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Sample records for interleukin-15 affects patient

  1. Targeting interleukin-15 in patients with rheumatoid arthritis: a proof-of-concept study

    DEFF Research Database (Denmark)

    Baslund, Bo; Tvede, Niels; Danneskiold-Samsøe, Bente

    2005-01-01

    Interleukin-15 (IL-15) is a proinflammatory, innate response cytokine that mediates pleiotropic effector function in rheumatoid arthritis (RA) inflammatory synovitis. Our objective was to study the ability of HuMax-IL15, a human IgG1 anti-IL-15 monoclonal antibody, to neutralize exogenous...... and endogenous IL-15 activity in vitro and to perform a phase I-II dose-escalation trial with HuMax-IL15 in patients with active RA....

  2. OSTEOPONTIN, INTERLEUKIN-15 AND DYSFUNCTION OF LEFT VENTRICULAR MYOCARDIUM IN HYPERTENSIVE PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    O. M. Kovalyova

    2016-12-01

    Full Text Available Based on a survey of 108 patients with hypertension complicated by chronic heart failure, studied the connection concentration of osteopontin, interleukin-15 inserum and morpho-functional characteristics of the left ventricle of the heart. In patients with CHF osteopontin levels were significantly higher, it revealed a relationship between adverse LV filling state and knots in serum osteopontin, while the level of IL-15 did not show such a relationship. The results indicate the potential value of osteopontin as a biomarker for the diagnosis of CHF.

  3. Interleukin-15-mediated inflammation promotes non-alcoholic fatty liver disease

    NARCIS (Netherlands)

    Cepero-Donates, Yuneivy; Lacraz, Grégory; Ghobadi, Farnaz; Rakotoarivelo, Volatiana; Orkhis, Sakina; Mayhue, Marian; Chen, Yi Guang; Rola-Pleszczynski, Marek; Menendez, Alfredo; Ilangumaran, Subburaj; Ramanathan, Sheela

    2016-01-01

    Interleukin-15 (IL-15) is essential for the homeostasis of lymphoid cells particularly memory CD8+ T cells and NK cells. These cells are abundant in the liver, and are implicated in obesity-associated pathogenic processes. Here we characterized obesity-associated metabolic and cellular changes in

  4. Oncolytic effects of a novel influenza A virus expressing interleukin-15 from the NS reading frame.

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    Marijke van Rikxoort

    Full Text Available Oncolytic influenza A viruses with deleted NS1 gene (delNS1 replicate selectively in tumour cells with defective interferon response and/or activated Ras/Raf/MEK/ERK signalling pathway. To develop a delNS1 virus with specific immunostimulatory properties, we used an optimised technology to insert the interleukin-15 (IL-15 coding sequence into the viral NS gene segment (delNS1-IL-15. DelNS1 and delNS1-IL-15 exerted similar oncolytic effects. Both viruses replicated and caused caspase-dependent apoptosis in interferon-defective melanoma cells. Virus replication was required for their oncolytic activity. Cisplatin enhanced the oncolytic activity of delNS1 viruses. The cytotoxic drug increased delNS1 replication and delNS1-induced caspase-dependent apoptosis. Interference with MEK/ERK signalling by RNAi-mediated depletion or the MEK inhibitor U0126 did not affect the oncolytic effects of the delNS1 viruses. In oncolysis sensitive melanoma cells, delNS1-IL-15 (but not delNS1 infection resulted in the production of IL-15 levels ranging from 70 to 1140 pg/mL in the cell culture supernatants. The supernatants of delNS1-IL-15-infected (but not of delNS1-infected melanoma cells induced primary human natural killer cell-mediated lysis of non-infected tumour cells. In conclusion, we constructed a novel oncolytic influenza virus that combines the oncolytic activity of delNS1 viruses with immunostimulatory properties through production of functional IL-15. Moreover, we showed that the oncolytic activity of delNS1 viruses can be enhanced in combination with cytotoxic anti-cancer drugs.

  5. Endurance training enhances skeletal muscle interleukin-15 in human male subjects

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    Rinnov, Anders; Yfanti, Christina; Nielsen, Søren

    2014-01-01

    Regular endurance exercise promotes metabolic and oxidative changes in skeletal muscle. Overexpression of interleukin-15 (IL-15) in mice exerts similar metabolic changes in muscle as seen with endurance exercise. Muscular IL-15 production has been shown to increase in mice after weeks of regular...... endurance running. With the present study we aimed to determine if muscular IL-15 production would increase in human male subjects following 12 weeks of endurance training. In two different studies we obtained plasma and muscle biopsies from young healthy subjects performing: (1) 12 weeks of ergometer...... weeks of regular endurance training induced a 40% increase in basal skeletal muscle IL-15 protein content (p...

  6. Expression of interleukin-15 in human skeletal muscle effect of exercise and muscle fibre type composition

    DEFF Research Database (Denmark)

    Nielsen, Anders Rinnov; Mounier, Remi; Plomgaard, Peter

    2007-01-01

    The cytokine interleukin-15 (IL-15) has been demonstrated to have anabolic effects in cell culture systems. We tested the hypothesis that IL-15 is predominantly expressed by type 2 skeletal muscle fibres, and that resistance exercise regulates IL-15 expression in muscle. Triceps brachii, vastus...... lateralis quadriceps and soleus muscle biopsies were obtained from normally physically active, healthy, young male volunteers (n = 14), because these muscles are characterized by having different fibre-type compositions. In addition, healthy, normally physically active male subjects (n = 8) not involved...

  7. Myxoma Virus Expressing Interleukin-15 Fails To Cause Lethal Myxomatosis in European Rabbits▿

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    Liu, Jia; Wennier, Sonia; Reinhard, Mary; Roy, Edward; MacNeill, Amy; McFadden, Grant

    2009-01-01

    Myxoma virus (MYXV) is a poxvirus pathogenic only for European rabbits, but its permissiveness in human cancer cells gives it potential as an oncolytic virus. A recombinant MYXV expressing both the tdTomato red fluorescent protein and interleukin-15 (IL-15) (vMyx-IL-15-tdTr) was constructed. Cells infected with vMyx-IL-15-tdTr secreted bioactive IL-15 and had in vitro replication kinetics similar to that of wild-type MYXV. To determine the safety of this virus for future oncolytic studies, we tested its pathogenesis in European rabbits. In vivo, vMyx-IL-15-tdTr no longer causes lethal myxomatosis. Thus, ectopic IL-15 functions as an antiviral cytokine in vivo, and vMyx-IL-15-tdTr is a safe candidate for animal studies of oncolytic virotherapy. PMID:19279088

  8. Myxoma virus expressing interleukin-15 fails to cause lethal myxomatosis in European rabbits.

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    Liu, Jia; Wennier, Sonia; Reinhard, Mary; Roy, Edward; MacNeill, Amy; McFadden, Grant

    2009-06-01

    Myxoma virus (MYXV) is a poxvirus pathogenic only for European rabbits, but its permissiveness in human cancer cells gives it potential as an oncolytic virus. A recombinant MYXV expressing both the tdTomato red fluorescent protein and interleukin-15 (IL-15) (vMyx-IL-15-tdTr) was constructed. Cells infected with vMyx-IL-15-tdTr secreted bioactive IL-15 and had in vitro replication kinetics similar to that of wild-type MYXV. To determine the safety of this virus for future oncolytic studies, we tested its pathogenesis in European rabbits. In vivo, vMyx-IL-15-tdTr no longer causes lethal myxomatosis. Thus, ectopic IL-15 functions as an antiviral cytokine in vivo, and vMyx-IL-15-tdTr is a safe candidate for animal studies of oncolytic virotherapy.

  9. Production of bioactive soluble interleukin-15 in complex with interleukin-15 receptor alpha from a conditionally-replicating oncolytic HSV-1.

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    David C Gaston

    Full Text Available Oncolytic type-1 herpes simplex viruses (oHSVs lacking the γ134.5 neurovirulence gene are being evaluated for treatment of a variety of malignancies. oHSVs replicate within and directly kill permissive cancer cells. To augment their anti-tumor activity, oHSVs have been engineered to express immunostimulatory molecules, including cytokines, to elicit tumor-specific immune responses. Interleukin-15 (IL-15 holds potential as an immunotherapeutic cytokine because it has been demonstrated to promote both natural killer (NK cell-mediated and CD8(+ T cell-mediated cytotoxicity against cancer cells. The purpose of these studies was to engineer an oHSV producing bioactive IL-15. Two oHSVs were constructed encoding murine (mIL-15 alone (J100 or with the mIL-15 receptor α (mIL-15Rα, J100D to determine whether co-expression of these proteins is required for production of bioactive mIL-15 from oHSV. The following were demonstrated: i both oHSVs retain replication competence and cytotoxicity in permissive tumor cell lines. ii Enhanced production of mIL-15 was detected in cell lysates of neuro-2a cells following J100D infection as compared to J100 infection, suggesting that mIL-15Rα improved mIL-15 production. iii Soluble mIL-15 in complex with mIL-15Rα was detected in supernates from J100D-infected, but not J100-infected, neuro-2a, GL261, and CT-2A cells. These cell lines vary in permissiveness to oHSV replication and cytotoxicity, demonstrating soluble mIL-15/IL-15Rα complex production from J100D was independent of direct oHSV effects. iv The soluble mIL-15/IL-15Rα complex produced by J100D was bioactive, stimulating NK cells to proliferate and reduce the viability of syngeneic GL261 and CT-2A cells. v J100 and J100D were aneurovirulent inasmuch as no neuropathologic effects were documented following direct inoculation into brains of CBA/J mice at up to 1x10(7 plaque forming units. The production of mIL-15/mIL-15Rα from multiple tumor lines, as well

  10. Selenium status and over-expression of interleukin-15 in celiac disease and autoimmune thyroid diseases

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    Anna Velia Stazi

    2010-12-01

    Full Text Available In celiac disease (CD, for its multifactorial nature, the target organs are not limited to the gut, but include thyroid, liver, skin and reproductive and nervous systems. Between the extraintestinal symptoms associated with CD, autoimmune thyroid diseases (AITDs are more evident, underlining as CD-related autoimmune alterations can be modulated not only by gluten but also by various concurrent endogenous (genetic affinity, over-expression of cytokines and exogenous (environment, nutritional deficiency factors. In their pathogenesis a central role for over-expression of interleukin-15 (IL-15 is shown, by inhibiting apoptosis, leading to the perpetuation of inflammation and tissue destruction. Thyroid is particularly sensitive to selenium deficiency because selenoproteins are significant in biosynthesis and activity of thyroid hormones; besides, some selenoproteins as glutathione peroxidase are involved in inhibiting apoptosis. Thus, selenium malabsorption in CD can be thought as a key factor directly leading to thyroid and intestinal damage. Considering the complexity of this interaction and on the basis of available evidence, the aim of this review is to assess as preventive and therapeutic target the role of IL-15 and selenium in the pathogeneses of both CD and AITD.

