw on psychological theories in self-management interventions, but over-reliance on these theories can reinforce a narrow focus on specified attitudinal and behavioural processes, omitting aspects of living with a chronic condition. While advances have been made in health behaviour change theory and practice, scant attention has been paid to the social, with the question of social context remaining under-theorised and under-explored empirically. This is particularly noticeable in trials of behaviour change interventions for self-management. The common sociological critique is that these ignore context and thus no explanation can be given as to why, for whom and under what circumstances a treatment works. Conversely, sociologists are criticised for offering no positive suggestions as to how context can be taken into account and for over-emphasising context with the risk of inhibiting innovation. This article provides an overview of these issues and provides examples of how context can be incorporated into the rigid method of trials of self-management for chronic conditions. We discuss modifications to both trial interventions and design that make constructive use of the concept of context.

  18. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications.

    Science.gov (United States)

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.

  19. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications

    Science.gov (United States)

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service. PMID:27559474

  20. Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions: ExMC Pharmacy Research Plan

    Science.gov (United States)

    Antonsen, Erik

    2016-01-01

    The Exploration Medical Capabilities (ExMC) Element of NASA's Human Research Program is charged with identifying medical capabilities that can address the challenges of prevention, diagnosis, and treatment of disease and injuries that could occur during exploration missions beyond Earth's orbit. Faced with the obstacle of access to in-flight medical care, and limitations of vehicle space, time, and communications; it is necessary to prioritize what medical consumables are manifested for the flight, and which medical conditions are addressed. Studies of astronaut health establish the incidence of common and high risk medical conditions that require medical intervention during long-duration exploration missions. In 2000, the Institute of Medicine (IOM) convened a committee of experts, Committee on Creating a Vision for Space Medicine during Travel beyond Earth Orbit, to examine the issues surrounding astronaut health and safety for long duration space missions. Two themes run throughout the committee's final report: (1) that not enough is known about the risks to human health during long-duration missions beyond Earth's orbit or about what can effectively mitigate those risks to enable humans to travel and work safely in the environment of deep space and (2) that everything reasonable should be done to gain the necessary information before humans are sent on missions of space exploration (IOM, 2001). Although several spaceflight focused pharmaceutical research studies have been conducted, few have provided sufficient data regarding medication usage or potency changes during spaceflight. The Du pharmaceutical stability study assessed medications flown on space shuttles to and from the International Space Station (ISS) from 2006 until 2008; of which some medications were still viable beyond their expiration dates (Du et al, 2011). However, as with many spaceflight studies, the small 'n' associated with this study limits the ability to draw strong conclusions from it

  1. Which chronic conditions are associated with better or poorer quality of life?

    NARCIS (Netherlands)

    Sprangers, MAG; de Regt, EB; Andries, F; van Agt, HME; Bijl, RV; de Boer, JB; Foets, M; Hoeymans, N; Jacobs, AE; Kempen, GIJM; Miedema, HS; Tijhuis, MAR; de Haes, HJM; de Haes, J.C.J.M.

    2000-01-01

    The objective of the present study is to compare the QL of a wide range of chronic disease patients. Secondary analysis of eight existing data sets, including over 15,000 patients, was performed. The studies were conducted between 1993 and 1996 and included population-based samples, referred samples

  2. Changes in hospitalizations due to opportunistic infections, chronic conditions and other causes among HIV patients (1989–2011. A study in a HIV unit

    Directory of Open Access Journals (Sweden)

    C Redondo Sanchez

    2012-11-01

    Full Text Available Background: Reduction in mortality and morbidity in HIV patients due to the introduction of HAART have resulted in changes in patterns of hospital admissions. Objective: To examine trends of HIV patients hospital admissions. Design and method: Serial cross-sectional analysis of HIV-hospitalized patients from 1989 to 2011 in an HIV Care Unit. Each hospitalization was classified as major categories: opportunistic infections, other infections, drug-related admissions, chronic hepatopathy, AIDS and non-AIDS-related tumours and chronic medical conditions (COPD, diabetes and as specific diagnosis: tuberculosis, PCP, CMV, bacterial pneumonia and others. We considered 4 periods of time: pre-HAART, 1989–1996; early HAART, 1997–2001; intermediate HAART, 2002–2006; and present HAART, 2007–2011. Results: We evaluated 2588 admissions. 20.7% of patients were unaware of HIV infection before first admission; this proportion did not change along the time (p=0.27. No previous outpatient follow-up was seen in 34.9% of patients. There were differences in diagnosis, mortality, age and mean inpatient stay time (Table 1 between the analyzed periods of time. Conclusions: (i HAART and older age have changed the pattern of hospital admissions with a decrease of OI-related admissions and an increase of chronic diseases and non-AIDS-related tumours and with a decrease in mortality and length of inpatient stay. (ii Proportion of patients with unknown HIV serostatus before admission has not changed along the time. (iii Pneumonia, respiratory tract infection and tuberculosis were the more common causes of admission.

  3. ls with Chronic Conditions Want More Guidance from Health Professionals in Finding Quality Online Health SourcesIndividua

    Directory of Open Access Journals (Sweden)

    Cari Merkley

    2016-04-01

    Full Text Available Objective – To explore how and when individuals with chronic health conditions seek out health information online, and the challenges they encounter when doing so. Design – Qualitative study employing thematic analysis. Setting – Urban Western Australia. Subjects – 17 men and women between 19 and 85 years of age with at least 1 chronic health condition. Methods – Participants were recruited in late 2013 at nine local pharmacies, through local radio, media channels, and a university's social media channels. Participants were adult English speakers who had looked for information on their chronic health condition(s using the Internet. Semi-structured face-to-face interviews were conducted with each participant, audio recorded, and transcribed. The transcripts were coded in QSR Nvivo using two different processes – an initial data-driven inductive approach to coding, followed by a theory driven analysis of the data. Main Results – Three major themes emerged: trust, patient activation, and relevance. Many of the participants expressed trust both in health professionals and in the efficacy of search engines like Google. However, there was uncertainty about the quality of some of the health information sources found. Searching for information online was seen by some participants as a way to feel more empowered about their condition(s and treatment, but they reported frustration in finding information that was relevant to their specific condition(s given the volume of information available. Low health literacy emerged in participant interviews as an intrinsic barrier to effective online searches for health information, along with low patient motivation and lack of time. The many extrinsic barriers identified included difficulty determining the quality of information found, the accessibility of the information (e.g., journal paywalls, and poor relationships with health care providers. Conclusion – Individuals look for online health

  4. Skin diseases and conditions among students of a medical college in southern India

    Directory of Open Access Journals (Sweden)

    Nitin Joseph

    2014-01-01

    Conclusion: Skin disorders, particularly the cosmetic problems are very common among medical students. Gender and place of origin were found to significantly influence the development of certain morbidities.

  5. Health-related quality of life (HRQL) for individuals with self-reported chronic physical and/or mental health conditions

    DEFF Research Database (Denmark)

    Bayliss, Martha; Rendas-Baum, Regina; White, Michelle K

    2012-01-01

    In the US, approximately 53% of adults have at least one chronic condition. Comorbid physical and mental health conditions often have an incremental negative impact on health-related quality of life (HRQL). Primary study objectives were to quantify the impact on HRQL of a) ≥ 1 physical condition...... , b) ≥ 1 comorbid mental health conditions added to a physical one, c) ≥ 1 mental health condition, and d) ≥ 1 comorbid physical conditions added to at least one related to mental health. Decrements were based on a "Healthy" reference group reporting no chronic conditions....

  6. Acute and chronic effects of selective serotonin reuptake inhibitor treatment on fear conditioning: implications for underlying fear circuits.

    Science.gov (United States)

    Burghardt, N S; Bauer, E P

    2013-09-01

    Selective serotonin reuptake inhibitors (SSRIs) are widely used for the treatment of a spectrum of anxiety disorders, yet paradoxically they may increase symptoms of anxiety when treatment is first initiated. Despite extensive research over the past 30 years focused on SSRI treatment, the precise mechanisms by which SSRIs exert these opposing acute and chronic effects on anxiety remain unknown. By testing the behavioral effects of SSRI treatment on Pavlovian fear conditioning, a well characterized model of emotional learning, we have the opportunity to identify how SSRIs affect the functioning of specific brain regions, including the amygdala, bed nucleus of the stria terminalis (BNST) and hippocampus. In this review, we first define different stages of learning involved in cued and context fear conditioning and describe the neural circuits underlying these processes. We examine the results of numerous rodent studies investigating how acute SSRI treatment modulates fear learning and relate these effects to the known functions of serotonin in specific brain regions. With these findings, we propose a model by which acute SSRI administration, by altering neural activity in the extended amygdala and hippocampus, enhances both acquisition and expression of cued fear conditioning, but impairs the expression of contextual fear conditioning. Finally, we review the literature examining the effects of chronic SSRI treatment on fear conditioning in rodents and describe how downregulation of N-methyl-d-aspartate (NMDA) receptors in the amygdala and hippocampus may mediate the impairments in fear learning and memory that are reported. While long-term SSRI treatment effectively reduces symptoms of anxiety, their disruptive effects on fear learning should be kept in mind when combining chronic SSRI treatment and learning-based therapies, such as cognitive behavioral therapy.

  7. Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review

    Science.gov (United States)

    Harris, Lauren; Ploeg, Jenny; Markle-Reid, Maureen; Valaitis, Ruta; Ibrahim, Sarah; Gafni, Amiram; Isaacs, Sandra

    2016-01-01

    Background The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. Objectives The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. Methods A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. Results We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing m

  8. Plasma cortisol activity in rats under conditions of chronic stress supplemented with resveratrol

    Directory of Open Access Journals (Sweden)

    Miryam Vélez-Marín

    2012-09-01

    Full Text Available Normal 0 21 false false false ES-CO X-NONE X-NONE Objective: Determine the activity of cortisol in rats treated with exogenous ACTH and a resveratrol supplement. Methodology; Forty-eight adult male rats and 16 adult female rats (Rattus norvegicus three months old with a body weight of 200 to 250g and 300 to 350g for both male and female were used and kept in controlled environmental conditions, temperature of 20±2°C and light-dark cycles of 14 and 10 hours. They were fed with balanced food and had free access to water. The rats were randomly divided into four groups: group 1, was treated with 5 µg/kg of ACTH i.p. every twelve hours; group 2, received the same treatment with ACTH plus a grape extract supplementation of 40 mg/Kg; group 3, only received grape extract and group 4, served as control and only received saline solution (0,9% i.p. The experimental was designed as a 2×2 factorial with two ACTH levels and two extract grape levels. Results:  Significant differences were not found in cortisol concentrations for day, gender or treatment effects (0.75ug/dl ± 0.11; p Conclusion: Results suggest that chronic stress and consume of resveratrol did not produce any effect in the activity of plasmatic cortisol, in stressed and unstressed rats stressed. In the same way, possibly, dose of ACTH did not produce stimulation of the suprarenal gland for these animals. Key words: ACTH, adrenal, cortisol, stress, rat wistar, resveratrol.RESUMEN Objetivo: Determinar la actividad de cortisol en ratas tratadas con ACTH exógena y un suplemento de resveratrol. Metodología: Se utilizaron 48 ratas hembras adultas y 16 machos de la cepa wistar (Rattus norvegicus de tres meses de edad y con un peso corporal de 200-250g y 300-350, para hembras y machos, respectivamente, los cuales permanecieron bajo condiciones ambientales controladas, temperatura 20±2°C de ciclos de luz-oscuridad de 14 y 10 horas, respectivamente. Se les proporcionó alimento balanceado con

  9. Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

    Directory of Open Access Journals (Sweden)

    Erro Janet

    2004-07-01

    Full Text Available Abstract Background Although back pain is the most common reason patients use complementary and alternative medical (CAM therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. Methods We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months of 70% of the patients with such diagnoses and all eligible respondents were interviewed. Results Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively, mostly for back pain (45% and 24%, respectively. Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23% than users of other therapies (5–16%. Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale and meditation least helpful (median of 3 in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. Conclusions Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional

  10. Unraveling dynamics of human physical activity patterns in chronic pain conditions

    Science.gov (United States)

    Paraschiv-Ionescu, Anisoara; Buchser, Eric; Aminian, Kamiar

    2013-06-01

    Chronic pain is a complex disabling experience that negatively affects the cognitive, affective and physical functions as well as behavior. Although the interaction between chronic pain and physical functioning is a well-accepted paradigm in clinical research, the understanding of how pain affects individuals' daily life behavior remains a challenging task. Here we develop a methodological framework allowing to objectively document disruptive pain related interferences on real-life physical activity. The results reveal that meaningful information is contained in the temporal dynamics of activity patterns and an analytical model based on the theory of bivariate point processes can be used to describe physical activity behavior. The model parameters capture the dynamic interdependence between periods and events and determine a `signature' of activity pattern. The study is likely to contribute to the clinical understanding of complex pain/disease-related behaviors and establish a unified mathematical framework to quantify the complex dynamics of various human activities.

  11. An Open-Label Study of an Herbal Topical Medication (QoolSkin for Patients with Chronic Plaque Psoriasis

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    Arnon D. Cohen

    2007-01-01

    Full Text Available QoolSkin is novel herbal topical medication indicated for the treatment of patients with psoriasis and we endeavored to determine the efficacy of QoolSkin in patients with chronic plaque psoriasis. In an open-label, parallel-group study conducted at four sites in Israel, patients with chronic plaque psoriasis were treated by application of QoolSkin two to three times per day, for a period of 16 weeks. Clinical assessment was performed using the Psoriasis Area and Severity Index (PASI and the Beer-Sheva Psoriasis Severity Score (BPSS. The study included 100 patients (48 men, 52 women; age 18–65 years. QoolSkin was well tolerated and there were no local or systemic side effects. There was a 19% reduction in PASI, from a mean of 9.8 ± 9.5 before treatment to 8.0 ± 9.6 after treatment (p = 0.09. There was a 20% reduction in BPSS, from a mean of 16.1 ± 9.8 before treatment to 12.8 ± 10.6 after treatment (p = 0.01. The reduction in PASI and BPSS was pronounced in women (32 and 31%, respectively as compared to men (9 and 11%, respectively. The reduction in PASI and BPSS was parallel to the length of time the patients were treated by QoolSkin. In patients treated by one of the investigators, who applied QoolSkin three times per day and for a long period of time (mean 101.1 days, the reduction in PASI was 32.0% and the reduction in BPSS was 37.8%. In patients with chronic plaque psoriasis, QoolSkin treatment was well tolerated. Application of QoolSkin was associated with a decrease in disease severity, as assessed by the patients and physicians. Application of QoolSkin three times per day for long period is associated with a better response to treatment.

  12. Men in extreme conditions: some medical and psychological aspects of the Auschwitz concentration camp.

    Science.gov (United States)

    Radil-Weiss, T

    1983-08-01

    The second world war ended many years ago. Most of those who survived the stay at the German concentration camp at Auschwitz have already died of the consequences of their imprisonment; those still alive are already in the last third of their life. Is there any point in returning to the experiences of those days? Consideration of the mental hygiene of former prisoners cautions us that perhaps we should not do it. But consideration of the general interest holds that we are not entitled to ignore any knowledge that can contribute to social development--including medicine and psychology--even if acquired under unspeakably awful conditions. In addition, since the war new generations have grown up that play an increasingly significant role in various spheres of life but have little concrete information about those events; they can neither rationally nor emotionally understand how the horrors connected with fascism and the war could have happened. In a sense it is encouraging that they cannot grasp such inhuman behavior; nevertheless, we must adhere to the following motto: "Nothing must be forgotten, nobody will be forgotten." We owe it to those millions who did not survive--both the victims of the Holocaust and those who fought against it. These are arguments in favor of returning to the facts that are ineffaceably recorded somewhere in our memories. In doing so, however, we must remember that at times we are revisiting experiences of a boy of 14 as recalled by a 50-year-old man. The material below, examining the medical as well as psychological aspects of imprisonment at Auschwitz, is based on my own memories, as an adolescent imprisoned at Auschwitz. I have tried to move from this individual account to more general statements, although the methodological apparatus on which scientific analysis is usually based is absent.

  13. E-learning module on chronic low back pain in older adults: evidence of effect on medical student objective structured clinical examination performance.

    Science.gov (United States)

    Weiner, Debra K; Morone, Natalia E; Spallek, Heiko; Karp, Jordan F; Schneider, Michael; Washburn, Carol; Dziabiak, Michael P; Hennon, John G; Elnicki, D Michael

    2014-06-01

    The Institute of Medicine has highlighted the urgent need to close undergraduate and graduate educational gaps in treating pain. Chronic low back pain (CLBP) is one of the most common pain conditions, and older adults are particularly vulnerable to potential morbidities associated with misinformed treatment. An e-learning case-based interactive module was developed at the University of Pittsburgh Center of Excellence in Pain Education, one of 12 National Institutes of Health-designated centers, to teach students important principles for evaluating and managing CLBP in older adults. A team of six experts in education, information technology, pain management, and geriatrics developed the module. Teaching focused on common errors, interactivity, and expert modeling and feedback. The module mimicked a patient encounter using a standardized patient (the older adult with CLBP) and a pain expert (the patient provider). Twenty-eight medical students were not exposed to the module (Group 1) and 27 were exposed (Group 2). Their clinical skills in evaluating CLBP were assessed using an objective structured clinical examination (OSCE). Mean scores were 62.0 ± 8.6 for Group 1 and 79.5 ± 10.4 for Group 2 (P students (60.7%) and 26 of 27 Group 2 students (96.3%) passed. The CLBP OSCE was one of 10 OSCE stations in which students were tested at the end of a Combined Ambulatory Medicine and Pediatrics Clerkship. There were no between-group differences in performance on eight of the other nine OSCE stations. This module significantly improved medical student clinical skills in evaluating CLBP. Additional research is needed to ascertain the effect of e-learning modules on more-advanced learners and on improving the care of older adults with CLBP.

  14. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Science.gov (United States)

    2010-10-01

    ... a doctor of medicine, osteopathy, or podiatric medicine. (a) Standard: Plan of care. The plan of..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE... HEALTH SERVICES Administration § 484.18 Condition of participation: Acceptance of patients, plan of...

  15. Cannabinoid modulation of chronic mild stress-induced selective enhancement of trace fear conditioning in adolescent rats.

