Sample records for etiological treatment programs

  1. Etiology and Treatment of Developmental Stammering

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    J Gordon Millichap


    Full Text Available The etiology and treatment of developmental stammering in childhood (DS, also called idiopathic stammering or stuttering are reviewed by a speech pathologist and psychologist at the University of Reading, UK.

  2. Pediatric Obesity: Etiology and Treatment


    Crocker, Melissa K.; Yanovski, Jack A.


    This paper reviews factors that contribute to excessive weight gain in children and outlines current knowledge regarding approaches for treating pediatric obesity. Virtually all of the known genetic causes of obesity primarily increase energy intake. Genes regulating the leptin signaling pathway are particularly important for human energy homeostasis. Obesity is a chronic disorder that requires long-term strategies for management. The foundation for all treatments for pediatric obesity remain...

  3. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment (United States)

    Bellato, Enrico; Marini, Eleonora; Castoldi, Filippo; Barbasetti, Nicola; Mattei, Lorenzo; Bonasia, Davide Edoardo; Blonna, Davide


    Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable bowel disease, and heat and cold intolerance) can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2), milnacipran (NNT 19), and pregabalin (NNT 8.6) are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy. PMID:23213512

  4. Aminoacidopathies: Prevalence, Etiology, Screening, and Treatment Options. (United States)

    Wasim, Muhammad; Awan, Fazli Rabbi; Khan, Haq Nawaz; Tawab, Abdul; Iqbal, Mazhar; Ayesha, Hina


    Inborn errors of metabolism (IEMs) are a group of inherited metabolic disorders which are caused by mutations in the specific genes that lead to impaired proteins or enzymes production. Different metabolic pathways are perturbed due to the deficiency or lack of enzymes. To date, more than 500 IEMs have been reported with most of them being untreatable. However, fortunately 91 such disorders are potentially treatable, if diagnosed at an earlier stage of life. IEMs have been classified into different categories and one class of IEMs, characterized by the physiological disturbances of amino acids is called as aminoacidopathies. Out of 91 treatable IEM, thirteen disorders are amino acid related. Aminoacidopathies can be detected by chromatography and mass spectrometry based analytical techniques (e.g., HPLC, GC-MS, LC-MS/MS) for amino acid level changes, and through genetic assays (e.g., PCR, TaqMan Genotyping, DNA sequencing) at the mutation level in the corresponding genes. Hence, this review is focused to describe thirteen common aminoacidopathies namely: Phenylketonuria (PKU), Maple Syrup Urine Disease (MSUD), Homocystinuria/Methylene Tetrahydrofolate Reductase (MTHFR) deficiency, Tyrosinemia type II, Citrullinemia type I and type II, Argininosuccinic aciduria, Carbamoyl Phosphate Synthetase I (CPS) deficiency, Argininemia (arginase deficiency), Hyperornithinemia-Hyperammonemia-Homocitrullinuria (HHH) syndrome, N-Acetylglutamate Synthase (NAGS) deficiency, Ornithine Transcarbamylase (OTC) deficiency, and Pyruvate Dehydrogenase (PDH) complex deficiency. Furthermore, the etiology, prevalence and commonly used analytical techniques for screening of aminoacidopathies are briefly described. This information would be helpful to researchers and clinicians especially from developing countries to initiate newborn screening programs for aminoacidopathies.

  5. Acute Pancreatitis: Etiology, Pathology, Diagnosis, and Treatment. (United States)

    Majidi, Shirin; Golembioski, Adam; Wilson, Stephen L; Thompson, Errington C


    Acute pancreatitis is a fascinating disease. In the United States, the two most common etiologies of acute pancreatitis are gallstones and excessive alcohol consumption. The diagnosis of acute pancreatitis is made with a combination of history, physical examination, computed tomography scan, and laboratory evaluation. Differentiating patients who will have a benign course of their pancreatitis from patients who will have severe pancreatitis is challenging to the clinician. C-reactive protein, pro-calcitonin, and the Bedside Index for Severity of Acute Pancreatitis appeared to be the best tools for the early and accurate diagnosis of severe pancreatitis. Early laparoscopic cholecystectomy is indicated for patients with mild gallstone pancreatitis. For patients who are going to have a prolonged hospitalization, enteral nutrition is preferred. Total parenteral nutrition should be reserved for patients who cannot tolerate enteral nutrition. Prophylactic antibiotics are not indicated for patients with pancreatic necrosis. Surgical intervention for infected pancreatic necrosis should be delayed as long as possible to improve patient outcomes.

  6. Pedophilia: Clinical Features, Etiology and Treatment

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    Ayten Erdogan


    Full Text Available There is a growing recognition that child sexual abuse is a critical public health problem. Child sexual abusement is not a medical diagnosis and is not necessarily a term synonymous with pedophilia. According to DSM-IV, a pedophile is an individual who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally <13 years for a period of at least 6 months. It is difficult to estimate the true prevalence of pedophilia because few pedophiles voluntarily seek treatment. Most of the available data are based on individuals who have become involved with the legal system. Most individuals who engage in pedophilia are male. When compared with other sex offenders, pedophiles are in the older adult age range (age, 40-70 years. Pedophiles may engage in a wide range of sexual acts with children. These activities includes exposing themselves to children, looking at naked children, masturbating in the presence of children, physical contact, rubbing, fondling a child, engaging in oral sex, or penetration of the mouth, anus, and/or vagina. Generally, pedophiles do not use force to have children engage in these activities but instead rely on various forms of psychic manipulation and desensitization. People with pedophilia use internet to be a vehicle capable of meeting their needs: obtaining information, monitoring and contacting victims, developing fantasy, overcoming inhibitions, avoiding apprehension, and communicating with other offenders. The compulsive-aggressive trait is more pronounced in people with pedophilia. Generally they plan the sexual offending with the intention of relieving internal pressures or urges. Pedophiles generally experience feelings of inferiority, isolation or loneliness, low self-esteem, internal dysphoria, and emotional immaturity. There are likely multiple factors and multiple pathways involved in the development of pedophilia. Since there has been no treatment method that can


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    L.K. Aslamazyan


    Full Text Available The article is dedicated to the papilloma virus infection. As it became known in October 2008, the nobel prize in the field of medicine and physiology this year is awarded to the German doctor of Harald Zur Hausen who has proved the role of the human papilloma virus as causative factor of the cervical carcinoma. This is epoch making discovery because of human papilloma virus is most frequent of sexually transmitted infections. The authors demonstrated the high HPV prevalence. One of the most frequent manifestations of this infection is in more details presented pointed condy loma, clinical course of the disease and differential diagnostics of its various forms. Considering treatment inefficiency, the authors convincingly demonstrate that the only opportunity available to keep a human from the illness development is a specific immune prevention.Key words: papillomavirus infection, pointed condylomas, precancers, prevention.

  8. Narcolepsy: etiology, clinical features, diagnosis and treatment

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    Jolanta B. Zawilska


    Full Text Available [u][/u] Narcolepsy is a chronic hypersomnia characterized by excessive daytime sleepiness (EDS and manifestations of disrupted rapid eye movement sleep stage (cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. Mechanisms underlying narcolepsy are not fully understood. Experimental data indicate that the disease is caused by a loss of hypocretin neurons in the hypothalamus, likely due to an autoimmune process triggered by environmental factors in susceptible individuals. Most patients with narcolepsy and cataplexy have very low hypocretin-1 levels in the cerebrospinal fluid. An appropriate clinical history, polysomnogram, and multiple sleep latency test are necessary for diagnosis of the disease. Additionally, two biological markers, i.e., cerebrospinal fluid hypocretin-1 levels and expression of the DQB1*0602 gene, are used. The treatment of narcolepsy is aimed at the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with psychostimulants (amphetamine-like, modafinil and armodafinil. Cataplexy is treated with sodium oxybate (GHB, tricyclic antidepressants, or selective serotonin and noradrenaline reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with sodium oxybate. Patients with narcolepsy should follow proper sleep hygiene and avoid strong emotions.

  9. [Periodontal abscess: etiology, diagnosis and treatment]. (United States)

    Vályi, Péter; Gorzó, István


    The periodontal abscess is an acute destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp. The prevalence of periodontal abscess is relatively high and it affects the prognosis of the tooth. Periodontal abscesses can develop on the base of persisting periodontitis but can also occur in the absence of periodontitis. The cause of the development of periodontal abscess originating from chronic periodontitis is the marginal closure of a periodontal pocket, or the pocket lumen might be too tight to drain the increased suppuration due to changes in the composition of subgingival microflora, alteration of bacterial virulence or host defenses. Diagnosis of a periodontal abscess is based on medical and dental history as well as oral examination (pocket depth, swelling, suppuration, mobility, sensibility of the tooth). The most prevalent group of bacteria: P. gingivalis, P. intermedia, B. forsythus, F. nucleatum and P. micros. Previous studies have suggested that the complete therapy of the periodontitis patients with acute periodontal abscess has to do in two stages: the first stage is the management of acute lesions, then the second stage is the appropriate comprehensive treatment of the original and/or residual lesions. The management of acute lesions includes establishing drainage via pocket lumen, subgingival scaling and root planing, curettage of the lining pocket epithelia and seriously inflamed connective tissue, compressing pocket wall to underlying tooth and periodontal support, and maintaining tissue contact. Some authors recommend the incision or to establish drainage and irrigation, or a flap surgery, or even extraction of hopeless teeth. We recommend the use of systemic antibiotics as a preventive measure of systemic disease or in case of systemic symptoms.

  10. ["Flare-up" during endodontic treatment--etiology and management]. (United States)

    Zuckerman, O; Metzger, Z; Sela, G; Lin, S


    "Flare-ups" during or following endodontic treatment are not uncommon. A "Flare-up" refers to post-operative pain and/or swelling resulting from bacterial, mechanical or chemical irritation. Prompt diagnosis and treatment are essential for reducing patients' pain and discomfort. Prevention of bacterial, chemical or mechanical invasion to the periapical tissues is the best approach. Other treatment modalities which reduce the probability of periradicular tissue irritation should also be adopted. Etiology, prevention, diagnosis and treatment options of "flare-up" cases are discussed as well as indications for analgesics, in accordance with the severity of the pain.

  11. Future Directions in Etiologic, Prevention, and Treatment Research for Eating Disorders (United States)

    Stice, Eric; South, Kelsey; Shaw, Heather


    Significant advances have occurred regarding the understanding of etiologic processes that give rise to eating disorders and the design and evaluation of efficacious prevention programs and treatment interventions. Herein we offer suggestions regarding potentially fruitful directions for future research in these areas. We suggest it would be…

  12. Prevalence, etiological factors and the treatment of infant exogenous obesity


    Edio Luiz Petroski; Ludmila Dalben Soares


    In the last few years, there has been considerable interest in the effects of excessive weight gain during childhood, due to the fact that the development of fat tissue in this period is a determinant of adult body composition. The objective of this study was to investigate the prevalence of infant obesity, to identify possible etiological factors, and to highlight treatments that have been used to reduce and/or prevent child obesity. Results have shown that obesity has increased more than an...

  13. Current Diagnosis, Treatment and Etiology of Status Epilepticus

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    Çetin Kürşad Akpınar


    Full Text Available Status Epilepticus (SE is a medical emergency that causes significant morbidity and mortality and requires prompt diagnosis and treatment. Although SE can be divided into two subgroups as convulsive and nonconvulsive, treatment principles are generally similar. Treatment should be prompt and underlying cause should be corrected. Although intravenous lorazepam is the first-line treatment due to a lower risk of relapse, diazepam becomes the first choice since loeazepan is not available in our country. Even though intravenous benzodiazepine stops seizures, intravenous antiepileptic drug (phenytoin, etc. should be administered at a loading dose. Patients with refractory status epilepticus should be supported with respect to vital, respiratory, metabolic and hemodynamic aspects and followed up in an intensive care unit to monitor cerebral electrical activity. The most common cause in the etiology is the cessation of antiepileptic drugs. The aim of SE treatment is to stop seizures and prevent complications and recurrence. In this paper, current diagnosis, treatment and etiology of SE are reviewed.


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    Anton Raharjo


    Full Text Available Background: Oral malodor, a generic descriptor term for foul smells emanating from the mouth can be classified as either pathological or physiological halitosis. Some problems are often confounded by the clinician's mismanagement. Objective: This paper reviews the etiology of classification and determination of treatment needs (TN for oral malodor. Literature review and discussion: In the majority of cases the problem has been shown to originate in the oral cavity. Although oral malodor cases are often related to physiological aspects, sometimes they can be related to extra oral sources and psychological aspects. Classification methods of oral malodor with corresponding treatment needs (TN have already been established. Although PTC & tongue brushing and appropriate mouthrinses are both important and basic treatment measures for halitosis, other dental treatments are sometimes required. Conclusion: Accurate screening and diagnosis of halitosis followed by appropriate TN may give better results and consequently reduce the risk of mismanagement.

  15. Lifestyle and Sarcopenia—Etiology, Prevention, and Treatment

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    Oren Rom


    Full Text Available The term sarcopenia describes the loss of skeletal muscle mass, strength, and function in old age. As the world population continues to grow older, more attention is given to the phenomena of sarcopenia and the search for strategies of prevention and treatment. The progression of sarcopenia is affected by age-related physiological and systemic changes in the body, including alterations in skeletal muscle tissue, hormonal changes, increased inflammatory activities, and oxidative stress. Sarcopenia progression is also affected by lifestyle factors which are far more controllable. These factors include various aspects of nutrition, physical activity, exercise, alcohol intake, and tobacco use. Raising the public awareness regarding the impact of these factors, as causes of sarcopenia and potential strategies of prevention and treatment, is of great importance. In this review we aim to describe various lifestyle factors that affect the etiology, prevention, and treatment of sarcopenia.

  16. Scleroderma: nomenclature, etiology, pathogenesis, prognosis, and treatments: facts and controversies. (United States)

    Fett, Nicole


    Scleroderma refers to a heterogeneous group of autoimmune fibrosing disorders. The nomenclature of scleroderma has changed dramatically in recent years, with morphea (localized scleroderma), limited cutaneous systemic sclerosis, diffuse cutaneous systemic sclerosis, and systemic sclerosis sine scleroderma encompassing the currently accepted disease subtypes. Major advances have been made in the molecular studies of morphea and systemic sclerosis; however, their etiologies and pathogenesis remain incompletely understood. Although morphea and systemic sclerosis demonstrate activation of similar inflammatory and fibrotic pathways, important differences in signaling pathways and gene signatures indicate they are likely biologically distinct processes. Morphea can cause significant morbidity but does not affect mortality, whereas systemic sclerosis has the highest disease-specific mortality of all autoimmune connective tissue diseases. Treatment recommendations for morphea and systemic sclerosis are based on limited data and largely expert opinions. Current collaborative efforts in morphea and systemic sclerosis research will hopefully lead to better understanding of the etiology and pathogenesis of these rare and varied diseases and improved treatment options. Published by Elsevier Inc.


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    A.B. Sugak


    Full Text Available Pericarditis maybe caused by different agents: viruses, bacteria, tuberculosis, and it may be autoimmune. All these types of diseases have similar clinical signs, but differ by prevalence, prognosis and medical tactics. Due to achievements of radial methods of visualization, molecular biology, and immunology, we have an opportunity to provide early specific diagnostics and etiological treatment of inflammatory diseases of pericardium. The second part of lecture presents main principles of differential diagnostics of specific types of pericarditis, gives characteristics of several often accruing types of disease, and describes treatment and tactics of management of patients with pericarditis.Key words: children, pericarditis.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(3:76-81

  18. Acute symptomatic neonatal seizures in preterm neonates: etiologies and treatments. (United States)

    Pisani, Francesco; Spagnoli, Carlotta


    Acute symptomatic neonatal seizures in preterm newborns are a relevant clinical challenge due to the presence of many knowledge gaps. Etiology-wise, acute symptomatic seizures have an age-specific epidemiology, with intraventricular hemorrhage and its complications representing the first cause in extremely and very preterm neonates, whereas other etiologies have similar occurrence rates as in full-term infants. Specific treatment strategies for the premature neonates are not yet available. Studies suggest a similarly low response rate with even more unfavorable prognosis than in full-term infants. Pharmacodynamic and pharmacokinetic changes are likely under way during the preterm period, with the potential to affect both effectiveness and safety of antiepileptic drugs in these patients. However, due to the lack of clear evidence to guide prioritization of second-line drugs, off-label medications are frequently indicated by review papers and flow-charts, and are prescribed in clinical practice. We therefore conclude by exploring potential future lines of research. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Late-onset hypogonadism: etiology, clinical features, diagnostics, treatment

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    E. Yu. Pashkova


    Full Text Available In a critical review of the literature current data concerning etiology, clinical features, diagnostics, treatment of late-onset hypogonadism (LOH are given. LOH is a multidisciplinary problem, because a patient with LOH can have osteoporosis, anemia, depression, obesity, diabetes mellitus, erectile dysfunction. Sometimes it is hard to realize that all this complaints are symptoms of LOH. LOH has a negative impact on a patient,s quality of life and it,s impossible to help without androgen replacement therapy. Furthermore doctors often have doubts about testosterone replacement therapy safety because of lack of accurate information. In a convenient for medical practitioners form clinical and laboratory diagnostic criteria of LOH are presented together with formulas for conversion from one measurement unit of main sex hormones into another. Based on latest ISSAM guidelines (International Society for the Study of the Aging Male modern treatment options of LOH are summarized, full information about available testosterone preparations (oral, transdermal, injectable with comparative analysis of advantages and disadvantages of each is given. A full description of indications and contraindications for androgen replacement treatment is presented, also treatment regimen and medical supervision algorithm during treatment are described. 

  20. Late-onset hypogonadism: etiology, clinical features, diagnostics, treatment

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    E. Yu. Pashkova


    Full Text Available In a critical review of the literature current data concerning etiology, clinical features, diagnostics, treatment of late-onset hypogonadism (LOH are given. LOH is a multidisciplinary problem, because a patient with LOH can have osteoporosis, anemia, depression, obesity, diabetes mellitus, erectile dysfunction. Sometimes it is hard to realize that all this complaints are symptoms of LOH. LOH has a negative impact on a patient,s quality of life and it,s impossible to help without androgen replacement therapy. Furthermore doctors often have doubts about testosterone replacement therapy safety because of lack of accurate information. In a convenient for medical practitioners form clinical and laboratory diagnostic criteria of LOH are presented together with formulas for conversion from one measurement unit of main sex hormones into another. Based on latest ISSAM guidelines (International Society for the Study of the Aging Male modern treatment options of LOH are summarized, full information about available testosterone preparations (oral, transdermal, injectable with comparative analysis of advantages and disadvantages of each is given. A full description of indications and contraindications for androgen replacement treatment is presented, also treatment regimen and medical supervision algorithm during treatment are described. 

  1. [Etiologies of cerebral palsy and classical treatment possibilities]. (United States)

    Maurer, Ute


    Cerebral palsy is a non-progressive disorder of the developing brain with different etiologies in the pre-, peri- or postnatal period. The most important of these diseases is cystic periventricular leukomalacia (PVL), followed by intra- and periventricular hemorrhage, hypoxic-ischemic encephalopathy, vascular disorders, infections or brain malformations. The underlying cause is always a damage of the first motor neuron. Prevalence of cerebral palsy in Europe is 2-3 per 1000 live births with a broad spectrum in different birth weight groups. Our own data concerning only pre-term infants in the NICU with birth weight below 1500 g (VLBW) are between 10%-20%. Established classical treatment methods include physiotherapy (Bobath, Vojta, Hippotherapy), methods of speech and occupational therapists (Castillo-Morales, Sensory Integration) and other therapeutical concepts (Petö, Affolter, Frostig).

  2. Current concepts of etiology and treatment of chondromalacia patellae. (United States)

    Bentley, G; Dowd, G


    Chondromalacia patellae is a distinct clinical entity characterized by retropatellar pain that is associated with recognizable changes in the articular cartilage of the posterior surface of the patella. Several factors may be involved in the etiology, such as severe patella alta, trauma, and, in rare cases, abnormal patellar tracking. Clinical symptoms and signs are reliable in only 50% of cases, but measurable quadriceps wasting, palpable patellofemoral crepitus, and effusion are strongly suggestive. Diagnosis must be confirmed by arthroscopy or direct examination of the posterior surface of the patella. Radiologic measurements of patellofemoral relations are of limited value in diagnosis. The initial pathologic finding is usually surface cartilage breakdown. Radioisotope studies show cartilage cell replication which suggests a healing capacity in early cases following treatment that alters the load through the affected cartilage. There is no evidence of progression to patellofemoral osteoarthritis, which is probably a different entity. The treatment should be conservative where possible with isometric quadriceps exercises and simple anti-inflammatory drugs such as aspirin. Operative treatment is indicated for patients with persistent pain and macroscopic involvement of more than half a centimeter of the articular cartilage surface. The simplest effective procedure that avoids quadriceps dysfunction and fibrosis is a distal patellar tendon medial realignment with lateral release and medial reefing of the quadriceps expansion. Patellectomy is indicated in more extensive involvement of the patella of 2 or more centimeters in diameter, but this must be performed only when the patient has excellent quadriceps function before surgery and is motivated to exercise after surgery.

  3. Selective mutism: a review of etiology, comorbidities, and treatment. (United States)

    Wong, Priscilla


    Selective mutism is a rare and multidimensional childhood disorder that typically affects children entering school age. It is characterized by the persistent failure to speak in select social settings despite possessing the ability to speak and speak comfortably in more familiar settings. Many theories attempt to explain the etiology of selective mutism.Comorbidities and treatment. Selective mutism can present a variety of comorbidities including enuresis, encopresis, obsessive-compulsive disorder, depression, premorbid speech and language abnormalities, developmental delay, and Asperger's disorders. The specific manifestations and severity of these comorbidities vary based on the individual. Given the multidimensional manifestations of selective mutism, treatment options are similarly diverse. They include individual behavioral therapy, family therapy, and psychotherapy with antidepressants and anti-anxiety medications.Future directions. While studies have helped to elucidate the phenomenology of selective mutism, limitations and gaps in knowledge still persist. In particular, the literature on selective mutism consists primarily of small sample populations and case reports. Future research aims to develop an increasingly integrated, multidimensional framework for evaluating and treating children with selective mutism.

  4. Tactics and Surgical Treatment of Obstructive Jaundice of Different Etiology

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    V.M. Ratchik


    Full Text Available In the department of surgery of the digestive organs of State institution «Institute of gastroenterology of National aca-demy of medical sciences of Ukraine» for the period from 2003 to 2013, 567 patients with pathology of the hepatopancreatobiliary zone of different etiology, complicated with obstructive jaundice, underwent surgery. 197 (34.7 % patients with bilirubinemia more than 200 µmol/l and III degree of liver failure underwent two-stage treatment. Endoscopic (two-step techniques were applied for the treatment of 143 (25.2 % patients with choledocholithiasis. One-step minimally invasive interventions — laparoscopic cholecystectomy, external drainage of the common bile duct, lithoextraction, balloon dilatation of the sphincter of Oddi — implemented in 41 (10.4 % patients. In complications chronic pancreatitis, draining surgeries were performed in 20 (25.6 % patients and resection-draining — in 39 (50.0 %, with the correction of bile outflow, as well as endoscopic, laparoscopic and minimally invasive puncture-draining operations were carried out. 2 (2.6 % patients underwent pancreatoduodenectomy by Whipple. Two-stage surgeries were performed in 26 (33.3 % patients. At tumors of cholangiopancreatoduodenal zone, 18 (30.5 % patients underwent percutaneous endobiliary reducing interventions followed by radical surgery in 10 (16.9 % patients.

  5. Chronic urticaria in children: Etiologies, Clinical Manifestations, Diagnosis and Treatment

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    Javad Ghaffari


    Full Text Available Chronic urticaria is defined as a skin disease with central induration (wheal and erythema formation around it (flare that appears at least twice a week and remains at least for 6 weeks continually. The incidence of urticaria in children is about 0.1-3%. Most cases of chronic urticaria occur in children between 6-11 years. Autoimmune and allergy immaturity is one of the reasons of lower incidence of chronic urticaria in younger children. Quality of life impairment in children with urticaria has been known to be similar to diseases with severe atopic dermatitis, epilepsy, diabetes mellitus and asthma. There are several causes for chronic urticaria in children in different reports. In most of cases the known etiologic agents are varies from 21 to 83%. Overall, infectious causes of chronic urticaria in children are more common and obvious than other in adults .In most cases, the cause of chronic urticaria are idiopathic or autoimmune. Urticaria severity divided to mild, moderate and severe was based on the number of wheals and severity of pruritus. Diagnosis of chronic urticaria is based on a good history and physical examination. The treatment of chronic urticaria is a patient education that is to remove the triggering and aggravating agents, resolving and treating of the known disease and the use of various medicines based on the history and clinical findings. The first medical therapeutics lines in children are anti-histamines, beta-blocker H1 and new generation of non-sedating agents.

  6. Urinary tract infections in women: etiology and treatment options

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    Minardi D


    Full Text Available Daniele Minardi, Gianluca d'Anzeo, Daniele Cantoro, Alessandro Conti, Giovanni MuzzonigroDepartment of Clinical and Specialist Sciences, Urology, Polytechnic University of the Marche Medical School and United Hospitals, Ancona, ItalyAbstract: Urinary tract infections (UTI are common among the female population. It has been calculated that about one-third of adult women have experienced an episode of symptomatic cystitis at least once. It is also common for these episodes to recur. If predisposing factors are not identified and removed, UTI can lead to more serious consequences, in particular kidney damage and renal failure. The aim of this review was to analyze the factors more commonly correlated with UTI in women, and to see what possible solutions are currently used in general practice and specialized areas, as well as those still under investigation. A good understanding of the possible pathogenic factors contributing to the development of UTI and its recurrence will help the general practitioner to interview the patient, search for causes that would otherwise remain undiscovered, and to identify the correct therapeutic strategy.Keywords: urinary tract infection, women, etiology, diagnosis, treatment

  7. Epidemiology, Etiology, and Treatment of Isolated Cleft Palate (United States)

    Burg, Madeleine L.; Chai, Yang; Yao, Caroline A.; Magee, William; Figueiredo, Jane C.


    Isolated cleft palate (CPO) is the rarest form of oral clefting. The incidence of CPO varies substantially by geography from 1.3 to 25.3 per 10,000 live births, with the highest rates in British Columbia, Canada and the lowest rates in Nigeria, Africa. Stratified by ethnicity/race, the highest rates of CPO are observed in non-Hispanic Whites and the lowest in Africans; nevertheless, rates of CPO are consistently higher in females compared to males. Approximately fifty percent of cases born with cleft palate occur as part of a known genetic syndrome or with another malformation (e.g., congenital heart defects) and the other half occur as solitary defects, referred to often as non-syndromic clefts. The etiology of CPO is multifactorial involving genetic and environmental risk factors. Several animal models have yielded insight into the molecular pathways responsible for proper closure of the palate, including the BMP, TGF-β, and SHH signaling pathways. In terms of environmental exposures, only maternal tobacco smoke has been found to be strongly associated with CPO. Some studies have suggested that maternal glucocorticoid exposure may also be important. Clearly, there is a need for larger epidemiologic studies to further investigate both genetic and environmental risk factors and gene-environment interactions. In terms of treatment, there is a need for long-term comprehensive care including surgical, dental and speech pathology. Overall, five main themes emerge as critical in advancing research: (1) monitoring of the occurrence of CPO (capacity building); (2) detailed phenotyping of the severity (biology); (3) understanding of the genetic and environmental risk factors (primary prevention); (4) access to early detection and multidisciplinary treatment (clinical services); and (5) understanding predictors of recurrence and possible interventions among families with a child with CPO (secondary prevention). PMID:26973535

  8. Prevalence, etiological factors and the treatment of infant exogenous obesity

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    Edio Luiz Petroski


    Full Text Available In the last few years, there has been considerable interest in the effects of excessive weight gain during childhood, due to the fact that the development of fat tissue in this period is a determinant of adult body composition. The objective of this study was to investigate the prevalence of infant obesity, to identify possible etiological factors, and to highlight treatments that have been used to reduce and/or prevent child obesity. Results have shown that obesity has increased more than any other nutritional problem in both developed and developing countries over the last decade. Etiological factors linked to childhood obesity were early weaning, introduction of inadequate nutrition, and physical inactivity. The treatment of childhood obesity requires a multidisciplinary team consisting of a doctor, nutritionist, psychologist, and physical educator. There are also some general recommendations to be followed: a balanced diet for adequate growth and weight control, and controlled physical exercise together with individual and family emotional support. Parental cooperation is important for the best results. Schools also have a fundamental role in teaching children positive attitudes and behavior towards physical activity and nutrition. RESUMO Nos últimos anos, o interesse sobre os efeitos do ganho de peso excessivo na infância tem aumentado consideravelmente, devido ao fato que o desenvolvimento da celularidade adiposa neste período ser determinante nos padrões de composição corporal de um indivíduo adulto. Este trabalho teve como objetivo investigar a prevalência da obesidade infantil, identificar os possíveis fatores etiológicos além de verifi car quais as intervenções que se destacaram nesta última década como forma de diminuir e/ou prevenir a obesidade em crianças. Os resultados encontrados foram que a obesidade é uma das enfermidades nutricionais que mais têm apresentado aumento de sua prevalência, tanto nos pa

  9. Selective Mutism: A Review of Etiology, Comorbidities, and Treatment


    Wong, Priscilla


    Selective mutism is a rare and multidimensional childhood disorder that typically affects children entering school age. It is characterized by the persistent failure to speak in select social settings despite possessing the ability to speak and speak comfortably in more familiar settings. Many theories attempt to explain the etiology of selective mutism.

  10. Ketosis in dairy cows: etiologic factors, monitoring, treatment

    NARCIS (Netherlands)

    van der Drift, S.G.A.


    Ketosis is a metabolic disorder that mainly occurs during the negative energy balance in early-lactation dairy cows. It is characterized by elevated concentrations of ketone bodies in blood (hyperketonemia), urine, and milk. The thesis of Saskia van der Drift covers investigations on etiologic

  11. Anemia in chronic heart failure : etiology and treatment options

    NARCIS (Netherlands)

    Westenbrink, B. Daan; de Boer, Rudolf A.; Voors, Adriaan A.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    Purpose of review Anemia is common in patients with chronic heart failure, and is related to increased morbidity and mortality. The etiology of anemia in heart failure is complex and still not fully resolved. The review will describe current advances in the understanding of the pathophysiology of

  12. Etiology, prevalence, and treatment of dry eye disease


    Gayton, Johnny L


    Johnny L GaytonEyesight Associates, Warner Robins, GA, USAPurpose: This review article examines the prevalence, etiology, and current therapies of dry eye disease, with special focus on postmenopausal women.Method: A systematic literature search utilizing MEDLINE was conducted to identify peer-reviewed articles related to dry eye published prior to September 2008. The terms “dry eye” and “women” were searched in combination with one or more of the follo...

  13. Scoliosis: review of types of curves, etiological theories and conservative treatment. (United States)

    Shakil, Halima; Iqbal, Zaheen A; Al-Ghadir, Ahmad H


    Scoliosis is the deviation in the normal vertical spine. Although there are numerous studies available about treatment approaches for scoliosis, the numbers of studies that talk about its etiology and pathology are limited. Aim of this study was to discuss the different types of scoliosis; its curves and etiological theories; and to note their implication on its treatment. We examined various electronic databases including Pub MED, Medline, Cinhal, Cochrane library and Google scholar using key words "scoliosis", "etiology", "pathology" and "conservative treatment". References of obtained articles were also examined for cross references. The search was limited to articles in English language. A total of 145 papers, about Prevalence, History, Symptoms, classification, Biomechanics, Pathogenesis, Kinematics and Treatment of scoliosis were identified to be relevant. To choose the appropriate treatment approach for scoliosis we need to understand its etiology and pathogenesis first. Early intervention with conservative treatment like physiotherapy and bracing can prevent surgery.

  14. Zoonotic bacterial meningitis in adults: clinical characteristics, etiology, treatment and outcome

    NARCIS (Netherlands)

    van Samkar, A.


    In this thesis, we describe the clinical characteristics, etiology, treatment and outcome of zoonotic bacterial meningitis. Each chapter describes meningitis patients infected by a specific zoonotic pathogen, such as Streptococcus equi, Streptococcuis suis, Capnocytophaga canimorsus, Campylobacter

  15. The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Mohamed, A.S.; Skolasky, R.L.; Laarhoven, C.J.H.M. van; Cohen, D.B.


    STUDY DESIGN: Descriptive, retrospective cohort analysis. OBJECTIVE: To evaluate the presentation, etiology, and treatment of surgical site infections (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA: SSI after spine surgery is frequently seen. Small case control studies have been published

  16. Etiology, diagnosis and treatment of renal colic during pregnancy. (United States)

    Grasso, Angelica Anna Chiara; Cozzi, Gabriele


    To assess the incidence and causes of renal stones in pregnant women, investigate the reliability and accuracy of diagnostic investigations and to consider the various therapeutic options available. A review of the literature was conducted, searching for relevant papers on the physiology of urinary apparatus changes during pregnancy, as well as the etiology, diagnosis and management of renal colic in pregnant women. Standards of care in renal colic during pregnancy include accurate diagnosis primarily with ultrasound, or MRI if necessary, conservative therapy and careful surgical approach for urinary drainage in the first place or ureterorenoscopy when needed. Renal colic during pregnancy is potentially troublesome and likely to lead to serious adverse effects on both mother and fetus. A multi-disciplinary approach is needed, which includes experts in the fields of Urology, Obstetrics, Radiology and Anesthesiology, to ensure the optimal care of this delicate cohort of patients.

  17. Achalasia: A Review of Etiology, Pathophysiology, and Treatment

    Directory of Open Access Journals (Sweden)

    Nor Hedayanti


    Full Text Available Achalasia was a condition marked by peristaltic movement absent in lower esophageal sphincter and segment that hypertonic result in imperfect relaxation during food ingestion. Achalasia incidence did not differ between men and women, account for 1 in 100.000 people every year with prevalence of 10 in 100.000 people, unrelated specifically with ethnic, and has its highest incidence on 30-60 age group. Based on its etiology, it was divided into primary and secondary Achalasia, while based on its motility, it was into hypermotil, hypomotil, and amotil Achalasia. Until present, several therapeutic modalities were available to treat Achalasia, among them was pharmacology therapy, botulinum toxin injection via endoscopy, pneumatic dilatation, Heller myotomy surgery, and Per Oral Endoscopy Myotomy (POEM.

  18. Psychological treatment for vaginal pain: does etiology matter? A systematic review and meta-analysis. (United States)

    Flanagan, Esther; Herron, Katherine A; O'Driscoll, Ciarán; Williams, Amanda C de C


    Classification of vaginal pain within medical or psychiatric diagnostic systems draws mainly on the presumed presence or absence (respectively) of underlying medical etiology. A focus on the experience of pain, rather than etiology, emphasizes common ground in the aims of treatment to improve pain and sexual, emotional, and cognitive experience. Thus, exploring how vaginal pain conditions with varying etiology respond to psychological treatment could cast light on the extent to which they are the same or distinct. To examine the combined and relative efficacy of psychological treatments for vaginal pain conditions. A systematic search of EMBASE, MEDLINE, PsycINFO, and CINAHL was undertaken. Eleven randomized controlled trials were entered into a meta-analysis, and standardized mean differences and odds ratios were calculated. Effect sizes for individual psychological trial arms were also calculated. Main outcome measures were pain and sexual function. Equivalent effects were found for psychological and medical treatments. Effect sizes for psychological treatment arms were comparable across vaginal pain conditions. Effectiveness was equivalent regardless of presumed medical or psychiatric etiology, indicating that presumed etiology may not be helpful in selecting treatment. Research recommendations and clinical implications are discussed. © 2014 International Society for Sexual Medicine.


    Directory of Open Access Journals (Sweden)

    N. G. Mokrysheva


    Full Text Available Parathyroid hormone (PTH is the main regulator of calcium and phosphorus metabolism. PTH deficiency or tissue resistance to its effects results in hypoparathyroidism characterized by low serum calcium and elevated serum phosphate levels. The most common is post-operative hypoparathyroidism caused by an inadvertent damage or removal of the parathyroid glands, deterioration of blood supply to the neck region, most often during thyroid surgery. The second common form of the disease is the autoimmune one related with immune destruction of parathyroid cells. Less frequent causes of hypoparathyroidism include a variety of genetic syndromes, mitochondrial genome defects, and hypomagnesemia. The main signs and symptoms of hypoparathyroidism are related to hypocalcaemia and hyperphosphatemia land result in increased neuromuscular irritability and general autonomic reactivity, with finger and toe tingling, muscle cramps, tonic seizures, laryngo- and bronchospasm, and neurosis. These symptoms are closely associated with serum calcium levels; their severity depends on the degree of hypocalcaemia. Laboratory parameters confirming the diagnosis of hypoparathyroidism are hypocalcaemia, hyperphosphatemia, and reduced serum PTH. Treatment of hypoparathyroidism involves management of hypocalcaemic crisis and maintenance therapy. Acute hypocalcaemia, a  potentially life-threatening condition, is treated as an emergency with intravenous calcium combined with oral calcium and active vitamin D. Standard chronic treatment for hypoparathyroidism is based on oral calcium and active metabolites of vitamin  D / vitamin  D analogs and is aimed at the balance between optimal low-normal serum calcium concentrations and normocalciuria. Worsening hypercalciuria is often underestimated by specialists, although it can cause severe renal problems, such as nephrocalcinosis and neprolithiasis. Hypoparathyroidism is one of the few endocrine deficiencies for which replacement

  20. [Etiological analysis and individualized treatment of pharyngeal paraesthesia]. (United States)

    Lou, Zhengcai; Gong, Xuhong; Lou, Fangyi; He, Lanjuan; Zhu, Qiaoying


    To analyze the nosazontology of pharyngeal paraesthesia and investigate the treatment. Two hundred and twelve misdiagnosed pharyngeal paraesthesia patients were investigated by history inquiry, routine examination, 24-hour esophageal pH monitoring, barium X-ray of the oesophagus, anxieties-athymic private measuring scale, coefficient of variation of the R-R (CVR-R), bioavailable testosterone detection (Bio-T), erection experiment and questionnaire about man climacteric syndrome. The concomitant symptoms and positions of pharyngeal paresthesia were also studied. We adopted individuallized sequential multi-therapy for every patient according to the cause of disease. The cause of disease within 212 cases of pharyngeal paraesthesia included 62 psychic trauma, 32 endocrine system disease, 106 upper gastrointestinal disease, circulatory disease, 9 circulatory disease, 3 idiopathic. With individualized treatment, 110 cases had fully recovered, 63 cases excellence and 31 cases utility, and the efficiency rate was 96.23%. Pharyngeal paraesthesia can be caused by several factors. Thorough examination and comprehensive analysis should be applied to those incurable patient who has been treated for a long time. Short course of treatment and irrational drug use are the main causes of short-term recurrence and unsatisfactory curative effect.

  1. Bacteriological etiology and treatment of mastitis in Finnish dairy herds. (United States)

    Vakkamäki, Johanna; Taponen, Suvi; Heikkilä, Anna-Maija; Pyörälä, Satu


    The Finnish dairy herd recording system maintains production and health records of cows and herds. Veterinarians and farmers register veterinary treatments in the system. Milk samples for microbiological analysis are routinely taken from mastitic cows. The laboratory of the largest dairy company in Finland, Valio Ltd., analyzes most samples using real-time PCR. This study addressed pathogen-specific microbiological data and treatment and culling records, in combination with cow and herd characteristics, from the Finnish dairy herd recording system during 2010-2012. The data derived from 240,067 quarter milk samples from 93,529 dairy cows with mastitis; 238,235 cows from the same herds served as the control group. No target pathogen DNA was detected in 12% of the samples. In 49% of the positive samples, only one target species and in 19%, two species with one dominant species were present. The most common species in the samples with a single species only were coagulase-negative staphylococci (CNS) (43%), followed by Staphylococcus aureus (21%), Streptococcus uberis (9%), Streptococcus dysgalactiae (8%), Corynebacterium bovis (7%), and Escherichia coli (5%). On average, 36% of the study cows and 6% of the control cows had recorded mastitis treatments during lactation. The corresponding proportions were 16 and 6% at drying-off. For more than 75% of the treatments during lactation, diagnosis was acute clinical mastitis. In the milk samples from cows with a recorded mastitis treatment during lactation, CNS and S. aureus were most common, followed by streptococci. Altogether, 48% of the cows were culled during the study. Mastitis was reported as the most common reason to cull; 49% of study cows and 18% of control cows were culled because of mastitis. Culling was most likely if S. aureus was detected in the milk sample submitted during the culling year. The PCR test has proven to be an applicable method also for large-scale use in bacterial diagnostics. In the present

  2. Lung abscess-etiology, diagnostic and treatment options. (United States)

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Tsirgogianni, Katerina; Tsavlis, Drosos; Kioumis, Ioannis; Kosmidis, Christoforos; Tsakiridis, Kosmas; Mpakas, Andrew; Zarogoulidis, Paul; Zissimopoulos, Athanasios; Baloukas, Dimitris; Kuhajda, Danijela


    Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. It can be caused by aspiration, which may occur during altered consciousness and it usually causes a pus-filled cavity. Moreover, alcoholism is the most common condition predisposing to lung abscesses. Lung abscess is considered primary (60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. There are several imaging techniques which can identify the material inside the thorax such as computerized tomography (CT) scan of the thorax and ultrasound of the thorax. Broad spectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection. In the current review we will present all current information from diagnosis to treatment.

  3. Etiology and Treatment Modalities of Occipital Artery Aneurysms. (United States)

    Chaudhry, Nauman S; Gaynor, Brandon G; Hussain, Shahrose; Dernbach, Paul D; Aziz-Sultan, Mohammad A


    Aneurysms of the external carotid artery represent approximately 2% of cervical carotid aneurysms, with the majority being traumatic pseudoaneurysms. Given the paucity of literature available for guidance, the diagnosis, treatment, and follow-up of such lesions are completely individualized. We report an 83-year-old woman with an 8-week history of headache in the occipital region, transient episode of gait disturbance, and pulsatile tinnitus on the right. She had no history of trauma, surgery, autoimmune disease, or infection. Physical examination revealed a pulsatile mass tender to palpation in the right occipital scalp. The mass was surgically excised, and histopathological diagnosis of a true aneurysm was made. Postoperatively, the patient's symptoms resolved; however, 1 month after the procedure, she developed occipital neuralgia, which was successfully treated with a percutaneous nerve block. To the best of our knowledge, this is the second reported case of a true aneurysm of the occipital artery in a patient with no history of trauma. The clinical examination, diagnosis, and treatment are discussed and the literature is reviewed for previously reported cases. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Common causes of poisoning: etiology, diagnosis and treatment. (United States)

    Müller, Dieter; Desel, Herbert


    In 2011, German hospitals treated approximately 205 000 patients suffering from acute poisoning. Change is seen over time both in the types of poisoning that occur and in the indications for specific treatment. This article is based on a selective review of the literature, with special attention to the health reports of the German federal government, the annual reports of the GIZ-Nord Poisons Center (the poison information center for the four northwestern states of Germany, i.e. Bremen, Hamburg, Lower Saxony and Schleswig-Holstein), and the recommendations of international medical associations. From 1996 to 2011, the GIZ-Nord Poisons Center answered more than 450 000 inquiries, most of which involved exposures to medical drugs, chemicals, plants, foods, or cosmetics. Poisoning was clinically manifest in only a fraction of these cases. Ethanol intoxication is the commonest type of acute poisoning and suicide by medical drug overdose is the commonest type of suicide by poisoning. Death from acute poisoning is most commonly the result of either smoke inhalation or illegal drug use. Severe poisoning is only rarely due to the ingestion of chemicals (particularly detergents and cleaning products), cosmetics, or plant matter. Medical procedures that are intended to reduce the absorption of a poison or enhance its elimination are now only rarely indicated. Antidotes (e.g., atropine, 4-dimethylaminophenol, naloxone, toluidine blue) are available for only a few kinds of poisoning. Randomized clinical trials of treatment have been carried out for only a few substances. Most exposures to poisons can be treated with general emergency care and, if necessary, with symptomatic intensive-care measures. Poison information centers help ensure that cases of poisoning are dealt with efficiently. The data they collect are a useful aid to toxicological assessment and can serve as a point of departure for research projects.

  5. Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment. (United States)

    Lahaie, Marie-André; Boyer, Stéphanie C; Amsel, Rhonda; Khalifé, Samir; Binik, Yitzchak M


    Vaginismus is currently defined as an involuntary vaginal muscle spasm interfering with sexual intercourse that is relatively easy to diagnose and treat. As a result, there has been a lack of research interest with very few well-controlled diagnostic, etiological or treatment outcome studies. Interestingly, the few empirical studies that have been conducted on vaginismus do not support the view that it is easily diagnosed or treated and have shed little light on potential etiology. A review of the literature on the classification/diagnosis, etiology and treatment of vaginismus will be presented with a focus on the latest empirical findings. This article suggests that vaginismus cannot be easily differentiated from dyspareunia and should be treated from a multidisciplinary point of view.

  6. Sex differences in drug abuse: Etiology, prevention, and treatment. (United States)

    Evans, Suzette M; Reynolds, Brady


    This special issue exemplifies one of the major goals of the current editor of Experimental and Clinical Psychopharmacology (Dr. Suzette Evans): to increase the number of manuscripts that emphasize females and address sex differences. Taken together, these articles represent a broad range of drug classes and approaches spanning preclinical research to treatment to better understand the role of sex differences in drug abuse. While not all studies found sex differences, we want to emphasize that finding no sex difference is just as important as confirming one, and should be reported in peer-reviewed journals. It is our intention and hope that this special issue will further advance scientific awareness about the importance of accounting for sex differences in the study of substance abuse. Participant sex is an essential variable to consider in developing a more comprehensive understanding of substance abuse. Rather than viewing investigating sex differences as burdensome, investigators should seize this opportune area ripe for innovative research that is long overdue. (c) 2015 APA, all rights reserved).

  7. Failure of operative treatment for glenohumeral instability: etiology and management. (United States)

    Shah, Apurva S; Karadsheh, Mark S; Sekiya, Jon K


    Failure of primary shoulder stabilization procedures is often related to uncorrected anatomic pathology. Orthopaedic surgeons must recognize excessive capsular laxity or large glenohumeral bone defects preoperatively to avoid recurrence of instability. When history, physical examination, and radiographic evaluation are used in conjunction, patients at risk for failure can be identified. The instability severity index score permits precise identification of patients at risk. When treating patients in whom prior surgical intervention has failed, the success of revision procedures correlates to the surgeon's ability to identify the essential pathology and use lesion-specific treatment strategies. Revision procedures remain technically demanding. Keen preoperative and intraoperative judgment is required to avoid additional recurrence of instability after revision procedures, particularly because results deteriorate with each successive operation. Glenoid or humeral defects with greater than 25% bone loss compromise stability provided through the mechanism of concavity compression. These defects must be specifically addressed to avoid recurrence of instability. We prefer anatomic reconstruction techniques combined with capsulolabral repair and, if bone defects are present, anatomic reconstruction with osteochondral allograft. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  8. Impact of etiology and duration of pain on pharmacological treatment effects in painful polyneuropathy

    DEFF Research Database (Denmark)

    Sindrup, Søren Hein; Holbech, J.; Demant, Dyveke T


    Background: The pharmacological treatments for painful polyneuropathy have not changed much for more than a decade, and less than half of the patients obtain adequate pain relief with first line treatments. Therefore, patient-specific factors which could predict drug response are searched for...... baseline registration of symptoms, signs and quantitative sensory testing. 244 patient records of drug effect distributed over treatments with three antidepressants (imipramine, venlafaxine, escitalopram) and two anticonvulsants (pregabalin, oxcarbazepine) were analysed. Results: Diabetes as etiology...

  9. Oral Lichen Planus: Clinical Features, Etiology, Treatment and Management; A Review of Literature

    Directory of Open Access Journals (Sweden)

    Marzieh Boorghani


    Full Text Available Lichen planus is a chronic inflammatory mucocutaneous disease. Mucosal lesions are classified into six clinical forms and there is malignant potential for two forms of OLP; therefore, follow-up should be considered. There are many unestablished etiological factors for OLP and some different treatment modalities are based on etiology. The aims of current OLP therapy are to eliminate mucosal erythema and ulceration, alleviate symptoms and reduce the risk of oral cancer. We have used review papers, case reports, cohort studies, and case-and-control studies published from 1985 to 2010 to prepare this review of literature.

  10. Depression in Parkinson’s disease: Health risks, etiology, and treatment options

    Directory of Open Access Journals (Sweden)

    Pasquale G Frisina


    Full Text Available Pasquale G Frisina1,2, Joan C Borod3,4, Nancy S Foldi3,5, Harriet R Tenenbaum61Leir Parkinson’s Disease Program, The Jewish Home and Hospital Lifecare System, New York, NY, USA; 2Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY, USA; 3Department of Psychology, Queens College and The Graduate Center of the City University of New York (CUNY, Flushing, NY, USA; 4Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA; 5Department of Medicine, Winthrop-University Hospital, State University of New York, Stony Brook School of Medicine; 6Department of Psychology, Kingston University, Kingston upon Thames, UKAbstract: Depression is found in about 30%–40% of all patients with Parkinson’s disease (PD, but only a small percentage (about 20% receive treatment. As a consequence, many PD patients suffer with reduced health-related quality of life. To address quality of life in depressed PD patients, we reviewed the literature on the health correlates of depression in PD (eg, cognitive function, etiology of depression in PD, and treatment options (ie, antidepressants, electroconvulsive therapy, and psychotherapy. The current review is unique in its focus on psychosocial aspects, as well as neuropathological factors, of depression in PD. Overall, we conclude that neurochemical (eg, serotonin and psychosocial factors (eg, coping style, self-esteem, and social support contribute to the affective disturbances found in this neuropsychiatric population. Therefore, we recommend that a multidisciplinary (eg, pharmacotherapeutic, psychoeducational, and/or psychotherapeutic approach to treatment be taken with depressed PD patients.Keywords: depression, Parkinson’s disease, health outcomes, treatment options

  11. A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). (United States)

    Sharma, Alok; Couture, Justin


    To review the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). A literature search was conducted in PubMed and EMBASE using the terms attention deficit hyperactive disorder, ADHD, pathophysiology, etiology, and neurobiology. Limits applied were the following: published in the past 10 years (January 2003 to August 2013), humans, review, meta-analysis, and English language. These yielded 63 articles in PubMed and 74 in EMBASE. After removing duplicate/irrelevant articles, 86 articles and their relevant reference citations were reviewed. ADHD is a neurological disorder that affects children, but symptoms may persist into adulthood. Individuals suffering from this disorder exhibit hyperactivity, inattention, impulsivity, and problems in social interaction and academic performance. Medications used to treat ADHD such as methylphenidate, amphetamine, and atomoxetine indicate a dopamine/norepinephrine deficit as the neurochemical basis of ADHD, but the etiology is more complex. Moreover, these agents have poor adverse effect profiles and a multitude of drug interactions. Because these drugs are also dispensed to adults who may have concomitant conditions or medications, a pharmacist needs to be aware of these adverse events and drug interactions. This review, therefore, focuses on the pathophysiology, etiology, and treatment of ADHD and details the adverse effects and drug interaction profiles of the drugs used to treat it. Published research shows the benefit of drug therapy for ADHD in children, but given the poor adverse effect and drug interaction profiles, these must be dispensed with caution.

  12. Recurrent balanoposthitis of mixed etiology: relation to oral sex and selection of an efficient treatment method

    Directory of Open Access Journals (Sweden)

    O. B. Demianova


    Full Text Available Goal. To study the dependence between the recurrent balanoposthitis of mixed etiology and oral sex. To assess the efficacy, tolerance and cosmetic acceptability of a combination topical drug on the basis of a cream for the treatment of balanoposthitis of Candida and bacterial etiology. Materials and methods. An open-label single-arm non-randomized study involved 48 men aged 22-43 suffering from recurrent balanoposthitis of mixed etiology and their long-term sex partners. All of the subjects underwent the following tests: complete blood count, clinical urine test, blood biochemistry (AST, ALT, total bilirubin, thymol test and blood glucose, MRSA, blood tests for anti-hepatitis B and C virus antibodies, HIV-1/-2 antibody screening test, microscopy of urethral, vaginal and cervical canal materials, PCR for Chlamydia trachomatis, Trichomonas vaginalis, N. gonorrhoeae, Mycoplasma genitalium, Ureaplasma spp, bacterial swab tests based on urethral materials (in men, vaginal materials (in women and throat (in subjects of both sexes, and microscopy of tongue scrapings. 46 male patients used the Candiderm cream (Glenmark Pharmaceuticals Ltd. for 10-14 days. Physicians assessed the efficacy based on the symptom intensity and patient’s opinion. Results. In people who practiced unprotected oral sex, a high contamination of mucous coats in the oral cavity, throat and genitals with yeast fungi and opportunistic bacteria was revealed. C. Аlbicans was often found in diagnostically significant amounts in couples. The authors substantiate the possibility of a contact-type transmission of opportunistic bacteria during oral sex resulting in balanoposthitis of mixed Candida and bacterial etiology or exacerbation of their condition after sexual contacts in men practicing unprotected oral sex. Evident clinical efficacy and safety of the combination as well as good tolerance and convenience of application of the combination topical drug comprising beclomethasone

  13. Intermediate uveitis: pattern of etiology, complications, treatment and outcome in a tertiary academic center. (United States)

    Ness, Thomas; Boehringer, Daniel; Heinzelmann, Sonja


    Patients with intermediate uveitis (IU) represent a heterogenous group characterized by a wide spectrum of etiologies and regional differences. Aim of the study was to analyze the characteristics of patients with IU examined in an academic center in Germany. We conducted a retrospective analysis of the clinical records of all patients with intermediate uveitis referred to the Eye Center, University of Freiburg from 2007 to 2014. Diagnosis followed the Standardization in Uveitis Nomenclature (SUN) criteria. Data analysis included: etiology of IU, demographics, complications, treatment and visual acuity. We identified 159 patients with intermediate uveitis during that period. Mean age at diagnosis was 35 years. Most are female (64%), and the mean duration of IU was 6.1 years (range 1 month - 35 years). Etiology of IU was idiopathic in 59%. Multiple sclerosis (MS) (20%) and sarcoidosis (10%) were frequent systemic causes of IU. Other etiologies including infectious diseases (tuberculosis, borreliosis) or immune-mediated conditions (eg, after vaccination) were present in 11%. The pattern of complications included macular edema (CME) (36%), cataract (24%), secondary glaucoma (7%), and epiretinal membrane formation (19%). Periphlebitis and optic neuritis were more frequent in conjunction with MS. Treatment comprised local and systemic steroids, immunosuppressive agents, biologics, and surgery. Best corrected visual acuity was better than 20/25 in 60% of the eyes after more than 10 years of follow-up. In our German academic center, most IU cases were idiopathic or associated with MS or sarcoidosis. In contrast to other countries, infectious cases were rare. Patients' overall visual prognosis is favorable even when the duration of IU has been long and and despite numerous complications.

  14. Comparing the etiology and treatment of skin fissure in traditional and conventional medicine; a brief review

    Directory of Open Access Journals (Sweden)

    A. Jedkareh


    Full Text Available Dry skin is a common problem which affects wound healing, severity of other skin diseases and quality of life of people. One of its undesirable effects is fissure that is a cutaneous condition in which there is a linear loss of epidermis and dermis with sharply defined, nearly vertical walls. In the present study, we have investigated the etiology of the disease and its treatments in conventional medicine and Iranian Traditional Medicine (ITM. Two traditional medicine references, current scientific data bases and medicinal texts were explored with the selected keywords such as "sheqaq-e-poosti", "skin fissure" and "dry skin" to find the etiology and treatment of skin fissure. From the view point of both conventional medicine and ITM, dry skin is the cause of skin fissure and some causes of dry skin are similar. In conventional medicine, moisturizers are mainly used for treatment of dry skin; while in ITM some herbs, oils and other natural remedies have been used. A topical dosage form which was called "qeirooti", a mixture of wax and oil, was used to treat skin fissure in ITM. It comprised of oily ingredients that acted as occlusives and also some herbal components that directly improved dry skin (similar to moisturizers. Components efficacy of traditional dosage forms for treatment of dry skin lead us to study about formulation of “qeirooti” for treatment of dry skin.

  15. Disorders of orgasm in women: a literature review of etiology and current treatments. (United States)

    Ishak, Waguih William; Bokarius, Anna; Jeffrey, Jessica K; Davis, Michael C; Bakhta, Yekaterina


    Disorders of orgasm in women, defined as the persistent or recurrent delay in or absence of orgasm, affect up to a quarter of the female population. To review existing research findings on the etiology and treatments of disorders of orgasm in women to provide a useful reference tool for clinicians who evaluate and treat patients with these conditions. PubMed and PsycINFO search for articles published between 1980 and 2009 using the keywords "orgasm*,"anorgasmia," and "female*,"woman," or "women," in addition to "female orgasmic disorder" and "disorders of orgasm in women." Findings on the etiological factors and effects of a variety of treatment interventions on improving disorders of orgasm in women. Results.  Literature on prevalence and causes of disorders of orgasm in women is abundant, yet more reports of successful treatments are needed. Nevertheless, many promising approaches have been suggested, and data support several potential treatments such as bupropion, sildenafil, estrogen, and testosterone among others. Although more research is needed to better understand and manage disorders of orgasm in women, significant progress is being made. © 2010 International Society for Sexual Medicine.

  16. A Review of Acne Etiology and Treatment in Iranian Traditional Medicine

    Directory of Open Access Journals (Sweden)

    Laila Shirbeigi


    Full Text Available Context Iranian traditional medicine (ITM is based on humoral theory. Temperament or Mizaj is the result of a combination of four cardinal humors. They are blood, phlegm, yellow bile (Safra and black bile (melancholy. Like any other disease, acne is the result of humoral imbalance. Acne is a highly prevalent dermatologic problem, which has both physical and psychological effects. The aim of this study was to introduce the etiology of acne and its remedies from the perspective of ITM. Evidence Acquisition Etiology and treatment of acne were studied and analyzed from selected medical textbooks of ITM. Some of the effective plants in these books were assessed in a table, and their anti-acne activities were compared with conventional medicine’s database. Results From the perspective of ITM, considering six essential schemes for health, diet and herbal remedies as well as manipulation are recommended for acne treatment. Although the introduced plants have antibacterial, anti-inflammatory and antioxidant effects but some of them have special proven effects on acne formation process. There is also a strong relationship between digestive system and skin. Conclusions This paper was rendered to show ancient Persian scholar’s point of view about acne and its treatment, and it was shown that Iranian traditional medicine has practical recommendations for acne treatment.

  17. Tic Disorders and Tourette Syndrome: Current Concepts of Etiology and Treatment in Children and Adolescents. (United States)

    Tagwerker Gloor, Friederike; Walitza, Susanne


    Tic disorders (TD), including chronic/persistent TD (CTD) and Tourette syndrome, have been described and studied for many years. Within the last two decades, intensified study efforts led to more specific assumptions about genesis and influences of both hereditary and environmental factors. TD in children and adolescents are very often accompanied by attention-deficit/hyperactivity disorders and obsessive-compulsive disorders (OCD) as comorbid disorders. Comorbidities are aggravating factors concerning prognosis and treatment opportunities. Therefore, etiological considerations and treatment strategies have to take associated psychiatric disorders into account. Treatment approaches are symptom targeted and include behavioral treatments and/or medication and show positive outcomes concerning tic symptomatology, global functioning, and associated psychopathology. This review presents an update of the research, definitions, and classification according to ICD-10 and DSM-5 and summarizes the diagnostic procedures and most effective clinical strategies. Georg Thieme Verlag KG Stuttgart · New York.

  18. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options. (United States)

    Vora, Molly; Curry, Emily; Chipman, Amanda; Matzkin, Elizabeth; Li, Xinning


    Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS.

  19. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options (United States)

    Vora, Molly; Curry, Emily; Chipman, Amanda; Matzkin, Elizabeth; Li, Xinning


    Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS. PMID:29564075

  20. Translational Evidence for a Role of Endocannabinoids in the Etiology and Treatment of Posttraumatic Stress Disorder (United States)

    Neumeister, Alexander; Seidel, Jordan; Ragen, Benjamin J.; Pietrzak, Robert H.


    Introduction Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and disabling anxiety disorder that may develop following exposure to a traumatic event. Despite the public health significance of PTSD, relatively little is known about the etiology or pathophysiology of this disorder, and pharmacotherapy development to date has been largely opportunistic instead of mechanism-based. Recently, an accumulating body of evidence has implicated the endocannabinoid system in the etiology of PTSD, and targets within this system are believed to be suitable for treatment development. Methods Herein, we describe evidence from translational studies arguing for the relevance of the endocannabinoid system in the etiology of PTSD. We also show mechanisms relevant for treatment development. Results There is convincing evidence from multiple studies for reduced endocannabinoid availability in PTSD. Brain imaging studies show molecular adaptations with elevated cannabinoid type 1 (CB1) receptor availability in PTSD which is linked to abnormal threat processing and anxious arousal symptoms. Conclusion Of particular relevance is evidence showing reduced levels of the endocannabinoid anandamide and compensatory increase of CB1 receptor availability in PTSD, and an association between increased CB1 receptor availability in the amygdala and abnormal threat processing, as well as increased severity of hyperarousal, but not dysphoric symptomatology, in trauma survivors. Given that hyperarousal symptoms are the key drivers of more disabling aspects of PTSD such as emotional numbing or suicidality, novel, mechanism-based pharmacotherapies that target this particular symptom cluster in patients with PTSD may have utility in mitigating the chronicity and morbidity of the disorder. PMID:25456347

  1. Defining a Therapeutic Program for Recurrent Acute Pancreatitis Patients with Unknown Etiology

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    Vincenzo Neri


    Full Text Available Aim To define a therapeutic program for mild-moderate acute pancreatitis (AP, often recurrent, which at the end of the diagnostic process remains of undefined etiology. Material and Methods In the period 2011-2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined. Results Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs, 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence. Conclusion The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy.

  2. Present and future etiological treatment of bacterial pneumonia 3. The antibacterial drugs under development

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    A.A. Abaturov


    Full Text Available The rapid spread of antibiotic-resistant bacterial strains necessitates the development of new antibacterial agents and a review of the guidelines for etiological treatment of bacterial infections, including pneumonia. Currently, new antibacterial agents are being developed that disrupt the biosynthesis of peptidoglycan, teichoic and lipoteichoic acids, and also block the attachment of virulent factors to the bacterial wall. New molecules of old classes of antibiotics and representatives of new classes of antibiotics with their targets (lipid II and III, teichoic and lipoteichoic acids, alanine racemase, and sortase A will become practical tools in clinical practice in the very near future. The goals and mechanisms of action of new antibacterial compounds predetermine their clinical prospects in future strategies for the treatment of infectious bacterial diseases.