  11. Interleukin-15 promotes intestinal dysbiosis with butyrate deficiency associated with increased susceptibility to colitis

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    Meisel, Marlies; Mayassi, Toufic; Fehlner-Peach, Hannah; Koval, Jason C.; O' Brien, Sarah L.; Hinterleitner, Reinhard; Lesko, Kathryn; Kim, Sangman; Bouziat, Romain; Chen, Li; Weber, Christopher R.; Mazmanian, Sarkis K.; Jabri, Bana; Antonopoulos, Dionysios A.

    2016-09-20

    Dysbiosis resulting in gut-microbiome alterations with reduced butyrate production are thought to disrupt intestinal immune homeostasis and promote complex immune disorders. However, whether and how dysbiosis develops before the onset of overt pathology remains poorly defined. Interleukin 15 (IL-15) is upregulated in distressed tissue and its overexpression is thought to predispose susceptible individuals to and play a role in the pathogenesis of celiac disease and inflammatory bowel disease (IBD). While the immunological roles of IL-15 have been largely studied, its potential impact on the microbiota remains unexplored. Analysis of 16S rRNA-based inventories of bacterial communities in mice overexpressing IL-15 in the intestinal epithelium (v-IL-15tg mice) shows distinct changes in the composition of the intestinal bacteria. While some alterations are specific to individual intestinal compartments, others are found across the ileum, cecum, and feces. In particular, IL-15 overexpression restructures the composition of the microbiota with a decrease in butyrate producing bacteria that is associated with a reduction in luminal butyrate levels across all intestinal compartments. Fecal microbiota transplant experiments of wild-type and v-IL-15tg microbiota into germ-free mice further indicate that diminishing butyrate concentration observed in the intestinal lumen of v-IL-15tg mice is the result of intrinsic alterations in the microbiota induced by IL-15. This reconfiguration of the microbiota is associated with increased susceptibility to dextran sodium sulfate induced colitis. Altogether, this study reveals that IL-15 impacts butyrate-producing bacteria and lowers butyrate levels in the absence of overt pathology, which represent events that precede and promote intestinal inflammatory diseases.

  12. First-in-Human Study of Interleukin-15 as Immunotherapy for Metastatic Cancer | Center for Cancer Research

    Science.gov (United States)

    One of the hallmarks of cancer that is now more clearly recognized is tumors’ ability to avoid recognition and destruction by the immune system. A novel class of treatments, dubbed immunotherapy, attempts to overcome this aspect by stimulating the immune system to attack cancer cells. The cytokine interleukin-2 (IL-2), which is approved for the treatment of renal cancer and melanoma, is the prototypic immunotherapy. Treatment with IL-2 enhances the proliferation of effector immune cells, such as cytotoxic T lymphocytes and natural killer (NK) cells. Unfortunately, IL-2 also exerts immunosuppressive activity through maintenance of regulatory T cells and activation-induced cell death. The related cytokine, interleukin-15 (IL-15), displays similar immune cell stimulatory activity, but without the inhibitory effects of IL-2. These findings, suggest that IL-15 may have greater potential as an immunotherapeutic agent and is consistent with the results seen in melanoma and prostate and colon cancer mouse models.

  13. Does patient satisfaction affect patient loyalty?

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    Kessler, Daniel P; Mylod, Deirdre

    2011-01-01

    This paper aims to investigate how patient satisfaction affects propensity to return, i.e. loyalty. Data from 678 hospitals were matched using three sources. Patient satisfaction data were obtained from Press Ganey Associates, a leading survey firm; process-based quality measures and hospital characteristics (such as ownership and teaching status) and geographic areas were obtained from the Centers for Medicare and Medicaid Services. The frequency with which end-of-life patients return to seek treatment at the same hospital was obtained from the Dartmouth Atlas. The study uses regression analysis to estimate satisfaction's effects on patient loyalty, while holding process-based quality measures and hospital and market characteristics constant. There is a statistically significant link between satisfaction and loyalty. Although satisfaction's effect overall is relatively small, contentment with certain hospitalization experience may be important. The link between satisfaction and loyalty is weaker for high-satisfaction hospitals, consistent with other studies in the marketing literature. RESEARCH LIMITATION/IMPLICATIONS: The US hospitals analyzed are not a random sample; the results are most applicable to large, non-profit teaching hospitals in competitive markets. Satisfaction ratings have business implications for healthcare providers and may be useful as a management tool for private and public purchasers. The paper is the first to show that patient satisfaction affects actual hospital choices in a large sample. Because patient satisfaction ratings are also correlated with other quality measures, the findings suggest a pathway through which individuals naturally gravitate toward higher-quality care.

  14. Expression and correlation of matrix metalloproteinase-7 and interleukin-15 in human osteoarthritis.

    Science.gov (United States)

    Tao, Yulei; Qiu, Xianxing; Xu, Changbo; Sun, Bo; Shi, Changxiu

    2015-01-01

    To investigate the expression and correlation of matrix metalloproteinase (MMP)-7 and interleukin (IL)-15 in human osteoarthritis (OA). From October 2013 to December 2014, 30 patients with OA were enrolled. In addition, anther 30 patients with simple meniscus injury were collected as a control group. There were no significant differences in age and gender between the two groups. Articular cartilage tissue was obtained from both OA patients and control group patients. Protein, mRNA, and serum expression levels of MMP-7 and IL-15 in the both two groups were determined by immunohistochemical (IHC), in situ hybridization, and enzyme-linked immunosorbent assay (ELISA) assay, respectively. Additionally, correlation between MMP-7 and IL-15 expression level in cartilage tissue and serum was assessed using Pearson correlation analysis. Protein, mRNA, and serum expression levels of MMP-7 and IL-15 in patients with OA were all significantly increased in OA patients compared with the control group. Besides, there were strong positive relationships between articular MMP-7 level and serum MMP-7 level (R(2) = 0.573, P = 0.018), between articular IL-15 level and serum IL-15 level (R(2) = 0.861, P = 0.023), and between serum IL-15 level and serum MMP-7 level (R(2) = 0.602, P = 0.012). These results suggest that MMP-7 and IL-15 might play important roles in the pathogenesis of OA, and IL-15 and MMP-7 has positive correlation in OA.

  15. Proinflammatory Soluble Interleukin-15 Receptor Alpha Is Increased in Rheumatoid Arthritis

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    Ana Cecilia Machado Diaz

    2012-01-01

    Full Text Available Rheumatoid arthritis (RA is an autoimmune and inflammatory disease in which many cytokines have been implicated. In particular, IL-15 is a cytokine involved in the inflammatory processes and bone loss. The aim of this study was to investigate the existence in synovial fluid of soluble IL-15Rα, a private receptor subunit for IL-15 which may act as an enhancer of IL-15-induced proinflammatory cytokines. Soluble IL-15Rα was quantified by a newly developed enzyme-linked immunosorbent assay (ELISA in samples of synovial fluid from patients with RA and osteoarthritis (OA. The levels of IL-15Rα were significantly increased in RA patients compared to OA patients. Also, we studied the presence of membrane-bound IL-15 in cells from synovial fluids, another element necessary to induce pro-inflammatory cytokines through reverse signaling. Interestingly, we found high levels of IL-6 related to high levels of IL-15Rα in RA but not in OA. Thus, our results evidenced presence of IL-15Rα in synovial fluids and suggested that its pro-inflammatory effect could be related to induction of IL-6.

  16. Human Renal Normal, Tumoral, and Cancer Stem Cells Express Membrane-Bound Interleukin-15 Isoforms Displaying Different Functions

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    Sandy Azzi

    2015-06-01

    Full Text Available Intrarenal interleukin-15 (IL-15 participates to renal pathophysiology, but the role of its different membrane-bound isoforms remains to be elucidated. In this study, we reassess the biology of membrane-bound IL-15 (mb-IL-15 isoforms by comparing primary cultures of human renal proximal tubular epithelial cells (RPTEC to peritumoral (ptumTEC, tumoral (RCC, and cancer stem cells (CSC/CD105+. RPTEC express a 14 to 16 kDa mb-IL-15, whose existence has been assumed but never formally demonstrated and likely represents the isoform anchored at the cell membrane through the IL-15 receptor α (IL-15Rα chain, because it is sensitive to acidic treatment and is not competent to deliver a reverse signal. By contrast, ptumTEC, RCC, and CSC express a novel N-hyperglycosylated, short-lived transmembrane mb-IL-15 (tmb-IL-15 isoform around 27 kDa, resistant to acidic shock, delivering a reverse signal in response to its soluble receptor (sIL-15Rα. This reverse signal triggers the down-regulation of the tumor suppressor gene E-cadherin in ptumTEC and RCC but not in CSC/CD105+, where it promotes survival. Indeed, through the AKT pathway, tmb-IL-15 protects CSC/CD105+ from non-programmed cell death induced by serum starvation. Finally, both mb-IL-15 and tmb-IL-15 are sensitive to metalloproteases, and the cleaved tmb-IL-15 (25 kDa displays a powerful anti-apoptotic effect on human hematopoietic cells. Overall, our data indicate that both mb-IL-15 and tmb-IL-15 isoforms play a complex role in renal pathophysiology downregulating E-cadherin and favoring cell survival. Moreover, “apparently normal” ptumTEC cells, sharing different properties with RCC, could contribute to organize an enlarged peritumoral “preneoplastic” environment committed to favor tumor progression.