    Science.gov (United States)

    Reich, Christian G; Iskander, Anthony N; Weiss, Michael S

    2013-10-01

    History of stress is considered a major risk factor for the development of major depression and posttraumatic stress disorder (PTSD). Elucidating the neurobiological mechanisms of Pavlovian fear conditioning may provide insight into the etiology of PTSD. In the current study, adolescent male Sprague-Dawley rats were exposed to 3 weeks of a chronic-mild-unpredictable stress (CMS) protocol. Immediately following the CMS, the animals were subjected to hippocampal-dependent (trace and contextual) and hippocampal-independent (delay) fear conditioning. CMS exposure enhanced trace freezing behavior compared to non-stress controls. This effect was not observed in contextual or delay conditioned animals. Given that the endocannabinoid system is negatively affected by CMS procedures, separate groups of stressed rats were administered the CB1 receptor agonist, ACEA (0.1 mg/kg), prior to trace fear conditioning or a memory-recall test. Regardless of administration time, ACEA significantly reduced freezing behavior in stressed animals. Furthermore, when administered during the first memory recall test, ACEA enhanced long-term extinction in both stress and non-stress groups. The results demonstrate that chronic unpredictable stress selectively enhances hippocampal-dependent episodic fear memories. Pathologies of the episodic memory and fear response may increase the susceptibility of developing PTSD. Reduction in fear responses via exogenous activation of the CB1 receptor suggests that a deficiency in the endocannabinoid system contributes to this pathology.

  16. Nine children over the age of one year with full trisomy 13: a case series describing medical conditions.

    Science.gov (United States)

    Bruns, Deborah A; Campbell, Emily

    2014-12-01

    Trisomy 13 (Patau syndrome), identified by Patau and colleagues [1960; Lancet 1: 790-793] is the third most common autosomal condition. Population studies indicate less than one in 10 children reaches their first birthday. In the face of mixed findings and recommendations for treatment, additional research is needed to further determine what contributes to longevity and implications for treatment for presenting medical conditions. The purpose of the present study is to report on presenting medical conditions and the presence or absence of the specific conditions (age at survey completion). Data on nine survivors (seven female, two male) with trisomy 13 indicated mean gestational age of approximately 36 weeks, birth weight ranging from 1100 to 3290 g and mean length of 45.3 cm. Length of hospital stay after birth varied. The majority of infants presented with well-known physical characteristics. Medical conditions and their treatment varied at birth and at survey completion. Notably, several infants' cardiac anomalies resolved without surgical intervention. Surgeries were provided for a range of conditions including gastrostomy tube placement to address feeding issues and removal of intestinal blockage. There were no reports of holoprosencephaly. Implications and recommendations are provided.

  17. Content of NCAM in the brain and pancreas of rats in response to endointoxication under conditions of experimental chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    V. A. Makarchuk

    2014-08-01

    Full Text Available The study was undertaken to examine the influence of chronic pancreatitis on the distribution of neuronal cell adhesion molecule (NCAM in the pancreas and various brain regions of rats under the conditions of endogenous intoxication. The study was conducted using 36 white nonlinear male rats (6 months old, 190–220 g. To develop the state of chronic pancreatitis, animals were subjected tolaparotomy under general anesthesia and prolonged occlusion of the pancreatic duct. The morphological examination of pancreatic tissue hasbeen performed to confirm the chronic pancreatitis development in animals. Biochemical evaluation of the pancreatic fibrosis has been performed by measuring plasma levels of hyaluronic acid, hydroxyproline and protein-free hydroxyproline. The intensity of free radical oxidation has been assessed by the change in the concentration of TBA-active products in plasma. The level of endotoxemia has been determinedby the content of average weight molecules in plasma. Protein fractions were extracted from the pancreas and various parts of the rat brain and the levels of soluble (sNCAM and membrane (mNCAM proteins were studied with the use of the competitive ELISA. Total protein in the obtained fractions was measured by the Bradford assay. Occlusion of the pancreatic duct resultedin significant atrophy of acinar tissue, fibrosis and disfunction of the pancreas along with the decreasing in the antioxidant defense of animals. The present study shows developing of endointoxication in experimentalrats, signified by considerable increase of molecules with average weight in plasma due to the activation of lipid peroxidation. It was established that, as a result of the experimental pancreas dysfunction, significant redistribution of soluble and membrane forms of NCAM took place, more especially in the cerebellum and thalamus of rats; it caused changing of cell-cell adhesion in these brain regions. Multidirectional NCAM distribution in the

  18. Adolescent rats are resistant to the development of ethanol-induced chronic tolerance and ethanol-induced conditioned aversion.

    Science.gov (United States)

    Pautassi, Ricardo Marcos; Godoy, Juan Carlos; Molina, Juan Carlos

    2015-11-01

    The analysis of chronic tolerance to ethanol in adult and adolescent rats has yielded mixed results. Tolerance to some effects of ethanol has been reported in adolescents, yet other studies found adults to exhibit greater tolerance than adolescents or comparable expression of the phenomena at both ages. Another unanswered question is how chronic ethanol exposure affects subsequent ethanol-mediated motivational learning at these ages. The present study examined the development of chronic tolerance to ethanol's hypothermic and motor stimulating effects, and subsequent acquisition of ethanol-mediated odor conditioning, in adolescent and adult male Wistar rats given every-other-day intragastric administrations of ethanol. Adolescent and adult rats exhibited lack of tolerance to the hypothermic effects of ethanol during an induction phase; whereas adults, but not adolescents, exhibited a trend towards a reduction in hypothermia at a challenge phase (Experiment 1). Adolescents, unlike adults, exhibited ethanol-induced motor activation after the first ethanol administration. Adults, but not adolescents, exhibited conditioned odor aversion by ethanol. Subsequent experiments conducted only in adolescents (Experiment 2, Experiment 3 and Experiment 4) manipulated the context, length and predictability of ethanol administration. These manipulations did not promote the expression of ethanol-induced tolerance. This study indicated that, when moderate ethanol doses are given every-other day for a relatively short period, adolescents are less likely than adults to develop chronic tolerance to ethanol-induced hypothermia. This resistance to tolerance development could limit long-term maintenance of ethanol intake. Adolescents, however, exhibited greater sensitivity than adults to the acute motor stimulating effects of ethanol and a blunted response to the aversive effects of ethanol. This pattern of response may put adolescents at risk for early initiation of ethanol intake.

  19. Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

    Directory of Open Access Journals (Sweden)

    Jabaaij Lea

    2012-06-01

    Full Text Available Abstract Background The number of cancer patients and the number of patients surviving initial treatments is expected to rise. Traditionally, follow-up monitoring takes place in secondary care. The contribution of general practice is less visible and not clearly defined. This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. We also examined the influence of comorbid conditions on healthcare utilisation by these patients in general practice. Methods We compared health care use of N=8,703 cancer patients with an age and gender-matched control group of patients without cancer from the same practice. Data originate from the Netherlands Information Network of General Practice (LINH, a representative network consisting of 92 general practices with 350,000 enlisted patients. Health care utilisation was assessed using data on contacts with general practice, prescription and referral rates recorded between 1/1/2001 and 31/12/2007. The existence of additional comorbid chronic conditions (ICPC coded was taken into account. Results Compared to matched controls, cancer patients had more contacts with their GP-practice (19.5 vs. 11.9, p Conclusion We found that cancer patients in the follow-up phase consulted general practice more often and suffered more often from comorbid chronic conditions, compared to patients without cancer. It is expected that the number of cancer patients will rise in the years to come and that primary health care professionals will be more involved in follow-up care. Care for comorbid chronic conditions, communication between specialists and GPs, and coordination of tasks then need special attention.

  20. Intraspecific variation in physiological condition of reef-building corals associated with differential levels of chronic disturbance.

    Directory of Open Access Journals (Sweden)

    Chiara Pisapia

    Full Text Available Even in the absence of major disturbances (e.g., cyclones, bleaching, corals are subject to high levels of partial or whole-colony mortality, often caused by chronic and small-scale disturbances. Depending on levels of background mortality, these chronic disturbances may undermine individual fitness and have significant consequences on the ability of colonies to withstand subsequent acute disturbances or environmental change. This study quantified intraspecific variations in physiological condition (measured based on total lipid content and zooxanthellae density through time in adult colonies of two common and widespread coral species (Acropora spathulata and Pocillopora damicornis, subject to different levels of biological and physical disturbances along the most disturbed reef habitat, the crest. Marked intraspecific variation in the physiological condition of A. spathulata was clearly linked to differences in local disturbance regimes and habitat. Specifically, zooxanthellae density decreased (r2 = 26, df = 5,42, p<0.02, B =  -121255, p = 0.03 and total lipid content increased (r2 = 14, df = 5,42, p = 0.01, B = 0.9, p = 0.01 with increasing distance from exposed crests. Moreover, zooxanthellae density was strongly and negatively correlated with the individual level of partial mortality (r2 = 26, df = 5,42, p<0.02, B =  -7386077, p = 0.01. Conversely, P. damicornis exhibited very limited intraspecific variation in physiological condition, despite marked differences in levels of partial mortality. This is the first study to relate intraspecific variation in the condition of corals to localized differences in chronic disturbance regimes. The next step is to ascertain whether these differences have further ramifications for susceptibility to periodic acute disturbances, such as climate-induced coral bleaching.

  1. Do Workers Underreport Morbidity? The Accuracy of Self-reports of Chronic Conditions

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Jürges, Hendrik

    2012-01-01

    We use matched Danish health survey and register data to investigate discrepancies between register-based diagnoses and self-reported morbidity. We hypothesize that false negatives (medical diagnoses existing in the register but not reported in the survey) arise partly because individuals fear...

  2. Learning about the experience of living with chronic conditions: A framework analysis of nursing students' reflections on their conversations with older adults.

    Science.gov (United States)

    Olson, Amanda; Reiland, Stephanie; Davies, Susan; Koehler, Amy Reitmaier

    2016-10-17

    Preparing nursing students to work effectively with older adults is an important element of undergraduate nursing education. Reflective journals written as course assignments represent a source of data about students' learning. The aim of this study was to analyze nursing students' reflective journals based on conversations with older adults who are community dwelling, to identify learning in relation to experiences of living with a chronic condition. This was one element of a wider study to evaluate learning partnerships between older adults who are community dwelling and nursing students as an alternative to traditional clinical placements in long-term care settings. Nursing students worked with faculty to complete a qualitative secondary analysis of 47 journals utilizing framework analysis. Students learned about three main aspects of living with chronic conditions: beliefs about chronic conditions, managing chronic conditions, and experiencing chronic conditions, with some evidence that these themes may be interconnected. Findings suggest that learning partnerships with older adults combined with reflective journaling enable nursing students to understand the experience of chronic conditions in later life as reflected within current literature and to identify interventions for gerontological nursing practice. Enabling nursing students to recognize the highly skilled nature of working with older adults with chronic illness has the potential to influence their future career choices.

  3. Effects of chronic academic stress on mental state and expression of glucocorticoid receptor α and β isoforms in healthy Japanese medical students.

    Science.gov (United States)

    Kurokawa, Ken; Tanahashi, Toshihito; Murata, Akiho; Akaike, Yoko; Katsuura, Sakurako; Nishida, Kensei; Masuda, Kiyoshi; Kuwano, Yuki; Kawai, Tomoko; Rokutan, Kazuhito

    2011-07-01

    Chronic academic stress responses were assessed by measuring mental state, salivary cortisol levels, and the glucocorticoid receptor (GR) gene expression in healthy Japanese medical students challenging the national medical license examination. Mental states of 17 male and 9 female medical undergraduates, aged 25.0 ± 1.2 years (mean ± SD), were assessed by the State and Trait Anxiety Inventory (STAI) and the Self-Rating Depression Scale (SDS) 2 months before, 2 days before, and 1 month after the examination. At the same time points, saliva and blood were collected. STAI-state scores peaked 2 days before the examination. Scores on STAI-trait and SDS, and salivary cortisol levels were consistently higher during the pre-examination period. One month after the examination, all these measures had significantly decreased to baseline levels. Real-time reverse transcription PCR showed that this chronic anxious state did not change the expression of the functional GRα mRNA isoform in peripheral leukocytes, while it resulted in reduced expression of the GRβ isoform 2 days before the examination. Our results replicate and extend a significant impact of chronic academic stressors on the mental state of healthy Japanese medical students and suggest a possible association of GRβ gene in response to psychological stress.

  4. Chronic Heat Stress and Cognitive Development: An Example of Thermal Conditions Influencing Human Development

    Science.gov (United States)

    Riniolo, Todd C.; Schmidt, Louis A.

    2006-01-01

    Although thermal conditions influence the development of living organisms in a wide variety of ways, this topic has been recently ignored in humans. This paper reintroduces thermal conditions as a topic of importance for developmentalists by presenting an example of how thermal conditions are hypothesized to influence a particular developmental…

  5. Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results

    Directory of Open Access Journals (Sweden)

    Harold G. Koenig

    2012-01-01

    Full Text Available This paper (1 reviews the physical and religious barriers to CBT that disabled medically ill-depressed patients face, (2 discusses research on the relationship between religion and depression-induced physiological changes, (3 describes an ongoing randomized clinical trial of religious versus secular CBT in chronically ill patients with mild-to-moderate major depression designed to (a overcome physical and religious barriers to CBT and (b compare the efficacy of religious versus secular CBT in relieving depression and improving immune and endocrine functions, and (4 presents preliminary results that illustrate the technical difficulties that have been encountered in implementing this trial. CBT is being delivered remotely via instant messaging, telephone, or Skype, and Christian, Jewish, Muslim, Buddhist, and Hindu versions of religious CBT are being developed. The preliminary results described here are particular to the technologies employed in this study and are not results from the CBT clinical trial whose findings will be published in the future after the study ends and data are analyzed. The ultimate goal is to determine if a psychotherapy delivered remotely that integrates patients’ religious resources improves depression more quickly than a therapy that ignores them, and whether religious CBT is more effective than conventional CBT in reversing depression-induced physiological changes.

  6. Multiple Chronic Conditions and Use of Complementary and Alternative Medicine Among US Adults: Results From the 2012 National Health Interview Survey

    Science.gov (United States)

    Shi, Zaixing; Greenlee, Heather

    2016-01-01

    Introduction More than 25% of American adults report having 2 or more chronic conditions. People with chronic conditions often use complementary and alternative medicine (CAM) for self-care and disease management, despite a limited evidence base. Methods Data from the 2012 National Health Interview Survey (NHIS) (n = 33,557) were analyzed to assess associations between presence of multiple chronic conditions (n = 13) and CAM use, using multivariable relative risk and linear regressions weighted for complex NHIS sampling. CAM use was defined as self-reported use of one or more of 16 therapies in the previous 12 months. Results Chronic conditions were common. US adults reported one (22.3%) or 2 or more (33.8%) conditions. Many used at least one form of CAM. Multivitamins, multiminerals, or both (52.7%); vitamins (34.8%); and minerals (28.4%) were the most common. Compared with adults with no conditions, adults with 2 or more conditions were more likely to use multivitamins or multiminerals or both, vitamins, minerals, nonvitamins or herbs, mind–body therapies, chiropractic or osteopathic manipulation, massage, movement therapies, special diets, acupuncture, naturopathy, or some combination of these therapies (P <.003). Conclusion People with multiple chronic conditions have a high prevalence of CAM use. Longitudinal studies are needed to understand the association between CAM use and chronic disease prevention and treatment. PMID:27149072

  7. THE METHODOLOGY FOR CALCULATING OF LABOR COSTS OF MEDICAL PERSONNEL IN MARKET CONDITIONS

    Directory of Open Access Journals (Sweden)

    S. V. Katasonov

    2015-01-01

    Full Text Available The article presents the approximate calculations of working time of physician to work with the patient and documentation. On the base of these calculations they outline the possible ways to optimize the work of the medical staff.

  8. Garre's chronic diffuse sclerosing osteomyelitis of the sacrum: a rare condition mimicking malignancy.

    LENUS (Irish Health Repository)

    Nasir, N

    2012-02-03

    Garre\\'s chronic diffuse sclerosing osteomyelitis (DSOM) is a rare disease that occurs most commonly in the mandible. We present a case of sacral DSOM that simulated an expanding destructive sacral tumour. Treatment was conducted on the basis of the available experience with the mandibular form of the disease, with partial symptomatic relief, but progressive sclerosis of the sacral lesion. To the best of our knowledge, this is the first case initially presenting in the sacrum. As an osteolytic expanding lesion simulating malignancy, it is important to recognize this entity in the sacrum.

  9. Validation of the Danish version of the Patient Assessment of Care for Chronic Conditions questionnaire (PACIC)

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Maindal, Helle Terkildsen; Vedsted, Peter

    18 or more with type1 or type2 diabetes sampled in a national register of people with diabetes. They were sent a Danish version of the PACIC. Main outcome measures: Data quality (mean, median, item response, missing, floor and ceiling effects), internal consistency (Cronbach's alpha and average...... interitem correlation), item-rest correlations. Model fit from confirmatory factor analysis (CFA). Results: We present the psychometric properties of the questionnaire and the first results evaluating chronic care in Danish people with diabetes. Conclusions: The complexity of validation is greater when...

  10. Cognitive impairments in first-episode drug-naive and chronic medicated schizophrenia: MATRICS consensus cognitive battery in a Chinese Han population.

    Science.gov (United States)

    Wu, Jing Qin; Chen, Da Chun; Tan, Yun Long; Xiu, Mei Hong; Yang, Fu De; Soares, Jair C; Zhang, Xiang Yang

    2016-04-30

    Cognitive deficits are a core feature of schizophrenia and we examined the cognitive profile of first-episode and chronic schizophrenia in a Chinese Han population using the MATRICS Consensus Cognitive Battery (MCCB). We recruited 79 first-episode drug-naïve (FEDN) schizophrenia, 132 chronic medicated schizophrenia inpatients and 124 healthy controls. We assessed patient psychopathology using the Positive and Negative Syndrome Scale (PANSS). MCCB total score (pMSCEIT) were significantly higher in FEDN than in chronic patients (all p<0.05). FEDN exhibited relative weakness in continuous performance, whereas chronic patients exhibited relative weakness in mazes. Multiple regression analysis confirmed that in FEDN and chronic patients, total score and negative symptom of PANSS were independent contributors to MCCB total score, respectively. Our results not only demonstrate the applicability of the MCCB as a sensitive measure of cognitive impairment for schizophrenia patients in a Chinese Han population, but also suggest that the compromised cognition is present in the early stage of schizophrenia, some of which could be more severe in the chronic stage of illness.