  3. Understanding the etiology of prescription opioid abuse: implications for prevention and treatment. (United States)

    Rigg, Khary K; Murphy, John W


    Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

  4. Pediatric sudden sensorineural hearing loss: Etiology, diagnosis and treatment in 20 children. (United States)

    Dedhia, Kavita; Chi, David H


    1. To report our experience in children with sudden-onset sensorineural hearing loss (SSNHL). 2. To describe the etiology and management of children with SSNHL. Retrospective review of 20 children with SSNHL, from 2000 to 2013 at a tertiary pediatric facility. Patients had the following inclusion criteria: history of normal hearing, hearing loss occurring in less than 3 days, and audiogram documentation. The average age of patients presenting with SSNHL is 11 years 3 months (22months-18years). Only 6 (30%) children presented prior to 2 weeks. Tinnitus (55%) was the most common associated symptoms followed by otalgia (25%), and vertigo (20%). Eight patients had bilateral hearing loss, 6 only right and 6 only left. Hearing loss severity ranged from profound (45%) being most common to mild. Etiology was unknown (30%), viral (25%), anatomic abnormality (25%), Meniere's disease (5%), autoimmune (5%), perilymphatic fistula (5%), and suppurative labyrinthitis (5%). Eight patients had initial treatment with oral steroids of which 50% had improvement on audiograms. Two patients underwent intratympanic injections, both showed improvement. Of the 12 patients with no treatment, only 1 had improved hearing. The true incidence of pediatric SSNHL is not well established in our literature. Unique aspects of pediatric SSNHL are delayed presentation and higher percent of anatomic findings. In our study 70% presented more than 2 weeks after experiencing symptoms. Anatomic abnormalities are in 40% of patients. Hearing improvement occurred in 50% of children treated with oral steroids. Intratympanic steroid treatment is another option but may have practical limitation in the pediatric population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. The Broader Autism Phenotype and Its Implications on the Etiology and Treatment of Autism Spectrum Disorders

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    Jennifer Gerdts


    Full Text Available The presence of autism-related traits has been well documented in undiagnosed family members of individuals with autism spectrum disorder (ASD. The most common finding is mild impairments in social and communication skills that are similar to those shown by individuals with autism, but exhibited to a lesser degree. Termed the broader autism phenotype (BAP, these traits suggest a genetic liability for autism-related traits in families. Genetic influence in autism is strong, with identical twins showing high concordance for the diagnosis and related traits and approximately 20% of all ASD cases having an identified genetic mechanism. This paper highlights the studies conducted to date regarding the BAP and considers the implications of these findings for the etiology and treatment of ASD.

  6. Small vessel vasculitis History, classification, etiology, histopathology, clinic, diagnosis and treatment

    International Nuclear Information System (INIS)

    Iglesias Gamarra, Antonio; Matteson, Eric L; Restrepo, Jose Felix


    Small-vessel vasculitis is a convenient descriptor for a wide range of diseases characterized by vascular inflammation of the venules, capillaries, and/or arterioles with pleomorphic clinical manifestations. The classical clinical phenotype is leucocytoclastic vasculitis with palpable purpura, but manifestations vary widely depending upon the organs involved. Histopathologic examination in leucocytoclastic vasculitis reveals angiocentric segmental inflammation, fibrinoid necrosis, and a neutrophilic infiltrate around the blood vessel walls with erythrocyte extravasation. The etiology of small-vessel vasculitis is unknown in many cases, but in others, drugs, post viral syndromes, malignancy, primary vasculitis such as microscopic polyarteritis, and connective tissue disorders are associated, The diagnosis of small- vessel vasculitis relies on a thorough history and physical examination, as well as relevant antibody testing including antinuclear antibody and anti neutrophil cytoplasmic antibody, hepatitis B and C serologies, assessment of complement, immunoglobulins, blood count, serum creatinine liver function tests, urinalysis, radiographic imaging and biopsy. The treatment is based primarily on corticosteroid and immunosuppressive agents

  7. Clinical Profile, Etiology, and Treatment of Chronic Pancreatitis in North American Women: Analysis of a Large Multicenter Cohort. (United States)

    Romagnuolo, Joseph; Talluri, Jyothsna; Kennard, Elizabeth; Sandhu, Bimaljit S; Sherman, Stuart; Cote, Gregory A; Al-Kaade, Samer; Gardner, Timothy B; Gelrud, Andres; Lewis, Michele D; Forsmark, Christopher E; Guda, Nalini M; Conwell, Darwin L; Banks, Peter A; Muniraj, Thiruvengadam; Wisniewski, Stephen R; Tian, Ye; Wilcox, C Mel; Anderson, Michelle A; Brand, Randall E; Slivka, Adam; Whitcomb, David C; Yadav, Dhiraj


    Historically, chronic pancreatitis (CP) was considered a disease of alcoholic males, but recent data suggest its etiology to be complex. To better understand CP in women, we compared data on women and men with CP in a large, prospectively ascertained multicenter US cohort. Patients with CP enrolled in the NAPS2 Continuation and Validation study were studied. Information on demographics, etiology, risk factors, phenotype, and treatment(s) used was obtained from detailed questionnaires completed by the patients and physicians. Of 521 cases, 45% were women. Women were significantly (P etiology (30% vs 58.5%) and more likely to have nonalcoholic etiologies (idiopathic, 32% vs 18%; obstructive, 12% vs 2.4%; genetic, 12.8% vs 7.3%). Demographics, pain experience, morphologic findings, exocrine and endocrine insufficiency, CP-related disability, and use of medical therapies were mostly similar in both sexes. Sphincterotomy (biliary, 33% vs 24%; pancreatic, 38% vs 28%; P etiologies. In contrast to many other chronic diseases, clinical phenotype of CP is determined by the disease and is independent of sex.

  8. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal


    Parajuli, Ramesh


    Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a te...

  9. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal (United States)


    Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09%) followed by hypertension (27.38%), trauma (15.47%), and coagulopathy (8.33%). Regarding treatment methods, most (52.38%) of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38%) patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients. PMID:26346242

  10. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal. (United States)

    Parajuli, Ramesh


    Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09%) followed by hypertension (27.38%), trauma (15.47%), and coagulopathy (8.33%). Regarding treatment methods, most (52.38%) of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38%) patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients.

  11. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal

    Directory of Open Access Journals (Sweden)

    Ramesh Parajuli


    Full Text Available Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09% followed by hypertension (27.38%, trauma (15.47%, and coagulopathy (8.33%. Regarding treatment methods, most (52.38% of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38% patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients.

  12. The etiologies and incidences of congenital hypothyroidism before and after neonatal TSH screening program implementation: a study in southern Thailand. (United States)

    Jaruratanasirikul, Somchit; Piriyaphan, Jutarat; Saengkaew, Tansit; Janjindamai, Waricha; Sriplung, Hutcha


    Congenital hypothyroidism (CH) is one of the common causes of intellectual disability which can be prevented by early detection of an elevated thyroid stimulating hormone (TSH) level in the newborn and by treatment with thyroxine. In Thailand, neonatal TSH screening was implemented nationwide in 2005. The objective of the study was to determine the etiologies and the estimated incidences of CH in southern Thailand before and after the implementation of a neonatal TSH screening program in 2005. The medical records of pediatric patients who were diagnosed with primary CH at Songklanagarind Hospital during 1995-2013 were retrospectively reviewed. The study was divided into two time periods: study period 1 (SP1) (1995-2004) and study period 2 (SP2) (2005-2013), the time before and after TSH program implementation. The most common form of CH during SP1 was overt permanent CH (66%), mostly caused by athyreosis or ectopic thyroid. In SP2, the most common form of CH was mild permanent CH (39%) (mostly due to dyshormonogenesis), followed by overt CH (32%) and transient CH (29%). The overall annual estimated incidence of CH per 10,000 live births in Songkhla Province was 1.69 (1:5021) in SP1, increasing to 4.77 (1:2238) in SP2; in all 14 provinces in southern Thailand, the estimated incidence was 1.24 (1:8094) in SP1 and 2.33 (1:4274) in SP2. Neonatal TSH screening has a significant impact on the increased detection of the mild form of permanent and transient CH cases, which may be important for the prevention of brain damage from less severe CH although this remains to be documented.

  13. The Etiology and Treatment of the Softened Phallus after the Radial Forearm Osteocutaneous Free Flap Phalloplasty

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    Seok-Kwun Kim


    Full Text Available BackgroundThe radial forearm osteocutaneous free flap is considered to be the standard technique for penile construction. One year after their operation, most patients experience a softened phallus, so that they suffer from difficulties in sexual intercourse. In this report, we present our experience with phalloplasty by radial forearm osteocutaneous free flap, as well as an evaluation of the etiology and treatment of the softened phallus.MethodsBetween March 2005 and February 2010, 58 patients underwent phalloplasty by radial forearm osteocutaneous free flap. Most of their neophallus had been softened subjectively and among them, 12 patients who wanted correction were investigated. We performed repetitive fat injection, artificial dermis grafting, silicone rod insertion, and rib bone with cartilaginous tip graft. Physical examination, plain radiograph, computed tomography, bone scintigraphy, and satisfaction scores were investigated.ResultsMost of the participants' penises have been softened after phalloplasty, and the skin elasticity had been also decreased. On plain radiograph, the distal end of the bone was self-rounded; however, the bone shape of the neophallus had no significant interval changes or resorption. Computed tomography showed equivocal density of cortical bone. On bone scintigraphy, the bone metabolism was active at 3 months postoperatively, and remained active 9 years postoperatively.ConclusionsThe use of a rib bone with cartilaginous tip graft could be an option for improvement of the softened phallus. Silicon rod insertion is also worth considering for rigidity of the softened phallus. Decreased rigidity due to soft tissue atrophy could be alleviated with repeated fat injection and artificial dermis grafting.

  14. Etiological Beliefs, Treatments, Stigmatizing Attitudes toward Schizophrenia. What Do Italians and Israelis Think?

    Directory of Open Access Journals (Sweden)

    Stefania Mannarini


    Full Text Available Background: Although scientific research on the etiology of mental disorders has improved the knowledge of biogenetic and psychosocial aspects related to the onset of mental illness, stigmatizing attitudes and behaviors are still very prevalent and pose a significant social problem.Aim: The aim of this study was to deepen the knowledge of how attitudes toward people with mental illness are affected by specific personal beliefs and characteristics, such as culture and religion of the perceiver. More precisely, the main purpose is the definition of a structure of variables, namely perceived dangerousness, social closeness, and avoidance of the ill person, together with the beliefs about the best treatment to be undertaken and the sick person’ gender, capable of describing the complexity of the stigma construct in particular as far as schizophrenia is concerned.Method: The study involved 305 university students, 183 from the University of Padua, Italy, and 122 from the University of Haifa, Israel. For the analyses, a latent class analysis (LCA approach was chosen to identify a latent categorical structure accounting for the covariance between the observed variables. Such a latent structure was expected to be moderated by cultural background (Italy versus Israel and religious beliefs, whereas causal beliefs, recommended treatment, dangerousness, social closeness, and public avoidance were the manifest variables, namely the observed indicators of the latent variable.Results: Two sets of results were obtained. First, the relevance of the manifest variables as indicators of the hypothesized latent variable was highlighted. Second, a two-latent-class categorical dimension represented by prejudicial attitudes, causal beliefs, and treatments concerning schizophrenia was found. Specifically, the differential effects of the two cultures and the religious beliefs on the latent structure and their relations highlighted the relevance of the observed

  15. [Etiological diagnosis of leg ulcers]. (United States)

    Debure, Clélia


    Etiological diagnosis of leg ulcers must be the first step of treatment, even if we know that veinous disease is often present. We can build a clinical decisional diagram, which helps us to understand and not forget the other causes of chronic wounds and choose some basic examination, like ultrasound and histological findings. This diagnosis helps to choose the right treatment in order to cure even the oldest venous ulcers. Educational programs should be improved to prevent recurrence.

  16. Eating Disorders of the Adolescent: Current Issues in Etiology, Assessment, and Treatment. (United States)

    Phelps, LeAdelle; Bajorek, Ellen


    Literature on the prevalence, symptomatology, and etiology of anorexia nervosa and bulimia in adolescents is reviewed. The school psychologist is in an essential position to help the adolescent and family. Assessment, consultation, and intervention strategies are discussed for the school psychologist, and psychological and pharmacological…

  17. The role of the immune system in Alzheimer disease: Etiology and treatment. (United States)

    Jevtic, Stefan; Sengar, Ameet S; Salter, Michael W; McLaurin, JoAnne


    The immune system is now considered a major factor in Alzheimer Disease (AD). This review seeks to demonstrate how various aspects of the immune system, both in the brain and peripherally, interact to contribute to AD. We highlight classical nervous system immune components, such as complement and microglia, as well as novel aspects of the peripheral immune system that can influence disease, such as monocytes and lymphocytes. By detailing the roles of various immune cells in AD, we summarize an emerging perspective for disease etiology and future therapeutic targets. Copyright © 2017. Published by Elsevier B.V.

  18. Paresthesia: A Review of Its Definition, Etiology and Treatments in View of the Traditional Medicine. (United States)

    Emami, Seyed Ahmad; Sahebkar, Amirhossein; Javadi, Behjat


    To search major Islamic Traditional Medicine (ITM) textbooks for definition, etiology and medicinal plants used to manage 'khadar' or 'paresthesia', a common sensory symptom of multiple sclerosis (MS) and peripheral neuropathies. In addition, the conformity of the efficacy of ITM-suggested plants with the findings from modern pharmacological research on MS will be discussed. Data on the medicinal plants used to treat 'khadar' were obtained from major ITM texts. A detailed search in PubMed, ScienceDirect, Scopus and Google Scholar databases was performed to confirm the effects of ITM-mentioned medicinal plants on MS in view of identified pharmacological actions. Moringa oleifera Lam., Aloe vera (L.) Burm.f., Euphorbia species, Citrullus colocynthis (L.) Schrad., and Costus speciosus (Koen ex. Retz) Sm. are among the most effective ITM plants for the management of 'khadar'. Recent experimental evidence confirms the effectiveness of the mentioned plants in ameliorating MS symptoms. Moreover, according to ITM, prolonged exposure to cold and consuming foodstuff with cold temperament might be involved in the etiopathogenesis of MS. The use of traditional knowledge can help finding neglected risk factors as well as effective and safe therapeutic approaches, phytomedicines and dietary habits for the management of paresthesia and related disorders such as MS.

  19. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. (United States)

    Thomas, Jennifer J; Lawson, Elizabeth A; Micali, Nadia; Misra, Madhusmita; Deckersbach, Thilo; Eddy, Kamryn T


    DSM-5 defined avoidant/restrictive food intake disorder (ARFID) as a failure to meet nutritional needs leading to low weight, nutritional deficiency, dependence on supplemental feedings, and/or psychosocial impairment. We summarize what is known about ARFID and introduce a three-dimensional model to inform research. Because ARFID prevalence, risk factors, and maintaining mechanisms are not known, prevailing treatment approaches are based on clinical experience rather than data. Furthermore, most ARFID research has focused on children, rather than adolescents or adults. We hypothesize a three-dimensional model wherein neurobiological abnormalities in sensory perception, homeostatic appetite, and negative valence systems underlie the three primary ARFID presentations of sensory sensitivity, lack of interest in eating, and fear of aversive consequences, respectively. Now that ARFID has been defined, studies investigating risk factors, prevalence, and pathophysiology are needed. Our model suggests testable hypotheses about etiology and highlights cognitive-behavioral therapy as one possible treatment.

  20. An integrated perspective on diabetic, alcoholic, and drug-induced neuropathy, etiology, and treatment in the US

    Directory of Open Access Journals (Sweden)

    Zeng L


    Full Text Available Lily Zeng,1 Doungkamol Alongkronrusmee,2 Richard M van Rijn2 1Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, 2Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, USA Abstract: Neuropathic pain (NeuP is a syndrome that results from damaged nerves and/or aberrant regeneration. Common etiologies of neuropathy include chronic illnesses and medication use. Chronic disorders, such as diabetes and alcoholism, can cause neuronal injury and consequently NeuP. Certain medications with antineoplastic effects also carry an exquisitely high risk for neuropathy. These culprits are a few of many that are fueling the NeuP epidemic, which currently affects 7%–10% of the population. It has been estimated that approximately 10% and 7% of US adults carry a diagnosis of diabetes and alcohol disorder, respectively. Despite its pervasiveness, many physicians are unfamiliar with adequate treatment of NeuP, partly due to the few reviews that are available that have integrated basic science and clinical practice. In light of the recent Centers for Disease Control and Prevention guidelines that advise against the routine use of μ-opioid receptor-selective opioids for chronic pain management, such a review is timely. Here, we provide a succinct overview of the etiology and treatment options of diabetic and alcohol- and drug-induced neuropathy, three different and prevalent neuropathies fusing the combined clinical and preclinical pharmacological expertise in NeuP of the authors. We discuss the anatomy of pain and pain transmission, with special attention to key ion channels, receptors, and neurotransmitters. An understanding of pain neurophysiology will lead to a better understanding of the rationale for the effectiveness of current treatment options, and may lead to better diagnostic tools to help distinguish types of neuropathy. We close with a discussion of ongoing research

  1. Contemporary conceptions of etiology, pathogenesis, management and treatment of primary diffuse large b-cell central nervous system lymphoma

    Directory of Open Access Journals (Sweden)

    S. V. Voloshin


    Full Text Available In this article we present the most up-to-date information about etiology, pathogenesis, diagnostic and treatment principles of primary central nervous system diffuse large B-cell lymphoma. We propose algorithm of diagnosis and treatment based on literature review and own experience. The main methods for diagnosis verification are magneto-resonance tomography and stereotactic biopsy of mass with subsequent histological examination including immune staining. The common first-line therapy regimen is high-dose methotrexate therapy. However long-term prognosis still remains poor. Adverse prognostic factors for therapy response are age > 60 years, multifocal lesions, neurologic symptoms,previous treated disease. Considerable part of patient have contraindications or high-risk of adverse events for high-dose chemotherapy treatment. Anti-CD20 monoclonal antibody has no neurological toxicity with intravenous and intrathecal administrations. Combination therapy with reduced dose methotrexate and monoclonal antibody can be a reasonable treatment alternative for old and disable persons. The further survival improvement would be achieved by patient stratification and using of risk-adapted treatment algorithm. 

  2. Contemporary conceptions of etiology, pathogenesis, management and treatment of primary diffuse large b-cell central nervous system lymphoma

    Directory of Open Access Journals (Sweden)

    S. V. Voloshin


    Full Text Available In this article we present the most up-to-date information about etiology, pathogenesis, diagnostic and treatment principles of primary central nervous system diffuse large B-cell lymphoma. We propose algorithm of diagnosis and treatment based on literature review and own experience. The main methods for diagnosis verification are magneto-resonance tomography and stereotactic biopsy of mass with subsequent histological examination including immune staining. The common first-line therapy regimen is high-dose methotrexate therapy. However long-term prognosis still remains poor. Adverse prognostic factors for therapy response are age > 60 years, multifocal lesions, neurologic symptoms,previous treated disease. Considerable part of patient have contraindications or high-risk of adverse events for high-dose chemotherapy treatment. Anti-CD20 monoclonal antibody has no neurological toxicity with intravenous and intrathecal administrations. Combination therapy with reduced dose methotrexate and monoclonal antibody can be a reasonable treatment alternative for old and disable persons. The further survival improvement would be achieved by patient stratification and using of risk-adapted treatment algorithm. 

  3. Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults

    Institute of Scientific and Technical Information of China (English)

    Rona L Levy; Shelby L Langer; William E Whitehead


    This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominal pain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials,the majority of which are multi-modal in orientation,incorporating elements of cognitive behavioral therapy,social learning, and relaxation. Based on this review,we offer methodological and clinical suggestions: (1)Research investigations should include adequate sample sizes, long-term follow-up assessments, and a credible,active control group. (2) Standard gastrointestinal practice should include, when appropriate, learning opportunities for patients and family members, for example, instruction regarding the encouragement of wellness behavior.

  4. The First World Congress on Tourette Syndrome and Tic Disorders: Controversies and Hot Topics in Etiology and Treatment (United States)

    Mathews, Carol A.; Stern, Jeremy S.


    The first World Congress on Tourette Syndrome and Tic Disorders was held in London, June 2016 by the Tourette Association of America, Tourettes Action (UK), and the European Society for the Study of Tourette Syndrome. Presentations arising from large-scale collaborative projects were an important component of the scientific programme. This article focuses on areas raised in the hot topics session and two moderated debates, which covered emerging research in etiology and treatment. The hot topics ranged across genetics, arguably including the first confirmed Tourette Syndrome (TS) susceptibility gene NRXN1, neurocognition, and neurophysiology, including the possibility of a neurocognitive endophenotype for TS and the use of depth and cortical surface electrodes to investigate the neurophysiology of tics on the background of the evolving field of deep brain stimulation (DBS), to novel treatment approaches such as dental orthotics and an online behavioral intervention. The debates aired controversies in treatment; pharmacotherapy vs. behavioral treatment and the place of medical cannabinoids. These sessions demonstrate the vibrancy of a field that has considerably expanded in the last decade, the significant progress that has been made, and the direction that some of the most fruitful next phases of research will take. PMID:27375411

  5. Neo-Vascular Glaucoma: Etiology and Outcome of Treatment in Lagos

    African Journals Online (AJOL)


    therapy of ocular medications, intraocular bevacizumab injections and retinal laser photocoagulation treatments showed an average IOP reduction of 19 mmHg [Table 5]. However, the remaining 11 patients who came for follow-up but did not receive either intravitreal bevacizumab or PRP showed different paern of IOP.

  6. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. (United States)

    Lirette, Lesley Smallwood; Chaiban, Gassan; Tolba, Reda; Eissa, Hazem


    Despite its small size, the coccyx has several important functions. Along with being the insertion site for multiple muscles, ligaments, and tendons, it also serves as one leg of the tripod-along with the ischial tuberosities-that provides weight-bearing support to a person in the seated position. The incidence of coccydynia (pain in the region of the coccyx) has not been reported, but factors associated with increased risk of developing coccydynia include obesity and female gender. This article provides an overview of the anatomy, physiology, and treatment of coccydynia. Conservative treatment is successful in 90% of cases, and many cases resolve without medical treatment. Treatments for refractory cases include pelvic floor rehabilitation, manual manipulation and massage, transcutaneous electrical nerve stimulation, psychotherapy, steroid injections, nerve block, spinal cord stimulation, and surgical procedures. A multidisciplinary approach employing physical therapy, ergonomic adaptations, medications, injections, and, possibly, psychotherapy leads to the greatest chance of success in patients with refractory coccyx pain. Although new surgical techniques are emerging, more research is needed before their efficacy can be established.

  7. A Decentralized Group Treatment Program. (United States)

    Conrow, Douglas C.

    Old style and new style mental hospitals are criticized for not dealing directly with a person's inability to live within his community and relate effectively with significant people. The comprehensive mental health programs, which arose in reaction to the deficits of previous facilities and treatment, are viewed as frequently following a similar,…

  8. Anakinra as a diagnostic challenge and treatment option for systemic autoinflammatory disorders of undefined etiology. (United States)

    Harrison, Stephanie R; McGonagle, Dennis; Nizam, Sharmin; Jarrett, Stephen; van der Hilst, Jeroen; McDermott, Michael F; Savic, Sinisa


    Some adult patients presenting with unexplained pyrexia, serositis, skin rashes, arthralgia, myalgia, and other symptoms commonly found in autoinflammatory disorders may not fit a specific diagnosis, either because their clinical phenotype is nondiagnostic or genetic tests are negative. We used the term undifferentiated systemic autoinflammatory disorder (uSAID) to describe such cases. Given that well-defined autoinflammatory diseases show responses to IL-1 blockade, we evaluated whether anakinra was useful for both diagnosing and treating uSAID patients. We performed a retrospective analysis of consecutive patients presenting with uSAID between 2012-2015 who were treated with the recombinant IL-1 receptor antagonist anakinra. uSAID was diagnosed after excluding malignancy, infection, and pathogenic mutations in known hereditary fever syndromes (HFS) genes and where clinical criteria for adult onset Still's disease (AOSD) were not met. A total of 11 patients presented with uSAID (5 males and 6 females), with a mean time to diagnosis of 3.5 years (1-8 years). Patients were unresponsive or only partially controlled on disease-modifying antirheumatic drug (DMARD)/steroid treatment. Anakinra controlled symptoms within 4-6 weeks of starting treatment in 9 of 11 cases. Two patients discontinued therapy - one due to incomplete response and another due to severe injection-site reactions. This retrospective case series demonstrates that the spectrum of poorly defined autoinflammatory disorders that show responsiveness to anakinra is considerable. Anakinra seems a viable treatment option for these patients, who are unresponsive to standard steroid/DMARD treatments. Moreover, given the mechanisms of action, response to anakinra implicates underlying IL-1 dysregulation in the disease pathogenesis of responding uSAIDs patients.

  9. [Modern concepts of etiology, pathogenesis and treatment approaches to endo-perio lesions]. (United States)

    Grudianov, A I; Makeeva, M K; Piatgorskaia, N V


    A combination ofperiodontitis and pulp or periapical tissues inflammation in one tooth is known as endo-periodontal lesions. Such kind of lesion is serious problem of modern dentistry. It was found that pathogenic microflora of periodontal pocket and root canal of tooth with eno-perio lesion is almost the equal and consist of anaerobic microorganisms. Pathogenic effects have not only microorganisms but also their life products. Apical foramen, lateral and additional canals are physiological ways for pathogens migration. Inflammatory processes in these structures complicate each other. Lack of information among dentists about treatment possibilities of endo-perio lesions is a main reasons of extraction such kind of teeth. Simultaneous elimination of pathogens both from periodontal pocket and root canal is a key factor for effective treatment. Periodontal status is main factor for prognosis of tooth with endo-perio lesion, because of it treatment of endo-perio lesions should consist of two stages: infection elimination and regeneration of tooth-supported structures.

  10. Development of a Conceptual Etiological Model of Treatment Regimen Fatigue Among Patients Engaged in HIV Care: A Qualitative Study. (United States)

    Claborn, Kasey; Miller, Mary Beth; Meier, Ellen; Carbone, Sofia

    Treatment regimen fatigue (TRF) is a decreased desire and motivation to maintain vigilance in adhering to treatment, and little is known about TRF in people living with HIV. We aimed to develop a conceptual framework of TRF. Five focus groups were conducted in 2014. Eligible participants were (a) HIV infected, (b) at least 18 years of age, (c) prescribed antiretroviral therapy, and (d) fluent in English. Data were analyzed using thematic analysis. Analyses revealed these themes: patient experiences of TRF; etiological factors at the systems, provider, and patient levels; strategies to manage TRF; consequences of TRF; and protective factors that prevent the occurrence of TRF. The results provided a conceptual framework for future investigations to build on in an effort to improve adherence and retention in HIV care. Study results indicate avenues for intervention at multiple levels (systems, provider, and patient) to reduce treatment burden and improve patient resources and capacity. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  11. [Modern view on etiology, pathogenesis and treatment of chronic pelvic pain syndrome]. (United States)

    Vinarov, A Z


    The manuscript presents the analysis of scientific manuscripts written by Russian and foreign researchers devoted to chronic pelvic pain syndrome (CPPS) studies. In spite of widespread disease, there is no clear understanding on etiopathogenetic mechanisms of CPPS development and it is shown that besides infectious process cardiovascular, neuronal, locomotor, endocrine and immune systems are involved into pathological process of CPPS. Mentioned factors complicate the doctors task on effective therapy choice and stress the reasonability of complex approach to CPPS treatment. Combination drug containing affinity purified antibodies to endothelial NO-synthase and prostate-specific antigen in released-active form influences different pathogenetic mechanisms of CPPS and thereby reveals pronounced clinical efficacy.


    Directory of Open Access Journals (Sweden)

    B. U. Mardanov


    Full Text Available This review is devoted to the study of issues relating to the features of associated course of chronic heart failure (CHF and diabetes mellitus (DM. The modern views on the epidemiology, pathogenesis of DM and CHF are systematized. The pathogenesis of diabetic cardiomyopathy is described in details. The results of the well-known studies that show the negative impact of DM on CHF prognosis are presented. The principles of CHF pathogenetic therapy in patients with DM including the role of neurohormonal modulators are analyzed. The results of multicenter studies in patients with CHF and concomitant DM type 2 show that almost all first-line drugs recommended for CHF treatment are effective in patients with DM.

  13. [Small for gestational age newborns--definition, etiology and neonatal treatment]. (United States)

    Slancheva, B; Mumdzhiev, Hr


    Newborns with intrauterine hypotrophy are at particular risk group of neonates. Diagnosis based on an adequate estimated gestational age, compared with accurate anthropometric measurements after birth. Among children born with low birth weight (leading experts in obstetrics, perinatal and neonatal medicine, pediatricians endocrinologists, pharmacologists and epidemiologists, with the following main tasks: the definition of small for gestational age children, diagnosis of SGA, SGA children growth and role of growth hormone in their treatment. Subsequent meetings of this committee discuss consensus on SGA infants who acquire their final form at a meeting in Prague in 2009 Small for gestational age (SGA, SGA), is described children whose body weight and/or height is lower than the average by more than 2 standard deviations (< - 2SD). Some authors use the boundary 3rd, 5th, or 10th percentile, but most believe that the use of indicators (< - 2SD) comprises the largest percentage of newborns with fetal growth disorders. Small for gestational age children are divided into: newborn weight retardation (SGAW), growth retardation (SGAL), matched up in weight and height (SGAWL). "Intrauterine growth retardation" (Intra-Uterine Growth Retardation (IUGR) are born with fetal growth retardation, documented at least two ultrasound scans, one of which in the 1st trimester Intrauterine hypotrophy is the second most common cause of perinatal death after prematurity. Hypotrophy is present in about 53% of premature and stillborn at 26% of full-term stillborn children. The incidence of asphyxia in SGA intrapartum is about 50%. Neonatal care includes effective primary resuscitation, treatment of existing and prevention of complications anticipated adaptation. These children are subject to follow-up for later risk of socially significant diseases in the adult.

  14. Hypoxic encephalopathy after heart valve replacement: etiology and pathogenesis, diagnostic criteria and treatment

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    В. Г. Постнов


    Full Text Available Reviewed in this paper are modern approaches in the intensive therapy of acute hypoxic encephalopathy developing in a number of occasions after the heart valve replacement surgery. The study is based on the results of neurological, neuropsychological and neurophysiological (EEG examinations of 240 patients who underwent heart valve replacement surgery under cardiopulmonary bypass conditions complicated later by the development of hypoxic encephalopathies of varying severity and who received complex intensive care. Relying on many years of experience in the treatment of heart surgery patients in whom manifestations of encephalopathy developed in the early postoperative period, or were delayed, we have formulated the following algorithms of therapy. (1 Maintenance of normal blood gas: Hb>100 g/L, pH 7.45, PaCO2 35 mmHg. (2 Maintenance of hemodynamics: ABPsystolic>90 mmHg. (3 Supplying fluids and electrolytes: isoosmolar infusion solutions, adding of KCl and MgSO4 to the infusion. (4 Antiedemic therapy: 15% mannitol or 40% glycerol solution. (5 If necessary (in case of psychomotor agitation, seizures, short-acting barbiturates (sodium thiopental, neuroleptics (haloperidol, propofol. No benzodiazepines in case of psychoses (6 Cerebral metabolism stimulation (not earlier than 48 hours after surgery with cholinomimetics, nootropics, cerebral blood flow protectors. Cholinomimetics are allowed on the first day after surgery. This algorithm and the above-mentioned groups of drugs, especially central cholinomimetics, allow for correcting the neurocognitive impairment in the discussed group of patients quickly and effectively.

  15. A stepwise approach to the etiologic diagnosis of pleural effusion in respiratory intensive care unit and short-term evaluation of treatment

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    Nilesh J Chinchkar


    Full Text Available Background: Pleural effusions in respiratory intensive care unit (RICU are associated with diseases of varied etiologies and often carry a grave prognosis. This prospective study was conducted to establish an etiologic diagnosis in a series of such patients before starting treatment. Materials and Methods: Fifty consecutive patients, diagnosed with pleural effusion on admission or during their stay in RICU, were further investigated by a two-step approach. (1 Etiologic diagnosis was established by sequential clinical history and findings on physical examination, laboratory tests, chest radiograph, CECT/HRCT/PET-CT and pleural fluid analysis. (2 Patients who remained undiagnosed were subjected to fiber-optic bronchoscopy, video-assisted thoracoscopic pleural biopsy, and histopathology. Results: Etiologic diagnosis of pleural effusion was established in 44 (88% Metastases (24%; para-pneumonia (22%; congestive cardiac failure (18%; tuberculosis (14%; hemothorax (4%; trapped lung, renal failure, and liver cirrhosis (2% each. Six patients (12% remained undiagnosed, as the final diagnostic thoracoscopic biopsy could not be performed in five and tissue histopathology findings were inconclusive in one. Out of the 50 patients, 10 died in the hospital; 2 left against medical advice; and 2 were referred to oncology center for further treatment. The remaining 36 patients were clinically stabilized and discharged. During a 3-month follow-up, eight of them were re-hospitalized, of which four died. Conclusions: Pleural effusion in RICU carries a high risk of mortality. Etiologic diagnosis can be established in most cases.

  16. A stepwise approach to the etiologic diagnosis of pleural effusion in respiratory intensive care unit and short-term evaluation of treatment (United States)

    Chinchkar, Nilesh J; Talwar, Deepak; Jain, Sushil K


    Background: Pleural effusions in respiratory intensive care unit (RICU) are associated with diseases of varied etiologies and often carry a grave prognosis. This prospective study was conducted to establish an etiologic diagnosis in a series of such patients before starting treatment. Materials and Methods: Fifty consecutive patients, diagnosed with pleural effusion on admission or during their stay in RICU, were further investigated by a two-step approach. (1) Etiologic diagnosis was established by sequential clinical history and findings on physical examination, laboratory tests, chest radiograph, CECT/HRCT/PET-CT and pleural fluid analysis. (2) Patients who remained undiagnosed were subjected to fiber-optic bronchoscopy, video-assisted thoracoscopic pleural biopsy, and histopathology. Results: Etiologic diagnosis of pleural effusion was established in 44 (88%) Metastases (24%); para-pneumonia (22%); congestive cardiac failure (18%); tuberculosis (14%); hemothorax (4%); trapped lung, renal failure, and liver cirrhosis (2% each). Six patients (12%) remained undiagnosed, as the final diagnostic thoracoscopic biopsy could not be performed in five and tissue histopathology findings were inconclusive in one. Out of the 50 patients, 10 died in the hospital; 2 left against medical advice; and 2 were referred to oncology center for further treatment. The remaining 36 patients were clinically stabilized and discharged. During a 3-month follow-up, eight of them were re-hospitalized, of which four died. Conclusions: Pleural effusion in RICU carries a high risk of mortality. Etiologic diagnosis can be established in most cases. PMID:25814793

  17. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. (United States)

    Mandell, Jacob C; Khurana, Bharti; Smith, Stacy E


    Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

  18. Role of Omega-3 Fatty Acids in the Etiology, Treatment, and Prevention of Depression: Current Status and Future Directions (United States)

    McNamara, Robert K.


    Over the past three decades a body of translational evidence has implicated dietary deficiency in long-chain omega-3 (LCn-3) fatty acids, including eicosapenaenoic acid (EPA) and docosahexaenoic acid (DHA), in the pathophysiology and etiology of major depressive disorder (MDD). Cross-national and cross-sectional data suggest that greater habitual intake of preformed EPA+DHA is associated with reduced risk for developing depressive symptoms and syndromal MDD. Erythrocyte EPA and DHA composition is highly correlated with habitual fish or fish oil intake, and case-control studies have consistently observed lower erythrocyte EPA and/or DHA levels in patients with MDD. Low erythrocyte EPA+DHA composition may also be associated with increased risk for suicide and cardiovascular disease, two primary causes of excess premature mortality in MDD. While controversial, dietary EPA+DHA supplementation may have antidepressant properties and may augment the therapeutic efficacy of antidepressant medications. Neuroimaging and rodent neurodevelopmental studies further suggest that low LCn-3 fatty acid intake or biostatus can recapitulate central pathophysiological features associated with MDD. Prospective findings suggest that low LCn-3 fatty acid biostatus increases risk for depressive symptoms in part by augmenting pro-inflammatory responsivity. When taken collectively, these translational findings provide a strong empirical foundation in support of dietary LCn-3 fatty acid deficiency as a modifiable risk factor for MDD. This review provides an overview of this translational evidence and then discusses future directions including strategies to translate this evidence into routine clinical screening and treatment algorithms. PMID:27766299


    Directory of Open Access Journals (Sweden)

    Chernyakova A.M.


    postpartum sepsis and postoperative peritonitis. Among other gram-negative bacteria should be noted genus Klebsiella. Therefore, therapy of inflammatory diseases of the pelvic organs high demands due to the risk that represents this state to the reproductive function of patients. The mixed nature of the infection, the increasing rates of resistance of pathogens to antibiotics creates difficulties in selecting antimicrobial therapy, which remains the empirical till now. The inclusion of specific bacteriophages and plant antiseptics in therapeutic regimens for local treatment of inflammatory diseases of the vagina associated with an excessive colonization of the vaginal mucosa by aerobic opportunistic bacteria justified and can serve as an alternative to the traditional antibiotic therapy. All this determines the necessity for further studying the etiology and pathogenesis of infectious and inflammatory complications, the development of new highly effective methods of prevention and treatment.

  20. Study of the incidence and etiology of congenital hypothyroidism in an endemic goiter area after treatment with iodine enriched salt

    International Nuclear Information System (INIS)

    Liu Shizhen


    A screening program for congenital hypothyroidism (CH) was performed in a severe endemic goiter area, Chengde district including 7 counties, after treatment with Iodine enriched salt, and Beijing city as a control area. From May 1985 to Sep. 1991, 26570 newborns in Beijing city and 16227 in Chengde were screened. The incidence of primary hypothyroidism in Beijing city was 1/8800 and that in Chengde 1/8100. Of all the 5 Ch detected, 3 from Beijing city and 2 from Chengde, were thyroid dysgenesis. Not a single case of endemic goiter cretinism (including both myxedematous and neurological cretinism) was found in our study. We conclude that Iodine deficiency is the only cause of endemic cretinism and this problem can be solved by Iodine enriched salt treatment

  1. Etiología bacteriana de la neumonía nosocomial y resistencia a los antimicrobianos en pacientes con y sin tratamiento antimicrobiano previo Bacterial etiology of nosocomial pneumonia and antimicrobial resistance in patients with and without antimicrobial treatment

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    Beatriz Weyland


    Full Text Available La neumonía nosocomial (NN se asocia a una elevada morbimortalidad y es la segunda causa de infección intrahospitalaria después de la infección urinaria. El objetivo de este trabajo fue conocer la etiología de la NN en adultos y evaluar el perfil de resistencia a los antimicrobianos de los microorganismos aislados teniendo en cuenta si los pacientes recibieron o no tratamiento antimicrobiano previo. Desde el año 2000 hasta el 2005 se analizaron 430 lavados broncoalveolares provenientes de 430 pacientes adultos con diagnóstico de neumonía internados en la unidad de cuidados intensivos del Hospital de Clínicas "José de San Martín". El 74% (199/ 269 de los pacientes con tratamiento previo tuvieron cultivos positivos, mientras que en el grupo sin tratamiento previo esta proporción fue del 83% (134/161 (p = 0,03. Los microorganismos prevalentes fueron Acinetobacter spp., Staphylococcus aureus y Pseudomonas aeruginosa (37,9% ; 21,3% y 20,9% vs. 36,1%; 26,6% y 17,7% en los pacientes con tratamiento previo o sin él, respectivamente; p > 0,05. La resistencia a los antimicrobianos de los citados microorganismos cuando los aislamientos provinieron de pacientes que recibieron antes tratamiento antibiótico fue superior a la encontrada en el grupo de pacientes que no recibió tratamiento previo (p Nosocomial pneumonia (NP is associated with high morbimortality, representing the second cause of nosocomial infection after urinary tract infection. The objective of this work was to become acquainted with the etiology of NP and to evaluate the antimicrobial resistance profile of the isolated microorganisms from adult patients with and without previous antimicrobial treatment admitted in the intensive care unit (ICU. From 2000 to 2005, 430 bronchoalveolar lavages from 430 adult patients diagnosed with pneumonia admitted in the ICU were analyzed. Seventy-four percent (199/ 269 of the patients with previous treatment had positive cultures, whereas in

  2. Catatonia in the medically ill: Etiology, diagnosis, and treatment. The Academy of Consultation-Liaison Psychiatry Evidence-Based Medicine Subcommittee Monograph. (United States)

    Denysenko, Lex; Sica, Nicole; Penders, Thomas M; Philbrick, Kemuel L; Walker, Audrey; Shaffer, Scott; Zimbrean, Paula; Freudenreich, Oliver; Rex, Nicole; Carroll, Brendan T; Francis, Andrew


    Catatonia in medically ill patients is rare but often unrecognized. This monograph summarizes current knowledge on the diagnosis, epidemiology, etiology, and management of catatonia occurring in the medical setting. PubMed searches were used to identify relevant articles from 1962 to present. More than 3,000 articles were obtained and reviewed for relevance, including references of articles identified by the initial search. Several areas were identified as important, including: (1) catatonia and delirium; (2) malignant catatonia; (3) pediatric catatonia; (4) catatonia associated with another medical condition (CAMC); (5) drug exposure and withdrawal syndromes associated with catatonia; and (6) treatment of catatonia in the medical setting. Catatonia in the medically ill appears to have numerous etiologies, although etiology does not seem to modify the general treatment approach of prompt administration of lorazepam. Delirium and catatonia are commonly comorbid in the medical setting and should not be viewed as mutually exclusive. Electroconvulsive therapy should be offered to patients who do not respond to benzodiazepines or have malignant features. Removing offending agents and treating the underlying medical condition is paramount when treating CAMC. Memantine or amantadine may be helpful adjunctive agents. There is not enough evidence to support the use of antipsychotics or stimulants in treating CAMC.

  3. Clinical, Etiological and Therapeutic Features of Jaw-opening and Jaw-closing Oromandibular Dystonias: A Decade of Experience at a Single Treatment Center

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    Pedro Gonzalez-Alegre


    Full Text Available Background: Dystonia is a heterogeneous hyperkinetic disorder. The anatomical location of the dystonia helps clinicians guide their evaluation and treatment plan. When dystonia involves masticatory, lingual, and pharyngeal muscles, it is referred to as oromandibular dystonia (OMD.Methods: We identified patients diagnosed with OMD in a Movement Disorders Clinic and Laryngeal Movement Disorders Clinic from a single institution. Demographic, etiological, clinical, and therapeutic information was retrospectively reviewed for patients with jaw‐opening (O‐OMD and jaw‐closing (C‐OMD OMD.Results: Twenty‐seven patients were included. Their average age of onset was in the sixth decade of life and there was a female predominance. Etiological factors linked in this study to OMD included a family history of dystonia or essential tremor, occupation, cerebellar disease, a dental disorder, and tardive syndrome. Clinically, patients with C‐OMD presented with more prominent feeding difficulties, but seemed to respond better to therapy than those with O‐OMD. In addition to the known benefits of botulinum toxin therapy, patients who described sensory tricks obtained benefit from the use of customized dental prosthesis.Discussion: This works provides useful information on potential etiological factors for OMD and its response to therapy, and highlights the potential benefit of dental prosthesis for the treatment of OMD.

  4. Compression etiology in tendinopathy. (United States)

    Almekinders, Louis C; Weinhold, Paul S; Maffulli, Nicola


    Recent studies have emphasized that the etiology of tendinopathy is not as simple as was once thought. The etiology is likely to be multifactorial. Etiologic factors may include some of the traditional factors such as overuse, inflexibility, and equipment problems; however, other factors need to be considered as well, such as age-related tendon degeneration and biomechanical considerations as outlined in this article. More research is needed to determine the significance of stress-shielding and compression in tendinopathy. If they are confirmed to play a role, this finding may significantly alter our approach in both prevention and in treatment through exercise therapy. The current biomechanical studies indicate that certain joint positions are more likely to place tensile stress on the area of the tendon commonly affected by tendinopathy. These joint positions seem to be different than the traditional positions for stretching exercises used for prevention and rehabilitation of tendinopathic conditions. Incorporation of different joint positions during stretching exercises may exert more uniform, controlled tensile stress on these affected areas of the tendon and avoid stresshielding. These exercises may be able to better maintain the mechanical strength of that region of the tendon and thereby avoid injury. Alternatively, they could more uniformly stress a healing area of the tendon in a controlled manner, and thereby stimulate healing once an injury has occurred. Additional work will have to prove if a change in rehabilitation exercises is more efficacious that current techniques.

  5. Etiological periodontal treatment with and without low-level laser therapy on IL-1β level in gingival crevicular fluid: an in vivo multicentric pilot study. (United States)

    Mastrangelo, F; Dedola, A; Cattoni, F; Ferrini, F; Bova, F; Tatullo, M; Gherlone, E; Lo Muzio, L


    Cytokine proteins may have important roles during different human physiological and pathological processes. In the oral cavity, the bone loss and periodontal tissue pathology was related to inflammatory process activation. The aim of the present study was to assess the effects of etiological periodontal therapy with and without the use of Low Level Laser Therapy (LLLT) on clinical periodontal parameters and interleukin (IL)-1β level in gingival crevicular fluid (GCF) from chronic periodontitis (CP) patients. Thirty non-smoker CP patients were selected from the Foggia University Dental Clinic and other 2 private dental clinics. All patients were divided into two homogeneous randomized groups: 15 patients were treated with only scaling and root planing (group 1) and 15 patients with scaling and root planing etiological treatment and LLLT (group 2). In all sites, at baseline before treatment, the periodontal pocket depth (PPD) and bleeding on probing (BOP) were measured. In the PPD sites, the GCF samples were collected from 30 deep (≥5 mm) and shallow (≤3 mm) sites and IL-1β were evaluated at baseline, after 10 days and 1 month. In all the samples at baseline, the IL-1β concentration in GCF and BOP rate were significantly higher at deep PPD sites than at the shallow ones. After 10 days in all samples no PPD improvement was observed in the BOP rate but the IL-1 β level was statistically significantly improved (pdeep PPD sites, PPD and BOP improvements were observed. At same time, IL-1β levels were lower and statistically significantly (pdeep PPD sites with or with-out associated LLLT promotes periodontal health. Etiological treatment associated with LLLT, improves BOP and inflammation in periodontal disease. Moreover, the IL-1β concentration changes in GCF suggest these cytokines as a predictable marker of gingival inflammation in chronic periodontitis patients.

  6. Management practices in substance abuse treatment programs. (United States)

    McConnell, K John; Hoffman, Kim A; Quanbeck, Andrew; McCarty, Dennis


    Efforts to understand how to improve the delivery of substance abuse treatment have led to a recent call for studies on the "business of addiction treatment." This study adapts an innovative survey tool to collect baseline management practice data from 147 addiction treatment programs enrolled in the Network for the Improvement of Addiction Treatment 200 project. Measures of "good" management practice were strongly associated with days to treatment admission. Management practice scores were weakly associated with revenues per employee but were not correlated with operating margins. Better management practices were more prevalent among programs with a higher number of competitors in their catchment area.

  7. Burning mouth syndrome: etiology. (United States)

    Cerchiari, Dafne Patrícia; de Moricz, Renata Dutra; Sanjar, Fernanda Alves; Rapoport, Priscila Bogar; Moretti, Giovana; Guerra, Marja Michelin


    The Burning Mouth Syndrome (BMS) is an oral mucosa pain--with or without inflammatory signs--without any specific lesion. It is mostly observed in women aged 40-60 years. This pain feels like a moderate/severe burning, and it occurs more frequently on the tongue, but it may also be felt at the gingiva, lips and jugal mucosa. It may worsen during the day, during stress and fatigue, when the patient speaks too much, or through eating of spicy/hot foods. The burning can be diminished with cold food, work and leisure. The goal of this review article is to consider possible BMS etiologies and join them in 4 groups to be better studied: local, systemic, emotional and idiopathic causes of pain. Knowing the different diagnoses of this syndrome, we can establish a protocol to manage these patients. Within the local pain group, we must investigate dental, allergic and infectious causes. Concerning systemic causes we need to look for connective tissue diseases, endocrine disorders, neurological diseases, nutritional deficits and salivary glands alterations that result in xerostomia. BMS etiology may be of difficult diagnosis, many times showing more than one cause for oral pain. A detailed interview, general physical examination, oral cavity and oropharynx inspection, and lab exams are essential to avoid a try and error treatment for these patients.

  8. An etiological model of perfectionism.

    Directory of Open Access Journals (Sweden)

    Gayle K Maloney

    Full Text Available OBJECTIVE: Perfectionism has been recognized as a transdiagnostic factor that is relevant to anxiety disorders, eating disorders and depression. Despite the importance of perfectionism in psychopathology to date there has been no empirical test of an etiological model of perfectionism. METHOD: The present study aimed to address the paucity of research on the etiology of perfectionism by developing and testing an etiological model using a sample of 311 clients seeking treatment. RESULTS: Structural equation modeling showed a direct relationship between high Parental Expectations and Criticism, and Perfectionism. There was also an indirect relationship between Parental Bonding and Perfectionism that was mediated by core schemas of disconnection and rejection. Finally, it was found that Neuroticism had both an indirect relationship, which was mediated by core schemas, and a direct relationship with perfectionism. CONCLUSIONS: The study provided the first direct test of an etiological model of perfectionism to date. Clinical implications include investigating whether the inclusion of etiological factors in the understanding and treatment of perfectionism is effective.

  9. Outcome of Minnesota's gambling treatment programs. (United States)

    Stinchfield, R; Winters, K C


    This study measured the outcome of four state-supported outpatient gambling treatment programs in Minnesota. The programs were developed specifically for the treatment of pathological gamblers and offered multiple modalities of treatment including individual, group, education, twelve-step work, family groups, and financial counseling. The therapeutic orientation was eclectic with an emphasis on the twelve steps of Gamblers Anonymous (GA) and a treatment goal of abstinence. The sample included 348 men and 220 women treated between January 1992 and January 1995. A pretest-posttest design was utilized with multidimensional assessments obtained at intake, discharge, six-months, and twelve-months post-discharge. Variables assessed included a range of clinical and outcome variables. At six month follow-up, 28% reported that they had abstained from gambling during the six months following discharge and an additional 20% had gambled less than once per month. Almost half of the sample (48%) showed clinically significant improvement in gambling frequency at six month follow-up. Outcome variables of gambling frequency, SOGS scores, amount of money gambled, number of friends who gamble, psychosocial problems, and number of financial problems, all showed statistically significant improvements from pretreatment to follow-up. The treatment programs yielded outcome results similar to those reported for alcohol and drug abuse treatment programs.

  10. Small vessel vasculitis History, classification, etiology, histopathology, clinic, diagnosis and treatment; Vasculitis de pequenos vasos. Historia, clasificacion, etiologia, histopatologia, clinica, diagnostico y tratamiento

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    Iglesias Gamarra, Antonio; Matteson, Eric L; Restrepo, Jose Felix


    Small-vessel vasculitis is a convenient descriptor for a wide range of diseases characterized by vascular inflammation of the venules, capillaries, and/or arterioles with pleomorphic clinical manifestations. The classical clinical phenotype is leucocytoclastic vasculitis with palpable purpura, but manifestations vary widely depending upon the organs involved. Histopathologic examination in leucocytoclastic vasculitis reveals angiocentric segmental inflammation, fibrinoid necrosis, and a neutrophilic infiltrate around the blood vessel walls with erythrocyte extravasation. The etiology of small-vessel vasculitis is unknown in many cases, but in others, drugs, post viral syndromes, malignancy, primary vasculitis such as microscopic polyarteritis, and connective tissue disorders are associated, The diagnosis of small- vessel vasculitis relies on a thorough history and physical examination, as well as relevant antibody testing including antinuclear antibody and anti neutrophil cytoplasmic antibody, hepatitis B and C serologies, assessment of complement, immunoglobulins, blood count, serum creatinine liver function tests, urinalysis, radiographic imaging and biopsy. The treatment is based primarily on corticosteroid and immunosuppressive agents.

  11. A case of osteoradionecrosis of maxilla. Etiology and reconstruction of full-thickness skin defect following treatment

    International Nuclear Information System (INIS)

    Umino, Satoshi; Ono, Shigeru; Hayashi, Seiichi; Katada, You


    Osteoradionecrosis of the jaws mainly occurs in the mandible but rarely in the maxilla due to anatomical factors. This report describes a rare case of maxillary osteoradionecrosis that occurred 2 years 2 months after treatment of advanced cancer of the maxillary sinus. Because of advanced cancer of the maxillary sinus (T3N0M0), a 74-years-old female underwent 50 Gy irradiation with intraarterial infusion of 2,500 mg 5-Fu, tumor reduction surgery, and 24 Gy intracavitary brachytherapy with high dose rate iridium from March to May in 1993. While the cancer was well controlled by these treatments, the patient was found to have abscess formation in the left infraorbital region on June 26, 1995 and referred to our department on July 10, 1995. After incision of the abscess, conservation treatment was given to the patient as an outpatient; sequestration began to occur; and the sequester (24 x 15 mm) in the left orbital base was separated on October 17, 1995. Although the inflammation disappeared, a full-thickness skin defect (18 x 8 mm) penetrating through the maxillary sinus in the left infraorbital region developed. This defect was reconstructed by using the triangular hinge flap below it and the buccal flap. The result of reconstruction was esthetically satisfactory. (author)



    Fayal El Guendouz; Hicham Boussouf; Nabil Hammoune.


    Hyperthyroidism is a common endocrine disorder in young women of childbearing age. Approximately one to three cases of gestational hyperthyroidism occur per 1000 pregnancies. All etiologies of hyperthyroidism may be encountered during pregnancy but they are dominated by Graves\\\\\\' disease and gestational transient thyrotoxicosis. The first requires an antithyroid drug treatment and the second progresses well under symptomatic treatment. Hence the interest of the Establishment of the cause of ...

  13. A quality framework for addiction treatment programs

    NARCIS (Netherlands)

    Nabitz, Udo; van den Brink, Wim; Walburg, Jan


    AIM: To identify and specify the structure and the elements of a quality framework for addiction treatment programs. METHOD: Concept mapping strategy was applied. In brainstorm sessions, 70 statements were generated and rated by 90 representatives of three stakeholder groups. Using multivariate

  14. Functional dyspepsia in adolescents: particulars of its etiology, premorbid background, and a comprehensive treatment approach

    Directory of Open Access Journals (Sweden)

    D. V. Pechkurov


    Full Text Available The adolescence is characterized by high rates of gastroenterological morbidity due to physiological characteristics of the body and social and psychological status of the teenager. Dyspepsia takes the leading position in the structure of functional pathology. Studies have shown the role of family, unhealthy habits and addictions in the development of this disorder. One should also bear in mind that the adolescence is characterized by an increase in organic pathology. There is a  close association of the functional dyspepsia and the premorbid background, such as autonomous dysfunction and vertebral abnormalities. The use of cholinolytics, prokinetics, opioid receptor antagonists, antacids and anti-secretory agents seems rational for treatment of dyspepsia. If the above mentioned groups of agents lack efficacy, the second line therapy is proposed, which includes tricyclic antidepressants.

  15. Developments in the treatment of transfusion-dependent anemia in patients with myelodysplastic syndromes: epidemiology, etiology, genetics, and targeted therapies

    Directory of Open Access Journals (Sweden)

    Raza A


    Full Text Available Azra Raza, Nicholas Iverson, Abdullah M AliThe MDS Center, Columbia University, New York, NY, USAAbstract: Myelodysplastic syndromes are malignant hematopoietic stem cell disorders that present with variable cytopenias and predominantly affect the elderly. Treatment options are limited, with allogeneic transplant being the only potentially curative strategy. Recent mutational profiling studies have led to cataloguing of driver and passenger mutations most commonly affecting the epigenetic regulators and genes involved in RNA splicing. Despite improved understanding of the disease biology, these emerging molecular insights have not led to identification of novel therapeutic strategies. Although several drugs approved in the last decade improve the cytopenias, the relief is temporary, most likely due to the sequential activation of clones. Future advances depend upon identification of signaling pathways in dominant clones and targeting these with agents that might be known but need to be matched to suit the needs of individual patients in a longitudinal, dynamic fashion. Myelodysplastic syndromes are ideally suited for the development of such personalized medicine.Keywords: cancer, epigenetics, iron, MDS, myelodysplasia, splicing

  16. [The etiology of obsessive-compulsive disorder from the aspects of attachment theory, with special regard to perceived parental treatment, attachment patterns and emotion regulation difficulties]. (United States)

    Rejtô, Nóra; Papp, Gábor; Molnár, Judit

    The focus of our study was the etiology of obsessive-compulsive disorder from attachment aspects. Our aim was to examine the representations of perceived parental treatment, attachment patterns and the level of emotion regulation of people who suffer from obsessive-compulsive disorder. 223 people participated in our study. The clinical group consisted of 92 persons with obsessive-compulsive symptoms, while the control group involved 131 people without OC symptoms. In the study we used the Young Parenting Inventory, the Relationship Questionnaire, and the Difficulties in Emotion Regulation Scale. Besides we compiled a questionnaire based on the DSM-5 and a demographic questionnaire. Respondents could fill the questionnaires online. The clinical group is characterized by significantly higher toxic frustration of each five basic emotional needs than the control group. Specifically, in the case of people with OC smptoms the toxic parental treatments for Defectiveness/ Shame, Dependence/Incompetence, Enmeshment/Undeveloped self, Entitlement/Grandiosity, Approval-seeking/ Recognition-seeking, Negativity/Pessimism, Emotional inhibition, Unrelenting standards/Hypercriticalness and Punitiveness were significantly more frequent than in the control group. The OC group is also characterized by significantly lower rate of secure attachment style, while dismissive attachment style proved to be the most frequent attachment style among them. The OC group also struggle with significantly higher level of emotion regulation difficulties.

  17. Etiology of Inguinal Hernias

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob


    BACKGROUND: The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. RESULTS: Lateral a...

  18. Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men. (United States)

    Bronner, Gila; Ben-Zion, Itzhak Z


    Masturbation is a common sexual activity among people of all ages throughout life. It has been traditionally prohibited and judged as immoral and sinful by several religions. Although it is no longer perceived as a negative behavior, masturbation is often omitted in the diagnostic inquiry of patients with sexual problems. The aims of this study are to increase the awareness of clinicians to the importance of including questions regarding masturbatory habits in the process of sexual history taking, to analyze cases of male sexual dysfunction (SD) associated with unusual masturbatory practices, and to propose a practical tool for clinicians to diagnose and manage such problems. A clinical study of four cases that include a range of unusual masturbatory practices by young males who applied for sex therapy is described. An intervention plan involving specific questions in case history taking was devised. It was based on detailed understanding of each patient's masturbatory practice and its manifestation in his SD. Effects of identifying and altering masturbatory practices on sexual function. The four men described unusual and awkward masturbatory practices, each of which was associated with different kinds of SD. The unlearning of the masturbatory practices contributed notably to improvement of their sexual function. The four cases in this study indicate that the detailed questioning of masturbatory habits is crucial for a thorough assessment and adequate treatment of sexual problems in men. We propose specific questions on masturbatory behavior as well as a diagnostic and therapeutic flowchart for physicians and sex therapists to address those problems. © 2014 International Society for Sexual Medicine.

  19. Are the Gut Bacteria Telling Us to Eat or Not to Eat? Reviewing the Role of Gut Microbiota in the Etiology, Disease Progression and Treatment of Eating Disorders. (United States)

    Lam, Yan Y; Maguire, Sarah; Palacios, Talia; Caterson, Ian D


    Traditionally recognized as mental illnesses, eating disorders are increasingly appreciated to be biologically-driven. There is a growing body of literature that implicates a role of the gut microbiota in the etiology and progression of these conditions. Gut bacteria may act on the gut-brain axis to alter appetite control and brain function as part of the genesis of eating disorders. As the illnesses progress, extreme feeding patterns and psychological stress potentially feed back to the gut ecosystem that can further compromise physiological, cognitive, and social functioning. Given the established causality between dysbiosis and metabolic diseases, an altered gut microbial profile is likely to play a role in the co-morbidities of eating disorders with altered immune function, short-chain fatty acid production, and the gut barrier being the key mechanistic links. Understanding the role of the gut ecosystem in the pathophysiology of eating disorders will provide critical insights into improving current treatments and developing novel microbiome-based interventions that will benefit patients with eating disorders.

  20. Are the Gut Bacteria Telling Us to Eat or Not to Eat? Reviewing the Role of Gut Microbiota in the Etiology, Disease Progression and Treatment of Eating Disorders

    Directory of Open Access Journals (Sweden)

    Yan Y. Lam


    Full Text Available Traditionally recognized as mental illnesses, eating disorders are increasingly appreciated to be biologically-driven. There is a growing body of literature that implicates a role of the gut microbiota in the etiology and progression of these conditions. Gut bacteria may act on the gut–brain axis to alter appetite control and brain function as part of the genesis of eating disorders. As the illnesses progress, extreme feeding patterns and psychological stress potentially feed back to the gut ecosystem that can further compromise physiological, cognitive, and social functioning. Given the established causality between dysbiosis and metabolic diseases, an altered gut microbial profile is likely to play a role in the co-morbidities of eating disorders with altered immune function, short-chain fatty acid production, and the gut barrier being the key mechanistic links. Understanding the role of the gut ecosystem in the pathophysiology of eating disorders will provide critical insights into improving current treatments and developing novel microbiome-based interventions that will benefit patients with eating disorders.

  1. Diagnóstico etiológico do hirsutismo e implicações para o tratamento Etiological diagnosis of hirsutism and implications for the treatment

    Directory of Open Access Journals (Sweden)

    Poli Mara Spritzer


    identifying the etiology and potential risk for associated comorbidities. The aims of the treatment are: to suppress androgen overproduction, if present; to block androgen action on hair follicles; to identify and treat patients at risk for metabolic disturbances or reproductive neoplasias.

  2. Hypothyroidism: etiology, diagnosis, and management. (United States)

    Almandoz, Jaime P; Gharib, Hossein


    Hypothyroidism is the result of inadequate production of thyroid hormone or inadequate action of thyroid hormone in target tissues. Primary hypothyroidism is the principal manifestation of hypothyroidism, but other causes include central deficiency of thyrotropin-releasing hormone or thyroid-stimulating hormone (TSH), or consumptive hypothyroidism from excessive inactivation of thyroid hormone. Subclinical hypothyroidism is present when there is elevated TSH but a normal free thyroxine level. Treatment involves oral administration of exogenous synthetic thyroid hormone. This review presents an update on the etiology and types of hypothyroidism, including subclinical disease; drugs and thyroid function; and diagnosis and treatment of hypothyroidism. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Etiology of Inguinal Hernias

    DEFF Research Database (Denmark)

    Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob


    BACKGROUND: The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. RESULTS: Lateral...... and medial hernias seem to have common as well as different etiologies. A patent processus vaginalis and increased cumulative mechanical exposure are risk factors for lateral hernias. Patients with medial hernias seem to have a more profoundly altered connective tissue architecture and homeostasis compared...... mechanisms why processus vaginalis fails to obliterate in certain patients should also be clarified. Not all patients with a patent processus vaginalis develop a lateral hernia, but increased intraabdominal pressure appears to be a contributing factor....