  17. Depressive affect in incident hemodialysis patients

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    Larkin, John W; Wingard, Rebecca L; Jiao, Yue; Rosen, Sophia; Ma, Lin; Usvyat, Len A; Maddux, Franklin W

    2018-01-01

    Abstract Background The prevalence of depressive affect is not well defined in the incident hemodialysis (HD) population. We investigated the prevalence of and associated risk factors and hospitalization rates for depressive affect in incident HD patients. Methods We performed a prospective investigation using the Patient Health Questionnaire 2 (PHQ2) depressive affect assessment. From January to July of 2013 at 108 in-center clinics randomly selected across tertiles of baseline quality measures, we contacted 577 and 543 patients by telephone for depressive affect screening. PHQ2 test scores range from 0 to 6 (scores  ≥3 suggest the presence of depressive affect). The prevalence of depressive affect was measured at 1–30 and 121–150 days after initiating HD; depressive affect risk factors and hospitalization rates by depressive affect status at 1–30 days after starting HD were computed. Results Of 1120 contacted patients, 340 completed the PHQ2. In patients screened at 1–30 or 121–150 days after starting HD, depressive affect prevalence was 20.2% and 18.5%, respectively (unpaired t-test, P = 0.7). In 35 patients screened at both time points, there were trends for lower prevalence of depressive affect at the end of incident HD, with 20.0% and 5.7% of patients positive for depressive affect at 1–30 and 121–150 days, respectively (paired t-test, P = 0.1). Hospitalization rates were higher in patients with depressive affect during the first 30 days, exhibiting 1.5 more admissions (P < 0.001) and 10.5 additional hospital days (P = 0.008) per patient-year. Females were at higher risk for depressive affect at 1–30 days (P = 0.01). Conclusions The prevalence of depressive affect in HD patients is high throughout the incident period. Rates of hospital admissions and hospital days are increased in incident HD patients with depressive affect. PMID:29423211

  18. Cosilencing Intestinal Transglutaminase-2 and Interleukin-15 Using Gelatin-Based Nanoparticles in an in Vitro Model of Celiac Disease.

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    Attarwala, Husain; Clausen, Valerie; Chaturvedi, Prasoon; Amiji, Mansoor M

    2017-09-05

    In this study, we have developed a type B gelatin nanoparticle based siRNA delivery system for silencing of intestinal transglutaminase-2 (TG2) and interleukin-15 (IL-15) genes in cultured human intestinal epithelial cells (Caco-2) and murine alveolar macrophage cells (J774A.1). Small interfering RNA (siRNA) targeting the TG2 or IL-15 gene was encapsulated within gelatin nanoparticles using ethanol-water solvent displacement method. Size, charge, and morphology of gelatin nanoparticles were evaluated using a Zetasizer instrument and transmission electron microscopy. siRNA encapsulation efficiency was determined using an siRNA specific stem-loop quantitative polymerase chain reaction (qPCR) assay. Cellular uptake of siRNA-containing gelatin nanoparticles was determined using fluorescent microscopy and stem-loop qPCR assay. siRNA loading in the RISC (RNA-induced silencing complex) was determined by immunoprecipitation of argonaute 2 (AGO2) protein followed by stem-loop qPCR for siRNA quantification. Gene expression analysis of TG2, IL-15, and the proinflammatory cytokines, tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ), was performed using qPCR assays. Efficacy of silencing TG2 and IL-15 knockdown was evaluated in an in vitro model of celiac disease by utilizing immunogenic α-gliadin peptide p31-43 in cultured J774A.1 cells. siRNA-containing gelatin nanoparticles were spherical in shape with mean particle size and charge of 217 ± 8.39 nm and -6.2 ± 0.95 mV, respectively. siRNA loading efficiency within gelatin nanoparticles was found to be 89.3 ± 3.05%. Evaluations of cellular uptake using fluorescent microscopy showed rapid internalization of gelatin nanoparticles within 2 h of dosing, with cytosolic localization of delivered siRNA in Caco-2 cells. Gelatin nanoparticles showed greater intracellular siRNA exposure with a longer half-life, when compared to Lipofectamine-mediated siRNA delivery. Approximately 0.1% of total intracellular si

  19. Factors affecting patient dose in diagnostic radiology

    International Nuclear Information System (INIS)

    Poletti, J.L.

    1994-03-01

    The report, Factors Affecting Patient Dose in Diagnostic Radiology is divided into three main sections. Part one is introductory and covers the basic principles of x-ray production and image formation. It includes discussion of x-ray generators and x-ray tubes, radiation properties and units, specification and measurement of x-ray beams, methods of patient dose measurement, radiation effects, radiation protection philosophy and finally the essentials of imaging systems. Part two examines factors affecting the x-ray output of x-ray machines and the characteristics of x-ray beams. These include the influence of heat ratings, kVp, waveform, exposure timer, filtration, focus-film distance, beam intensity distribution, x-ray tube age and focal spot size. Part three examines x-ray machine, equipment and patient factors which affect the dose received by individual patients. The factors considered include justification of examinations, choice of examination method, film/screen combinations, kVp, mAs, focus-film distance, collimation and field size, exposure time, projection, scatter, generator calibration errors, waveform, filtration, film processing and patient size. The patient dose implications of fluoroscopy systems, CT scanners, special procedures and mammography are also discussed. The report concludes with a brief discussion of patient dose levels in New Zealand and dose optimisation. 104 refs., 32 figs., 27 tabs

  20. Ventricular enlargement in patients with affective disorders

    International Nuclear Information System (INIS)

    Murashita, Jun; Kato, Tadafumi; Shioiri, Toshiki; Hamakawa, Inubushi, Toshiro; Hiroshi; Takahashi, Saburo

    1994-01-01

    Ventricular enlargement was determined using linear measurement on MR images in a total of 71 patients with affective disorders, including bipolar affective disorder (41) and depression (30). Fourty-one healthy persons served as controls. Evans ratio, Huckman number and minimum distance of caudate nuclei (MDCN) were used as indices for ventricular enlargment. No significant difference in Evans ratio was observed between both the group of bipolar affective disorder and the group of depression and the control group. Nor did it correlate with age in any of the groups. Huckman number was significantly higher in the group of bipolar affective disorder than the other two groups. It positively correlated with age in the group of depression. MDCN was significantly increased in the group of bipolar affective disorder, as compared with the control group; and there was a positive correlation between MDCN and age in both the group of dipolar affective disorder and the group of depression. In conclusion, ventricular enlargement was dependent upon aging in affetive disorder patients. This tendency was more noticeable in the group of depression. In addition, atrophy of the caudate nuclei was likely to be severer in the group of dipolar affective disorder than the group of depression. (N.K.)

  1. Incidental nuclear medicine findings affecting patient management

    International Nuclear Information System (INIS)

    Hector, B. M.

    2009-01-01

    Full text:A 62-year-old female patient presenting with flank pain and severe renal failure. Initial imaging modalities were unable to diagnose the cause, however, following a 18F fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET) scan the patient was diagnosed and staged with Stage III cervical cancer. Stage III cervical cancer is usually treated by a combination of chemotherapy and radiotherapy. An incidental finding of a retroperitoneal urine leak on the PET scan and subsequent MAG-3 renal scan contraindicated the use of chemotherapy as a treatment and therefore severely affected patient management.

  2. The interleukin-15 system suppresses T cell-mediated autoimmunity by regulating negative selection and nT(H)17 cell homeostasis in the thymus.

    Science.gov (United States)

    Hou, Mau-Sheng; Huang, Shih-Ting; Tsai, Ming-Han; Yen, Ching-Cheng; Lai, Yein-Gei; Liou, Yae-Huei; Lin, Chih-Kung; Liao, Nan-Shih

    2015-01-01

    The interleukin-15 (IL-15) system is important for regulating both innate and adaptive immune responses, however, its role in autoimmune disease remained unclear. Here we found that Il15(-/-) and Il15ra(-/-) mice spontaneously developed late-onset autoimmune phenotypes. CD4(+) T cells of the knockout mice showed elevated autoreactivity as demonstrated by the induction of lymphocyte infiltration in the lacrimal and salivary glands when transferred into nude mice. The antigen-presenting cells in the thymic medullary regions expressed IL-15 and IL-15Rα, whose deficiency resulted in insufficient negative selection and elevated number of natural IL-17A-producing CD4(+) thymocytes. These findings reveal previously unknown functions of the IL-15 system in thymocyte development, and thus a new layer of regulation in T cell-mediated autoimmunity. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Expression of interleukin-15 and inflammatory cytokines in skeletal muscles of STZ-induced diabetic rats: effect of resistance exercise training.