  11. [Occupational sanitary-and-hygienic conditions and chronic dust bronchitis morbidity in the ore-mining industry of Krivoi Rog region].

    Science.gov (United States)

    Gural', O I

    2005-01-01

    Chronic dust bronchitis morbidity of ore-mining workers is caused not only by high concentration of dust but also conditioned by carbon monoxide, nitric oxide, oil aerosols, unfavorable microclimate as well as different combinations of these adverse agents.

  12. Using the new board game SeCZ TaLK to stimulate the communication on sexual health for adolescents with chronic conditions

    NARCIS (Netherlands)

    Stege, H.A. van der; Staa, A.L. van; Hilberink, S.R.; Visser, A.

    2010-01-01

    This study evaluated the feasibility and appreciation of a new educational board game (SeCZ TaLK) that stimulates communication on sexuality and intimate relationships in youth with chronic conditions.

  13. Microcirculation and structural reorganization of the bladder mucosa in chronic cystitis under conditions of ozone therapy.

    Science.gov (United States)

    Neimark, A I; Nepomnyashchikh, L M; Lushnikova, E L; Bakarev, M A; Abdullaev, N A; Sizov, K A

    2014-01-01

    Structural reorganization of the bladder mucosa in chronic cystitis and its correction by ozone therapy were studied. A relationship between the epithelial layer restructuring of different kinds (dystrophy, metaplasia, and degeneration), level of cell proliferation, and ultrastructural organization of urotheliocytes was detected. This complex of structural reactions was combined with dysregulation of tissue bloodflow in the bladder mucosa, shown by laser Doppler flowmetry. Positive structural changes were most marked in intravesical and less so in parenteral ozone therapy added to the therapeutic complex and manifested in reduction of inflammation and alteration in parallel with more intense reparative reactions. A special feature of parenteral ozone therapy was a significant improvement of microcirculation in the bladder mucosa.

  14. Chronic toxicity of silver nanoparticles to Daphnia magna under different feeding conditions

    DEFF Research Database (Denmark)

    Mackevica, Aiga; Skjolding, Lars Michael; Gergs, Andre

    2015-01-01

    Despite substantial information on the acute toxicity of silver nanoparticles (AgNP) to aquatic organisms, little is known about their potential chronic effects and the applicability of current test guidelines for testing nanomaterials. The purpose of this study was to study the influence of food...... availability on toxicity. This was done through a series of Daphnia magna 21-day reproduction tests (OECD 211) using 30 nm citric acid stabilized AgNP aimed at studying the influence of food abundance on the reproductive toxicity of AgNP in D. magna. The experiments were carried out as static renewal tests...... and reproduction were observed in concentrations higher than 10 mu g Ag/L, whereas the animals exposed to 10 mu g Ag/L had larger body length and produced more offspring than controls at both food treatments. High food treatment resulted in higher animal survival, growth and reproduction compared to result found...

  15. Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition

    Directory of Open Access Journals (Sweden)

    Yu Ri Woo

    2016-09-01

    Full Text Available Rosacea is a chronic cutaneous inflammatory disease that affects the facial skin. Clinically, rosacea can be categorized into papulopustular, erythematotelangiectatic, ocular, and phymatous rosacea. However, the phenotypic presentations of rosacea are more heterogeneous. Although the pathophysiology of rosacea remains to be elucidated, immunologic alterations and neurovascular dysregulation are thought to have important roles in initiating and strengthening the clinical manifestations of rosacea. In this article, we present the possible molecular mechanisms of rosacea based on recent laboratory and clinical studies. We describe the genetic predisposition for rosacea along with its associated diseases, triggering factors, and suggested management options in detail based on the underlying molecular biology. Understanding the molecular pathomechanisms of rosacea will likely aid toward better comprehending its complex pathogenesis.

  16. Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition

    Science.gov (United States)

    Woo, Yu Ri; Lim, Ji Hong; Cho, Dae Ho; Park, Hyun Jeong

    2016-01-01

    Rosacea is a chronic cutaneous inflammatory disease that affects the facial skin. Clinically, rosacea can be categorized into papulopustular, erythematotelangiectatic, ocular, and phymatous rosacea. However, the phenotypic presentations of rosacea are more heterogeneous. Although the pathophysiology of rosacea remains to be elucidated, immunologic alterations and neurovascular dysregulation are thought to have important roles in initiating and strengthening the clinical manifestations of rosacea. In this article, we present the possible molecular mechanisms of rosacea based on recent laboratory and clinical studies. We describe the genetic predisposition for rosacea along with its associated diseases, triggering factors, and suggested management options in detail based on the underlying molecular biology. Understanding the molecular pathomechanisms of rosacea will likely aid toward better comprehending its complex pathogenesis. PMID:27649161

  17. Prenatal and Postnatal Medical Conditions and the Risk of Brain Tumors in Children and Adolescents

    DEFF Research Database (Denmark)

    Tettamanti, Giorgio; Shu, Xiaochen; Adel Fahmideh, Maral

    2017-01-01

    to medical diagnostic radiation, was obtained from CEFALO, a multicenter case-control study performed in Denmark, Norway, Sweden, and Switzerland through face-to-face interview. Eligible cases of childhood and adolescent brain tumors (CABT) were ages 7 to 19 years, diagnosed between January 1, 2004...... and August 31, 2008, and living in the participating countries (n = 352). The cases were matched by age, sex, and region to 646 population-based controls. RESULTS: Prenatal exposure to medical diagnostic radiation and postnatal exposure to X-rays were not associated with CABTs. A higher risk estimate...

  18. Chronic Beryllium Disease

    Science.gov (United States)

    ... Science Education & Training Home Conditions Chronic Beryllium Disease Chronic Beryllium Disease Make an Appointment Find a Doctor ... MD, MSPH, FCCP (February 01, 2016) What is chronic beryllium disease (CBD)? Chronic beryllium disease (CBD) is ...

  19. Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Masaya Takemura

    2011-01-01

    Full Text Available Masaya Takemura1, Katsumi Mitsui2, Ryo Itotani1, Manabu Ishitoko1, Shinko Suzuki1, Masataka Matsumoto1, Kensaku Aihara1, Tsuyoshi Oguma1, Tetsuya Ueda1, Hitoshi Kagioka1, Motonari Fukui11Division of Respiratory Medicine, 2Division of Pharmacy, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Osaka, JapanPurpose: Adherence to inhalation therapy is a critical determinant of the success of chronic obstructive pulmonary disease (COPD management. However, in practice, nonadherence to inhalation therapy is very common in COPD patients. The effects of adherence to inhalation therapy in COPD have not been fully studied, and less is known about the relationship between medication adherence and quality of life in COPD. Our aim is to assess the factors that contribute to adherence to inhalation therapy and examine their correlation with quality of life.Patients and methods: A cross-sectional analysis of 88 COPD patients was performed using a self-reported adherence questionnaire with responses on a 5-point Likert scale.Results: Of the 88 patients who were potential participants, 55 (63% responded with usable information. The only significant factor associated with the overall mean adherence score was receiving repeated instruction about inhalation techniques (P = 0.032. Of the 55 respondents, 22 (40.0% were given repeated verbal instruction and/or demonstrations of inhalation technique by a respiratory physician. Significant correlations were found between the overall mean adherence score and the health-related quality of life score (St George’s Respiratory Questionnaire: total, r = −0.35, P = 0.023; symptoms, r = −0.43, P = 0.002; impacts, r = −0.35, P = 0.011. Furthermore, patients with repeated instruction showed better quality of life scores than those who did not receive instruction (total, P = 0.030; symptoms, P = 0.038; impacts, P = 0.019.Conclusions: Repeated instruction for inhalation techniques may contribute to adherence to

  20. Cognitive-Behavioral Couple Therapies: Review of the Evidence for the Treatment of Relationship Distress, Psychopathology, and Chronic Health Conditions.

    Science.gov (United States)

    Fischer, Melanie S; Baucom, Donald H; Cohen, Matthew J

    2016-09-01

    Cognitive-behavioral couple therapy (CBCT) is an approach to assisting couples that has strong empirical support for alleviating relationship distress. This paper provides a review of the empirical status of CBCT along with behavioral couple therapy (BCT), as well as the evidence for recent applications of CBCT principles to couple-based interventions for individual psychopathology and medical conditions. Several meta-analyses and major reviews have confirmed the efficacy of BCT and CBCT across trials in the United States, Europe, and Australia, and there is little evidence to support differential effectiveness of various forms of couple therapy derived from behavioral principles. A much smaller number of effectiveness studies have shown that successful implementation in community settings is possible, although effect sizes tend to be somewhat lower than those evidenced in randomized controlled trials. Adapted for individual problems, cognitive-behavioral couple-based interventions appear to be at least as effective as individual cognitive behavioral therapy (CBT) across a variety of psychological disorders, and often more effective, especially when partners are substantially involved in treatment. In addition, couple-based interventions tend to have the unique added benefit of improving relationship functioning. Findings on couple-based interventions for medical conditions are more varied and more complex to interpret given the greater range of target outcomes (psychological, relational, and medical variables).

  1. Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions.

    Science.gov (United States)

    DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M

    2013-01-01

    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs.

  2. Spiritually Competent Practice with Individuals and Families Dealing with Medical Conditions

    Science.gov (United States)

    Sperry, Len

    2011-01-01

    Counselors and psychotherapists are increasingly expected to provide services that are spiritually competent. Those counseling individuals and families where medical concerns are a focus would do well to consider the implications of spiritual competence in their work. The article defines spiritual competence, describes spiritual competencies, and…

  3. Treatment of Chronic Cough.

    Science.gov (United States)

    Soni, Resha S; Ebersole, Barbara; Jamal, Nausheen

    2017-01-01

    Objective Chronic cough remains a challenging condition, especially in cases where it persists despite comprehensive medical management. For these particular patients, there appears to be an emerging role for behavior modification therapy. We report a series of patients with refractory chronic cough to assess if there is any benefit of adding behavioral therapy to their treatment regimen. Study Design A case series with planned chart review of patients treated for chronic cough. Setting The review was performed with an outpatient electronic health record system at a tertiary care center. Subjects and Methods The charts of all patients treated for chronic cough by a single laryngologist over a 30-month period were analyzed. Patients' response to treatment and rate of cough improvement were assessed for those with refractory chronic cough who underwent behavior modification therapy. Results Thirty-eight patients with chronic cough were initially treated empirically for the most common causes of cough, of which 32% experienced improvement. Nineteen patients who did not significantly improve with medical management underwent behavior modification therapy with a speech-language pathologist. Of these patients, 84% experienced resolution or marked improvement of their symptoms. Conclusion Behavioral therapy may be underutilized in practice and could lead to improvement of otherwise recalcitrant cough.

  4. Intracranial Hypertension: Medication and Surgery

    Science.gov (United States)

    ... Intracraneal en Espanol. STORE Shop the IHRF Store Medication and Surgery Medication and Surgery Both drugs and surgery are used ... to treat the headache that accompanies chronic IH. Medications for chronic headache like tricyclic anti-depressants, beta- ...

  5. Central Nervous System Functional Condition In Interns With Different Progress Levels At Military Medical Institution Of Higher Education

    Directory of Open Access Journals (Sweden)

    N.A. Bochkarjova

    2009-06-01

    Full Text Available The characteristics of CNS functional condition and cognitive functions of interns with different progress levels at Military Medical School have been analyzed. According to the research results, the rate of excitement, noiseroof feature, functional mobility of nervous processes, development of verbal and logical thinking, verbal and operative memory as well as distribution and shifting of attention are the most important suppositions for successful military-professional training.

  6. Chronic daily headaches

    Directory of Open Access Journals (Sweden)

    Fayyaz Ahmed

    2012-01-01

    Full Text Available Chronic Daily Headache is a descriptive term that includes disorders with headaches on more days than not and affects 4% of the general population. The condition has a debilitating effect on individuals and society through direct cost to healthcare and indirectly to the economy in general. To successfully manage chronic daily headache syndromes it is important to exclude secondary causes with comprehensive history and relevant investigations; identify risk factors that predict its development and recognise its sub-types to appropriately manage the condition. Chronic migraine, chronic tension-type headache, new daily persistent headache and medication overuse headache accounts for the vast majority of chronic daily headaches. The scope of this article is to review the primary headache disorders. Secondary headaches are not discussed except medication overuse headache that often accompanies primary headache disorders. The article critically reviews the literature on the current understanding of daily headache disorders focusing in particular on recent developments in the treatment of frequent headaches.

  7. Analysis of related factors of compliance to medical order behavior in patients with chronic prostalitis%慢性前列腺炎患者治疗依从性的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    郑瑾; 句敏

    2008-01-01

    目的 分析影响慢性前列腺炎患者治疗依从性的相关因素.方法 采用慢性前列腺炎症状积分指数(NIH-CPSI)、艾森克个性问卷(EPQ)及自行设计的慢性前列腺炎患者治疗依从性问卷对482例患者进行调查,并分析患者的疾病特点与个性特征,通过等级回归分析影响患者治疗依从性的相关因素.结果 慢性前列腺炎患者年龄较轻、病情较重,患者的个性内倾,存在焦虑、抑郁、怀疑等心理问题,这些是影响患者治疗依从性的相关因素.结论 应重视慢性前列腺炎患者个性特征,有针对性地对存在心理问题的内向性格患者进行心理治疗,提高患者治疗的依从性,从而达到提高慢性前列腺炎患者治疗效果的目的 .%Objective To analyze the related factors of medical order compliance in patients with chronic prostatitis. Methods 482 patients with chronic prostatitis were investigated by using the National Institutes of Health chronic prostatitis symptom index(NIH-CPSI)、Eysenck personality qusetionnaire( EPQ)and the self-de-signed medical order compliance questionnaire and the patients' disease characteristics and personality were also analyzed.The related factores of medical order compliance in patients were analyzed through hierarchical multiple regression analysis. Results Patients with chronic pwstatitis were younger and their disease condition was seri-ous. Their personality was introverted. They had many psychological problems, such as anxiety, depression, sus-pect, et al. All these were related with patients' compliance. Conclusions Attention should be paid to the patients' personality, and psychotherapy should be given to patients with introverted personality to improve pa-tients' compliance,so that the treatment effect will be increased for patients with chronic prostatitis.

  8. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  9. Living Conditions, Ability to Seek Medical Treatment, and Awareness of Health Conditions and Healthcare Options among Homeless Persons in Tokyo, Japan

    Directory of Open Access Journals (Sweden)

    Ohtsu,Tadahiro

    2011-12-01

    Full Text Available Empirical data indicative of the health conditions and medical needs of homeless persons are scarce in Japan. In this study, with the aim of contributing to the formulation of future healthcare strategies for the homeless, we conducted a self-administered questionnaire survey and interviews at a park in Shinjuku Ward, Tokyo, to clarify the living conditions of homeless persons and their health conditions and awareness about the availability of medical treatment. Responses from 55 homeless men were recorded (response rate:36.7%. With the exception of one person, none of them possessed a health insurance certificate. Half of the respondents reported having a current income source, although their modal monthly income was 30,000 yen($1 was approximately 90 yen. The number of individuals who responded "yes" to the questions regarding "Consulting a doctor on the basis of someone's recommendation" and "Being aware of the location of the nearest hospital or clinic" was significantly higher among those who had someone to consult when they were ill than among those who did not (the odds ratios [95% confidence intervals] were 15.00 [3.05-93.57] and 11.45 [1.42-510.68], respectively. This showed that whether or not a homeless person had a person to consult might influence his healthcare-seeking behavior. When queried about the entity they consulted (multiple responses acceptable, respondents mentioned "life support organizations" (61.1% and "public offices" (33.3%. Overall, 94.5% of the respondents were aware of swine flu (novel influenza A (H1N1. Their main sources of information were newspapers and magazines. On the basis of these findings, with regard to the aim of formulating healthcare strategies for homeless persons, while life support organizations and public offices play significant roles as conduits to medical institutions, print media should be considered useful for communicating messages to homeless persons.

  10. Risk factors for development and maintenance of chronic whiplash

    OpenAIRE

    Myrtveit, Solbjørg Makalani

    2015-01-01

    Background: After experiencing whiplash accidents, most individuals recover rapidly. Others, however, develop chronic whiplash, a condition characterized by long lasting neck pain, somatic complaints and symptoms of anxiety and depression. Individuals with chronic whiplash report the condition to reduce their quality of life and ability to work. As most individuals recover from whiplash accidents without needing medical attention, identifying those at risk of chronic complai...