  4. Valvular Heart Disease in Cancer Patients: Etiology, Diagnosis, and Management. (United States)

    Stewart, Merrill H; Jahangir, Eiman; Polin, Nichole M


    Cardiac valvular disease as consequence of radiation and chemotherapy during treatment for malignancy is growing in its awareness. While the overwhelming emphasis in this population has been on the monitoring and preservation of left ventricular systolic function, we are now developing a greater appreciation for the plethora of cardiac sequelae beyond this basic model. To this end many institutions across the country have developed cardio-oncology programs, which are collaborative practices between oncologists and cardiologists in order to minimize a patient's cardiovascular risk while allowing them to receive the necessary treatment for their cancer. These programs also help to recognize early nuanced treatment complications such as valvular heart disease, and provide consultation for the most appropriate course of action. In this article we will discuss the etiology, prevalence, diagnosis, and current treatment options of valvular heart disease as the result of chemotherapy and radiation.

  5. Assessment and Treatment of Co-occurring Eating Disorders in Privately Funded Addiction Treatment Programs (United States)

    Killeen, Therese K.; Greenfield, Shelly F.; Bride, Brian E.; Cohen, Lisa; Gordon, Susan Merle; Roman, Paul M.


    Privately-funded addiction treatment programs were surveyed to increase understanding of assessment and current treatment options for patients with co-occurring substance use and eating disorders. Data were collected from face-to-face interviews with program administrators of a nationally representative sample of 345 private addiction treatment programs. Although the majority of programs reported screening for eating disorders, programs varied in screening instruments used. Sixty-seven percent reported admitting cases of low severity. Twenty-one percent of programs attempt to treat eating disorders. These results highlight the need for education of addiction treatment professionals in assessment, referral and treatment of eating disorders. PMID:21477048

  6. [Etiology of adult insomnia]. (United States)

    Dollander, M


    In the article, the author develops an analysis of external and intrapsychic factors related to adults' insomnia. First she undertakes a literature review to describe semiological, evolutive and etiological levels of insomnia. From a semiological point of view, it is usual to differenciate initial insomnia (associated to the first phase of sleeping), intermittent insomnia (related to frequent awakenings) and final insomnia (related to early morning awakenings). From an evolutive point of view, we can identify transitory insomnia (characterized by frequent awakenings) and chronic insomnia. On the other hand, we are allowed to distinguish organic insomnia (disorder where an organic cerebral injury is demonstrated or suspected) from insomnias related to psychiatric or somatic disease or idiopathic one. Then, the author makes a literary review to identify various insomnia causes and points out. Social factors: insomnia rates are higher by divorced, separated or widowed people. Percentages are higher when scholastic level is weak, domestic income is less then 915 O a month, or by unemployed people. Besides, sleep quality is deteriorated by ageing. Sleeping and waking rhythm is able to loose its synchronization. Complaints about insomnia occur far frequently from women than men. Environmental factors: working constraints increase sleep disorders. It is possible to make the same conclusion when we have to face overcharge of external events, deep intrapsychic conflicts (related to grief, unemployment, damage or hospitalization) or interpersonal conflicts' situations where we are confronted to stress related to socio-affective environment, lack of social support or conjugal difficulties. Medical and physiologic causes: legs impatience syndrome, recurrent limbs shakings syndrome, breathe stop during sleep, narcolepsy, excessive medicine or hypnotic drugs use, some central nervous system injuries, every nocturnal awakening (related to aches.), surgical operation

  7. Outcome of Congenitally Hypothyroid Screening Program in Isfahan: Iran From Prevention to Treatment

    Directory of Open Access Journals (Sweden)

    Mahin Hashemipour


    Full Text Available Objectives: Early and proper treatment is crucial to prevent neuropsychologic deficits in congenital hypothyroidism (CH. Considering the high prevalence of CH in Isfahan, the aim of this study was to evaluate the outcome of treatment in CH patients.Methods: In this study CH neonates diagnosed during screening program in Isfahan from May 2002 to September 2009 were studied. Frequent visits were performed to CH patients to monitor and follow their treatments. Quality of treatment was assessed by evaluating mean age of treatment initiation and mean TSH and T4 levels before and after treatment and during the first and second years according to their normal reference ranges.Results: Of 225,224 screened neonates, 536 were diagnosed as CH patients. The prevalence of CH was 1/420 live births. Mean age at starting treatment was 22.9  13.2 days. In 93.7% of patients, treatment was begun before the 45th day of life. In the first measurement after initiating the treatment, T4 and TSH were not in their acceptable range in 3.9% and 9.8% of CH patients, respec-tively. Mean T4 and TSH reached to normal range during the treatment period. T4 reached the normal range earlier than TSH.Conclusions: The mean age of treatment initiation was in acceptable range but the findings suggest that both early and high-dose treatments are crucial for optimal treatment, especially in patients with severe CH. Further studies are needed to determine the outcome of treatment specially regarding to different etiologies of CH.

  8. Interest in marijuana treatment programs among teenage smokers and nonsmokers. (United States)

    Sheer, Amy J; Gorelick, David A; Collins, Charles C; Schroeder, Jennifer R; Heishman, Stephen J; Leff, Michelle K; Moolchan, Eric T


    Little is known about adolescents' interest in marijuana treatment programs. This question was evaluated by telephone interview in a convenience sample of 575 adolescents responding to advertisements for tobacco research studies. Eighty-one percent of respondents endorsed the need for marijuana treatment programs for adolescents. These adolescents were younger and less likely to smoke tobacco, smoke marijuana, or use alcohol than those not endorsing such a need. Among the 192 marijuana smokers, the 58.8% who endorsed the need for marijuana treatment programs took their first puff of marijuana at a younger age than those who did not endorse the need. Those who were willing to participate in a marijuana treatment program were more likely African American and took their first marijuana puff at a younger age than those not interested in treatment. These findings suggest that most adolescent marijuana smokers endorse the need for and are willing to attend marijuana treatment programs.

  9. Etiological factors of psoas abscesses

    Directory of Open Access Journals (Sweden)

    Mehmet Nuri Bodakçi


    Full Text Available Objective: Psoas abscess (PA is a rare infection disease, which is difficult to diagnose. In the present study, we aimed to evaluate etiological factors and treatment results of patients with PA. Methods: Files of 20 patients who were diagnosed as PA between December 2006 and January 2013, were retrospectively analyzed. Patient’s whose data were entirely reached and diagnosed by Ultrasonography and/or Computed Tomography as an exact PA were included to the study. Results: The mean age of the 20 patients was 48.8 (range 17-82 year, and 6 of them were female and remaining were male. Psoas abscess were on the right side in 12 patients (60%, on the left side in seven patients (35%, and bilateral in one (5%. According to data records four patients had Diabetes Mellitus (20%, two had Hypertension (10%, one had cerebrovascular disease (5%, one had tuberculosis (5%, one had hyperthyroidism (5%, one had mental retardation (5%, and one had paraplegia (5%. Six case (30% were diagnosed as a primary psoas abscess (pPA, sPA and remaining (n=14, %70 were diagnosed as secondary. Percutaneous drainage was performed to 13 patients (65% and exploration was performed to three patients (15% as a treatment modality. Remaining four patients (20% were followed by medical treatment. Conclusion: Psoas abscess is rare and have variable and non-specific clinical characteristic, which may lead to difficulty in diagnosis. In developed and developing countries, it has been reported that the most common causes of sPA are Pott's disease, and Crohn's disease, also it should be taken into account that open surgery and urinary tract stone disease can receive a significant portion of the etiological factors. J Clin Exp Invest 2014; 5 (1: 59-63

  10. The role of culture in substance abuse treatment programs for American Indian and Alaska Native communities. (United States)

    Legha, Rupinder Kaur; Novins, Douglas


    Culture figures prominently in discussions regarding the etiology of alcohol and substance abuse in American Indian and Alaska Native (AI/AN) communities, and a substantial body of literature suggests that it is critical to developing meaningful treatment interventions. However, no study has characterized how programs integrate culture into their services. Furthermore, reports regarding the associated challenges are limited. Twenty key informant interviews with administrators and 15 focus groups with clinicians were conducted in 18 alcohol and substance abuse treatment programs serving AI/AN communities. Transcripts were coded to identify relevant themes. Substance abuse treatment programs for AI/AN communities are integrating culture into their services in two discrete ways: by implementing specific cultural practices and by adapting Western treatment models. More important, however, are the fundamental principles that shape these programs and their interactions with the people and communities they serve. These foundational beliefs and values, defined in this study as the core cultural constructs that validate and incorporate AI/AN experience and world view, include an emphasis on community and family, meaningful relationships with and respect for clients, a homelike atmosphere within the program setting, and an “open door” policy for clients. The primary challenges for integrating these cultural practices include AI/AN communities' cultural diversity and limited socioeconomic resources to design and implement these practices. The prominence of foundational beliefs and values is striking and suggests a broader definition of culture when designing services. This definition of foundational beliefs and values should help other diverse communities culturally adapt their substance abuse interventions in more meaningful ways.

  11. Dry eyes: etiology and management. (United States)

    Latkany, Robert


    Until recently, the cause of dry eye syndrome was uncertain and the treatment was palliative. Since discovering that dry eyes are caused by inflammation, there has been an abundance of research focusing on anti-inflammatory therapies, other contributing causes, and better diagnostic testing. This review summarizes some of the interesting published research on ocular surface disease over the past year. The definition of dry eye now highlights the omnipresent symptom of blurry vision. The re-evaluation of ocular surface staining, tear meniscus height, and visual change will allow for a better diagnosis and understanding of dry eyes. Punctal plugs, and oral and topical anti-inflammatory use will strengthen our arsenal against ocular surface disease. Major progress has occurred in the past few years in gaining a better understanding of the etiology of dry eye syndrome, which will inevitably lead to more effective therapeutic options.

  12. Use of modified lip repositioning technique associated with esthetic crown lengthening for treatment of excessive gingival display: A case report of multiple etiologies (United States)

    Mantovani, Matheus Bortoluzzi; Souza, Eduardo Clemente; Marson, Fabiano Carlos; Corrêa, Giovani Oliveira; Progiante, Patrícia Saram; Silva, Cléverson Oliveira


    Excessive gingival display during smile can result in compromised esthetics. This study aims to report a case of excessive gingival display with multiple etiologies treated by means of modified lip repositioning technique associated with esthetic crown lengthening. A 23-year-old female patient, with 5-mm gingival display during smile caused by altered passive eruption and hypermobility of the upper lip, underwent the modified lip repositioning technique associated with gingivectomy followed by flap elevation and ostectomy/osteoplasty. Seven months after the second procedure, the patient had her esthetic complaint solved appearing stable in the observation period. The modified lip repositioning technique is an effective procedure employed to reduce gingival display and when associated with esthetic clinical crown lengthening, can appropriately treat cases of gummy smile. PMID:27041845

  13. Understanding Etiology of Hearing Loss as a Contributor to Language Dysfluency and its Impact on Assessment and Treatment of People who are Deaf in Mental Health Settings. (United States)

    Crump, Charlene J; Hamerdinger, Stephen H


    Working with individuals who are deaf in mental health settings can be complex work, necessitating consideration for the difference in language abilities. These differences include not only the language differences of American Sign Language (ASL) and English, but also the range of heterogeneity within the Deaf Community. Multiple influences such as mental illness, medical conditions, language deprivation and the etiology of deafness can impact how a person acquires and uses language. This article will discuss how various causes of deafness create the potential for specific language dysfluencies with individuals who are deaf in mental health settings. The article will also discuss the use of communication assessments to examine specific language dysfluency patterns and attempt to offer possible corresponding interventions.

  14. Transportation and retention in outpatient drug abuse treatment programs. (United States)

    Friedmann, P D; Lemon, S C; Stein, M D


    To determine whether certain types of transportation assistance improve outpatient treatment retention beyond thresholds shown to have therapeutic benefits, we analyzed data from 1,144 clients in 22 outpatient methadone maintenance (OMM) programs and 2,031 clients in 22 outpatient drug-free (ODF) programs in the Drug Abuse Treatment Outcomes Study (DATOS), a national, 12-month, longitudinal study of drug abuse treatment programs. Directors' surveys provided information about provision of car, van, or contracted transportation services or individual vouchers/payment for public transportation. Chart-abstracted treatment retention was dichotomized at 365 days for OMM and 90 days for ODF. Separate multivariate hierarchical linear models revealed that provision of car, van, or contracted transportation services improved treatment retention beyond these thresholds for both OMM and ODF, but individual vouchers or payment for public transportation did not. Future research should validate whether car, van, or contracted transportation services improve retention and other treatment outcomes in outpatient drug abuse treatment.

  15. Priapism: etiology, pathophysiology and management

    Directory of Open Access Journals (Sweden)

    Van Der Horst C.


    Full Text Available The understanding of erectile physiology has improved the prompt diagnosis and treatment of priapism. Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation and failure to subside despite orgasm. Numerous etiologies of this condition are considered. Among others a disturbed detumescence mechanism, which may due to excess release of contractile neurotransmitters, obstruction of draining venules, malfunction of the intrinsic detumescence mechanism or prolonged relaxation of intracavernosal smooth muscle are postulated. Treatment of priapism varies from a conservative medical to a drastic surgical approach. Two main types of priapism; veno-occlusive low flow (ischemic and arterial high flow (non-ischemic, must be distinguished to choose the correct treatment option for each type. Patient history, physical examination, penile hemodynamics and corporeal metabolic blood quality provides distinction between a static or dynamic pathology. Priapism can be treated effectively with intracavernous vasoconstrictive agents or surgical shunting. Alternative options, such as intracavernous injection of methylene blue (MB or selective penile arterial embolization (SPEA, for the management of high and low flow priapism are described and a survey on current treatment modalities is given.

  16. Children Facing Divorce: A Treatment Program (United States)

    Magid, Kenneth M.


    The children facing divorce program began last year and was built on the talents of an interdisciplinary staff. Included are experts in client-centered counseling, sociometry and psychodrama, Gestalt and TA, behavior modification, and various eclectic approaches to family therapy. (Author)


    Directory of Open Access Journals (Sweden)



    Full Text Available Background: Vocal fold polyp is one of the most common causes for hoarseness. Many different etiological factors contribute to vocal fold polyp formation. The aim of the study was to find out whether the etiological factors for polyp formation have changed in the last 30 years.Methods: Eighty-one patients with unilateral vocal fold polyp were included in the study. A control group was composed of 50 volunteers without voice problems who matched the patients by age and gender. The data about etiological factors and the findings of phoniatric examination were obtained from the patients' medical documentation and from the questionnaires for the control group. The incidence of etiological factors was compared between the two groups. The program SPSS, Version 18 was used for statistical analysis.Results: The most frequent etiological factors were occupational voice load, GER, allergy and smoking. In 79% of patients 2 – 6 contemporary acting risk factors were found. Occupational voice load (p=0,018 and GER (p=0,004 were significantly more frequent in the patients than in the controls. The other factors did not significantly influence the polyp formation.Conclusions: There are several factors involved simultaneously in the formation of vocal fold polyps both nowadays and 30 years ago. Some of the most common factors remain the same (voice load, smoking, others are new (GER, allergy, which is probably due to the different lifestyle and working conditions than 30 years ago. Occupational voice load and GER were significantly more frequently present in the patients with polyp than in the control group. Regarding the given results it is important to instruct workers with professional vocal load about etiological factors for vocal fold polyp formation.

  18. Nuclear Waste Treatment Program: Annual report for FY 1986

    International Nuclear Information System (INIS)

    Burkholder, H.C.; Brouns, R.A.; Powell, J.A.


    To support DOE's attainment of its goals, Nuclear Waste Treatment Program (NWTP) is to provide technology necessary for the design and operation of nuclear waste treatment facilities by commercial enterprises as part of a licensed waste management system and problem-specific treatment approaches, waste form and treatment process adaptations, equipment designs, and trouble-shooting. This annual report describes progress during FY 1986 toward meeting these two objectives. 29 refs., 59 figs., 25 tabs

  19. Nuclear Waste Treatment Program: Annual report for FY 1986

    Energy Technology Data Exchange (ETDEWEB)

    Burkholder, H.C.; Brouns, R.A. (comps.); Powell, J.A. (ed.)


    To support DOE's attainment of its goals, Nuclear Waste Treatment Program (NWTP) is to provide technology necessary for the design and operation of nuclear waste treatment facilities by commercial enterprises as part of a licensed waste management system and problem-specific treatment approaches, waste form and treatment process adaptations, equipment designs, and trouble-shooting. This annual report describes progress during FY 1986 toward meeting these two objectives. 29 refs., 59 figs., 25 tabs.

  20. Use of Gestalt Therapy Within a Drug Treatment Program. (United States)

    Sideroff, Stephen I.


    Presents a Gestalt therapeutic approach that has shown promise within a drug treatment program. The major issues discussed include the acquisition of self-support, taking responsibility, dealing with anxiety, contact, and the expression of pent-up feelings. (Author)

  1. Professional liability. Etiology. (United States)

    White, K C


    Once again, I find Mr. Cooper quote-worthy for his statement, "It is incumbent upon the trial bar not to support the status quo merely because it is in our economic interest. Change is in the wind, and our tort system will be blown away on the winds of change for change's sake unless we participate in correcting deficiencies in the tort system and civil jury trial process." I suggest that we cannot ask for change for our own economic interest, nor can we lay blame exclusively to the other etiologic elements. We must improve those elements within our purview. The prayer of serenity may serve us well: God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. In the game of professional liability litigation as played by the rules extant there are clearly winners and losers. The winners are the legal profession, both plaintiff and defense, and the insurers, who in the face of adversity simply increase premiums or withdraw from the market. The losers are the medical profession, the patients for whom they care and, in the broadest sense, our society as a whole. So as not to close on a note of gloom, one last quote. Lawrence H. Cooke, former Chief Judge of New York State, in remarks to the April 1986 National Symposium on Civil Justice Issues stated, "Our justice systems are beset with very real problems.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Plasma vitrification program for radioactive waste treatment

    International Nuclear Information System (INIS)

    Hung, Tsungmin; Tzeng, Chinchin; Kuo, Pingchun


    In order to treat radioactive wastes effectively and solve storage problems, INER has developed the plasma arc technology and plasma process for various waste forms for several years. The plasma vitrification program is commenced via different developing stages through nine years. It includes (a) development of non-transferred DC plasma torch, (b) establishment of a lab-scale plasma system with home-made 100kW non-transferred DC plasma torch, (c) testing of plasma vitrification of simulated radioactive wastes, (d) establishment of a transferred DC plasma torch delivering output power more than 800 kW, (e) study of NOx reduction process for the plasma furnace, (f) development of a pilot-scale plasma melting furnace to verify the vitrification process, and (g) constructing a plasma furnace facility in INER. The final goal of the program is to establish a plasma processing plant with capacity of 250 kg/hr to treat the low-level radioactive wastes generated from INER itself and domestic institutes due to isotope applications. (author)

  3. Interest in marijuana treatment programs among teenage smokers and nonsmokers


    Sheer, Amy J.; Gorelick, David A.; Collins, Charles C.; Schroeder, Jennifer R.; Heishman, Stephen J.; Leff, Michelle K.; Moolchan, Eric T.


    Little is known about adolescents’ interest in marijuana treatment programs. This question was evaluated by telephone interview in a convenience sample of 575 adolescents responding to advertisements for tobacco research studies. Eighty-one percent of respondents endorsed the need for marijuana treatment programs for adolescents. These adolescents were younger and less likely to smoke tobacco, smoke marijuana, or use alcohol than those not endorsing such a need. Among the 192 marijuana smoker...

  4. Development and evaluation of addiction treatment programs in Latin America. (United States)

    Marín-Navarrete, Rodrigo; Medina-Mora, María Elena; Pérez-López, Alejandro; Horigian, Viviana E


    The aim of this article is to present a state-of-the-art review of the scientific studies that have evaluated healthcare systems, services and programs for addiction treatment in Latin America. As a secondary aim, this article presents a brief description and analysis of the addiction prevention and treatment resources and programs available in Latin America, based on information from the ATLAS on Substance Use (ATLAS-SU) project led by the WHO. Substance use disorders (SUDs) are among the main causes associated with global burden of disease. Around the world, many initiatives have been proposed to promote policies to reduce substance use and reduce the impact of SUD, including integrating treatments into healthcare systems, increasing access to treatment programs and impacting outcome measures. In Latin America, multiple efforts have been implemented to improve addiction services and programs, although little is known about the impact they have generated. International studies report the availability of strategies and public inicitatives on prevention and treatment of addiction in Latin America. These studies also report established networks of public and private services that include prevention and detoxification programs, outpatient and residential treatment, and also social reintegration initiatives. However, despite these advances, information on the evaluation of the progress, results and impact of these programs is limited.


    Directory of Open Access Journals (Sweden)



    Full Text Available In this study 100 cases of ascites, evaluated for the etiological causes. And observed as cirrhosis with portal hypertension 82%, heart failure 8%, chronic kidney disease 3%, nephritic syndrome 2%, peritoneal calcinomatosis 2%, chronic pancreatitis 1% por tal vein thrombosis 1%, Budd - chiari syndrome 1%. AIM OF THE STUDY: To study the various etiologies and their incidence of Ascites.

  6. Effectiveness of an intensive multidisciplinary headache treatment program. (United States)

    Gunreben-Stempfle, Birgit; Griessinger, Norbert; Lang, Eberhard; Muehlhans, Barbara; Sittl, Reinhard; Ulrich, Kathrin


    To investigate if the effectiveness of a 96-hour multidisciplinary headache treatment program exceeds the effectiveness of a 20-hour program and primary care. When dealing with chronic back pain, low-intensity multidisciplinary treatment yields no significantly better results than standard care and monodisciplinary therapy; however, high-intensity treatment does. For multidisciplinary headache treatment, such comparisons are not yet available. In a previous study undertaken by our Pain Center, the outcome of a minimal multidisciplinary intervention model (20-hour) did not exceed primary care. Forty-two patients suffering from frequent headaches (20 +/- 9 headache days/month; range: 8-30) were treated and evaluated in a 96-hour group program. The results were compared with the outcomes of the previous study. Subjects who had undergone either the 20-hour multidisciplinary program or the primary care were used as historical control groups. A significant reduction in migraine days (P tension-type headache days (P tension-type headache days (P = .016), and frequency of migraine attacks (P = .016). In comparison with the 20-hour multidisciplinary program, the 96-hour program showed significantly better effects only in the reduction of migraine days (P = .037) and depression score (P = .003). The responder-rates (> or =50% improvement) in the 96-hour program were significantly higher than in the 20-hour program (migraine days, P = .008; tension-type headache days, P = .044) and primary care (migraine days, P = .007; tension-type headache days, P = .003; tension-type headache intensity, P = .037). The effect sizes were small to medium in the 96-hour program. Particularly with the reduction of migraine symptomatology, the 96-hour program performed better than the 20-hour program, which produced only negligible or small effects. Intensive multidisciplinary headache treatment is highly effective for patients with chronic headaches. Furthermore, migraine symptomatology

  7. A model of nonparticipation in alcohol treatment programs. (United States)

    Burton, T L; Williamson, D L


    Why do the vast majority of those who suffer harm from drinking fail to obtain treatment? Based on a review of research literature and educational and treatment program materials, a model of nonparticipation in treatment is proposed whereby particular population groups are separated out according to whether or not they exhibit specified characteristics related to both harm from drinking and attitudes towards treatment. Eleven groups have been identified in the model, each of which has different reasons for failing to seek and/or obtain treatment. It is suggested that differing educational program messages should be sent to each group. While the model does not purport to be wholly inclusive of all nonparticipation, it offers a basis for addressing the variety of disparate groups that suffer harm from drinking but do not obtain treatment.

  8. Etiology, diagnosis, and clinical management of vulvodynia

    Directory of Open Access Journals (Sweden)

    Sadownik LA


    Full Text Available Leslie A Sadownik University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, BC, Canada Abstract: Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. It may affect girls and women across all age groups and ethnicities. Vulvodynia is a significant burden to society, the health care system, the affected woman, and her intimate partner. The etiology is multifactorial and may involve local injury or inflammation, and peripheral and or central sensitization of the nervous system. An approach to the diagnosis and management of a woman presenting with chronic vulvar pain should address the biological, psychological, and social/interpersonal factors that contribute to her illness. The gynecologist has a key role in excluding other causes for vulvar pain, screening for psychosexual and pelvic floor dysfunction, and collaborating with other health care providers to manage a woman's pain. An important component of treatment is patient education regarding the pathogenesis of the pain and the negative impact of experiencing pain on a woman's overall quality of life. An individualized, holistic, and often multidisciplinary approach is needed to effectively manage the woman's pain and pain-related distress. Keywords: vulvodynia, diagnosis, treatment, etiology, sexual pain disorder, dyspareunia, vestibulodynia, assessment, treatment, multidisciplinary

  9. The Etiology of Primary Hyperhidrosis

    DEFF Research Database (Denmark)

    Hashmonai, Moshe; Cameron, Alan E.P.; Connery, Cliff P.


    of patients with hyperhidrosis has been reported. Conclusions: Despite these accumulated data, the etiology of primary hyperhidrosis remains obscure. Nevertheless, three main lines for future research seem to be delineated: genetics, histological observations, and enzymatic studies.......Purpose: Primary hyperhidrosis is a pathological disorder of unknown etiology, affecting 0.6-5% of the population, and causing severe functional and social handicaps. As the etiology is unknown, it is not possible to treat the root cause. Recently some differences between affected and non......-affected people have been reported. The aim of this review is to summarize these new etiological data. Methods: Search of the literature was performed in the PubMed/Medline Database and pertinent articles were retrieved and reviewed. Additional publications were obtained from the references of these articles...

  10. A research-oriented treatment planning program system

    International Nuclear Information System (INIS)

    Kalet, I.J.; Jacky, J.P.


    The function of a treatment planning program is to graphically simulate radiation dose distributions from proposed radiation therapy treatments. While many such programs are available which provide this much-needed service, none addresses the question of how to intercompare calculation and display techniques. This paper describes a program system designed for support of research efforts, particularly development and testing of new calculation algorithms. The system emphasizes a modular flexible structure, enabling programs to be developed somewhat as interchangeable parts. Thus multiple variants of a calculation algorithm can be compared without undue software overhead or additional data management. Unusual features of the system include extensive use of command procedures, logical names and a structured language (PASCAL). These features are described along with other implementation details. Obstacles, limitations and future applications are also discussed. (Auth.)

  11. Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43 (United States)

    Tinkler, Emily; Vallejos Bartlett, Catalina; Brooks, Margaret; Gilbert, Johnatnan Max; Henderson, Randi; Shuman, Deborah, J.


    TIP 43 provides best-practice guidelines for medication-assisted treatment of opioid addiction in opioid treatment programs (OTPs). The primary intended audience for this volume is substance abuse treatment providers and administrators who work in OTPs. Recommendations in the TIP are based on both an analysis of current research and determinations…

  12. Boron neutron capture therapy: Brain Tumor Treatment Evaluation Program

    International Nuclear Information System (INIS)

    Griebenow, M.L.; Dorn, R.V. III; Gavin, P.R.; Spickard, J.H.


    The United States (US) Department of Energy (DOE) recently initiated a focused, multidisciplined program to evaluate Boron Neutron Capture Therapy (BNCT) for the treatment of brain tumors. The program, centered at the DOE/endash/Idaho National Engineering Laboratory (INEL), will develop the analytical, diagnostic and treatment tools, and the database required for BNCT technical assessment. The integrated technology will be evaluated in a spontaneously-occurring canine brain-tumor model. Successful animal studies are expected to lead to human clinical trials within four to five years. 2 refs., 3 figs

  13. Preparation and evaluation of a multimodal minoxidil microemulsion versus minoxidil alone in the treatment of androgenic alopecia of mixed etiology: a pilot study (United States)

    Sakr, Farouk M; Gado, Ali MI; Mohammed, Haseebur R; Adam, Abdel Nasser Ismail


    Background: The variable success of topical minoxidil in the treatment of androgenic alopecia has led to the hypothesis that other pathways could mediate this form of hair loss, including infection and/or microinflammation of the hair follicles. In this study, we prepared a multimodal microemulsion comprising minoxidil (a dihydrotestosterone antagonist), diclofenac (a nonsteroidal anti-inflammatory agent), and tea tree oil (an anti-infective agent). We investigated the stability and physicochemical properties of this formulation, and its therapeutic efficacy compared with a formulation containing minoxidil alone in the treatment of androgenic alopecia. Methods: We developed a multimodal oil/water (o/w) microemulsion, a formulation containing minoxidil alone, and another containing vehicle. A three-phase diagram was constructed to obtain the optimal concentrations of the selected oil, surfactant, and cosurfactant. Thirty-two men aged 18–30 years were randomized to apply 1 mL of microemulsion containing the multimodal formulation (formulation A, n = 11), minoxidil alone (formulation B, n = 11) or placebo (formulation C, n = 10) twice daily to the affected area for 32 weeks. Efficacy was evaluated by mean hair count, thickness, and weight on the targeted area of the scalp. Global photographs were taken, changes in the area of scalp coverage were assessed by patients and external investigators, and the benefits and safety of the study medications were evaluated. The physical stability of formula A was examined after a shelf storage period of 24 months. Results: Formulation A achieved a significantly superior response than formulations B and C in terms of mean hair count (P microemulsion comprising minoxidil, diclofenac, and tea tree oil was significantly superior to minoxidil alone and placebo in terms of stability, safety, and efficacy, and achieved an earlier response in the treatment of androgenic alopecia compared with minoxidil alone in this 32-week pilot study

  14. Preparation and evaluation of a multimodal minoxidil microemulsion versus minoxidil alone in the treatment of androgenic alopecia of mixed etiology: a pilot study. (United States)

    Sakr, Farouk M; Gado, Ali Mi; Mohammed, Haseebur R; Adam, Abdel Nasser Ismail


    The variable success of topical minoxidil in the treatment of androgenic alopecia has led to the hypothesis that other pathways could mediate this form of hair loss, including infection and/or microinflammation of the hair follicles. In this study, we prepared a multimodal microemulsion comprising minoxidil (a dihydrotestosterone antagonist), diclofenac (a nonsteroidal anti-inflammatory agent), and tea tree oil (an anti-infective agent). We investigated the stability and physicochemical properties of this formulation, and its therapeutic efficacy compared with a formulation containing minoxidil alone in the treatment of androgenic alopecia. We developed a multimodal oil/water (o/w) microemulsion, a formulation containing minoxidil alone, and another containing vehicle. A three-phase diagram was constructed to obtain the optimal concentrations of the selected oil, surfactant, and cosurfactant. Thirty-two men aged 18-30 years were randomized to apply 1 mL of microemulsion containing the multimodal formulation (formulation A, n = 11), minoxidil alone (formulation B, n = 11) or placebo (formulation C, n = 10) twice daily to the affected area for 32 weeks. Efficacy was evaluated by mean hair count, thickness, and weight on the targeted area of the scalp. Global photographs were taken, changes in the area of scalp coverage were assessed by patients and external investigators, and the benefits and safety of the study medications were evaluated. The physical stability of formula A was examined after a shelf storage period of 24 months. Formulation A achieved a significantly superior response than formulations B and C in terms of mean hair count (P minoxidil formulation significantly (P minoxidil alone and placebo formulations. These improvements were in agreement with the photographic assessments made by the investigators. Formula A was shown to be an o/w formulation with consistent pH, viscosity, specific gravity, and homogeneity, and was physically stable after 24 months

  15. Commercial waste treatment program annual progress report for FY 1983

    Energy Technology Data Exchange (ETDEWEB)

    McElroy, J.L.; Burkholder, H.C. (comps.)


    This annual report describes progress during FY 1983 relating to technologies under development by the Commercial Waste Treatment Program, including: development of glass waste form and vitrification equipment for high-level wastes (HLW); waste form development and process selection for transuranic (TRU) wastes; pilot-scale operation of a radioactive liquid-fed ceramic melter (LFCM) system for verifying the reliability of the reference HLW treatment proces technology; evaluation of treatment requirements for spent fuel as a waste form; second-generation waste form development for HLW; and vitrification process control and product quality assurance technologies.

  16. Congenital Hypoglycemia Disorders: New Aspects of Etiology, Diagnosis, Treatment and Outcomes: Highlights of the Proceedings of the Congenital Hypoglycemia Disorders Symposium, Philadelphia April 2016. (United States)

    De Leon, Diva D; Stanley, Charles A


    Hypoglycemia continues to be an important cause of morbidity in neonates and children. Prompt diagnosis and management of the underlying hypoglycemia disorder is critical for preventing brain damage and improving outcomes. Congenital hyperinsulinism (HI) is the most common and severe cause of persistent hypoglycemia in neonates and children. Recent discoveries of the genetic causes of HI have improved our understanding of the pathophysiology, but its management is complex and requires the integration of clinical, biochemical, molecular, and imaging findings to establish the appropriate treatment according to the subtype. Here we present a summary of a recent international symposium on congenital hypoglycemia disorders with emphasis on novel molecular mechanisms resulting in HI, genetic diagnosis, overall approach to management, novel therapies under development, and current outcomes. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Dropout of a multidisciplinary treatment program for women with fibromyalgia

    Directory of Open Access Journals (Sweden)

    Tatiana Rehder Gonçalves


    Full Text Available Objective: To evaluate the dropout of a multidisciplinary treatment program in fibromyalgia (FM. Methods: An observational study conducted during the period of April 2000 to December 2005, including 133 women with fibromyalgia, participating in a multidisciplinary treatment program. Those who had left the treatment for two weeks or more were classified as inactive and contacted by telephone to record the reasons for their noncompliance, which were divided into four groups: 1 Family; 2 Occupations; 3 Medical; 4 Other Reasons. Results: When collecting data, 92 (69.4% women were considered inactive. There was no significant difference between noncompliance before and after six months of treatment. Of the total number of inactive women, 54 (40.8% participants left for medical reasons, 30 (22.6% for other reasons, 26 (19.4% for family reasons and 23 (17.2% due to occupation. There was no statistical difference between the motives of dropout according to the length of stay in the program (p> 0.05. Conclusion: We conclude that the multidisciplinary program for women with fibromyalgia had high levels of noncompliance, half of them occurred in the first six months. Among the main reasons reported for dropout, the medical reasons were more frequent.

  18. Challenges and successes of a multidisciplinary pediatric obesity treatment program. (United States)

    Walsh, Stephanie M; Palmer, Wendy; Welsh, Jean A; Vos, Miriam B


    Despite the well-documented need for multidisciplinary pediatric obesity treatment programs, few programs exist and best practices are not clearly defined. We describe the design and initial quality-related outcomes of the Strong4Life multidisciplinary pediatric obesity treatment program along with some challenges and solutions implemented over the first 2 years. The purpose of this report is to inform others interested in designing similar programs. The Strong4Life Clinic obesity program was designed to provide children with the medical care, as well as the behavior change guidance and support needed to reverse their obesity and/or minimize the related health risks. This low-intensity program is designed to provide approximately 6 hours of care over 12 months from a medical provider, psychologist, registered dietitian nutritionist, exercise physiologist, and nurse. Between August 2011 and February 2014, the Strong4Life clinic served 781 high-risk (mean sex- and age-adjusted body mass index [BMI] percentile 98.8) and racially/ethnically diverse (45% non-Hispanic black and 24% Hispanic) patients. Of the 781 patients seen, 66% returned for at least 1 visit. Nearly all returning Strong4Life patients stabilized or improved their BMI (90% of those who participated 6 months, but longer follow-up and assessment of comorbidities are needed. © 2014 American Society for Parenteral and Enteral Nutrition.

  19. Preparation and evaluation of a multimodal minoxidil microemulsion versus minoxidil alone in the treatment of androgenic alopecia of mixed etiology: a pilot study

    Directory of Open Access Journals (Sweden)

    Sakr FM


    Full Text Available Farouk M Sakr,1 Ali MI Gado,2 Haseebur R Mohammed,2 Abdel Nasser Ismail Adam3 1Department of Pharmaceutics, 2Departments of Pharmacology and Pharmaceutical Chemistry, 3Department of Biology, College of Pharmacy, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia Background: The variable success of topical minoxidil in the treatment of androgenic alopecia has led to the hypothesis that other pathways could mediate this form of hair loss, including infection and/or microinflammation of the hair follicles. In this study, we prepared a multimodal microemulsion comprising minoxidil (a dihydrotestosterone antagonist, diclofenac (a nonsteroidal anti-inflammatory agent, and tea tree oil (an anti-infective agent. We investigated the stability and physicochemical properties of this formulation, and its therapeutic efficacy compared with a formulation containing minoxidil alone in the treatment of androgenic alopecia. Methods: We developed a multimodal oil/water (o/w microemulsion, a formulation containing minoxidil alone, and another containing vehicle. A three-phase diagram was constructed to obtain the optimal concentrations of the selected oil, surfactant, and cosurfactant. Thirty-two men aged 18–30 years were randomized to apply 1 mL of microemulsion containing the multimodal formulation (formulation A, n = 11, minoxidil alone (formulation B, n = 11 or placebo (formulation C, n = 10 twice daily to the affected area for 32 weeks. Efficacy was evaluated by mean hair count, thickness, and weight on the targeted area of the scalp. Global photographs were taken, changes in the area of scalp coverage were assessed by patients and external investigators, and the benefits and safety of the study medications were evaluated. The physical stability of formula A was examined after a shelf storage period of 24 months. Results: Formulation A achieved a significantly superior response than formulations B and C in terms of mean hair count (P

  20. Mathematical model for HIV spreads control program with ART treatment (United States)

    Maimunah; Aldila, Dipo


    In this article, using a deterministic approach in a seven-dimensional nonlinear ordinary differential equation, we establish a mathematical model for the spread of HIV with an ART treatment intervention. In a simplified model, when no ART treatment is implemented, disease-free and the endemic equilibrium points were established analytically along with the basic reproduction number. The local stability criteria of disease-free equilibrium and the existing criteria of endemic equilibrium were analyzed. We find that endemic equilibrium exists when the basic reproduction number is larger than one. From the sensitivity analysis of the basic reproduction number of the complete model (with ART treatment), we find that the increased number of infected humans who follow the ART treatment program will reduce the basic reproduction number. We simulate this result also in the numerical experiment of the autonomous system to show how treatment intervention impacts the reduction of the infected population during the intervention time period.

  1. Obesidade: atualização sobre sua etiologia, morbidade e tratamento Obesity: updated information about its etiology, morbidity and treatment

    Directory of Open Access Journals (Sweden)

    Rachel Pamfilio Prado de FRANCISCHI


    Full Text Available As tendências de transição nutricional ocorridas neste século direcionam para uma dieta mais ocidentalizada, a qual, aliada à diminuição progressiva da atividade física, converge para o aumento no número de casos de obesidade em todo o mundo. Isso representa aumento na morbidade e na mortalidade associadas à obesidade, já que esta é fator de risco para várias doenças como diabetes tipo II, hipertensão, doenças cardiovasculares e cálculo na vesícula biliar. A obesidade se apresenta não apenas como problema científico e de saúde pública, porém como grande indústria que envolve o desenvolvimento de fármacos, de alimentos modificados e estratégias governamentais estimulando a prática regular de atividade física e a orientação alimentar a fim de promover melhores hábitos. Assim, o conhecimento das causas e estratégias preventivas da obesidade é o objeto de estudo de pesquisadores de diferentes centros. Esse artigo tem como objetivo rever esses estudos, abordando o aumento na prevalência e incidência da obesidade, doenças relacionadas ao excesso de peso e os tratamentos para redução da gordura corporal.The trend in nutritional transition in this century leads to an occidentalized diet, which, allied to a decrease in physical activity, results in increasing of obesity all over the world. It raises the risk of morbidity and mortality, since obesity is the first step to several diseases such as Diabetes type II, hypertension, cardiovascular and gallbladder diseases. Obesity is not only a scientific and public health problem, but also an industry of pharmacos, special foods and governmental strategies to encourage people to be more active and to provide more food information in order to promote better habits. Several studies all around the world discuss the causes and treatments for obesity. In this way, this paper summarizes these researches, approaching the elements associated with higher obesity incidence and

  2. Preliminary Results of the Louisiana Sex Offender Treatment Program

    Directory of Open Access Journals (Sweden)

    Lee A. Underwood


    Full Text Available The purpose of this study was to offer preliminary support for the Louisiana Sex Offender Treatment Program (LSOTP in addressing the needs of juvenile sex offenders. Research objectives were (1 to offer statistical evidence for reductions in anxiety, depression, cognitive distortion and negative attitudes towards women comparing a group of 21 adolescents, 12 of whom received services as usual and nine of whom participated in the LSOTP. A controlled experimental evaluation design was utilized. The juvenile sex offenders were randomly assigned to the experimental group for 12 weeks receiving treatment services and a control group receiving care “as usual” in a residential group care program. Participants in the experimental group experienced statistically significant decreases in cognitive distortions related specifically to rape and molestation.The results of this study offer preliminary support of the LSOTP as a best practices alternative to other treatment modalities.

  3. Cost effective water treatment program in Heavy Water Plant (Manuguru)

    International Nuclear Information System (INIS)

    Mohapatra, C.; Prasada Rao, G.


    Water treatment technology is in a state of continuous evolution. The increasing urgency to conserve water and reduce pollution has in recent years produced an enormous demand for new chemical treatment programs and technologies. Heavy water plant (Manuguru) uses water as raw material (about 3000 m 3 /hr) and its treatment and management has benefited the plant in a significant way. It is a fact that if the water treatment is not proper, it can result in deposit formation and corrosion of metals, which can finally leads to production losses. Therefore, before selecting treatment program, complying w.r.t. quality requirements, safety and pollution aspects cost effectiveness shall be examined. The areas where significant benefits are derived, are raw water treatment using polyelectrolyte instead of inorganic coagulant (alum), change over of regenerant of cation exchangers from hydrochloric acid to sulfuric acid and in-house development of cooling water treatment formulation. The advantages and cost effectiveness of these treatments are discussed in detail. Further these treatments has helped the plant in achieving zero discharge and indirectly increased cost reduction of final product (heavy water); the dosage of 3 ppm of polyelectrolyte can replace 90 ppm alum at turbidity level of 300 NTU of raw water which has resulted in cost saving of Rs. 15-20 lakhs in a year beside other advantages; the change over of regenerant from HCl to H 2 SO 4 will result in cost saving of at least Rs.1.4 crore a year besides other advantages; the change over to proprietary formulation to in-house formulation in cooling water treatment has resulted in a saving about Rs.11 lakhs a year. To achieve the above objectives in a sustainable way the performance results are being monitored. (author)

  4. Risk management program for the 283-W water treatment facility

    International Nuclear Information System (INIS)

    Green, W.E.


    This Risk Management (RM) Program covers the 283-W Water Treatment Facility (283W Facility), located in the 200 West Area of the Hanford Site. A RM Program is necessary for this facility because it stores chlorine, a listed substance, in excess of or has the potential to exceed the threshold quantities defined in Title 40 of the Code of Federal Regulations (CFR) Part 68 (EPA, 1998). The RM Program contains data that will be used to prepare a RM Plan, which is required by 40 CFR 68. The RM Plan is a summary of the RM Program information, contained within this document, and will be submitted to the U.S. Environmental Protection Agency (EPA) ultimately for distribution to the public. The RM Plan will be prepared and submitted separately from this document


    Directory of Open Access Journals (Sweden)

    Miguel Díaz


    Full Text Available When selecting a chemical treatment program for wastewater to achieve an effective flocculation and coagulation is crucial to understand how individual colloids interact. The coagulation process requires a rapid mixing while flocculation process needs a slow mixing. The behavior of colloids in water is strongly influenced by the electrokinetic charge, where each colloidal particle carries its own charge, which in its nature is usually negative. Polymers, which are long chains of high molecular weight and high charge, when added to water begin to form longer chains, allowing removing numerous particles of suspended matter. A study of physico-chemical treatment by addition of coagulant and flocculant was carried out in order to determine a chemical program for oily wastewater coming from the gravity separation process in a crude oil refinery. The tests were carried out in a Jar Test equipment, where commercial products: aluminum polychloride (PAC, aluminum sulfate and Sintec D50 were evaluated with five different flocculants. The selected chemical program was evaluated with fluids at three temperatures to know its sensitivity to this parameter and the mixing energy in the coagulation and flocculation. The chemical program and operational characteristics for physico-chemical treatment with PAC were determined, obtaining a removal of more than 93% for suspended matter and 96% for total hydrocarbons for the selected coagulant / flocculant combination.

  6. Self-control program in the treatment of obesity. (United States)

    Rosen, L W


    In a pilot study utilizing self-control techniques for the purpose of modifying the cue-reactive eating habits of obese patients, three subjects maintained a continuous weight loss throughout the first year of treatment. Techniques included goal setting, self-monitoring, brief delay and self-confrontation prior to eating unauthorized food and direct observation of oneself in a mirror when eating unauthorized food. All patients are expected to remain in treatment for the foreseeable future with no termination of the program despite apparent success with regard to control of their feeding disturbance. The rationale for this approach is discussed.

  7. Etiological aspects of double monsters. (United States)

    Jaschevatzky, O E; Goldman, B; Kampf, D; Wexler, H; Grünstein, S


    Four cases of double monsters are reported, including a rare case of craniofacial duplication (diprosopus). Based on the findings observed, etiological factors of these malformations are discussed. We suggest that exogenous (environmental) factors such as habits, way of life or religious practices of certain populations can influence the development of double monsters.

  8. The etiology of thyroid tumours

    International Nuclear Information System (INIS)

    Bellabarba, Diego


    The etiology of thyroid tumors is a complex subject, complicated by the fact that these tumors are not one entity, but separate neoplasms with different histology, evolution and prognosis. The recognized etiological factors of thyroid cancer include the iodine content of the diet, the inheritance, racial predispositions, the presence of an autoimmune thyroiditis and mostly, the exposure of the thyroid gland to external radiation following radiotherapy. The role played by these factors varies from one type of tumor to another. Thyroid radiation probably represents the most important factor in the development of a papillary carcinoma, with other factors (iodine-rich diet, inheritance, racial predispositions) having a minor role. The follicular carcinoma is more common in regions with low-iodine diet, therefore suggesting that TSH stimulation could be an etiological factor of these tumors. Thyroid radiation may also be carcinogenic for follicular carcinoma although less than for papillary carcinoma. Anaplastic carcinoma appears to originate from a papillary carcinoma already in the thyroid gland. In medullary carcinoma, inheritance plays a major role (autosomal dominant) and lymphomas occur in thyroids already affected by autoimmune thyroiditis. Recent experimental studies have suggested other possible cellular factors as responsible for the development of thyroid tumors. They include an alteration of the responsivity of TSH cellular receptors and the monoclonal mutation of C-cells. These new factors could provide a new insight on the etiology of thyroid tumors

  9. Occupational diseases of dust etiology

    International Nuclear Information System (INIS)

    Sokolik, L.I.; Shkondin, A.N.


    Detailed etiologic and clinico-roentgenological characteristics of pneumoconiosis, as widely spread occupational disease caused by different kinds of dust, are given. The course of pneumoconiosis is discussed depending on working conditions of patients after the disease had been ascertained, as well as its complications, taking into account roentgeno-morphological types of fibrosis and the stages of the disease [ru

  10. An improvement of the child acute respiratory infection treatment program


    E. N. Simovan'yan; E. E. Badalyants; L. P. Sizyakina; A. A. Lebedenko; V. B. Denisenko; M. A. Kim


    High morbidity rate, frequent development of severe complication forms, unfavorable remote effects for children’s health, insufficient efficacy of the used acute respiratory infection therapy schemes necessitate a treatment program improvement for this group of diseases. A complex clinical-laboratory examination of 72 3-6-year-old children with acute nasopharyngites and bronchites was conducted. Dependence of the disease’s clinical form and course peculiarities from the premorbid setting stat...

  11. Preliminary Results of the Louisiana Sex Offender Treatment Program


    Lee A. Underwood; Frances L.L. Dailey; Carrie Merino; Yolanda Crump


    The purpose of this study was to offer preliminary support for the Louisiana Sex Offender Treatment Program (LSOTP) in addressing the needs of juvenile sex offenders. Research objectives were (1) to offer statistical evidence for reductions in anxiety, depression, cognitive distortion and negative attitudes towards women comparing a group of 21 adolescents, 12 of whom received services as usual and nine of whom participated in the LSOTP. A controlled experimental evaluation design was utilize...

  12. Etiology and Management of Sexual Dysfunction

    Directory of Open Access Journals (Sweden)

    Narendra Kumar Muthugaduru Shivarudrappa


    Full Text Available Sexual dysfunction is the impairment or disruption of any of the three phases of normal sexual functioning, including loss of libido, impairment of physiological arousal and loss, delay or alteration of orgasm. Each one of these can be affected by an orchestra of factors like senility, medical and surgical illnesses, medications and drugs of abuse. Non-pharmacological therapy is the main stay in the treatment of sexual dysfunction and drugs are used as adjuncts for a quicker and better result. Management in many of the cases depends on the primary cause. Here is a review of the major etiological factors of sexual dysfunction and its management

  13. Etiology of pediatric acute liver failure

    Directory of Open Access Journals (Sweden)

    GUO Jing


    Full Text Available Pediatric acute liver failure (PALF is a complex syndrome with rapid progression, and the cause of PALF is age-dependent. This article analyzes the common causes of PALF in clinical practice, including infection factors, inherited metabolic factors, poisoning and drugs, abnormal perfusion, and autoimmune diseases, among which infection factors are the most common cause. With the improvement in diagnosis and treatment techniques, the diagnostic rate of PALF caused by inherited metabolic diseases and autoimmune diseases keeps increasing. Due to the small number of PALF patients, there lacks experience in etiological diagnosis. This article summarizes related reports, in order to provide a reference for screening the causes of PALF.

  14. Etiology and treatment in craniofacial fractures

    Directory of Open Access Journals (Sweden)

    Mihail D. L.


    Full Text Available Introduction. Facial trauma remains an important pathology in present days because of its effects. Facial deformities and functional alteration affect patient’s life quality and his society reinsertion. First evaluation has to be thorough to avoid any secondary complications .This type of pathology involves a pluridisciplinary approach: ENT, OMF, neurosurgeon,plastic surgeon,intensive care doctor. Healing implies complex biological process .A healed bone is capable to perform normal duties without titanium plates help. Osteosynthesis allows a faster and correct recovery. Doctors need to possess profound knowledge with regard to anatomy and physiology and to be acquainted with the reconstructive methods used in craniofacial surgery. Material and methods. This study evaluates craniofacial trauma patients who suffered different types of surgical interventions at the ENT Clinic and OMF Department of Constanta County Hospital since January the 1st 2013 until June the 1st 2017. Results. The group involves 133 cases, both genders and all ages. These 2 elements play an important role in this pathology because of the fact that the vast majority of patients are young active males. The sex ratio in the study is 7:1. In most of cases, craniofacial traumas appear after aggressions and car accidents. The nose and mandibular are fractured in a higher percentage in comparison to other parts of facial structures. Discussions. Important and sensitive structures located at this level increase the risk of possible important and definitive damages.

  15. Pedophilia: Clinical Features, Etiology and Treatment


    Ayten Erdogan


    There is a growing recognition that child sexual abuse is a critical public health problem. Child sexual abusement is not a medical diagnosis and is not necessarily a term synonymous with pedophilia. According to DSM-IV, a pedophile is an individual who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally

  16. The excessively crying infant : etiology and treatment

    NARCIS (Netherlands)

    Akhnikh, S.; Engelberts, A.C.; Sleuwen, B.E. van; Hoir, M.P. L’; Benninga, M.A.


    Excessive crying, often described as infantile colic, is the cause of 10% to 20% of all early pediatrician visits of infants aged 2 weeks to 3 months. Although usually benign and selflimiting, excessive crying is associated with parental exhaustion and stress. However, and underlying organic cause

  17. A Census of Prison-Based Drug Treatment Programs: Implications for Programming, Policy, and Evaluation (United States)

    Welsh, Wayne N.; Zajac, Gary


    Despite a growing realization that unmeasured programmatic differences influence prison-based drug treatment effectiveness, few attempts to systematically measure such differences have been made. To improve program planning and evaluation in this area, we developed a census instrument to collect descriptive information about 118 prison-based drug…

  18. [Chronic diarrhea with uncommon etiology]. (United States)

    Gil Borrás, R; Juan Vidal, O; Talavera Encinas, M I; Bixquert Jiménez, M


    Chronic diarrhea is a common syndrome. An etiological diagnosis is often reached through clinical history, physical examination and simple tests. In some cases, when the etiology is not found, the syndrome is called functional diarrhea, even though established criteria are often not fulfilled. We present the case of a patient with diarrhea for several months. The most common causes were ruled out through clinical history, physical examination, radiographic studies and laboratory tests, and the patient was diagnosed with functional diarrhea. Three months later, the patient presented a neck mass, and biopsy revealed medullary carcinoma of the thyroid. A review of recommendations for the systematic evaluation of chronic diarrhea is presented. A general approach should include careful history taking characteristics of diarrhea (onset, associated symptoms, epidemiological factors, iatrogenic causes such as laxative ingestion), a thorough physical examination with special attention to the anorectal region, and routine laboratory tests (complete blood count and serum chemistry). In addition, stool analysis including electrolytes (fecal osmotic gap), leukocytes, fecal occult blood, excess stool fat and laxative screening can yield important objective information to classify the diarrhea as: osmotic (osmotic gaps > 125 mOsm/Kg), secretory (osmotic gaps diarrhea described above. A systematic approach to the evaluation of chronic diarrhea is warranted. Medullary thyroid carcinoma and other endocrine syndromes causing chronic diarrhea are very rare. Measurement of serum peptide concentrations should only be performed when clinical presentation and findings in stool or radiographic studies suggest this etiology.

  19. Etiological analysis and treatment of jaundice after liver transplantation during mid-later stage%肝移植术后中远期黄疸的原因分析与治疗

    Institute of Scientific and Technical Information of China (English)

    陈虹; 王旭; 张庆; 范铁艳; 牛玉坚; 沈中阳


    Objective To analyze the etiologies and diagnosis of jaundice after liver transplantation during mid later stage and summarize the experience of clinical practice.Methods 822 liver transplantation patients were collected from the Department of Internal Medicine, Organ Transplantation Institute in General Hospital of Chinese People's Armed Police Forces between June 2005 and Dec.2008.The clinical data of these cases were analyzed retrospectively.Results Amongst 822 patients,129 experienced jaundice after liver transplantation and the occurrence of jaundice ranged from 43 days to 39 months postoperation.Total bilirubin levels were from 27.4 to 503 μmol/L.The etiologies of jaundice and its percentage were as follow:59 cases of biliary complications (45.7%),36 of rejection (27.8% ),11 cases of virus infection (8.5%),5 cases of drug-induced hepatic injury (3.9%),4 cases of tumor recurrence (3.1%),4 cases of Gilbert syndrome (3.1%),3.cases of dysfunction of papillary muscle (2.3%),2 cases of vascellum complication (1.6%),2 cases of radiation hepatitis (1.6%),1 case of hepatapostema (0.8%),2 cases of unknown reasons (1.6%),respectively.The jaundice of most patients (93%) got released while small part of patients (7%)failed to treatment,of whom 5 cases received liver re-transplantation and 4 cases died of disease progression.Conclusion The etiologies of jaundice after liver transplantation during mid-later stage are diversiform and complex.And the etiological diagnosis is the premise to treat effectively.%目的 探讨肝移植术后中远期黄疸的发生原因,并总结诊断和治疗体会.方法 对2005年6月至2008年12月移植内科住院的822例肝移植受者进行统计,回顾性分析其中129例发生肝移植术后中远期黄疸患者的临床资料.结果 129例患者出现黄疸的时间为肝移植术后43 d至39个月,胆红素总量水平为27.4~503 μmol/L.出现黄疸的原因及治疗:胆道并发症59例(45.7

  20. Biomarkers of Acute Stroke Etiology (BASE) Study Methodology. (United States)

    Jauch, Edward C; Barreto, Andrew D; Broderick, Joseph P; Char, Doug M; Cucchiara, Brett L; Devlin, Thomas G; Haddock, Alison J; Hicks, William J; Hiestand, Brian C; Jickling, Glen C; June, Jeff; Liebeskind, David S; Lowenkopf, Ted J; Miller, Joseph B; O'Neill, John; Schoonover, Tim L; Sharp, Frank R; Peacock, W Frank


    Acute ischemic stroke affects over 800,000 US adults annually, with hundreds of thousands more experiencing a transient ischemic attack. Emergent evaluation, prompt acute treatment, and identification of stroke or TIA (transient ischemic attack) etiology for specific secondary prevention are critical for decreasing further morbidity and mortality of cerebrovascular disease. The Biomarkers of Acute Stroke Etiology (BASE) study is a multicenter observational study to identify serum markers defining the etiology of acute ischemic stroke. Observational trial of patients presenting to the hospital within 24 h of stroke onset. Blood samples are collected at arrival, 24, and 48 h later, and RNA gene expression is utilized to identify stroke etiology marker candidates. The BASE study began January 2014. At the time of writing, there are 22 recruiting sites. Enrollment is ongoing, expected to hit 1000 patients by March 2017. The BASE study could potentially aid in focusing the initial diagnostic evaluation to determine stroke etiology, with more rapidly initiated targeted evaluations and secondary prevention strategies.Clinical Trial Registration NCT02014896

  1. The EBR-II spent fuel treatment program

    International Nuclear Information System (INIS)

    Lineberry, M.J.; McFarlane, H.F.


    Argonne National Laboratory has refurbished and equipped an existing hot cell facility for demonstrating a high-temperature electrometallurgical process for treating spent nuclear fuel from the Experimental Breeder Reactor-11. Two waste forms will be produced and qualified for geologic disposal of the fission and activation products. Relatively pure uranium will be separated for storage. Following additional development, transuranium elements will be blended into one of the high-level waste streams. The spent fuel treatment program will help assess the viability of electrometallurgical technology as a spent fuel management option

  2. Needs assessment and treatment compliance at state opioid substitution treatment programes in Georgia. (United States)

    Piralishvili, G; Gamkrelidze, I; Nikolaishvili, N; Chavchanidze, M


    conduct needs assessments and treatment compliance evaluations in MMT and Suboxone Substitution State Programs in Georgia (Republic of). 506 patients (2 females) were surveyed (92% on Methadone, 8% on Suboxone) from 6 Tbilisi and 4 regional State Programs in 2011 November. Mean age - 40±8,56 (22-65) year; 254 (51.4%) were in treatment for 1-3 year. Evaluation was carried out on the base of structured self-questionnaire that covers demographics, drug use history, general drug use trends, psychotherapeutic sessions' acceptance and open label question regarding treatment challenges and satisfaction. 305 (60.3%) attended individual and 57 (11.3%) group psychotherapy sessions with 50.79% attending once/month or rare. The main reason given for therapy non-attendance - no needs for it (29.48%); the main drugs before admission - heroin (80.04%), buprenorphine (53.49%); Main drugs used in Georgia nowadays - desomorphine ("crocodile"), alcohol and marihuana. Commonly used drugs by program patients (136 positive answers) - alcohol-13.62%, marihuana-10.39%, pregabalin - 8.17%, opioids- 6.62% (mostly-"crocodile"), home-made stimulants-6.23%, sedatives -5.45%. 55.4% are extremely satisfied with treatment, 82.4% - with program staff. Patients' main wishes- free of charge programs (46.4%) and provide take-home doses (22.07%). Methadone and Suboxone ST are being well accepted in Georgia and appear to be reducing illegal opioid use. However, the psychotherapeutic sessions' attendance is very low.

  3. Assisted outpatient treatment in New York: regional differences in New York's assisted outpatient treatment program. (United States)

    Robbins, Pamela Clark; Keator, Karli J; Steadman, Henry J; Swanson, Jeffrey W; Wilder, Christine M; Swartz, Marvin S


    This study sought to describe the implementation of "Kendra's Law" in New York State and examine regional differences in the application of the program. Between February 2007 and April 2008, interviews were conducted with 50 key informants across New York State. Key informants included assisted outpatient treatment (AOT) county coordinators, county directors of community services, judges, attorneys from the Mental Hygiene Legal Service (MHLS), psychiatrists, treatment providers, peer advocates, family members, and other referred individuals. Additional analyses were conducted using AOT program administrative and evaluation databases and client history data. From program inception in 1999 through 2007, a total of 8,752 initial AOT orders and 5,684 renewals were granted. Notable regional differences were found in the use of two distinct models of AOT: AOT First and Enhanced Voluntary Services First. Regional differences were also found in how the AOT program was implemented and administered. Other variations stemmed from the court proceedings themselves, the continuity and interest of the presiding judge, and the attitudes of the MHLS attorneys. Many regional adaptations of the AOT program were found. Many were the result of lack of guidance in implementing Kendra's Law. Policy makers may want to consider whether the law should change to allow for these differences or whether additional support from a central source is warranted to ensure more uniformity in the implementation of AOT and thus the fairness of its application across the state.

  4. Nuclear waste treatment program: Annual report for FY 1987

    International Nuclear Information System (INIS)

    Brouns, R.A.; Powell, J.A.


    Two of the US Department of Energy's (DOE) nuclear waste management-related goals are to ensure that waste management is not an obstacle to the further development of light-water reactors and the closure of the nuclear fuel cycle and to fulfill its institutional responsibility for providing safe storage and disposal of existing and future nuclear wastes. As part of its approach to achieving these goals, the Office of Remedial Action and Waste Technology of DOE established what is now called the Nuclear Waste Treatment Program (NWTP) at the Pacific Northwest Laboratory during the second half of FY 1982. To support DOE's attainment of its goals, the NWTP is to provide technology necessary for the design and operation of nuclear waste treatment facilities by commercial enterprises as part of a licensed waste management system and problem-specific treatment approaches, waste form and treatment process adaptations, equipment designs, and trouble-shooting assistance, as required to treat existing wastes. This annual report describes progress during FY 1987 towards meeting these two objectives. 24 refs., 59 figs., 24 tabs

  5. Perceived Autonomy Support in the NIMH RAISE Early Treatment Program. (United States)

    Browne, Julia; Penn, David L; Bauer, Daniel J; Meyer-Kalos, Piper; Mueser, Kim T; Robinson, Delbert G; Addington, Jean; Schooler, Nina R; Glynn, Shirley M; Gingerich, Susan; Marcy, Patricia; Kane, John M


    This study examined perceived support for autonomy-the extent to which individuals feel empowered and supported to make informed choices-among participants in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). The aims of this study were to evaluate whether NAVIGATE, the active treatment studied in RAISE ETP, was associated with greater improvements in perceived autonomy support over the two-year intervention, compared with community care, and to examine associations between perceived autonomy support and quality of life and symptoms over time and across treatment groups. This study examined perceived autonomy support among the 404 individuals with first-episode psychosis who participated in the RAISE ETP trial (NAVIGATE, N=223; community care, N=181). Three-level conditional linear growth modeling was used given the nested data structure. The results indicated that perceived autonomy support increased significantly over time for those in NAVIGATE but not in community care. Once treatment began, higher perceived autonomy support was related to higher quality of life at six, 12, and 18 months in NAVIGATE and at 12, 18, and 24 months in community care. Higher perceived autonomy support was related to improved scores on total symptoms and on excited symptoms regardless of treatment group and time. Overall, perceived autonomy support increased in NAVIGATE but not for those in community care and was related to improved quality of life and symptoms across both treatment groups. Future research should examine the impact of perceived autonomy support on a wider array of outcomes, including engagement, medication adherence, and functioning.

  6. Agricultural Exposures, Multiple Myeloma Etiology: Profile of Jonathan Hofmann (United States)

    Tenure-track investigator Jonathan Hofmann, Ph.D., M.P.H., has established a research program in the Occupational and Environmental Epidemiology Branch focused on the role of agricultural exposures in the etiology of multiple myeloma and other cancers, and on understanding the biological mechanisms that influence the development and progression of multiple myeloma.