    Science.gov (United States)

    Molanouri Shamsi, M; Hassan, Z H; Gharakhanlou, R; Quinn, L S; Azadmanesh, K; Baghersad, L; Isanejad, A; Mahdavi, M

    2014-05-01

    Skeletal muscle atrophy is associated with type-1 diabetes. Skeletal muscle is the source of pro- and anti-inflammatory cytokines that can mediate muscle hypertrophy and atrophy, while resistance exercise can modulate both muscle mass and muscle cytokine expression. This study determined the effects of a 5-week resistance exercise training regimen on the expression of muscle cytokines in healthy and streptozotocin-induced diabetic rats, with special emphasis on interleukin-15 (IL-15), a muscle-derived cytokine proposed to be involved in muscle hypertrophy or responses to stress. Induction of diabetes reduced muscle weight in both the fast flexor hallucis longus (FHL) and slow soleus muscles, while resistance training preserved FHL muscle weight in diabetic rats. IL-15 protein content was increased by training in both FHL and soleus muscles, as well as serum, in normal and diabetic rats. With regard to proinflammatory cytokines, muscle IL-6 levels were increased in diabetic rats, while training decreased muscle IL-6 levels in diabetic rats; training had no effect on FHL muscle IL-6 levels in healthy rats. Also, tumor necrosis factor-alpha (TNF-α) and IL-1β levels were increased by diabetes, but not changed by training. In conclusion, we found that in diabetic rats, resistance training increased muscle and serum IL-15 levels, decreased muscle IL-6 levels, and preserved FHL muscle mass.

  4. Factors affecting patient dose in diagnostic radiology

    International Nuclear Information System (INIS)

    Poletti, J.L.

    1985-01-01

    There are two stages in the X-ray image forming process; first the irradiation of the patient to produce the X-ray pattern in space, known as the primary radiological image, and second, the conversion of this pattern into a visible form. This report discusses the first stage and its interrelation with image quality and patient dose

  5. Factors Affecting Patient Satisfaction During Endoscopic Procedures

    International Nuclear Information System (INIS)

    Qureshi, M. O.; Shafqat, F.; Ahmed, S.; Niazi, T. K.; Khokhar, N. K.

    2013-01-01

    Objective: To assess the quality and patient satisfaction in Endoscopy Unit of Shifa International Hospital. Study Design: Cross-sectional survey. Place and Duration of Study: Division of Gastroenterology, Shifa International Hospital, Islamabad, Pakistan, from July 2011 to January 2012. Methodology: Quality and patient satisfaction after the endoscopic procedure was assessed using a modified GHAA-9 questionnaire. Data was analyzed using SPSS version 16. Results: A total of 1028 patients were included with a mean age of 45 A+- 14.21 years. Out of all the procedures, 670 (65.17%) were gastroscopies, 181 (17.60%) were flexible sigmoidoscopies and 177 (17.21%) were colonoscopies. The maximum unsatisfactory responses were on the waiting time before the procedure (13.13 %), followed by unsatisfactory explanation of the procedure and answers to questions (7.58%). Overall, unsatisfied impression was 4.86%. The problem rate was 6.22%. Conclusion: The quality of procedures and level of satisfaction of patients undergoing a gastroscopy or colonoscopy was generally good. The factors that influence the satisfaction of these patients are related to communication between doctor and patient, doctor's manner and waiting time for the procedure. Feedback information in an endoscopy unit may be useful in improving standards, including the performance of endoscopists. (author)

  6. Affective functioning after delirium in elderly hip fracture patients

    NARCIS (Netherlands)

    Slor, C.J.; Witlox, J.; Jansen, R.W.M.M.; Adamis, D.; Meagher, D.J.; Tieken, E.; Houdijk, A.P.J.; van Gool, W.A.; Eikelenboom, P.; de Jonghe, J.F.M.

    2013-01-01

    ABSTRACT Background: Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. Methods: For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline

  7. Affective functioning after delirium in elderly hip fracture patients

    NARCIS (Netherlands)

    Slor, Chantal J.; Witlox, Joost; Jansen, René W. M. M.; Adamis, Dimitrios; Meagher, David J.; Tieken, Esther; Houdijk, Alexander P. J.; van Gool, Willem A.; Eikelenboom, Piet; de Jonghe, Jos F. M.

    2013-01-01

    Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and

  8. Psychosocial predictors of affect in adult patients undergoing orthodontic treatment.

    Science.gov (United States)

    Peñacoba, Cecilia; González, M José; Santos, Noelia; Romero, Martín

    2014-02-01

    In this paper we propose to study the role of psychosocial variables in affect in adult patients undergoing orthodontic treatment, considering that affect is a key variable in treatment adherence. Seventy-four patients (average age 33,24 ± 10,56) with metal multibracket-fixed orthodontic treatment were included. Patients were assessed twice. The first stage, at the beginning of treatment, included assessment of dental impact (Psychosocial Impact of Dental Aesthetics Questionnaire), trait anxiety (State-Trait Anxiety Inventory), self-esteem (Rosenberg's self-esteem scale), and self-efficacy (General Self-efficacy Scale). In the second stage, 6 months later, positive and negative affect towards treatment was assessed using the Positive and Negative Affect Scale. Dental social impact differentiates between patients with high and low negative affect, while self-efficacy differentiates between patients with high and low positive affect. Trait anxiety and self-esteem differentiate between both types of affect (positive and negative). Trait anxiety and self-esteem (when trait anxiety weight is controlled) are significant predictor variables of affective balance. These results have important practical implications, because it seems essential to adopt a bio-psychosocial model incorporating assessment methods focusing on day-to-day changes in mood and well-being.

  9. Factors affecting dignity of patients with multiple sclerosis.

    Science.gov (United States)

    Sharifi, Simin; Borhani, Fariba; Abbaszadeh, Abbas

    2016-12-01

    MS is one of the most common chronic diseases of the nervous system. Apart from disease progression, other complications such as unemployment, separation and divorce could potentially threat patients' dignity. Most of the previous studies have been done of maintaining patients' dignity in interaction with healthcare team, but studies on affecting factors of dignity in chronic patients in the society and in interaction with usual people are scarce. We aimed to investigate factors affecting dignity of Iranian patients with MS in daily living and in interaction of them with the society. In this qualitative study, 13 patients with multiple sclerosis were chosen by purposive sampling and semi-structured interviews were conducted until data saturation. The study was done in Tehran, the capital city of Iran. Factors affecting dignity were classified as 'personal factors' and 'social factors'. Personal factors consist of the following subcategories: patients' communication with self, patients' knowledge, patients' values and beliefs and patients' resources. Social factors include others' communication with patients, social knowledge, social values and beliefs and social resources. Multiple personal and social factors interfere in perceived patient dignity. In fact, interaction between personal and social factors can be influential in final perceived dignity. By focusing on whole aspects of the patients' lives, we can identify dignity-promoting or dignity-threatening factors and help patients maintain their dignity by taking appropriate measures for moderating threatening factors and improving dignity enhancing ones. © 2016 Nordic College of Caring Science.

  10. Factors affecting mortality and epidemiological data in patients ...

    African Journals Online (AJOL)

    Background. Burns continue to be responsible for significant morbidity and mortality in developing countries. In this study we aimed to determine the factors affecting mortality and epidemiological data by examining the records of burned patients. Method. The hospital records of 980 patients who were hospitalised in the ...

  11. Factors affecting quality of life in cancer patients undergoing ...

    African Journals Online (AJOL)

    Factors affecting quality of life in cancer patients undergoing chemotherapy. ... Objective: The aim of this study was to evaluate the QoL in cancer patients with solid tumors and at the different chemotherapy cycles (CT). ... Results: A significant relationship between the cancer type, pain intensity, and fatigue was found.

  12. How Communication Disharmonies between Patients and Nurses Can Affect Patients

    DEFF Research Database (Denmark)

    Thygesen, Marianne Kirstine; Pedersen, Birthe D.

    2017-01-01

    verbatim and analyzed using a Ricoeur inspired technique, which started open-minded. Situations with harmony between patients’ experience of their health state and nurses’ signals in this regard were more peaceful and energizing for the patients than situations with disharmony, which gave limbo experiences...... and drained of energy. The Broaden and Build theory and the Sense of Coherence theory might support our findings. True presence of the nurse is important in order to meet the patient where she is and communicate from there. More evidence based suggestions for future clinical foci are given. Female cancer...

  13. Symptom dimensions of affective disorders in migraine patients.

    Science.gov (United States)

    Louter, M A; Pijpers, J A; Wardenaar, K J; van Zwet, E W; van Hemert, A M; Zitman, F G; Ferrari, M D; Penninx, B W; Terwindt, G M

    2015-11-01

    A strong association has been established between migraine and depression. However, this is the first study to differentiate in a large sample of migraine patients for symptom dimensions of the affective disorder spectrum. Migraine patients (n=3174) from the LUMINA (Leiden University Medical Centre Migraine Neuro-analysis Program) study and patients with current psychopathology (n=1129), past psychopathology (n=477), and healthy controls (n=561) from the NESDA (Netherlands Study of Depression and Anxiety) study, were compared for three symptom dimensions of depression and anxiety. The dimensions -lack of positive affect (depression specific); negative affect (nonspecific); and somatic arousal (anxiety specific)- were assessed by a shortened adaptation of the Mood and Anxiety Symptom Questionnaire (MASQ-D30). Within the migraine group, the association with migraine specific determinants was established. Multivariate regression analyses were conducted. Migraine patients differed significantly (pmigraine patients were predominantly similar to the past psychopathology group. For the somatic arousal dimension, migraine patients scores were more comparable with the current psychopathology group. Migraine specific determinants for high scores on all dimensions were high frequency of attacks and cutaneous allodynia during attacks. This study shows that affective symptoms in migraine patients are especially associated with the somatic arousal component. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Affective functioning after delirium in elderly hip fracture patients.