  11. Influence of Ginkgo Biloba extract on beta-secretase in rat hippocampal neuronal cultures following chronic hypoxic and hypoglycemic conditions

    Institute of Scientific and Technical Information of China (English)

    Xueneng Guan; Fuling Yan

    2008-01-01

    BACKGROUND: Preparation of Ginkgo leaf has been widely used to improve cognitive deficits and dementia, in particular in Alzheimer's disease patients. However, the precise mechanism of action of Ginkgo leaf remains unclear.OBJECTIVE: To explore the effect of Ginkgo Biloba extract (Egb761), Ginaton, on β-secretase expression in rat hippocampal neuronal cultures following chronic hypoxic and hypoglycemic conditions.DESIGN, TIME AND SETTNG: Completely by randomized, grouping study. The experiment was performed at the Laboratory of Molecular Imaging, Southeast University between August 2006 and August 2007.MATERIALS: A total of 128 Wistar rats aged 24 hours were selected, and hippocampal neurons were harvested for primary cultures.METHODS: On day 7, primary hippocampal neuronal cultures were treated with Egb761 (0, 25, 50, 100, 150, and 200 μ g/mL) under hypoxic/hypoglycemic or hypoglycemic culture conditions for 12, 24, and 36 hours, respectively. Hippocampal neurons cultured in primary culture medium served as control.MAIN OUTCOME MEASURES: Cell viability was assayed using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT); fluorescence detection of β-secretase activity was performed; Western Blot was used to measure β -secretase expression.RESULTS: Cell viability under hypoxic/hypoglycemic or hypoglycemic culture conditions was significantly less than control cells (P 25 μ g/mL Egb761 induced greater cell viability (P 0.05). Α -secretase activity was increased after 12 hours in hypoxic/hypoglycemic culture (P 0.05). Β -secretase activity was greater after 12, 24, and 36 hours in hypoxic/hypoglycemic culture conditions, compared with control conditions (P < 0.05). Β-secretase activity was significantly decreased in neurons treated with Egb761 for 12, 24, or 36 hours, compared with the hypoxic/hypoglycemic group (P < 0.05).β-secretase protein expression was significantly up-regulated in neurons cultured in hypoxic/hypoglycemic conditions for

  12. Waiting for Treatment for Chronic Pain – a Survey of Existing Benchmarks: Toward Establishing Evidence-Based Benchmarks for Medically Acceptable Waiting Times

    Directory of Open Access Journals (Sweden)

    Mary E Lynch

    2007-01-01

    Full Text Available As medical costs escalate, health care resources must be prioritized. In this context, there is an increasing need for benchmarks and best practices in wait time management. In December 2005, the Canadian Pain Society struck a Task Force to identify benchmarks for acceptable wait times for treatment of chronic pain. The task force mandate included a systematic review and survey to identify national or international wait time benchmarks for chronic pain, proposed or in use, along with a review of the evidence upon which they are based. An extensive systematic review of the literature and a survey of International Association for the Study of Pain Chapter Presidents and key informants has identified that there are no established benchmarks or guidelines for acceptable wait times for the treatment of chronic pain in use in the world. In countries with generic guidelines or wait time standards that apply to all outpatient clinics, there have been significant challenges faced by pain clinics in meeting the established targets. Important next steps are to ensure appropriate additional research and the establishment of international benchmarks or guidelines for acceptable wait times for the treatment of chronic pain. This will facilitate advocacy for improved access to appropriate care for people suffering from chronic pain around the world.

  13. Gestational Medication Use, Birth Conditions, and Early Postnatal Exposures for Childhood Asthma

    Directory of Open Access Journals (Sweden)

    Yang-Ching Chen

    2012-01-01

    Full Text Available Our aim is to explore (1 whether gestational medication use, mode of delivery, and early postnatal exposure correlate with childhood asthma, (2 the dose responsiveness of such exposure, and (3 their links to early- and late-onset asthma. We conducted a matched case-control study based on the Taiwan Children Health Study, which was a nationwide survey that recruited 12-to-14-year-old school children in 14 communities. 579 mothers of the participants were interviewed by telephone. Exclusive breastfeeding protected children from asthma. Notably, childhood asthma was significantly associated with maternal medication use during pregnancy, vacuum use during vaginal delivery, recurrent respiratory tract infections, hospitalization, main caregiver cared for other children, and early daycare attendance. Exposure to these factors led to dose responsiveness in relationships to asthma. Most of the exposures revealed a greater impact on early-onset asthma, except for vacuum use and daycare attendance.

  14. Case-control study of disturbed eating behaviors and related psychographic characteristics in young adults with and without diet-related chronic health conditions.

    Science.gov (United States)

    Quick, Virginia M; McWilliams, Rita; Byrd-Bredbenner, Carol

    2012-08-01

    Young adults with diet-related chronic health conditions (DRCHCs; i.e., type 1 diabetes, celiac disease, cystic fibrosis, inflammatory bowel diseases, irritable bowel syndrome) face challenges complying with dietary restrictions required to effectively manage their health condition. These restrictions could put them at risk for disturbed eating. The purpose of this study was to determine if young adults with and without DRCHCs differed with regard to disturbed eating behaviors and related psychographics characteristics (i.e., body image attributes, mental disorders, intrapersonal characteristics and sociocultural environment [i.e., media and family]). Each DRCHC participant (cases=166) was matched to 4 healthy participants (controls=664) based on gender and BMI (±0.50 BMI units). Conditional logistic regression analyses indicate cases were twice as likely to have been diagnosed by a healthcare provider with an eating disorder (p=0.08, OR=1.99, CI(90) [1.03-3.83]). Cases were significantly more likely to use Inappropriate Compensatory Behaviors to manage their weight, i.e., excessive exercise (p=0.04, OR=1.41, CI(95) [1.02-1.94]) and misuse medication (p=0.04, OR=1.14, CI(95) [1.00-1.29]) than controls. Depression and anxiety were significantly higher, and health status was significantly poorer in cases compared with controls. DRCHC participants were less likely to report feeling body image pressures from the media, placed a greater value on their health, used social diversion, and recalled a greater emphasis being placed on their mothers' weights and mealtimes being less structured than control participants. Findings indicate that nutrition and other healthcare professionals should incorporate screening DRCHC patients for disturbed eating behaviors and eating disorders in their standards of care.

  15. Pharmacotherapy follow-up of patients under treatment with biologic agents for chronic inflammatory systemic conditions: an agreement

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Calleja Hernández

    2017-01-01

    Full Text Available Background and objective: The objective of this study was to reach a consensus on the minimum set of data that would allow to optimize the pharmacotherapy follow-up of patients on biologic agents for chronic systemic inflammatory conditions, through structured and standardized collection with an electronic tool in the hospital pharmacy. Materials and method: A scientific committee was formed (n = 5 hospital pharmacists. The Delphi Technique was used, 2 rounds of consultation by e-mail for hospital pharmacists. A structured questionnaire was used, based on a bibliographic review and recommendations by the scientific committee; 37 statements were assessed with the Likert 5-point scale (1= “Strongly Disagree”; 5= “Strongly Agree”. Consensus was reached when 75% or more of panel members assigned a score of 1-2 (rejection consensus or 4-5 (agreement consensus to the matter reviewed. Descriptive statistical analyses were conducted. Results: The study included 21 hospital pharmacists (70 were invited, there was 70% response. Consensus was reached for 100% of statements. The minimum set of data was agreed upon, as well as the recommendations that the pharmacist had to collect and make during visits: to document the health status, health-related quality of life, changes in treatment compliance and in patient autonomy, as well as the conditions to make feasible the systematic collection of the minimum data set. Conclusions: There is consensus among hospital pharmacists about a minimum data set to be collected, through an electronic tool, which will order, standardize and structure the pharmacotherapy follow-up of patients with chronic inflammatory conditions on treatment with biologic agents in the spanish public health system.

  16. Fluid-electrolyte changes in physically conditioned subjects after hypokinesia and chronic hyperhydration

    Science.gov (United States)

    Zorbas, Yan G.; Verentsov, Grigori E.; Federenko, Youri F.

    1995-09-01

    The aim of this study was to determine whether fluid-electrolyte changes, which are developed during prolonged hypokinesia (decreased number of km per day), can be prevented or minimized with the use of a daily intake of fluid and salt supplementation (FSS). The experiments on hypokinesia (HK) were performed for 364 days on 18 endurance-trained male volunteers in the age range of 21-23 years, with an average maximum oxygen uptake of 67 ml kg -1. All volunteers were divided into three equal groups: six volunteers were placed on a continuous regime of exercise of 14.0 km day -1 and served as control subjects. Six volunteers were subjected to continuous HK without FSS and were considered as the unsupplemented hypokinetic subjects (UHS). The remaining volunteers were under continuous HK and FSS and were considered as the supplemented hypokinetic subjects (SHS). For the simulation of the hypokinetic effect, the UHS and SHS groups were kept continuously under an average of 2.7 km day -1 for the duration of the experiment. Prior to exposure to HK, all volunteers were on the same exercise regime as the controls. During the pre-experimental period of 60 days and during the post-experimental period, urinary excretion of electrolytes and concentrations of sodium, potassium, calcium and magnesium in serum as well as serum osmolality were determined. An increased renal excretion of fluid and electrolytes and a decreased serum electrolyte concentration were observed in the SHS, while a decreased renal excretion of fluid and electrolytes and an increased serum electrolyte concentration were observed in the UHS, during the initial stages of the post-hypokinetic period. By day 30 of the post-hypokinetic period these changes were reverted back to the control levels. We concluded that chronic hyperhydration may be used to attenuate urinary and serum electrolyte changes in endurance-trained volunteers after exposure to prolonged HK.

  17. Relationship of coping and patterns of dependent behavior in patients with chronic pancreatitis of biliary and alcoholic etiology in aspect of differentiation of its medical and psychological support

    Directory of Open Access Journals (Sweden)

    Маріанна Владиславівна Маркова

    2015-08-01

    Full Text Available Choric pancreatitis is an actual medical and psychological problem in Ukraine. The aim of the work was to study the features of coping in patients with chronic pancreatitis of alcoholic and biliary etiology.Methods. For detecting coping-mechanisms the standard method WCQ Р of Lazarus was used. The study of addictive tendencies was carried out with the help of questionnaire AUDIT and UDIT-tests oriented on patterns of dependent behavior.Results. The study of features of coping-mechanisms and an addiction to dependent behavior in patients with chronic pancreatitis revealed intergroup and intragroup differences. Confrontation and low levels of self-control, responsibility and positive assessment were intrinsic for respondents with alcoholic etiology of pancreatitis. Women demonstrated the high addiction to the search of social support, men – to distancing. As to an addictive behavior there was revealed that the typical common tendencies were the consumption of coffee, alcohol, internet-dependence, the specific ones for women – TV, shopping-dependencies, for men – workaholism in patients with biliary and computer-addiction in patients with alcoholic chronic pancreatitis. Intergroup differences were demonstrated by an addiction to disorder of food behavior in patients with biliary and consumption of alcohol and smoking in respondents with alcoholic etiology of pancreatitis.Conclusions. The revealed differences in coping-strategies of patients with different nosological forms of chronic pancreatitis give important information for detecting the targets of medical and psychological influence and constructing of differentiated program of medical and psychological help to patients of this type

  18. Unique Genetic Loci Identified for Emotional Behavior in Control and Chronic Stress Conditions

    Science.gov (United States)

    2014-10-21

    expression profiles in hippocampus and amygdala after fear conditioning. Brain Res. Bull . 67, 1–12. doi: 10.1016/j.brainresbull.2005.03.023 Mizuno, K...under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the...use, distribution or reproduction is permitted which does not comply with these terms. Frontiers in Behavioral Neuroscience www.frontiersin.org October 2014 | Volume 8 | Article 341 | 11

  19. Disease-specific Data Sheets in the Management of Chronic Conditions - Case Example: Diabetes

    OpenAIRE

    Narus, Scott P.; Wilcox, Adam; Clayton, Paul D.; Pryor, T. Allan; Towner, Steven; Barlow, Stephen

    2002-01-01

    Intermountain Health Care (IHC) has developed a reporting infrastructure that allows researchers to build disease or condition specific data sheets. These reports run directly from an EMR application. The reports extract relevant information from a coded central data repository. Logic may be incorporated into the reports in order to provide decision support to clinicians at the point of care. A diabetes data sheet was one of the first reports developed. Use of the diabetes data sheet grew fro...

  20. "If"-Conditionals in Medical Discourse: From Theory to Disciplinary Practice

    Science.gov (United States)

    Carter-Thomas, Shirley; Rowley-Jolivet, Elizabeth

    2008-01-01

    "If"-conditionals are a highly valuable resource in academic discourses, whether spoken or written, as they can be used to hypothesize, hedge, manage interaction with the addressee, and promote or on the contrary circumscribe the scope of research claims. This article analyses how "if"-conditionals are brought into play in three genres of medical…

  1. Validation and usefulness of the Danish version of the Pain Medication Questionnaire in opioid-treated chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, J; Nielsen, P R; Kendall, S;

    2011-01-01

    Addiction is a feared complication of long-term opioid therapy for chronic pain patients. A screening tool to assess the potential risk of addiction may be helpful.......Addiction is a feared complication of long-term opioid therapy for chronic pain patients. A screening tool to assess the potential risk of addiction may be helpful....

  2. [A comparison of the effects of single and chronic microinjections of GABA and picrotoxin into the caudate nucleus on the conditioned reflexes of dogs].

    Science.gov (United States)

    Iakimovskiĭ, A F

    1990-01-01

    The effects on Pavlovian alimentary conditioned reflexes realization of two methods of intrastriatal microinjections--acute (separate) and long-term (chronic) one--are compared in experiments on dogs. Bilateral acute administration and the first week of chronic injection of 45 mcg of GABA into the caudate nuclei produced in dogs a manifest improvement of parameters of the conditioned differentiation inhibition, but only in the next period of chronic treatment an improvement of the positive Pavlovian alimentary conditioned reflex was obtained. The both ways of picrotoxin treatment impaired conditioned behaviour, and this effect was observed after the end of injection. No withdrawal effects were recorded. The data obtained give ground for discussion of the role of striatal GABAergic system in the positive modulation of adaptive alimentary behaviour. The application of novel psychopharmacological method in experimental and clinical fields of investigation is discussed.

  3. [Morbidity estimates of beneficiaries of national health insurance for seven chronic conditions].

    Science.gov (United States)

    Fender, P; Megnigbeto, C

    1997-06-01

    This work is aimed at providing improved coefficients applicable to the statistics of Health Insurance concerning the long-lasting conditions in order to assess morbidity of Health Insurance members concerning diseases invoked legislation on long-lasting conditions. To reach this objective, we have applied the consequences of successive equivalence (between diseases and their specific treatment, and between the use of special prescriptions for exempting diseases and the acknowledgment of long-lasting conditions by Health Insurance) to the results of a survey on medicines carried out by the Caisse Nationale d'Assurance Maladie des Travailleurs Salariés in 1993 on the basis of a representative sample. Improved coefficients were equal to the inverse of the proportion of special prescriptions within the whole of the prescriptions including specific treatment. Those coefficients and their confidence intervals have been calculated for seven affections: non-insulin dependent diabetes [1.56-1.67], coronary disease [1.51-1.61], Parkinson's disease [1.51-1.85], manic-depressive psychosis [1.49-1.89], haemorrhagic rectocolitis and Crohn's disease [1.49-2.04], insulin dependent diabetes [1.10-1.20] and tuberculosis [1.61-3.33]. The critical analysis of our work and its comparison with the rare literature on the same subject confirms the value of our results. The application of those improved coefficients to the figures of prevalence and incidence provided by Health Insurance makes it possible to set confidence bounds to the statistics of morbidity concerning the people who are affiliated to that system of Health Insurance and treated for these diseases however serious they are.

  4. Patient Priority-Directed Decision Making and Care for Older Adults with Multiple Chronic Conditions.

    Science.gov (United States)

    Tinetti, Mary E; Esterson, Jessica; Ferris, Rosie; Posner, Philip; Blaum, Caroline S

    2016-05-01

    Older adults with multiple conditions receive care that is often fragmented, burdensome, and of unclear benefit. An advisory group of patients, caregivers, clinicians, health system engineers, health care system leaders, payers, and others identified three modifiable contributors to this fragmented, burdensome care: decision making and care focused on diseases, not patients; inadequate delineation of roles and responsibilities and accountability among clinicians; and lack of attention to what matters to patients and caregivers (ie, their health outcome goals and care preferences). The advisory group identified patient priority-directed care as a feasible, sustainable approach to addressing these modifiable factors.

  5. Efficacy and safety of osteoporosis medications in a rat model of late-stage chronic kidney disease accompanied by secondary hyperparathyroidism and hyperphosphatemia.

    Science.gov (United States)

    Ota, M; Takahata, M; Shimizu, T; Kanehira, Y; Kimura-Suda, H; Kameda, Y; Hamano, H; Hiratsuka, S; Sato, D; Iwasaki, N

    2017-04-01

    This study showed that bisphosphonate was safe and effective for the treatment of bone disorders in stage 4 chronic kidney disease (CKD) rats. Intermittent teriparatide therapy showed an anabolic action on bone even under secondary hyperparathyroidism conditions without having an adverse effect on mineral metabolism in late-stage CKD.

  6. Evaluating the Referring Physician's Clinical History and Indication as a Means for Communicating Chronic Conditions That Are Pertinent at the Point of Radiologic Interpretation.

    Science.gov (United States)

    Obara, Piotr; Sevenster, Merlijn; Travis, Adam; Qian, Yuechen; Westin, Charles; Chang, Paul J

    2015-06-01

    The clinical history and indication (CHI) provided with a radiological examination are critical components of a quality interpretation by the radiologist. A patient's chronic conditions offer the context in which acute symptoms and findings can be interpreted more accurately. Seven pertinent (potentially diagnosis altering) chronic conditions, which are fairly prevalent at our institution, were selected. We analyze if and how in 140 CHIs there was mention of a patient's previously reported chronic condition and if and how the condition was subsequently described in the radiology report using a four-item scheme (Mention/Specialization, Generalization, Common comorbidity, No mention). In 40.7% of CHIs, the condition was rated Mention/Specialization. Therefore, we reject our first hypothesis that the CHI is a reliable source for obtaining pertinent chronic conditions (≥ 90.0%). Non-oncological conditions were significantly more likely rated No mention in the CHI than oncological conditions (58.7 versus 8.3%, P radiology report (χ(2) test, P radiology department to the care chain.

  7. Exercise as a Time-conditioning Effector in Chronic Disease: a Complementary Treatment Strategy

    Directory of Open Access Journals (Sweden)

    Luis F. B. P. Costa Rosa

    2004-01-01

    Full Text Available Exercise has been widely believed to be a preventive and therapeutic aid in the treatment of various pathophysiological conditions such as cardiovascular disease and cancer. A common problem associated with such pathologies is cachexia, characterized by progressive weight loss and depletion of lean and fat body mass, and is linked to poor prognosis. As this syndrome comprises changes in many physiological systems, it is tempting to assume that the modulation of the psychoneuroimmunoendocrine axis could attenuate or even prevent cachexia progression in cancer patients. Cancer cachexia is characterized by a disruption in the rhythmic secretion of melatonin, an important time-conditioning effector. This hormone, secreted by the pineal gland, transmits circadian and seasonal information to all organs and cells of the body, synchronizing the organism with the photoperiod. Considering that exercise modulates the immune response through at least two different mechanisms—metabolic and neuroendocrine—we propose that the adoption of a regular exercise program as a complementary strategy in the treatment of cancer patients, with the exercise bouts regularly performed at the same time of the day, will ameliorate cachexia symptoms and increase survival and quality of life.