  7. Etiologic stroke subtypes: updated definition and efficient workup strategies. (United States)

    Mehndiratta, Prachi; Chapman Smith, Sherita; Worrall, Bradford B


    Stroke affects approximately 16.9 million individuals per year worldwide and is the second leading cause of death. Stroke represents a family of related, but distinct subtypes. Classifying stroke subtypes must take into account various aspects of a standardized stroke workup to allow optimization of treatment and prevention strategies. Secondary prevention and pharmacologic treatment is tailored based on stroke mechanism. Additionally prognostication and recurrent risk also depends on stroke etiology. Efficient workup of stroke relies on a thorough history, clinical examination, imaging studies, and putative mechanism of stroke that lead the treating physician to a particular etiological path. Here , we provide the reader with updated definitions of etiologic ischemic stroke types as well as efficient workup strategies.

  8. Graphite electrode DC arc technology program for buried waste treatment

    International Nuclear Information System (INIS)

    Wittle, J.K.; Hamilton, R.A.; Cohn, D.R.; Woskov, P.P.; Thomas, P.; Surma, J.E.; Titus, C.H.


    The goal of the program is to apply EPI's Arc Furnace to the processing of Subsurface Disposal Area (SDA) waste from Idaho National Engineering Laboratory. This is being facilitated through the Department of Energy's Buried Waste Integrated Demonstration (BWID) program. A second objective is to apply the diagnostics capability of MIT's Plasma Fusion Center to the understanding of the high temperature processes taking place in the furnace. This diagnostics technology has promise for being applicable in other thermal treatment processes. The program has two parts, a test series in an engineering-scale DC arc furnace which was conducted in an EPI furnace installed at the Plasma Fusion Center and a pilot-scale unit which is under construction at MIT. This pilot-scale furnace will be capable of operating in a continuous feed and continuous tap mode. Included in this work is the development and implementation of diagnostics to evaluate high temperature processes such as DC arc technology. This technology can be used as an effective stabilization process for Superfund wastes

  9. Rhabdomyolysis with different etiologies in childhood (United States)

    Alaygut, Demet; Torun Bayram, Meral; Kasap, Belde; Soylu, Alper; Türkmen, Mehmet; Kavukcu, Salih


    AIM To investigate different etiologies and management of the rhabdomyolysis in children. METHODS Eight pediatric rhabdomyolysis cases who applied to the Dokuz Eylul University Faculty of Medicine Department of Pediatric Nephrology with different etiologies between January 2004 and January 2012 were evaluated in terms of age, gender, admission symptoms, physical examination findings, factors provoking rhabdomyolysis, number of rhabdomyolysis attacks, laboratory results, family history and the final diagnosis received after the treatment. RESULTS Average diagnosis ages of eight cases were 129 (24-192) ± 75.5 mo and five of them were girls. All of them had applied with the complaint of muscle pain, calf pain, and dark color urination. Infection (pneumonia) and excessive physical activity were the most important provocative factors and excessive licorice consumption was observed in one case. In 5 cases, acute kidney injury was determined and two cases needed hemodialysis. As a result of the further examinations; the cases had received diagnoses of rhabdomyolysis associated with mycoplasma pneumoniae, sepsis associated rhabdomyolysis, licorice-induced hypokalemic rhabdomyolysis, carnitine palmitoyltransferase II deficiency, very long-chain acyl-CoA dehydrogenase deficiency, congenital muscular dystrophy and idiopathic paroxysmal rhabdomyolysis (Meyer-Betz syndrome). CONCLUSION It is important to distinguish the sporadic and recurrent rhabdomyolysis cases from each other. Recurrent rhabdomyolysis cases should follow up more regardful and attentive. PMID:29184760

  10. Intrathoracic neoplasia: Epidemiology and etiology

    Energy Technology Data Exchange (ETDEWEB)

    Weller, R.E.


    Neoplasms of the thorax encompass those derived from the thoracic wall, trachea, mediastinum, lungs and pleura. They represent a wide variety of lesions including benign and malignant tumors arising from many tissues. The large surface area, 60 to 90 m{sup 2} in man, represented by the respiratory epithelium and associated thoracic structures are ideal targets for carcinogens carried by inspired air. The topic of discussion in this report is the epidemiology, etiology, and mechanisms of spontaneous intrathoracic neoplasia in animals and man. Much of what we know or suspect about thoracic neoplasia in animals has been extrapolated from experimentally-induced neoplasms.

  11. 28 CFR 550.53 - Residential Drug Abuse Treatment Program (RDAP). (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Residential Drug Abuse Treatment Program... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.53 Residential Drug Abuse Treatment... components: (1) Unit-based component. Inmates must complete a course of activities provided by drug abuse...

  12. Acquired pneumonias in the community in adults: An etiologic prospective study with emphasis in the diagnosis

    International Nuclear Information System (INIS)

    Robledo, J; Sierra, P; Bedoya, F; Londono, A; Porras, A; Lujan, M; Correa, N; Mejia, GI; Realpe, T; Trujillo, H


    Is defined prospectively in adults the etiology of acquired pneumonia in the community (NAC) in three hospitals of the city of Medellin. The etiology of NAC in the studied group does not vary of the one reported in other countries, the pneumococo frequency and M. pneumoniae, suggests that the empiric therapies should contemplate these two pathologies, the resource toasted by the microbiology laboratory allows to define the etiology and the specific treatment

  13. Etiology and clinical management of adult meningitis in Indonesia

    NARCIS (Netherlands)

    Rizal Ganiem, A.


    This thesis consists of 8 chapters and addresses the etiology, diagnosis, outcome and treatment of adult meningitis in Indonesia. The studies were conducted in Hasan Sadikin Hospital, Bandung, the referral hospital for West Java province, Indonesia between December 2006 and August 2012. In a cohort

  14. Effects of Program and Patient Characteristics on Retention of Drug Treatment Patients. (United States)

    Hser, Yih-Ing; Joshi, Vandana; Maglione, Margaret; Chou, Chih Ping; Anglin, M. Douglas


    Studied the effects of program and patient characteristics on patient retention in residential, out-patient, and methadone maintenance drug treatment programs. Data for 26,047 patients in 87 programs show that threshold retention rates were generally low for all 3 program types, although program practice and service provision played important…

  15. Results from a Multi-Modal Program Evaluation of a Four Year Statewide Juvenile Sex Offender Treatment and Reentry Program (United States)

    Underwood, Lee A.; Dailey, Frances L. L.; Merino, Carrie; Crump, Yolanda


    The results of the Program Evaluation show the OJJ Statewide Sex Offender Treatment program is exceptionally productive in meeting over 90% of its established performance markers. These markers included successful screening and assessment of risk and psychosocial needs, completion of initial and master treatment plans, establishment of sex…

  16. Goal Attainment Scaling: A Primary Method of Treatment and Program Evaluation in Project SAIL - A Special Education Dropout Prevention Program. (United States)

    Harris, Linda Hall; Thompson, John L.

    The manual discusses Project SAIL's (a special dropout prevention program) use of Goal Attainment Scaling as part of individualized education plans in the treatment of troubled adolescents and in overall program evaluation. The scaling is characterized as an explicit, respectful treatment contact through which the adolescent can learn to set…

  17. Linear programming based on neural networks for radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Xingen Wu; Limin Luo


    In this paper, we propose a neural network model for linear programming that is designed to optimize radiotherapy treatment planning (RTP). This kind of neural network can be easily implemented by using a kind of 'neural' electronic system in order to obtain an optimization solution in real time. We first give an introduction to the RTP problem and construct a non-constraint objective function for the neural network model. We adopt a gradient algorithm to minimize the objective function and design the structure of the neural network for RTP. Compared to traditional linear programming methods, this neural network model can reduce the time needed for convergence, the size of problems (i.e., the number of variables to be searched) and the number of extra slack and surplus variables needed. We obtained a set of optimized beam weights that result in a better dose distribution as compared to that obtained using the simplex algorithm under the same initial condition. The example presented in this paper shows that this model is feasible in three-dimensional RTP. (author)

  18. Voice Disorders: Etiology and Diagnosis. (United States)

    Martins, Regina Helena Garcia; do Amaral, Henrique Abrantes; Tavares, Elaine Lara Mendes; Martins, Maira Garcia; Gonçalves, Tatiana Maria; Dias, Norimar Hernandes


    Voice disorders affect adults and children and have different causes in different age groups. The aim of the study is to present the etiology and diagnosis dysphonia in a large population of patients with this voice disorder.for dysphonia of a large population of dysphonic patients. We evaluated 2019 patients with dysphonia who attended the Voice Disease ambulatories of a university hospital. Parameters assessed were age, gender, profession, associated symptoms, smoking, and videolaryngoscopy diagnoses. Of the 2019 patients with dysphonia who were included in this study, 786 were male (38.93%) and 1233 were female (61.07). The age groups were as follows: 1-6 years (n = 100); 7-12 years (n = 187); 13-18 years (n = 92); 19-39 years (n = 494); 41-60 years (n = 811); and >60 years (n = 335). Symptoms associated with dysphonia were vocal overuse (n = 677), gastroesophageal symptoms (n = 535), and nasosinusal symptoms (n = 497). The predominant professions of the patients were domestic workers, students, and teachers. Smoking was reported by 13.6% patients. With regard to the etiology of dysphonia, in children (1-18 years old), nodules (n = 225; 59.3%), cysts (n = 39; 10.3%), and acute laryngitis (n = 26; 6.8%) prevailed. In adults (19-60 years old), functional dysphonia (n = 268; 20.5%), acid laryngitis (n = 164; 12.5%), and vocal polyps (n = 156; 12%) predominated. In patients older than 60 years, presbyphonia (n = 89; 26.5%), functional dysphonia (n = 59; 17.6%), and Reinke's edema (n = 48; 14%) predominated. In this population of 2019 patients with dysphonia, adults and women were predominant. Dysphonia had different etiologies in the age groups studied. Nodules and cysts were predominant in children, functional dysphonia and reflux in adults, and presbyphonia and Reinke's edema in the elderly. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Charbel Niño El-Hani


    Full Text Available ABSTRACT. In this paper, we argue for a taxonomy of approaches to function based on different epistemological perspectives assumed with regard to the treatment of this central concept in the life sciences. We distinguish between etiological and organizational perspectives on function, analyzing two distinct theories related to each perspective: Wright’s selectionist etiological approach and Godfrey-Smith’s modern history theory of functions, in the case of the etiological perspective; and Cummins’ functional analysis and Collier’s interactivist approach to function, among organizational accounts. We explain differences and similarities between these theories and the broader perspectives on function, arguing for a particular way of understanding the consensus without unity in debates about function. While explaining the accounts of function, we also deal with the relationship between this concept and other important biological concepts, such as adaptation, selection, complexity, and autonomy. We also advance an argument for the limits and prospects of the explanatory role of function in evolution. By arguing that changes in functionality are always grounded on changes in systems’ organization, we show that function can never explain the origins of traits. Nevertheless, it can explain the spread of traits in populations, but only when we are dealing with functionally novel traits. Finally, we stress that organizational accounts of function are needed to understand how new functions appear by means of changes in systems’ organization. KEYWORDS: Function; Teleology; Explanation; Etiology; Organization.   RESUMEN. En este artículo, argumentamos a favor de una taxonomía de abordajes sobre función basada en diferentes perspectivas epistemológicas a cerca del tratamiento de este concepto central en las ciencias de la vida. Distinguimos entre perspectivas etiológicas y organizacionales sobre función, analizando dos teorías distintas

  20. Etiological explanation, treatability and preventability of childhood autism: a survey of Nigerian healthcare workers' opinion

    Directory of Open Access Journals (Sweden)

    Okonkwo Kevin O


    Full Text Available Abstract Background Because of their peculiar sociocultural background, healthcare workers in sub-Saharan African subcultures may have various conceptions on different aspects of autism spectrum disorders (ASD, such as etiology, treatment and issues of prognosis. These various conceptions, if different from current knowledge in literature about ASD, may negatively influence help-seeking behavior of parents of children with ASD who seek advice and information from the healthcare workers. This study assessed the opinions of healthcare workers in Nigeria on aspects of etiology, treatability and preventability of childhood autism, and relates their opinions to the sociodemographic variables. Methods Healthcare workers working in four tertiary healthcare facilities located in the south-east and south-south regions of Nigeria were interviewed with a sociodemographic questionnaire, personal opinion on etiology, treatability and preventability of childhood autism (POETPCA questionnaire and knowledge about childhood autism among health workers (KCAHW questionnaire to assess their knowledge and opinions on various aspects of childhood autism. Results A total of 134 healthcare workers participated in the study. In all, 78 (58.2%, 19 (14.2% and 36 (26.9% of the healthcare workers were of the opinion that the etiology of childhood autism can be explained by natural, preternatural and supernatural causes, respectively. One (0.7% of the healthcare workers was unsure of the explanation of the etiology. Knowledge about childhood autism as measured by scores on the KCAHW questionnaire was the only factor significantly associated with the opinions of the healthcare workers on etiology of childhood autism. In all, 73 (54.5% and 43 (32.1%, of the healthcare workers subscribed to the opinion that childhood autism is treatable and preventable respectively. Previous involvement with managing children with ASD significantly influenced the opinion of the healthcare

  1. Etiology, clinical features and management of acute recurrent pancreatitis. (United States)

    Deng, Yi Yun; Wang, Rui; Wu, Hao; Tang, Cheng Wei; Chen, Xin Zu


    To study the etiology and clinical features of acute recurrent pancreatitis (ARP) and to determine its optimal management and outcomes. ARP cases among acute pancreatitis patients who were admitted to the West China Hospital, Sichuan University from January 2008 to December 2012 were retrospectively collected. Their etiology, clinical features, treatments and outcomes were analyzed. Of all pancreatitis patients, 8.9% were classified as ARP. The proportions of mild and severe diseases were 85.7% and 14.3%, respectively. The common etiological factors were biliogenic (31.0%), alcohol (26.2%), hyperlipidemia (21.4%) and pancreaticobiliary malformation (15.4%). At first 46 cases were cryptogenic and among them 36 were subsequently confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Among the hyperlipidemic ARP patients, 72.2% failed to routinely monitor and control serum lipids. ERCP was performed in 88 cases, and 48 also required an endoscopic sphincterotomy or calculus removal. Twenty-two patients underwent cholangiopancreatic duct stent placement, and pancreatic necrosectomy was performed on eight severe cases. The overall outcomes indicate that 8.3% of the cases progressed to chronic pancreatitis and 33.3% of the cases receiving etiological treatment were recurrence-free. There were no deaths in this study. The etiological factors of ARP are similar to those of acute pancreatitis at the first attack. The management of ARP should be fully considered based on etiological investigation. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  2. Cortical Reorganisation during a 30-Week Tinnitus Treatment Program.

    Directory of Open Access Journals (Sweden)

    Catherine M McMahon

    Full Text Available Subjective tinnitus is characterised by the conscious perception of a phantom sound. Previous studies have shown that individuals with chronic tinnitus have disrupted sound-evoked cortical tonotopic maps, time-shifted evoked auditory responses, and altered oscillatory cortical activity. The main objectives of this study were to: (i compare sound-evoked brain responses and cortical tonotopic maps in individuals with bilateral tinnitus and those without tinnitus; and (ii investigate whether changes in these sound-evoked responses occur with amelioration of the tinnitus percept during a 30-week tinnitus treatment program. Magnetoencephalography (MEG recordings of 12 bilateral tinnitus participants and 10 control normal-hearing subjects reporting no tinnitus were recorded at baseline, using 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz tones presented monaurally at 70 dBSPL through insert tube phones. For the tinnitus participants, MEG recordings were obtained at 5-, 10-, 20- and 30- week time points during tinnitus treatment. Results for the 500 Hz and 1000 Hz sources (where hearing thresholds were within normal limits for all participants showed that the tinnitus participants had a significantly larger and more anteriorly located source strengths when compared to the non-tinnitus participants. During the 30-week tinnitus treatment, the participants' 500 Hz and 1000 Hz source strengths remained higher than the non-tinnitus participants; however, the source locations shifted towards the direction recorded from the non-tinnitus control group. Further, in the left hemisphere, there was a time-shifted association between the trajectory of change of the individual's objective (source strength and anterior-posterior source location and subjective measures (using tinnitus reaction questionnaire, TRQ. The differences in source strength between the two groups suggest that individuals with tinnitus have enhanced central gain which is not significantly influenced by

  3. Cortical Reorganisation during a 30-Week Tinnitus Treatment Program (United States)

    McMahon, Catherine M.; Ibrahim, Ronny K.; Mathur, Ankit


    Subjective tinnitus is characterised by the conscious perception of a phantom sound. Previous studies have shown that individuals with chronic tinnitus have disrupted sound-evoked cortical tonotopic maps, time-shifted evoked auditory responses, and altered oscillatory cortical activity. The main objectives of this study were to: (i) compare sound-evoked brain responses and cortical tonotopic maps in individuals with bilateral tinnitus and those without tinnitus; and (ii) investigate whether changes in these sound-evoked responses occur with amelioration of the tinnitus percept during a 30-week tinnitus treatment program. Magnetoencephalography (MEG) recordings of 12 bilateral tinnitus participants and 10 control normal-hearing subjects reporting no tinnitus were recorded at baseline, using 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz tones presented monaurally at 70 dBSPL through insert tube phones. For the tinnitus participants, MEG recordings were obtained at 5-, 10-, 20- and 30- week time points during tinnitus treatment. Results for the 500 Hz and 1000 Hz sources (where hearing thresholds were within normal limits for all participants) showed that the tinnitus participants had a significantly larger and more anteriorly located source strengths when compared to the non-tinnitus participants. During the 30-week tinnitus treatment, the participants’ 500 Hz and 1000 Hz source strengths remained higher than the non-tinnitus participants; however, the source locations shifted towards the direction recorded from the non-tinnitus control group. Further, in the left hemisphere, there was a time-shifted association between the trajectory of change of the individual’s objective (source strength and anterior-posterior source location) and subjective measures (using tinnitus reaction questionnaire, TRQ). The differences in source strength between the two groups suggest that individuals with tinnitus have enhanced central gain which is not significantly influenced by the

  4. 28 CFR 550.56 - Community Transitional Drug Abuse Treatment Program (TDAT). (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components of...

  5. UTIs in small animal patients: part 1: etiology and pathogenesis. (United States)

    Smee, Nicole; Loyd, Kimberly; Grauer, Greg


    Understanding how urinary tract infections (UTIs) can occur and how to classify them can help the practitioner to make a plan for treatment. This review summarizes the etiology, pathogenesis, and host defense mechanisms associated with bacterial UTIs in dogs and cats. UTIs in Small Animal Patients: Part 2: Diagnosis, Treatment, and Complications will appear in the March/April 2013 issue of the Journal of the American Animal Hospital Association.

  6. Etiologic profile of spastic quadriplegia in children. (United States)

    Venkateswaran, Sunita; Shevell, Michael I


    The etiologic profile and possible predictors of etiology in children with spastic quadriplegia were assessed in a consecutive cohort of children with this motor impairment. Medical records from a single pediatric neurology practice over a 14-year interval were retrospectively and systematically reviewed. Variables comprised possible demographic, prenatal, perinatal, and postnatal risk factors. Of the 99 patients included in the study, 39 were premature (quadriplegia was 83%, with differing underlying etiologies depending on gestational age. These results should help guide physicians in investigating possible underlying etiologies in patients with spastic quadriplegia.

  7. Radiation-related caries. Etiology and possible preventive strategies. What should the radiotherapist know?

    International Nuclear Information System (INIS)

    Schweyen, R.; Hey, J.; Fraenzel, W.; Vordermark, D.; Hildebrandt, G.; Kuhnt, T.


    After radiation treatment of head-and-neck cancer, the impairment of patient's quality of life still remains an issue. After completion of the treatment course, a substantial number of patients develop so-called radiation caries. In addition, almost 50% of all cases of infectious osteoradionecrosis (iORN) of the jaws are directly associated with radiation caries. This review addresses our current knowledge on the etiology and pathogenesis of radiation caries including possible preventive strategies. Materials and methods A PubMed search using the terms ''radiation caries'' (''radiation related caries'', ''radiation related damage to dentition'') and ''radiogenic caries'' (''postradiation caries'', ''dental complications and radiotherapy'') was performed. The analysis of its content focused on the etiology, the pathogenesis, and the available knowledge on prophylaxis as well as treatment of radiation caries. Results For this review, 60 publications were selected. As main causal factors for radiogenic caries, either indirect impairment, resulting from alterations in the oral environment (e.g., radiation-induced xerostomia) or direct radiation-induced damage in teeth hard tissues are discussed. Radiation caries remains a lifelong threat and, therefore, requires permanent prevention programs. Conclusion To enable optimal medical care of the patients during the time course of radiotherapy as well as afterwards, close interdisciplinary cooperation between radiotherapists, oral surgeons, otorhinolaryngologists, and dentists is absolutely essential. (orig.)

  8. The Role of Program Directors in Treatment Practices: The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs. (United States)

    Frimpong, Jemima A; Shiu-Yee, Karen; D'Aunno, Thomas


    To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors' characteristics and low methadone dosage. Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011. We used generalized linear regression models to examine associations between directors' characteristics and methadone dose, adjusting for program and patient factors. Data were collected through telephone surveys of program directors. The proportion of OAT programs with an African American director declined over time, from 29 percent in 1995 to 16 percent in 2011. The median percentage of patients in each program receiving role in explaining variations in methadone dosage across programs and patients. Further research should investigate the causal pathways through which directors' characteristics affect treatment practices. This may lead to new, multifaceted managerial interventions to improve patient outcomes. © Health Research and Educational Trust.

  9. [New etiological concepts in uveitis]. (United States)

    Bodaghi, B


    Uveitis remains an important cause of visual impairment, particularly in young patients. Idiopathic forms of intraocular inflammation should no longer be regarded as a presumed clinical entity, and the ophthalmologist must reconsider the specific etiology of primary uveitis when the clinical examination does not yield a definitive diagnosis or when the course of the disease on corticosteroids remains atypical. Laboratory tests based on serum analysis have limited value and should not be considered as diagnostic proof in different clinical presentations. The diagnostic management of infectious uveitis has been greatly improved by the use of molecular techniques applied to ocular fluids and tissues. Polymerase chain reaction (PCR) technology is a powerful tool that should be proposed in atypical cases of uveitis or retinitis of unclear but potentially infectious origin. This strategy is a major step before using unconventional and new immunomodulatory agents such as anti-TNF-alpha molecules. Under strict experimental conditions including adequate testing to rule out a possible contamination, PCR and its variants have changed our practical approach to intraocular inflammatory disorders and have provided new details for the understanding of infectious uveitis. The concept of pathogen-induced intraocular inflammation can be revisited in the light of molecular data obtained after anterior chamber paracentesis or diagnostic vitrectomy.

  10. Epigenetic Etiology of Intellectual Disability. (United States)

    Iwase, Shigeki; Bérubé, Nathalie G; Zhou, Zhaolan; Kasri, Nael Nadif; Battaglioli, Elena; Scandaglia, Marilyn; Barco, Angel


    Intellectual disability (ID) is a prevailing neurodevelopmental condition associated with impaired cognitive and adaptive behaviors. Many chromatin-modifying enzymes and other epigenetic regulators have been genetically associated with ID disorders (IDDs). Here we review how alterations in the function of histone modifiers, chromatin remodelers, and methyl-DNA binding proteins contribute to neurodevelopmental defects and altered brain plasticity. We also discuss how progress in human genetics has led to the generation of mouse models that unveil the molecular etiology of ID, and outline the direction in which this field is moving to identify therapeutic strategies for IDDs. Importantly, because the chromatin regulators linked to IDDs often target common downstream genes and cellular processes, the impact of research in individual syndromes goes well beyond each syndrome and can also contribute to the understanding and therapy of other IDDs. Furthermore, the investigation of these disorders helps us to understand the role of chromatin regulators in brain development, plasticity, and gene expression, thereby answering fundamental questions in neurobiology. Copyright © 2017 the authors 0270-6474/17/3710773-10$15.00/0.

  11. Overdose prevention in injecting opioid users: The role of substance abuse treatment and training programs

    Directory of Open Access Journals (Sweden)

    Ana Sarasa-Renedo


    Conclusions: These findings suggest that preventive programs would benefit from accounting for linguistic and educational limitations and from participation in every treatment episode. Comprehensiveness and broad coverage of such programs could help to maximize their impact.

  12. Enigma of urethral pain syndrome: why are there so many ascribed etiologies and therapeutic approaches? (United States)

    Phillip, Harris; Okewole, Idris; Chilaka, Victor


    Urethral pain syndrome has had several sobriquets, which have led to much confusion over the existence of this pathological condition and the useful options in the care of the afflicted patient. Our aim was to explore the proposed etiologies of this syndrome, and to provide a critical analysis of each proposed etiology and present a balanced argument on the plausibility of the proposed etiology and therapeutic approaches. We carried out an English language electronic search in the following databases: Medline, Embase, Amed, Cinahl, Pubmed, Cochrane Library, Trip Database and SUMSearch using the following search terms: urethral syndrome, urethral diseases, urethra, urologic diseases etiology/etiology, presentation, treatment, outcome, therapeutics and treatment from 1951 to 2011. In excess of 200 articles were recovered. With the clearly defined objectives of analyzing the proposed etiologies and therapeutic regimes, two author(s) (HP and IO) perused the abstracts of all the recovered articles, selecting those that addressed the etiologies and therapeutic approaches to treating the urethral pain syndrome. The number of articles was reduced to 25. The full text of all 25 articles were retrieved and reviewed. Through the present article, we hope to elucidate the most probable etiology of this condition whilst simultaneously, advance a logical explanation for the apparent success in the treatment of this condition using a range of different therapeutic modalities. We have carried out a narrative review, which we hope will reduce some of the confusion around this clinical entity by combining the known facts about the disease. © 2014 The Japanese Urological Association.

  13. Psychological Treatment as Part of Dropout Prevention: An Israeli Program (United States)

    Schwartz, Hava; Hain, Rebecca


    This article reports on the integration of psychotherapy in a comprehensive dropout prevention program developed at the Dean of Students' office of Ben-Gurion University of the Negev in Israel. The program's psychologists conducted psychotherapy with a subset of dropout prevention program participants who had reacted with emotional turmoil to the…

  14. An investigation of scale effects in family substance abuse treatment programs

    Directory of Open Access Journals (Sweden)

    Lee A James


    Full Text Available Abstract This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families was too small to be economical. Although the sample size (just nine programs was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.

  15. Papilledema: epidemiology, etiology, and clinical management

    Directory of Open Access Journals (Sweden)

    Rigi M


    Full Text Available Mohammed Rigi,1 Sumayya J Almarzouqi,2 Michael L Morgan,2 Andrew G Lee2–4 1Robert Cizik Eye Clinic, University of Texas, 2Department of Ophthalmology, Houston Methodist Hospital, Blanton Eye Institute, 3Baylor College of Medicine, 4Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, UTMB Galveston, UT MD Anderson Cancer Center, Houston, TX, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA Abstract: Papilledema is optic disc swelling due to high intracranial pressure. Possible conditions causing high intracranial pressure and papilledema include intracerebral mass lesions, cerebral hemorrhage, head trauma, meningitis, hydrocephalus, spinal cord lesions, impairment of cerebral sinus drainage, anomalies of the cranium, and idiopathic intracranial hypertension (IIH. Irrespective of the cause, visual loss is the feared morbidity of papilledema, and the main mechanism of optic nerve damage is intraneuronal ischemia secondary to axoplasmic flow stasis. Treatment is directed at correcting the underlying cause. In cases where there is no other identifiable cause for intracranial hypertension (ie, IIH the available options include both medical and surgical modalities. Weight loss and diuretics remain the mainstays for treatment of IIH, and surgery is typically reserved for patients who fail, are intolerant to, or non-compliant with maximum medical therapy. Keywords: papilledema, intracranial hypertension, idiopathic intracranial hypertension, epidemiology, papilledema management, papilledema etiology, acetazolamide, optic nerve sheath fenestration, ventriculoperitoneal shunt, lumboperitoneal shunt, venous sinus stenting

  16. Etiology of congenital hypothyroidism in Isfahan: Does it different?

    Directory of Open Access Journals (Sweden)

    Mahin Hashemipour


    Conclusion: Seven years of our experiences in CH screening program indicated that the etiology of CH in Isfahan, with a higher rate of CH, with a predominance of thyroid dyshormonogenesis is different from most of the studies world-wide and similar to other reports from Iran. The findings of the current study provide us baseline information for determination of CH pathogenesis in this region.

  17. Sarcomas: etiología y síntomas Sarcomas: etiology and symptoms

    Directory of Open Access Journals (Sweden)

    Roberto Gabriel Albín Cano


    Full Text Available Debido a la amplia diversidad de sarcomas, casi son inexistentes los textos que incluyen todas las variedades de este tipo de cáncer. Generalmente, su descripción y revisión se incluyen en las del sistema de órganos afectados específicamente, y la literatura que los aborda está muy fragmentada en las diferentes especialidades médicas. Se realiza una revisión bibliográfica sobre la etiología y síntomas de la mayor parte de los diferentes tipos de sarcomas. Es objetivo de esta revisión, lograr unir la información más actual disponible acerca de la etiología y síntomas de los sarcomas. Se han identificado diferentes factores de riesgo y factores etiológicos, tanto genéticos, infecciosos, como ambientales. Los grandes descubrimientos en relación con los mecanismos genéticos involucrados en los diferentes tipos de sarcoma, han abierto un camino de inestimable valor para introducir nuevos tratamientos, que incluyen ensayos con anticuerpos monoclonales y nuevos fármacos de terapia génica.

    Due to the wide diversity of sarcomas, almost no texts include all varieties of this type of cancer. Generally, their description and review is included in those of the specifically affected organ system, and the literature containing that information is very fragmented in different medical specialties. We performed a literature review on the etiology and symptoms of most types of sarcomas. It is aimed at achieving a recompilation of most current information available on the causes and symptoms of sarcomas. Different risks and etiologic factors have been identified regarding genetics, infections, and environment. The great discoveries regarding genetic mechanisms involved in different types of sarcomas, have opened an invaluable way to introduce new treatments, including monoclonal antibodies and new drugs of gene therapy.

  18. The impact of incontinence etiology on artificial urinary sphincter outcomes

    Directory of Open Access Journals (Sweden)

    Adam R. Miller


    Full Text Available Purpose: To evaluate the impact of incontinence etiology on artificial urinary sphincter (AUS device outcomes. Materials and Methods: We identified 925 patients who underwent primary AUS placement from 1983 to 2011. The etiology of incontinence was categorized as radical prostatectomy alone, radical prostatectomy with radiation, benign prostate resection, and those with cryotherapy as a salvage prostate cancer treatment. Hazard regression and competing risk analyses were used to determine the association of the etiology of incontinence with device outcomes. Results: The distribution of the 4 etiologies of incontinence included: 598 patients (64.6% treated with prostatectomy alone, 206 (22.2% with prostatectomy and pelvic radiation therapy, 104 (11.2% with benign prostate resection, and 17 (1.8% with prior cryotherapy. With a median follow-up of 4.9 years (interquartile range, 1.2–8.8 years, there was significant difference in the cumulative incidence of device infection/urethral erosion events between the four etiologies (p=0.003. On multivariable analysis, prior cryotherapy (reference prostatectomy alone; hazard ratio [HR], 3.44; p=0.01, older age (HR, 1.07; p=0.0009 and history of a transient ischemic attack (HR, 2.57; p=0.04 were associated with an increased risk of device infection or erosion. Notably, pelvic radiation therapy with prostatectomy was not associated with an increased risk of device infection or erosion (reference prostatectomy alone, p=0.30. Conclusions: Compared to prostatectomy alone, prior treatment with salvage cryotherapy for recurrent prostate cancer was associated with an increased risk of AUS infection/erosion, whereas radiation (in addition to prostatectomy was not.

  19. Status epilepticus: Role for etiology in determining response to benzodiazepines. (United States)

    Joshi, Suchitra; Rajasekaran, Karthik; Hawk, Kyle M; Chester, Stephen J; Goodkin, Howard P


    Clinical factors contributing to benzodiazepine failure in treating status epilepticus (SE) include suboptimal dosing and seizure duration. As many benzodiazepine-refractory episodes of SE arise from acute etiologies, we sought to determine whether etiology impacts SE treatment. The potency of diazepam to terminate SE induced by lithium-pilocarpine (LiPilo-SE) or kainic acid (KA-SE) in 3-week-old rats was studied by video-electroencephalography. Synaptic γ-aminobutyric acid type A receptor (GABAR)-mediated currents were recorded from dentate granule cells using voltage-clamp electrophysiology. Surface expression of γ2 subunit-containing GABARs and Kv4.2 potassium channels in hippocampal slices was determined using a biotinylation assay. Expression of phosphorylated forms of β2/3 and γ2 subunits was determined using phosphospecific antibodies and Western blotting. Diazepam failed to terminate late SE in LiPilo-SE animals but was successful in terminating KA-SE of 1- and 3-hour duration. One hour after SE onset, GABAR-mediated synaptic inhibition and γ2 subunit-containing GABAR surface expression were reduced in LiPilo-SE animals. These were unchanged in KA-SE animals at 1 and 3 hours. Phosphorylation of γ2 subunit residue S327 was unchanged in both models, although GABAR β3 subunit S408/409 residues were dephosphorylated in the LiPilo-SE animals. Kv4.2 potassium channel surface expression was increased in LiPilo-SE animals but reduced in KA-SE animals. SE-model-dependent differences support a novel hypothesis that the development of benzodiazepine pharmacoresistance may be etiologically predetermined. Further studies are required to investigate the mechanisms that underlie such etiological differences during SE and whether etiology-dependent protocols for the treatment of SE need to be developed. Ann Neurol 2018;83:830-841. © 2018 American Neurological Association.

  20. The portal hypertension syndrome: etiology, classification, relevance, and animal models. (United States)

    Bosch, Jaime; Iwakiri, Yasuko


    Portal hypertension is a key complication of portal hypertension, which is responsible for the development of varices, ascites, bleeding, and hepatic encephalopathy, which, in turn, cause a high mortality and requirement for liver transplantation. This review deals with the present day state-of-the-art preventative treatments of portal hypertension in cirrhosis according to disease stage. Two main disease stages are considered, compensated and decompensated cirrhosis, the first having good prognosis and being mostly asymptomatic, and the second being heralded by the appearance of bleeding or non-bleeding complications of portal hypertension. The aim of treatment in compensated cirrhosis is preventing clinical decompensation, the more frequent event being ascites, followed by variceal bleeding and hepatic encephalopathy. Complications are mainly driven by an increase of hepatic vein pressure gradient (HVPG) to values ≥10 mmHg (defining the presence of Clinically Significant Portal Hypertension, CSPH). Before CSPH, the treatment is limited to etiologic treatment of cirrhosis and healthy life style (abstain from alcohol, avoid/correct obesity…). When CSPH is present, association of a non-selective beta-blocker (NSBB), including carvedilol should be considered. NSBBs are mandatory if moderate/large varices are present. Patients should also enter a screening program for hepatocellular carcinoma. In decompensated patients, the goal is to prevent further bleeding if the only manifestation of decompensation was a bleeding episode, but to prevent liver transplantation and death in the common scenario where patients have manifested first non-bleeding complications. Treatment is based on the same principles (healthy life style..) associated with administration of NSBBs in combination if possible with endoscopic band ligation if there has been variceal bleeding, and complemented with simvastatin administration (20-40 mg per day in Child-Pugh A/B, 10-20 mg in Child C

  1. Treatment Readiness as a Determinant of Treatment Participation in a Prison-Based Rehabilitation Program: An Exploratory Study. (United States)

    Bosma, Anouk Q; Kunst, Maarten J J; Dirkzwager, Anja J E; Nieuwbeerta, Paul


    The current study had three aims. First, it measured treatment readiness among offenders who entered the Prevention of Recidivism program. This is a prison-based rehabilitation program in the Netherlands that aims to lower re-offending rates among offenders with a prison sentence of at least for months and that is carried out during the final months of incarceration. Second, the study evaluated whether treatment readiness was associated with treatment participation. Third, the study examined whether treatment readiness measured with a validated instrument predicted treatment participation above and beyond a clinical assessment of treatment readiness, currently used as a criterion to include offenders in rehabilitation programs. To address these aims, data were used from the fourth wave of a research project studying the effects of imprisonment on the life of detainees in the Netherlands. Results indicated that treatment readiness as measured with a validated instrument was a significant predictor of treatment participation. Also, the current study showed that treatment readiness measured with a validated instrument improved the prediction of treatment participation above and beyond a clinical assessment of treatment readiness. Outcomes were discussed in light of study limitations and implications.

  2. Acute pancreatitis in five European countries: etiology and mortality. (United States)

    Gullo, Lucio; Migliori, Marina; Oláh, Attila; Farkas, Gyula; Levy, Philippe; Arvanitakis, Constantine; Lankisch, Paul; Beger, Hans


    In recent years, many advances have been made in the diagnosis and treatment of acute pancreatitis that have lead to a significant reduction in both morbidity and mortality; however, knowledge of the etiology and of the relation between etiology and mortality is far from complete. To obtain a more comprehensive view of the etiology and mortality of acute pancreatitis in Europe than has been given by previous single-center studies. The study comprised 1,068 patients in five European countries who were admitted to hospitals for acute pancreatitis from January 1990 to December 1994. Data for each patient were collected on a standardized form. Of the 1,068 patients (692 men, 376 women; mean age, 52.8 years; range, 10-95 years), 589 had edematous pancreatitis, and 479 the necrotic form. Cholelithiasis (37.1%) and alcohol (41.0%) were the most frequent etiologic factors. In Germany, cholelithiasis and alcohol occurred with similar frequency (34.9 and 37.9%, respectively); in Hungary, alcohol predominates over cholelithiasis (60.7 vs. 24.0%); in France, a small predominance of alcohol was seen (38.5 vs. 24.6%); and in Greece and Italy, there was a clear predominance of cholelithiasis over alcohol (71.4 vs. 6.0% and 60.3 vs. 13.2%, respectively). The differences in the frequency of cholelithiasis and alcohol between Greece and Italy and the other countries were statistically significant (p relationship between mortality and age.

  3. 42 CFR 8.11 - Opioid treatment program certification. (United States)


    ... Substances Act (21 U.S.C. 823(g)(1)) to dispense opioid drugs in the treatment of opioid addiction. An OTP... opioid addiction. (2) To obtain certification from SAMHSA, an OTP must meet the Federal opioid treatment... governmental entities to regulate the use of opioid drugs in the treatment of opioid addiction. The provisions...

  4. Delay discounting, treatment motivation and treatment retention among substance-dependent individuals attending an in inpatient detoxification program

    NARCIS (Netherlands)

    Stevens, Laura; Verdejo-García, Antonio; Roeyers, Herbert; Goudriaan, Anna E.; Vanderplasschen, Wouter


    Recent studies consistently indicate high rates of delay discounting in drug users, which refers to a strong tendency to devaluate delayed rewards. Many addiction treatment programs however, place high demands on the ability to postpone immediate gratification. Therefore, these programs may be

  5. Epigenética y epigenoma: Un paso más allá en la etiología y potencial tratamiento de las enfermedades neurológicas Epigenetics and epigenome: A step forward in the etiology and potential treatment of neurological diseases

    Directory of Open Access Journals (Sweden)

    Sergio J. González


    Full Text Available Los mecanismos de regulación epigenética poseen una función muy importante en el desarrollo y en la función de todos los sistemas del organismo. El fracaso en el normal mantenimiento de esta regulación y desarrollo, debido a factores ambientales, podría contribuir al desarrollo de múltiples enfermedades en pacientes predispuestos genéticamente. Si bien la fisiopatología de gran parte de las enfermedades es desconocida en sus mecanismos moleculares más finos, existen evidencias de que la mayoría de los mecanismos fisiopatológicos convergerían a una interacción entre los genes y el ambiente. La epigenética nos permitiría estudiar la interacción mencionada en los niveles moleculares de regulación de la expresión o supresión de un gen y su relación con diversas enfermedades. Particularmente las enfermedades neurológicas, por su complejidad, la gran cantidad de genes involucrados y la influencia ambiental, son un ámbito más que apropiado para investigar potenciales mecanismos epigenéticos en su fisiopatogenia y desarrollo. La presente revisión tiene como objetivo describir en detalle los mecanismos de regulación epigenética y los hallazgos conocidos que provocarían la disfunción de estos mecanismos como posibles desencadenantes de diferentes enfermedades neurológicas.The mechanisms of epigenetic regulation play an important role in the development and function of body systems. Failure in the maintenance of this regulation as well as environmental factors could contribute to the development of multiple disease s in genetically predisposed patients. Although the molecular mechanisms responsible for the etiology of most diseases are unknown, there is evidence of both genetic and environmental factors that could influence this development. Recent findings involve epigenetic mechanisms in the origin of various diseases. This review aims to describe in detail the mechanisms of epigenetic regulation and the known findings

  6. Etiological approach to chronic urticaria. (United States)

    Krupa Shankar, D S; Ramnane, Mukesh; Rajouria, Eliz Aryal


    In 1769, William Cullen introduced the word "urticaria" (transient edematous papules, plaque with itching). Urticaria affects 15-25% of people at least once in their life time. It is a clinical reaction pattern triggered by many factors causing the liberation of vasoactive substances such as histamine, prostaglandins and kinins. Urticaria is classified according to its duration into acute (6 weeks duration). Various clinical investigations may be initiated to diagnosis the cause. To evaluate the types of chronic urticaria with reference to etiology from history and investigations. A total of 150 patients with chronic urticaria of more than six weeks were studied. Autologous serum skin test (ASST) was performed after physical urticarias were excluded. Standard batteries of tests were performed after ASST in all patients; and other specific investigations were done where necessary. Skin prick test was done in idiopathic urticaria. The study sample consisted of 62 male and 88 female patients with a mean age of 21-40 years. About 50% of patients showed an ASST positive reaction, 3.9% were positive for antinuclear antibody (ANA), IgE titer was elevated in 37%, H. pylori antibodies was positive in 26.7%. Thyroid antibodies were positive in 6.2%. Giardia and entamoeba histolytica was reported in 3.3% on routine stool examination and on urinalysis 8% had elevated WBC counts; 12% showed para nasal sinusitis, with maxillary sinusitis of 7.3%. Random blood sugar was high in 5.3%. Four patients had ASOM, two had positive KOH mount for dermatophytes, abdominal USG showed cholecystitis in two patients. Recurrent tonsillitis was noted in two patients. Urticaria following intake of NSAIDs was observed in four patients and with oral contraceptive pills in one patient. Contact urticaria to condom (latex) was seen in one patient. Cholinergic (4.7%) and dermographic (4.7%) urticaria were the predominant physical urticarias. Prick test was performed in idiopathic urticaria with maximum

  7. Factors Related to Medicaid Payment Acceptance at Outpatient Substance Abuse Treatment Programs (United States)

    Terry-McElrath, Yvonne M; Chriqui, Jamie F; McBride, Duane C


    Objective To examine factors associated with Medicaid acceptance for substance abuse (SA) services by outpatient SA treatment programs. Data Sources Secondary analysis of 2003–2006 National Survey of Substance Abuse Treatment Services data combined with state Medicaid policy and usage measures and other publicly available data. Study Design We used cross-sectional analyses, including state fixed effects, to assess relationships between SA treatment program Medicaid acceptance and (1) program-level factors, (2) county-level sociodemographics and treatment program density, and (3) state-level population characteristics, SA treatment-related factors, and Medicaid policy and usage. Data Extraction Methods State Medicaid policy data were compiled based on reviews of state Medicaid-related statutes/regulations and Medicaid plans. Other data were publicly available. Principal Findings Medicaid acceptance was significantly higher for programs: (a) that were publicly funded and in states with Medicaid policy allowing SA treatment coverage; (b) with accreditation/licensure and nonprofit/government ownership, as well as mental- and general-health focused programs; and (c) in counties with lower household income. Conclusions SA treatment program Medicaid acceptance related to program-, county, and state-level factors. The data suggest the importance of state policy and licensure/accreditation requirements in increasing SA program Medicaid access. PMID:21105870


    Directory of Open Access Journals (Sweden)



    Full Text Available Yeasts have to be considered as an etiological factor of autism. Urine testing by professor W. Shaw’s method is being done in all major laboratories in the USA. Tests for proving the existence of unidentified diseases with a fault in metabolism, lack of vitamins and the existence of abnormal metabolites cateholamine, dopamine, and serotonine can be done. The existence of 62 substances can be tested for time being, and according to that, adequate treatment can be undertaken.

  9. Characteristics and Outcomes of Female Infertility Treatment Programs Using Traditional Medicine in Korea: A Multisite Analysis. (United States)

    Kim, Kyeong Han; Jang, Soobin; Lee, Ju Ah; Go, Ho-Yeon; Jung, Jeeyoun; Park, Sunju; Lee, Myeong Soo; Ko, Seong-Gyu


    Infertility has long been recognized as a treatable disease, and complementary and alternative medicine treatments, such as acupuncture and moxibustion, have been used in Korea and China. This study describes female infertility treatment programs that used traditional Korean medicine (TKM) and were conducted by local governments in Korea and evaluates its effectiveness and safety. The authors officially requested related information from the report of the infertility treatment programs and related sources from 2006 to 2016 from the Health & Welfare Ministry of Korea and the Association of Korean Medicine (AKOM). Additional information was obtained from six Korean databases. Data including basic information about the programs, participant information, interventions, and outcomes were abstracted. A total of 9 reports, including multiple years of data from 6 programs (total 13 programs), were identified. In these 13 programs, a total of 1023 female subjects participated, and 205 of the 887 subjects who completed the program reported a successful pregnancy, indicating a 23.1% pregnancy rate. The programs lasted 3-9 months, and interventional elements, such as herbal medicine, acupuncture, fumigation, and massage, were identified. Significant adverse effects were not reported. This study suggests that infertility treatment programs with TKM interventions exhibited a positive effect on pregnancy in females with infertility. Thus, the infertility treatment programs with TKM interventions are expected to be useful and might serve as the primary treatment before assisted reproduction techniques.

  10. Fundamentals of clinical methodology: 2. Etiology. (United States)

    Sadegh-Zadeh, K


    The concept of etiology is analyzed and the possibilities and limitations of deterministic, probabilistic, and fuzzy etiology are explored. Different kinds of formal structures for the relation of causation are introduced which enable us to explicate the notion of cause on qualitative, comparative, and quantitative levels. The conceptual framework developed is an approach to a theory of causality that may be useful in etiologic research, in building nosological systems, and in differential diagnosis, therapeutic decision-making, and controlled clinical trials. The bearings of the theory are exemplified by examining the current Chlamydia pneumoniae hypothesis on the incidence of myocardial infarction.

  11. Disordered gambling: etiology, trajectory, and clinical considerations. (United States)

    Shaffer, Howard J; Martin, Ryan


    Gambling-related research has advanced rapidly during the past 20 years. As a result of expanding interest in pathological gambling (PG), stakeholders (e.g., clinicians, regulators, and policy makers) have a better understanding of excessive gambling, including its etiology (e.g., neurobiological/neurogenetic, psychological, and sociological factors) and trajectory (e.g., initiation, course, and adaptation to gambling exposure). In this article, we examine these advances in PG-related research and then consider some of the clinical implications of these advances. We consider criteria changes for PG recently proposed by the DSM-V Impulse Control Work Group for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). We also review how clinicians can more accurately and efficiently diagnose clients seeking help for gambling-related problems by utilizing brief screens. Finally, we consider the importance of future research that can identify behavioral markers for PG. We suggest that identifying these markers will allow clinicians to make earlier diagnoses, recommend targeted treatments, and advance secondary prevention efforts. © 2011 by Annual Reviews. All rights reserved

  12. Pain and endometriosis: Etiology, impact, and therapeutics

    Directory of Open Access Journals (Sweden)

    Robert N. Taylor


    Full Text Available The association of pain and endometriosis was recognized with the first definitive published reports of this disorder. Unfortunately, the precise etiologies and pathways leading to nociception and pain symptoms in endometriosis remain poorly understood, and as a result, effective therapeutic interventions are lacking with consequent profound effects on affected women’s quality of life. In this opinion paper we summarize selected proceedings presented at the 28th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE in Istanbul, Turkey, and review the clinical and translational evidence of chronic pain, neurogenesis, and the pernicious impact of dyspareunia on women with symptomatic endometriosis. The effectiveness of medical treatments is critically assessed and the findings indicate that good therapeutic options are available with extant medications effective in some sub-groups of women with endometriosis, many of which are affordable globally. Nevertheless, new management strategies and drugs need to be developed to increase the options of all afflicted women to minimize and ideally eradicate painful symptoms of endometriosis. However, only by elucidating distinctions among sub-groups with specific symptoms, suggesting different mechanisms, are we likely to derive truly successful therapeutic strategies.

  13. Etiological Aspects of Human Trafficking in Kosovo

    Directory of Open Access Journals (Sweden)

    Emine Abdyli


    Full Text Available Human trafficking is considered one of the most serious criminal offences, which is presented as a contemporary form of slavery and which implies the most brutal violation of basic human rights, which are guaranteed by international and law and national law. The phenomenon of human trafficking is present in many countries in transition (such as Kosovo, namely in those countries which were affected by internal political, economic, social, educational, etc. changes, and in such situations the perpetrators of this offense are in a very favorable position to victimize society. Therefore, this paper will focus on external criminogenic factors that influence the growth of this negative phenomenon, including the difficult economic situation, poverty and unemployment, poor housing, migration of people, domestic violence, the impact of mass media in society, lack of border control and insufficient effectiveness of institutions to deal with law enforcement. The paper is based on literature review, statistical data and interviews by treating the subject theoretically, legislatively and practically. To successfully fight against human trafficking, relevant authorities should more closely approach the etiological treatment of this negative phenomenon.

  14. Etiological approach to chronic urticaria

    Directory of Open Access Journals (Sweden)

    Krupa Shankar D


    Full Text Available Background: In 1769, William Cullen introduced the word "urticaria" (transient edematous papules, plaque with itching. Urticaria affects 15-25% of people at least once in their life time. It is a clinical reaction pattern triggered by many factors causing the liberation of vasoactive substances such as histamine, prostaglandins and kinins. Urticaria is classified according to its duration into acute (< 6 weeks duration and chronic (>6 weeks duration. Various clinical investigations may be initiated to diagnosis the cause. Aims: To evaluate the types of chronic urticaria with reference to etiology from history and investigations . Materials and Methods: A total of 150 patients with chronic urticaria of more than six weeks were studied. Autologous serum skin test (ASST was performed after physical urticarias were excluded. Standard batteries of tests were performed after ASST in all patients; and other specific investigations were done where necessary. Skin prick test was done in idiopathic urticaria. Results: The study sample consisted of 62 male and 88 female patients with a mean age of 21-40 years. About 50% of patients showed an ASST positive reaction, 3.9% were positive for antinuclear antibody (ANA, IgE titer was elevated in 37%, H. pylori antibodies was positive in 26.7%. Thyroid antibodies were positive in 6.2%. Giardia and entamoeba histolytica was reported in 3.3% on routine stool examination and on urinalysis 8% had elevated WBC counts; 12% showed para nasal sinusitis, with maxillary sinusitis of 7.3%. Random blood sugar was high in 5.3%. Four patients had ASOM, two had positive KOH mount for dermatophytes, abdominal USG showed cholecystitis in two patients. Recurrent tonsillitis was noted in two patients. Urticaria following intake of NSAIDs was observed in four patients and with oral contraceptive pills in one patient. Contact urticaria to condom (latex was seen in one patient. Cholinergic (4.7% and dermographic (4.7% urticaria were

  15. Fournier's gangrene with an unusual urologic etiology. (United States)

    Fialkov, J M; Watkins, K; Fallon, B; Kealey, G P


    Fournier's gangrene is a necrotizing infection affecting the male genitalia and perineum, caused by synergistic aerobic and anaerobic organisms. We report on a previously undescribed upper urinary tract etiology for this life-threatening infection.

  16. Etiology and Outcome of Neonatal Seizures

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available The prognostic value of seizure etiology, neurologic examination, EEG, and neuroimaging in the neurodevelopmental outcome of 89 term infants with neonatal seizures was determined at the Children’s Hospital and Harvard Medical School, Boston, MA.

  17. Etiological Evolution in Chronic Renal Failure


    Betul Battaloglu Inanc


    Aim: This study aimed to determine,demographic characteristics and etiologies chronic renal failure patients’ who applied to nephrology clinic. Material and Method: 232 chronic renal failure patients’ files, demographic specialities and etiologies evaluated retrospectively, who applied to nephrology clinic at Dr. Sadi Konuk Training and Research Hospital between February 2005 and August 2006. Results: Patiens were 52.6% women and 47.4% of the man. Mean ages’ of 61.7 ±...

  18. Less Common Etiologies of Status Epilepticus (United States)

    Bleck, Thomas P


    Status epilepticus is treated as a neurologic emergency and only later are the potential etiologies assessed. While sometimes the cause for status epilepticus is apparent (e.g., antiepileptic drug withdrawal), all too often it is not identified, even after extensive diagnostic testing has been performed. With emphasis on the less-common etiologies, this review will cover various probable and known causes of status epilepticus among adults, children, and those patients with refractory epilepsy. PMID:20231917

  19. Choices: An Interactive Decision Spport Program for Breast Cancer Treatment

    National Research Council Canada - National Science Library

    Pierce, Penny Fay


    When patients choose a treatment plan in a manner consistent with their values, preferences, and individual decision making style, they generally have better outcomes in part, because involvement also...

  20. Choices: An Interactive Decision Support Program for Breast Cancer Treatment

    National Research Council Canada - National Science Library

    Pierce, Penny Fay


    This project is developing a computer-assisted prototype of an individualized decision support system, called Choices, to assist women newly diagnosed with breast cancer in making stressful treatment...

  1. [Treatment program for dual-diagnosis substance abusers]. (United States)

    Kandel, Isack


    Dual-diagnosis mentally ill patients, i.e. those characterized with substance abuse problems combined with mental health problems, are a challenge both for systems treating substance abusers and for mental health services. These patients are not easily integrated in either of these healthcare systems and/or are treated only for one aspect of their problem by each of these systems. For such patients it is necessary to create a separate treatment model, combining care of the problem of substance abuse and attention to the patient's mental pathology, according to his individual personality traits. For purposes of this programme a treatment setting operating on the model of a therapeutic community is proposed. This setting will open an affiliated treatment programme for dual-diagnosed patients in a separate treatment programme that is not part of the therapeutic community but will be affiliated with it and will accept dual-diagnosis patients.

  2. Lidcombe Program Webcam Treatment for Early Stuttering: A Randomized Controlled Trial (United States)

    Bridgman, Kate; Onslow, Mark; O'Brian, Susan; Jones, Mark; Block, Susan


    Purpose: Webcam treatment is potentially useful for health care in cases of early stuttering in which clients are isolated from specialized treatment services for geographic and other reasons. The purpose of the present trial was to compare outcomes of clinic and webcam deliveries of the Lidcombe Program treatment (Packman et al., 2015) for early…

  3. Designing a Successful Acupuncture Treatment Program for Gulf War Illness (United States)


    recruit for, and subjects are often challenged to adhere for lengthy behavioral trials (ours was a 6 month-treatment trial). Books or other non be current smokers 1. In 2013, our study team competed the Army funded project “The Effectiveness of Acupuncture in the Treatment of Gulf...with three subscales (Task, Goal, and Bond). Each item is scored on a 7-point scale ranging from 1 ( never ) to 7 (always). The WAI has strong

  4. Evaluation of etiologic and prognostic factors in neonatal convulsions. (United States)

    Yıldız, Edibe Pembegul; Tatlı, Burak; Ekici, Barış; Eraslan, Emine; Aydınlı, Nur; Calışkan, Mine; Ozmen, Meral


    This study evaluated etiologic and risk factors affecting long-term prognoses of neurologic outcomes in newborns with neonatal seizures. We enrolled patients at chronologic ages of 23-44 months, referred to the Department of Pediatric Neurology, Istanbul Medical Faculty, from January 1, 2007-December 31, 2009, after manifesting seizures in their first postnatal 28 days. Of 112 newborns, 41 were female, 71 were male, 33 were preterm, and 79 were full-term. Perinatal asphyxia (28.6%) and intracranial hemorrhage (17%) were the most common causes of neonatal seizures. Cerebral palsy developed in 27.6% of patients during follow-up. The incidence of epilepsy was 35.7%. Almost 50% of patients manifested developmental delay in one or more areas. Global developmental delay was the most common (50.8%) neurologic disorder. The correlation between gestational age or birth weight and adverse outcomes was nonsignificant. Etiology, Apgar score, need for resuscitation at birth, background electroencephalogram, neonatal status epilepticus, cranial imaging findings, type/duration of antiepileptic treatment, and response to acute treatment were all strong prognostic factors in neurologic outcomes. Neonatal seizures pose a threat of neurologic sequelae for preterm and full-term infants. Although the number of recognized etiologic factors in neonatal seizures has increased because of improvements in neonatology and diagnostic methods, perinatal asphyxia remains the most common factor. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. The use of art and music therapy in substance abuse treatment programs. (United States)

    Aletraris, Lydia; Paino, Maria; Edmond, Mary Bond; Roman, Paul M; Bride, Brian E


    Although the implementation of evidence-based practices in the treatment of substance use disorders has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs' use of Motivational Enhancement Therapy was positively related to offering art therapy, whereas use of contingency management was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents.

  6. Congenital hypothyroidism: etiology and growth-development outcome. (United States)

    Dalili, Setila; Rezvani, Seyed Mahmood; Dalili, Hossein; Mohtasham Amiri, Zahra; Mohammadi, Hamid; Abrisham Kesh, Sahar; Novin, Mohammad Hassan; Medghalchi, Abdolreza; Gholamnezhad, Hajar


    One of the most preventable causes of mental and growth retardation is congenital hypothyroidism (CH). This study tries to investigate growth and mental outcome of patients with CH. Since November 2006 and November 2007 in Guilan province, north of Iran, all neonates who were diagnosed with CH, evaluated for etiology of CH by laboratory follow up, thyroid sonography or scan. Growth and development of patients with CH were compared with healthy children in same age, geographical area, social and economical classes in four years old. Demographic characteristics including height, weight, and head circumference at birth, follow up time (four years old) and IQ (Good enough test) were recorded in questionnaires. Among 28904 screened neonates, 37 patients with CH were diagnosed. Incidence of CH was 1:781 in live births, 20 (54%) in female neonates and 17 (46%) in male neonates. The incidences of permanent and transient hypothyroidism were 43.2% (16 cases) and 56. 8% (21 cases) respectively. The incidence of permanent and transient hypothyroidism were 16 (43.2%) and 21 (56, 8%), respectively. In permanent CH, 11 cases (%.68.2) had dyshormonogenesis and 5 cases (%.31.2) had thyroid dysgenesis. Significant statistical difference was only in family history of thyroid disease (34, 3% Positive family history in CH vs. 13.2% in control group, P-value 0.03). All other demographic characteristics and IQ had no statistical difference. Patients with CH diagnosed through neonatal screening and treated had normal growth as general population that indicates effective screening program and treatment in this area (3.2%).

  7. Secular trends in pediatric antiretroviral treatment programs in rural and urban Zambia: a retrospective cohort study. (United States)

    Sutcliffe, Catherine G; Bolton-Moore, Carolyn; van Dijk, Janneke H; Cotham, Matt; Tambatamba, Bushimbwa; Moss, William J


    Since 2003 pediatric antiretroviral treatment (ART) programs have scaled-up in sub-Saharan Africa and should be evaluated to assess progress and identify areas for improvement. We evaluated secular trends in the characteristics and treatment outcomes of children in three pediatric ART clinics in urban and rural areas in Zambia. Routinely collected data were analyzed from three ART programs in rural (Macha and Mukinge) and urban (Lusaka) Zambia between program implementation and July 2008. Data were obtained from electronic medical record systems and medical record abstraction, and were categorized by year of program implementation. Characteristics of all HIV-infected and exposed children enrolled in the programs and all children initiating treatment were compared by year of implementation. Age decreased and immunologic characteristics improved in all groups over time in both urban and rural clinics, with greater improvement observed in the rural clinics. Among children both eligible and ineligible for ART at clinic enrollment, the majority started treatment within a year. A high proportion of children, particularly those ineligible for ART at clinic enrollment, were lost to follow-up prior to initiating ART. Among children initiating ART, clinical and immunologic outcomes after six months of treatment improved in both urban and rural clinics. In the urban clinics, mortality after six months of treatment declined with program duration, and in the rural clinics, the proportion of children defaulting by six months increased with program duration. Treatment programs are showing signs of progress in the care of HIV-infected children, particularly in the rural clinics where scale-up increased rapidly over the first three years of program implementation. However, continued efforts to optimize care are needed as many children continue to enroll in ART programs at a late stage of disease and thus are not receiving the full benefits of treatment.

  8. The feasibility of a holistic wellness program for HIV/AIDS patients residing in a voluntary inpatient treatment program. (United States)

    Morgan, Vanessa


    The purpose of this project was to examine the feasibility of an ongoing holistic wellness program in a residential facility treating persons with HIV/AIDS. The goal was to create a voluntary, four week holistic wellness intensive within the established inpatient behavioral health treatment program. Participants were given practicable holistic self care tools to effectively manage HIV related symptoms, general medical issues, addiction, depression, stress and anxiety. The program incorporated evidence-based holistic activities including yoga, therapeutic dance, meditation, Reiki, and reflective journaling. Narrative survey results and post-program evaluation support that an ongoing holistic wellness program within the existing treatment model is feasible and could have numerous potential beneficial effects. This project clearly exemplified the ideal opportunity for holistic nurses to implement innovative holistic interventions within the current healthcare delivery system. It is the author's observation that future studies with a larger participant group to further examine measurable benefits can lend valuable information and insight into the future development of holistic wellness programs for residential treatment facilities.

  9. Etiology and Outcome of Chronic Kidney Disease in Iranian Children

    Directory of Open Access Journals (Sweden)

    Neamatollah Ataei


    Full Text Available Background Considering the significant geographical and ethnical differences in pattern of incidence, etiology and outcome of chronic kidney disease (CKD, the present study aimed to assess the etiology and outcome of CKD in Iranian children. Materials and Methods In a cross-sectional study etiology and outcome of 372 children aged 3 months to 18 years with CKD was studied during the period 1991 –2014. Children (186 boys, 186 girls with Stage 3 to 5 CKDs, defined as a glomerular filtration rate below 60 ml/min per 1.73 m2body surface area, were identified. Results Etiology was congenital anomalies of the kidney and urinary tract in 125 (33.60%, cystic/ hereditary/ congenital diseases in 91 (24.46%, glomerulopathy in 73(19.62%, and cause unknown in 71 (19.09% patients. Forty-eight (13.22% were on conservative treatment, 174(47.93% had end-stage renal disease (ESRD with chronic hemodialysis, 24 (6.61% were on continuous ambulatory peritoneal dialysis. Sixty-eight (18.74% underwent on renal transplant which was successful in 52 (14.33% patients but was associated with abnormal renal function in 16(4.41% children. Finally, 49 (13.50% patients died. Conclusion A large number of children developed CKD secondary to congenital anomalies of the kidney and urinary tract. Planning for screening, early detection and instituting timely treatment of preventable causes could lead to a lower incidence of CKD in this group of children.