    Science.gov (United States)

    Slor, Chantal J; Witlox, Joost; Jansen, René W M M; Adamis, Dimitrios; Meagher, David J; Tieken, Esther; Houdijk, Alexander P J; van Gool, Willem A; Eikelenboom, Piet; de Jonghe, Jos F M

    2013-03-01

    Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge. Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups. This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.

  15. Electroconvulsive therapy and subsequent epilepsy in patients with affective disorders

    DEFF Research Database (Denmark)

    Bøg, Fie Krossdal; Jørgensen, Martin Balslev; Andersen, Zorana Jovanovic

    2018-01-01

    and antipsychotic medication use. RESULTS: A total of 5875 patients had at least one ECT and 1873 patients developed epilepsy (Incidence rate: 213 pr. 100,000 person years) during the follow-up of mean 5 years. In patients below age 40 years, ECT was associated with a higher rate of epilepsy after adjustment...... epilepsy in patients with affective disorder. We also explored whether any association varied with number of ECTs and time since last treatment. METHODS: All 169,457 patients with first hospital contact for an affective disorder between January 2005 and December 2015 were identified in the Danish National...... for covariables (Hazard Ratio (HR) = 1.84; 95% Confidence Intervals (CI) = [1.24-2.74]). In patients aged 41-60 years ECT was not associated with epilepsy, while for those above 60 treated with ECT the rate was lower (HR = 0.57; (95% CI = [0.37-0.89]). CONCLUSION: In patients with affective disorders, we found...

  16. Alexithymia and affective verbal behaviour of three groups of patients.

    Science.gov (United States)

    Ahrens, S

    1985-01-01

    The study described in this article was designed to investigate patients' response to affective stimuli on two levels of measurement: one was designed to yield information about cognitive attribution processes whereas the second level was aimed at uncovering deeper, more unconscious responses to the given stimuli. These were displayed as part of an experimental setting, in which three groups were compared: psychosomatic (duodenal ulcer), somatic and psychoneurotic patients. Systematic variation was introduced by showing either of two versions of a short film which differed in the degree of friendliness displayed by the main character. The results show differential effects on the two levels of measurement: in the case of the first level, an interpretation within the framework of current conceptualizations of alexithymia would have been possible, but results for the second level of measurement (utilizing Gottschalk-Gleser content analysis of speech) indicate that psychosomatic patients show the same kind of sensitive response to affective stimuli as patients from the other two groups.

  17. Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients

    Science.gov (United States)

    Bruce, Lisa; Li, Nien-Chen; Mooney, Ann; Maddux, Franklin W.

    2014-01-01

    Background and objectives Recent studies demonstrated an association between depressive affect and higher mortality risk in incident hemodialysis patients. This study sought to determine whether an association also exists with hospitalization risk. Design, setting, participants, & measurements All 8776 adult incident hemodialysis patients with Medical Outcomes Study Short Form 36 survey results treated in Fresenius Medical Care North America facilities in 2006 were followed for 1 year from the date of survey, and all hospitalization events lasting >24 hours were tracked. A depressive affect score was derived from responses to two Medical Outcomes Study Short Form 36 questions (“down in the dumps” and “downhearted and blue”). A high depressive affect score corresponded with an average response of “some of the time” or more frequent occurrence. Cox and Poisson models were constructed to determine associations of depressive affect scores with risk for time to first hospitalization and risk for hospitalization events, as well as total days spent in the hospital, respectively. Results Incident patients with high depressive affect score made up 41% of the cohort and had a median (interquartile range) hospitalization event rate of one (0, 3) and 4 (0, 15) total hospital days; the values for patients with low depressive affect scores were one (0, 2) event and 2 (0, 11) days, respectively. For high-scoring patients, the adjusted hazard ratio for first hospitalization was 1.12 (1.04, 1.20). When multiple hospital events were considered, the adjusted risk ratio was 1.13 (1.02, 1.25) and the corresponding risk ratio for total hospital days was 1.20 (1.07, 1.35). High depressive affect score was generally associated with lower physical and mental component scores, but these covariates were adjusted for in the models. Conclusions Depressive affect in incident hemodialysis patients was associated with higher risk of hospitalization and more hospital days. Future

  18. Analysis of affective disorders in patients with vascular dementia

    Directory of Open Access Journals (Sweden)

    D. V. Zakharchenko

    2012-01-01

    Full Text Available The outpatient records of 147 patients followed up for diagnosed vascular dementia were analyzed to assess the relationship between affective disorders and severe cognitive impairments. It was found that 7% of the examinees had a history of depressive states. Estimating the development time for vascular dementia could divide the patients into 2 groups: 1 60% of the patients in whom cognitive impairments began to determine its clinical picture just within the first 2 years after identification of affective disorders and 2 40%, in whom cognitive impairments occurred 10—20 years later. In both groups, mental disorders occurred at an equal age in the presence of depressive disorders; in Group 1, vascular dementia developed nearly twice as often as that in Group 2. At the same time, the occurrence of cognitive impairments in Group 1 patients just in the early disease stages is indicative of the organic genesis of affective disorders, as confirmed by the moderately rapid progression of psychopathological symptoms, such as sharpening of personality traits, increased rigidity of psychic processes, emotional lability, variations in affective symptomatology, inadequate remissions, and the presence of neurological symptoms. Another type of a ratio of depressive to severe cognitive disorders was found in the elderly persons in Group 2. The long existence of affective disorders without signs of cognitive diminution leads one to say that they have recurrent depressive disorder with further addition of a comorbid vascular process. These patients showed a fairly high severity of affective pathology that was responsible for more frequent admissions, as well as a phase course with relatively pure remissions without any clear intellectual-mnestic reduction and a predominance of hysterical character traits.

  19. Affective disorders among patients with borderline personality disorder.

    Science.gov (United States)

    Sjåstad, Hege Nordem; Gråwe, Rolf W; Egeland, Jens

    2012-01-01

    The high co-occurrence between borderline personality disorder and affective disorders has led many to believe that borderline personality disorder should be considered as part of an affective spectrum. The aim of the present study was to examine whether the prevalence of affective disorders are higher for patients with borderline personality disorder than for patients with other personality disorders. In a national cross-sectional study of patients receiving mental health treatment in Norway (N = 36 773), we determined whether psychiatric outpatients with borderline personality disorder (N = 1 043) had a higher prevalence of affective disorder in general, and whether they had an increased prevalence of depression, bipolar disorder or dysthymia specifically. They were compared to patients with paranoid, schizoid, dissocial, histrionic, obsessive-compulsive, avoidant, dependent, or unspecified personality disorder, as well as an aggregated group of patients with personality disorders other than the borderline type (N = 2 636). Odds ratios were computed for the borderline personality disorder group comparing it to the mixed sample of other personality disorders. Diagnostic assessments were conducted in routine clinical practice. More subjects with borderline personality disorder suffered from unipolar than bipolar disorders. Nevertheless, borderline personality disorder had a lower rate of depression and dysthymia than several other personality disorder groups, whereas the rate of bipolar disorder tended to be higher. Odds ratios showed 34% lower risk for unipolar depression, 70% lower risk for dysthymia and 66% higher risk for bipolar disorder in patients with borderline personality disorder compared to the aggregated group of other personality disorders. The results suggest that borderline personality disorder has a stronger association with affective disorders in the bipolar spectrum than disorders in the unipolar spectrum. This association may reflect

  20. Affective disorders among patients with borderline personality disorder.

    Directory of Open Access Journals (Sweden)

    Hege Nordem Sjåstad

    Full Text Available BACKGROUND: The high co-occurrence between borderline personality disorder and affective disorders has led many to believe that borderline personality disorder should be considered as part of an affective spectrum. The aim of the present study was to examine whether the prevalence of affective disorders are higher for patients with borderline personality disorder than for patients with other personality disorders. METHODS: In a national cross-sectional study of patients receiving mental health treatment in Norway (N = 36 773, we determined whether psychiatric outpatients with borderline personality disorder (N = 1 043 had a higher prevalence of affective disorder in general, and whether they had an increased prevalence of depression, bipolar disorder or dysthymia specifically. They were compared to patients with paranoid, schizoid, dissocial, histrionic, obsessive-compulsive, avoidant, dependent, or unspecified personality disorder, as well as an aggregated group of patients with personality disorders other than the borderline type (N = 2 636. Odds ratios were computed for the borderline personality disorder group comparing it to the mixed sample of other personality disorders. Diagnostic assessments were conducted in routine clinical practice. RESULTS: More subjects with borderline personality disorder suffered from unipolar than bipolar disorders. Nevertheless, borderline personality disorder had a lower rate of depression and dysthymia than several other personality disorder groups, whereas the rate of bipolar disorder tended to be higher. Odds ratios showed 34% lower risk for unipolar depression, 70% lower risk for dysthymia and 66% higher risk for bipolar disorder in patients with borderline personality disorder compared to the aggregated group of other personality disorders. CONCLUSIONS: The results suggest that borderline personality disorder has a stronger association with affective disorders in the bipolar spectrum than

  1. Affective Disorders among Patients with Borderline Personality Disorder

    Science.gov (United States)