  8. Guide to Geriatric Syndromes: Common and Often Related Medical Conditions in Older Adults

    Science.gov (United States)

    ... There are many treatments, such as exercise and physical therapy, that can help improve your gait and walking and prevent falls. Osteoporosis Osteoporosis, or “thinning bones,” is a condition that ...

  9. Medical nutrition therapy in adults with chronic kidney disease: integrating evidence and consensus into practice for the generalist registered dietitian nutritionist.

    Science.gov (United States)

    Beto, Judith A; Ramirez, Wendy E; Bansal, Vinod K

    2014-07-01

    Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature.

  10. The Effect of Bone Marrow-Derived Mesenchymal Stem Cells and Their Conditioned Media Topically Delivered in Fibrin Glue on Chronic Wound Healing in Rats

    OpenAIRE

    Mehanna, Radwa A.; Iman Nabil; Noha Attia; Bary, Amany A.; Razek, Khalid A.; Ahmed, Tamer A. E.; Fatma Elsayed

    2015-01-01

    Bone marrow-derived mesenchymal stem cells (BM-MSCs) represent a modern approach for management of chronic skin injuries. In this work, we describe BM-MSCs application versus their conditioned media (CM) when delivered topically admixed with fibrin glue to enhance the healing of chronic excisional wounds in rats. Fifty-two adult male rats were classified into four groups after induction of large-sized full-thickness skin wound: control group (CG), fibrin only group (FG), fibrin + MSCs group (...

  11. Does total body irradiation conditioning improve outcomes of myeloablative human leukocyte antigen-identical sibling transplantations for chronic lymphocytic leukemia?

    Science.gov (United States)

    Sabloff, Mitchell; Sobecks, Ronald M; Ahn, Kwang Woo; Zhu, Xiaochun; de Lima, Marcos; Brown, Jennifer R; Inamoto, Yoshihiro; Holland, H Kent; Aljurf, Mahmoud D; Laughlin, Mary J; Kamble, Rammurti T; Hsu, Jack W; Wirk, Baldeep M; Seftel, Matthew; Lewis, Ian D; Arora, Mukta; Alyea, Edwin P; Kalaycio, Matt E; Cortes, Jorge; Maziarz, Richard T; Gale, Robert Peter; Saber, Wael

    2014-03-01

    An allogeneic hematopoietic cell transplantation from an HLA-identical donor after high-dose (myeloablative) pretransplantation conditioning is an effective therapy for some people with chronic lymphocytic leukemia (CLL). Because CLL is a highly radiosensitive cancer, we hypothesized that total body irradiation (TBI) conditioning regimens may be associated with better outcomes than those without TBI. To answer this, we analyzed data from 180 subjects with CLL receiving myeloablative doses of TBI (n = 126) or not (n = 54), who received transplants from an HLA-identical sibling donor between 1995 and 2007 and reported to the Center for International Blood & Marrow Transplant Research. At 5 years, treatment-related mortality was 48% (95% confidence interval [CI], 39% to 57%) versus 50% (95% CI, 36% to 64%); P = NS. Relapse rates were 17% (95% CI, 11% to 25%) versus 22% (95% CI, 11% to 35%); P = NS. Five-year progression-free survival and overall survival were 34% (95% CI, 26% to 43%) versus 28% (95% CI, 15% to 42%); P = NS and 42% (95% CI, 33% to 51%) versus 33% (95% CI, 19% to 48%); P = NS, respectively. The single most common cause of death in both cohorts was recurrent/progressive CLL. No variable tested in the multivariate analysis was found to significantly affect these outcomes, including having failed fludarabine. Within the limitations of this study, we found no difference in HLA-identical sibling transplantation outcomes between myeloablative TBI and chemotherapy pretransplantation conditioning in persons with CLL.

  12. Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

    Directory of Open Access Journals (Sweden)

    Eva H. DuGoff

    2016-06-01

    Full Text Available Follow us on Twitter Co-Editors-in-Chief Martin Fortin Jane Gunn Stewart W. Mercer Susan Smith Marjan van den Akker Society for Academic Primary Care Journal Help USER You are logged in as... avalster My Profile Log Out JOURNAL CONTENT Search Search Scope Search Browse By Issue By Author By Title By Sections By Identify Types OPEN JOURNAL SYSTEMS FONT SIZE Make font size smallerMake font size defaultMake font size larger INFORMATION For Readers For Authors For Librarians ARTICLE TOOLS Print this article Indexing metadata How to cite item Supplementary files Finding References Email this article Email the author Post a Comment NOTIFICATIONS View (378 new Manage IRCMO NEWS ‘Addressing the global challenge of... Publications on multimorbidity... The CARE Plus study Prevalence of multimorbidity in the... Multimorbidity in adults from a... CURRENT ISSUE Atom logo RSS2 logo RSS1 logo HOSTED BY Part of the PKP Publishing Services Network HOME ABOUT USER HOME SEARCH CURRENT ARCHIVES ANNOUNCEMENTS PUBLISHER AUTHOR GUIDELINES SUBMISSIONS WHY PUBLISH WITH US? Home > Vol 6, No 2 (2016 >\tDuGoff Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes Eva H. DuGoff, Karen Bandeen-Roche, Gerard F. Anderson Abstract Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. Multivariate regression models were used to examine the association of baseline continuity (the first 6 months and the composite outcome of any emergency room use or inpatient

  13. Reliability of self-reported health risk factors and chronic conditions questions collected using the telephone in South Australia, Australia

    Directory of Open Access Journals (Sweden)

    Dal Grande Eleonora

    2012-07-01

    Full Text Available Abstract Background Accurate monitoring of health conditions and behaviours, and health service usage in the population, using an effective and economical method is important for planning and evaluation. This study examines the reliability of questions asked in a telephone survey by conducting a test/retest analysis of a range of questions covering demographic variables, health risk factors and self-reported chronic conditions among people aged 16 years and over. Methods A Computer Assisted Telephone Interviewing (CATI survey on health issues of South Australians was re-administered to a random sub-sample of 154 respondents between 13-35 days (mean 17 after the original survey. Reliability between questions was assessed using Cohen’s kappa and intraclass correlation coefficients. Results Demographic questions (age, gender, number of adults and children in the household, country of birth showed extremely high reliability (0.97 to 1.00. Health service use (ICC = 0.90 95% CI 0.86-0.93 and overall health status (Kappa = 0.60 95% CI 0.46-0.75 displayed moderate agreement. Questions relating to self-reported risk factors such as smoking (Kappa = 0.81 95% CI 0.72-0.89 and alcohol drinking (ICC 0.75 = 95% CI 0.63-0.83 behaviour showed good to excellent agreement, while questions relating to self-reported risk factors such as time spent walking for physical activity (ICC 0.47 = 95% CI 0.27-0.61, fruit (Kappaw = 0.60 95% CI 0.45-0.76 and vegetable consumption (Kappaw = 0.50 95% CI 0.32-0.69 showed only moderate agreement. Self-reported chronic conditions displayed substantial to almost perfect agreement (0.72 to 1.00 with the exception of moderate agreement for heart disease (Kappa = 0.82 95% CI 0.57-0.99. Conclusion These results show the questions assessed to be reliable in South Australia for estimating health conditions and monitoring health related behaviours using a CATI survey.

  14. [Hygienic aspects of the lifestyle of medical students under the present conditions].

    Science.gov (United States)

    Kozhevnikova, N G; Kataeva, V A

    2011-01-01

    The paper gives the results of a study of the lifestyle of medical students. The students' motor activity has been found to be lower and to continue to drop in the undergraduates. Examination of the daily routine has shown that 92% of the students break the study-and-rest routine; the reported reasons for this are a high academic load, a prolonged academic day, a study-work combination, mental stress during examinations, and computer-aided learning. The students' nutrition is inadequate in major nutrients, poor-quality, irregular, and uncontrolled. The college crowd shows a preponderance of bad habits; 85% of cases had these or those combinations of risk factors: smoking, low motor activity, overweight, alcohol consumption, etc.

  15. Cocaine-conditioned odor cues without chronic exposure: Implications for the development of addiction vulnerability

    Science.gov (United States)

    Lowen, Steven B.; Rohan, Michael L.; Gillis, Timothy E.; Thompson, Britta S.; Wellons, Clara B.W.; Andersen, Susan L.

    2015-01-01

    Adolescents are highly vulnerable to addiction and are four times more likely to become addicted at first exposure than at any other age. The dopamine D1 receptor, which is typically overexpressed in the normal adolescent prefrontal cortex, is involved in drug cue responses and is associated with relapse in animal models. In human drug addicts, imaging methods have detected increased activation in response to drug cues in reward- and habit-associated brain regions. These same methods can be applied more quantitatively to rodent models. Here, changes in neuronal activation in response to cocaine-conditioned cues were observed using functional magnetic resonance imaging in juvenile rats that were made to over-express either D1 receptors or green fluorescent protein by viral-mediated transduction. Reduced activation was observed in the amygdala and dopamine cell body regions in the low cue-preferring/control juvenile rats in response to cocaine cues. In contrast, increased activation was observed in the dorsal striatum, nucleus accumbens, prefrontal cortex, and dopamine cell bodies in high cue-preferring/D1 juveniles. The increase in cue salience that is mediated by increased D1 receptor density, rather than excessive cocaine experience, appears to underlie the transition from aversion to reward in cue-induced neural response and may form the basis for habit-forming vulnerability. PMID:27006904

  16. Cocaine-conditioned odor cues without chronic exposure: Implications for the development of addiction vulnerability

    Directory of Open Access Journals (Sweden)

    Steven B. Lowen

    2015-01-01

    Full Text Available Adolescents are highly vulnerable to addiction and are four times more likely to become addicted at first exposure than at any other age. The dopamine D1 receptor, which is typically overexpressed in the normal adolescent prefrontal cortex, is involved in drug cue responses and is associated with relapse in animal models. In human drug addicts, imaging methods have detected increased activation in response to drug cues in reward- and habit-associated brain regions. These same methods can be applied more quantitatively to rodent models. Here, changes in neuronal activation in response to cocaine-conditioned cues were observed using functional magnetic resonance imaging in juvenile rats that were made to over-express either D1 receptors or green fluorescent protein by viral-mediated transduction. Reduced activation was observed in the amygdala and dopamine cell body regions in the low cue-preferring/control juvenile rats in response to cocaine cues. In contrast, increased activation was observed in the dorsal striatum, nucleus accumbens, prefrontal cortex, and dopamine cell bodies in high cue-preferring/D1 juveniles. The increase in cue salience that is mediated by increased D1 receptor density, rather than excessive cocaine experience, appears to underlie the transition from aversion to reward in cue-induced neural response and may form the basis for habit-forming vulnerability.

  17. Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners

    Directory of Open Access Journals (Sweden)

    Johnston KN

    2011-12-01

    Full Text Available Kylie N Johnston1, Mary Young2, Karen A Grimmer-Somers1, Ral Antic3, Peter A Frith41International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia; 2Transitional and Community Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 3Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 4Respiratory, Allergy and Sleep Services, Repatriation General Hospital and Flinders University Adelaide, South Australia, AustraliaBackground: Clinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD.Methods: Semi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners' experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis.Results: Nine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1 role clarity of the medical practitioner; (2 persuasive communication with the patient; (3 complexity of behavioral change required; (4 awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to

  18. Investigation and Analysis of Associated Factors of Chronic Constipation in Medical Staff in Shanghai%上海地区医务人员慢性便秘调查及其相关因素分析

    Institute of Scientific and Technical Information of China (English)

    袁春英; 袁蕙芸

    2015-01-01

    Background:With the increase in pace and pressure of modern life,the aging of population,the change in dietary pattern and the challenge of social psychological problems,the overall prevalence of chronic constipation is increasing in general population in recent decades. Aims:To investigate the prevalence and associated factors of chronic constipation in medical staff. Methods:A total of 1 000 medical staffs were enrolled at random in Shanghai Ren Ji Hospital for fulfilling a questionnaire on associated factors of chronic constipation. Diagnosis of chronic constipation met the Rome Ⅲ criteria. Chi-square test and Logistic regression model analysis were performed to screen the potential risk factors for chronic constipation. The statistically significant variables revealed by chi-square test were taken into the Logistic regression model. Results:Nine hundred and eighty-six medical staffs completed the questionnaire,of them 115 were diagnosed as chronic constipation with a prevalence of 11. 7% . Multivariate Logistic regression analysis revealed that reading/ playing cell phone when defecation,working pressure,anxiety,and depression were the risk factors,which might increase the prevalence of chronic constipation;while regular life style,regular diet,drinking water,and regular bowel movement were the protective factors,which might decrease the prevalence of chronic constipation. Conclusions:Chronic constipation is prevalent in medical staff in Shanghai. Psychological factors,dietary pattern and life style,etc. are considered to be implicated in the pathogenesis of chronic constipation. Favorable life style,dietary pattern,bowel habit and mental status are associated with the reduced risk of chronic constipation.

  19. A six year review of hysterectomy for benign gynaecological conditions at the Federal Medical Centre, Owerri

    Directory of Open Access Journals (Sweden)

    Duke A. Onyeabochukwu

    2014-04-01

    Conclusions: Hysterectomy for benign gynaecological conditions is relatively common and safe in our centre, but there is need for improvement on the high post-operative morbidity rate. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 352-356

  20. Conditions for successful reflective use of portfolios in undergraduate medical education

    NARCIS (Netherlands)

    Driessen, Erik W.; Van Tartwijk, Jan; Overeem, Karlijn; Vermunt, Jan D.; Van Der Vleuten, C. P M

    2005-01-01

    AIM: Portfolios are often used as an instrument with which to stimulate students to reflect on their experiences. Research has shown that working with portfolios does not automatically stimulate reflection. In this study we addressed the question: What are the conditions for successful reflective us

  1. 42 CFR 416.47 - Condition for coverage-Medical records.

    Science.gov (United States)

    2010-10-01

    ... Section 416.47 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Specific Conditions for Coverage § 416...-operative diagnostic studies (entered before surgery), if performed. (4) Findings and techniques of...

  2. The growing caseload of chronic life-long conditions calls for a move towards full self-management in low-income countries

    Directory of Open Access Journals (Sweden)

    Kegels Guy

    2011-10-01

    Full Text Available Abstract Background The growing caseload caused by patients with chronic life-long conditions leads to increased needs for health care providers and rising costs of health services, resulting in a heavy burden on health systems, populations and individuals. The professionalised health care for chronic patients common in high income countries is very labour-intensive and expensive. Moreover, the outcomes are often poor. In low-income countries, the scarce resources and the lack of quality and continuity of health care result in high health care expenditure and very poor health outcomes. The current proposals to improve care for chronic patients in low-income countries are still very much provider-centred. The aim of this paper is to show that present provider-centred models of chronic care are not adequate and to propose 'full self-management' as an alternative for low-income countries, facilitated by expert patient networks and smart phone technology. Discussion People with chronic life-long conditions need to 'rebalance' their life in order to combine the needs related to their chronic condition with other elements of their life. They have a crucial role in the management of their condition and the opportunity to gain knowledge and expertise in their condition and its management. Therefore, people with chronic life-long conditions should be empowered so that they become the centre of management of their condition. In full self-management, patients become the hub of management of their own care and take full responsibility for their condition, supported by peers, professionals and information and communication tools. We will elaborate on two current trends that can enhance the capacity for self-management and coping: the emergence of peer support and expert-patient networks and the development and distribution of smart phone technology both drastically expand the possibilities for full self-management. Conclusion Present provider-centred models

  3. Short-course oral steroids alone for chronic rhinosinusitis

    NARCIS (Netherlands)

    Head, Karen; Chong, Lee Yee; Hopkins, Claire; Philpott, Carl; Burton, Martin J; Schilder, Anne G M

    2016-01-01

    BACKGROUND: This review is one of a suite of six Cochrane reviews looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is a common condition involving inflammation of the lining of the nose and paranasal sinuses. It is characterised by nas

  4. Recognizing Family Dynamics in the Treatment of Chronic Fatigue Syndrome

    Science.gov (United States)

    Sperry, Len

    2012-01-01

    Chronic fatigue syndrome (CFS) is an increasingly common chronic medical condition that affects not only patients but also their families. Because family dynamics, particularly the family life cycle, can and does influence the disease process, those providing counseling to CFS patients and their families would do well to recognize these dynamics.…

  5. The Genus Aloe: Phytochemistry and Therapeutic Uses Including Treatments for Gastrointestinal Conditions and Chronic Inflammation.

    Science.gov (United States)

    Cock, I E

    2015-01-01

    Plants of the genus Aloe have perhaps the longest recorded history of medicinal usage and are amongst the most widely used plants for traditional medicinal purposes worldwide. Aloe vera, Aloe ferox, Aloe arborescens and Aloe perryi are the best known and most widely used, but many other species are also used for their therapeutic properties. The Aloes have been used since ancient times, particularly for the treatment of microbial infections, gastrointestinal disorders and inflammatory conditions. In addition to their myriad uses in traditional therapeutics, the Aloes have also been used as components of cosmetic formulations, and in the food and beverage industries. Despite their wide acceptance, studies from different laboratories often report wide variations in the therapeutic bioactivities from within the same Aloe species, even when the same extraction procedures are used. Furthermore, leaves from individual Aloe plants within the same species may have widely varying levels of the bioactive phytochemicals. Phytochemical analyses have shown that many Aloe species contain various carbohydrate polymers (notably glucomannans) and a range of other low molecular weight phenolic compounds including alkaloids, anthraquinones, anthrones, benzene and furan derivatives, chromones, coumarins, flavonoids, phytosterols, pyrans and pyrones. There has been a wealth of information published about the phytochemistry and therapeutic potential of the Aloes (especially Aloe vera). Much of this has been contradictory. Intra- and interspecies differences in the redox state of the individual Aloe components and in the ratios of these components may occur between individual plants. These factors may all affect the physiological properties of Aloe extracts. Due to the structure and chemical nature of many of the Aloe phytochemicals, it is likely that many of the reported medicinal properties are due to antioxidant or prooxidant effects. The antioxidant/prooxidant activities of many Aloe

  6. Overview of Systematic Reviews: Yoga as a Therapeutic Intervention for Adults with Acute and Chronic Health Conditions

    Directory of Open Access Journals (Sweden)

    Marcy C. McCall

    2013-01-01

    Full Text Available Objectives. Overview the quality, direction, and characteristics of yoga interventions for treatment of acute and chronic health conditions in adult populations. Methods. We searched for systematic reviews in 10 online databases, bibliographic references, and hand-searches in yoga-related journals. Included reviews satisfy Oxman criteria and specify yoga as a primary intervention in one or more randomized controlled trials for treatment in adults. The AMSTAR tool and GRADE approach evaluated the methodological quality of reviews and quality of evidence. Results. We identified 2202 titles, of which 41 full-text articles were assessed for eligibility and 26 systematic reviews satisfied inclusion criteria. Thirteen systematic reviews include quantitative data and six papers include meta-analysis. The quality of evidence is generally low. Sixteen different types of health conditions are included. Eleven reviews show tendency towards positive effects of yoga intervention, 15 reviews report unclear results, and no, reviews report adverse effects of yoga. Yoga appears most effective for reducing symptoms in anxiety, depression, and pain. Conclusion. Although the quality of systematic reviews is high, the quality of supporting evidence is low. Significant heterogeneity and variability in reporting interventions by type of yoga, settings, and population characteristics limit the generalizability of results.