  10. [Pedophilia. Prevalence, etiology, and diagnostics]. (United States)

    Mokros, A; Osterheider, M; Nitschke, J


    Pedophilia is a disorder of sexual preference that increases the risk for committing sexual offenses against children. Consequently, pedophilia is not only relevant in psychiatric therapy and prognostics, but also greatly influences the public attitude towards criminality. Public opinion seems to equate pedophilia with child sexual abuse and vice versa which leads to stigmatization of patients and may impede treatment. The present paper provides information on recent studies on the potential origins of the disorder and introduces new diagnostic methods. Moreover, the article presents estimates on the prevalence of pedophilic sexual interest.

  11. The MICA Case Conference Program at Tewksbury Hospital, Mass.: an integrated treatment model. (United States)

    Clodfelter, Reynolds C; Albanese, Mark J; Baker, Gregg; Domoto, Katherine; Gui, Amy L; Khantzian, Edward J


    This report describes the MICA (Mentally Ill Chemically Abusing) Program at the Tewksbury Hospital campus in Tewksbury, Massachusetts. Several campus facilities collaborate in the MICA Program. Through Expert Case Conferences, principles of integrated psychosocial treatment with dual diagnosis patients are demonstrated. An expert clinician focuses on the interplay between psychological pain, characterological traits, defenses, and the patient's drug of choice. Patients who have participated in the program have reported positive experiences. The staff reported that the program has resulted in facility improvement in assessment and treatment of complex dual diagnosis patients.

  12. Spanish-Language Community-Based Mental Health Treatment Programs, Policy-Required Language-Assistance Programming, and Mental Health Treatment Access Among Spanish-Speaking Clients (United States)

    McClellan, Sean R.


    Objectives. We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California’s Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Methods. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997–2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. Results. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Conclusions. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services. PMID:23865663

  13. Spanish-language community-based mental health treatment programs, policy-required language-assistance programming, and mental health treatment access among Spanish-speaking clients. (United States)

    Snowden, Lonnie R; McClellan, Sean R


    We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California's Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997-2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services.

  14. Hypnosis and behavioral treatment in a worksite smoking cessation program. (United States)

    Frank, R G; Umlauf, R L; Wonderlich, S A; Ashkanazi, G S


    In the initial study, 48 subjects of the total (N = 63) ultimately used, were assigned to one of three treatments: four hypnotic sessions with a booster, two hypnotic sessions, or two hypnotic and two behavioral sessions with a booster. A follow-up group was later recruited composed of 15 subjects who received four hypnotic sessions and a booster session with less time between sessions. The results indicated no difference in smoking cessation 6 months after treatment regardless of the frequency, length between sessions, or addition of behavioral methods. Successful subjects were more educated, less able to utilize their imagination, and had fewer smokers at home.

  15. Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities. (United States)

    Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve


    Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional

  16. Operation of Wastewater Treatment Plants: A Home Study Training Program. (United States)

    California State Univ., Sacramento. Dept. of Civil Engineering.

    This manual was prepared by experienced wastewater treatment plant operators to provide a home study course to develop new qualified workers and expand the abilities of existing workers. The objective of this manual is to provide the knowledge and skills necessary for certification. Participants learn the basic operational aspects of treatment…

  17. [Causes of emergency dizziness stratified by etiology]. (United States)

    Qiao, Wenying; Liu, Jianguo; Zeng, Hong; Liu, Yugeng; Jia, Weihua; Wang, Honghong; Liu, Bo; Tan, Jing; Li, Changqing


    To explore the causes of emergency dizziness stratified to improve the diagnostic efficiency. A total of 1 857 cases of dizziness at our emergency department were collected and their etiologies stratified by age and gender. The top three diagnoses were benign paroxysmal positional vertigo (BPPV, 31.7%), hypertension (24.0%) and posterior circulation ischemia (PCI, 20.5%). Stratified by age, the main causes of dizziness included BPPV (n = 6), migraine-associated vertigo (n = 2), unknown cause (n = 1) for the group of vertigo (14.5%) and neurosis (7.3%) for 18-44 years; BPPV (36.8%), hypertension (22.4%) and migraine-associated vertigo (11.2%) for 45-59 years; hypertension (30.8%), PCI (29.8%) and BPPV (22.9%) for 60-74 years; PCI (30.7%), hypertension (28.6%) and BPPV (25.5%) for 75-92 years. BPPV, migraine and neurosis were more common in females while hypertension and PCI predominated in males (all P hypertension, neurosis and migraine showed the following significant demographic features: BPPV, PCI, hypertension, neurosis and migraine may be the main causes of dizziness. BPPV should be considered initially when vertigo was triggered repeatedly by positional change, especially for young and middle-aged women. And the other common causes of dizziness were migraine-associated vertigo, neurosis and Meniere's disease.Hypertension should be screened firstly in middle-aged and elderly patients presenting mainly with head heaviness and stretching. In elders with dizziness, BPPV is second in constituent ratio to PCI and hypertension.In middle-aged and elderly patients with dizziness, psychological factors should be considered and diagnosis and treatment should be offered timely.

  18. The Use of Art and Music Therapy in Substance Abuse Treatment Programs (United States)

    Aletraris, Lydia; Paino, Maria; Edmond, Mary Bond; Roman, Paul M.; Bride, Brian E.


    While the implementation of evidence-based practices (EBPs) in the treatment of substance use disorders (SUD) has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs’ use of Motivational Enhancement Therapy (MET) was positively related to offering art therapy, while use of Contingency Management (CM) was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings, and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents. PMID:25514689

  19. Designing a Successful Acupuncture Treatment Program for Gulf War Illness (United States)


    Acupuncture in the Treatment Of Gulf War Illness W81XWH-09-2-0064) on current symptom levels and use of services to explore the long-term effects of an...of Math and Computer Science, Menoufia University, Shebin EIKom, Egypt g Department of Biostatistics & Bioinfonnatics, Duke University Medical Center...significantly higher levels of au- toantibody reactivity in all proteins examined except S-1 OOB. Fold increase of the cases relative to controls in

  20. Self-management program in treatment of asthma

    Directory of Open Access Journals (Sweden)

    Milenković Branislava


    Full Text Available Introduction. Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms. Objective. The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment. Method. Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peakflow based self-management (Group A, n=30 or to conventional treatment (Group B, n=30, with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist, courses of oral prednisolone, courses of antibiotics, days off work. Results. There was a significant difference between groups in number of asthma exacerbations (p<0.05, unscheduled visits to ambulatory care facilities (p<0.005, days off work (p<0.0001, courses of oral prednisolone (p<0.001 and antibiotics (p<0.05. At the final visit, there was a significant improvement in some measurements of asthma severity in group A (reduced unscheduled visits for ambulatory care, reduced treatment requirements for oral corticosteroids and antibiotics, reduced days off work, but a lack of statistical difference in lung function and the maintenance-inhaled corticosteroid dose. There was no significant change in group B. Conclusion. These results suggest that peak-flow based self management is more effective than traditonal treatment in mild and moderate persistent asthma. .

  1. 38 CFR 1.478 - Disclosures to prevent multiple enrollments in detoxification and maintenance treatment programs... (United States)


    ... psychological effects incident to withdrawal from the sustained use of a narcotic drug. (3) Maintenance... heroin or other morphine-like drugs. (4) Member program means a non-VA detoxification treatment or...

  2. Anglo-Saxon experience in the implementation of correctional treatment and the Polish individual rehabilitation program

    Directory of Open Access Journals (Sweden)

    Maciej Bernasiewicz


    Full Text Available The authors cite American and British research on the effectiveness of correctional treatment. On that basis, they describe several crucial factors that affect the success of rehabilitation (e.g., educators’ skills, working with families of juvenile offenders. The article broadly discusses the specific juvenile residential treatment program that has been implemented in Florida. The conclusions of this program are drawn from the research conducted through interviews with juvenile offenders (young adults who have effectively completed the process of rehabilitation in correctional facilities. Furthermore, the authors discuss an individual program of rehabilitation (IPR implemented in Polish correctional facilities. Using the experience and the impact of correctional treatment in the West, it is proposed to introduce certain modifications in the planning and implementation of Polish correctional treatment programs (IPR s.


    This document is the final report for EPA's Mine WAste Technology Program (MWTP) Activity III, Project 20--Selenium Treatment/Removal Alternatives Demonstration project. Selenium contamination originates from many sources including mining operations, mineral processing, abandoned...

  4. Treatment Response to an Intensive Summer Treatment Program for Adolescents with ADHD (United States)

    Sibley, Margaret H.; Smith, Bradley H.; Evans, Steven W.; Pelham, William E.; Gnagy, Elizabeth M.


    Objective: There are presently almost no empirically validated treatments for adolescents with ADHD. However, in childhood, behavioral treatments for ADHD typically include behavioral parent training, classroom interventions, and intensive child-directed interventions. Method: The present investigation examines treatment gains following an 8-week…

  5. The base moments in etiological prevention of peri-odontal disease in children and adolescents

    Directory of Open Access Journals (Sweden)

    Kharitonova T.L.


    Full Text Available Anatomical and physiological features of the growing organism requires a different approach to prevention and treatment of periodontal disease. This article presents the highlights of the etiological prevention of periodontal diseases, taking into account the anatomical and physiological, and psycho-emotional features of childhood, are based on current data on the prevalence periodontal disease in children, recent research findings in the etiology and patho-genesis of periodontal disease

  6. The base moments in etiological prevention of peri-odontal disease in children and adolescents


    Kharitonova T.L.; Suyetenkov D.Ye.; Gritsenko Е.А.; Lebedeva S.N.


    Anatomical and physiological features of the growing organism requires a different approach to prevention and treatment of periodontal disease. This article presents the highlights of the etiological prevention of periodontal diseases, taking into account the anatomical and physiological, and psycho-emotional features of childhood, are based on current data on the prevalence periodontal disease in children, recent research findings in the etiology and patho-genesis of periodontal disease


    Directory of Open Access Journals (Sweden)

    G.V. Volynets


    Full Text Available In the article the data on the study of the etiological factors of various types of chronic gastritis in children are presented. Based on revealing of the auto antibodies to parietal gastric cells in 40,0% of children autoimmune gastritis (a type gastritis is diagnosed. Helicobacterr pylori infection is revealed in 44,8% of children. In 27,6% of children type c gastritis is diagnosed. Autoimmune gastritis in children has been linked to the active phase of chronic epsteinbbarr virus infection. the etiological factors of nonautoimmune gastritis are Helicobacter pylori infection (type b gastritis and multiple duodenogastric refluxes (type c gastritis.Key words: children, chronic gastritis, etiological factors, autoimmune gastritis, nonautoimmune gastritis, active phase of chronic Epstein-Barr virus infection, Helicobacter pylori infection.

  8. Bladder outlet obstruction (BOO) in female: etiology and management

    International Nuclear Information System (INIS)

    Shaikh, N.A.; Ahuja, K.; Shaikh, G.S.; Soomro, A.K.


    To determine the etiology and management outcome of bladder outlet obstruction (BOO) in female. Methodology: From 2009 to 2012, 37 females with a mean age of 40 (range 20-65) were investigated for etiology and management outcome of BOO. Typical complaints were slow urinary flow, difficulty in emptying bladder, frequency of micturition and urgency. Mean duration of symptoms was 6 month. Results: 15 women were confirmed as atrophic urethritis, 5 had functional bladder, 3 had urethral caruncle, 5 had cystocele, 7 had complete procedentia of uterus, and 2 had impacted urethral stone. Cystoscopy was performed in all patients to exclude other pathology like vesical stone and bladder growth. 12 patients were referred to Gynecology due to complete procedentia of uterus and cystocele. Three cases of urethral caruncle were treated by excision and biopsy, 2 patients with urethral stone were treated by endoscopic push back and litholapaxy while 5 required conservative treatment and 15 cases of atrophic urethritis were kept on Hormone Replacement Therapy (HRT). Conclusion: BOO is uncommon in female and management depends upon the etiology. (author)

  9. A collaborative community-based treatment program for offenders with mental illness. (United States)

    Roskes, E; Feldman, R


    The paper describes initial results of collaboration between a mental health treatment program at a community mental health center in Baltimore and a probation officer of the U.S. federal prison system to serve the mental health needs of offenders on federal probation, parole, supervised release, or conditional release in the community. A forensic psychiatrist in the treatment program and a licensed social worker in the probation office facilitate the close working relationship between the agencies. Treatment services provided or brokered by the community mental health center staff include psychiatric and medical treatment, intensive case management, addictions treatment, urine toxicology screening, psychosocial or residential rehabilitation services, intensive outpatient care, partial hospitalization, and inpatient treatment. Among the 16 offenders referred for treatment during the first 24 months of the collaborative program, 14 were male and 14 were African American. Three of the 16 violated the terms of their release due to noncompliance with stipulated mental health treatment; only one of the three had been successfully engaged in treatment. One patient died, two completed their terms of supervision, and ten remained in treatment at the time of the report. The major strength of this collaboration is the cooperation of the treatment and monitoring agencies with the overall goal of maintaining the offender in the community. Further research is needed to confirm the effectiveness of the clinical model in reducing recidivism and retaining clients.

  10. Perceptions of a Prison-Based Substance Abuse Treatment Program among Some Staff and Participants (United States)

    Goodrum, Sarah; Staton, Michele; Leukefeld, Carl; Webster, J. Matthew; Purvis, Richard T.


    Almost 90% of all State and Federal prisons in the U.S. offer some form of substance abuse counseling, and one in eight prisoners have participated in a substance abuse treatment program while incarcerated. Evidence indicates that these programs can be successful in stopping prisoners' substance abuse. While some data are available about the…

  11. Substance Abuse Treatment Outcomes: A Multi-Site Study of Male and Female Prison Programs (United States)

    Pelissier, Bernadette; Motivans, Mark; Rounds-Bryant, Jennifer L.


    The present study examined whether there were program differences with respect to post-release outcomes in 20 federal in-prison substance abuse programs which used a cognitive-behavioral treatment approach. Recidivism and post-release drug use were examined for a sample of 1,343 individuals--1,065 men and 278 women. Discrete time proportional…

  12. Recidivism of Offenders with Mental Illness Released from Prison to an Intensive Community Treatment Program (United States)

    Theurer, Gregory; Lovell, David


    An intensive case management treatment program for mentally ill offenders (MIOs) is outlined, and subsequent recidivism of participants is evaluated. Features of the program and its development are discussed. Sixty-four (64) participants released from state prison between 1998 and 2003 were matched with a group of MIOs released earlier on eight…

  13. Screening for illicit heroin use in patients in a heroin-assisted treatment program

    NARCIS (Netherlands)

    Rook, Elisabeth J.; Huitema, Alwin D. R.; van den Brink, Wim; Hillebrand, Michel J. X.; van Ree, Jan M.; Beijnen, Jos H.


    The aim of this study was to investigate the use of illicit heroin among patients in a heroin-assisted treatment program. In this program, pharmaceutical-grade heroin was administered to heroin-addicted patients. Monitoring of illicit heroin use was considered important for the evaluation of this

  14. PTSD Treatment Programs in the U.S. Department of Veterans Affairs (United States)

    ... Programs in the U.S. Department of Veterans Affairs PTSD: National Center for PTSD Menu Menu PTSD PTSD Home For the Public ... Enter ZIP code here Enter ZIP code here PTSD Treatment Programs in the U.S. Department of Veterans ...

  15. Spirituality as a Component in a Treatment Program for Sexually Addicted Roman Catholic Clergy. (United States)

    Hudson, Patricia E.


    A treatment program that integrates spirituality and therapy for sex abusers who are Roman Catholic priests or brothers is described. Selections from an interview with the program director cover definitions, philosophy, women as therapists, daily activity, candidates, and the spiritual dimension. Measures of success and after-care are discussed.…

  16. Improved survival in HIV treatment programs in Asia (United States)

    De La Mata, Nicole L; Kumarasamy, Nagalingeswaran; Khol, Vohith; Ng, Oon Tek; Van Nguyen, Kinh; Merati, Tuti Parwati; Pham, Thuy Thanh; Lee, Man Po; Durier, Nicolas; Law, Matthew


    Background Antiretroviral treatment (ART) for HIV-positive patients has expanded rapidly in Asia over the last ten years. Our study aimed to describe the time trends and risk factors for overall survival in patients receiving first-line ART in Asia. Methods We included HIV-positive adult patients who initiated ART between 2003–2013 (n=16 546), from seven sites across six Asia-Pacific countries. Patient follow-up was to May 2014. We compared survival for each country and overall by time period of ART initiation using Kaplan-Meier curves. Factors associated with mortality were assessed using Cox regression, stratified by site. We also summarized first-line ART regimens, CD4 count at ART initiation, and CD4 and HIV viral load testing frequencies. Results There were 880 deaths observed over 54 532 person-years of follow-up, a crude rate of 1.61 (1.51, 1.72) per 100 person-years. Survival significantly improved in more recent years of ART initiation. The survival probabilities at 4 years follow-up for those initiating ART in 2003–05 was 92.1%, 2006–09 was 94.3% and 2010–2013 was 94.5% (pAsia have improved survival in more recent years of ART initiation. This is likely a consequence of improvements in treatment and, patient management and monitoring over time. PMID:26961354

  17. Epidemiology of Cerebellar Ataxia on the Etiological Basis: A Cross Sectional Study

    Directory of Open Access Journals (Sweden)

    Simindokht Hosseini Seyede


    Full Text Available Cerebellar ataxias are a heterogenous group of disorders, clinically and etiologically, that result in considerable health burden. Finding out about the various etiologies, and their relative prevalences in the population suffering from cerebellar ataxia helps the clinician to perform a better management, in treatment process. This is a cross sectional study designed to estimate the relative prevalence of each etiologic factor. One-hundred and thirty-five patients ,in the range of 6 to 73 years from march 1993 to march1999, were classified in different groups on the basis of etiological findings. Relative prevalence of each of the etiological factors , common accompanying disorders besides ataxia in the patients,CT and MRI changes,and CSF alterations are studied and recorded. A widely spread age group, and the extended number of the cases under study, are the advantages of the current study over the previously reported case series. Among the etiologic groups, multiple sclerosis, cerebrovascular accidents and hereditary cerebellar ataxia, were the most common etiologic factors associated with cerebellar ataxia respectively.

  18. 75 FR 80762 - Medicare Program; Emergency Medical Treatment and Labor Act: Applicability to Hospital and... (United States)


    ... [CMS-1350-ANPRM] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act... Emergency Medical Treatment and Labor Act (EMTALA). Specifically, this document serves as a request for... available to persons without Federal government identification, commenters are encouraged to leave their...

  19. 77 FR 5213 - Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital... (United States)


    ... [CMS-1350-NC] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA... the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) to hospital inpatients... available to persons without Federal government identification, commenters are encouraged to leave their...

  20. A Preliminary Outcome Study of an Outpatient Treatment Program for Gamblers. (United States)

    Blackman, Sheldon; And Others

    The Gamblers Treatment Clinic (GTC) opened in 1982 as a New York State Office of Mental Health Demonstration Program. The basic premise of the GTC is that excessive gambling is a disorder of impulse control. Treatment, conducted in the community in a time-limited fashion, attempts to uncover the underlying dynamics that precipitate disorders of…

  1. Multiple Measures of Outcome in Assessing a Prison-Based Drug Treatment Program (United States)

    Prendergast, Michael L.; Hall, Elizabeth A.; Wexler, Harry K.


    Evaluations of prison-based drug treatment programs typically focus on one or two dichotomous outcome variables related to recidivism. In contrast, this paper uses multiple measures of outcomes related to crime and drug use to examine the impact of prison treatment. Crime variables included self-report data of time to first illegal activity,…

  2. Water Treatment Plant Operation. Volume II. A Field Study Training Program. (United States)

    California State Univ., Sacramento. School of Engineering.

    The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  3. Water Treatment Plant Operation. Volume I. A Field Study Training Program. (United States)

    California State Univ., Sacramento. School of Engineering.

    The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  4. Operation of Wastewater Treatment Plants. Volume 1. A Field Study Training Program. Third Edition. Revised. (United States)

    California State Univ., Sacramento. Dept. of Civil Engineering.

    The purpose of this wastewater treatment field study training program is to: (1) develop new qualified wastewater treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  5. Water Treatment Plant Operation Volume 2. A Field Study Training Program. Revised. (United States)

    California State Univ., Sacramento. School of Engineering.

    The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  6. Counting the cost: estimating the economic benefit of pedophile treatment programs. (United States)

    Shanahan, M; Donato, R


    The principal objective of this paper is to identify the economic costs and benefits of pedophile treatment programs incorporating both the tangible and intangible cost of sexual abuse to victims. Cost estimates of cognitive behavioral therapy programs in Australian prisons are compared against the tangible and intangible costs to victims of being sexually abused. Estimates are prepared that take into account a number of problematic issues. These include the range of possible recidivism rates for treatment programs; the uncertainty surrounding the number of child sexual molestation offences committed by recidivists; and the methodological problems associated with estimating the intangible costs of sexual abuse on victims. Despite the variation in parameter estimates that impact on the cost-benefit analysis of pedophile treatment programs, it is found that potential range of economic costs from child sexual abuse are substantial and the economic benefits to be derived from appropriate and effective treatment programs are high. Based on a reasonable set of parameter estimates, in-prison, cognitive therapy treatment programs for pedophiles are likely to be of net benefit to society. Despite this, a critical area of future research must include further methodological developments in estimating the quantitative impact of child sexual abuse in the community.

  7. Intellectual disability: definition, etiological factors, classification, diagnosis, treatment and prognosis Discapacidad intelectual: definición, factores etiológicos, clasificación, diagnóstico, tratamiento y prognosis

    Directory of Open Access Journals (Sweden)

    Gregorio Katz


    Full Text Available Etiology and classification: Causal factors related with cognitive disability are multiples and can be classified as follows: Genetic, acquired (congenital and developmental, environmental and sociocultural. Likewise, in relation to the classification, cognitive disability has as a common denominator a subnormal intellectual functioning level; nevertheless, the extent to which an individual is unable to face the demands established by society for the individual’s age group has brought about four degrees of severity: Mild, moderate, severe and profound. Diagnostic: The clinical history must put an emphasis on healthcare during the prenatal, perinatal and postnatal period and include the results of all previous studies, including a genealogical tree for at least three generations and an intentional search for family antecedents of mental delay, psychiatric illnesses and congenital abnormalities. The physical exam should focus on secondary abnormalities and congenital malformations, somatometric measurements and neurological and behavioral phenotype evaluations. If it is not feasible to establish a clinical diagnosis, it is necessary to conduct high-resolution cytogenetic studies in addition to metabolic clinical evaluations. In the next step, if no abnormal data are identified, submicroscopic chromosomal disorders are evaluated. Prognosis: Intellectual disability is not curable; and yet, the prognostic in general terms is good when using the emotional wellbeing of the individual as a parameter. Conclusions: Intellectual disability should be treated in a comprehensive manner. Nevertheless, currently, the fundamental task and perhaps the only one that applies is the detection of the limitation and abilities as a function of subjects’ age and expectations for the future, with the only goal being to provide the support necessary for each one of the dimensions or areas in which the person’s life is expressed and exposed.Etiología y clasificaci

  8. Etiology of Inguinal Hernias: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Stina Öberg


    Full Text Available BackgroundThe etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias.ResultsLateral and medial hernias seem to have common as well as different etiologies. A patent processus vaginalis and increased cumulative mechanical exposure are risk factors for lateral hernias. Patients with medial hernias seem to have a more profoundly altered connective tissue architecture and homeostasis compared with patients with lateral hernias. However, connective tissue alteration may play a role in development of both subtypes. Inguinal hernias have a hereditary component with a complex inheritance pattern, and inguinal hernia susceptible genes have been identified that also are involved in connective tissue homeostasis.ConclusionThe etiology of lateral and medial hernias are at least partly different, but the final explanations are still lacking on certain areas. Further investigations of inguinal hernia genes may explain the altered connective tissue observed in patients with inguinal hernias. The precise mechanisms why processus vaginalis fails to obliterate in certain patients should also be clarified. Not all patients with a patent processus vaginalis develop a lateral hernia, but increased intraabdominal pressure appears to be a contributing factor.

  9. Symptomatology and etiology of chronic pediatric rhinosinusitis. (United States)

    Ilhan, Adem Emre; Karaman, Murat; Tekin, Arman


    This study aims to define symptoms and etiology and determine how to prevent chronic rhinosinusitis in children. Between February 2003 and February 2005, 50 pediatric patients (25 girls and 25 boys; mean age 8.22 years; range 4 to 14 years) with chronic rhinosinusitis were included in the study. The patients were questioned about anterior/posterior nasal dripping, night cough, headache, nausea, vomiting and nasal obstruction for symptomatology; about school condition, smoking behavior of parents and history of asthma for etiology. Hemogram, serum biochemistry, allergy test, nasal smear, chest and lateral neck radiography and sweat test were performed. Symptomatologic examination revealed that 48% had anterior nasal dripping, 62% with postnasal dripping, 70% with headache and 90% with nasal obstruction. Evaluation of etiological factors revealed that 68% were going to school, 48% of the parents had the history of smoking, 42% with allergy test-positivity and 60% with adenoid vegetation. Our study results indicated that environmental factors are important as etiological factors in rhinosinusitis. For prevention, we recommend restriction of close relationship at school, not to smoke at home and vaccination in each year with influenza and S. pneumonia vaccine.

  10. CKD of Uncertain Etiology: A Systematic Review. (United States)

    Lunyera, Joseph; Mohottige, Dinushika; Von Isenburg, Megan; Jeuland, Marc; Patel, Uptal D; Stanifer, John W


    Epidemics of CKD of uncertain etiology (CKDu) are emerging around the world. Highlighting common risk factors for CKD of uncertain etiology across various regions and populations may be important for health policy and public health responses. We searched PubMed, Embase, Scopus and Web of Science databases to identify published studies on CKDu. The search was generated in January of 2015; no language or date limits were used. We used a vote-counting method to evaluate exposures across all studies. We identified 1607 articles, of which 26 met inclusion criteria. Eighteen (69%) were conducted in known CKDu-endemic countries: Sri Lanka (38%), Nicaragua (19%), and El Salvador (12%). The other studies were from India, Japan, Australia, Mexico, Sweden, Tunisia, Tanzania, and the United States. Heavy metals, heat stress, and dietary exposures were reported across all geographic regions. In south Asia, family history, agrochemical use, and heavy metal exposures were reported most frequently, whereas altitude and temperature were reported only in studies from Central America. Across all regions, CKDu was most frequently associated with a family history of CKDu, agricultural occupation, men, middle age, snake bite, and heavy metal exposure. Studies examining etiologies of CKDu have reported many exposures that are heterogeneous and vary by region. To identify etiologies of CKDu, designing consistent and comparative multisite studies across high-risk populations may help elucidate the importance of region-specific versus global risk factors. Copyright © 2016 by the American Society of Nephrology.

  11. The Etiology of Conflict in Multicultural Relations. (United States)

    Byrd, Marquita L.

    This paper focuses on the common sources of etiologies of conflict in multicultural contexts. Multicultural communication is the creation and sharing of meaning among citizens of the same geopolitical system who belong to divergent tributary cultures. The sources of conflict in multicultural relations can be grouped into five broad categories.…

  12. Multifocal chronic osteomyelitis of unknown etiology

    International Nuclear Information System (INIS)

    Kozlowski, K.; Masel, J.; Harbison, S.; Yu, J.; Royal Brisbane Children Hospital; Regional Hospital Bowral


    Five cases of chronic, inflammatory, multifocal bone lesions of unknown etiology are reported. Although bone biopsy confirmed osteomyelitis in each case in none of them were organisms found inspite of an extensive work up. Different clinical course of the disease reflects different aetiology in respective cases. These cases present changing aspects of osteomyelitis emerging since introduction of antibiotics. (orig.)

  13. Recent Research on the Etiologies of Autism. (United States)

    Fisher, Eileen; Van Dyke, Don C.; Sears, Lonnie; Matzen, Jane; Lin-Dyken, Deborah; McBrien, Dianne M.


    Reviews recent research on the etiologies of autism, including genetic research, anatomic and neuroimaging studies, topics in neurophysiology research (including serotonin, dopamine, and opiods), immunologic research, studies of autism phenotype, and electroencephalographic studies. It concludes that, as of yet, research has found no clear…

  14. On the Etiology of Sexual Dysfunction (United States)

    Apfelbaum, Bernard


    Lack of consideration of the sexually functional population has led to misconceptions about causes of sexual dysfunction functioning. Automatic functioning can mask effects of pathogenic influences on sexuality, making these effects appear random, confounding etiological issues and creating the belief that causes of sexual dysfunction and disorder…

  15. Odontogenic cervical necrotizing fasciitis, etiological aspects

    African Journals Online (AJOL)


    Jun 26, 2015 ... Results: In the majority of cases, the disease evolved without the presence of associated systemic disorders (60% [45.49-. 72.69]) ... immune deficiencies, chronic alcoholism, or hepatic ... of these reports regarding the etiology of the development ..... periodontal lesions, where the Streptococcus strains are.

  16. The Effectiveness of Stress Management Program on Quality of Life among Methadone Maintenance Treatment Members

    Directory of Open Access Journals (Sweden)

    s Zarei


    Full Text Available Objective: The aim of present study was to investigate the effectiveness of stress management program on quality of life among methadone maintenance treatment members. Method: In this pre-test, post-test experimental study, 30 individual who referred to Saba MMT center in Pakdasht were randomly divided into experimental group (n=15 participants and control group (n=15 participants. The experimental group was undergone ten 90 minutes sessions of stress management program and the control group didn’t receive any treatment program. Quality of life questionnaire (SF-36 was administered. Result: The results showed that the mean sf-36 score in the experimental group had significant higher increased in comparison of control group. Conclusion: It can be concluded stress management program is effective on increasing of quality of life among methadone maintenance treatment members.

  17. Contaminated Materials Treatment Program annual report for FY 1989

    International Nuclear Information System (INIS)

    Ross, W.A.; Powell, J.A.


    The Western New York Nuclear Services Center reprocessed nuclear fuel for five years until operations were terminated in 1972. Underground tanks at the site contain high-level waste (HLW) generated during the reprocessing operations. Based on original agreements, the state of New York has assumed responsibility for the wastes and the site. The Department of Energy (DOE) is assisting New York State, through the West Valley Demonstration Project (WVDP), in processing and solidifying the HLW. The site contractor for the WVDP is West Valley Nuclear Services Co., Inc. (WVNS). The Pacific Northwest Laboratory (PNL), through the West Valley Support Project, has been supporting WVNS and DOE in establishing vitrification and waste processing technology and capability at the West Valley Site. The specific objective of the West Valley Support Project during FY 1989 were to complete designs of remote equipment, assist in characterizing the WVNS feed, sampling, ceramic melter and off-gas systems, provide chemical analysis of the radioactive wastes and testing of future processes with actual radioactive wastes, provide testing and modeling studies of the reference WV waste product, and conduct special studies, such as evaluating corrosion of the waste tanks and supporting operation of the supernatant treatment system. 13 refs., 13 figs., 5 tabs

  18. The Impulsive Lifestyle Counseling Program for Antisocial Behavior in Outpatient Substance Abuse Treatment. (United States)

    Thylstrup, Birgitte; Hesse, Morten


    Antisocial behavior is associated with low quality of life for the patient and with adverse effects on society and those close to the antisocial patient. However, most patients with antisocial behavior are not seen in treatment settings that focus on their personality but rather in criminal justice settings, substance-abuse treatment, and social welfare settings. This article describes the adaptation and implementation of a highly structured manualized treatment, Impulsive Lifestyle Counseling (ILC), based on the Lifestyle Issues program, a 10-week psychoeducation program studied in prison settings. ILC consists of four sessions over 4 weeks and a booster session 8 weeks later. The goal of treatment is described to patients as "to help people identify their impulsive thoughts and lifestyle leading to problems with drug use, other people, and the police." Two clinical examples and reflections on our experiences with the training and implementation of the ILC program are presented. © The Author(s) 2011.

  19. Facial diplegia: etiology, clinical manifestations, and diagnostic evaluation

    Directory of Open Access Journals (Sweden)

    Sefer Varol


    Full Text Available ABSTRACT Objective Facial diplegia (FD is a rare neurological manifestation with diverse causes. This article aims to systematically evaluate the etiology, diagnostic evaluation and treatment of FD. Method The study was performed retrospectively and included 17 patients with a diagnosis of FD. Results Patients were diagnosed with Guillain-Barré syndrome (GBS (11, Bickerstaff’s brainstem encephalitis (1, neurosarcoidosis (1, non-Hodgkin’s Lymphoma (1, tuberculous meningitis (1 herpes simplex reactivation (1 and idiopathic (1. In addition, two patients had developed FD during pregnancy. Conclusion Facial diplegia is an ominous symptom with widely varying causes that requires careful investigation.

  20. Prostate cancer - epidemiology, etiology, diagnostics, clinical symptoms, screening

    International Nuclear Information System (INIS)

    Ondrus, D.


    Prostate cancer presents a real important medical and social problem at present. It is one of the most common malignancy in males. In global point of view it means permanent incidence increase of this disease. Despite improvement of prostate cancer diagnosis and complex treatment mortality does not decreased significantly. Knowledge of etiological factors are relatively limited. Important factors are: genetic disposition, age, life style, race, positive familial history, circulated androgens. Diagnostics is well known, based on routine clinical methods: digital rectal examination, measurement of PSA a transrectal ultrasound. Benefit of prostate cancer screening is until now unclear, controversial. (author)

  1. Major Depressive Disorder Definition, Etiology and Epidemiology: A Review

    Directory of Open Access Journals (Sweden)

    Fatmagul Helvaci Celik


    Full Text Available Depression is one of the most common psychiatric disorders influencing the all population. Untreated depression may lead to early death and worsening in general health. Depression has several clinically distinct subtypes which are sometimes difficult to diagnose. Diagnosis and treatment of these disorders are of concern to physicians other than psychiatrists, because of their effect on course and prognosis of general medical diseases. This is a concise and up to date overview of the epidemiology,etiology physiopathology and diagnosis of major depressive disorder. [J Contemp Med 2016; 6(1.000: 51-66

  2. Demographic Trends of Adults in New York City Opioid Treatment Programs--An Aging Population. (United States)

    Han, Benjamin; Polydorou, Soteri; Ferris, Rosie; Blaum, Caroline S; Ross, Stephen; McNeely, Jennifer


    The population of adults accessing opioid treatment is growing older, but exact estimates vary widely, and little is known about the characteristics of the aging treatment population. Further, there has been little research regarding the epidemiology, healt h status, and functional impairments in this population. To determine the utilization of opioid treatment services by older adults in New York City. This study used administrative data from New York State licensed drug treatment programs to examine overall age trends and characteristics of older adults in opioid treatment programs in New York City from 1996 to 2012. We found significant increases in utilization of opioid treatment programs by older adults in New York City. By 2012, those aged 50-59 made up the largest age group in opioid treatment programs. Among older adults there were notable shifts in demographic background including gender and ethnicity, and an increase in self-reported impairments. More research is needed to fully understand the specific characteristics and needs of older adults with opioid dependence.

  3. Tics and Tourette: a clinical, pathophysiological and etiological review. (United States)

    Dale, Russell C


    Describe developments in the etiological understanding of Tourette syndrome. Tourette syndrome is a complex heterogenous clinical syndrome, which is not a unitary entity. Pathophysiological models describe gamma-aminobutyric acid-ergic-associated disinhibition of cortico-basal ganglia motor, sensory and limbic loops. MRI studies support basal ganglia volume loss, with additional white matter and cerebellar changes. Tourette syndrome cause likely involves multiple vulnerability genes and environmental factors. Only recently have some vulnerability gene findings been replicated, including histidine decarboxylase and neurexin 1, yet these rare variants only explain a small proportion of patients. Planned large genetic studies will improve genetic understanding. The role of inflammation as a contributor to disease expression is now supported by large epidemiological studies showing an association with maternal autoimmunity and childhood infection. Investigation of blood cytokines, blood mRNA and brain mRNA expression support the role of a persistent immune activation, and there are similarities with the immune literature of autistic spectrum disorder. Current treatment is symptomatic, although there is a better appreciation of factors that influence treatment response. At present, therapeutics is focused on symptom-based treatments, yet with improved etiological understanding, we will move toward disease-modifying therapies in the future.

  4. Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change. (United States)

    Becan, Jennifer E; Knight, Danica K; Crawley, Rachel D; Joe, George W; Flynn, Patrick M


    Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (time 1) and 35 days after admission (time 2). The design consisted of a comparison sample (n=281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n=238). Repeated measures ANCOVAs were conducted using each time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race-ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Health economics evaluation of a gastric cancer early detection and treatment program in China. (United States)

    Li, Dan; Yuan, Yuan; Sun, Li-Ping; Fang, Xue; Zhou, Bao-Sen


    To use health economics methodology to assess the screening program on gastric cancer in Zhuanghe, China, so as to provide the basis for health decision on expanding the program of early detection and treatment. The expense of an early detection and treatment program for gastric cancer in patients found by screening, and also costs of traditional treatment in a hospital of Zhuanghe were assessed. Three major techniques of medical economics, namely cost-effective analysis (CEA), cost-benefit analysis (CBA) and cost-utility analysis (CUA), were used to assess the screening program. RESULTS from CEA showed that investing every 25, 235 Yuan on screening program in Zhuanghe area, one gastric cancer patient could be saved. Data from CUA showed that it was cost 1, 370 Yuan per QALY saved. RESULTS from CBA showed that: the total cost was 1,945,206 Yuan with a benefit as 8,669,709 Yuan and an CBR of 4.46. The early detection and treatment program of gastric cancer appears economic and society-beneficial. We suggest that it should be carry out in more high risk areas for gastric cancer.

  6. A mathematical programming framework for early stage design of wastewater treatment plants

    DEFF Research Database (Denmark)

    Bozkurt, Hande; Quaglia, Alberto; Gernaey, Krist


    The increasing number of alternative wastewater treatment technologies and stricter effluent requirements make the optimal treatment process selection for wastewater treatment plant design a complicated problem. This task, defined as wastewater treatment process synthesis, is currently based on e...... the design problem is formulated as a Mixed Integer (Non)linear Programming problem e MI(N)LP e and solved. A case study is formulated and solved to highlight the application of the framework. © 2014 Elsevier Ltd. All rights reserved....... on expert decisions and previous experiences. This paper proposes a new approach based on mathematical programming to manage the complexity of the problem. The approach generates/identifies novel and optimal wastewater treatment process selection, and the interconnection between unit operations to create...

  7. "Transcend": initial outcomes from a posttraumatic stress disorder/substance abuse treatment program. (United States)

    Donovan, B; Padin-Rivera, E; Kowaliw, S


    This paper describes the development of a comprehensive treatment program for combat veterans diagnosed with posttraumatic stress disorder (PTSD) and substance abuse (SA). Outcome data are presented on 46 male patients who completed treatment between 1996 and 1998. The treatment approach, defined by a detailed manual, integrates elements of cognitive-behavioral skills training, constructivist theory approaches, SA relapse prevention strategies, and peer social support into a group-focused program. The Clinician-Administered PTSD Scale (CAPS) and the Addiction Severity Index (ASI) were used to assess treatment effectiveness at discharge and 6- and 12-month follow-up. Significant symptom changes revealed on CAPS and ASI scores at discharge and follow-up are analyzed. Discussion focuses on hypotheses regarding treatment effectiveness, study limitations, and suggestions for further research.

  8. Predictors of buprenorphine treatment success of opioid dependence in two Baltimore City grassroots recovery programs. (United States)

    Damian, April Joy; Mendelson, Tamar; Agus, Deborah


    Despite evidence for the efficacy of buprenorphine treatment in primary care, few studies have identified factors associated with treatment success, nor have such factors been evaluated in community settings. Identifying correlates of treatment success can facilitate the development of treatment models tailored for distinct populations, including low-income communities of color. The current study examined client-level socio-demographic factors associated with treatment success in community-based buprenorphine programs serving vulnerable populations. Data were abstracted from client records for participants (N=445) who met DSM-IV criteria for opioid dependence and sought treatment at one of Behavioral Health Leadership Institute's two community-based recovery programs in Baltimore City from 2010 to 2015. Logistic regression estimated the odds ratios of treatment success (defined as retention in treatment for ≥90days) by sociodemographic predictors including age, race, gender, housing, legal issues and incarceration. The odds of being retained in treatment ≥90days increased with age (5% increase with each year of age; pfactors. Clients who reported unstable housing had a 41% decreased odds of remaining in treatment for 90 or more days compared to clients who lived independently at intake. Treatment success did not significantly differ by several other client-level characteristics including gender, race, employment, legal issues and incarceration. In vulnerable populations, the age factor appears sufficiently significant to justify creating models formulated for younger populations. The data also support attention to housing needs for people in treatment. Findings from this paper can inform future research and program development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. The spectrum of aphasia subtypes and etiology in subacute stroke. (United States)

    Hoffmann, Michael; Chen, Ren


    Aphasia is one of the most common stroke syndrome presentations, yet little is known about the spectrum of different subtypes or their stroke mechanisms. Yet, subtypes and etiology are known to influence the prognosis and recovery. Our aim is to analyze aphasia subtypes and etiology in a large subacute stroke population. Consecutive patients from a dedicated cognitive stroke registry were accrued. A validated cognitive screening examination was administered during the first month of stroke presentation, which enabled a diagnosis of 14 different aphasic subtypes. The evolution from one subtype to another in the acute and subacute period, at times, resulted in more than 1 subtype being diagnosed. Etiology of stroke was determined by the modified Trial of Org 10172 in Acute Stroke Treatment criteria that included intracerebral hemorrhage. Exclusions included dementia, chronic medical illness, substance abuse, and severe depression. Of 2389 stroke patients, after exclusions (n=593), aphasias numbered 625 (625 of 1796; 34.8%), and the subtype frequencies included Broca aphasia (n=170; 27.2%), anomic aphasia (n=165; 26.4%), global aphasia (n=119; 19.04%), and subcortical aphasia (n=57; 9.12%). Less frequent subtypes (total n=40; 6.7%) included transcortical aphasia (n=11), Wernicke aphasia (n=10), conduction aphasia (n=7), aphemia (n=3), semantic aphasia (n=3), crossed aphasia (n=3), pure word deafness (n=2), and foreign accent syndrome (n=1). Aphasia subtypes and etiologies had some significant associations (chi-square: 855.8, P valueaphasia had a significant association with small-vessel disease (SVD) (odds ratio [OR]=2.0254, 95% confidence interval [CI]: 1.3820-2.9681), and global aphasia patients mostly had cardioembolic (CE) causes (OR=2.3589, 95% CI: 1.5506-3.5885) and less likely SVD (OR=.2583, 95% CI: .1444-.4654). Other notable inferences were included. Wernicke aphasia was caused by either CE (6 of 12; 50%) or hemorrhage (4 of 12; 33.3%) in a combined 83% of

  10. Posttreatment attrition and its predictors, attrition bias, and treatment efficacy of the anxiety online programs. (United States)

    Al-Asadi, Ali M; Klein, Britt; Meyer, Denny


    Although relatively new, the field of e-mental health is becoming more popular with more attention given to researching its various aspects. However, there are many areas that still need further research, especially identifying attrition predictors at various phases of assessment and treatment delivery. The present study identified the predictors of posttreatment assessment completers based on 24 pre- and posttreatment demographic and personal variables and 1 treatment variable, their impact on attrition bias, and the efficacy of the 5 fully automated self-help anxiety treatment programs for generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with or without agoraphobia (PD/A), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). A complex algorithm was used to diagnose participants' mental disorders based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders were offered an online 12-week disorder-specific treatment program. A total of 3199 individuals did not formally drop out of the 12-week treatment cycle, whereas 142 individuals formally dropped out. However, only 347 participants who completed their treatment cycle also completed the posttreatment assessment measures. Based on these measures, predictors of attrition were identified and attrition bias was examined. The efficacy of the 5 treatment programs was assessed based on anxiety-specific severity scores and 5 additional treatment outcome measures. On average, completers of posttreatment assessment measures were more likely to be seeking self-help online programs; have heard about the program from traditional media or from family and friends; were receiving mental health assistance; were more likely to learn best by reading, hearing and doing; had a lower pretreatment Kessler-6 total score; and were older

  11. Mixed Waste Integrated Program interim evaluation report on thermal treatment technologies

    International Nuclear Information System (INIS)

    Gillins, R.L.; DeWitt, L.M.; Wollerman, A.L.


    The Mixed Waste Integrated Program (MWIP) is one of several US Department of Energy (DOE) integrated programs established to organize and coordinate throughout the DOE complex the development of technologies for treatment of specific waste categories. The goal of the MWIP is to develop and deploy appropriate technologies for -the treatment of DOE mixed low-level and alpha-contaminated wastes in order to bring all affected DOE installations and projects into compliance with environmental laws. Evaluation of treatment technologies by the MWIP will focus on meeting waste form performance requirements for disposal. Thermal treatment technologies were an early emphasis for the MWIP because thermal treatment is indicated (or mandated) for many of the hazardous constituents in DOE mixed waste and because these technologies have been widely investigated for these applications. An advisory group, the Thermal Treatment Working Group (TTWG), was formed during the program's infancy to assist the MWIP in evaluating and prioritizing thermal treatment technologies suitable for development. The results of the overall evaluation scoring indicate that the four highest-rated technologies were rotary kilns, slagging kilns, electric-arc furnaces, and plasma-arc furnaces. The four highest-rated technologies were all judged to be applicable on five of the six waste streams and are the only technologies in the evaluation with this distinction. Conclusions as to the superiority of one technology over others are not valid based on this preliminary study, although some general conclusions can be drawn

  12. Noncarious Cervical Lessions: From Etiology to Therapy


    Marta Krolo; Aleksandra Kovačević


    The purpose of this article was to briefly summarize the most important characteristics of non-carious cervical lesions, as well as the etiological factors that lead to their formation. Cervical area represents one of the most sensitive parts of the tooth due to the specific position, as well as the structure and thickness of hard tissue. It is less resistant to various chemical and mechanical stimuli, and as a result the lesions in this area are frequently encountered in everyday practice.

  13. Review: Recent Finding about Etiology of


    Parvaneh Karim-Zadeh


    Autism and the other disorders in the autism spectrum are behaviorally defined syndromes that can be a prolonged disorder. The specific underlying neurophysiologic mechanisms simply not known, but probably several causes lead to disorders in the autism spectrum. This article is summary of recent research about etiology of autism but the search must continue. 1) Neurobiological origin, the neurobiological investigations show the role of dopamine and serotonin in pathogenesis of autism. 2) Gene...

  14. Towards a balanced account of autism etiology


    Hall, Genae A.


    Drash and Tudor describe six sets of reinforcement contingencies which may be present in the environments of some children eventually diagnosed with autism and suggest that these contingencies account for the etiology of “autistic” behaviors. Nevertheless, merely observing such contingencies in the environments of these children is insufficient to establish a positive correlation between the contingencies and “autistic” behaviors, let alone a causal relationship. To demonstrate a positive cor...

  15. Etiology of short stature in children

    International Nuclear Information System (INIS)

    Sultan, M.; Afzal, M.; Ali, S.


    To determine the causes of short stature in children with special emphasis on growth hormone deficiency. Two hundred and fourteen children (140 boys and 74 girls), ranging from 02 to 15 years presenting with short stature were studied. Height and weight were plotted on appropriate growth charts and centiles determined. Relevant hematological and biochemical investigations including thyroid profile were done. Bone age was determined in all cases. Growth hormone axis was investigated after excluding other causes. Karyotyping was done in selected cases. Data was analyzed by SPSS 10.0 by descriptive statistics. Mean values were compared using t-test. In this study, the five most common etiological factors in order of frequency were Constitutional Growth Delay (CGD), Familial Short Stature (FSS), malnutrition, coeliac disease and Growth Hormone Deficiency (GHD). In 37.4% of patients, the study revealed normal variants of growth - CGD, FSS or combination of both, 46.7% cases had nonendocrinological and 15.9% had endocrinological etiology. CGD (22.1%) in males and FSS (27%) in females were the most common etiology. GHD was found in 6.1% children and it comprised 38.2% of all endocrinological causes. Children with height falling below 0.4th centile were more likely to have a pathological short stature (79.2%) compared to 39.3% whose height was below 3rd centile but above 0.4th centile (p<0.05). CGD and FSS are most common causes of short stature in boys and girls respectively, whereas, GHD is a relatively uncommon etiology. (author)

  16. Etiology, Localization and Prognosis in Cerebellar Infarctions

    Directory of Open Access Journals (Sweden)

    Yavuz Yücel


    Full Text Available Cerebrovasculer disease are the most frequent disease of the brain. Cerebellar infarct remains % 1.5-4.2 of these diseases. Etiological factors, lesion localization, symptoms and findings and relationship with prognosis of our patients with cerebellar infarct were investigated in our study. For this purpose, 32 patients were evaluated who were admitted to the Dicle University Medical School Department of Neurology in 1995-2001 hospitalized with the diagnosis of clinically and radiological confirmed cerebellar infarction.All of patients in the study group, 21 (%65.6 were male and 11 (%34.3 female. Age of overall patients ranged between 40 and 75 years with a mean of 57.8±10.2 years. Atherothrombotic infarct was the most frequent reason at the etiologic clinical classification. The most frequently found localization was the posterior inferior cerebellar artery infarct (%50. The leading two risk factors were hypertension (%78.1 and cigarette smoking (%50. The most common sign and symptoms were vertigo (%93.7, vomiting (%75, headache (%68.7 and cerebellar dysfunction findings (%50. The mean duration of hospitalization was 16.3±7.6 days. Overall mortality rate was found to be % 6.2. Finally, the most remarkable risk factors at cerebellar infarct patients are hypertension and atherosclerosis at etiology. We are considering that, controlling of these factors will reduce the appearance frequency of cerebellar infarcts.

  17. High ca-hardness treatment program of secondary cooling system in HANARO

    International Nuclear Information System (INIS)

    Park, Y. C.; Woo, J. S.; Ryu, J. S.; Cho, Y. K.; Jeon, B. J.


    The secondary cooling water in HANARO had been treated with a low ca-hardness treatment program. The program has now been altered to a high ca-hardness treatment program to reduce the consumption of service water and the maintenance cost. After the alteration of the water treatment method, the water quality of the secondary cooling system is maintained below the limit of water quality control as same as before the alteration. This means indirectly that the secondary cooling system is not much affected by the water quality. To confirm this fact, it is necessary to analyze the effects of corrosion, scale, sludgy and slime that the water qualities are directly interfered with the secondary cooling system. We analyzed the deteriorating effects with a water monitoring equipment connected to the secondary cooling system to measure the monitoring parameters every 6 months. As a result, it is confirmed through this examination that the effects are maintained below the control limits and the high ca-hardness treatment program is applicable to treatment of the water quality of the secondary cooling system in HANARO

  18. Association between body mass index and response to a brief interdisciplinary treatment program in fibromyalgia. (United States)

    Kim, Chul-Hyun; Luedtke, Connie A; Vincent, Ann; Thompson, Jeffrey M; Oh, Terry H


    The aim of this study was to evaluate the association between baseline body mass index (BMI) and treatment outcome after a brief interdisciplinary fibromyalgia treatment program. Subjects (n = 477) with fibromyalgia participated in the fibromyalgia treatment program. They completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form-36 Health Status Questionnaire (SF-36) at baseline and 6 to 12 mos after the fibromyalgia treatment program. Posttreatment changes in FIQ and SF-36 scores were compared after stratifying participants into four BMI groups: nonobese, overweight, moderately obese, and severely obese. All BMI groups achieved significant improvement in the FIQ total score; the FIQ subscales feel good, pain, fatigue, and morning tiredness; and the SF-36 subscales pain index, vitality, social functioning, and mental health index. Posttreatment changes in mean scores for each subscale generally did not differ significantly across BMI groups after adjusting for age and baseline scores. However, the SF-36 subscale scores of physical functioning and role-emotional were significantly less improved in the severely obese compared with the nonobese. Baseline BMI did not affect response to the fibromyalgia treatment program, as measured by the FIQ total score or SF-36 physical and mental component summary scores. However, the severely obese group showed less improvement compared with the nonobese group in the SF-36 physical functioning and role-emotional subscales.

  19. Etiological classification of ischemic stroke in young patients: a comparative study of TOAST, CCS, and ASCO. (United States)

    Gökçal, Elif; Niftaliyev, Elvin; Asil, Talip


    Analysis of stroke subtypes is important for making treatment decisions and prognostic evaluations. The TOAST classification system is most commonly used, but the CCS and ASCO classification systems might be more useful to identify stroke etiologies in young patients whose strokes have a wide range of different causes. In this manuscript, we aim to compare the differences in subtype classification between TOAST, CCS, and ASCO in young stroke patients. The TOAST, CCS, and ASCO classification schemes were applied to 151 patients with ischemic stroke aged 18-49 years old and the proportion of subtypes classified by each scheme was compared. For comparison, determined etiologies were defined as cases with evident and probable subtypes when using the CCS scheme and cases with grade 1 and 2 subtypes but no other grade 1 subtype when using the ASCO scheme. The McNemar test with Bonferroni correction was used to assess significance. By TOAST, 41.1% of patients' stroke etiology was classified as undetermined etiology, 19.2% as cardioembolic, 13.2% as large artery atherosclerosis, 11.3% as small vessel occlusion, and 15.2% as other causes. Compared with TOAST, both CCS and ASCO assigned fewer patients to the undetermined etiology group (30.5% p CCS and ASCO classification schemes in young stroke patients seems feasible, and using both schemes may result in fewer patients being classified as undetermined etiology. New studies with more patients and a prospective design are needed to explore this topic further.

  20. Childhood hydrocephalus – is radiological morphology associated with etiology

    DEFF Research Database (Denmark)

    Foss-Skiftesvik, Jon; Andresen, Morten; Juhler, Marianne


    Clinicians use a non-standardized, intuitive approach when correlating radiological morphology and etiology of hydrocephalus.......Clinicians use a non-standardized, intuitive approach when correlating radiological morphology and etiology of hydrocephalus....

  1. Laboratory methods for determining pneumonia etiology in children

    NARCIS (Netherlands)

    Murdoch, David R.; O'Brien, Katherine L.; Driscoll, Amanda J.; Karron, Ruth A.; Bhat, Niranjan; Black, Robert E.; Bhutta, Zulfiqar A.; Campbell, Harry; Cherian, Thomas; Crook, Derrick W.; de Jong, Menno D.; Dowell, Scott F.; Graham, Stephen M.; Klugman, Keith P.; Lanata, Claudio F.; Madhi, Shabir A.; Martin, Paul; Nataro, James P.; Piazza, Franco M.; Qazi, Shamim A.; Zar, Heather J.; Levine, Orin S.; Knoll, Maria Deloria; Feikin, Daniel R.; Scott, J. Anthony G.; Driscoll, Amanda; DeLuca, Andrea; Crawley, Jane


    Laboratory diagnostics are a core component of any pneumonia etiology study. Recent advances in diagnostic technology have introduced newer methods that have greatly improved the ability to identify respiratory pathogens. However, determining the microbial etiology of pneumonia remains a challenge,

  2. Differentiating progress in a clinical group of fibromyalgia patients during and following a multicomponent treatment program. (United States)

    Van Den Houte, Maaike; Luyckx, Koen; Van Oudenhove, Lukas; Bogaerts, Katleen; Van Diest, Ilse; De Bie, Jozef; Van den Bergh, Omer


    Treatments including multiple nonpharmacological components have beneficial effects on the key symptoms of fibromyalgia, although effects are limited and often do not persist. In this study, we examined different patterns of clinical progress and the dynamic interplay between predictors and outcomes over time. Fibromyalgia patients (N=153; 135 women) followed a multidisciplinary group program spanning 12weeks, aimed at "regaining control over daily functioning". Anxiety, depression, pain coping and kinesiophobia were used as predictor variables. Outcome variables were pain severity, pain-related disability, physical functioning and functional interference. All variables were assessed at 3 moments: on the first and last day of treatment, and 12weeks after the last day of treatment. Overall treatment effects were analyzed using mixed model analyses. Latent class growth analysis identifying different treatment trajectory classes was used to investigate individual differences in treatment effects. Finally, cross-lagged structural equation models were used to investigate the dynamic interplay between predictors and outcomes over time. Only a fourth to a third of the total group showed improvement on the outcome variables. These patients had lower baseline anxiety, depression and kinesiophobia, and improved more on anxiety, depression and kinesiophobia. Physical well-being had a stronger effect on anxiety and depression than vice versa. Physical functioning predicted relative changes in kinesiophobia, while kinesiophobia predicted relative changes in pain-related disability. The results emphasize the importance of tailoring treatments to individual needs in order to improve overall effectiveness of treatment programs. Copyright © 2017. Published by Elsevier Inc.

  3. Post-stroke hemiparesis: Does chronicity, etiology, and lesion side are associated with gait pattern? (United States)

    Gama, Gabriela Lopes; Larissa, Coutinho de Lucena; Brasileiro, Ana Carolina de Azevedo Lima; Silva, Emília Márcia Gomes de Souza; Galvão, Élida Rayanne Viana Pinheiro; Maciel, Álvaro Cavalcanti; Lindquist, Ana Raquel Rodrigues


    Studies that evaluate gait rehabilitation programs for individuals with stroke often consider time since stroke of more than six months. In addition, most of these studies do not use lesion etiology or affected cerebral hemisphere as study factors. However, it is unknown whether these factors are associated with post-stroke motor performance after the spontaneous recovery period. To investigate whether time since stroke onset, etiology, and lesion side is associated with spatiotemporal and angular gait parameters of individuals with chronic stroke. Fifty individuals with chronic hemiparesis (20 women) were evaluated. The sample was stratified according to time since stroke (between 6 and 12 months, between 13 and 36 months, and over 36 months), affected cerebral hemisphere (left or right) and lesion etiology (ischemic and hemorrhagic). The participants were evaluated during overground walking at self-selected gait speed, and spatiotemporal and angular gait parameters were calculated. Results Differences between gait speed, stride length, hip flexion, and knee flexion were observed in subgroups stratified based on lesion etiology. Survivors of a hemorrhagic stroke exhibited more severe gait impairment. Subgroups stratified based on time since stroke only showed intergroup differences for stride length, and subgroups stratified based on affected cerebral hemisphere displayed between-group differences for swing time symmetry ratio. In order to recruit a more homogeneous sample, more accurate results were obtained and an appropriate rehabilitation program was offered, researchers and clinicians should consider that gait pattern might be associated with time since stroke, affected cerebral hemisphere and lesion etiology.

  4. Experiences of burnout among drug counselors in a large opioid treatment program: A qualitative investigation. (United States)

    Beitel, Mark; Oberleitner, Lindsay; Muthulingam, Dharushana; Oberleitner, David; Madden, Lynn M; Marcus, Ruthanne; Eller, Anthony; Bono, Madeline H; Barry, Declan T


    Little is known about possible experiences of burnout among drug counselors in opioid treatment programs that are scaling up capacity to address the current opioid treatment gap. Participants in this quality improvement study were 31 drug counselors employed by large opioid treatment programs whose treatment capacities were expanding. Experiences of burnout and approaches for managing and/or preventing burnout were examined using individual semi-structured interviews, which were audiotaped, transcribed, and systematically coded by a multidisciplinary team using grounded theory. Rates of reported burnout (in response to an open-ended question) were lower than expected, with approximately 26% of participants reporting burnout. Counselor descriptions of burnout included cognitive, affective, behavioral, and physiological symptoms; and job-related demands were identified as a frequent cause. Participants described both self-initiated (e.g., engaging in pleasurable activities, exercising, taking breaks during workday) and system-supported strategies for managing or preventing burnout (e.g., availing of supervision and paid time off). Counselors provided recommendations for system-level changes to attenuate counselor risk of burnout (e.g., increased staff-wide encounters, improved communication, accessible paid time off, and increased clinical supervision). Findings suggest that drug counselor burnout is not inevitable, even in opioid treatment program settings whose treatment capacities are expanding. Organizations might benefit from routinely assessing counselor feedback about burnout and implementing feasible recommendations to attenuate burnout and promote work engagement.

  5. Developing an Integrative Treatment Program for Cancer-Related Fatigue Using Stakeholder Engagement - A Qualitative Study. (United States)

    Canella, Claudia; Mikolasek, Michael; Rostock, Matthias; Beyer, Jörg; Guckenberger, Matthias; Jenewein, Josef; Linka, Esther; Six, Claudia; Stoll, Sarah; Stupp, Roger; Witt, Claudia M


    Although cancer-related fatigue (CRF) has gained increased attention in the past decade, it remains difficult to treat. An integrative approach combining conventional and complementary medicine interventions seems highly promising. Treatment programs are more likely to be effective if the needs and interests of the people involved are well represented. This can be achieved through stakeholder engagement. The aim of the study was to develop an integrative CRF treatment program using stakeholder engagement and to compare it to an expert version. In a qualitative study, a total of 22 stakeholders (4 oncologists, 1 radiation-oncologist, 1 psycho-oncologist, 5 nurses/nurse experts, 9 patients, 1 patient family member, 1 representative of a local Swiss Cancer League) were interviewed either face-to-face or in a focus group setting. For data analysis, qualitative content analysis was used. With stakeholder engagement, the integrative CRF treatment program was adapted to usual care using a prioritizing approach and allowing more patient choice. Unlike the expert version, in which all intervention options were on the same level, the stakeholder engagement process resulted in a program with 3 different levels. The first level includes mandatory nonpharmacological interventions, the second includes nonpharmacological choice-based interventions, and the third includes pharmacological interventions for severe CRF. The resulting stakeholder based integrative CRF treatment program was implemented as clinical practice guideline at our clinic (Institute for Complementary and Integrative Medicine, University Hospital Zurich). Through the stakeholder engagement approach, we integrated the needs and preferences of people who are directly affected by CRF. This resulted in an integrative CRF treatment program with graded recommendations for interventions and therefore potentially greater sustainability in a usual care setting.

  6. Efficacy of a multidisciplinary treatment program in patients with severe fibromyalgia. (United States)

    Casanueva-Fernández, Benigno; Llorca, Javier; Rubió, Josep Blanch I; Rodero-Fernández, Baltasar; González-Gay, Miguel A


    The purpose of this study was to evaluate the efficacy of a multidisciplinary treatment program in patients severely affected by fibromyalgia. Thirty-four fibromyalgia patients were randomly divided into two groups. The control group: 17 women who continued their medical treatment and participated in four educational sessions and the experimental group that included 17 patients who besides the former medical treatment also underwent a weekly 1-h session program for 8 weeks including massage therapy, ischemic pressure on the 18 tender points, aerobic exercise and thermal therapy. At the beginning of the program, there were no significant differences between the two groups in any of the parameters. At the end of treatment, there was a significant improvement in the experimental group in the following items: vitality, social functioning, grip strength and the 6-min walk test. At 1 month after the end of treatment, the experimental group showed significant differences in overall health perception, social functioning, grip strength and the 6-min walk test. At that time, considering the threshold for clinical efficacy set at an improvement of 30% or above for the analyzed variables, 25% of the patients met the requirement for improvement of the following: number of symptoms: Visual Analogic Scale for fatigue, Fibromyalgia Impact Questionnaire and Beck Anxiety Inventory. In conclusion, patients with severe manifestations of fibromyalgia can obtain improvement with a short-term, low-cost and simple-delivery multidisciplinary program. However, additional studies including higher numbers of patients are needed to confirm the beneficial effect of this treatment program.