    Sjåstad, Hege Nordem; Gråwe, Rolf W.; Egeland, Jens

    2012-01-01

    Background The high co-occurrence between borderline personality disorder and affective disorders has led many to believe that borderline personality disorder should be considered as part of an affective spectrum. The aim of the present study was to examine whether the prevalence of affective disorders are higher for patients with borderline personality disorder than for patients with other personality disorders. Methods In a national cross-sectional study of patients receiving mental health treatment in Norway (N = 36 773), we determined whether psychiatric outpatients with borderline personality disorder (N = 1 043) had a higher prevalence of affective disorder in general, and whether they had an increased prevalence of depression, bipolar disorder or dysthymia specifically. They were compared to patients with paranoid, schizoid, dissocial, histrionic, obsessive-compulsive, avoidant, dependent, or unspecified personality disorder, as well as an aggregated group of patients with personality disorders other than the borderline type (N = 2 636). Odds ratios were computed for the borderline personality disorder group comparing it to the mixed sample of other personality disorders. Diagnostic assessments were conducted in routine clinical practice. Results More subjects with borderline personality disorder suffered from unipolar than bipolar disorders. Nevertheless, borderline personality disorder had a lower rate of depression and dysthymia than several other personality disorder groups, whereas the rate of bipolar disorder tended to be higher. Odds ratios showed 34% lower risk for unipolar depression, 70% lower risk for dysthymia and 66% higher risk for bipolar disorder in patients with borderline personality disorder compared to the aggregated group of other personality disorders. Conclusions The results suggest that borderline personality disorder has a stronger association with affective disorders in the bipolar spectrum than disorders in the unipolar

  2. Human Factors Affecting the Patient's Acceptance of Wireless Biomedical Sensors

    Science.gov (United States)

    Fensli, Rune; Boisen, Egil

    In monitoring arrhythmia, the quality of medical data from the ECG sensors may be enhanced by being based on everyday life situations. Hence, the development of wireless biomedical sensors is of growing interest, both to diagnose the heart patient, as well as to adjust the regimen. However, human factors such as emotional barriers and stigmatization, may affect the patient's behavior while wearing the equipment, which in turn may influence quality of data. The study of human factors and patient acceptance is important both in relation to the development of such equipment, as well as in evaluating the quality of data gathered from the individual patient. In this paper, we highlight some important aspects in patient acceptance by comparing results from a preliminary clinical trial with patients using a wireless ECG sensor for three days out-of-hospital service, to available published results from telehomecare projects, and discuss important aspects to be taken into account in future investigations.

  3. Electronic monitoring of patients with bipolar affective disorder

    DEFF Research Database (Denmark)

    Jacoby, Anne Sophie; Faurholt-Jepsen, Maria; Vinberg, Maj

    2012-01-01

    Bipolar disorder is a great challenge to patients, relatives and clinicians, and there is a need for development of new methods to identify prodromal symptoms of affective episodes in order to provide efficient preventive medical and behavioural intervention. Clinical trials prove that electronic...

  4. Electronic monitoring of patients with bipolar affective disorder

    DEFF Research Database (Denmark)

    Jacoby, Anne Sophie; Faurholt-Jepsen, Maria; Vinberg, Maj

    2012-01-01

    Bipolar disorder is a great challenge to patients, relatives and clinicians, and there is a need for development of new methods to identify prodromal symptoms of affective episodes in order to provide efficient preventive medical and behavioural intervention. Clinical trials prove that electronic...... monitoring is a feasible, valid and acceptable method. Hence it is recommended, that controlled trials on the effect of electronic monitoring on patients' course of illness, level of function and quality of life are conducted.......Bipolar disorder is a great challenge to patients, relatives and clinicians, and there is a need for development of new methods to identify prodromal symptoms of affective episodes in order to provide efficient preventive medical and behavioural intervention. Clinical trials prove that electronic...

  5. Factors affecting functional prognosis of patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, M T

    2011-01-01

    to just one or two single factors. The current article reviews important factors affecting the functional prognosis, and clinicians are encouraged to include all factors potentially influencing the outcome of patients with hip fracture in their individualised treatment and rehabilitation plan. Especially......Having a hip fracture is considered one of the most fatal fractures for elderly people, resulting in impaired function, and increased morbidity and mortality. This challenges clinicians in identifying patients at risk of worse outcome, in order to optimise and intensify treatment in these patients....... A variety of factors such as age, prefracture function and health status, fracture type, pain, anaemia, muscle strength, and the early mobility level have been shown to influence patient outcome. Thus, the outcome of patients with hip fracture is considered multi-factorial, and can therefore not be related...

  6. Alexithymia, affect intensity and emotional range in suicidal patients.

    Science.gov (United States)

    Iancu, I; Horesh, N; Offer, D; Dannon, P N; Lepkifker, E; Kotler, M

    1999-01-01

    Although negative affect in general has been widely associated with suicide, the role of specific emotions and affect features in depression and suicidality is unclear. This study examined the potential of three major components of the affect structure as predictors of suicidal behavior. Twenty suicidal depressed (SD) inpatients were compared with 20 nonsuicidal depressed (NSD) inpatients and 20 healthy controls for alexithymia, emotional range (ER; i.e. variety of emotions experienced by the subjects) and affect intensity (AI; i.e. the intensity of their emotional responsiveness). Both the SD and the NSD patients had a narrower range of emotions, a stronger AI and a higher degree of alexithymia than did the healthy controls. No differences were found between the scores of the two inpatients groups. The three affect components examined (alexithymia, AI and ER) did not prove to represent sensitive predictors of suicidal behavior. Hopelessness and depression severity were found to be more reliable in the prediction of suicidal risk. We discuss the implications of this study, particularly the possibility of early detection and intervention in patients at risk.

  7. Nutritional problems among patients affected by cancer during chemotherapy

    Directory of Open Access Journals (Sweden)

    Marzena Kamińska

    2016-01-01

    Full Text Available Chemotherapy is one of the primary methods of treating cancer. Symptoms occurring during this form of therapy affect patients’ general health status, cause malnutrition, and deteriorate the quality of life of oncology patients, which results in cachexia. Malnutrition during treatment and the resulting bad general health status of patients may lead to disqualification from chemotherapy treatment. Cachexia is a complex and multi-factorial process, characterised by the nearly unknown mechanism of its development. What is extremely crucial is the evaluation of the state of malnutrition among patients qualified for cytostatic therapy and regular control of this state during therapy and immediately after its termination. Clinical practice indicates the importance of applying pharmacotherapy, nutritional treatment, and targeted education for the patient and their closest family regarding diet and correct behaviour, which significantly reduces anxiety and stress.

  8. A holistic approach to factors affecting depression in haemodialysis patients.

    Science.gov (United States)

    Gerogianni, Georgia; Kouzoupis, Anastasios; Grapsa, Eirini

    2018-05-19

    Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.

  9. Factors affecting bone mineral density in multiple sclerosis patients

    Science.gov (United States)

    Ayatollahi, Azin; Mohajeri-Tehrani, Mohammad Reza

    2013-01-01

    Background Multiple sclerosis (MS) is a demyelinating disease which can cause many disabilities for the patient. Recent data suggests that MS patients have higher risk for osteoporosis. This study was performed to investigate if the osteoporosis prevalence is higher in MS patients and to determine the possible factors affecting bone mineral density (BMD). Methods 51 definite relapsing-remitting MS patients according to McDonald's criteria (45 females, 6 males aged between 20 and 50 years) participated in this study. The control group included 407 females aged from 20 to 49 years; they were healthy and had no history of the diseases affecting bone metabolism. Femoral and lumbar BMD were measured by Dual Energy X-ray Absorptiometry (DXA). The disability of MS patients was evaluated by Expanded Disability Status Scale (EDSS). The patient's quality of life was evaluated by the validated Persian version of multiple sclerosis impact scale (MSIS-29). Results Patients’ mean age was 36 ± 3.3 years and their mean disease duration was 8.7 ± 1.7 years. The mean EDSS score and the mean body mass index (BMI) of the patients were 3 ± 0.9 and 23.5 ± 2.3 kg/m2, respectively. 29% of the patients had never been treated by ß-interferon and 6% of them had not received glucocorticoids (GCs) pulses since their MS had been diagnosed. 26% of the patients had a history of fracture.18% of our patients were osteoporotic and 43% of them were osteopenic. Femoral BMD was significantly lower among MS patients than age matched controls (P < 0.001), but lumbar BMD showed no difference. There was no correlation between administration of GCs pulses, interferon and BMD; however, we found a significant correlation between EDSS score, quality of life (QoL), disease duration and BMD of both site. Conclusion As a result of this study, bone loss inevitably occurs in MS patients. The major factor of BMD loss is immobility. Osteoporosis should be managed as part of MS patients’ treatment protocols

  10. Factors Affecting Hemodialysis Patients' Satisfaction with Their Dialysis Therapy

    Directory of Open Access Journals (Sweden)

    M. Al Eissa

    2010-01-01

    Full Text Available Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72.6% of the total eligible patients. The mean age was 51.7 years (±15.4; 58% have been on dialysis for >3 years. The mean Charlson Comorbidity Index was 3.2 (±2, and Kt/V was 1.3 (±0.44. The mean satisfaction score was (7.41 ± 2.75 and the mean score of the impact of the dialysis on the patients' lives was 5.32 ± 2.55. Male patients reported worse effect of dialysis on family life, social life, energy, and appetite. Longer period since the commencement of dialysis was associated with adverse effect on finances and energy. Lower level of education was associated with worse dialysis effect on stress, overall health, sexual life, hobbies, and exercise ability. Conclusion. The level of satisfaction is affected by gender, duration on dialysis, educational level, and standard of care given.