  7. Overview of systematic reviews: yoga as a therapeutic intervention for adults with acute and chronic health conditions.

    Science.gov (United States)

    McCall, Marcy C; Ward, Alison; Roberts, Nia W; Heneghan, Carl

    2013-01-01

    Objectives. Overview the quality, direction, and characteristics of yoga interventions for treatment of acute and chronic health conditions in adult populations. Methods. We searched for systematic reviews in 10 online databases, bibliographic references, and hand-searches in yoga-related journals. Included reviews satisfy Oxman criteria and specify yoga as a primary intervention in one or more randomized controlled trials for treatment in adults. The AMSTAR tool and GRADE approach evaluated the methodological quality of reviews and quality of evidence. Results. We identified 2202 titles, of which 41 full-text articles were assessed for eligibility and 26 systematic reviews satisfied inclusion criteria. Thirteen systematic reviews include quantitative data and six papers include meta-analysis. The quality of evidence is generally low. Sixteen different types of health conditions are included. Eleven reviews show tendency towards positive effects of yoga intervention, 15 reviews report unclear results, and no, reviews report adverse effects of yoga. Yoga appears most effective for reducing symptoms in anxiety, depression, and pain. Conclusion. Although the quality of systematic reviews is high, the quality of supporting evidence is low. Significant heterogeneity and variability in reporting interventions by type of yoga, settings, and population characteristics limit the generalizability of results.

  8. Influence of oral health condition on swallowing and oral intake level for patients affected by chronic stroke

    Directory of Open Access Journals (Sweden)

    Mituuti CT

    2014-12-01

    Full Text Available Cláudia T Mituuti,1 Vinicius C Bianco,2 Cláudia G Bentim,3 Eduardo C de Andrade,1 José H Rubo,2 Giédre Berretin-Felix1 1Speech Language and Hearing Department, 2Department of Prosthodontics, Bauru School of Dentistry/University of São Paulo, Bauru, Brazil; 3SORRI-BAURU, Bauru, Brazil Background: According to the literature, the occurrence of dysphagia is high in cases of stroke, and its severity can be enhanced by loss of teeth and the use of poorly fitting prostheses.Objective: To verify that the status of oral health influences the level of oral intake and the degree of swallowing dysfunction in elderly patients with stroke in chronic phase.Methods: Thirty elderly individuals affected by stroke in chronic phase participated. All subjects underwent assessment of their oral condition, with classification from the Functional Oral Intake Scale (FOIS and nasoendoscopic swallowing assessment to classify the degree of dysphagia. The statistical analysis examined a heterogeneous group (HG, n=30 and two groups designated by the affected body part, right (RHG, n=8 and left (LHG, n=11, excluding totally dentate or edentulous individuals without rehabilitation with more than one episode of stroke.Results: There was a negative correlation between the need for replacement prostheses and the FOIS scale for the HG (P=0.02 and RHG (P=0.01. Differences in FOIS between types of prostheses of the upper dental arch in the LHG (P=0.01 and lower dental arch in the RHG (P=0.04. A negative correlation was found between the number of teeth present and the degree of dysfunction in swallowing liquid in the LHG (P=0.05. There were differences in the performance in swallowing solids between individuals without prosthesis and those with partial prosthesis in the inferior dental arch (P=0.04 for the HG.Conclusion: The need for replacement prostheses, type of prostheses, and the number of teeth of elderly patients poststroke in chronic phase showed an association with

  9. A randomized controlled trial of telemonitoring in older adults with multiple chronic conditions: the Tele-ERA study

    Directory of Open Access Journals (Sweden)

    Takahashi Paul Y

    2010-09-01

    Full Text Available Abstract Background Older adults with multiple chronic illnesses are at risk for worsening functional and medical status and hospitalization. Home telemonitoring may help slow this decline. This protocol of a randomized controlled trial was designed to help determine the impact of home telemonitoring on hospitalization. The specific aim of the study reads as follows: to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at-risk population 60 years of age or older. Methods/Design Two-hundred patients with the highest 10% Mayo Clinic Elder Risk Assessment scores will be randomly assigned to one of two interventions. Home telemonitoring involves the use of a computer device, the Intel Health Guide, which records biometric and symptom data from patients in their homes. This information is monitored by midlevel providers associated with a primary care medical practice. Under the usual care scenario, patients make appointments with their providers as problems arise and use ongoing support such as a 24-hour nurse line. Patients will have initial evaluations of gait and quality of life using instruments such as the SF-12 Health Survey, the Kokmen Short Test of Mental Status, and the PHQ-9 health questionnaire. Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency department visits. Secondary analysis will include quality of life, compliance with the device, and attitudes about telemonitoring. Sample size is based on an 80% power to detect a 36% difference between the two groups. The primary analysis will involve Cox proportional time-to-event analysis. Secondary analysis will use t-test comparisons for continuous variables and the chi square test for proportional analysis. Discussion Patients randomized to home telemonitoring will have daily assessments of their health status using the device

  10. Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

    Directory of Open Access Journals (Sweden)

    Duplantie Julie

    2006-08-01

    Full Text Available Abstract Background Telehealth, as other information and communication technologies (ICTs introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. Methods A qualitative field study was conducted in four remote regions of Quebec (Canada to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. Results According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and

  11. An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas

    DEFF Research Database (Denmark)

    Zawadzki, Antoni; Johnson, Louis Banka; Bohe, Måns;

    2017-01-01

    PURPOSE: It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal...... fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal...... fistulas without any concomitant medication. METHODS: An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( ClinicalTrial.gov identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted...

  12. PubMed search strategies for the identification of etiologic associations between hypothalamic-pituitary disorders and other medical conditions.

    Science.gov (United States)

    Guaraldi, Federica; Grottoli, Silvia; Arvat, Emanuela; Mattioli, Stefano; Ghigo, Ezio; Gori, Davide

    2013-12-01

    Biomedical literature has enormously grown in the last decades and become broadly available through online databases. Ad-hoc search methods, created on the basis of research field and goals, are required to enhance the quality of searching. Aim of this study was to formulate efficient, evidence-based PubMed search strategies to retrieve articles assessing etiologic associations between a condition of interest and hypothalamic-pituitary disorders (HPD). Based on expert knowledge, 17 MeSH (Medical Subjects Headings) and 79 free terms related to HPD were identified to search PubMed. Using random samples of abstracts retrieved by each term, we estimated the proportion of articles containing pertinent information and formulated two strings (one more specific, one more sensitive) for the detection of articles focusing on the etiology of HPD, that were then applied to retrieve articles identifying possible etiologic associations between HPD and three diseases (malaria, LHON and celiac disease) considered not associated to HPD, and define the number of abstracts needed to read (NNR) to find one potentially pertinent article. We propose two strings: one sensitive string derived from the combination of articles providing the largest literature coverage in the field and one specific including combined terms retrieving ≥40% of potentially pertinent articles. NNR were 2.1 and 1.6 for malaria, 3.36 and 2.29 for celiac disease, 2.8 and 2.2 for LHON, respectively. For the first time, two reliable, readily applicable strings are proposed for the retrieval of medical literature assessing putative etiologic associations between HPD and other medical conditions of interest.

  13. Disqualifying Medical Conditions of Flying Personnel in Chinese Army and Air Force

    Institute of Scientific and Technical Information of China (English)

    Chun-wei Wang; Shu-xuan Xu; Xian-rong Xu; Tong-xin Chen

    2008-01-01

    @@ After inpatient aircrews of Chinese Army and Air Force are treated at local hospitals,their health status will be evaluated.If it is aeronantieally adaptable,the conclusion would be flying qualification;if it may impact the flight safety or the flight environment may aggravate the illness,the conclusion would be flight suspension,and then the patient should be forwarded from local hospital to our hospital.After detailed examination,if the conditions of flying personnel are considered not qualified for flight,the conclusion of flying disqualification should be made finally.

  14. Assistance in dying for older people without a serious medical condition who have a wish to die: a national cross-sectional survey.

    NARCIS (Netherlands)

    Raijmakers, N.J.H.; Heide, A. van der; Kouwenhoven, P.S.C.; Thiel, G.J.M.W. van; Delden, J.J.M. van; Rietjens, J.A.C.

    2015-01-01

    Background: The Dutch euthanasia law regulates physician assistance in dying for patients who are suffering unbearably from a medical condition. We studied the attitudes of the Dutch population to assistance in dying for older persons who have a wish to die without the presence of a serious medical

  15. Assistance in dying for older people without a serious medical condition who have a wish to die : a national cross-sectional survey

    NARCIS (Netherlands)

    Raijmakers, Natasja J H; van der Heide, Agnes; Kouwenhoven, Pauline S C; van Thiel, Ghislaine J M W; van Delden, Johannes J M; Rietjens, Judith A C

    2015-01-01

    BACKGROUND: The Dutch euthanasia law regulates physician assistance in dying for patients who are suffering unbearably from a medical condition. We studied the attitudes of the Dutch population to assistance in dying for older persons who have a wish to die without the presence of a serious medical

  16. Chronic mucus hypersecretion

    DEFF Research Database (Denmark)

    Harmsen, L; Thomsen, S F; Sylvan Ingebrigtsen, Truls;

    2010-01-01

    Chronic mucus hypersecretion (CMH) is a common condition in patients with chronic respiratory diseases. Little is known about the incidence, prevalence and determinants of CMH in younger individuals....

  17. Impact of participation in a theatre programme on quality of life among older adults with chronic conditions: a pilot study.

    Science.gov (United States)

    Yuen, Hon Keung; Mueller, Kris; Mayor, Ellise; Azuero, Andres

    2011-12-01

    The purpose of this mixed methods study was to evaluate the effect of participation in the "Seasoned Arts At the Samford for You" (SAASY) programme, which included a 6-week acting class and four public performances, on the psychological well-being and health-related quality of life of older adults. Twelve older adults with chronic conditions from a low-income senior apartment and a senior living community participated in the programme. The acting class, led by two professional artists, met for a 2-hour class weekly for six weeks. Participants completed the General Well-being Schedule (GWBS) and the 36-Item Short-Form Health Survey (SF-36) both at the beginning of the programme and one month after the programme ended. In addition, participants were individually interviewed to explore the perceived impact of the theatre programme on their well-being. Participants reported a significantly higher score in the GWBS and on the physical but not on the mental component summary of the SF-36 at post-SAASY programme. Content analysis of the interview transcripts revealed that participants attained an improved sense of self-worth and self-advocacy and overcame self-imposed limitations. Results showed improvement in psychological well-being and health-related quality of life, most notably in the physical health component of SF-36 after participating in the programme. Practice implications for occupational therapists using drama as a creative leisure occupation to promote health among older adults with chronic conditions may involve analysis of participants' occupational profile, identification of deficit areas and adaptation of the acting programme content to meet specific needs and goals. The present study used a pretest and post test one group design that has numerous inherent limitations that affect the ability to make valid inferences from study findings. A more rigorous research design with a wait-listed control group and collection of outcome measures immediately after

  18. Acute, but not chronic, exposure to d-cycloserine facilitates extinction and modulates spontaneous recovery of a conditioned taste aversion.

    Science.gov (United States)

    Mickley, G Andrew; Remus, Jennifer L; Ramos, Linnet; Wilson, Gina N; Biesan, Orion R; Ketchesin, Kyle D

    2012-01-18

    D-cycloserine, the glutamate N-methyl-D-aspartate receptor partial agonist, has been reported to facilitate the extinction of learned fears acquired in both naturalistic and laboratory settings. The current study extended this literature by evaluating the ability of either chronic or acute administrations of DCS to modulate the extinction and spontaneous recovery of a conditioned taste aversion (CTA). Twenty-three hour fluid-deprived Sprague-Dawley rats acquired a strong CTA following 3 pairings of a conditioned stimulus (CS; 0.3% oral saccharin)+unconditioned stimulus [US; 81 mg/kg (i.p.) lithium chloride (LiCl)]. In separate groups of rats, we then employed 2 different extinction paradigms: (1) CS-only (CSO-EXT) in which saccharin was presented every-other day, or (2) Explicitly Unpaired (EU-EXT) in which both saccharin and LiCl were presented but on alternate days. Previous studies have indicated that the EU-EXT procedure speeds up the extinction process. Further, spontaneous recovery of a CTA emerges following CSO-EXT but the EU-EXT paradigm causes a suppression of spontaneous recovery. DCS (15 mg/kg, i.p.) was administered immediately after daily liquid presentations (saccharin or water, alternate days) during the extinction period. In an acute drug manipulation, DCS (15 mg/kg, i.p.) or saline control injections were administered for 4 days only. This was done during one of 3 different phases of extinction [i.e., static (2-5%), early dynamic (8-16%), or middle dynamic (20-40%) saccharin reacceptance]. Other animals assigned to the chronic DCS condition received daily DCS (15 mg/kg, i.p.) throughout extinction. Changes in saccharin drinking in these animals were compared to the data from rats that received no drug (saline controls). Once rats met our criterion for asymptotic extinction (90% reacceptance of the CS) they entered a 30-day latency period during which they received water for 1 h/day. The day after the completion of the latency period, a final

  19. Pharmacological modulation of caspase-8 in thymus-related medical conditions.

    Science.gov (United States)

    Pozzesi, Nicola; Fierabracci, Alessandra; Thuy, Trinh Thy; Martelli, Maria Paola; Liberati, Anna Marina; Ayroldi, Emira; Riccardi, Carlo; Delfino, Domenico V

    2014-10-01

    The thymus is a lymphoid organ that governs the development of a diverse T-cell repertoire capable of defending against nonself-antigens and avoiding autoimmunity. However, the thymus can also succumb to different diseases. Hypertrophic diseases, such as thymomas, are typically associated with impairment of negative selection, which leads to autoimmune disease, or disruption of positive selection, which results in immunodeficiency. Hypotrophic diseases of the thymus can manifest during acute infections, cancer, allogeneic bone marrow transplantation, or with aging. This condition leads to decreased immune function and can be treated by either replacing lost thymic tissue or by preventing thymic tissue death. Studies have demonstrated the critical role of caspase-8 in regulating apoptosis in the thymus. In this review, we discuss how pharmacological activation and inhibition of caspase-8 can be used to treat hypertrophic and hypotrophic diseases of the thymus, respectively, to improve its function.

  20. Medical problems in pregnancy.

    Science.gov (United States)

    Narayan, Bhaskar; Nelson-Piercy, Catherine

    2016-12-01

    The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy. This includes prepregnancy measures such as counselling and optimisation of medical therapy, as well as multidisciplinary management throughout pregnancy and the postpartum period. Prompt recognition and treatment of acute and chronic illness is of clear benefit, and most drugs and many radiological investigations may be used in pregnancy.

  1. Comparing specialist medical care with specialist medical care plus the Lightning Process® for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME): study protocol for a randomised controlled trial (SMILE Trial)

    OpenAIRE

    Crawley, Esther; Mills, Nicola; Hollingworth, Will; Deans, Zuzana; Sterne, Jonathan A; Donovan, Jenny L; Beasant, Lucy; Montgomery, Alan

    2013-01-01

    Background Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and potentially serious condition with a limited evidence base for treatment. Specialist treatment for paediatric CFS/ME uses interventions recommended by National Institute for Health and Clinical Excellence (NICE) including cognitive behavioural therapy, graded exercise therapy and activity management. The Lightning Process® (LP) is a trademarked intervention derived from osteopathy, life-coachi...

  2. [MEDICAL CANNABIS].

    Science.gov (United States)

    Naftali, Timna

    2016-02-01

    The cannabis plant has been known to humanity for centuries as a remedy for pain, diarrhea and inflammation. Current research is inspecting the use of cannabis for many diseases, including multiple sclerosis, epilepsy, dystonia, and chronic pain. In inflammatory conditions cannabinoids improve pain in rheumatoid arthritis and:pain and diarrhea in Crohn's disease. Despite their therapeutic potential, cannabinoids are not free of side effects including psychosis, anxiety, paranoia, dependence and abuse. Controlled clinical studies investigating the therapeutic potential of cannabis are few and small, whereas pressure for expanding cannabis use is increasing. Currently, as long as cannabis is classified as an illicit drug and until further controlled studies are performed, the use of medical cannabis should be limited to patients who failed conventional better established treatment.

  3. Medication monitoring and optimization : a targeted pharmacist program for effective and cost-effective improvement of chronic therapy adherence

    NARCIS (Netherlands)

    van Boven, Job F.M.; Stuurman-Bieze, Ada G.G.; Hiddink, Eric G.; Postma, Maarten J.; Vegter, Stefan

    2014-01-01

    BACKGROUND: Community pharmacies provide a promising platform for monitoring and improving therapy adherence and providing pharmaceutical care. Structured methods and appropriate software are important tools to increase pharmacist effectiveness and improve health outcomes. In 2006, the Medication Mo

  4. Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain.