  7. Oral Anaerobic Bacteria in the Etiology of Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Mesut Öğrendik


    Full Text Available Ankylosing spondylitis (AS is associated with periodontitis. Anti– Porphyromonas gingivalis and anti– Prevotella intermedia antibody titers were higher in patients with spondyloarthritis than in healthy people. Sulfasalazine is an effective antibiotic treatment for AS. Moxifloxacin and rifamycin were also found to be significantly effective. The etiology hypothesis suggests that oral anaerobic bacteria such as Porphyromonas spp and Prevotella spp contribute to the disease. These bacteria have been identified in AS, and we will discuss their pathogenic properties with respect to our knowledge of the disease. Periodontal pathogens are likely to be responsible for the development of AS in genetically susceptible individuals. This finding should guide the development of more comprehensive and efficacious treatment strategies for AS.

  8. Halitosis: Current concepts on etiology, diagnosis and management (United States)

    Kapoor, Uditi; Sharma, Gaurav; Juneja, Manish; Nagpal, Archna


    Halitosis or oral malodor is an offensive odor originating from the oral cavity, leading to anxiety and psychosocial embarrassment. A patient with halitosis is most likely to contact primary care practitioner for the diagnosis and management. With proper diagnosis, identification of the etiology and timely referrals certain steps are taken to create a successful individualized therapeutic approach for each patient seeking assistance. It is significant to highlight the necessity of an interdisciplinary method for the treatment of halitosis to prevent misdiagnosis or unnecessary treatment. The literature on halitosis, especially with randomized clinical trials, is scarce and additional studies are required. This article succinctly focuses on the development of a systematic flow of events to come to the best management of the halitosis from the primary care practitioner's point of view. PMID:27095913

  9. Infertility in Mazandaran province - north of Iran: an etiological study

    Directory of Open Access Journals (Sweden)

    Nadali Musanejad


    Full Text Available Background: The prevalence and etiology of infertility are not similar in different parts of the world. There are only few reports of this topic in Iran.Objective: This study was conducted to determine the clinical patterns and major causes of infertility in Mazandaran province in north of Iran.Materials and Methods: The medical records of 3734 consecutive couples attending two infertility clinics in Mazandaran province, from 2003 to 2008, were reviewed. The couples had not had a viable birth after at least 1 year of unprotected intercourse and were fully investigated.Results: Of the entire samples, 78.7% had primary infertility and 21.3% had secondary infertility. The mean duration of infertility in couples was 5.7±4 years. The etiology of infertility in couples revealed; male factor in 38.9%, female factor in 34.7%, combined factors in 14.6% and undetermined cause in 11.8%.Conclusion: In this study, delayed attendance of infertile couples to the infertility clinic was found. Therefore, there is a need to revise public health program on infertility to focus on the education and prevention of infertility and its risk factors.

  10. Service dog training program for treatment of posttraumatic stress in service members. (United States)

    Yount, Rick A; Olmert, Meg D; Lee, Mary R


    In July 2008, social worker and certified service dog trainer Rick Yount created the first Warrior dog-training program designed to be a safe, effective, nonpharmaceutical intervention to treat the symptoms of posttraumatic stress disorder (PTSD) and traumatic brain injury in Veterans and service members undergoing treatment at a large Veterans Administration residential treatment facility. In 2009, Yount was asked to establish the program at a prominent Department of Defense medical center. In October 2010, Yount was invited to create a service dog training program to support the research and treatment mission at the new National Intrepid Center of Excellence (NICoE), in Bethesda, Maryland. This program, now being offered through the nonprofit foundation Warrior Canine Connection, continues to produce anecdotal evidence that training service dogs reduces the PTSD symptoms of Warrior-trainers and that the presence of the dogs enhances the sense of wellness in the NICoE staff and the families of our Wounded Warriors. Under the research leadership of the NICoE, the Warrior Canine Connection research team plans to systematically investigate the physiological, psychological, and behavioral benefits of this program.

  11. Evaluation of a brief treatment program of cognitive behavior therapy for insomnia in older adults. (United States)

    Lovato, Nicole; Lack, Leon; Wright, Helen; Kennaway, David J


    To evaluate the efficacy of a brief 4-w group-administered treatment program of cognitive behavior therapy for insomnia (CBT-I) for older adults with sleep maintenance insomnia. Randomized controlled trial of CBT-I compared to waitlist control with comparisons at pretreatment, posttreatment, and 3-mo follow-up. Flinders University Sleep and Circadian Rhythm Research Laboratory, Adelaide, South Australia. One-hundred eighteen adults with sleep maintenance insomnia (mean age = 63.76 y, standard deviation = 6.45 y, male = 55). A 4-w, group-based treatment program of CBT-I including bedtime restriction therapy, sleep education, and cognitive restructuring. Seven-day sleep diaries, actigraphy, and several self-report measures to assess perceived insomnia severity, daytime functioning, and confidence in and beliefs about sleep. The brief group-administered CBT-I program produced improvements in the timing and quality of sleep including later bedtimes, earlier out-of-bed times, reduced wake after sleep onset, and improved sleep efficiency. Participants also reported a reduction of the Insomnia Severity Index, Flinders Fatigue Scale, Epworth Sleepiness Scale, Daytime Feeling and Functioning Scale, Sleep Anticipatory Anxiety Questionnaire, the Dysfunctional Beliefs and Attitudes Scale, and increased Sleep Self-Efficacy Scale. The treatment program used in the current study has demonstrated potential for a brief, inexpensive, and effective treatment of sleep maintenance insomnia in the older adult population.

  12. An Assessment of Prison-Based Drug Treatment; Texas' In-Prison Therapeutic Community Program. (United States)

    Knight, Kevin; Simpson, D. Dwayne; Chatham, Lois R.; Camacho, L. Mabel


    Provides an overview of a comprehensive, prison-based treatment assessment, including a six-month follow-up study. Results show that 80% of the inmates referred to the program graduated. Graduates demonstrated marked reductions in criminal and drug-use activity and had lower relapse and recidivism rates when compared to other parolees. (RJM)

  13. The Effect of a Multiple Treatment Program and Maintenance Procedures on Smoking Cessation. (United States)

    Powell, Don R.

    The efficacy of a multiple treatment smoking cessation program and three maintenance strategies was evaluated. Phases I and II of the study involved 51 subjects who participated in a five-day smoking cessation project consisting of lectures, demonstrations, practice exercises, negative smoking, and the teaching of self-control procedures. At the…

  14. A Treatment Program for Failure to Thrive: A Cost-Effectiveness Analysis. (United States)

    Karniski, Walt; And Others


    Analysis of treatment of infants suffering from Failure to Thrive placed in foster medical placement homes (MPH, N=17) or admitted to hospitals (N=18) revealed that the MPH infants grew more than hospitalized infants and parents of MPH children had advantages of education and support. The MPH program cost less than 25 percent of hospital care.…

  15. Treatment Plans in Psychiatric Community Housing Programs : Do They Reflect Rehabilitation Principles?

    NARCIS (Netherlands)

    de Heer-Wunderink, Charlotte; Visser, Ellen; Caro-Nienhuis, Annemarie D.; van Weeghel, Jaap; Sytema, Sjoerd; Wiersma, Durk


    Objective: This study examined the extent to which treatment plans of service users of community housing programs measure up to rehabilitation principles according to the Choose-Get-Keep model of psychiatric rehabilitation. The study evaluates whether these plans correspond with service-user and

  16. Evaluating a School-Based Day Treatment Program for Students with Challenging Behaviors (United States)

    Hickman, Antoine Lewis


    Jade County Public Schools has provided school-based therapeutic day treatment in its public schools for more than 10 years. This program was adopted by the school system to provide an intervention in the school and classroom to address the challenging behaviors of students with emotional and behavioral disorders. Currently, three human services…

  17. Innovative Adolescent Chemical Dependency Treatment and Its Outcome: A Model Based on Outward Bound Programming. (United States)

    McPeake, John D.; And Others


    Describes adolescent chemical dependency treatment model developed at Beech Hill Hospital (New Hampshire) which integrated Twelve Step-oriented alcohol and drug rehabilitation program with experiential education school, Hurricane Island Outward Bound School. Describes Beech Hill Hurricane Island Outward Bound School Adolescent Chemical Dependency…

  18. Expansion of HIV-1 screening and anti-retroviral treatment programs ...

    African Journals Online (AJOL)

    Objective: To report the expansion of HIV-1 screening, enrollment in an ART program, and treatment outcomes over twelve months among HIV-positive patients at a nonprofit, non-governmental faith-based clinic providing free and holistic care in Jos City, Plateau State, Nigeria. Design: This was a retrospective analysis of ...

  19. Permanent maxillary canines - review of eruption pattern and local etiological factors leading to impaction. (United States)

    Sajnani, Anand K


    The position of the permanent maxillary canine at the angle of the mouth is strategically significant in maintaining the harmony and symmetry of the occlusal relationship. However, the maxillary canine is the second most frequently impacted tooth, with prevalence reported to be between 1% and 2%. Moreover, treatment of this condition is often complex and involves substantial time and financial cost. Hence, it is only prudent to monitor the eruption and identify the etiological factors that lead to impaction of the maxillary canine. Numerous researchers have tried to identify specific and nonspecific etiological factors responsible for displacement of canines. The purpose of this review was to track the development processes of maxillary canines and determine the hindrances that affect the eruption at different ages. Awareness of the eruption process and etiology of noneruption will help to reduce the incidence of impacted canines by allowing for early recognition and interceptive treatment. © 2013 Wiley Publishing Asia Pty Ltd.

  20. [Perspective of peer helpers regarding their experience animating a self-treatment program for panic disorders]. (United States)

    Perreault, Michel; Bouchard, Stéphane; Lapalme, Micheline; Laverdure, Anick; Audet, Denis; Cusson, Jean-Claude; Zacchia, Camillo; Milton, Diana; Sam Tion, Michaël; Chartier-Otis, Mariko; Marchand, André; Bélanger, Claude


    Support groups can help to reach individuals with anxiety disorders who are not or are only partly obtaining health services. The present study is based on a program that involves peer helpers as animators of a self-treatment group (Zéro-ATAQ). Their perspective has been documented in order to identify the aspects of the program which can be improved. Eleven peer helpers led the 12 sessions of the program, which was dispensed in four regions of Quebec for 32 persons having panic disorders with agoraphobia. The perspectives of ten peer animators were documented based on a semi-structured interview that took place at the end of the program, and a focus group that was held over six months later with peer animators from each of the groups. Their comments were transcribed and a thematic content analysis was conducted. All of the peer helper animators reported that they enjoyed participating in the program, that they appreciated being able to help others having an anxiety disorder, and that the program helped them in their role as animators of these types of activities. Nearly all of the peer helpers emphasized the importance of being able to count on the supervision of a professional when needed. This study revealed (1) the feasibility of implementing a program of this kind in partnership with peers, (2) the qualifications necessary to lead this type of program, (3) the requirements in terms of training and available material, and (4) the importance of supervision.

  1. [Laser treatment for retinopathy of prematurity in neonatal intensive care units. Premature Eye Rescue Program]. (United States)

    Maka, Erika; Imre, László; Somogyvári, Zsolt; Németh, János


    Retinopathy of prematurity is a leading cause of childhood blindness around the world. The Department of Ophthalmology at the Semmelweis University and the Peter Cerny Neonatal Emergency and Ambulance Service started an innovative Premature Eye Rescue Program to reduce the non-essential transport of premature babies suffering from retinopathy of prematurity. During the first 5 years 186 eyes of 93 premature babies were treated at the bedside with stage 3 retinopathy of prematurity in the primary hospitals. In this first 5-years period the authors reduced the number of transports of premature babies for laser treatment; 93 children avoided the unnecessary transport, saving altogether a distance of 21,930 kilometers for children, as well as the ambulance service. The Premature Eye Rescue Program offers a good and effective alternative for treatment of retinopathy in the primary hospitals. The authors propose the national extension of this program.

  2. Depressive symptoms as a predictor of alcohol relapse after residential treatment programs for alcohol use disorder. (United States)

    Suter, Marius; Strik, Werner; Moggi, Franz


    Alcohol use disorder (AUD) and depressive disorders often co-occur. Findings on the effects of major depressive disorder (MDD) or depressive symptoms on posttreatment alcohol relapse are controversial. The study's aim is to examine the association of MDD and depressive symptoms with treatment outcomes after residential AUD programs. In a naturalistic-prospective, multisite study with 12 residential AUD treatment programs in the German-speaking part of Switzerland, 64 patients with AUD with MDD, 283 patients with AUD with clinically significant depressive symptoms at admission, and 81 patients with AUD with such problems at discharge were compared with patients with AUD only on alcohol use, depressive symptoms, and treatment service utilization. MDD was provisionally identified at admission and definitively defined at discharge. Whereas patients with MDD did not differ from patients with AUD only at 1-year follow-up, patients with AUD with clinically significant depressive symptoms had significantly shorter time-to-first-drink and a lower abstinence rate. These patients also had elevated AUD indices and treatment service utilization for psychiatric disorders. Our results suggest that clinically significant depressive symptoms are a substantial risk factor for relapse so that it may be important to treat them during and after residential AUD treatment programs. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Etiology of hearing loss in children.

    Directory of Open Access Journals (Sweden)

    José Ignacio BENITO-OREJAS


    Full Text Available Introduction and objective: The neonatal hearing loss is one of the most common disabilities, with lifelong implications for the child and his family. The implementation of the universal newborn hearing screening and the development in molecular medicine, genetic and integrative neuroscience has perfected the early diagnosis of the hearing loss children and consequently its intervention. With this work, we want to clarify the audiological aspects and causes of the permanent hearing loss diagnosed during the past 20 years. Method: We reviewed retrospectively the records of the children diagnosed with less than 3 years of age of permanent hearing loss, during the period 1994-2015, in a tertiary center. Evaluate the time of home, laterality, type and degree of hearing loss. Depending on the background, genetic testing and other complementary explorations, we present the results of our diagnostic study. Results: In the study-population (n = 183, 71% of the permanent hearing loss > 30 dB HL was diagnosed at birth (congenital. Its main features are the bilaterality (81%, the predominance sensorineural (85% and the grade profound (42% or moderate (30%, more prevalent in the unilateral forms. About the etiologic diagnosis, a 47% of the cases are of origin genetic (29% of which are syndromic, a 25% of cause environmental and a 28% unknown. Discussion: Our results are consistent for the generally accepted distribution of causes, but there are discrepancies in the literature. Despite the different tests used, we had to infer the etiology in 62% of children with hearing loss, finally unknown by 28%. Conclusions: We consider fundamental the monitoring for a consensus standardized etiological protocol that orient in the diagnostic process of hearing loss in children.

  4. The Cost of Providing Comprehensive HIV Treatment in PEPFAR-Supported Programs (United States)

    Menzies, Nicolas A; Berruti, Andres A; Berzon, Richard; Filler, Scott; Ferris, Robert; Ellerbrock, Tedd V; Blandford, John M


    PEPFAR, national governments, and other stakeholders are investing unprecedented resources to provide HIV treatment in developing countries. This study reports empirical data on costs and cost trends in a large sample of HIV treatment sites. In 2006–2007, we conducted cost analyses at 43 PEPFAR-supported outpatient clinics providing free comprehensive HIV treatment in Botswana, Ethiopia, Nigeria, Uganda, and Vietnam. We collected data on HIV treatment costs over consecutive 6-month periods from scale-up of dedicated HIV treatment services at each site. The study included all patients receiving HIV treatment and care at study sites (62,512 ART and 44,394 pre-ART patients). Outcomes were costs per-patient and total program costs, subdivided by major cost categories. Median annual economic costs were $202 (2009 USD) for pre-ART patients and $880 for ART patients. Excluding ARVs, per-patient ART costs were $298. Care for newly initiated ART patients cost 15–20% more than for established patients. Per-patient costs dropped rapidly as sites matured, with per-patient ART costs dropping 46.8% between first and second 6-month periods after the beginning of scale-up, and an additional 29.5% the following year. PEPFAR provided 79.4% of funding for service delivery, and national governments provided 15.2%. Treatment costs vary widely between sites, and high early costs drop rapidly as sites mature. Treatment costs vary between countries and respond to changes in ARV regimen costs and the package of services. While cost reductions may allow near-term program growth, programs need to weigh the trade-off between improving services for current patients and expanding coverage to new patients. PMID:21412127

  5. Clinical features and etiology of retinal vasculitis in Northern Thailand

    Directory of Open Access Journals (Sweden)

    Supanut Apinyawasisuk


    Full Text Available Purpose: To report on the clinical features and etiology of patients with retinal vasculitis (RV. Materials and Methods: We reviewed medical records of 47 patients (75 affected eyes diagnosed with RV. Clinical presentations, ocular complications, associated systemic diseases, and treatment regimens were registered. Results: Etiology of RV included infectious causes in 10/47, (21% while an association with systemic and/or ocular non-infectious disorders was noted in 22/47 (47%. Eales′ disease and Behcet′s disease represented the most common clinical entities in non-infectious group while tuberculosis-associated RV was diagnosed in 6/10 (60% among those with infectious disorders. RV was bilateral in 28/47 (60% patients. Retinal veins were most commonly affected (72%, 34/47. Involvement of arteries was present in 12/47 (25% and was associated with viral infections and Behcet′s disease. Ocular complications developed in 60/75 (80% eyes. The most common complications were elevated intraocular pressure and/or glaucoma (33/75, 44%. Retinal detachment, vitreous hemorrhage, and cystoid macular edema developed in similar percentages (15%. Conclusions: RV in Thailand manifested mostly in male patients, was typically bilateral and involved mostly veins. Involvement of arteries was observed in patients with viral infections and Behcet′s disease. Tuberculosis was the most common infectious cause.

  6. Epiglottic cyst as an etiological factor of globus sensation. (United States)

    Polat, Bahtiyar; Karahatay, Serdar; Gerek, Mustafa


    Globus is a subjective complaint that describes a sensation of a lump or a foreign body in the throat. Despite being a well-known and common clinical condition, the etiological factors have not been definitely elucidated yet. The study was set up to ascertain the relationship between epiglottic cysts and globus sensation. All patients undergoing investigation and treatments for globus sensation were included in the study. Patients with epiglottic cysts but no other possible causes of globus sensation were constituted the series of patients. Patients were asked to assess the levels of complaint before and after the carbon dioxide (CO2) laser excisions of the cysts. Epiglottic cysts were found in 10 (5.4%) of the 182 patients. Three of these 10 patients who had concomitant diseases or conditions that may cause globus sensation and one patient who refused the surgery were excluded from the study. All the remaining six patients reported relief of the globus sensation after the CO2 laser excisions of the cysts. Our results, obtained from this limited series, indicated that epiglottic cysts may be considered as one of the etiological factors of globus sensation.

  7. Testicular cancer - epidemiology, etiology and risk factors

    International Nuclear Information System (INIS)

    Ondrusova, M.; Ondrus, D.


    Testicular cancer is a rare malignancy, that affects 1-2 % of male population. Trends of testicular cancer mortality are stable for a long period of time, even that incidence shows a rapid growth. This paper deals with national trends in testicular cancer incidence and mortality in Slovakia from 1968 to 2007 by using the join-point regression analysis to propose potential changes in health care. The authors noted a statistically significant increase in the values of incidence and improvement in mortality after 1975. Paper also deals with the etiology and risk factors of this malignancy. (author)

  8. Etiology, evaluation, and management of xerostomia. (United States)

    Millsop, Jillian W; Wang, Elizabeth A; Fazel, Nasim

    Xerostomia is defined as the complaint of oral dryness. It is a condition that primarily affects older adults and can have a significant negative effect on one's quality of life. Patients with xerostomia often do not have objective signs of hyposalivation. The underlying etiology of xerostomia includes a variety of systemic diseases and local factors. Our aim is to provide a comprehensive review of the differential diagnosis, evaluation, and management of xerostomia. Prompt diagnosis and management can alleviate the clinical manifestations of this debilitating condition. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Etiology and Treatment of Enteritis Disease in Cultured Junviles of Apostichopus japonicus%刺参(Apostichopus japonicus)保苗期“肠炎病”及其治疗方法

    Institute of Scientific and Technical Information of China (English)

    逄慧娟; 廖梅杰; 李彬; 荣小军; 王印庚; 张正; 孙金生; 孟繁林


    ) and specific growth rate (SGR).The results showed that the sea cucumber infected with the enteritis disease displayed dark body color,poor feeding rate,weak motility and adhesion ability.The ingested food in the intestine of sick sea cucumber was discontinuous,and large amount of yellow-white mucus was found in the intestine.The intestinal wall was brittle,poor toughness and easy to fracture.A large amount of bacteria was detected in the intestinal tract under the microscope.The histopathological analysis on infected sea cucumbers revealed the scattered intestinal villus,dispersed mucous layer,scattered connective tissue and obviously separated muscle layers.One dominant bacterium (In-l) was isolated from the infected sea cucumber intestine and was confirmed as the causative pathogen using the artificial infection experiment.The bacteriological analysis indicated that the deteriorated feed (algae powder) was most likely the origin of the pathogen.The pathogen was identified as Vibrio harveyi using morphology observation,physiological and biochemical,and molecular methods (16S rDNA and gyrB).The strain was highly sensitive to 12 kinds of drugs such as ceftriaxone,azithromycin,doxycycline and florfenicol.The medication treatment using florfenicol with three different methods showed that medicated bath treatment was the most effective and achieved the best results of the WGR of (24.23±0.41)% and SGR of (0.77±0.01) %/d.The study provides the theoretical basis and technical reference for disease prevention and control in sea cucumber culture and its healthy breeding.

  10. Renal cortical calcification in syngeneic intact rats and those receiving an infrarenal thoracic aortic graft: possible etiological roles of endothelin, nitrate and minerals, and different preventive effects of long-term oral treatment with magnesium, citrate and alkali-containing preparations. (United States)

    Schmiedl, A; Schmiedl, P O; Bonucci, E; Seitz, T; Schwille, R M; Manoharan, M


    Renal cortical nephrocalcinosis (C-NC) is a rare disorder of uncertain etiology. Using highly inbred (syngeneic) male Lewis rats, we describe the spontaneous occurrence of histologically detectable C-NC in sham operated control rats (Sham; n=12), its aggravation following grafting of the ascending thoracic aorta from a donor rat to the infrarenal aorta of a recipient (ATx; n=12), and differences in C-NC inhibition after 12 weeks of oral administration of magnesium (Mg), citrate and alkali. C-NC is characterized by Kossa-positive areas located in cells of the proximal tubule close to blood vessels and also, to a lesser extent, within glomeruli. After ATx there was vascular overproduction of endothelin (ET-1) but decreased production of nitrate; in renal cortical tissue there was an excess of calcium over Mg and phosphorus and oxalate over citrate. In plasma there was an increase in calcium and creatinine within the normal range. Calcification of tubular cells was eliminated by a preparation containing potassium, sodium and bases (from citrate degradation and bicarbonate) in addition to Mg. Less effective than the latter was Mg-potassium citrate and least effective, Mg citrate. The former treatment also normalized calcemia and urinary nitrate, but only incompletely suppressed ET-1 and had no significant effect on glomerular calcification or tissue and urinary oxalate. Urinary ET-1 excess appeared directly related to the cortical tissue calcium/Mg ratio, and urinary excretion of Mg, citrate and total protein appeared to be inversely related to the severity of C-NC. It was concluded that (1) the highly inbred rat is prone to precipitation of calcium phosphate in the renal cortex; (2) this type of C-NC occurs in close proximity to and within renal vascular tissue and is associated with an imbalance of vasoconstrictors and vasodilators of endothelial origin; (3) effective inhibition of C-NC can be achieved by an alkalinizing combination of Mg, potassium, sodium and

  11. Rape: psychopathology, theory and treatment. (United States)

    Gannon, Theresa A; Collie, Rachael M; Ward, Tony; Thakker, Jo


    Whether treatment programs are effective at rehabilitating rapists is yet to be determined empirically. From a scientist-practitioner perspective, treatment should be based on an empirical understanding of rape and rapists, and evidence-based knowledge of treatment outcome with rapists. In this paper we comprehensively review the characteristics of rapists, etiological features implicated in the commission of rape, and relevant treatment outcome research. We pay particular attention to contemporary knowledge about the core vulnerabilities and features required to understand and treat rapists effectively, and, where possible, highlight similarities and differences between rapists, child molesters and non-sexual violent offenders. We use an epistemological framework to (a) critique the various etiological accounts of rape available and (b) help guide professionals' use of such knowledge in both treatment design and evaluation. Gaps in the understanding of rapists' characteristics and etiological features are highlighted, as are discrepancies between current knowledge and treatment approaches. We conclude by highlighting areas for future research and practice innovation.

  12. Obesity in Children: Definition, Etiology and Approach. (United States)

    Aggarwal, Bhawana; Jain, Vandana


    Childhood obesity is an important public health issue worldwide. Urbanization, sedentary lifestyle and change in food habits are the chief reasons behind this pandemic. In a small proportion of children, obesity is the result of endocrine, syndromic or monogenic causes. The present paper summarizes the methods, definitions and cut-offs for identification of obesity in children. We have briefly reviewed the various techniques used for estimation of body fat in children and the cut-offs for defining obesity based on body fat percentage, and the reference curves based on body mass index and waist circumference. The etiology of obesity in children, including individual behaviors, macro- and micro-environmental influences, and endocrine causes have been discussed, and an approach to etiological assessment of obese children has been presented. Special emphasis has been laid on clinical pointers that suggest the presence of syndromic, endocrine or monogenic forms of obesity, such as, short stature, dysmorphism, neurocognitive impairment and early age at onset.

  13. Review: Recent Finding about Etiology of

    Directory of Open Access Journals (Sweden)

    Parvaneh Karim-Zadeh


    Full Text Available Autism and the other disorders in the autism spectrum are behaviorally defined syndromes that can be a prolonged disorder. The specific underlying neurophysiologic mechanisms simply not known, but probably several causes lead to disorders in the autism spectrum. This article is summary of recent research about etiology of autism but the search must continue. 1 Neurobiological origin, the neurobiological investigations show the role of dopamine and serotonin in pathogenesis of autism. 2 Genetic, studies in autism was established the hypothesis that genetic factors can be etiologically significant in subsets of patients. 3 With the Regional cerebral glucose metabolism measurement, autistic children had a left> right anterior rectal gyrus asymmetry as opposed to the normal right> left asymmetry in that region. 4 With the Regional cerebral blood flow measurement no cortical regional abnormalities were found. 5 Association of epilepsy and autism pediatric epilepsy lead to autistic regression. 6 Association of tuberous sclerosis and autism the number of tubers was significantly greater in individuals with a diagnosis of autism than in those without this diagnosis. 7 Embryological origin for autism, the results and two new lines of evidence that place the initiating injury for autism around the time of neural tube closure. 8 Obstetric complications and later autistic disorder, these data do not support the view that obstetric complications increase the risk for later autism. 9 Food allergy, recent findings show a relationship between food allergy and infantile autism. 10 Head circumferences measurement in children with autism show the large head circumference and increased growth.

  14. Recurring waterbird mortalities and unusual etiologies (United States)

    Cole, Rebecca A.; Franson, J. Christian; Boere, Gerard C.; Galbraith, Colin A.; Stroud, David A.


    Over the last decade, the National Wildlife Health Center of the United States Geological Survey has documented various largescale mortalities of birds caused by infectious and non-infectious disease agents. Some of these mortality events have unusual or unidentified etiologies and have been recurring. While some of the causes of mortalities have been elucidated, others remain in various stages of investigation and identification. Two examples are discussed: 1) Leyogonimus polyoon (Class: Trematoda), not found in the New World until 1999, causes severe enteritis and has killed over 15 000 American Coot Fulica americana in the upper mid-western United States. The geographic range of this parasite within North America is predicted to be limited to the Great Lakes Basin. 2) In the early 1990s, estimates of up to 6% of the North American population of the Eared Grebe Podiceps nigricollis died at Salton Sea, California, with smaller mortalities occurring throughout the 1990s. Birds were observed to have unusual preening behaviour, and to congregate at freshwater drains and move onto land. Suggested etiologies included interactions of contaminants, immuno-suppression, an unusual form of a bacterial disease, and an unknown biotoxin. During studies carried out from 2000 to 2003, Eared Grebe mortality did not approach the level seen in the early 1990s and, although bacteria were identified as minor factors, the principal cause of mortality remains undetermined. The potential population impact of these emerging and novel disease agents is currently unknown.

  15. First external quality assurance program for bloodstream Real-Time PCR monitoring of treatment response in clinical trials of Chagas disease.

    Directory of Open Access Journals (Sweden)

    Juan C Ramírez

    Full Text Available Real-Time PCR (qPCR testing is recommended as both a diagnostic and outcome measurement of etiological treatment in clinical practice and clinical trials of Chagas disease (CD, but no external quality assurance (EQA program provides performance assessment of the assays in use. We implemented an EQA system to evaluate the performance of molecular biology laboratories involved in qPCR based follow-up in clinical trials of CD. An EQA program was devised for three clinical trials of CD: the E1224 (NCT01489228, a pro-drug of ravuconazole; the Sampling Study (NCT01678599, that used benznidazole, both conducted in Bolivia; and the CHAGASAZOL (NCT01162967, that tested posaconazole, conducted in Spain. Four proficiency testing panels containing negative controls and seronegative blood samples spiked with 1, 10 and 100 parasite equivalents (par. eq./mL of four Trypanosoma cruzi stocks, were sent from the Core Lab in Argentina to the participating laboratories located in Bolivia and Spain. Panels were analyzed simultaneously, blinded to sample allocation, at 4-month intervals. In addition, 302 random blood samples from both trials carried out in Bolivia were sent to Core Lab for retesting analysis. The analysis of proficiency testing panels gave 100% of accordance (within laboratory agreement and concordance (between laboratory agreement for all T. cruzi stocks at 100 par. eq./mL; whereas their values ranged from 71 to 100% and from 62 to 100% at 1 and 10 par. eq./mL, respectively, depending on the T. cruzi stock. The results obtained after twelve months of preparation confirmed the stability of blood samples in guanidine-EDTA buffer. No significant differences were found between qPCR results from Bolivian laboratory and Core Lab for retested clinical samples. This EQA program for qPCR analysis of CD patient samples may significantly contribute to ensuring the quality of laboratory data generated in clinical trials and molecular diagnostics laboratories of

  16. An evaluation of substance misuse treatment providers used by an employee assistance program. (United States)

    Miller, N A


    Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.

  17. The Development and Validation of a Transformational Leadership Survey for Substance Use Treatment Programs (United States)

    Edwards, Jennifer R.; Knight, Danica K.; Broome, Kirk M.; Flynn, Patrick M.


    Directors in substance use treatment programs are increasingly required to respond to external economic and socio-political pressures. Leadership practices that promote innovation can help offset these challenges. Using focus groups, factor analysis, and validation instruments, the current study developed and established psychometrics for the Survey of Transformational Leadership. In 2008, clinical directors were evaluated on leadership practices by 214 counselors within 57 programs in four U.S. regions. Nine themes emerged: integrity, sensible risk, demonstrates innovation, encourages innovation, inspirational motivation, supports others, develops others, delegates tasks, and expects excellence. Study implications, limitations and suggested future directions are discussed. Funding from NIDA. PMID:20509734

  18. Study and establishment of a computer program for radiotherapy treatment planning development

    International Nuclear Information System (INIS)

    Djennaoui, N.


    The modern radiotherapy requires the use of computers. In addition to their accuracy, computers involve an appreciable saving of time in the calculation of isodoses, permitting us to change several times a technique in order to choose the best dose distribution for each case of tumor. The aim of this work was to set a computer program calculating a suitable dose distribution for a given treatment. The algorithm of calculation of the depth dose used in our program permits us to calculate the dose distribution for all photon energies used in radiotherapy, whatever are the energy and modification of the field by the use of wedge filters or bolus [fr

  19. The relationship between the quality of drug user treatment and program completion: understanding the perceptions of women in a prison-based program. (United States)

    Strauss, S M; Falkin, G P


    To determine why some women offenders complete prison-based drug user treatment and others leave early, clients' (N = 101) perceptions of various aspects of the quality of the treatment experience were compared. Analyses of both quantitative and qualitative data indicate that clients who completed the program had a more favorable perception of staff and felt empowered by the experience in treatment. Most of the clients who left early did so because of conflicts or disagreements with the program's rules. We discuss how a supportive approach to personal development may enhance client perceptions of program quality and increase retention rates.

  20. HIV lipodystrophy etiology and pathogenesis. Body composition and metabolic alterations: etiology and pathogenesis. (United States)

    Kotler, Donald P


    The results of epidemiologic investigations have clearly indicated that the development of lipodystrophy is multifactorial. Factors related to HIV infection, hormonal influences, mitochondrial dysfunction, cytokine activation related to immune reconstitution, and individual genetic predisposition all have been hypothesized as etiologic. Recent studies suggest that immune dysregulation rather than HIV infection per se may be the predominant factor in the development of lipodystrophy.

  1. Implementation of a management applied program for liquid radioactive waste treatment

    International Nuclear Information System (INIS)

    Lee, Y. H.; Ann, S. J.; Jo, H. S.; Son, J. S.


    A data collection of a liquid radioactive waste treatment process of a research organization became necessary while developing the RAWMIS(Radioactive Waste Management Integration System) which it can generate personal history management for efficient management of a waste, documents, all kinds of statistics. This paper introduces an input and output application program design to do to database with data in the results and a stream process of a treatment that analyzed the waste occurrence present situation and data by treatment process. Data on the actual treatment process that is not limited experiment improve by a document, human traces, saving of material resources and improve with efficiency of tracking about a radioactive waste and a process and give help to radioactive waste material valance and inventory study

  2. DOE's Innovative Treatment Remediation Demonstration Program accelerating the implementation of innovative technologies

    International Nuclear Information System (INIS)

    Hightower, M.


    A program to help accelerate the adoption and implementation of new and innovative remediation technologies has been initiated by the Department of Energy's (DOE) Environmental Restoration Program Office (EM40). Developed as a Public-Private Partnership program in cooperation with the US Environmental Protection Agency's (EPA) Technology Innovation Office (TIO) and coordinated by Sandia National Laboratories, the Innovative Treatment Remediation Demonstration (ITRD) Program attempts to reduce many of the classic barriers to the use of new technologies by involving government, industry, and regulatory agencies in the assessment, implementation, and validation of innovative technologies. In this program, DOE facilities work cooperatively with EPA, industry, national laboratories, and state and federal regulatory agencies to establish remediation demonstrations using applicable innovative technologies at their sites. Selected innovative technologies are used to remediate small, one to two acre, sites to generate the full-scale and real-world operating, treatment performance, and cost data needed to validate these technologies and gain acceptance by industry and regulatory agencies, thus accelerating their use nationwide. Each ITRD project developed at a DOE site is designed to address a typical soil or groundwater contamination issue facing both DOE and industry. This includes sites with volatile organic compound (VOC), semi-VOC, heavy metal, explosive residue, and complex or multiple constituent contamination. Projects are presently underway at three DOE facilities, while additional projects are under consideration for initiation in FY96 at several additional DOE sites. A brief overview of the ITRD Program, program plans, and the status and progress of existing ITRD projects are reviewed in this paper

  3. [Recent achievements in the microbiological etiology of dental caries]. (United States)

    Jing, Chen; Lei, Cheng; Xuedong, Zhou; Xian, Peng


    Dental caries is the most common chronic infectious disease of the oral cavity. The bacterium Streptococcus mutans is the sole pathogen that causes this disease. However, substantial evidence suggests that prevention and treatment strategies developed from traditional "cariogenic pathogen theory" are inefficient in reducing the prevalence of dental caries. An increasing number of individuals adopt the ecological view of the microbiota in the pathogenesis of dental caries. Recent technological improvements have enabled the detection and analysis of oral microorganisms, and many studies have focused on this area. The core microbiota is defined as a cluster of microbes playing critical roles in the initial and development phases of dental caries and may provide future direction for microorganism-related etiological studies.

  4. [Etiology and therapy in anorexia nervosa (author's transl)]. (United States)

    Wurst, E


    ASPERGER (1963) mentioned as a very important etiological aspect of anorexia nervosa a desintegration of intellectual and thymical functions causing the fact, that these patients are not able to accept the role of an adult, especially that one of a woman. We discuss that statment in connexion with ERIKSON'S (1974) concept about "ego-identity" ("Ich-Identitat") and "negative-identity" ("negative Identitat"). The pathological family-structure seems to reinforce the situation and the existence of inadequate behavior of patients with anorexia nervosa, who are often introverted and predestinated for conditioning. The therapy of these patients should focuse on the development of ego-identity, including the treatment of the family members, the modification of the inadapted behavior and a special endocrinological therapy.

  5. Causes and patterns of referral to a tertiary, multidisciplinary program for the treatment of childhood obesity. (United States)

    Yaeger-Yarom, Gili; Nemet, Dan; Eliakim, Alon


    Despite the childhood obesity epidemic, few obese children receive therapy and relatively few weight management multidisciplinary programs exist. The objective of this study was to examine the patterns and causes for obese children referrals to a tertiary multidisciplinary childhood obesity treatment program. A total of 227 children (10.6 +/- 2.6 years; 108 boys, 119 girls) were evaluated at the beginning of the programs for personal and familial demographic and anthropometric details, the referring agent to the program, and the main reasons for participation and for the child's desire to lose weight. The majority of participants had an obese family member (83%), in particular an obese parent (62%). The majority of patients were self-referred (86.8%), mainly by their mothers (74%). Only a small fraction were referred by healthcare providers (15.4%). The desire to improve appearance (44.5%), social/psychological issues (39.2%) and the will to improve fitness (29.5%) were the main reasons for joining the program. Understanding the motives for participation and referral patterns can improve recruitment and participation of obese children in weight reduction intervention programs.

  6. Exercise program for children and adolescents with leukemia and lymphoma during treatment: A comprehensive review. (United States)

    Zucchetti, Giulia; Rossi, Francesca; Chamorro Vina, Carolina; Bertorello, Nicoletta; Fagioli, Franca


    An exercise program (EP) during cancer treatment seems to be a valid strategy against physiological and quality-of-life impairments, but scientific evidence of benefits among pediatric patients is still limited. This review summarizes the literature focused on randomized controlled trials of EP offered to patients during leukemia and lymphoma treatment. Studies published up to June 2017 were selected from multiple databases and assessed by three independent reviewers for methodological validity. The review identified eight studies, but several types of bias have to be avoided to provide evidence-based recommendations accessible to patients, families, and professionals. © 2018 Wiley Periodicals, Inc.

  7. Epidemiology, etiology, and treatment of chronic leg ulcer ...

    African Journals Online (AJOL)

    recovered accounting for 32.61% and 23.91%, respectively. Radiological investigation with plain. X-ray showed evidence of bony involvement in two patients. We managed our patients with wound dressing using. Table 1: Associated medical conditions seen in patients with chronic leg ulcer (n=60). Frequency Percent.

  8. Epidemiology, etiology, and treatment of chronic leg ulcer ...

    African Journals Online (AJOL)

    Background: Chronic leg ulcer (CLU) is reported to have an impact on virtually all ... Conclusion: Most patients benefited from debridement with or without split thickness skin graft or flap. .... low incidence of arterial and venous diseases in.

  9. Postpartum depression: Etiology, treatment and consequences for maternal care. (United States)

    Brummelte, Susanne; Galea, Liisa A M


    This article is part of a Special Issue "Parental Care". Pregnancy and postpartum are associated with dramatic alterations in steroid and peptide hormones which alter the mothers' hypothalamic pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes. Dysregulations in these endocrine axes are related to mood disorders and as such it should not come as a major surprise that pregnancy and the postpartum period can have profound effects on maternal mood. Indeed, pregnancy and postpartum are associated with an increased risk for developing depressive symptoms in women. Postpartum depression affects approximately 10-15% of women and impairs mother-infant interactions that in turn are important for child development. Maternal attachment, sensitivity and parenting style are essential for a healthy maturation of an infant's social, cognitive and behavioral skills and depressed mothers often display less attachment, sensitivity and more harsh or disrupted parenting behaviors, which may contribute to reports of adverse child outcomes in children of depressed mothers. Here we review, in honor of the "father of motherhood", Jay Rosenblatt, the literature on postnatal depression in the mother and its effect on mother-infant interactions. We will cover clinical and pre-clinical findings highlighting putative neurobiological mechanisms underlying postpartum depression and how they relate to maternal behaviors and infant outcome. We also review animal models that investigate the neurobiology of maternal mood and disrupted maternal care. In particular, we discuss the implications of endogenous and exogenous manipulations of glucocorticoids on maternal care and mood. Lastly we discuss interventions during gestation and postpartum that may improve maternal symptoms and behavior and thus may alter developmental outcome of the offspring. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. 21 CFR 1301.73 - Physical security controls for non-practitioners; compounders for narcotic treatment programs... (United States)


    ...; compounders for narcotic treatment programs; manufacturing and compounding areas. 1301.73 Section 1301.73 Food... controls for non-practitioners; compounders for narcotic treatment programs; manufacturing and compounding... unauthorized persons may not enter or leave the area without his knowledge. (c) During the production of...

  11. Considering a Private Residential Treatment Program for a Troubled Teen? Questions for Parents and Guardians to Ask (United States)

    Federal Trade Commission, 2008


    Private residential treatment programs for young people offer a range of services, including drug and alcohol treatment, confidence building, military-style discipline, and psychological counseling for a variety of addiction, behavioral, and emotional problems. Many of these programs are intended to provide a less-restrictive alternative to…

  12. Sudden sensorineural hearing loss in children: Etiology, management, and outcome. (United States)

    Pitaro, Jacob; Bechor-Fellner, Avital; Gavriel, Haim; Marom, Tal; Eviatar, Ephraim


    Pediatric sudden sensorineural hearing loss (SSNHL) is uncommon, and the current guidelines for its management refer to adults. Our objective was to review cases of SSNHL in children and examine their etiologies, management, and outcome. We performed a retrospective chart review of all children under the age of 18 years treated for SSNHL between January 2003 and September 2014. Data recorded included age, gender, symptoms, onset of hearing loss, audiometric results, diagnostic studies, treatment, and outcome. Nineteen children were included. Mean age was 14 years (range 7-18 years). Male: female ratio was 9:10. Degree of hearing loss varied from mild to profound across the tested frequencies. Most common accompanying symptom was tinnitus. Serologic tests demonstrated recent Epstein-Barr virus infection in one patient and previous cytomegalovirus infection in six patients. Imaging studies included computed tomography scan (n=3) and/or magnetic resonance imaging (n=12). All imaging studies did not demonstrate any pathology. Treatment included systemic steroids in 19 (100%) children and intratympanic steroids in eight (42%). Hearing completely improved in three (16%) children, partially improved in nine (47%), and there was no improvement in six (32%). One child was lost to follow-up. Viral infection was a common finding in children with SSNHL and no pathological changes were demonstrated on imaging studies. In most patients (63%), hearing improvement was observed. Intratympanic steroid injection can benefit these children. Further studies are required to investigate the etiologies and establish guidelines for the management of SSNHL in children. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. An outcome study of an inpatient treatment program for pathological gamblers. (United States)

    Russo, A M; Taber, J I; McCormick, R A; Ramirez, L F


    In 1972 the Brecksville Unit of the Cleveland Veterans Administration Medical Center began the first inpatient treatment program for pathological gambling in the United States. The 30-day, highly structured gambling treatment program aims for abstinence from gambling, reduction of the urge to gamble, and restoration of a maximum level of social functioning. The authors report the results of a preliminary outcome study of 60 former patients who completed a survey form rating various aspects of their lives one year postdischarge. Fifty-five percent of the respondents reported complete abstinence from gambling since discharge. Chi-square analyses demonstrated significant relationships between abstinence from gambling and improved interpersonal relationships, better financial status, decreased depression, and participation in professional aftercare and Gamblers Anonymous. The authors believe that their initial results support the contention that pathological gambling is a treatable disorder.

  14. Effects of a partnership support program for couples undergoing fertility treatment. (United States)

    Asazawa, Kyoko


    The study's purpose was to examine the effects of providing a partnership support program. It was designed to improve Japanese couples' partnership, maintain quality of life, decrease psychological distress, and improve marital relationship satisfaction while they underwent infertility treatment that included the possibility of using assisted reproductive technology. This quasi-experimental study with a two-group pretest-post-test design used purposive sampling and non-random assignment of 318 consenting Japanese patients from previous phases of assisted reproductive technology fertility treatment who were patients from a fertility clinic in Tokyo, Japan. The intervention group of 152 patients (76 couples) participated in the partnership support program. The comparison group of 166 patients (83 couples) received usual care. Recruitment was age matched. The program provided information and used a participatory-interactive approach to enhance understanding and cooperation in couples undergoing fertility treatment. The main outcome measures were: "partnership", FertiQoL, Quality Marriage Index, and "psychological distress". There were 311 participants (intervention group n = 148; comparison group, n = 163). The intervention group showed significant improvement in the couples' partnerships and a significant decrease in women's psychological distress using subgroup analysis. The partnership support program provided effective improvement in partnership for the couples, and reduced psychological distress for the women; however, it had less impact for the men. The program was not effective in improving couples' overall quality of life (QOL); however, it was effective in improving the "mind-body" aspects of the QOL subscale. © 2015 The Author. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

  15. Racial differences in treatment effect among men in a substance abuse and domestic violence program. (United States)

    Scott, Melanie C; Easton, Caroline J


    It is unclear whether racial differences in treatment effect exist for individuals in substance abuse and domestic violence programs. This study examined racial differences in treatment effect among substance dependent Caucasian and African-American male intimate partner violence (IPV) offenders court mandated to an integrated substance abuse and domestic violence treatment. From baseline to completion of treatment (week 12), 75 participants (39 Caucasian; 36 African-American) were assessed on demographics, substance use, legal characteristics, and use of violence (physical, verbal, and psychological). African-American men served more months incarcerated in their life than Caucasian men. Both groups showed decreases in their use of physical violence and alcohol abuse over treatment. Caucasian men also showed a decrease in their use of verbal abuse. At treatment completion, both groups showed a reduction in physical abuse and alcohol abuse. Caucasian men showed a reduction in their use of verbal abuse, but African-American men did not. Substance dependent African-American male IPV offenders may benefit from interventions that thoroughly target communication skills in addition to issues of substance abuse and IPV to reduce use of verbal abuse and improve treatment outcomes among African American men.

  16. Results from a Community-Based Smoking Cessation Treatment Program for LGBT Smokers

    Directory of Open Access Journals (Sweden)

    Alicia K. Matthews


    Full Text Available Introduction. Little is known about lesbian, gay, bisexual, and transgender (LGBT people’s response to smoking cessation interventions. This descriptive study examined the benefits of a community-based, culturally tailored smoking cessation treatment program for LGBT smokers. Methods. A total of N=198 LGBT individuals recruited from clinical practice and community outreach participated in group-based treatment. Sessions were based on the American Lung Association’s “Freedom from Smoking Program” (ALA-FFS and were tailored to LGBT smokers’ needs. Seven-day smoking point prevalence abstinence served as the primary outcome. Results. Participants (M age = 40.5 were mostly White (70.4% and male (60.5% and had at least a college degree (58.4%. Forty-four percent scored in the moderate range on the Fagerström Test for Nicotine Dependence pretreatment, and 42.4% completed treatment (≥75% sessions. Higher educational attainment and use of nicotine replacement therapy (NRT were associated with treatment completion. Self-reported quit rates were 32.3% at posttreatment assessment. Treatment attendance (OR = 2.45, use of NRT (OR = 4.24, and lower nicotine dependency (OR = 0.73 were positively associated with quitting smoking. Conclusions. Results suggest the benefits of offering LGBT smokers culturally tailored smoking cessation treatments. Future research could improve outcomes by encouraging treatment attendance and promoting NRT uptake.

  17. Predicting changes in drug use and treatment entry for local programs: a case study. (United States)

    Flaherty, E W; Olsen, K; Bencivengo, M


    Recent sharp decline in treatment admissions by opiate abusers stimulated the conduct of a study designed to provide timely data to treatment system administrators for the next cycle of program and budgetary planning. The process of designing the study involved definition of required study characteristics, review of four categories of drug abuse research, and generation of seven locally relevant hypotheses. Interviews were conducted with 335 heroin adicts: 196 new admissions to treatment and 139 "street" addicts not currently in treatment. Major findings were a marked reduction in the quality, availability, and price of heroin; very negative perceptions of methadone maintenance, especially by female respondents; decline in heroin popularity and increase in reported use of alcohol, amphetamines, and barbiturates; and differing perceptions of treatment by sex of respondent. Response patterns suggest that users who are not entering treatment are less "strung-out than those entering treatment because of decline in availability and quality of heroin and consequent increased mixing of drugs. The emphasis in the report is on the conduct of a study which can be timely, feasible, and useful to local planners. The study weaknesses and recommended remedies are discussed, as well as the characteristics which made the findings immediately useful to administrators and planners.

  18. Diabetes Prevention and Treatment Programs for Western PA FY04 and FY05 (United States)


    Monica m. Dinardo, Patrick Forte, Laura Bettencourt, Suzanne Rocks, Mary T . Korytkowski. Use of a Peri- Operative Treatment Prot ocol Improv es...Linda Siminerio, PhD Megan G. Marks, PhD This project was designed to develop a Diabetes Self- Managemen t Education program t o improve access...minimum 20 minutes), and required the addition of clinical, medication managemen t , patient snapshot, patient -provider interface and new lett er

  19. Disseminating contingency management: Impacts of staff training and implementation at an opiate treatment program


    Hartzler, Bryan; Jackson, T. Ron; Jones, Brinn E.; Beadnell, Blair; Calsyn, Donald A.


    Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (interventio...

  20. Developing a Treatment Program for Obesity in Preschool Age Children: Preliminary Data


    Boles, Richard E.; Scharf, Cynthia; Stark, Lori J.


    We developed and tested the feasibility of a behavioral intervention that utilizes clinic and home visitations to reduce overweight in preschool children above the 95th BMI percentile. Five families of preschool children ages 2 to 5 years with a BMI above the 95th percentile and one overweight parent were enrolled in a 24-week behavioral weight management program. Phase I, Intensive Treatment included 12 weekly sessions, alternating group-based clinic sessions and home settings. Phase II, Mai...

  1. The Status of Billing and Reimbursement in Pediatric Obesity Treatment Programs (United States)

    Gray, Jane Simpson; Filigno, Stephanie Spear; Santos, Melissa; Ward, Wendy L.; Davis, Ann M.


    Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service. PMID:23224661

  2. The status of billing and reimbursement in pediatric obesity treatment programs. (United States)

    Gray, Jane Simpson; Spear Filigno, Stephanie; Santos, Melissa; Ward, Wendy L; Davis, Ann M


    Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service.

  3. The potential use of genetics to increase the effectiveness of treatment programs for criminal offenders. (United States)

    Beaver, Kevin M; Jackson, Dylan B; Flesher, Dillon


    During the past couple of decades, the amount of research examining the genetic underpinnings to antisocial behaviors, including crime, has exploded. Findings from this body of work have generated a great deal of information linking genetics to criminal involvement. As a partial result, there is now a considerable amount of interest in how these findings should be integrated into the criminal justice system. In the current paper, we outline the potential ways that genetic information can be used to increase the effectiveness of treatment programs designed to reduce recidivism among offenders. We conclude by drawing attention to how genetic information can be used by rehabilitation programs to increase program effectiveness, reduce offender recidivism rates, and enhance public safety.

  4. The Untreated Addiction: Going Tobacco-Free in a VA Substance Abuse Residential Rehabilitation Treatment Program (SARRTP). (United States)

    Conrad, Megan; Bolte, Teri; Gaines, Leigh; Avery, Zackery; Bodie, Linda


    Despite negative effects of tobacco on the human body and the high prevalence of smoking among those who enter treatment for substance use, few residential programs endorse a tobacco-free policy. Conventional wisdom suggests that it is overwhelming to quit more than one substance at a time, and as a result, many clinicians believe that a shift to a tobacco-free treatment environment is unfeasible. However, the most recent scientific literature suggests the opposite: targeting tobacco use during substance use treatment can increase abstinence rates from both smoking and substances of choice. Therefore, the purpose of the current project is to outline the process by which a residential substance use treatment program within a Veterans Affairs (VA) medical center implemented a tobacco-free policy. In addition, preliminary program evaluation data dispels the myth that eliminating tobacco use in a residential treatment program leads to a decline in patient interest and program utilization.

  5. [Chronic diarrhea: etiologies and diagnostic evaluation]. (United States)

    Schoepfer, A


    Chronic diarrhea is defined as a decrease in fecal consistency lasting for four or more weeks. A myriad of disorders are associated with chronic diarrhea. In developed countries, chronic diarrhea is mostly caused by non-infectious diseases. There are four pathogenic mechanisms leading to chronic diarrhea: osmotic diarrhea, secretory diarrhea, inflammatory diarrhea, and dysmotility. Overlaps between these mechanisms are possible. A 72-hour fecal collection as well as the fasting test are important diagnostic tools to identify the underlying pathomechanism. The identification of the pathomechanism narrows down the possible etiologies of chronic diarrhea and allows therefore a cost-saving diagnostic workup. The endoscopy is well established in the workup of chronic diarrhea. This article gives an overview about the main causes and mechanisms leading to chronic diarrhea and proposes an algorithm for the diagnostic evalution.

  6. Etiology and Pathogenesis of Epithelial Ovarian Cancer

    Directory of Open Access Journals (Sweden)

    Samuel C. Mok


    Full Text Available Ovarian cancer is complex disease composed of different histological grades and types. However, the underlying molecular mechanisms involved in the development of different phenotypes remain largely unknown. Epidemiological studies identified multiple exogenous and endogenous risk factors for ovarian cancer development. Among them, an inflammatory stromal microenvironment seems to play a critical role in the initiation of the disease. The interaction between such a microenvironment, genetic polymorphisms, and different epithelial components such as endosalpingiosis, endometriosis, and ovarian inclusion cyst in the ovarian cortex may induce different genetic changes identified in the epithelial component of different histological types of ovarian tumors. Genetic studies on different histological grades and types provide insight into the pathogenetic pathways for the development of different disease phenotypes. However, the link between all these genetic changes and the etiological factors remains to be established.

  7. Premenstrual disorders: prevalence, etiology and impact. (United States)

    Winer, Sharon A; Rapkin, Andrea J


    Millions of reproductive-age U.S. women experience premenstrual symptoms with varying degrees of severity. The large number and variety of premenstrual symptoms reported have made premenstrual disorders difficult to characterize. A number of mechanisms have been proposed to explain the etiology of premenstrual symptoms. Some women appear to have a genetic predisposition toward severe premenstrual symptoms or to have vulnerability traits that increase their risk. It has been suggested that 1 or more neurotransmitters and/or neurohormonal systems in certain women may have an abnormal response to normal fluctuations in gonadal hormones across the menstrual cycle. Premenstrual disorders can have a significant negative impact on a woman's quality of life and work productivity.

  8. A Two-Year Multidisciplinary Training Program for the Frontline Workforce in Community Treatment of Severe Mental Illness. (United States)

    Ruud, Torleif; Flage, Karin Blix; Kolbjørnsrud, Ole-Bjørn; Haugen, Gunnar Brox; Sørlie, Tore


    Since 1999, a national two-year multidisciplinary onsite training program has been in operation in Norway. The program trains frontline workforce personnel who provide community treatment to people with severe mental illness. A national network of mental health workers, consumers, caregivers, and others providing or supporting psychosocial treatment and rehabilitation for people with severe mental illness has organized local onsite part-time training programs in collaboration with community mental health centers (CMHCs), municipalities, and primary care providers. CMHC and primary care staff are trained together to increase collaboration. Nationwide dissemination has continued, with new local programs established every year. Evaluations have shown that the program is successful.

  9. LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease

    Directory of Open Access Journals (Sweden)

    Cynthia Fox


    Full Text Available Recent advances in neuroscience have suggested that exercise-based behavioral treatments may improve function and possibly slow progression of motor symptoms in individuals with Parkinson disease (PD. The LSVT (Lee Silverman Voice Treatment Programs for individuals with PD have been developed and researched over the past 20 years beginning with a focus on the speech motor system (LSVT LOUD and more recently have been extended to address limb motor systems (LSVT BIG. The unique aspects of the LSVT Programs include the combination of (a an exclusive target on increasing amplitude (loudness in the speech motor system; bigger movements in the limb motor system, (b a focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel “too loud” or “too big,” and (c training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes. In addition, the intensive mode of delivery is consistent with principles that drive activity-dependent neuroplasticity and motor learning. The purpose of this paper is to provide an integrative discussion of the LSVT Programs including the rationale for their fundamentals, a summary of efficacy data, and a discussion of limitations and future directions for research.

  10. Addressing Prediabetes in Childhood Obesity Treatment Programs: Support from Research and Current Practice (United States)

    Grow, H. Mollie; Fernandez, Cristina; Lukasiewicz, Gloria J.; Rhodes, Erinn T.; Shaffer, Laura A.; Sweeney, Brooke; Woolford, Susan J.; Estrada, Elizabeth


    Abstract Background: Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs. Methods: This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics. Results: The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed. Conclusion: Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes. PMID:25055134

  11. Etiology of severe pneumonia in Ecuadorian children.

    Directory of Open Access Journals (Sweden)

    Sivani Jonnalagadda

    Full Text Available In Latin America, community-acquired pneumonia remains a major cause of morbidity and mortality among children. Few studies have examined the etiology of pneumonia in Ecuador.This observational study was part of a randomized, double blind, placebo-controlled clinical trial conducted among children aged 2-59 months with severe pneumonia in Quito, Ecuador. Nasopharyngeal and blood samples were tested for bacterial and viral etiology by polymerase chain reaction. Risk factors for specific respiratory pathogens were also evaluated.Among 406 children tested, 159 (39.2% had respiratory syncytial virus (RSV, 71 (17.5% had human metapneumovirus (hMPV, and 62 (15.3% had adenovirus. Streptococcus pneumoniae was identified in 37 (9.2% samples and Mycoplasma pneumoniae in three (0.74% samples. The yearly circulation pattern of RSV (P = 0.0003 overlapped with S. pneumoniae, (P = 0.03 with most cases occurring in the rainy season. In multivariable analysis, risk factors for RSV included younger age (adjusted odds ratio [aOR] = 1.9, P = 0.01 and being underweight (aOR = 1.8, P = 0.04. Maternal education (aOR = 0.82, P = 0.003, pulse oximetry (aOR = 0.93, P = 0.005, and rales (aOR = 0.25, P = 0.007 were associated with influenza A. Younger age (aOR = 3.5, P = 0.007 and elevated baseline respiratory rate were associated with HPIV-3 infection (aOR = 0.94, P = 0.03.These results indicate the importance of RSV and influenza, and potentially modifiable risk factors including undernutrition and future use of a RSV vaccine, when an effective vaccine becomes NCT 00513929.


    Directory of Open Access Journals (Sweden)

    H. S. Ibishev


    Full Text Available Introduction. Recurrent urinary tract infection is an actual problem of modern urology.Objective. Complex investigation of urinary tract infections including viral etiology for chronic recurrent cystitis in womenMaterials and methods. The study included 31 women with recurrent infection of urinary tract. Inclusion criteria were the presence of lower urinary tract symptoms caused by infection, severe recurrent course, the lack of anatomical and functional disorders of the urinary tract, the absence of bacterial pathogens during the study, taking into account the culture of aerobic and anaerobic culturing techniques.Results. The analysis of the clinical manifestations, the dominant in the study group were pain and urgency to urinate at 100% and 90% of women surveyed, respectively, and less frequent urination were recorded in 16.1% of patients. In general clinical examination of urine in all cases identified leukocyturia and 90% of the hematuria. By using a polymerase chain reaction (PCR in midstream urine of all examined was verified 10 types of human papilloma virus (HPV with the predominance of 16 and 18 types . Considering the presence of recurrent infectious and inflammatory processes of the urinary tract, cystoscopy with bladder biopsy was performed for all patients. When histomorphological biopsies of all patients surveyed noted the presence of the specific characteristics of HPV: papillary hyperplasia with squamous koilocytosis, pale cytoplasm and shrunken kernels. When analyzing the results of PCR biopsy data corresponded with the results of PCR in midstream urine in all biopsies was detected HPV.Conclusions. Human papillomavirus infection may be involved in the development of viral cystitis. In the etiological structure of viral cystitis, both highly oncogenic and low oncogenic HPV types can act.

  13. Etiologic analysis of 100 anatomically failed dacryocystorhinostomies (United States)

    Dave, Tarjani Vivek; Mohammed, Faraz Ali; Ali, Mohammad Javed; Naik, Milind N


    Background The aim of this study was to assess the etiological factors contributing to the failure of a dacryocystorhinostomy (DCR). Patients and methods Retrospective review was performed in 100 consecutive patients who were diagnosed with anatomically failed DCR at presentation to a tertiary care hospital over a 5-year period from 2010 to 2015. Patient records were reviewed for demographic data, type of past surgery, preoperative endoscopic findings, previous use of adjuvants such as intubation and mitomycin C, and intraoperative notes during the re-revision. The potential etiological factors for failure were noted. Results Of the 100 patients with failed DCRs, the primary surgery was an external DCR in 73 and endoscopic DCR in 27 patients. Six patients in each group had multiple revisions. The mean ages at presentation in the external and endoscopic groups were 39.41 years and 37.19 years, respectively. All patients presented with epiphora. The most common causes of failure were inadequate osteotomy (69.8% in the external group and 85.1% in the endoscopic group, P=0.19) followed by inadequate or inappropriate sac marsupialization (60.2% in the external group and 77.7% in the endoscopic group, P=0.16) and cicatricial closure of the ostium (50.6% in the external group and 55.5% in the endoscopic group, P=0.83). The least common causes such as ostium granulomas and paradoxical middle turbinate (1.37%, n=1) were noted in the external group only. Conclusion Inadequate osteotomy, incomplete sac marsupialization, and cicatricial closure of the ostium were the most common causes of failure and did not significantly differ in the external and endoscopic groups. Meticulous evaluation to identify causative factors for failure and addressing them are crucial for subsequent successful outcomes. PMID:27555748

  14. Use of a radiation therapy treatment planning computer in a hospital health physics program

    International Nuclear Information System (INIS)

    Addison, S.J.