  11. Factors affecting 30-month survival in lung cancer patients.

    Science.gov (United States)

    Mahesh, P A; Archana, S; Jayaraj, B S; Patil, Shekar; Chaya, S K; Shashidhar, H P; Sunitha, B S; Prabhakar, A K

    2012-10-01

    Age adjusted incidence rate of lung cancer in India ranges from 7.4 to 13.1 per 100,000 among males and 3.9 to 5.8 per 100,000 among females. The factors affecting survival in lung cancer patients in India are not fully understood. The current study was undertaken to evaluate the factors affecting survival in patients diagnosed with lung cancer attending a tertiary care cancer institute in Bangalore, Karnataka, India. Consecutive patients with primary lung cancer attending Bangalore Institute of Oncology, a tertiary care centre at Bangalore, between 2006 and 2009 were included. Demographic, clinical, radiological data were collected retrospectively from the medical records. A total of 170 consecutive subjects (128 males, 42 females) diagnosed to have lung cancer; 151 non-small cell lung cancer (NSCLC) and 19 small cell lung cancer (SCLC) were included. A higher proportion of never-smokers (54.1%) were observed, mostly presenting below the age of 60 yr. Most subjects were in stage IV and III at the time of diagnosis. More than 50 per cent of patients presented with late stage lung cancer even though the duration of symptoms is less than 2 months. The 30-month overall survival rates for smokers and never-smokers were 32 and 49 per cent, respectively. No significant differences were observed in 30 month survival based on age at presentation, gender and type of lung cancer. Cox proportional hazards model identified never-smokers and duration of symptoms less than 1 month as factors adversely affecting survival. Our results showed that lung cancer in Indians involved younger subjects and associated with poorer survival as compared to other ethnic population. Studies on large sample need to be done to evaluate risk factors in lung cancer patients.

  12. Heavy metals accumulation affects bone microarchitecture in osteoporotic patients.

    Science.gov (United States)

    Scimeca, Manuel; Feola, Maurizio; Romano, Lorenzo; Rao, Cecilia; Gasbarra, Elena; Bonanno, Elena; Brandi, Maria Luisa; Tarantino, Umberto

    2017-04-01

    Bone metabolism is affected by mechanical, genetic, and environmental factors and plays a major role in osteoporosis. Nevertheless, the influence of environmental pollution on the occurrence of osteoporosis is still unclear and controversial. In this context, heavy metals are the most important pollutants capable to affect bone mass. The aim of this study was to investigate whether heavy metals accumulation in bone tissues could be related to the altered bone metabolism and architecture of osteoporotic patients. To this end, we analyzed 25 bone head biopsies osteoporotic patients and 25 bone head biopsies of osteoarthritic patients. Moreover we enrolled 15 patients underwent hip arthroplasty for high-energy hip fracture or osteonecrosis of the femoral head as a control group. Bone head biopsies were studied by BioQuant-osteo software, scanning electron microscopy and Energy Dispersive X-ray microanalysis. We found a prevalence of lead, cadmium and chromium accumulation in osteoporotic patients. Noteworthy, high levels of sclerostin, detected by immunohistochemistry, correlate with the accumulation of heavy metal found in the bone of osteoporotic patients, suggesting a molecular link between heavy metal accumulation and bone metabolism impairment. In conclusion, the presence of heavy metals into bone shed new light on the comprehension of the pathogenesis of osteoporosis since these elements could play a non redundant role in the development of osteoporosis at cellular/molecular and epigenetic level. Nevertheless, in vivo and in vitro studies need to better elucidate the molecular mechanism in which heavy metals can participate to osteoporosis. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1333-1342, 2017. © 2016 Wiley Periodicals, Inc.

  13. Factors Affecting Mortality in Elderly Patients Hospitalized for Nonmalignant Reasons

    Directory of Open Access Journals (Sweden)

    Teslime Ayaz

    2014-01-01

    Full Text Available Elderly population is hospitalized more frequently than young people, and they suffer from more severe diseases that are difficult to diagnose and treat. The present study aimed to investigate the factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. Demographic data, reason for hospitalization, comorbidities, duration of hospital stay, and results of routine blood testing at the time of first hospitalization were obtained from the hospital records of the patients, who were over 65 years of age and hospitalized primarily for nonmalignant reasons. The mean age of 1012 patients included in the study was 77.8 ± 7.6. The most common reason for hospitalization was diabetes mellitus (18.3%. Of the patients, 90.3% had at least a single comorbidity. Whilst 927 (91.6% of the hospitalized patients were discharged, 85 (8.4% died. Comparison of the characteristics of the discharged and dead groups revealed that the dead group was older and had higher rates of poor general status and comorbidity. Differences were observed between the discharged and dead groups in most of the laboratory parameters. Hypoalbuminemia, hypertriglyceridemia, hypopotassemia, hypernatremia, hyperuricemia, and high TSH level were the predictors of mortality. In order to meet the health necessities of the elderly population, it is necessary to well define the patient profiles and to identify the risk factors.

  14. Factors affecting RAIU in hyperthyroidism patients: an analysis

    International Nuclear Information System (INIS)

    Fang Yi; Liu Jianfeng; Zhang Xiuli

    2003-01-01

    Objective: To analyze the factors affecting thyroid radioiodine uptake (RAIU) of hyperthyroidism patients. Methods; RAIU was performed in 106 hyperthyroidism patients. Some factors were studied to analyze influences on the peak of RAIU, including patients' age and sex, gland weight, taking antithyroid drugs (ATD) or not, time of ATD taking and withdrawal. Results: Patients' RAIU peak had no significant difference for different ages and sex (F=1.68, P=0.1439). If preparation was performed according to the requirements before RAIU measurement, taking ATD or not had no influence on RAIU (t=1.1362, P=0.2625). RAIU peak was different between patients whose gland weight was ≤ 30 g and >30 g. Conclusions: Age and sex have no influence on RAIU. As long as ATD was discontinued at least one week before RAIU measurement, time of taking ATD and discontinuation have no influence on RAIU, and the result of measurement coincide with that of patients who do not take medicine. RAIU peak has relation with gland weight, and RAIU of people with gland weight ≤30 g was lower than that of people with gland weight >30 g

  15. A systematic study on factors affecting patient dose, (1)

    International Nuclear Information System (INIS)

    Otsuka, Akiyoshi; Higashida, Yoshiharu; Utsumi, Hiromoto; Ota, Masaji; Nakanishi, Takashi

    1979-01-01

    In the study of possible reduction in irradiation dose to patients during medical treatments, the following two methods can be considered: (1) To obtain absorbed doses for each part of a body in diagnostic X-ray examinations. (2) To obtain data on factors such as the tube voltage which may affect patient dose. There are a number of reports both at home and abroad concerning the above (1), but very few reports are available concerning the above (2). Moreover, most of them are on fragmentary aspects of each factor and no systematic reports have been made. For this reason, we have taken up, as factors affecting the patient dose, the field size, the tube voltage, and by checking them again, we wanted to obtain some systematic data. Our aim has been fully attained by conducting an experiment. In the ICRP's Publ. 26 issued last year, the idea of the critical organ which had not been fully elucidated in the Publ. 9 was abandoned. As a result, assessment of the irradiation doses has become more rational and the total risk for an individual was obtained. In Japan, the idea proposed in the Publ. 9 is adopted. Therefore, in this paper, we will raise some questions regarding the assessment of the irradiation doses, pointing out at the same time the rationality of the idea put forward in Publ. 26. (author)

  16. Vicarious experience affects patients' treatment preferences for depression.

    Directory of Open Access Journals (Sweden)

    Seth A Berkowitz

    Full Text Available Depression is common in primary care but often under-treated. Personal experiences with depression can affect adherence to therapy, but the effect of vicarious experience is unstudied. We sought to evaluate the association between a patient's vicarious experiences with depression (those of friends or family and treatment preferences for depressive symptoms.We sampled 1054 English and/or Spanish speaking adult subjects from July through December 2008, randomly selected from the 2008 California Behavioral Risk Factor Survey System, regarding depressive symptoms and treatment preferences. We then constructed a unidimensional scale using item analysis that reflects attitudes about antidepressant pharmacotherapy. This became the dependent variable in linear regression analyses to examine the association between vicarious experiences and treatment preferences for depressive symptoms.Our sample was 68% female, 91% white, and 13% Hispanic. Age ranged from 18-94 years. Mean PHQ-9 score was 4.3; 14.5% of respondents had a PHQ-9 score >9.0, consistent with active depressive symptoms. Analyses controlling for current depression symptoms and socio-demographic factors found that in patients both with (coefficient 1.08, p = 0.03 and without (coefficient 0.77, p = 0.03 a personal history of depression, having a vicarious experience (family and friend, respectively with depression is associated with a more favorable attitude towards antidepressant medications.Patients with vicarious experiences of depression express more acceptance of pharmacotherapy. Conversely, patients lacking vicarious experiences of depression have more negative attitudes towards antidepressants. When discussing treatment with patients, clinicians should inquire about vicarious experiences of depression. This information may identify patients at greater risk for non-adherence and lead to more tailored patient-specific education about treatment.

  17. Airway inflammation in patients affected by obstructive sleep apnea syndrome.

    Science.gov (United States)

    Salerno, F G; Carpagnano, E; Guido, P; Bonsignore, M R; Roberti, A; Aliani, M; Vignola, A M; Spanevello, A

    2004-01-01

    Obstructive sleep apnea syndrome (OSAS) has been shown to be associated to upper airway inflammation. The object of the present study was to establish the presence of bronchial inflammation in OSAS subjects. In 16 subjects affected by OSAS, and in 14 healthy volunteers, airway inflammation was detected by the cellular analysis of the induced sputum. OSAS patients, as compared to control subjects, showed a higher percentage of neutrophils (66.7+/-18.9 vs. 25.8+/-15.6) (Pbronchial inflammation characterized by a significant increase in neutrophils.