    Science.gov (United States)

    Flor, H; Birbaumer, N

    1993-08-01

    In this study, three types of treatments for chronic musculoskeletal pain were compared. Fifty-seven patients who suffered from chronic back pain and 21 patients who suffered from temporomandibular pain and dysfunction were randomly assigned to either electromyographic (EMG) biofeedback, cognitive-behavioral therapy, or conservative medical treatment. At posttreatment, improvements were noted in all three treatment groups, with the biofeedback group displaying the most substantial change. At the 6- and 24-month follow-up, only the biofeedback group maintained significant reductions in pain severity, interference, affective distress, pain-related use of the health care system, stress-related reactivity of the affected muscles, and an increase in active coping self-statements. Treatment outcome was predicted by chronicity and treatment-specific variables. Analysis of attrition showed a significant effect for therapist and extent of somatic pathology. Results suggest that pain patients who suffer from musculoskeletal pain problems and display few physical disabilities may profit the most from short-term EMG biofeedback treatment.

  5. Changes in Depressive Symptoms among Older Adults with Multiple Chronic Conditions: Role of Positive and Negative Social Support

    Directory of Open Access Journals (Sweden)

    SangNam Ahn

    2016-12-01

    Full Text Available Depression severely affects older adults in the United States. As part of the social environment, significant social support was suggested to ameliorate depression among older adults. We investigate how varying forms of social support moderate depressive symptomatology among older adults with multiple chronic conditions (MCC. Data were analyzed using a sample of 11,400 adults, aged 65 years or older, from the 2006–2012 Health and Retirement Study. The current study investigated the moderating effects of positive or negative social support from spouse, children, other family, and friends on the association between MCC and depression. A linear mixed model with repeated measures was used to estimate the effect of MCC on depression and its interactions with positive and negative social support in explaining depression among older adults. Varying forms of social support played different moderating roles in depressive symptomatology among older adults with MCC. Positive spousal support significantly weakened the deleterious effect of MCC on depression. Conversely, all negative social support from spouse, children, other family, and friends significantly strengthened the deleterious effect of MCC on depression. Minimizing negative social support and maximizing positive spousal support can reduce depression caused by MCC and lead to successful aging among older adults.

  6. Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management.

    Science.gov (United States)

    Lawn, Sharon; Delany, Toni; Sweet, Linda; Battersby, Malcolm; Skinner, Timothy

    2015-01-01

    Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.

  7. Identifying Chronic Conditions and Other Selected Factors That Motivate Physical Activity in World Senior Games Participants and the General Population

    Directory of Open Access Journals (Sweden)

    Ray M. Merrill PhD, MPH

    2015-07-01

    Full Text Available This study assesses chronic disease or disease-related conditions as motivators of physical activity. It also compares these and other motivators of physical activity between Senior Games participants (SGPs and the general population. Analyses are based on an anonymous cross-sectional survey conducted among 666 SGPs and 177 individuals from the general population. SGPs experienced better general health and less obesity, diabetes, and depression, as well as an average of 14.7 more years of regular physical activity (p < .0001, 130.8 more minutes per week of aerobic activity (p < .0001, and 42.7 more minutes of anaerobic activity per week (p < .0001. Among those previously told they had diabetes, high blood pressure, high cholesterol, or depression, 74.2%, 72.2%, 70.4%, and 60.6%, respectively, said that it motivated them to increase their physical activity. Percentages were similar between SGPs and the general population. SGPs were more likely motivated to be physically active to improve physical and mental health in the present, to prevent physical and cognitive decline in the future, and to increase social opportunities. The Senior Games reinforces extrinsic motivators to positively influence intrinsic promoters such as skill development, satisfaction of learning, enjoyment, and fun.

  8. Human embryonic mesenchymal stem cell-derived conditioned medium rescues kidney function in rats with established chronic kidney disease.

    Directory of Open Access Journals (Sweden)

    Arianne van Koppen

    Full Text Available Chronic kidney disease (CKD is a major health care problem, affecting more than 35% of the elderly population worldwide. New interventions to slow or prevent disease progression are urgently needed. Beneficial effects of mesenchymal stem cells (MSC have been described, however it is unclear whether the MSCs themselves or their secretome is required. We hypothesized that MSC-derived conditioned medium (CM reduces progression of CKD and studied functional and structural effects in a rat model of established CKD. CKD was induced by 5/6 nephrectomy (SNX combined with L-NNA and 6% NaCl diet in Lewis rats. Six weeks after SNX, CKD rats received either 50 µg CM or 50 µg non-CM (NCM twice daily intravenously for four consecutive days. Six weeks after treatment CM administration was functionally effective: glomerular filtration rate (inulin clearance and effective renal plasma flow (PAH clearance were significantly higher in CM vs. NCM-treatment. Systolic blood pressure was lower in CM compared to NCM. Proteinuria tended to be lower after CM. Tubular and glomerular damage were reduced and more glomerular endothelial cells were found after CM. DNA damage repair was increased after CM. MSC-CM derived exosomes, tested in the same experimental setting, showed no protective effect on the kidney. In a rat model of established CKD, we demonstrated that administration of MSC-CM has a long-lasting therapeutic rescue function shown by decreased progression of CKD and reduced hypertension and glomerular injury.

  9. A cross-sectional study on occurrence of type 2 diabetes among patients admitted with chronic liver diseases in a medical college in Kolkata

    Directory of Open Access Journals (Sweden)

    Shuvankar Mukherjee

    2013-01-01

    Full Text Available Objectives: To study the magnitude of the problem of type 2 diabetes mellitus and impaired glucose intolerance among the patients with various types of chronic liver diseases and to find out the association of diabetes mellitus and impaired glucose tolerance with the demographic and clinical characteristics of the patients. Materials and Methods: This observational study, which was cross-sectional in design, was undertaken in the Department of General Medicine at a medical College in Kolkata during October 2010 to July 2011. Altogether 161 patients diagnosed with chronic liver disease (CLD were admitted in the General Medicine ward during the study period, out of which 9 patients got themselves discharged against medical advice. From the remaining 152 patients, a total of 136 patients aged 20 years and above were selected for the study according to the inclusion criteria. A detailed history was taken, and a thorough clinical examination was done followed by further investigations, all of which were recorded in a pre-designed, structured proforma. Results : Among the study subjects, 58.1% had impaired glucose tolerance (IGT, while 14.0% had overt diabetes mellitus. IGT and diabetes were significantly higher among the CLD patients aged 45 years or more (P < 0.05. However, similar association was not observed with regard to sex of the patients. No association was found between the occurrence of IGT and/or overt diabetes with either severity (as per Child-Pugh score or with the duration of CLD. More than half of the study subjects having alcoholic liver disease or chronic hepatitis B or C or autoimmune hepatitis and one third of those having Wilson's disease had IGT, while one third of those with either chronic hepatitis C or Wilson's disease and one fourth of those having autoimmune hepatitis had overt diabetes. Twenty-one percent of those with chronic hepatitis B also found to have overt diabetes, which was least in those with alcoholic liver

  10. Pharmacist Web-Based Training Program on Medication Use in Chronic Kidney Disease Patients: Impact on Knowledge, Skills, and Satisfaction

    Science.gov (United States)

    Legris, Marie-eve; Seguin, Noemie Charbonneau; Desforges, Katherine; Sauve, Patricia; Lord, Anne; Bell, Robert; Berbiche, Djamal; Desrochers, Jean-Francois; Lemieux, Jean-Philippe; Morin-Belanger, Claudia; Paradis, Francois Ste-Marie; Lalonde, Lyne

    2011-01-01

    Introduction: Chronic kidney disease (CKD) patients are multimorbid elderly at high risk of drug-related problems. A Web-based training program was developed based on a list of significant drug-related problems in CKD patients requiring a pharmaceutical intervention. The objectives were to evaluate the impact of the program on community…

  11. Prevalence and risk factors of chronic post-thoracotomy pain in Chinese patients from Peking Union Medical College Hospital

    Institute of Scientific and Technical Information of China (English)

    WANG Hai-tang; LIU Wei; LUO Ai-lun; MA Chao; HUANG Yu-guang

    2012-01-01

    Background In clinical practice,the mechanisms underlying chronic post-surgical pain (CPSP) remain insufficientlyunderstood.The primary goals of this study were to determine the incidence of chronic pain after thoracic surgery and to identify possible risk factors associated with the development of chronic post-thoracotomy pain in Chinese patients.The secondary goal was to determine whether the difference between pre-and post-operative white blood cell (WBC) counts could predict the prevalence of CPSP after thoracotomy.The impact of chronic pain on daily life was also investigated.Methods We contacted by phone 607 patients who had undergone thoracotomy at our hospital during the period February 2009 to May 2010.Statistical comparisons were made between patients with or without CPSP.Results Results were ultimately analyzed from 466 qualified patients.The overall incidence of CPSP was 64.5%.Difference between pre-and post-operative WBC counts differed significantly between patients with or without CPSP (P<0.001) and was considered as an independent risk factor for the development of CPSP following thoracotomy (P<0.001).Other predictive factors for chronic pain included younger age (<60 years,P <0.001),diabetes mellitus (P=0.023),acute post-operative pain (P=0.005) and the duration of chest tube drainage (P <0.001).At the time of interviews,the pain resulted in at least moderate restriction of daily activities in 15% of the patients,of which only 16 patients had paid a visit to the doctor and only three of them were satisfied with the therapeutic effects.Conclusions Chronic pain is common after thoracotomy.WBC count may be a new independent risk factoring surgical patients during peri-operative period.Besides,age,diabetes mellitus,acute post-operative pain,and duration of chest tube drainage may also play a role in chronic post-surgical pain occurrence.

  12. Understanding exercise uptake and adherence for people with chronic conditions: a new model demonstrating the importance of exercise identity, benefits of attending and support.

    Science.gov (United States)

    Pentecost, C; Taket, A

    2011-10-01

    Understanding the factors influencing uptake and adherence to exercise for people with chronic conditions from different ages, genders and ethnicities is important for planning exercise services. This paper presents evidence supporting a new model of exercise uptake and adherence applicable to people with chronic conditions from diverse socio-demographic backgrounds. The study is based on 130 semi-structured interviews with people with chronic conditions, including both those who did and those who did not attend exercise services, and supporters of those who attended. Analysis followed the guidelines of 'framework analysis'. Results show that three factors were particularly important in influencing adherence behavior: (i) exercise identity, (ii) support and (iii) perceived benefits of attending. Social and cultural identities impacted on willingness to exercise, importance of exercise and perceived appropriateness of exercising. Having at least one supporter providing different types of support was associated with high levels of attendance. Those people who valued the social and psychological benefits of attending were more likely to be high attenders. The new model illustrates interaction between these three factors and discusses how these can be taken into account when planning exercise services for people with chronic conditions drawn from diverse socio-demographic groups.

  13. The Engagement in Physical Activity for Middle-Aged and Older Adults with Multiple Chronic Conditions: Findings from a Community Health Assessment

    Directory of Open Access Journals (Sweden)

    Wei-Chen Lee

    2013-01-01

    Full Text Available The current aging trends accompanying the increasing prevalence of multiple chronic conditions (MCCs and decreasing participation in physical activity (PA have swept the United States. In light of the magnitude of this phenomenon, this study seeks to identify the most common MCC combinations and their relationships with PA level. A cross-sectional study, Brazos Valley Health Assessment, was conducted between October 2009 and July 2010. All data analyses were performed by STATA 12.0. The overall sample which met the inclusion criteria is 2,603. Among people older than 45 years, chronic conditions of cardiovascular, endocrine, and musculoskeletal systems were the most prevalent. Participants with three chronic conditions were less likely to meet the PA standard than those with only two chronic conditions. Younger age, women, rural residence, and unsafe environments were related to the lower PA level. After adjusting for seven covariates, all MCCs combinations adversely affect the level of PA (, . People with MCCs were among the least active subgroups despite the health benefits of doing exercise. Given the well-documented benefits of physical activity for delaying the onset or progression of MCCs, public health efforts to enhance regular PA in middle-aged and older adults are recommended.

  14. The Importance of Self-Determination to Perceived Quality of Life for Youth and Young Adults with Chronic Conditions and Disabilities

    Science.gov (United States)

    McDougall, Janette; Evans, Jan; Baldwin, Patricia

    2010-01-01

    This study examined the relationship between self-determination and perceived quality of life for youth and young adults with chronic conditions and disabilities over time. A total of 34 individuals completed the "Life Satisfaction Index-Adolescents" and the "Arc's Self-Determination Scale" at study baseline and again 1 year later. Controlling for…

  15. Association between School District Policies That Address Chronic Health Conditions of Students and Professional Development for School Nurses on Such Policies

    Science.gov (United States)

    Jones, S. Everett; Brener, Nancy D.; Bergren, Martha Dewey

    2015-01-01

    Supportive school policies and well-prepared school nurses can best address the needs of students with chronic health conditions. We analyzed nationally representative data from the 2012 School Health Policies and Practices Study to examine whether districts with policies requiring that schools provide health services to students with chronic…

  16. Caring for people with multiple chronic conditions in the United Kingdom: policy and practices with a focus on England and Scotland.

    NARCIS (Netherlands)

    Bramwell, C.; Don, R.M.; Porter, I.; Lloyd, H.; Kadam, U.; Rijken, M.; Valderas, J.M.

    2016-01-01

     General Practice (Primary Care) is responsible for the provision of health care for people with chronic conditions in the UK. General Practitioners (GPs) and practice nurses play a key role in the coordination of care with input from secondary care specialists.  The prevalence of coexisting chro

  17. Single-institution long-term outcomes for patients receiving nonmyeloablative conditioning hematopoeitic cell transplantation for chronic lymphocytic leukemia and follicular lymphoma

    DEFF Research Database (Denmark)

    Mortensen, Bo K; Petersen, Søren; Kornblit, Brian;

    2012-01-01

    Non-myeloablative conditioning hematopoietic cell transplantation (NMC-HCT) has improved the treatment of chronic lymphocytic leukemia (CLL) and follicular lymphoma (FL). In a cohort of 85 patients (45 with CLL and 40 with FL), we observed 5-yr overall survival (OS) and progression-free survival ...

  18. The Importance of Self-Determination to Perceived Quality of Life for Youth and Young Adults with Chronic Conditions and Disabilities

    Science.gov (United States)

    McDougall, Janette; Evans, Jan; Baldwin, Patricia

    2010-01-01

    This study examined the relationship between self-determination and perceived quality of life for youth and young adults with chronic conditions and disabilities over time. A total of 34 individuals completed the "Life Satisfaction Index-Adolescents" and the "Arc's Self-Determination Scale" at study baseline and again 1 year…

  19. Reduced-intensity conditioning lowers treatment-related mortality of allogeneic stem cell transplantation for chronic lymphocytic leukemia : a population-matched analysis

    NARCIS (Netherlands)

    Dreger, P; Brand, R; Milligan, D; Corradini, P; Finke, J; Deliliers, GL; Martino, R; Russell, N; van Biezen, A; Michallet, M; Niederwieser, D

    2005-01-01

    To elucidate whether reduced-intensity conditioning (RIC) decreases treatment-related mortality (TRM) after allogeneic stem cell transplantation (allo-SCT) for chronic lymphocytic leukemia (CLL), we retrospectively compared 73 RIC cases from a recent EBMT survey with 82 patients from the EBMT databa

  20. Living in a country with a strong primary care system is beneficial to people with chronic conditions

    NARCIS (Netherlands)

    Hansen, Johan; Groenewegen, Peter P.; Boerma, Wienke G W; Kringos, Dionne S.

    2015-01-01

    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries o

  1. Living in a country with a strong primary care system is beneficial to people with chronic conditions.

    NARCIS (Netherlands)

    Hansen, J.; Groenewegen, P.P.; Boerma, W.G.W.; Kringos, D.S.

    2015-01-01

    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries o

  2. Effect of acute and chronic graft-versus-host disease on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma

    Science.gov (United States)

    Ringdén, Olle; Shrestha, Smriti; da Silva, Gisela Tunes; Zhang, Mei-Jie; Dispenzieri, Angela; Remberger, Mats; Kamble, Rammurti; Freytes, Cesar O.; Gale, Robert Peter; Gibson, John; Gupta, Vikas; Holmberg, Leona; Lazarus, Hillard; McCarthy, Philip; Meehan, Kenneth; Schouten, Harry; Milone, Gustavo A.; Lonial, Sagar; Hari, Parameswaran N

    2011-01-01

    We evaluated the effect of acute and chronic graft-versus-host disease (GVHD) on relapse and survival after allogeneic haematopoietic stem cell transplantation (HSCT) for multiple myeloma (MM) using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005 following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (grades I–IV) was 42% (95% confidence interval (CI) 35 – 49%) and of chronic GVHD at five years was 59% (95% CI 49 – 69%), with 70% developing extensive chronic GVHD. In multivariate analysis, acute GVHD (≥ grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42; p=0.016), whereas limited chronic GVHD significantly decreased the risk of myeloma relapse (RR=0.35, p=0.035) and was associated with superior event-free survival (RR=0.40, p=0.027). Acute GVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52; p=0.001). The reduction in relapse risk associated with chronic GVHD is consistent with a beneficial graft-versus-myeloma effect, but this did not translate into a survival advantage. PMID:21946381

  3. The Lorazepam and Diazepam Protocol for Catatonia Due to General Medical Condition and Substance in Liaison Psychiatry

    Science.gov (United States)

    Lin, Chin-Chuen; Hung, Yi-Yung; Tsai, Meng-Chang; Huang, Tiao-Lai

    2017-01-01

    Objective The lorazepam-diazepam protocol had been proved to rapidly and effectively relieve catatonia in patients with schizophrenia or mood disorder. This study aims to investigate the efficacy of lorazepam-diazepam protocol in catatonia due to general medical conditions (GMC) and substance. Method Patients with catatonia that required psychiatric intervention in various settings of a medical center were included. The lorazepam-diazepam protocol had been used to treat the catatonia due to GMC or substance according to DSM-IV criteria. The treatment response had been assessed by two psychiatrists. Results Eighteen (85.7%) of 21 catatonic patients due to GMC or substance became free of catatonia after the lorazepam-diazepam protocol. Five (23.8%) of the 21 patients had passed away with various causes of death and wide range of time periods after catatonia. Conclusion Our results showed that the lorazepam-diazepam protocol could rapidly and effectively relieve catatonia due to GMC and substance. PMID:28114315

  4. Special medical conditions associated with catatonia in the internal medicine setting: hyponatremia-inducing psychosis and subsequent catatonia.