    An onsite treatment planning computer has become state of the art in the care of radiation therapy patients, but in most installations the computer is used for therapy planning a diminutive amount of the day. At St. Mary's Hospital, arrangements have been negotiated for part time use of the treatment planning computer for health physics purposes. Computerized Medical Systems, Inc. (CMS) produces the Modulex radiotherapy planning system which is programmed in MUMPS, a user oriented language specially adapted for handling text string information. St. Mary's Hospital's CMS computer has currently been programmed to assist in data collection and write-up of diagnostic x-ray surveys, meter calibrations, and wipe/leak tests. The computer is setup to provide timely reminders of tests and surveys, and billing for consultation work. Programs are currently being developed for radionuclide inventories. Use of a therapy planning computer for health physics purposes can enhance the radiation safety program and provide additional grounds for the acquisition of such a computer system

  15. Hanford Tank Waste Treatment and Immobilization Plant (WTP) Waste Feed Qualification Program Development Approach - 13114

    Energy Technology Data Exchange (ETDEWEB)

    Markillie, Jeffrey R.; Arakali, Aruna V.; Benson, Peter A.; Halverson, Thomas G. [Hanford Tank Waste Treatment and Immobilization Plant Project, Richland, WA 99354 (United States); Adamson, Duane J.; Herman, Connie C.; Peeler, David K. [Savannah River National Laboratory, Aiken, SC 29808 (United States)


    The Hanford Tank Waste Treatment and Immobilization Plant (WTP) is a nuclear waste treatment facility being designed and constructed for the U.S. Department of Energy by Bechtel National, Inc. and subcontractor URS Corporation (under contract DE-AC27-01RV14136 [1]) to process and vitrify radioactive waste that is currently stored in underground tanks at the Hanford Site. A wide range of planning is in progress to prepare for safe start-up, commissioning, and operation. The waste feed qualification program is being developed to protect the WTP design, safety basis, and technical basis by assuring acceptance requirements can be met before the transfer of waste. The WTP Project has partnered with Savannah River National Laboratory to develop the waste feed qualification program. The results of waste feed qualification activities will be implemented using a batch processing methodology, and will establish an acceptable range of operator controllable parameters needed to treat the staged waste. Waste feed qualification program development is being implemented in three separate phases. Phase 1 required identification of analytical methods and gaps. This activity has been completed, and provides the foundation for a technically defensible approach for waste feed qualification. Phase 2 of the program development is in progress. The activities in this phase include the closure of analytical methodology gaps identified during Phase 1, design and fabrication of laboratory-scale test apparatus, and determination of the waste feed qualification sample volume. Phase 3 will demonstrate waste feed qualification testing in support of Cold Commissioning. (authors)

  16. A structural model of treatment program and individual counselor leadership in innovation transfer. (United States)

    Joe, George W; Becan, Jennifer E; Knight, Danica K; Flynn, Patrick M


    A number of program-level and counselor-level factors are known to impact the adoption of treatment innovations. While program leadership is considered a primary factor, the importance of leadership among clinical staff to innovation transfer is less known. Objectives included explore (1) the influence of two leadership roles, program director and individual counselor, on recent training activity and (2) the relationship of counselor attributes on training endorsement. The sample included 301 clinical staff in 49 treatment programs. A structural equation model was evaluated for key hypothesized relationships between exogenous and endogenous variables related to the two leadership roles. The importance of organizational leadership, climate, and counselor attributes (particularly counseling innovation interest and influence) to recent training activity was supported. In a subset of 68 counselors who attended a developer-led training on a new intervention, it was found that training endorsement was higher among those with high innovation interest and influence. The findings suggest that each leadership level impacts the organization in different ways, yet both can promote or impede technology transfer.

  17. Development and piloting of a treatment foster care program for older youth with psychiatric problems. (United States)

    McMillen, J Curtis; Narendorf, Sarah Carter; Robinson, Debra; Havlicek, Judy; Fedoravicius, Nicole; Bertram, Julie; McNelly, David


    Older youth in out-of-home care often live in restrictive settings and face psychiatric issues without sufficient family support. This paper reports on the development and piloting of a manualized treatment foster care program designed to step down older youth with high psychiatric needs from residential programs to treatment foster care homes. A team of researchers and agency partners set out to develop a treatment foster care model for older youth based on Multi-dimensional Treatment Foster Care (MTFC). After matching youth by mental health condition and determining for whom randomization would be allowed, 14 youth were randomized to treatment as usual or a treatment foster home intervention. Stakeholders were interviewed qualitatively at multiple time points. Quantitative measures assessed mental health symptoms, days in locked facilities, employment and educational outcomes. Development efforts led to substantial variations from the MTFC model and a new model, Treatment Foster Care for Older Youth was piloted. Feasibility monitoring suggested that it was difficult, but possible to recruit and randomize youth from and out of residential homes and that foster parents could be recruited to serve them. Qualitative data pointed to some qualified clinical successes. Stakeholders viewed two team roles - that of psychiatric nurse and skills coaches - very highly. However, results also suggested that foster parents and some staff did not tolerate the intervention well and struggled to address the emotion dysregulation issues of the young people they served. Quantitative data demonstrated that the intervention was not keeping youth out of locked facilities. The intervention needed further refinement prior to a broader trial. Intervention development work continued until components were developed to help address emotion regulation problems among fostered youth. Psychiatric nurses and skills coaches who work with youth in community settings hold promise as important

  18. Role of personality traits in cocaine craving throughout an outpatient psychosocial treatment program

    Directory of Open Access Journals (Sweden)

    Flávia Ismael


    Full Text Available Objective: Cocaine dependence is a major international public health concern. Its chronically relapsing nature is possibly related to craving intensity, which can be influenced by diverse biological and psychological aspects. This study aimed to evaluate the role of different personality traits in craving measured throughout a psychosocial treatment program. Method: The sample comprised 66 cocaine-dependent outpatients who were enrolled in an individual and manualized cognitive-behavioral therapy program. The influence of personality traits on craving intensity, frequency, and duration was analyzed using a generalized estimating equations model with an autoregressive correlation structure. Results: Craving varied during treatment. The personality traits of novelty seeking, reward dependence, and harm avoidance interacted with craving intensity, and the personality trait of persistence interacted with craving duration throughout the treatment period. Furthermore, there were significant interactions between drug use and craving intensity, and between different routes of administration and craving intensity. Participants who used cocaine/crack while in treatment and concurrent users of crack (i.e., freebase cocaine and powder cocaine also had a higher craving intensity. Conclusion: The extent of craving variation can depend on certain personality styles. This study shows that craving is influenced by personality traits, and this may presumably change clinical expression involved in disease.

  19. Comparison of alexithymia scale and stress coping strategies in patients with methadone and addicts without treatment programs

    Directory of Open Access Journals (Sweden)

    Mehdi Madanifard


    Conclusion: The results showed that patients with methadone and addiction without treatment programs in the variables of alexithymia and coping strategies are flawed. However, the group was treated through the use of psychological and physical treatment and return relative to health conditions has fewer problems compared to untreated addicted individuals. In addition to the prescription drug treatment programs in these people who pay more attention to psychological interventions are proposed.

  20. Early Successes in an Open Access, Provincially Funded Hepatitis C Treatment Program in Prince Edward Island. (United States)

    Smyth, Daniel; Francheville, Jordan W; Rankin, Robin; Beck, Jeremy; Hoare, Connie; Materniak, Stefanie; German, Greg; Barrett, Lisa; Bunimov-Wall, Natalie


    The availability of curative hepatitis C therapies has created an opportunity to improve delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation. Using a community based prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: 1) Treatment effectiveness using intention-to-treat analysis; and 2) Patient treatment experience assessed using demographics, adverse events, and medication adherence. During the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses. In conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.

  1. A Cognitive and Virtual Reality Treatment Program for the Fear of Flying. (United States)

    Ferrand, Margot; Ruffault, Alexis; Tytelman, Xavier; Flahault, Cécile; Négovanska, Vélina


    Passenger air transport has considerably increased in the past 50 yr. It is estimated that between 7 and 40% of the population of industrialized countries is currently afraid of flying. Programs treating the fear of flying have been developed to meet this problem. This study measures the effectiveness of one of these programs by focusing on flight-related anxiety before the program and after the first flight following the intervention. There were 157 individuals recruited to participate in a 1-d intervention aiming at treating the fear of flying, and using both cognitive behavioral techniques and virtual reality. Anxiety was measured with the Flight Anxiety Situations (FAS) and the Flight Anxiety Modality (FAM) questionnaires. Statistical analyses were conducted on 145 subjects (69.7% female; ages from 14 to 64) after the exclusion of individuals with missing data. The results showed a decrease in flight-related anxiety for each subscale of the two questionnaires: the somatic (d=2.44) and cognitive anxiety (d=1.47) subscales of the FAM, and the general flight anxiety (d=3.20), the anticipatory flight anxiety (d=1.74), and the in-flight anxiety (d=1.04) subscales of the FAS. The effectiveness of the treatment program using both cognitive behavioral techniques and virtual reality strategies for fear of flying reduced flight-related anxiety in the subjects in our study. Our results show that subjects demonstrated lower anxiety levels after the first flight following the program than before the intervention.

  2. Moving empirically supported practices to addiction treatment programs: recruiting supervisors to help in technology transfer. (United States)

    Amodeo, Maryann; Storti, Susan A; Larson, Mary Jo


    Federal and state funding agencies are encouraging or mandating the use of empirically supported treatments in addiction programs, yet many programs have not moved in this direction (Forman, Bovasso, and Woody, 2001 ; Roman and Johnson, 2002 ; Willenbring et al., 2004 ). To improve the skills of counselors in community addiction programs, the authors developed an innovative Web-based course on Cognitive Behavioral Therapy (CBT), a widely accepted empirically-supported practice (ESP) for addiction. Federal funding supports this Web course and a randomized controlled trial to evaluate its effectiveness. Since supervisors often play a pivotal role in helping clinicians transfer learned skills from training courses to the workplace, the authors recruited supervisor-counselor teams, engaging 54 supervisors and 120 counselors. Lessons learned focus on supervisor recruitment and involvement, supervisors' perceptions of CBT, their own CBT skills and their roles in the study, and implications for technology transfer for the addiction field as a whole. Recruiting supervisors proved difficult because programs lacked clinical supervisors. Recruiting counselors was also difficult because programs were concerned about loss of third-party reimbursement. Across the addiction field, technology transfer will be severely hampered unless such infrastructure problems can be solved. Areas for further investigation are identified.

  3. Marketing Residential Treatment Programs for Eating Disorders: A Call for Transparency. (United States)

    Attia, Evelyn; Blackwood, Kristy L; Guarda, Angela S; Marcus, Marsha D; Rothman, David J


    Residential behavioral treatment is a growing sector of the health care industry and is used by a large proportion of adolescent and adult patients with eating disorders. These programs and the organizations that own them have developed extensive marketing strategies that target clinicians and include promotional gifts, meals, travel reimbursement, and continuing education credit. Legislation and policy changes have limited these types of activities when conducted by the pharmaceutical industry, and awareness of conflicts of interest associated with clinician-targeted advertising of drugs and devices has increased. However, similar practices by the behavioral health care industry have evolved without oversight. The authors urge clinicians to consider how marketing strategies by treatment facilities may influence their referral behaviors and call for improved transparency regarding gifts and payments from treatment facilities.

  4. The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence. (United States)

    McCauley, Elizabeth; Gudmundsen, Gretchen; Schloredt, Kelly; Martell, Christopher; Rhew, Isaac; Hubley, Samuel; Dimidjian, Sona


    This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation (BA) based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression. The urban sample was 64% female, predominantly Non-Hispanic White (67%), and had an average age of 14.9 years. Measures of depression, global functioning, activation, and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at preintervention and end of intervention. Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pretreatment to end of treatment in depression, global functioning, and activation and avoidance. There were no significant differences across treatment conditions. These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.

  5. Evaluation of an Evidence-Based Tobacco Treatment Curriculum for Psychiatry Residency Training Programs (United States)

    Prochaska, Judith J.; Fromont, Sebastien C.; Leek, Desiree; Hudmon, Karen Suchanek; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.


    Objective Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness. Methods The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review, consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in 2005–2006, using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California. Results The curriculum was associated with improvements in psychiatry residents’ knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients, with initial changes from pre- to posttraining sustained at 3-months’ follow-up. Residents’ self-reported changes in treating patients’ tobacco use were substantiated through systematic chart review. Conclusion The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers. PMID:19190293

  6. Antiretroviral treatment knowledge and stigma--implications for programs and HIV treatment interventions in rural Tanzanian populations.

    Directory of Open Access Journals (Sweden)

    Abela Mpobela Agnarson

    Full Text Available OBJECTIVE: To analyse antiretroviral treatment (ART knowledge and HIV- and ART-related stigma among the adult population in a rural Tanzanian community. DESIGN: Population-based cross-sectional survey of 694 adults (15-49 years of age. METHODS: Latent class analysis (LCA categorized respondents' levels of ART knowledge and of ART-related stigma. Multinomial logistic regression assessed the association between the levels of ART knowledge and HIV- and ART-related stigma, while controlling for the effects of age, gender, education, marital status and occupation. RESULTS: More than one-third of men and women in the study reported that they had never heard of ART. Among those who had heard of ART, 24% were east informed about ART, 8% moderately informed, and 68% highly informed. Regarding ART-related stigma, 28% were least stigmatizing, 41% moderately stigmatizing, and 31% highly stigmatizing toward persons taking ART. Respondents that had at least primary education were more likely to have high levels of knowledge about ART (OR 3.09, 95% CI 1.61-5.94. Participants highly informed about ART held less HIV- and ART-related stigma towards ART patients (OR 0.26, 95% CI 0.09-0.74. CONCLUSION: The lack of ART knowledge is broad, and there is a strong association between ART knowledge and individual education level. These are relevant findings for both HIV prevention and HIV treatment program interventions that address ART-related stigma across the entire spectrum of the community.

  7. Branchial cleft or cervical lymphoepithelial cysts: etiology and management. (United States)

    Glosser, Jeffrey W; Pires, Carlos Alberto S; Feinberg, Stephen E


    The cervical lymphoepithelial or branchial cleft cyst is a developmental cyst that has a disputed pathogenesis. The objective of this article is to provide a brief review of the literature and to define diagnostic terms related to this anomaly, as well as to describe its etiology, clinical presentation and treatment. The cervical lymphoepithelial or branchial cleft cyst usually presents as a unilateral, soft-tissue fluctuant swelling that typically appears in the lateral aspect of the neck, anterior to the sternocleidomastoid muscle, and becomes clinically evident late in childhood or in early adulthood. Clinicians can diagnose the cyst with appropriate imaging to assess the extent of the lesion before definitive surgical treatment. The authors describe a patient who underwent excision of a well-encapsulated cystic structure that was diagnosed as a branchial cleft cyst. The cervical lymphoepithelial or branchial cleft cyst can be easily misdiagnosed as a parotid swelling or odontogenic infection. It is imperative that clinicians make an accurate diagnosis so that appropriate treatment (that is, surgical excision) can be performed. If the cysts are treated properly, recurrences are rare.

  8. Study of acute undifferentiated fever cases and their etiologies in rural Konkan area of Maharashtra state

    Directory of Open Access Journals (Sweden)

    Patil S. N


    Full Text Available Background: Acute undifferentiated fever (AUF is a common cause for which the patients seek health care in India. It is region specific and has similar clinical presentation, with varied etiologies. Due to this it posses challenge to the diagnosis, treatment and public health. Majority of patients present with nondescript symptoms. Scrub typhus, Malaria, Enteric Fever, Dengue, Leptospirosis, Chikungunya, Spotted fever, Rickettsiosis, Hantavirus, Q fever, Brucellosis, Influenza and other bacterial infections are some of the common etiologies of AUF. The prevalence of local AUF etiologies helps to prioritize differential diagnosis and guide the treatment. The study aimed to find out the predominant AUF etiologies in the rural Konkan area of Maharashtra state in India. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital on the samples received from District hospitals and Primary health centers from Sindhudurg District of Maharashtra state for the duration of October 2012 to January 2014. Patients with age 5years and with classical symptoms of febrile illness were included in the study. About 500 blood samples received were investigated for Malaria, Bacterial culture sensitivity, Leptospira culture, ELISA for scrub typhus, Brucella, Dengue and Leptospira and further evaluated for commonest region specific AUF etiology. Results: The study included 500 blood samples obtained from patients presenting with classical symptoms of AUF. Samples received from males showed highest number of positive cases amounting for 82.47% with majority of cases (83% cases in middle age group. The sero-positivity of samples accounted for 42.8%. Brucella was the most common cause of AUF (28.50% followed by Leptospira (27.10% and Scrub typhus (21.49%. Interestingly there were no positive cases of malaria and only 11.21% samples positive for Dengue which are considered as most common AUF etiologies and treated accordingly

  9. Optimization of radio-therapeutic treatment and the program of quality assurance in ionizing radiation therapy

    International Nuclear Information System (INIS)

    Rosca, A.; Bahnarel, I.; Coretchi, L.


    The Program of Quality Assurance (PQA) in Ionizing Radiation Therapy (IRT) addresses the most important problems of assuring the quality of IRT utilization in the treatment of patients with neoplasm. In this context, the IRT value grows considerably, hence the implementation of PQA is of great significance. The study concentrates on a detailed description of the PQA as concerns the activity involving IRT devices applied in the IRT departments (rooms) of public medical/sanitary institutions, science research institutions etc., where IRT is employed using technogenic sources and ionizing radiation generators. For the performing of the study, annual statistics reports about the activity of the IRT, and data of Cancer Registry of the Oncologic Institute of the Republic of Moldova were analyzed. The work also includes an in-depth description of the personnel categories involved in PQA, possible errors in radiotherapy, the responsibilities of the bioengineer in this program, importance of source calibration, the impact of the quality control in PQA, the role of topometric training, the interaction between the medical and technical personnel and the patient. Optimization of IRT is very important and necessary in the Republic of Moldova. PQA incontestably contributes to reducing specialist's errors in planning correct treatment, dictates the need of team work and proper delegation of the responsibilities in co-optation of other professionals, performance of duty of bioengineering, the influence of quality control of profile installations, meaning accurate topographic planning, applying several methods of work, quality assurance program assuming the major importance. (authors)

  10. Pilot study of a graded exercise program for the treatment of anorexia nervosa. (United States)

    Thien, V; Thomas, A; Markin, D; Birmingham, C L


    To determine whether a graded exercise program used in the treatment of anorexia nervosa improves quality of life and does not decrease the rate of gain of body fat. A randomized controlled trial with outcome measures: change in percent body fat, body mass index (BMI), and Medical Outcomes Survey Short Form 36-item Quality of Life questionnaire. Fifteen females and one male meeting the DSM-IV criteria for the diagnosis of anorexia nervosa were randomized. There was no difference in change in BMI or percent body fat at 3 months. Quality of life outcomes improved from baseline in the experimental group compared with the control group. However, this difference was not statistically significant. Incorporation of a graded exercise program may increase compliance with treatment, but it did not reduce the short-term rate of gain of body fat or BMI. Longer studies with more subjects are necessary to determine the usefulness of a graded exercise program in anorexia nervosa. Copyright 2000 by John Wiley & Sons, Inc.

  11. Treatment of short bowel syndrome in children. Value of the Intestinal Rehabilitation Program

    Directory of Open Access Journals (Sweden)

    Uenis Tannuri

    Full Text Available Summary The main cause of acute intestinal failure is short bowel syndrome, generally as a result of resection of extensive segments of small intestine. As a result, the main symptoms are watery diarrhea, malabsorption syndrome, chronic malnutrition, and death, if the patient is not properly treated. If the length of the remaining intestine is greater than 30 cm, complete adaptation is possible and the patient may not require parenteral nutrition. The currently recommended treatment includes the use of prolonged parenteral nutrition and enteral nutrition, always aimed at constant weight gain, in conjunction with surgeries aimed at elongating the dilated bowel. This set of procedures constitutes what is called an Intestinal Rehabilitation Program. This therapy was used in 16 children in periods ranging from 8 months to 7.5 years, with survival in 75% of the cases. Finally, the last resort to be used in children with complete resection of the small bowel is an intestinal transplant. However, to date there is no record of a Brazilian child that has survived this procedure, despite it being attempted in seven patients. We conclude that the results of the intestinal rehabilitation program are encouraging for the continuation of this type of treatment and stimulate the creation of the program in other pediatric care institutions.

  12. Availability of tobacco cessation services in substance use disorder treatment programs: Impact of state tobacco control policy. (United States)

    Abraham, Amanda J; Bagwell-Adams, Grace; Jayawardhana, Jayani


    Given the high prevalence of smoking among substance use disorder (SUD) patients, the specialty SUD treatment system is an important target for adoption and implementation of tobacco cessation (TC) services. While research has addressed the impact of tobacco control on individual tobacco consumption, largely overlooked in the literature is the potential impact of state tobacco control policies on availability of services for tobacco cessation. This paper examines the association between state tobacco control policy and availability of TC services in SUD treatment programs in the United States. State tobacco control and state demographic data (n=51) were merged with treatment program data from the 2012 National Survey of Substance Abuse Treatment Services (n=10.413) to examine availability of TC screening, counseling and pharmacotherapy services in SUD treatment programs using multivariate logistic regression models clustered at the state-level. Approximately 60% of SUD treatment programs offered TC screening services, 41% offered TC counseling services and 26% offered TC pharmacotherapy services. Results of multivariate logistic regression showed the odds of offering TC services were greater for SUD treatment programs located in states with higher cigarette excise taxes and greater spending on tobacco prevention and control. Findings indicate cigarette excise taxes and recommended funding levels may be effective policy tools for increasing access to TC services in SUD treatment programs. Coupled with changes to insurance coverage for TC under the Affordable Care Act, state tobacco control policy tools may further reduce tobacco use in the United States. Published by Elsevier Ltd.

  13. National Institute on Drug Abuse International Program: improving opioid use disorder treatment through international research training. (United States)

    Gust, Steven W; McCormally, Judy


    For more than 25 years, the National Institute on Drug Abuse (NIDA) has supported research-training programs, establishing a global research network and expanding the knowledge base on substance use disorders. International research to inform approaches to opioid addiction is particularly important and relevant to the United States, where opioid misuse, addiction, and overdose constitute an emerging public health crisis. This article summarizes the NIDA International Program and illustrates its impact by reviewing recent articles about treatment approaches for opioid use disorders (OUD). Studies in several countries have demonstrated the effectiveness of physician office-based opioid substitution therapies. Other research has demonstrated the effectiveness of different formulations and doses of the opioid antagonist naltrexone, as well as different approaches to providing naloxone to treat opioid overdose. Continuing research into implementation of evidence-based treatment in international settings with limited resources is applicable to US regions that face similar structural, legal, and fiscal constraints. The current review describes international research on OUD treatment and opioid overdose, most coauthored by former NIDA fellows. The findings from outside the United States have important implications for best practices domestically and in other countries that are experiencing increases in OUD prevalence and related overdose deaths.

  14. [The model program of psycho-social treatment and staff training]. (United States)

    Ikebuchi, Emi


    The model program of psycho-social treatment and staff training were reported in this issue. The mission of model program is supporting recovery of persons with mental illness and their family as well as empowering their hope and sense of values. The personal support specialists belonging to multi-disciplinary team have responsibility to support life-long process of recovery across hospitalization, out-patients clinic, day treatment, and outreach service. The shared value of multi-disciplinary team (the community life supporting team) is recovery so that the team renders self directive life, various alternatives of their lives, and peer group with models of recovery to persons with mental illness. There should be several technologies which are used in the team such as engagement, psycho-education, cognitive-behavior therapy, care-management, cooperating with other resources. The responsibility, assessment and evaluation techniques, guarantee of opportunities for training, and auditing system of the team and process of treatment are important factors to educate team staff. Raising effective multi-disciplinary team requires existence of a mentor or good model near the team.

  15. Patient and program factors that bridge the detoxification-treatment gap: a structured evidence review. (United States)

    Timko, Christine; Below, Maureen; Schultz, Nicole R; Brief, Deborah; Cucciare, Michael A


    Although completion of detoxification (detox) and a successful transition from detox to substance use disorder (SUD) treatment and/or mutual-help groups are associated with better SUD outcomes, many patients do not complete detox or do not receive SUD care following detox. The purpose of this structured evidence review, summarizing data extraction on a yield of 26 articles, is to identify patient, program, and system factors associated with the outcomes of completion of alcohol detox and successful transitions from alcohol detox to SUD treatment and mutual-help group participation. The review found wide variability among studies in the rates at which patients complete a detox episode (45 to 95%) and enter SUD treatment or mutual-help groups after detox (14 to 92%). Within program factors, behavioral practices that contribute to both detox completion and transitioning to SUD care after detox entail involving the patient's family and utilizing motivational-based approaches. Such practices should be targeted at younger patients, who are less likely to complete detox. Although more studies using a randomized controlled trial design are needed, the evidence suggests that barriers to detox completion and transition to SUD care can be overcome to improve patient outcomes. Published by Elsevier Inc.

  16. Self care programs and multiple sclerosis: physical therapeutics treatment - literature review. (United States)

    Demaille-Wlodyka, S; Donze, C; Givron, P; Gallien, P


    To clarify the therapeutic education program impact with multiple sclerosis patients, literature review. Highlight contents and efficacy. A non-systematic review on Medline, PubMed and Cochrane library databases from 1966 to 2010 using the following keywords: "multiple sclerosis", "self-care", "self-management" and specific symptoms keywords. Clinical trials and randomized clinical trials, as well as literature reviews published in English, French and German will be analyzed. Counseling is a part of the non-pharmacological management of chronic illnesses such as multiple sclerosis. Symptoms' diversity and the different clinical forms limit standardized programs of self-care management, applicable to patients. In the literature review, counseling programs have often low metrology. A behavior change with patients and medical staff could exist. To empower the patient, to reduce symptoms' impact and to improve treatment access are the aims of educational therapy. Therapeutic education program for multiple sclerosis patients could progress with their standardization and assessment, for each sign. To promote the educational therapy of multiple sclerosis patients, a specific training for medical staff, as specific financing are necessary. 2011 Elsevier Masson SAS. All rights reserved.

  17. Understanding and determining the etiology of autism. (United States)

    Currenti, Salvatore A


    Worldwide, the rate of autism has been steadily rising. There are several environmental factors in concert with genetic susceptibilities that are contributing to this rise. Impaired methylation and mutations of mecp2 have been associated with autistic spectrum disorders, and related Rett syndrome. Genetic polymorphisms of cytochrome P450 enzymes have also been linked to autism, specifically CYP27B1 that is essential for proper vitamin D metabolism. Vitamin D is important for neuronal growth and neurodevelopment, and defects in metabolism or deficiency have been implicated in autistic individuals. Other factors that have been considered include: maternally derived antibodies, maternal infection, heavy metal exposure, folic acid supplementation, epigenetics, measles, mumps, rubella vaccination, and even electromagnetic radiation. In each case, the consequences, whether direct or indirect, negatively affect the nervous system, neurodevelopment, and environmental responsive genes. The etiology of autism is a topic of controversial debate, while researchers strive to achieve a common objective. The goal is to identify the cause(s) of autism to understand the complex interplay between environment and gene regulation. There is optimism that specific causes and risk factors will be identified. The results of future investigations will facilitate enhanced screening, prevention, and therapy for "at risk" and autistic patients.

  18. Etiology and immunology of infectious bronchitis virus

    Directory of Open Access Journals (Sweden)

    LF Caron


    Full Text Available Infectious bronchitis virus (IBV of chickens is currently one of the main diseases associated with respiratory syndrome in domestic poultry, as well as with losses related to egg production. The etiological agent is a coronavirus, which presents structural differences in the field, mainly in the S1 spike protein. The immune response against this virus is complicated by the few similarities among serotypes. Environmental and management factors, as well as the high mutation rate of the virus, render it difficult to control the disease and compromise the efficacy of the available vaccines. Bird immune system capacity to respond to challenges depend on the integrity of the mucosae, as an innate compartment, and on the generation of humoral and cell-mediated adaptive responses, and may affect the health status of breeding stocks in the medium run. Vaccination of day-old chicks in the hatchery on aims at eliciting immune responses, particularly cell-mediated responses that are essential when birds are first challenged. Humoral response (IgY and IgA are also important for virus clearance in subsequent challenges. The presence of antibodies against the S1 spike protein in 3- to 4-week-old birds is important both in broilers and for immunological memory in layers and breeders.

  19. Molar Incisor Hypomineralization, Prevalence, and Etiology

    Directory of Open Access Journals (Sweden)

    Sulaiman Mohammed Allazzam


    Full Text Available Aim. To evaluate the prevalence and possible etiological factors associated with molar incisor hypomineralization (MIH among a group of children in Jeddah, Saudi Arabia. Methods. A group of 8-12-year-old children were recruited (n=267  from the Pediatric Dental Clinics at the Faculty of Dentistry, King Abdulaziz University. Children had at least one first permanent molar (FPM, erupted or partially erupted. Demographic information, children’s medical history, and pregnancy-related data were obtained. The crowns of the FPM and permanent incisors were examined for demarcated opacities, posteruptive breakdown (PEB, atypical restorations, and extracted FPMs. Children were considered to have MIH if one or more FPM with or without involvement of incisors met the diagnostic criteria. Results. MIH showed a prevalence of 8.6%. Demarcated opacities were the most common form. Maxillary central incisors were more affected than mandibular (P=0.01. The condition was more prevalent in children with history of illnesses during the first four years of life including tonsillitis (P=0.001, adenoiditis (P=0.001, asthma (P=0.001, fever (P=0.014, and antibiotics intake (P=0.001. Conclusions. The prevalence of MIH is significantly associated with childhood illnesses during the first four years of life including asthma, adenoid infections, tonsillitis, fever, and antibiotics intake.

  20. The Pathophysiology and Etiology of Vaginismus

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    Cherng-Jye Jeng


    Full Text Available Vaginismus is defined as an involuntary spasm of the pelvic muscles surrounding the outer third of the vagina, especially the perineal muscles and the levator ani muscles. Its severe form usually makes penetration virtually impossible and causes a severe, burning pain, and leads to unconsummated marriage. There appears to be basic agreement that vaginismus is a psychosociologic disorder with phobic elements resulting from actual or imagined negative experiences with penetration attempts. Fear and anxiety concerning penetration is expressed physiologically via the involuntary vaginal muscle spasm that characterizes vaginismus. Since 1547, when vaginismus was first described, thousands of research papers have been published on this female sexual disorder. However, the etiology of vaginismus remains controversial. Women with vaginismus generally experience shame, disgust and dislike toward their genitals. They frequently have or have had other phobias. They are usually overprotected by their fathers and have been “good girls” since childhood. Their sexual partners are usually kind, gentle, considerate and passive “nice guys”. The male partner's lack of aggressiveness actually leads to unconsummation of the marriage. The sexually secure husband can usually overcome mild degrees of vaginismus by persistent but firm penile insertion. For moderate to severe degrees of vaginismus, medical intervention is usually necessary to lead to consummation of the marriage.

  1. A etiological factors in mechanical intestinal obstruction

    International Nuclear Information System (INIS)

    Asad, S.; Khan, H.; Khan, I.A.; Ghaffar, S.; Rehman, Z.U.


    Background: Intestinal obstruction occurs when the normal flow of intestinal contents is interrupted. The most frequent causes of intestinal obstruction are postoperative adhesions and hernias, which cause extrinsic compression of the intestine. Less frequently, tumours or strictures of the bowel can cause intrinsic blockage. Objective of the study was to find out the various a etiological factors of mechanical intestinal obstruction and to evaluate the morbidity and mortality in adult patients presenting to Surgical 'A' unit of Ayub teaching hospital with mechanical intestinal obstruction. Methods: This cross-sectional study was conducted from March 2009 to September, 2009. All patients presenting with intestinal obstruction and were above the age of 12 years were included in the study. Patients with non-mechanical obstruction were excluded from the study and those who responded to conservative measures were also excluded. Results: A total of 36 patients with age ranging from 12 to 80 years (Mean age 37.72+-19.74 years) and male to female ratio of 1.77:1, were treated for mechanical intestinal obstruction. The most common cause for mechanical intestinal obstruction was adhesions (36.1%). Intestinal tuberculosis was the second most common cause (19.4%), while hernias and sigmoid volvulus affected 13.9% patients each. Malignancies were found in 5.6% cases. Conclusion: Adhesions and Tuberculosis are the leading causes of mechanical intestinal obstruction in Pakistan. Although some patients can be treated conservatively, a substantial portion requires immediate surgical intervention. (author)

  2. Update on the National Cholesterol Education Program Adult Treatment Panel III guidelines: getting to goal. (United States)

    McKenney, James M


    Considerable data on the pathophysiology, epidemiology, and treatment of dyslipidemia-induced coronary heart disease (CHD) have accumulated in recent years. These data have been assessed and incorporated into the guidelines of the National Cholesterol Education Program Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel [ATP] III). A major focus of the new guidelines is the assessment of the near-term (i.e., 10-yr) risk of experiencing a CHD event and matching the intensity of treatment to this risk. Patients with diabetes and those with a greater than 20% 10-year risk of experiencing a CHD event have been elevated to the risk level of CHD equivalent. The ATP III guidelines also modify several lipid and lipoprotein classifications. A low-density lipoprotein cholesterol (LDL) level below 100 mg/dl is now considered optimum for all individuals. In addition, high-density lipoprotein cholesterol (HDL) and triglyceride cutoff points have been modified to reflect more accurately the risk associated with abnormalities in these lipoproteins. As with the previous guidelines, the primary target of therapy remains LDL. Therapeutic lifestyle changes consisting of diet, weight reduction, and increased physical activity should be included in all treatment regimens. Based on their potent LDL-lowering properties and their proven ability to decrease mortality in a variety of patient populations, statins are generally the first choice for pharmacologic therapy. A secondary target of therapy includes non-HDL goals for patients with high triglyceride levels and the metabolic syndrome, which is characterized by abdominal obesity, elevated triglyceride levels, low HDL levels, and insulin resistance. Management of these secondary targets includes weight reduction and increased physical activity, and treatment of the lipid and nonlipid risk factors. Overall, ATP III represents an aggressive approach to treating dyslipidemia

  3. From Logic Programming Semantics to the Consistency of Syntactical Treatments of Knowledge and Belief

    DEFF Research Database (Denmark)

    Bolander, Thomas


    that we can keep the predicate approach if we make suitable restrictions to our set of epistemic axioms. Their results are proved by careful translations from corresponding modal formalisms. In the present paper we show that their results fit nicely into the framework of logic programming semantics......, in that we show their results to be corollaries of well-known results in this field. This does not only allow us to demonstrate a close connection between consistency problems in the syntactic treatment of propositional attitudes and problems in semantics for logic programs, but it also allows us......This paper concerns formal theories for reasoning about the knowledge and belief of agents. It has seemed attractive to researchers in artificial intelligence to formalise these propositional attitudes as predicates of first-order predicate logic. This allows the agents to express stronger...

  4. The impact of an educational program on recognition, treatment and report of child abuse. (United States)

    Ferrara, Pietro; Gatto, Antonio; Manganelli, Nunzia Pia; Ianniello, Francesca; Amodeo, Maria Elisa; Amato, Maria; Giardino, Ida; Chiaretti, Antonio


    Pediatricians play a crucial role in the identification and management of child abuse and neglect (CAN) but they often don't have a formal specialized training. We analysed retrospectively data about patients, 0 - 18 years of age, victims of CAN between 1 April 2005 and 30 April 2015. The aim of the study was to evaluate the effect of a multidisciplinary educational program, "CAN: prevention strategies, individuation and treatment", on the knowledge, case recognition, treatment and follow-up of physicians of Gemelli University Hospital in Rome, regarding physical, sexual abuse and neglect. This program, in 3 different editions biannually, respectively in May-July 2010, November-January 2012 and February-May 2014, was based on 4 sessions, each one of 2 days. Considering the number of victims of CAN between 2005 and 2015 we observed 66 cases of maltreatment. We divided the study population in 2 groups: group A, before the educational programs, patients evaluated from 1 April 2005 to 30 July 2010; group B, after the educational program from 1 August 2010 to 30 April 2015. We observed 23 children in group A and 43 children in group B with an improvement of 87%. Analyzing our data about sex, nationality, type of perpetrators, we found that: 37/66 (56%) of children were females compared to 29/66 (44%) males; 41/66 (62%) of children came from Italy compared to 25/66 (38%) of foreign children; 52/66 (79%) of the perpetrators of abuse were parents or family members compared to acquaintances 10/66 (15%) and to strangers 4/66 (6%). Considering the prevalence of CAN, the need to develop clinically competent clinicians and the improving of residency education in child maltreatment is imperative. Improving the clinical skills of pediatricians to identify and evaluate CAN may lead to reduce morbidity and mortality of these children.

  5. Summer treatment program for children with attention deficit hyperactivity disorder: Japanese experience in 5 years. (United States)

    Yamashita, Yushiro; Mukasa, Akiko; Anai, Chizuru; Honda, Yuko; Kunisaki, Chie; Koutaki, Junichi; Tada, Yahuhiro; Egami, Chiyomi; Kodama, Naoko; Nakashima, Masayuki; Nagamitsu, Shin-ichiro; Matsuishi, Toyojiro


    In 2005 we established the first American-style summer treatment program (STP) for children with attention deficit hyperactivity disorder (ADHD) located outside North America. This program was based on methods established by professor Pelham and has been used in a number of studies and at a number of sites in the USA. A total of 137 children diagnosed with ADHD, ranging in age from 6 to 12 years, participated in at least one of five annual summer treatment programs in Kurume city, Japan, during 2005-2009. The duration of the STP was 2 weeks in 2005, 2008, and 2009; 3 weeks in 2006 and 2007. A set of evidence-based behavioral modification techniques comprising the STP behavioral program (e.g., point system, daily report card, positive reinforcement, time out) was used. We also assessed the cognitive function of individual children before and after STP using the CogState(R) batteries. Every year, regardless of the duration of the STP, most children showed positive behavioral changes in multiple domains of functioning, demonstrated by significant improvement in points earned daily, which reflect behavior frequencies. Cognitive functions, particularly the rate of anticipatory errors in executive function, significantly improved after the STP, suggesting that STP has positive effects not only on behavioral aspects but also on some cognitive functions. Further studies are necessary to confirm this finding by studying sequential cognitive function of age-matched children who do not attend STP. Copyright © 2010 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  6. Effect of a multidisciplinary treatment program on eating behavior in overweight and obese preschool children. (United States)

    Bocca, Gianni; Kuitert, Mirije W B; Sauer, Pieter J J; Corpeleijn, Eva


    The effects of multidisciplinary treatment programs on eating behavior in overweight preschool-aged children are largely unknown. We evaluated a multidisciplinary intervention program on eating behavior in 3- to 5-year-old overweight children, comparing them with children given standard treatment. We also assessed the parental eating behavior changes and investigated associations between parents and children. We randomized 75 children to a multidisciplinary intervention or to a standard care program. During a 16-week period, children and parents in the multidisciplinary group were given dietary advice, physical activity sessions and, for parents only, psychological counseling. Children and parents in the standard group visited a pediatrician 3 times and were given information on a healthy lifestyle. At baseline, after 16 weeks, and after 12 months, children were measured and parents completed the Dutch Child Eating Behavior Questionnaire (DEBQ-C) for their children and the DEBQ for themselves. At the three time points, 70 (93.3%), 57 (91.9%), and 42 (73.7%) DEBQ-Cs were analyzed. We found no differences in the changes in eating behavior between the two groups over time. In both groups, there was a significant increase in restrained eating behavior present at 16 weeks, however, this was no longer present at 12 months. We found no associations between changes in eating behavior between the children and their parents. A multidisciplinary obesity intervention program in preschool-aged children induced more restrained eating behavior between baseline and 16 weeks. However, there was no difference with the children in the standard care group.

  7. Epstein-Barr Virus Infection in Children: Improving the Diagnosis and Treatment Program

    Directory of Open Access Journals (Sweden)

    E. N. Simovanyan


    Full Text Available Widespread, severe course, frequent development of chronic forms, adverse effects of the Epstein-Barr virus infection to the health of children, the difficulties of diagnosis and therapy dictate the need to improve the diagnostic and treatment programs in this disease. A total of 286 patients with acute and chronic Epstein-Barr virus infection. It was established, that for the timely diagnosis of the disease requires a comprehensive analysis of anamnesis, clinical symptoms, including symptoms of acute and chronic mononucleosis syndrome in combination with multiorgan pathology, and the results of laboratory examination (enzyme immunoassay, polymerase chain reaction, immune status.

  8. Characteristics of substance abuse treatment programs providing services for HIV/AIDS, hepatitis C virus infection, and sexually transmitted infections: the National Drug Abuse Treatment Clinical Trials Network. (United States)

    Brown, Lawrence S; Kritz, Steven Allan; Goldsmith, R Jeffrey; Bini, Edmund J; Rotrosen, John; Baker, Sherryl; Robinson, Jim; McAuliffe, Patrick


    Illicit drug users sustain the epidemics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis C (HCV), and sexually transmitted infections (STIs). Substance abuse treatment programs present a major intervention point in stemming these epidemics. As a part of the "Infections and Substance Abuse" study, established by the National Drug Abuse Treatment Clinical Trials Network, sponsored by National Institute on Drug Abuse, three surveys were developed; for treatment program administrators, for clinicians, and for state and District of Columbia health and substance abuse department administrators, capturing service availability, government mandates, funding, and other key elements related to the three infection groups. Treatment programs varied in corporate structure, source of revenue, patient census, and medical and non-medical staffing; medical services, counseling services, and staff education targeted HIV/AIDS more often than HCV or STIs. The results from this study have the potential to generate hypotheses for further health services research to inform public policy.

  9. Etiology, Severity and Recurrence of Acute Pancreatitis in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Chun-Hao Chen


    Conclusion: Alcoholic pancreatitis was the major etiology of acute pancreatitis in southern Taiwan, exhibiting a strong male predominance and higher risk of severe CT grading. Abnormal serum triglyceride was independently associated with the severity of acute pancreatitis. Alcoholic pancreatitis had a higher risk of recurrence than other etiologies.

  10. Heart failure etiology impacts survival of patients with heart failure

    DEFF Research Database (Denmark)

    Pecini, Redi; Møller, Daniel Vega; Torp-Pedersen, Christian


    BACKGROUND: The impact of heart failure (HF) etiology on prognosis of HF is not well known. METHODS: 3078 patients (median age 75years, 61% male) hospitalized with HF were studied. Patients were classified into six etiology groups: hypertension (HTN, 13.9%), ischemic heart disease (IHD, 42...

  11. Epidemiologie et etiologies des epistaxis dans notre pratique: A ...

    African Journals Online (AJOL)

    Introduction: A frequent ailment in ENT, the epistaxis is an emergency that can put the vital prognosis at stake. An adequate follow up care deserves some knowledge of etiology. Objectives: Study the epidemiological and etiological aspects of the epistaxis. Methodology: A retrospective and descriptive study conducted on ...

  12. Using Advanced Mixed Waste Treatment Technology To Meet Accelerated Cleanup Program Milestones

    International Nuclear Information System (INIS)

    Larsen, P.J.; Garcia, J.; Estes, C.H.; Palmer, C.R.; Meyers, G.S.


    Some DOE Complex facilities are entering the late stages of facility closure. As waste management operations are completed at these sites, remaining inventories of legacy mixed wastes must be finally disposed. These wastes have unique physical, chemical and radiological properties that have made their management troublesome, and hence why they have remained on site until this late stage of closure. Some of these wastes have had no approved or practical treatment alternative until just recently. Results are provided from using advanced mixed waste treatment technology to perform two treatment campaigns on these legacy wastes. Combinations of macro-encapsulation, vacuum thermal desorption (VTD), and chemical stabilization, with off-site incineration of the organic condensate, provided a complete solution to the problem wastes. One program included approximately 1,900 drums of material from the Fernald Environmental Management Project. Another included approximately 1,200 drums of material from the Accelerated Cleanup Program at the Oak Ridge Reservation. Both of these campaigns were conducted under tight time schedules and demanding specifications, and were performed in a matter of only a few months each. Coordinated rapid waste shipment, flexible permitting and waste acceptance criteria, adequate waste receiving and storage capacity, versatile feed preparation and sorting capability, robust treatment technology with a broad feed specification, and highly reliable operations were all valuable components to successful accomplishment of the project requirements. Descriptions of the waste are provided; material that was difficult or impossible to treat in earlier phases of site closure. These problem wastes included: 1) the combination of special nuclear materials mixed with high organic chemical content and/or mercury, 2) high toxic metal content mixed with high organic chemical content, and 3) very high organic chemical content mixed with debris, solids and sludge

  13. [Bad breath--etiological, diagnostic and therapeutic problems]. (United States)

    Reiss, M; Reiss, G


    Oral malodor has many etiologies and is a clinical problem for many people. This paper reviews the causes and management of oral malador. In the majority of cases the problem has been shown to originate in the oral cavity. Oral malodor, a generic descriptor term for foul smells emanating from the mouth, encompasses ozostomia, stomatodysodia, halitosis (both pathological halitosis and physiological halitosis) and fetor oris or fetor ex ore. These latter terms, in turn, denote different sources of oral malodor. All conditions that favour the retention of anaerobic, mainly gram-negative, bacteria will predispose for the development of bad breath. In addition to periodontal pockets, the most important retention site is the dorsum of the tongue with its numerous papillae. During the night and between meals the conditions are optimal for odour production. Systemic pathological states, such as diabetes mellitus, uremia and hepatic diseases, induce metabolic products that are detectable as oral smells. It is always easy to recognize halitosis, but identifying the exact cause is more complex. The clinical labelling and interpretation of different oral malodors both contribute to the diagnosis and treatment of underlying disease. Treatment is directed at the underlying cause.

  14. The development of an attachment-based treatment program for borderline personality disorder. (United States)

    Bateman, Anthony W; Fonagy, Peter


    The treatment of borderline personality disorder (BPD) remains controversial. The authors have developed an evidence-based treatment program rooted in attachment theory that integrates research on constitutional factors with environmental influences. BPD is conceived of as a disorder in the self-structure brought about through environmentally induced distortion of psychological functioning, which decouples key mental processes necessary for interpersonal and social function. The primary mental function involved is mentalization, which is enfeebled by an absence of contingent and marked mirroring during development. Treatment strategies target mentalization in order to foster the development of stable internal representations, to aid the formation of a coherent sense of self, and to enable to borderline patient to form more secure relationships in which motivations of self and other are better understood. Destabilization of the self leads to emotional volatility, so treatment also needs to focus on identification and appropriate expression of affect. This article describes some of the techniques used to enhance mentalization within the context of group and individual psychotherapy. Targeting of current symptomatology and behavior is insufficient. Therapists need to retain their own ability to mentalize, maintain mental closeness, focus on current mental states, and avoid excessive use of conflict interpretation and metaphor while paying careful attention to the use of transference and countertransference.

  15. Urinary Tract Infection in Children: Etiological Structure, Age and Gender Characteristics

    Directory of Open Access Journals (Sweden)

    V.V. Bezruk


    Full Text Available Objective. To study the etiological structure of urinary tract infections, dynamics, gender and age dependence in the child population of Chernivtsi region. Patients and methods. During 2009–2013 2432 urine samples of the children treated in health care centers of Chernivtss region were investigated by bacteriological method with purpose of verification of the diagnosis urinary tract infections. Six hundred and fifty five strains of bacteria and fungi were isolated as etiological agents. Results. The patient’s gender was found to correlate with etiological structure of the urinary tract infections and the content of the residential urine microflora. The main etiological role of the Enterobacteriaceae family in general was demonstrated. As a causative agent of the urinary tract infection E.coli has been isolated more frequently in the urine samples of female patients (р < 0.05. In contrary, Proteus spp. has been isolated in male patients (р < 0.01. As a part of the urine resident microflora E.coli strains were more frequently isolated in the female urine samples (р < 0.05. Conclusion. The research will allow to hold the correct and reasoned medical and rehabilitation events on all stages of rendering of specialized medical care for children and to develop the programs directed on the improvement of indicators of health and prevention of disability in children.

  16. Impact of warfarin discharge education program on hospital readmission and treatment costs. (United States)

    Brunetti, Luigi; Lee, Seung-Mi; Doherty, Nancy; Suh, David; Kim, Jeong-Eun; Lee, Sun-Hong; Choi, Yong Chan; Suh, Dong-Churl


    Background Although warfarin is highly effective, management of patients prescribed warfarin is complex due to its narrow therapeutic window. Objective To evaluate the impact of a formal warfarin discharge education program (WDEP) on hospital readmission and treatment costs in patients who received warfarin therapy. Setting Robert Wood Johnson University Hospital Somerset in Somerville, New Jersey, USA. Method In this interventional cohort study, patients were assigned to either the WDEP group or the usual care group. The effects of the WDEP on readmission within 90 days after discharge were analyzed using Cox proportional hazards models. Factors influencing treatment cost were identified using generalized linear model with log-link function and gamma distribution. Main outcome measure Hospital readmission within 90 days and treatment costs associated with hospital readmission. Results Among 692 eligible patients, 203 in each group were matched using propensity scores and there were no statistically significant differences in the patient baseline characteristics between two groups. The risk of all-cause readmission within 90 days was significantly lower in the WDEP group compared to the usual care group (relative risk = 0.46, 95% CI 0.28-0.76). The treatment costs associated with hospital readmission in the WDEP group were 19% lower than those in the usual care group after adjusting for the study variables. Conclusion A formal, individualized WDEP provided by pharmacists resulted in significant reduction of readmission and treatment costs. The economic burden of treatment costs associated with warfarin can be controlled if well-organized warfarin education is provided to patients who received warfarin therapy.


    Lopes, Felipe de Lucena Moreira; Coelho, Fabricio Ferreira; Kruger, Jaime Arthur Pirolla; Fonseca, Gilton Marques; Araujo, Raphael Leonardo Cunha de; Jeismann, Vagner Birk; Herman, Paulo


    Hepatocellular carcinoma (HCC) is the most frequent type of primary liver cancer and its incidence is increasing around the world in the last decades, making it the third cause of death by cancer in the world. Hepatic resection is one of the most effective treatments for HCC with five-year survival rates from 50-70%, especially for patients with a single nodule and preserved liver function. Some studies have shown a worse prognosis for HCC patients whose etiology is viral. That brings us to the question about the existence of a difference between the various causes of HCC and its prognosis. To compare the prognosis (overall and disease-free survival at five years) of patients undergoing hepatectomy for the treatment of HCC with respect to various causes of liver disease. Was performed a review of medical records of patients undergoing hepatectomy between 2000 and 2014 for the treatment of HCC. They were divided into groups according to the cause of liver disease, followed by overall and disease-free survival analysis for comparison. There was no statistically significant difference in the outcomes of the groups of patients divided according to the etiology of HCC. Overall and disease-free survival at five years of the patients in this sample were 49.9% and 40.7%, respectively. From the data of this sample, was verified that there was no prognostic differences among the groups of HCC patients of the various etiologies. O carcinoma hepatocelular (CHC) é o mais frequente tipo de câncer primário do fígado e a sua incidência vem aumentando nas últimas décadas, tornando-o hoje a terceira causa de morte por câncer no mundo. A ressecção hepática é um dos tratamentos mais eficazes para ele com taxas de sobrevida em cinco anos de 50-70%, especialmente para pacientes com nódulo único e função hepática preservada. Alguns estudos mostraram pior prognóstico para os pacientes com CHC cuja causa é a infecção por vírus B ou C. Isso leva à questão sobre a

  18. [Etiologic spectrum of solitary constitutional syndrome]. (United States)

    Hernández Hernández, J L; Matorras Galán, P; Riancho Moral, J A; González-Macías, J


    To know the spectrum of diseases responsible for the solitary constitutional syndrome in our setting. This syndrome was defined as a clinical picture characterized by the presence of asthenia, anorexia, and weight loss of at least 5% of body weight in the last six months, not associated with any other symptom or sign suggesting the diagnosis of an organ or system disease. All patients diagnosed of the solitary constitutional syndrome (328) in a tertiary-care level teaching hospital between January 1991 and December 1996. Fifty-two (170) percent of patients with solitary constitutional syndrome were males and 48% (158) females. The mean age was 65.4%, ranging from 15 to 97 years. The average of the monthly estimated weight loss was 3 to 4 kilograms. A total of 115 (35%) malignant neoplasms and 5 (1.5%) benign tumors were diagnosed. The most common malignant tumors corresponded to the digestive tract (51.3% of the total malignant tumors). The second cause in frequency of the solitary constitutional syndrome corresponded to psychiatric diseases, with a total of 80 patients (24.3%). A total of 116 non-neoplastic organic diseases were detected, with digestive tract diseases --mainly peptic disease-- being the most common cause in this group. After follow-up, only in twenty cases were we unable to detect the underlying disease responsible for the syndrome. In nine of these, the solitary constitutional syndrome was self-limited. Forty-four percent of patients had at least another concomitant disease and in 24% of patients more than one associated condition was found. The most common diseases responsible for the solitary constitutional syndrome were, by decreasing frequency, malignant tumors, psychiatric disorders, and non-malignant organic diseases located in the digestive tract. A better knowledge of the etiological spectrum of this syndrome might be useful for a more efficient management of these patients.

  19. [Chlamydia pneumoniae--etiology of ophthalmia neonatorum]. (United States)

    Krásný, J; Borovanská, J; Hrubá, D


    The authors observed mucous discharge in palpebral aperture, accompanied by a different degree of effusion of eyelids and chemosis of conjunctivae, particularly the tarsal ones, in 12 physiological newborns. Chlamydia pneumoniae proved to be the etiological agent in the newborn ophthalmia. The eye infection was not detected in the same period of time and in the same maternity hospital in the period of observation from September 1999 to March 2001. The detection of Chlamydia pneumoniae was performed in conjunctiva smears. The impression films on slides were examined by the method of indirect immunofluorescence with the use of specific monoclonal antibodies (medac, Germany). In the early stages the secretion included a sanguineous component, which was then changing into a mucoid or mucopurulent form. The character of conjunctival symptoms was changing in the course of inflammation. Effusion of the lower transitory fold (plica) was gradually accompanied by a picture of pseudofollicular changes on the tarsal conjunctiva. Clarithromycin in the form of syrup at daily doses of 15 mg/kg/day for the period of two weeks offered an efficient therapy of the affection. Control smears after 14 days were always negative and, at the same time, the pathological finding on the conjunctivae disappeared. The nasolacrimal obstruction was the only complication of this chlamydia infection, taking place in seven sucklings, i.e. in 58%. The passage through lacrimal drainage system reappeared in all the affected infants until they reached one year of age. The remaining question to be answered is the way the newborns encountered the infection. A nosocomial infection may be the case, but Chlamydia pneumoniae could also be present in the urogenital tract of mothers and transferred to the newborn via the birth canal similarly as is the case of Chlamydia trachomatis infection. The mode of infection deserves further investigation.

  20. Etiologic agents of cervicovaginitis in Turkish women. (United States)

    Ozturk, Cihadiye E; Ozdemir, Ismail; Yavuz, Tevfik; Kaya, Demet; Behcet, Mustafa


    To investigate the distribution of microbiologic agents causing cervicovaginitis. We conducted the study between October 2002 and December 2004 in Abant Izzet Baysal University, Duzce School of Medicine Hospital, Turkey. The samples were obtained from the posterior vaginal fornix and cervix by swabs in 828 patients. Direct microscopic examination, culture and enzyme immune assay (EIA) methods were performed in all patients for diagnosis of microbiologic agents. Gardnerella vaginalis (G. vaginalis) were diagnosed in 254 (30.7%) patients, Candida albicans (C. albicans) in 152 (18.4%), Candida glabrata (C. glabrata) in 36 (4.3%), Candida species in 52 (6.3%), Staphylococcus aureus (S. aureus) in 62 (7.5%), Streptococcus group B in 28 (3.4%), Escherichia coli (E. coli) in 42 (5.1%), Klebsiella species in 24 (2.9%), and Streptococcus group D in 8 (1%) patients in culture. Less frequent enterobacteria in 30 (3.6%) were: Pseudomonas species, Proteus species Enterobacter species, Hafnia alvei and Nonfermenter species. Neisseria gonorrheae (N. gonorrheae) was detected in one patient (0.1%) in culture. The Chlamydia trachomatis (C. trachomatis) antigen was detected by EIA methods in 130 (15.7%) patients and Trichomonas vaginalis (T. vaginalis) was observed in 8 (1%) patients by direct microscopic examination. Performing the etiologic diagnosis of cervicovaginitis is necessary in order to take appropriate therapeutic and preventive measures. Therefore, we recommend G. vaginalis, C. albicans and C. trachomatis should be investigated in patients having a diagnosis of cervicovaginitis in our population, since these were detected in a considerable number of cases. Additionally, C. glabrata and T. vaginalis should be kept in mind as possible pathogens.

  1. [Definition, etiology, classification and presentation forms]. (United States)

    Mas Garriga, Xavier


    Osteoarthritis is defined as a degenerative process affecting the joints as a result of mechanical and biological disorders that destabilize the balance between the synthesis and degradation of joint cartilage, stimulating the growth of subchondral bone; chronic synovitis is also present. Currently, the joint is considered as a functional unit that includes distinct tissues, mainly cartilage, the synovial membrane, and subchondral bone, all of which are involved in the pathogenesis of the disease. Distinct risk factors for the development of osteoarthritis have been described: general, unmodifiable risk factors (age, sex, and genetic makeup), general, modifiable risk factors (obesity and hormonal factors) and local risk factors (prior joint anomalies and joint overload). Notable among the main factors related to disease progression are joint alignment defects and generalized osteoarthritis. Several classifications of osteoarthritis have been proposed but none is particularly important for the primary care management of the disease. These classifications include etiological (primary or idiopathic forms and secondary forms) and topographical (typical and atypical localizations) classifications, the Kellgren and Lawrence classification (radiological repercussions) and that of the American College of Rheumatology for osteoarthritis of the hand, hip and knee. The prevalence of knee osteoarthritis is 10.2% in Spain and shows a marked discrepancy between clinical and radiological findings. Hand osteoarthritis, with a prevalence of symptomatic involvement of around 6.2%, has several forms of presentation (nodal osteoarthritis, generalized osteoarthritis, rhizarthrosis, and erosive osteoarthritis). Symptomatic osteoarthritis of the hip affects between 3.5% and 5.6% of persons older than 50 years and has different radiological patterns depending on femoral head migration. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  2. Effects of a Family-Based Childhood Obesity Treatment Program on Parental Weight Status. (United States)

    Trier, Cæcilie; Dahl, Maria; Stjernholm, Theresa; Nielsen, Tenna R H; Bøjsøe, Christine; Fonvig, Cilius E; Pedersen, Oluf; Hansen, Torben; Holm, Jens-Christian


    The aim of this study was to investigate the prevalence of overweight/obesity among parents of children entering childhood obesity treatment and to evaluate changes in the parents' weight statuses during their child's treatment. The study included parents of 1,125 children and adolescents aged 3-22 years, who were enrolled in a multidisciplinary childhood obesity treatment program. At baseline, weight and height of the parents were obtained by self-reported information and parental body mass index (BMI) was calculated. Weight and height of the children were measured in the clinic and BMI standard deviation scores were calculated. Furthermore, anthropometric data from parents of 664 children were obtained by telephone interview after a mean of 2.5 years of treatment (ranging 16 days to 7 years), and changes in parental BMI were analyzed. Data on changes in BMI were available in 606 mothers and 479 fathers. At baseline, the median BMI of the mothers was 28.1 kg/m2 (range: 16.9-66.6), and the median BMI of the fathers was 28.9 kg/m2 (range: 17.2-48.1). Seventy percent of the mothers and 80% of the fathers were overweight or obese at the time of their child's treatment initiation. Both the mothers and fathers lost weight during their child's treatment with a mean decrease in BMI in the mothers of 0.5 (95% CI: 0.2-0.8, p = 0.0006) and in the fathers of 0.4 (95% CI: 0.2-0.6, p = 0.0007). Of the overweight/obese parents, 60% of the mothers and 58% of the fathers lost weight during their child's treatment. There is a high prevalence of overweight/obesity among parents of children entering childhood obesity treatment. Family-based childhood obesity treatment with a focus on the child has a positive effect on parental BMI with both mothers and fathers losing weight. NCT00928473.

  3. The Etiology of Vaginal Discharge Syndrome in Zimbabwe Results from the Zimbabwe STI Etiology Study. (United States)

    Chirenje, Z Mike; Dhibi, Nicholas; Handsfield, H Hunter; Gonese, Elizabeth; Barr, Beth Tippett; Gwanzura, Lovemore; Latif, Ahmed S; Maseko, Dumisili Venessa; Kularatne, Ranmini S; Tshimanga, Mufuta; Kilmarx, Peter H; Machiha, Anna; Mugurungi, Owen; Rietmeijer, Cornelis A


    Symptomatic vaginal discharge is a common gynecological condition managed syndromically in most developing countries. In Zimbabwe, women presenting with symptomatic vaginal discharge are treated with empirical regimens that commonly cover both sexually transmitted infections (STI) and reproductive tract infections, typically including a combination of an intramuscular injection of kanamycin, and oral doxycycline and metronidazole regimens. This study was conducted to determine the current etiology of symptomatic vaginal discharge and assess adequacy of current syndromic management guidelines. We enrolled 200 women with symptomatic vaginal discharge presenting at 6 STI clinics in Zimbabwe. Microscopy was used to detect bacterial vaginosis and yeast infection. Nucleic acid amplifications tests were used to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium. In addition, serologic testing was performed to detect HIV infection. Of the 200 women, 146 (73%) had an etiology detected, including bacterial vaginosis (24.7%); N. gonorrhoeae (24.0%); yeast infection (20.7%); T. vaginalis (19.0%); C. trachomatis (14.0%) and M. genitalium (7.0%). Among women with STIs (N=90), 62 (68.9%) had a single infection, 18 (20.0%) had a dual infection and 10 (11.1%) had three infections.Of 158 women who consented to HIV testing, 64 (40.5%) were HIV infected.The syndromic management regimen covered 115 (57.5%) of the women in the sample who had gonorrhea, chlamydia, M. genitalium, or bacterial vaginosis, while 85 (42.5%) of women were treated without such diagnosis. Among women presenting with symptomatic vaginal discharge, bacterial vaginosis was the most common etiology and gonorrhea was the most frequently detected STI. The current syndromic management algorithm is suboptimal for coverage of women presenting with symptomatic vaginal discharge; addition of point of care testing could compliment the effectiveness of the syndromic approach.

  4. How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials. (United States)

    Sateren, Warren B; Trimble, Edward L; Abrams, Jeffrey; Brawley, Otis; Breen, Nancy; Ford, Leslie; McCabe, Mary; Kaplan, Richard; Smith, Malcolm; Ungerleider, Richard; Christian, Michaele C


    We chose to examine the impact of socioeconomic factors on accrual to National Cancer Institute (NCI)-sponsored cancer treatment trials. We estimated the geographic and demographic cancer burden in the United States and then identified 24,332 patients accrued to NCI-sponsored cancer treatment trials during a 12-month period. Next, we examined accrual by age, sex, geographic residence, health insurance status, health maintenance organization market penetration, several proxy measures of socioeconomic status, the availability of an oncologist, and the presence of a hospital with an approved multidisciplinary cancer program. Pediatric patients were accrued to clinical trials at high levels, whereas after adolescence, only a small percentage of cancer patients were enrolled onto clinical trials. There were few differences by sex. Black males as well as Asian-American and Hispanic adults were accrued to clinical trials at lower rates than white cancer patients of the same age. Overall, the highest observed accrual was in suburban counties. Compared with the United States population, patients enrolled onto clinical trials were significantly less likely to be uninsured and more like to have Medicare health insurance. Geographic areas with higher socioeconomic levels had higher levels of clinical trial accruals. The number of oncologists and the presence of approved cancer programs both were significantly associated with increased accrual to clinical trials. We must work to increase the number of adults who enroll onto trials, especially among the elderly. Ongoing partnership with professional societies may be an effective approach to strengthen accrual to clinical trials.

  5. Randomized Trial of a Family-based, Automated, Conversational Obesity Treatment Program for Underserved Populations (United States)

    Wright, J. A.; Phillips, B.D.; Watson, B.L.; Newby, P.K.; Norman, G. J.; Adams, W.G.


    Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p 75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations. PMID:23512915

  6. Transarterial embolization in the management of intractable epistaxis: the angiographic findings and results based on etiologies. (United States)

    Wang, Bin; Zu, Qing-Quan; Liu, Xing-Long; Zhou, Chun-Gao; Xia, Jin-Guo; Zhao, Lin-Bo; Shi, Hai-Bin; Liu, Sheng


    Transarterial embolization (TAE) appears to be a safe and effective treatment for patients with intractable epistaxis, despite different etiologies or angiography findings. Idiopathic epistaxis is prone to present with negative angiographic findings. To retrospectively evaluate the safety and effectiveness of TAE for intractable epistaxis, and focus on the factors of etiology and angiographic findings. From March 2008 to December 2014, the data of 43 patients with intractable bleeding undergoing TAE were reviewed. The outcomes of interventional therapy were assessed according to different etiology (malignant or benign disease) and angiographic finding (positive or negative angiogram). Positive angiographic findings were found in 11 of 12 cases with malignant diseases and 22 of 31 cases with benign diseases, respectively (p = 0.237). Among the 10 cases with negative angiographic findings, the negative angiography rate of idiopathic epistaxis was higher than that of epistaxis with definite etiology (p = 0.003). Bleeding was controlled successfully in all of the 43 patients after embolization. During the mean follow-up period of 24.0 ± 16.7 months, five patients relapsed. No significant difference was found in recurrence rates between malignant and benign diseases or between positive and negative angiography (p = 0.241, p = 0.704, respectively).

  7. The Etiology and Clinical Course of Chronic Pancreatitis in Children With Early Onset of the Disease. (United States)

    Wejnarska, Karolina; Kolodziejczyk, Elwira; Wertheim-Tysarowska, Katarzyna; Dadalski, Maciej; Sobczynska-Tomaszewska, Agnieszka; Kierkus, Jarosław; Bal, Jerzy; Rygiel, Agnieszka Magdalena; Oracz, Grzegorz


    The etiological factors of chronic pancreatitis (CP) in children differ from those in adults. To date, no study has assessed the clinical course of CP in young children. The aim of our study was to evaluate the etiology and the clinical presentation of the disease in children with disease onset before 5 years of age in comparison to later-onset of CP. A total of 276 children with CP, hospitalized from 1988 to 2015, were enrolled in the study. Data on presentation, diagnostic findings, and treatment were reviewed. Two hundred sixty patients were screened for the most frequent mutations in major pancreatitis-associated genes, such as cationic trypsinogen/serine protease gene (PRSS1), serine protease inhibitor, Kazal type 1 gene (SPINK1), and cystic fibrosis transmembrane conductance regulator gene (CFTR). The disease onset before the age of 5 years occurred in 51 patients (group 1), the later onset in 225 patients (group 2). We found no significant discrepancies in distribution of the etiological factors between groups. The youngest patients (group 1) had more pancreatitis episodes (median 5.0 vs 3.00; P pancreatic function. Early- and later-onset pancreatitis have similar etiological factors with predominance of gene mutations. The most frequent mutation found was p.Asn34Ser (N34S) in SPINK1 gene. The clinical presentation differed in number of pancreatitis episodes and frequency of surgeries.

  8. Summer Treatment Program for Preschoolers with Externalizing Behavior Problems: a Preliminary Examination of Parenting Outcomes. (United States)

    Graziano, Paulo A; Ros, Rosmary; Hart, Katie C; Slavec, Janine


    Within an at-risk sample of preschoolers with externalizing behavior problems (EBP), the current study examined the initial promise of a multimodal intervention, the Summer Treatment Program for Pre-Kindergarteners (STP-PreK), in improving parenting outcomes. Using an open trial design, 154 parents and their preschool children (73% male; M age  = 5.06 years; 82% Hispanic/Latino background) with at-risk or clinically elevated levels of EBP (57% of which were referred by schools or mental health/medical professionals) completed a baseline and post-treatment assessment. A subsample of 90 families completed a follow-up assessment approximately 6 to 9 months after treatment completion. Parental measures of parenting stress and discipline strategies were collected across all three assessments. Observational data were also collected across all assessments during a 5-min standardized child-led play situation and a 5-min parent-led clean up task. The parenting component of the STP-PreK included a School Readiness Parenting Program (SRPP) of which the behavioral management component was implemented via a Parent-Child Interaction Therapy (PCIT) adaptation (8 weekly group sessions with 15-20 parents in each group, lack of requirement of "mastery" criteria). All parenting outcomes (both ratings and observed) significantly improved after the intervention (Cohen's d mean effect size across measures 0.89) with all effects being maintained at the 6-9 month follow-up. These findings highlight the initial promise of our SRPP's PCIT adaptation in targeting multiple aspects of parenting while yielding comparable parenting skills acquisition compared to traditional individual PCIT.

  9. [Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program]. (United States)

    Krischer, Maya; Ponton-Rodriguez, Tamara; Gooran, Ghazal Rostami; Bender, Stephan


    Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program This paper focuses on the concept of transference focused psychotherapy (TFP) modified for juvenile borderline patients. Adolescents with borderline developmental personality disorder (bpd) have an essential deficit in their personality structure that leads to oscillations in their self-esteem and in a "split" perception of the world. They suffer from a variety of symptoms and severe impairments on their own and their families' quality of life. Their fragmented perception of themselves and others make relationships almost unbearable for them. Relationships are mostly marked by severe anxiety of resentment and rejection. For these patients this causes intolerable trouble at school where every day conflicts take place. Self-mutilation and suicidal thoughts often seem the only way out. By now, there is an agreement that an early specialized assessment and treatment is necessary in order to stop the typical consequences of their self-mutilative and dysfunctional behavior. Still, in contrast to adult age, empirical evidence is missing which proves the effectiveness of treating adolescent borderline patients. In this paper we present a research project on the effectiveness of transference focused psychotherapy with adolescent borderline patients (TFP-A) in a day clinic setting, combining TFP with group skills training as known from dialectic behavior therapy (DBT). Furthermore, we give first results on analyzing the effectiveness of our day clinic treatment program based on TFP-A, focusing on improving core symptoms such as affective problems, aggressive behavior against self and others and interpersonal problems.

  10. Evaluation of a four- versus six-week length of stay in the Navy's alcohol treatment program. (United States)

    Trent, L K


    Attempts to balance escalating health care costs with resource downsizing have prompted alcohol treatment directors in the U.S. Navy to consider reducing the standard length of stay in treatment. The objectives of this study were to (1) determine whether a 4-week inpatient treatment program is as effective as a 6-week program, and (2) explore the potential for matching patients to a 4- or 6-week program according to the severity of their condition at intake. A total of 2,823 active-duty alcohol-dependent inpatients (2,685 men, 138 women) at 12 Navy treatment facilities participated in the evaluation. All facilities conducted a 6-week program until data had been collected for 1,380 participants; they then switched to a 4-week program (n = 1,443). Background information and clinical profile were obtained when patients entered treatment; 1-year outcome data (e.g., alcohol use, behavior problems, job performance, quality of life) were obtained from participants, work supervisors and aftercare advisors. Hierarchical multiple regression analyses were used to assess the effect of length of stay on outcome and to examine patient-program interactions. The single best predictor of success at 1 year was months of aftercare attendance. Program membership failed to explain any of the observed differences in the criterion measures, once the effects of other predictors had been taken into account. Severity of condition and patient-program interactions were likewise nonsignificant. It was concluded that a reduction in length of stay from 6 weeks to 4 weeks in the Navy's inpatient alcohol treatment program would not have an adverse effect on outcome.

  11. Spoken language outcomes after hemispherectomy: factoring in etiology. (United States)

    Curtiss, S; de Bode, S; Mathern, G W


    We analyzed postsurgery linguistic outcomes of 43 hemispherectomy patients operated on at UCLA. We rated spoken language (Spoken Language Rank, SLR) on a scale from 0 (no language) to 6 (mature grammar) and examined the effects of side of resection/damage, age at surgery/seizure onset, seizure control postsurgery, and etiology on language development. Etiology was defined as developmental (cortical dysplasia and prenatal stroke) and acquired pathology (Rasmussen's encephalitis and postnatal stroke). We found that clinical variables were predictive of language outcomes only when they were considered within distinct etiology groups. Specifically, children with developmental etiologies had lower SLRs than those with acquired pathologies (p =.0006); age factors correlated positively with higher SLRs only for children with acquired etiologies (p =.0006); right-sided resections led to higher SLRs only for the acquired group (p =.0008); and postsurgery seizure control correlated positively with SLR only for those with developmental etiologies (p =.0047). We argue that the variables considered are not independent predictors of spoken language outcome posthemispherectomy but should be viewed instead as characteristics of etiology. Copyright 2001 Elsevier Science.

  12. Survey of Radiation Oncology Centres in Australia: report of the radiation oncology treatment quality program

    International Nuclear Information System (INIS)

    Klybaba, M.; Kenny, L.; Kron, T.; Harris, J.; O'Brien, P.


    Full text: One of the first steps towards the development of a comprehensive quality program for radiation oncology in Australia has been a survey of practice. This paper reports on the results of the survey that should inform the development of standards for radiation oncology in Australia. A questionnaire of 108 questions spanning aspects of treatment services, equipment, staff, infrastructure and available quality systems was mailed to all facilities providing radiation treatment services in Australia (n = 45). Information of 42 sites was received by June 2006 providing data on 113 operational linear accelerators of which approximately 2/3 are equipped with multi-leaf collimators. More than 75% of facilities were participating in a formal quality assurance (QA) system, with 63% following a nationally or internationally recognised system. However, there was considerable variation in the availability of policies and procedures specific to quality aspects, and the review of these. Policies for monitoring patient waiting times for treatment were documented at just 71% of all facilities. Although 85% of all centres do, in fact, monitor machine throughput, the number and types of efficiency measures varied markedly, thereby limiting the comparative use of these results. Centres identified workload as the single most common factor responsible for limiting staff involvement in both QA processes and clinical trial participation. The data collected in this 'snapshot' survey provide a unique and comprehensive baseline for future comparisons and evaluation of changes

  13. Deuterodiacetylmorphine as a marker for use of illicit heroin by addicts in a heroin-assisted treatment program

    NARCIS (Netherlands)

    Klous, Marjolein G.; Rook, Elisabeth J.; Hillebrand, Michel J. X.; van den Brink, Wim; van Ree, Jan M.; Beijnen, Jos H.


    In preparation for a treatment program concerning the medical coprescription of heroin and methadone to treatment-resistant addicts in the Netherlands, we studied a novel strategy for monitoring co-use of illicit (nonprescribed) heroin. A deuterated analogue of heroin was added (1:20) to

  14. Web-Based Treatment Program Using Intensive Therapeutic Contact for Patients With Eating Disorders : Before-After Study

    NARCIS (Netherlands)

    ter Huurne, E.D.; Postel, Marloes Gerda; de Haan, H.A.; Drossaert, Constance H.C.; Jong, C.A.J.


    Background: Although eating disorders are common in the Netherlands, only a few patients are treated by mental health care professionals. To reach and treat more patients with eating disorders, Tactus Addiction Treatment developed a web-based treatment program with asynchronous and intensive

  15. Adolescents in Public Substance Abuse Treatment Programs: The Impacts of Sex and Race on Referrals and Outcomes. (United States)

    Shillington, Audrey M.; Clapp, John D.


    Analyses of study on adolescents in publicly funded treatment programs present sex and ethnic differences. Among some of the findings: females were more likely to report methamphetamine use, males reported marijuana use; Hispanics and African Americans were referred to treatment from criminal justice; reported marijuana as primary drug; mandated…

  16. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs. (United States)


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...

  17. Etiology and outcome of community-acquired lung abscess. (United States)

    Takayanagi, Noboru; Kagiyama, Naho; Ishiguro, Takashi; Tokunaga, Daidou; Sugita, Yutaka


    Anaerobes are the first and Streptococcus species the second most common cause of community-acquired lung abscess (CALA) in the West. The etiologic pathogens of this disease have changed in Taiwan, with Klebsiella pneumoniae being reported as the most common cause of CALA. To determine the etiologies of community-acquired lung abscess. We retrospectively reviewed the records of 205 Japanese adult patients with CALA to evaluate etiologies and outcomes. We used not only traditional microbiological investigations but also percutaneous ultrasonography-guided transthoracic needle aspiration and protected specimen brushes. Of these 205 patients, 122 had documented bacteriological results, with 189 bacterial species isolated. Pure aerobic, mixed aerobic and anaerobic, and pure anaerobic bacteria were isolated in 90 (73.8%), 17 (13.9%), and 15 (12.3%) patients, respectively. The four most common etiologic pathogens were Streptococcus species (59.8%), anaerobes (26.2%), Gemella species (9.8%), and K. pneumoniae (8.2%). Streptococcus mitis was the most common among the Streptococcus species. Mean duration of antibiotic administration was 26 days. Six patients (2.9%, 3 with actinomycosis and 3 with nocardiosis) were treated with antibiotics for 76-189 days. Two patients with anaerobic lung abscess died. The first and second most common etiologic pathogens of CALA in our hospital were Streptococcus species and anaerobes, respectively. The etiologies in our study differ from those in Taiwan and are similar to those in the West with the exception that Streptococcus species were the most common etiologic pathogens in our study whereas anaerobes are the most frequent etiologic pathogens in Western countries. S. mitis and Gemella species are important etiologic pathogens as well. The identification of Actinomyces and Nocardia is important in order to define the adequate duration of antibiotic administration. Copyright 2010 S. Karger AG, Basel.

  18. Modern views on the epidemiology, etiology and pathogenesis of gynecomastia

    Directory of Open Access Journals (Sweden)

    Yu. N. Yashina


    Full Text Available The review deals with one of the pressing andrological issues – gynecomastia, its etiology and pathogenesis. Based on the current epidemiological and experimental data, most common etiological factors of gynecomastia were investigated. A multiple-valued role of various causes of gynecomastia in several age-groups was revealed. Literature data show that gynecomastia may be a manifestation of various diseases: endocrine, genetic, systematic. As well as that, gynecomastia may occur in patients with oncological diseases. However, gynecomastia can be an iatrogenic complication. Currently, we continue to make insights to the problem of gynecomastia in order to be able to classify its etiological factors and determine its basic pathogenesis pathways.

  19. [Therapeutic education of elderly patients under antivitamin - K treatment: evaluation of the program after 5 years]. (United States)

    Thiriat, N; Peyron, I; Bernard-Charrière, S; Monti, A; Pariel, S; Pautas, E


    Elderly people with vitamin K antagonists (VKA) have a higher risk of potentially serious hemorrhagic complications. An education program for patients (EPP) aged > or = 75 years with VKA was set up in 2008 in a French geriatric hospital. It includes individual and group sessions conducted by a nurse and a geriatrician. The aim of this study was to assess this EPP after 5 years. Strengths, weaknesses and difficulties of implementation were highlighted, and some improvements were proposed. This study is an external audit conducted by a pharmacist trained in EPP. Files of consecutive patients included in the program between may 2008 and March 2013 were reviewed allowing the data collection of patients characteristics and results of the different sessions. The educational objectives were assessed by the rate of correct responses to the questionnaires during the program. The results are presented taking into account the changes made during the 5 years of the program. One hundred forty-three patients, mean age 83.3 +/- 6.5 years, were included in the EPP. 51 sessions were conducted (2.8 patients/session on average). 58% of selected patients were hospitalized. The mean time between the start of anticoagulant treatment and the incLusion in the program was 48.9 +/- 71 months. For 95 patients (66.4%) the medication management at home required a caregiver who was present for sessions in 82 cases (57.3%). The questionnaires form and the organisation of the sessions were gradually improved between 2008 and the end of 2010. Thus, the impact of the EPP has been estimated from November 2010 to March 2013. The correct responses rates before and after the sessions were respectively: 47.8% vs 91.3% for knowledge of INR target values, 25.4% vs 91.3% for knowledge of hemorrhagic signs, 14.9% vs 87.0% for knowledge of the situations or the medications that may disturb the INR equilibrium. Furthermore, the mean number of correct responses, for the 23 patients participating in the entire

  20. Etiology and sequelae of root resorption. (United States)

    Vlaskalic, V; Boyd, R L; Baumrind, S


    This article reviews the current status of investigation into apical root resorption within the context of orthodontic treatment. Treatment and patient factors that have traditionally been investigated are discussed, along with the results of current research in this area. The need for rethinking traditional research strategies in the quest for identifying both control and causative mechanisms is explored. Finally, proposals for key areas of future interest are highlighted.

  1. The transition to medication adoption in publicly funded substance use disorder treatment programs: organizational structure, culture, and resources. (United States)

    Knudsen, Hannah K; Roman, Paul M


    Medications for the treatment of substance use disorders (SUDs) are not widely available in publicly funded SUD treatment programs. Few studies have drawn on longitudinal data to examine the organizational characteristics associated with programs transitioning from not delivering any pharmacotherapy to adopting at least one SUD medication. Using two waves of panel longitudinal data collected over a 5-year period, we measured the transition to medication adoption in a cohort of 190 publicly funded treatment organizations that offered no SUD medications at baseline. Independent variables included organizational characteristics, medical resources, funding, treatment culture, and detailing activities by pharmaceutical companies. Of 190 programs not offering SUD pharmacotherapy at baseline, 22.6% transitioned to offering at least one SUD medication at follow-up approximately 5 years later. Multivariate logistic regression results indicated that the employment of at least one physician at baseline, having a greater proportion of Medicaid clients, and pharmaceutical detailing were positively associated with medication adoption. Adoption of pharmacotherapy was more likely in programs that had greater medical resources, Medicaid funding, and contact with pharmaceutical companies. Given the potential expansion of Medicaid under the Affordable Care Act, patients served by publicly funded programs may gain greater access to such treatments, but research is needed to document health reform's impact on this sector of the treatment system.

  2. Male infertility in Kuwait: Etiologic and Therapeutic aspects

    International Nuclear Information System (INIS)

    Qadan, Laila R.; Ahmed, Adel A.; Kapila, Kusum A.; Hassan, Nahida A.; Kodaj, Jan A.; Pathan, Shahed K.


    Objective was to evaluate the pathological patterns associated with male infertility in Kuwait and to characterize treatment outcome after varicocele repair using percutaneous varicocele embolization. We carried out a prospective study of 64 infertile men in Kuwait between 2001 and 2005. All patients included had proven non-obstructive azoospermia or oligospermia (sperm count <20 million /ml). All patients underwent ultrasonographic evaluation of the scrotum. Fine needle aspiration of the testes was performed on all azoospermic patients. A total of 24(38%) patients were azoospermic and 40(62%) were oligospermic. Sertoli-cell-only pattern was the most common cytopathology associated with primary testicular failure. Among the oligospermic patients, 50% had small to moderate varicocele. Spermatic vein embolization resulted in a significant rise in the mean sperm count from 10.6+-3.8 million/ml to 30.2+-6.8 million/mn (p<0.05) in 5 treated oligospermic patients, followed by spontaneous pregnancy in 2 couples. No effect was seen azoospermic patients. From an etiological point of view, we believe that the high incidence of Sertoli cell-only-syndrome among nationals and residents of a country that underwent a major environmental insult strengths the chances of an environmental role in the development of this syndrome. From a management point of view, in cultures wherein vitro fertilization is either still not widely acceptable or is unaffordable, oligospermia with clinical or subclinical varicocele deserves a trial of low risk, outpatient procedure, spermatic, vein embolization that could improve fertility. (author)

  3. Chronic kidney disease of unknown etiology in Sri Lanka. (United States)

    Rajapakse, Senaka; Shivanthan, Mitrakrishnan Chrishan; Selvarajah, Mathu


    In the last two decades, chronic kidney disease of unknown etiology (CKDu) has emerged as a significant contributor to the burden of chronic kidney disease (CKD) in rural Sri Lanka. It is characterized by the absence of identified causes for CKD. The prevalence of CKDu is 15.1-22.9% in some Sri Lankan districts, and previous research has found an association with farming occupations. A systematic literature review in Pubmed, Embase, Scopus, and Lilacs databases identified 46 eligible peer-reviewed articles and one conference abstract. Geographical mapping indicates a relationship between CKDu and agricultural irrigation water sources. Health mapping studies, human biological studies, and environment-based studies have explored possible causative agents. Most studies focused on likely causative agents related to agricultural practices, geographical distribution based on the prevalence and incidence of CKDu, and contaminants identified in drinking water. Nonetheless, the link between agrochemicals or heavy metals and CKDu remains to be established. No definitive cause for CKDu has been identified. Evidence to date suggests that the disease is related to one or more environmental agents, however pinpointing a definite cause for CKDu is challenging. It is plausible that CKDu is multifactorial. No specific guidelines or recommendations exist for treatment of CKDu, and standard management protocols for CKD apply. Changes in agricultural practices, provision of safe drinking water, and occupational safety precautions are recommended by the World Health Organization.

  4. Gene-environment interplay in the etiology of psychosis. (United States)

    Zwicker, Alyson; Denovan-Wright, Eileen M; Uher, Rudolf


    Schizophrenia and other types of psychosis incur suffering, high health care costs and loss of human potential, due to the combination of early onset and poor response to treatment. Our ability to prevent or cure psychosis depends on knowledge of causal mechanisms. Molecular genetic studies show that thousands of common and rare variants contribute to the genetic risk for psychosis. Epidemiological studies have identified many environmental factors associated with increased risk of psychosis. However, no single genetic or environmental factor is sufficient to cause psychosis on its own. The risk of developing psychosis increases with the accumulation of many genetic risk variants and exposures to multiple adverse environmental factors. Additionally, the impact of environmental exposures likely depends on genetic factors, through gene-environment interactions. Only a few specific gene-environment combinations that lead to increased risk of psychosis have been identified to date. An example of replicable gene-environment interaction is a common polymorphism in the AKT1 gene that makes its carriers sensitive to developing psychosis with regular cannabis use. A synthesis of results from twin studies, molecular genetics, and epidemiological research outlines the many genetic and environmental factors contributing to psychosis. The interplay between these factors needs to be considered to draw a complete picture of etiology. To reach a more complete explanation of psychosis that can inform preventive strategies, future research should focus on longitudinal assessments of multiple environmental exposures within large, genotyped cohorts beginning early in life.

  5. Oxidative Stress and Liver Cancer: Etiology and Therapeutic Targets

    Directory of Open Access Journals (Sweden)

    Zhanpeng Wang


    Full Text Available Accumulating evidence has indicated that oxidative stress (OS is associated with the development of hepatocellular carcinoma (HCC. However, the mechanisms remain largely unknown. Normally, OS occurs when the body receives any danger signal—from either an internal or external source—and further induces DNA oxidative damage and abnormal protein expression, placing the body into a state of vulnerability to the development of various diseases such as cancer. There are many factors involved in liver carcinogenesis, including hepatitis B virus (HBV and hepatitis C virus (HCV infection, alcohol abuse, and nonalcoholic fatty liver disease (NAFLD. The relationship between OS and HCC has recently been attracting increasing attention. Therefore, elucidation of the impact of OS on the development of liver carcinogenesis is very important for the prevention and treatment of liver cancer. This review focuses mainly on the relationship between OS and the development of HCC from the perspective of cellular and molecular mechanisms and the etiology and therapeutic targets of HCC.

  6. Voiding dysfunction: another etiology of vulvovaginitis in young girls. (United States)

    Romero, P; Rodríguez, E; Muñoz, M; Delucchi, A; Guerrero, J L; Lillo, A M; Cano, F; Matilde Osses, Sra; Romero, M I; Gonzalez Roca, C


    To determine the prevalence of voiding dysfunction (VD) in patients with persistent vulvovaginitis (PVV), and to evaluate the clinical response of PVV in the treatment of VD. Girls four years or older who consulted for PVV for at least one month and who did not respond to general measures. A physical examination was performed with visual inspection and colposcopy; vaginal samples for culture and vaginoscopy were carried out. On every patient urodynamic studies were performed. Girls who were diagnosed with VD were treated. A pediatric gynecologist did the follow-up; a successful response was considered when inflammatory symptoms and vaginal discharge ceased. Twenty patients were included, mean age 8.6 years (range: 4.6-14 years); 75% prepubertal symptoms lasted for 1.8 years; 19 (95%) had urodynamia, 10 (52.6%) had an overactive bladder, 8 (42.1%) external bladder sphincter dyssynergia, 1 (5.2%) hypotonic bladder, and 13 (65%) showed improvement. VD is an important cause when considering the etiology of PVV. 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  7. Frequency of etiological factors leading to patent ductus arteriosus

    International Nuclear Information System (INIS)

    Waheed, I.; Shahbaz, A.


    Background: Patent Ductus Arteriosus (PDA) is developing as major problem in our society. Many studies in Pakistan has been done to analyze the efficacy of surgical procedures but no one tried to find the frequency of factors leading to this problem. Objective: The purpose of this study was to find out the frequency of factors leading to patent ductus arteriosus in children presented at Punjab Institute of Cardiology. Method: A cross sectional study was conducted on 242 patients of PDA who already have been treated during the year 2006 - 2007. They were interviewed on their regular follow up visits. Their operative information was gathered from their files. Results: Mean age of children at time of treatment was 6.12 + 5.203 years. Out of 242 children, there were more female (62.8%) as compared to male (37.2%). In this study, 17.8% children inherited the disease from their close relatives and 105 (43.4%) mothers had some infectious problems during pregnancy. 103 (42.6%) mothers used antibiotics or other drugs during pregnancy. 11 (4.5%) children had Down syndrome. One hundred and thirty seven (56.61%) children had premature birth. Conclusion: Female gender, preterm birth, infection during pregnancy, mother's exposure to drugs and smoking, low birth weight may be etiological factors for development of PDA. (author)

  8. Etiology and antimicrobial resistance patterns in pediatric urinary tract infection. (United States)

    Wang, Jun; He, Lijiao; Sha, Jintong; Zhu, Haobo; Huang, Liqu; Zhu, Xiaojiang; Dong, Jun; Li, Guogen; Ge, Zheng; Lu, Rugang; Ma, Geng; Shi, Yaqi; Guo, Yunfei


    Urinary tract infection (UTI) is one of most common pediatric infections. The aim of this study was to investigate the etiology and antimicrobial resistance patterns in children hospitalized at Children's Hospital of Nanjing Medical University. We conducted a retrospective, descriptive study of all UTI from 1 January 2013 to 30 November 2016 in children discharged from Nanjing Children's Hospital. The isolated pathogens and their resistance patterns were examined using midstream urine culture. A total of 2,316 children with UTI were included in the study. The occurrence rates of isolated pathogens were as follows: Enterococcus spp., 35.15%; Escherichia coli, 22.32%; Staphylococcus aureus spp., 7.73%; Streptococcus spp., 7.51%; and Klebsiella spp., 6.95%. Uropathogens had a low susceptibility to linezolid (3.47%), vancomycin (0.92%), imipenem (5.74%), and amikacin (3.17%), but they had a high susceptibility to erythromycin (90.52%), penicillin G (74.01%), cefotaxime (71.41%), cefazolin (73.41%), cefuroxime (72.52%), and aztreonam (70.11%). There is high antibiotic resistance in hospitalized children with UTI. Susceptibility testing should be carried out on all clinical isolates, and the empirical antibiotic treatment should be altered accordingly. © 2018 Japan Pediatric Society.

  9. Etiologies and clinical presentation of gigantism in Algeria. (United States)

    Chentli, Farida; Azzoug, Said; Amani, Mohammed El Amine; Haddam, Ali El Mahdi; Chaouki, Dalal; Meskine, Djamila; Chaouki, Mohamed Lamine


    True gigantism is an exceptional and fascinating pediatric disease. Our aim in this study was to describe the different etiologies of a large group of children with gigantism and the natural history of their growth. In this multicenter study, we considered as giant children, adolescents and adults whose heights were ≥3 SD compared to their target stature or to our population average lengths. Isolated hypogonadism and Klinefelter syndrome were excluded from this series. All underwent clinical exam, and hormonal and neurological investigations. From 1980 to 2010, we observed 30 giants: 26 males (86.6%) and 4 females (mean age 19.8 ± 11 years). Among the 13 patients (40.3%) who consulted before the age of 16 years, 9 had acromegaly and 6 had mental retardation and body malformations. Based on growth hormone (GH) secretion evaluation, 2 groups were observed: pituitary gigantism (n = 16): GH = 150 ± 252 ng/ml (n ≤ 5), and other causes with normal GH (0.7 ± 0.6 ng/ml): 6 Sotos syndrome and 8 idiopathic cases. Only the first group had neurological, ophthalmological, metabolic and cardiovascular complications and received treatment. The result was not optimal as GH normalization was not observed. Reduction of tumor size and decreased GH plasma values were not observed. Gigantism predominates in males. The main cause is GH excess. The diagnosis was very late except for cerebral gigantism. Complications were observed in pituitary gigantism only. Copyright © 2012 S. Karger AG, Basel.

  10. Review of hepatocellular carcinoma: Epidemiology, etiology, and carcinogenesis

    Directory of Open Access Journals (Sweden)

    Yezaz Ahmed Ghouri


    Full Text Available Since the 1970s, the epidemic of hepatocellular carcinoma (HCC has spread beyond the Eastern Asian predominance and has been increasing in Northern hemisphere, especially in the United States (US and Western Europe. It occurs more commonly in males in the fourth and fifth decades of life. Among all cancers, HCC is one of the fastest growing causes of death in the US and poses a significant economic burden on healthcare. Chronic liver disease due to hepatitis B virus or hepatitis C virus and alcohol accounts for the majority of HCC cases. Incidence of nonalcoholic fatty liver disease has been on the risem and it has also been associated with the development of HCC. Its pathogenesis varies based on the underlying etiological factor although majority of cases develop in the setting of background cirrhosis. Carcinogenesis of HCC includes angiogenesis, chronic inflammation, and tumor macroenvironment and microenvironment. There is a significant role of both intrinsic genetic risk factors and extrinsic influences such as alcohol or viral infections that lead to the development of HCC. Understanding its etiopathogenesis helps select appropriate diagnostic tests and treatments.

  11. Review of hepatocellular carcinoma: Epidemiology, etiology, and carcinogenesis. (United States)

    Ghouri, Yezaz Ahmed; Mian, Idrees; Rowe, Julie H


    Since the 1970s, the epidemic of hepatocellular carcinoma (HCC) has spread beyond the Eastern Asian predominance and has been increasing in Northern hemisphere, especially in the United States (US) and Western Europe. It occurs more commonly in males in the fourth and fifth decades of life. Among all cancers, HCC is one of the fastest growing causes of death in the US and poses a significant economic burden on healthcare. Chronic liver disease due to hepatitis B virus or hepatitis C virus and alcohol accounts for the majority of HCC cases. Incidence of nonalcoholic fatty liver disease has been on the risem and it has also been associated with the development of HCC. Its pathogenesis varies based on the underlying etiological factor although majority of cases develop in the setting of background cirrhosis. Carcinogenesis of HCC includes angiogenesis, chronic inflammation, and tumor macroenvironment and microenvironment. There is a significant role of both intrinsic genetic risk factors and extrinsic influences such as alcohol or viral infections that lead to the development of HCC. Understanding its etiopathogenesis helps select appropriate diagnostic tests and treatments.

  12. Etiologic study of urinary tract infection in dogs

    Directory of Open Access Journals (Sweden)

    Marcia Mery Kogika


    Full Text Available Urinary tract infections were documented in 51 dogs. Several factors such as etiologic agents, localization of the infection, predisposing factors, sex, age, and breed were considered. The diagnosis of urinary tract infection (UTI was based on bacteriological investigation and it was considered positive when urine sample collected by catheterization contained more than 105 bacteria/ml. Mixed infection was found in 4 of the infected dogs, totallizing 55 isolates. Among them, Escherichia coli (35.3% was the most frequently isolated, followed by Staphylococcus sp. (23.5%, Proteus mirabilis (15.7%, Streptococcus sp. (13.7%, Klebsiella sp. (9.8%. Pseudomonas aeruginosa (3.9%, Enterobacter cloacae (2.0%, Citrobacter freundii (2.0% and Providencia rettgeri (2.0%. As to antimicrobial susceptibility, norfloxacin and gentamicin were successful for the treatment of gram-negative microorganisms, while the most effective drugs for gram-positive bacteria were cephalothin and nitrofurantoin. UTI was observed more frequently in Cocker Spaniel and German Shepherd; male dogs were more involved, and pyelonephritis was the predominant disease observed. Infection was seen in all ages, but the frequency was higher in middle aged dogs. Urolithiasis were observed as common predisposing or underlying factors to UTI being, cither Staphylococcus sp. or Proteus mirabilis isolated in those cases which alkaline urine pH was observed.

  13. Fulminant hepatic failure in children: Etiology, histopathology and MDCT findings

    International Nuclear Information System (INIS)

    Cakir, Banu; Kirbas, Ismail; Demirhan, Beyhan; Tarhan, Nefise Cagla; Bozkurt, Alper; Ozcay, Figen; Coskun, Mehmet


    Introduction: The purpose of this study is to determine the etiologies, histopathology and MDCT findings of children with fulminant hepatic failure admitted to our institution. Materials and methods: Between June 2004 and November 2006, 15 children with fulminant hepatic failure who underwent MDCT were included retrospectively in this study. Twelve patients had liver biopsies. The patients were divided into three groups as hyperacute (Group I), acute (Group II) and subacute (Group III) depending on onset of hepatic encephalopathy. Results: Hepatitis A in 4 patients, non-A, non-E hepatitis in 4; mushroom poisoning in 3; fulminant Wilson's disease in 2; autoimmune hepatitis in 1; and both hepatitis B and toxic hepatitis (with leflunomide treatment) in 1 patient were detected. MDCT of all three groups revealed diffuse reduction in hepatic attenuation in 11 patients; ascites in 9; periportal edema in 6; edema of gallbladder wall in 6; splenomegaly in 6; heterogeneous hepatic parenchyma in 6; hepatomegaly in 3; irregular contours of liver in 2; multiple micronodules in 1 and necrotic areas and regeneration in liver parenchyma in 2 patients. Histopathologic evaluation of liver biopsies showed massive hepatic necrosis, inflammatory cell infiltration and ductular proliferation in 8 patients, periportal edema in 6, edema of gallbladder wall in 5, regenerating nodules and fibrous septa consistent with cirrhotic pattern in 2, and regenerating nodules and necrotic areas in 2 patients. Conclusion: The most common MDCT findings in fulminant hepatic failure were diffuse reduction in hepatic attenuation and ascites. Massive hepatic necrosis was the most common histopathologic finding.

  14. Efficacy of a hyperglycemia treatment program in a Vascular Surgery Department supervised by Endocrinology. (United States)

    Caimari, Francisca; González, Cintia; Ramos, Analía; Chico, Ana; Cubero, José M; Pérez, Antonio


    The aim of this study was to evaluate the strategy and efficacy of a hyperglycemia treatment program supervised by Endocrinology. All patients with type 2 diabetes hospitalized at the vascular surgery department over a 12 month period were retrospectively reviewed. Clinical characteristics and hyperglycemia treatment during hospitalization, at discharge and 2-6 month after discharge were collected. Glycemic control was assessed using capillary blood glucose profiles and HbA1c at admission and 2-6 months post-discharge. A total of 140 hospitalizations of 123 patients were included. The protocol to choose the insulin regimen was applied in 96.4% of patients (22.8% correction dose, 23.6% basal-correction dose and 50% basal-bolus-correction dose [BBC]). Patients with BBC had higher HbA1c (7.7±1.5% vs. 6.7 ±0.8%; P<.001) and mean glycemia on the first day of hospitalization (184.4±59.2 vs. 140.5±31.4mg/dl; P<.001). Mean blood glucose was reduced to 162.1±41.8mg/dl in the middle and 160.8±43.3mg/dl in the last 24h of hospitalization in patients with BBC (P=.007), but did not change in the remaining patients. In 22.1% patients with treatment changes performed at discharge, HbA1c decreased from 8.2±1.6 to 6.8±1.6% at 2-6 months post-discharge (P=.019). The hyperglycemia treatment protocol applied by an endocrinologist in the hospital, allows the identification of the appropriate therapy and the improvement of the glycemic control during hospitalization and discharge, supporting its efficacy in clinical practice. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Effects of a parent-implemented Developmental Reciprocity Treatment Program for children with autism spectrum disorder. (United States)

    Gengoux, Grace W; Schapp, Salena; Burton, Sarah; Ardel, Christina M; Libove, Robin A; Baldi, Gina; Berquist, Kari L; Phillips, Jennifer M; Hardan, Antonio Y


    Developmental approaches to autism treatment aim to establish strong interpersonal relationships through joint play. These approaches have emerging empirical support; however, there is a need for further research documenting the procedures and demonstrating their effectiveness. This pilot study evaluated changes in parent behavior and child autism symptoms following a 12-week Developmental Reciprocity Treatment parent-training program. A total of 22 children with autism spectrum disorder between 2 and 6 years (mean age = 44.6 months, standard deviation = 12.7) and a primary caregiver participated in 12 weekly sessions of Developmental Reciprocity Treatment parent training, covering topics including introduction to developmental approaches, supporting attention and motivation, sensory regulation and sensory-social routines, imitation/building nonverbal communication, functional language development, and turn taking. Results indicated improvement in aspects of parent empowerment and social quality of life. Improvement in core autism symptoms was observed on the Social Responsiveness Scale total score (F(1,19): 5.550, p = 0.029), MacArthur-Bates Communicative Development Inventories number of words produced out of 680 (F(1,18): 18.104, p = 0.000), and two subscales of the Repetitive Behavior Scale, Revised (compulsive, p = 0.046 and restricted, p = 0.025). No differences in sensory sensitivity were observed on the Short Sensory Profile. Findings from this pilot study indicate that Developmental Reciprocity Treatment shows promise and suggest the need for future controlled trials of this developmentally based intervention.

  16. Etiologic pattern of genital ulcers in Lusaka, Zambia: has chancroid been eliminated? (United States)

    Makasa, Mpundu; Buve, Anne; Sandøy, Ingvild Fossgard


    Genital ulcers are a public health problem in developing countries. The World Health Organization recommends the use of syndromic guidelines for sexually transmitted infection treatment in resource-constrained countries. Monitoring local etiologies provides information that may aid policy for sexually transmitted infection treatment. We investigated the etiology of genital ulcer disease among outpatients in Lusaka, Zambia. Swabs from genital ulcers of 200 patients were tested using polymerase chain reaction for Treponema pallidum, herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), Haemophilus ducreyi, and Chlamydia trachomatis. The prevalence of the detected pathogens was as follows; HSV-2, 28%; T. pallidum, 11.5%; C. trachomatis, 3%; HSV-1, 0.5%; and H. ducreyi, 0%. Coinfection with HSV-2 and T. pallidum was 1.5%, and coinfection of HSV-2 and C. trachomatis was 1%. In 55% of the patients, no etiologic diagnosis could be established. H. ducreyi was not detected, whereas HSV-2 and T. pallidum were the commonest pathogens. Nondetection of H. ducreyi requires further studies. If the present findings are validated, treatment guidelines would require to be revised in Zambia.

  17. The effectiveness of a cardiometabolic prevention program in general practices offering integrated care programs including a patient tailored lifestyle treatment.

    NARCIS (Netherlands)

    Hollander, M.; Eppink, L.; Nielen, M.; Badenbroek, I.; Stol, D.; Schellevis, F.; Wit, N. de


    Background & Aim: Selective cardio-metabolic prevention programs (CMP) may be especially effective in well-organized practices. We studied the effect of a CMP program in the academic primary care practices of the Julius Health Centers (JHC) that offer integrated cardiovascular disease management

  18. Bio-media Citizenship and Chronic Kidney Disease of Unknown Etiology in Sri Lanka. (United States)

    de Silva, M W Amarasiri


    In this article, I examine the crucial role of the biomedical industry, epidemiological and biomedical research, and the media in forming attitudes to and the understanding of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Local conceptions of CKDu have been shaped by the circulation in the media of epidemiological research findings pertaining to the disease, biomedical interventions in the management of the disease in hospitals and clinics, community programs involving mass blood surveys and the testing of well water, and local food and health education programs carried out through village health committees. This process of circulation I identify as bio-media citizenship.

  19. Four-year treatment outcomes of adult patients enrolled in Mozambique's rapidly expanding antiretroviral therapy program.

    Directory of Open Access Journals (Sweden)

    Andrew F Auld

    Full Text Available BACKGROUND: In Mozambique during 2004-2007 numbers of adult patients (≥15 years old enrolled on antiretroviral therapy (ART increased about 16-fold, from 60 kg, WHO stage IV (AHR 1.7; 95% CI, 1.3-2.4, reference group WHO stage I/II, lack of co-trimoxazole prescription (AHR 1.4; 95% CI, 1.0-1.8, and later calendar year of ART initiation (AHR 1.5; 95% CI, 1.2-1.8. Rates of immunologic treatment failure and regimen-switch were 14.0 and 0.6 events per 100-patient years, respectively. CONCLUSIONS: ART initiation at earlier disease stages and scale-up of co-trimoxazole among ART patients could improve outcomes. Research to determine reasons for low regimen-switch rates and increasing rates of attrition during program expansion is needed.

  20. Watertrak, a computerized liquid waste treatment system status and performance monitoring program

    International Nuclear Information System (INIS)

    Vance, J.N.; Tafazzoli, M.M.


    Because of continuing problems in the radwaste system operations of a large number of plants currently operating, there is an increasing need to provide greater quantities of radwaste system information to plant operators and managers. Current and more complete information is required to enhance the operation and performance of the radwaste treatment systems, to assess the current system status, to plan for changing plant conditions and to diagnose actual or impending problems. The information needs include: real-time system status monitoring, equipment performance monitoring, report generation for operators and plant management, and training information. The nature and quantity of information required makes this program well-suited for a computer-aided engineering application

  1. The improvement program of radwaste treatment at Chinshan nuclear power station

    International Nuclear Information System (INIS)

    Lin, M.M.H.; Huang, C.Y.


    Chinshan-1 and 2, the twin 636-megawatt boiling water reactors with independent radwaste treatment facilities, located at northern Taiwan, started power generation in 1977 and 1978, respectively. Initial years of operation of CSNPS indicated a need for improvement of the radwaste scheme originally provided. The major betterment programs for radwaste system include: (1) addition of auxiliary demineralization system and addition resin storage tank/demineralizer, (2) addition of dry laundry and miscellant drain system, (3) addition of off-gas charcoal delay system, (4) tie connection of the liquid waste system of unit 1 and 2, (5) solid waste system retrofit study, (6) volume reduction study. The administration and water quality controls have also been much improved and the discharge of radioactivity is considerably lower after the improvement has been implemented

  2. Patient-centered care in cancer treatment programs: the future of integrative oncology through psychoeducation. (United States)

    Garchinski, Christina M; DiBiase, Ann-Marie; Wong, Raimond K; Sagar, Stephen M


    The reciprocal relationship between the mind and body has been a neglected process for improving the psychosocial care of cancer patients. Emotions form an important link between the mind and body. They play a fundamental role in the cognitive functions of decision-making and symptom control. Recognizing this relationship is important for integrative oncology. We define psychoeducation as the teaching of self-evaluation and self-regulation of the mind-body process. A gap exists between research evidence and implementation into clinical practice. The patients' search for self-empowerment through the pursuit of complementary therapies may be a surrogate for inadequate psychoeducation. Integrative oncology programs should implement psychoeducation that helps patients to improve both emotional and cognitive intelligence, enabling them to better negotiate cancer treatment systems.

  3. Adherence to a behavioral weight loss treatment program enhances weight loss and improvements in biomarkers

    Directory of Open Access Journals (Sweden)

    Sushama D Acharya


    Full Text Available Sushama D Acharya3, Okan U Elci3, Susan M Sereika1,2,3, Edvin Music3, Mindi A Styn3, Melanie Warziski Turk3, Lora E Burke2,31Department of Biostatistics, Graduate School of Public Health, 2Department of Epidemiology, Graduate School of Public Health, 3School of Nursing, University of Pittsburgh, Pittsburgh, PA, USAObjectives: To describe participants’ adherence to multiple components (attendance, energy intake, fat gram, exercise goals, and self-monitoring eating and exercise behaviors of a standard behavioral treatment program (SBT for weight loss and how adherence to these components may influence weight loss and biomarkers (triglycerides, low density lipoproteins [LDL], high density lipoprotein, and insulin during the intensive and less-intensive intervention phases. Methods: A secondary analysis of a randomized clinical trial consisting of a SBT with either fat-restricted standard or lacto-ovo vegetarian diet. The 12-month intervention was delivered in 33 group sessions. The first six months reflected the intensive phase; the second six months, the less-intensive intervention phase. We conducted the analysis without regard to treatment assignment. Eligible participants included overweight/obese adults (N = 176; mean body mass index = 34.0 kg/m2. The sample was 86.9% female, 70.5% White, and 44.4 ± 8.6 years old. The outcome measures included weight and biomarkers. Results: There was a significant decline in adherence to each treatment component over time (P < 0.0001. In the first six months, adherence to attendance, self-monitoring and the energy goal were significantly associated with greater weight loss (P < 0.05. Adherence to attendance and exercise remained significantly associated with weight loss in the second six months (P < 0.05. Adherence to attendance, self-monitoring and exercise had indirect effects through weight loss on LDL, triglycerides, and insulin (P < 0.05.Conclusions: We observed a decline in adherence to each

  4. Review and evaluation of online tobacco dependence treatment training programs for health care practitioners. (United States)

    Selby, Peter; Goncharenko, Karina; Barker, Megan; Fahim, Myra; Timothy, Valerie; Dragonetti, Rosa; Kemper, Katherine; Herie, Marilyn; Hays, J Taylor


    Training health care professionals is associated with increased capacity to deliver evidence-based smoking cessation interventions and increased quit rates among their patients. Online training programs hold promise to provide training but questions remain regarding the quality and usability of available programs. The aim was to assess the quality of English-language online courses in tobacco dependence treatment using a validated instrument. An environmental scan was conducted using the Google search engine to identify available online tobacco dependence treatment courses. The identified courses were then evaluated using the Peer Review Rubric for Online Learning, which was selected based on its ability to evaluate instructional design. It also has clear and concise criteria descriptions to ensure uniformity of evaluations by trained experts. A total of 39 courses were identified, of which 24 unique courses were assessed based on their accessibility and functionality during the period of evaluation. Overall, the course ratings indicated that 17 of 24 courses evaluated failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior. However, many excelled in providing effective navigation, course rationale, and content. Many were weak in the use of instructional design elements, such as teaching effectiveness, learning strategies, instructor's role, and assessment and evaluation. Evaluation results and suggestions for improvement were shared with course administrators. Based on the courses evaluated in this review, course developers are encouraged to employ best practices in instructional design, such as cohesiveness of material, linearity of design, practice exercises, problem solving, and ongoing evaluation to improve existing courses and in the design of new online learning opportunities.

  5. Reclassification of clinical sleep disorders using traditional models of syndromic, neuroanatomic, pathophysiological and etiological diagnosis. (United States)

    Spitzer, A Robert


    Existing classifications of central nervous system sleep disorders do not often provide tools to diagnose the majority of patients complaining of sleep-related symptoms, nor always guide effective treatment. I present a novel classification system that completely separates clinical syndromes from anatomical localization, pathophysiology, and etiology. The clinical syndrome I present can describe the majority of patients, but can be fractionated into individual subgroups for further study. By then separating the anatomy and physiology from the symptoms, an avenue of research becomes available to study the different possible structures that regulate sleep, that may be damaged and cause syndromes of sleep dysfunction. Some of these may produce symptoms that overlap with narcolepsy and some may be distinct. Because the clinical syndrome should be distinguished from anatomy or physiology, I have proposed the term narcoleptiform syndrome for the clinical syndrome. The model also clearly separates etiology from anatomy in a classical neurological manner. This allows etiology, localization and symptoms to be studied separately. It is likely that different etiologies may produce damage in areas that produce similar syndromes. For example, in this model, different causes of damage to the orexin nucleus would result in the same clinical syndrome. This reinforces the concept of studying anatomy, symptoms and etiology separately. By studying the relationship of syndromes or symptoms to anatomic localization and pathophysiology, it should be possible to test novel approaches to treatment based on different underlying structure or function. For example, patients with lesions in the ventrolateral preoptic nucleus or the thalamic intralaminar nuclei may both present with insomnia symptoms but need different treatment; or they might present with symptoms overlapping narcolepsy (a narcoleptiform syndrome) yet need different treatment. In some cases, a single treatment may cross over

  6. Dry eye syndrome. Etiological and therapeutic aspects. (United States)

    Apostol, Silvia; Filip, M; Dragne, Carmen; Filip, A


    "Dry eye syndrome" is a common disorder of the tear film that results from inadequate tear production, excessive tear evaporation or abnormality in mucin or lipid components of the tear film. A number of 53 patients suffering from dry eye syndrome were followed up for a period of 18 months. The study group was heterogeneous, including a lot of conditions accompanied by dry eye syndrome: Syogren's syndrome, lupus erythematous, ocular rosacea, patients with systemic treatments with antidepressants, betablockers, diuretics, oral contraceptives, glaucomatous patients with topical beta-blockers, postmenopausal women, aging people, computer users and long-term contact lens wearers. The therapeutical options were dictated by the severity of the syndrome: substitution therapy, treatment of the underlying eyelid diseases, modifying of the environmental conditions and treatment of the complications in the most severe cases. The new pathological approach is innovative and it may provide a real therapeutical measure for this condition: topical A Cyclosporine and androgen drops.

  7. Burden, etiology and predictors of visual impairment among children ...

    African Journals Online (AJOL)

    . Knowledge of CVI is important in planning preventive measures. The aim of this study was determine the prevalence, etiology and the factors associated with childhood visual impairment among the children attending the eye clinic in Mulago ...

  8. Etiological Study of Mental Retardation in Budapest, Hungary. (United States)

    Czeizel, A.; And Others


    The first complex etiological study of mental retardation in Budapest was carried out with 1,364 children ages 7 to 14 years. Results are compared with findings from previous surveys in the United States and the United Kingdom. (Author)

  9. Etiology and Antibiotic Susceptibility Pattern of Community-acquired

    African Journals Online (AJOL)

    Sheyin et. al

    difference in occurrence of infection between married and singles p=0.101 ... prevalence of 18.8%, with female participants having the highest occurrence of .... Performance standards ... age- dependent Etiology of community-aquired urinary.

  10. Results of the F/H Effluent Treatment Facility biological monitoring program, July 1987--July 1991

    International Nuclear Information System (INIS)

    Specht, W.L.


    As required by the South Carolina Department of Health and Environmental Control (SCDHEC) under NPDES Permit SCO000175, biological monitoring was conducted in Upper Three Runs Creek to determine if discharges from the F/H Effluent Treatment Facility have adversely impacted the biotic community of the receiving stream. Data included in this summary report encompass July 1987 through July 1991. As originally designed, the F/H ETF was not expected to remove all of the mercury from the wastewater; therefore, SCDHEC specified that studies be conducted to determine if mercury was bioaccumulating in aquatic biota. Subsequent to approval of the biological monitoring program, an ion exchange column was added to the F/H ETF specifically to remove mercury, which eliminated mercury from the F/H ETF effluent. The results of the biological monitoring program indicate that at the present rate of discharge, the F/H ETF effluent has not adversely affected the receiving stream with respect to any of the parameters that were measured. The effluent is not toxic at the in-stream waste concentration and there is no evidence of mercury bioaccumulation

  11. Organizational Consequences of Staff Turnover in Outpatient Substance Abuse Treatment Programs (United States)

    Knight, Danica K.; Edwards, Jennifer R.; Flynn, Patrick M.


    The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. The sample consisted of 353 clinical staff from 63 outpatient agencies. Two scales from the Survey of Organizational Functioning (SOF) measured work-environment demands (Stress, Inadequate Staffing), and three measured supportive work relationships (Communication, Cohesion, Peer Collaboration). Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work-environment demands, but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands and decreases perceptions of support, and underscore the need to reduce stress and minimize subsequent turnover among clinical staff. PMID:22154028

  12. Organizational consequences of staff turnover in outpatient substance abuse treatment programs. (United States)

    Knight, Danica K; Becan, Jennifer E; Flynn, Patrick M


    The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. The sample consisted of 353 clinical staff from 63 outpatient agencies. Two scales from the Survey of Organizational Functioning measured work environment demands (stress and inadequate staffing), and 3 measured supportive work relationships (communication, cohesion, and peer collaboration). Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work environment demands but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands, decreases perceptions of support, and underscores the need to reduce stress and minimize subsequent turnover among clinical staff. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Harm reduction program use, psychopathology and medical severity in patients with methadone maintenance treatment. (United States)

    Martínez-Luna, Nieves Gudelia; Rodríguez-Cintas, Laia; Esojo, Abderraman; Palma-Álvarez, Raúl Felipe; Robles-Martínez, María; Grau-López, Lara; Perea, Marta; Roncero, Carlos


    Methadone maintenance programs (MMP) for opioid dependence treatment have been widely used due to their effective therapeutic outcomes. Harm reduction programs (HRP) are complementary programs for severe patients with high risk behaviors and when abstinence is not possible. This study aims to compare patients in MMP that use HRP (MMP-HRP) and patients in MMP who do not use HRP (MMP-NO HRP). The sample was composed of 143 patients (MMP-HRP = 42 vs. MMP-NO HRP = 101). An additional subanalysis was performed with patients under 45 years of age (n = 116; MMP-HRP = 38 vs. MMP-NO HRP = 78). All patients were assessed with an ad hoc socio-demographic questionnaire, EuropASI, SCID-I, and SCID-II. Results show that MMP-HRP patients were younger with more frequent use of intravenous drugs and with a high prevalence of Cluster B personality disorders. MMP-NO HRP patients had lower methadone doses compared to MMP-HRP patients and preferred to use drugs by smoked route more frequently. In the subanalysis of patients under 45, MMP-HRP patients were younger, had a higher prevalence of liver diseases, more intravenous drug use, greater severity on the drug use scale, less social and family support in the suescales of EUROP-ASI than compared to patients under 45 years in the group MMP-NO HRP. In conclusion, MMP-HRP patients are younger compared to MMP-NO HRP patients, they also receive higher doses of methadone and had more intravenous use. The above findings imply that the early onset of high risk drug use and long-term exposure to heroin have more severe outcomes such as higher comorbidities (e.g. infectious diseases, medical and psychiatric disorders), and consequently, these patients are a more vulnerable group with a worse prognosis.

  14. Etiología del colesteatoma ótico Etiology of otic cholesteatoma

    Directory of Open Access Journals (Sweden)

    Julianis Loraine Quintero Noa


    Full Text Available El colesteatoma es una estructura quística caracterizada por la presencia de epitelio escamoso productor de queratina, que sustituye o recubre la mucosa normal en la hendidura del oído medio y ápex petroso, y puede ser causa de hipoacusia irreversible, destrucción ósea y graves complicaciones por su crecimiento expansivo. Clásicamente se describen los colesteatomas en congénitos y adquiridos. La etiología de su formación es multifactorial y continúa siendo poco claro y controversial. Se reportan diferentes teorías que han tratado de explicar el colesteatoma congénito, la transición de un bolsillo de retracción hasta la aparición del colesteatoma adquirido primario, y otras en la génesis del colesteatoma adquirido secundario. Se describe la presencia de algunas citoquinas dentro del colesteatoma que inducen la hiperproliferación e invasión incoordinada de los queratinocitos de la piel del conducto auditivo externo y la pars fláccida, más agresiva en el colesteatoma adquirido pediátrico, y que desempeñan un papel fundamental en la proliferación y en la apoptosis del queratinocito. En cultivo in vitro de una muestra de tejido colesteatomatoso, se ha identificado recientemente que el TNF-a estimula la producción de la IL-8. Se considera de interés ofrecer esta revisión sobre la etiología del colesteatoma, que aún se mantiene en el campo de la investigación y continúa siendo un reto para los otocirujanos por su alta incidencia de recidivas y posibles complicaciones.Cholesteatoma is a cystic structure characterized by presence of squamous epithelium producing keratin substituting or recovering the normal mucosa in the groove of middle ear and petrous apex and may to be caused by irreversible hypoacusia, bone destruction and severe complications due to its expansive growth. Typically the cholesteatomas are described as congenital and acquired. The etiology of its formation is multifactor and still remains a subject not

  15. Car drivers with dementia: Different complications due to different etiologies? (United States)

    Piersma, Dafne; de Waard, Dick; Davidse, Ragnhild; Tucha, Oliver; Brouwer, Wiebo


    Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various etiologies and the question is whether dementias of different etiology have similar effects on driving ability. The literature on the effects of dementia of various etiologies on driving ability is reviewed. Studies addressing dementia etiologies and driving were identified through PubMed, PsychINFO, and Google Scholar. Early symptoms and prognoses differ between dementias of different etiology. Therefore, different etiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia etiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all etiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route, whereas patients with frontotemporal dementia are more inclined to make tactical-level errors because of impaired hazard perception. Patients with other dementia etiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various etiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behavior can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g., compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for

  16. [Infectious mononucleosis: etiology, immunological variants, methods of correction]. (United States)

    Gordeets, A V; Savina, O G; Beniova, S N; Chernikova, A A


    Clinical options of infectious mononucleosis course depending on infecting agent etiology are presented for Epstein-Barr virus (EBV), cytomegalovirus (CMV), mono and mixed forms of the disease. Examined cytokine profiles demonstrate analogous changes of serum cytokines in the acute stage of the disease irrespective of etiological factors. Data show that it is important and useful clinically and immunologically to include immunomodulators--in particular, cycloferon--info a complex therapy of different types of mononucleosis.

  17. Program for suicidal prevention, mental disorder treatment, and mental health development for resident doctors

    Directory of Open Access Journals (Sweden)

    José Luis Jiménez López


    Full Text Available High demand of care and the academic burden of courses of specialization in medicine affect the mental health of medical residents with events ranging from simple emotional discomfort to development of affective disorders in susceptible individuals. The suicide of physicians has produced programs for their attention in some countries. We present the first mental health clinic for residents of a high specialty hospital in Mexico, focused on the prevention of suicide and depression, treatment of mental disorders and mental health promotion. Unlike the reports of other countries, we get participation of more than 95%, we provide appropriate treatment and follow-up to residents with mental disorder, and there has not been a consummate suicide. We assume that the use of different strategies (scrutiny, adapting models of prevention of suicide as a peer and gatekeeper training, informative sessions of mental health promotion and stigma, interventions targeted at individuals and groups with conflicts has been useful against barriers that do not allow doctors to identify the risk of suicide warning signs, seek help for mental disorder, and seek to improve their mental health.

  18. Pouchitis – What’s new in etiology and management

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    R John Nicholls


    Full Text Available Pouchitis requires a clear clinicopathological definition. There are many conflicting data concerning etiology. It is linked to an initial diagnosis of ulcerative colitis by clinical association and occurrence of extra-alimentary manifestations, histologically and by macrophage types and inflammatory mediators. Evidence for a bacteriological cause comes from response to metronidazole, increased counts of intramucosal bacteria in pouchitis and the possible association of hypochlorhydria. Most studies have, however, shown no specific bacterial pathogen or luminal bacterial count differences in pouches with or without pouchitis. Abnormal fecal bile salt concentrations have been reported. Stasis and evacuation efficiency of the pouch are not associated with pouchitis in most studies. Reduced mucosal bloodflow may be associated perhaps leading to increased permeability to toxins causing activation of interleukin-1, platelet-activating factor (PAF and tumour necrosis factor (TNF. PAF may be increased in pouchitis. Pouchitis may respond to allopurinol. Volatile short chain fatty acids (VSFA may be reduced in ileal reservoirs compared with straight ileoanal segments and in pouchitis. The response of pouchitis to administered VSFA is, however, variable. Glutamine administration may help. There is evidence that intraepithelial T lymphocytes are reduced. Crypt cell turnover is higher in colitic than in polypotic pouches. Mucosal morphological changes of villous atrophy and inflammation occur early after relapsing polychondritis and may predict future susceptibility to pouchitis. Early mucosal biopsy appears to have prognostic value. Metronidazole and antibiotics (amoxicillin/potassium clavulanate, ciprofloxacin may be effective although in a controlled trial of the former there was little advantage over placebo. The results of treatment using VSFA, glutamine, allopurinol sucralfate and anti-inflammatory agents, including aminosalicylic acid (5-ASA and

  19. Opiate addiction in Republic of Srpska: Characteristics and etiology

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    Niškanović Jelena


    Full Text Available Opiate addiction is a significant social and health problem with a negative impact on individuals' health and their social environment. The aim of this paper is to analyze the characteristics of opiate addicts in order to determine the social and contextual factors underlying the development of addiction. All health care facilities and therapeutic communities which provide care and help addicts are required to fill in the Form of treated addicts. The analysis included people who sought treatment during the period from 25th November 2010 to 21st May 2013 in health care facilities and associations for substance abuse treatment in the Republic of Srpska. The majority of treated addicts belong to opiate addiction (N= 241: 91%. Opiate addicts are mostly males (88.8%, while 11.2% of treated opiate addicts are female. The highest percentage of opiate addicts live in urban areas (86.7%, have secondary education (73.4%, 63.3% are unemployed, while 70.5% live with primary family. Predominant etiologic factor for the development of addiction is peer or partner pressure (29%, pathology of the family as family breakdown or alcoholism (19.3%, while on the third place is low self control (16.8%. For 19.1% of opiate addicts, delinquent behavior started before taking any drugs. The presented data confirms the importance of social environment, like low family control and presence of family pathology. The mentioned factors in combination with negative peer pressure can lead to risky behavior and potential addiction.

  20. [Etiology and airway management in children with tracheobronchomalacia]. (United States)

    Yin, Yong; Schonfeld, Tommy; Chen, Tong-xin


    To investigate etiology and airway management in children with tracheobronchomalacia. Bronchoscopic examinations were performed in 671 children. The cases with tracheomalacia and bronchomalacia were analyzed in etiopathogenesis and summarized their therapy simultaneously. Bronchoscopic examination indicated tracheomalacia and bronchomalacia in 148 cases, tracheomalacia in 77 cases and bronchomalacia in 71 cases. Among the cases with tracheomalacia, compression by vascular rings was found in 46 cases, incorporated congenital esophageal atresia with tracheoesophageal fistula was found in 5 cases, tracheomalacia was associated with tracheostoma and mechanical ventilation in 6 cases, with congenital airway malformation in 11 cases and isolated tracheomalacia was found in 4 cases. Among the cases with bronchomalacia, incorporated congenital cardiovascular malformation was found in 64 cases, congenital airway malformation in 6 cases and isolated bronchomalacia in 1 case. Ten children with anomalous innominate artery underwent aortopexy, twelve children with dextro-aorta arch with concomitant aberrant left subclavian artery and double aorta underwent arches vascular ring lysis, six children with pulmonary sling underwent plasty. Severe malacia segments were resected directly in four children during operation. Mechanical ventilation was performed in 38 children. Tracheostoma was performed in 4 children to treat tracheomalacia and bronchomalacia, it could relieve symptom to a certain extent. In 2 children metal stents were inserted into the bronchus for the treatment of bronchomalacia, one was successful and the other needed re-insertion of stent again, these two patients underwent balloon-dilatation in distal part of stent afterwards. The congenital cardiovascular malformation was the main reason to develop tracheobronchomalacia in children. The symptom of majority of the cases with cardiovascular malformation would be improved within 6 months after surgical intervention