    Science.gov (United States)

    Novac, Andrei A; Bota, Daniela; Witkowski, Joanne; Lipiz, Jorge; Bota, Robert G

    2014-01-01

    Diagnosis and treatment of catatonia in the psychiatry consultation service is not infrequent. Usually, the patient either presents to the Emergency Department or develops catatonia on the medical floor. This condition manifests with significant behavioral changes (from mildly decreased speech output to complete mutism) that interfere with the ability to communicate. After structural brain disorders are excluded, one of the diagnoses that always should be considered is catatonia. However, the causes of catatonia are numerous, ranging from psychiatric causes to a plethora of medical illnesses. Therefore, it is not surprising that there are many proposed underlying mechanisms of catatonia and that controversy persists about the etiology of specific cases.There are only 6 reports of hyponatremia-induced catatonia and psychosis in the literature. Here, we present the case of a 30-year-old woman with catatonia and psychosis induced by hyponatremia, and we use this report to exemplify the multitude of biologic causes of catatonia and to propose a new way to look at the neuroanatomical basis of processing, particularly the vertical processing systems we believe are involved in catatonia.

  5. Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers.

    Science.gov (United States)

    Cornell, Portia Y; Grabowski, David C; Cohen, Marc; Shi, Xiaomei; Stevenson, David G

    2016-08-01

    A key feature of private long-term care insurance is that medical underwriters screen out would-be buyers who have health conditions that portend near-term physical or cognitive disability. We applied common underwriting criteria based on data from two long-term care insurers to a nationally representative sample of individuals in the target age range (50-71 years) for long-term care insurance. The screening criteria put upper bounds on the current proportion of Americans who could gain coverage in the individual market without changes to medical underwriting practice. Specifically, our simulations show that in the target age range, approximately 30 percent of those whose wealth meets minimum industry standards for suitability for long-term care insurance would have their application for such insurance rejected at the underwriting stage. Among the general population-without considering financial suitability-we estimated that 40 percent would have their applications rejected. The predicted rejection rates are substantially higher than the rejection rates of about 20-25 percent of applicants in the actual market. In evaluating reforms for long-term care financing and their potential to increase private insurance rates, as well as to reduce financial pressure on public safety-net programs, policy makers need to consider the role of underwriting in the market for long-term care insurance.

  6. Medical Fitness for Expeditionary Missions: A NATO Guide for Assessing Deployability for Military Personnel with Medical Conditions. Task Group 174, Human Factors and Medicine Panel

    Science.gov (United States)

    2013-07-30

    Obsessive - Compulsive Disorder PASI Psoriasis Area & Severity Index PE Pulmonary embolism PEF...of using this medical screening guide are: • Generalized Anxiety Disorder • Obsessive - Compulsive Disorder (OCD) • Panic Disorder • Social...potential to be a commonly seen medical problem on deployment. • Risk : Risk takes into account two separate factors : • The probability of

  7. Quality of life and affective well-being in middle-aged and older people with chronic medical illnesses: a cross-sectional population based study.

    Directory of Open Access Journals (Sweden)

    Anna Wikman

    Full Text Available BACKGROUND: There has been considerable research into the impact of chronic illness on health-related quality of life. However, few studies have assessed the impact of different chronic conditions on general quality of life (QOL. The objective of this paper was to compare general (rather than health-related QOL and affective well-being in middle aged and older people across eight chronic illnesses. METHODS AND FINDINGS: This population-based, cross-sectional study involved 11,523 individuals aged 50 years and older, taking part in wave 1 of the English Longitudinal Study of Ageing. General QOL was assessed using the CASP-19, happiness was evaluated using two items drawn from the GHQ-12, and depression was measured with the CES-D. Analysis of covariance and logistic regression, adjusting for age, gender and wealth, were performed. General QOL was most impaired in people with stroke (mean 37.56, CI 36.73-38.39, and least in those reporting cancer (mean 41.78, CI 41.12-42.44, respectively, compared with no illness (mean 44.15, CI 43.92-44.39. Stroke (mean 3.65, CI 3.58-3.73 was also associated with the greatest reduction in positive well-being whereas diabetes (mean 3.81, CI 3.76-3.86 and cancer were least affected (3.85, CI 3.79-3.91, compared with no illness (mean 3.97, CI 3.95-4.00. Depression was significantly elevated in all conditions, but was most common in chronic lung disease (OR 3.04, CI 2.56-3.61, with more modest elevations in those with osteoarthritis (OR 2.08, CI 1.84-2.34 or cancer (OR 2.07, CI 1.69-2.54. Multiple co-morbidities were associated with greater decrements in QOL and affective well-being. CONCLUSION: The presence of chronic illness is associated with impairments in broader aspects of QOL and affective well-being, but different conditions vary in their impact. Further longitudinal work is needed to establish the temporal links between chronic illness and impairments in QOL and affective well-being.

  8. [Chronic disease and health condition prevention in childhood: emphases from the 13th Symposium of Preventive Pediatrics].

    Science.gov (United States)

    Batinica, Maja; Grgurić, Josip; Jadrijević-Cvrlje, Filip

    2013-01-01

    Chronic diseases in childhood have become an important priority, especially in developed countries, because of higher prevalence, relatively and absolutely. Besides that, inappropriate procedures a chronically ill child can result in child's growth and development disorder. According to literature data, 15-20% of children have chronic disease with the impact on their physical, mental and emotional status. Disease prevention strategies are described at the primary, secondary and tertiary level: how to avoid occurrence of disease, how to diagnose and treat existent disease in early stages, before it causes significant morbidity, and finally how to reduce negative impact of existent disease by restoring function and reducing disease-related complications - how to improve quality of life of children with chronic diseases. The new term of quaternary prevention describes methods to mitigate or avoid results of unnecessary or excessive interventions in the health system. In this paper the authors present recent attitudes about chronic diseases prevention modalities in childhood, which, at the beggining of the 21st century, have become more intriguing and represent a new challenge for pediatric health care. Thus, from preventive standpoint, the following chronic illnesses are discussed: asthma, malignant diseases, autism, epilepsy, cerebral palsy, tuberculosis, diabetes type 1, congenital heart diseases, arterial hypertension, celiac disease, and eating disorders. These emphases are from the 13th Preventive Pediatrics Symposium, which took place in Skrad, June 2nd, 2012. Further activities are planned with the aim of continuation of health care furtherance for children with other chronic illnesses.

  9. Comparison by objective parameters in patients with chronic rhinosinusitis managed medically and surgically (with and without powered instruments)

    Science.gov (United States)

    Behera, Samarendra; Patro, Sourabha K.; Gupta, Ashok K.

    2016-01-01

    Objective: To compare mucociliary clearance time and quality of life in patients who underwent sinus surgery using conventional and powered instruments, and in patients who were treated nonsurgically. Methods: A total of 151 patients with chronic rhinosinusitis were included. Fifty-four patients were treated conservatively, 48 patients were managed surgically by using conventional instruments and 49 patients were managed by using a microdebrider. Kupferberg nasal endoscopy grades, 20-item Sino-Nasal Outcome Test scores, Lund-Mackay scores, and mucociliary clearance time were analyzed. Results: On comparison among the groups, it was found that there was a significant difference between group A (nonsurgically treated) compared with group B (surgery by conventional means) or group C (surgery with microdebrider) in nasal endoscopic grades, Lund-Mackay scores, 20-item Sino-Nasal Outcome Test scores, and mucociliary clearance time. However, in comparison between groups B and C, there was no statistically significant difference. Conclusion: Mucociliary clearance time tended to recover after starting treatment for chronic rhinosinusitis both after conservative treatment and after surgical treatment. Surgery provided better improvement in different objective scores in chronic rhinosinusitis. There exists no statistical difference in parameters independent of the instrument used for surgery. PMID:28107141

  10. Chronic ethanol intake modifies pyrrolidon carboxypeptidase activity in mouse frontal cortex synaptosomes under resting and K+ -stimulated conditions: role of calcium.

    Science.gov (United States)

    Mayas, María Dolores; Ramírez-Expósito, María Jesús; García-López, María Jesús; Carrera, María Pilar; Martínez-Martos, José Manuel

    2008-07-04

    Pyrrolidon carboxypeptidase (Pcp) is an omega peptidase that removes pyroglutamyl N-terminal residues of peptides such as thyrotrophin-releasing hormone (TRH), which is one of the neuropeptides that has been localized into many areas of the brain and acts as an endogenous neuromodulator of several parameters related to ethanol (EtOH) consumption. In this study, we analysed the effects of chronic EtOH intake on Pcp activity on mouse frontal cortex synaptosomes and their corresponding supernatant under basal and K+ -stimulated conditions, in presence and absence of calcium (Ca2+) to know the regulation of Pcp on TRH. In basal conditions, chronic EtOH intake significantly decreased synaptosomes Pcp activity but only in absence of Ca2+. However, supernatant Pcp activity is also decreased in presence and absence of calcium. Under K+-stimulated conditions, chronic EtOH intake decreased synaptosomes Pcp activity but only in absence of Ca2+, whereas supernatant Pcp activity was significantly decreased only in presence of Ca2+. The general inhibitory effect of chronic EtOH intake on Pcp activity suggests an inhibition of TRH metabolism and an enhancement of TRH neurotransmitter/neuromodulator functions, which could be related to putative processes of tolerance to EtOH in which TRH has been involved. Our data may also indicate that active peptides and their degrading peptidases are released together to the synaptic cleft to regulate the neurotransmitter/neuromodulator functions of these peptides, through a Ca2+ -dependent mechanism.

  11. Association between ambient air pollution, meteorological conditions and exacerbations of asthma and chronic obstructive pulmonary disease in adult citizens of the town of Smederevo

    Directory of Open Access Journals (Sweden)

    Stevanović Ivan

    2016-01-01

    Full Text Available Introduction. Smederevo is the only town in Serbia with a steel factory, whose exhausts contribute to air pollution. Therefore, the city conducts continuous monitoring of air quality. In recent years, high levels of particulate matter (PM, including coarse (PM10 and fine (PM2.5 particles in the air have frequently been recorded. The aim of this study was to assess association between exacerbation of asthma or chronic obstructive pulmonary disease (COPD in adults and air pollution or meteorological conditions. Methods. The study was conducted in the secondary care General Hospital in Smederevo covering approximately 81, 000 inhabitants living in the area of about 7 km around the automatic station for air quality monitoring from which the verified data were collected. Data on patients were obtained from medical records. The correlation between the incidence of diseases exacerbation and the number of days with exceedance of air pollutants limit level per month, as well as meteorological conditions, was tested with parametric Pearson bivariate correlation test in program SPSS. Results. The study population consisted of adults registered as asthma or COPD suffering patients (n = 1,624 with 570 episodes of remarkable exacerbations (moderate or severe of the disease in 2011. Asthma exacerbation was significantly more frequent in women than in men. The number of days with high levels of PM2.5 per month was statistically significantly associated with the total number of exacerbation (moderate and severe of both asthma and COPD episodes among the female patients. There was also a statistically significant association between the number of days with PM2.5 exceedance and the number of moderate exacerbations in the subgroups of nonsmokers and obese patients. A significant correlation of the number of days with the exceedance of PM10 limit level was shown only for the subgroup of obese, non-smoking patients with moderate exacerbation. A significant negative

  12. Grade retention risk among children with asthma and other chronic health conditions in a large urban school district.

    Science.gov (United States)

    Moonie, Sheniz; Cross, Chad L; Guillermo, Chrisalbeth J; Gupta, Tina

    2010-09-01

    Asthma accounts for 12.8 million missed school days for children nationwide. Whether this excess absenteeism contributes to poor outcomes such as grade retention is of interest. The Clark County School District in Las Vegas, NV has incorporated the Federal "No Child Left Behind Act," which states that absences per individual in excess of 10 per school year are considered unapproved and may put a child at risk for repeating a grade. The purpose of this study was to determine if children with asthma are at increased risk for absenteeism associated with grade retention. Secondary data were obtained for students in attendance for the 2006-2007 school year. Days absent were weighted for enrollment time. Frequencies were obtained using descriptive statistics, and multivariate logistic regression was used to model the odds of absenteeism > 10 days per year. Of 300 881 students, 27 299 (9.1%) reported having asthma, as determined by school health records. The population was 52% male, 37% white, and 39% Hispanic. Significant predictors of missing > 10 days per school year included ethnicity, gender, grade, and health status (P 10 school days per year compared with healthy students or those with a medical condition other than asthma (P school setting for school-aged children.

  13. Chronic NMDA receptor blockade in early postnatal period, but not in adulthood, impairs methamphetamine-induced conditioned place preference in rats.

    Science.gov (United States)

    Furuie, Hiroki; Yamada, Kazuo; Ichitani, Yukio

    2016-03-15

    Early postnatal glutamatergic N-methyl-d-aspartate (NMDA) receptor blockade in animals is known to produce various behavioral deficits in adulthood. In the present study rats postnatally (day 7-20) treated chronically with MK-801, an NMDA receptor antagonist, were tested later in adulthood in methamphetamine (MAP)-induced conditioned place preference (CPP) using a unbiased procedure in a three-compartment apparatus. Rats with the same chronic treatment in adulthood were also tested. CPP test consisted of a baseline test before conditioning, place conditioning, and a preference test after conditioning. Rats postnatally treated with MK-801 did not show any evidence of preference for MAP-paired compartment compared with that for unpaired one in the preference test that was shown in rats postnatally treated with saline. On the other hand, rats treated with MK-801 in adulthood were not affected by the treatment and showed significant CPP as was shown in saline-treated control animals. Results suggest the possibility that chronic early postnatal, but not adulthood, NMDA receptor blockade induces persistent deficit of subsequent appetitive classical conditioning.

  14. The role of illness perception and emotions on quality of life in fibromyalgia compared with other chronic pain conditions The role of illness perception and emotions on quality of life in fibromyalgia compared with other chronic pain conditions

    Directory of Open Access Journals (Sweden)

    E. Sgnaolin

    2012-07-01

    Full Text Available Objective: Fibromyalgia syndrome (FMs is a chronic widespread pain condition that can negatively impact on all aspects of patient’s life. The purpose of this study was: first, to evaluate illness perception (IP, quality of life (QoL and affective-emotive variables (EAV of patients with FM; and second, to compare these variables to different pain conditions. Methods: Consecutive 34 women (mean age 47.4±8.3 years affected by FM were enrolled for the study from December 2009 to May 2011. IP was evaluated by means of the Revised Illness Perception Questionnaire, QoL through Nottigham Health Profile and EAV through the Beck Depression Inventory. Scores were compared with rheumatoid arthritis (RA (n=20; mean age 53±12.8 years and low back pain (LBP (n=20; 51.3±7.8 years groups. Results: FM patients scored higher than RA and LBP groups on IP (Identity scale mean: FM=8.8±2.3, AR=5.5±3.3, LBP=4.1±2.9; Kruskal-Wallis=24.42. Moreover FM patients show higher EAV (mean FM=21±9.6, AR=8.9±5.6, LBP=14.9±6.5; Kolmogorov-Smirnov Z=2.17 and QoL (Pain scale mean: FM=74.2±24.1; AR=35.7±19.9; LBP=56.5±20.4; Kolmogorov-Smirnov Z=2.27; Energy scale mean: FM=86.2±28.5; AR=46.8±35.4; LBP=61.6 ±63.7; Kolmogorov-Smirnov Z=1.98 than RA group. Conclusions: Our study highlighted dysfunctional IP, low QoL, high EAV scores in FM patients and the significant relations between these variables. Research results provided support for relevance of a multidisciplinary approach to the management of FM, including psychological interventions, according to a biopsychosocial perspective.Objective: Fibromyalgia syndrome (FMs is a chronic widespread pain condition that can negatively impact on all aspects of patient’s life. The purposes of this study were: i to evaluate illness perception (IP, quality of life (QoL and affective-emotive variables (EAV of patients with FM; and ii to compare these variables to different pain conditions. Methods: Consecutive 34 women (mean age

  15. An Overview of Multiple Sclerosis: Medical, Psychosocial, and Vocational Aspects of a Chronic and Unpredictable Neurological Disorder

    Science.gov (United States)

    Rumrill, Phillip D., Jr.; Roessler, Richard T.

    2015-01-01

    This article presents an overview of multiple sclerosis (MS), one of the most common neurological disorders in the western hemisphere. Medical and psychosocial aspects of the disease such as causes and risk factors, diagnosis, incidence and prevalence, symptoms, courses, and treatment are described. Existing research regarding the employment…

  16. [The condition of the system "peroxide oxidation of lipids-antioxidant defense" in mixed saliva of patients with chronic generalized periodontitis].

    Science.gov (United States)

    Butiyugin, I A; Volchegorskiy, I A

    2014-02-01

    The comparative analysis was made concerning conditions of the system "Peroxide oxidation of lipids-antioxidant defenses in mixed saliva of patients with chronic disseminated periodontitis of light (n = 45), mean (n = 36) and severe (n = 18) degrees. The control group consisted of 25 clinically healthy persons with intact periodontium. The study revealed that in comparison with control group, in patients with chronic disseminated periodontitis occurred an increasing of content of heptane-soluble diene conjugates, isopropanol-soluble ketodienes and conjugated trienes, ceruloplasmin and a decreasing of level of alpha-tocopherol, especially under severe degree of disease. The study also established a non-linear U-dependence between indicators of the system "Peroxide oxidation of lipids-antioxidant defenses" in mixed saliva and severity of affection of tissues of periodontium in patients with chronic disseminated dermatosis.

  17. Frontal white matter alterations in short-term medicated panic disorder patients without comorbid conditions: a diffusion tensor imaging study.

    Directory of Open Access Journals (Sweden)

    Borah Kim

    Full Text Available The frontal cortex might play an important role in the fear network, and white matter (WM integrity could be related to the pathophysiology of panic disorder (PD. A few studies have investigated alterations of WM integrity in PD. The aim of this study was to determine frontal WM integrity differences between patients with PD without comorbid conditions and healthy control (HC subjects by using diffusion tensor imaging. Thirty-six patients with PD who had used medication within 1 week and 27 age- and sex-matched HC subjects participated in this study. Structural brain magnetic resonance imaging was performed on all participants. Panic Disorder Severity Scale and B