  18. Recurrens Rates and Affecting Factors in Patients Operated for Endometrioma

    Directory of Open Access Journals (Sweden)

    Cüneyt Eftal Taner

    2008-09-01

    Full Text Available OBJECTIVE: Our aim was to investigate reurrens rates and affecting factors in patients operated for endometrioma.\tMATERIAL-METHOD: The cases operated for over cyst diagnosis and pathologically endometrioma diagnosis between the years 2000-2004 has been reviewed retrospectively. Cases’s age, cyst diameter, endometriosis stage and operation procedure have been recorded and the cases that have recurrence and factors affecting recurrence are evaluated.\tRESULTS: Results: 51 of 137 (37.3% cases with endometrioma that have average age of 29.1 in course of operation ± 5.4 had left side, 37 of 137(27% had right side and 49 of 137 (35.7% had bilateral endometrioma. Average diameter of endometriomas was 5.1 ±1.9 cm (1-1.5 cm. After average 3.3±1.8 years from first operation time in 42 cases(30.6% had recurrence. in the left over recurrence rate was signifciantly high (10.8% to 41.2% than right over. For recurrence rate There were no significiant diference between the 102 cases that had laparoscopy and 35 cases that had laparotomy according to cyst diameter, case ages and type of operation.\tWhen the cases were reviewed according to endometriozis staging, There were significiantly high recurrence rate at stage III (28.9% and stage IV(46.0%. With respect to the operation type, patients that had one-sided ooferektomi,relapse is not seen. Patients that had fenestration and ablation as operation, relapse rate is 52.9% significiantly higher than patients that had kistektomi (26.9%.Despite decrease in preoperative complaints (dysmenorrhea, dyspareunia, chronic pelvic pain in early postoperative period, they recurred in late postoperative period. 47(56% of 84 patients who have fertility desire gave live birth unfortunately 12(14.3% of them.\tCONCLUSION: Recurrence rates were signifiantly higher in cases with lift sided endometrioma, advanced stafe of endometriosis and in patient udergone fenestration and ablation for treatment.

  19. Does CPAP Affect Patient-Reported Voice Outcomes?

    Science.gov (United States)

    Hartke, Vance; Gillespie, Amanda; Smith, Libby J; Soose, Ryan J

    2018-04-01

    Upper aerodigestive tract symptoms are common in patients with obstructive sleep apnea (OSA). It remains unclear whether continuous positive airway pressure (CPAP) improves or worsens these otolaryngology symptoms. As therapy-related side effects limit CPAP adherence, this study aimed to determine if CPAP negatively affects voice, sinonasal, and reflux symptoms of the upper airway. Case series with planned data collection was performed at an academic otolaryngology sleep center. Newly diagnosed patients with OSA were evaluated before and 6 months after initiating CPAP therapy. Data collected included CPAP data download, Reflux Symptom Index (RSI), Epworth Sleepiness Scale (ESS), Voice Handicap Index 10 (VHI-10), Sino-Nasal Questionnaire (SNQ), and oral dryness visual analog scale (VAS). For the 11 CPAP-adherent participants, the RSI significantly improved with CPAP (mean RSI, 22.0-9.5; P = .002); however, the VAS, VHI-10, and SNQ did not change after 6 months of CPAP therapy. In a small sample size, patient-reported voice outcomes (VHI-10) and other upper aerodigestive tract symptoms did not worsen with CPAP; rather, CPAP therapy was associated with a reduction in reflux symptoms.

  20. Factors affecting intellectual outcome in pediatric brain tumor patients

    International Nuclear Information System (INIS)

    Ellenberg, L.; McComb, J.G.; Siegel, S.E.; Stowe, S.

    1987-01-01

    A prospective study utilizing repeated intellectual testing was undertaken in 73 children with brain tumors consecutively admitted to Childrens Hospital of Los Angeles over a 3-year period to determine the effect of tumor location, extent of surgical resection, hydrocephalus, age of the child, radiation therapy, and chemotherapy on cognitive outcome. Forty-three patients were followed for at least two sequential intellectual assessments and provide the data for this study. Children with hemispheric tumors had the most general cognitive impairment. The degree of tumor resection, adequately treated hydrocephalus, and chemotherapy had no bearing on intellectual outcome. Age of the child affected outcome mainly as it related to radiation. Whole brain radiation therapy was associated with cognitive decline. This was especially true in children below 7 years of age, who experienced a very significant loss of function after whole brain radiation therapy

  1. Stress load during childhood affects psychopathology in psychiatric patients

    Directory of Open Access Journals (Sweden)

    Popov Tzvetan

    2008-07-01

    Full Text Available Abstract Background Childhood stress and trauma have been related to adult psychopathology in different psychiatric disorders. The present study aimed at verifying this relationship for stressful experiences during developmental periods by screening stress load across life in adult psychiatric inpatients with different diagnoses compared to healthy subjects. In addition, a relationship between the amount of adverse experiences and the severity of pathology, which has been described as a 'building block' effect in posttraumatic stress disorder (PTSD, was explored for non-traumatic events in psychiatric disorders other than PTSD. Methods 96 patients with diagnoses of Major Depressive Disorder (MDD, schizophrenia, drug addiction, or personality disorders (PD and 31 subjects without psychiatric diagnosis were screened for adverse experiences in childhood (before the age of six years, before onset of puberty, and in adulthood using the Early Trauma Inventory and the Posttraumatic Stress Diagnostic Scale. Effects of stress load on psychopathology were examined for affective symptoms, PTSD, and severity of illness by regression analyses and comparison of subgroups with high and low stress load. Results High stress load in childhood and before puberty, but not in adulthood, was related to negative affect in all participants. In patients, high stress load was related to depressive and posttraumatic symptoms, severity of disorder, and the diagnoses of MDD and PD. Conclusion Results support the hypothesis of stress-sensitive periods during development, which may interact with genetic and other vulnerability factors in their influence on the progress of psychiatric disorders. A 'dose' effect of stress load on the severity of psychopathology is not restricted to the relationship between traumata and PTSD.

  2. Obesity adversely affects survival in pancreatic cancer patients.

    Science.gov (United States)

    McWilliams, Robert R; Matsumoto, Martha E; Burch, Patrick A; Kim, George P; Halfdanarson, Thorvardur R; de Andrade, Mariza; Reid-Lombardo, Kaye; Bamlet, William R

    2010-11-01

    Higher body-mass index (BMI) has been implicated as a risk factor for developing pancreatic cancer, but its effect on survival has not been thoroughly investigated. The authors assessed the association of BMI with survival in a sample of pancreatic cancer patients and used epidemiologic and clinical information to understand the contribution of diabetes and hyperglycemia. A survival analysis using Cox proportional hazards by usual adult BMI was performed on 1861 unselected patients with pancreatic adenocarcinoma; analyses were adjusted for covariates that included clinical stage, age, and sex. Secondary analyses incorporated self-reported diabetes and fasting blood glucose in the survival model. BMI as a continuous variable was inversely associated with survival from pancreatic adenocarcinoma (hazard ratio [HR], 1.019 for each increased unit of BMI [kg/m2], PFasting blood glucose and diabetes did not affect the results. Higher BMI is associated with decreased survival in pancreatic cancer. Although the mechanism of this association remains undetermined, diabetes and hyperglycemia do not appear to account for the observed association. Copyright © 2010 American Cancer Society.

  3. Bipolar Affective Disorder in a Patient of Profound Deafness.

    Science.gov (United States)

    Zubair, Usama Bin; Mumtaz, Humza; Mansoor, Sawera

    2018-03-01

    Profound deafness is a lifelong impairment, leading to the physical disability as well as poor psychological adjustment. We herein present a mental health disorder rarely seen among the patients of profound deafness. A 16-year deaf and dumb girl, previously treated for depression, presented with unusual laughter, irritability, flight of ideas, decreased sleep, ideas of self importance, and decreased social functioning and educational performance. These problems were understood by the parents via sign language, who interpreted them to the interviewer. Her Young Mania Rating Scale (YMRS) score was 19 and Brief Psychiatric Rating Scale (BPRS) score was 52. She was diagnosed as a case of bipolar affective disorder (BPAD). Marked improvement in the symptoms and social and educational performance was noted after two weeks of the treatment with sodium valproate, resperidone and clonazepam. Treatment options were explained to the patient with risks and benefits, and she was involved in the decision-making. This case report highlights the importance of accurately diagnosing and managing a rare mental health disorder among the physically handicapped people, especially those who cannot communicate effectively and explain their unusual subjective experiences.

  4. Factors affecting experiences of intensive care patients in Turkey: patient outcomes in critical care setting.

    Science.gov (United States)

    Demir, Yurdanur; Korhan, Esra Akin; Eser, Ismet; Khorshid, Leyla

    2013-07-01

    To determine the factors affecting a patient's intensive care experience. The descriptive study was conducted at an intensive care unit in the Aegean Region of Turkey, and comprised 158 patients who spent at least 48 hours at the unit between June and November 2009. A questionnaire form and the Intensive Care Experience Scale were used as data collection tools. SPSS 11.5 was used for statistical analysis of the data. Of the total, 86 (54.4%) patients related to the surgical unit, while 72 (45.5%) spent time at the intensive care unit. Most of the subjects (n=113; 71.5%) reported that they constantly experienced pain during hospitalisation. Patients receiving mechanical ventilation support and patients reporting no pain had significantly higher scores on the intensive care experience scale. Patients who reported pain remembered their experiences less than those having no pain. Interventions are needed to make the experiences of patients in intensive care more positive.

  5. Affect

    NARCIS (Netherlands)

    Cetinic, M.; Diamanti, J.; Szeman, I.; Blacker, S.; Sully, J.

    2017-01-01

    This chapter historicizes four divergent but historically contemporaneous genres of affect theory – romantic, realist, speculative, and materialist. While critics credited with the turn to affect in the 1990s wrote largely in the wake of poststructuralism from the perspective of gender and queer

  6. Cognitive subtypes in non-affected siblings of schizophrenia patients: characteristics and profile congruency with affected family members

    NARCIS (Netherlands)

    Quee, P.J.; Alizadeh, BZ; Aleman, A.; van den Heuvel, E.R.; Bruggeman, R.; Cahn, W.; de Haan, L.; Kahn, R.; Krabbendam, L.; Linzen, D.; Myin-Germeys, I.; van Os, J; Wiersma, D.

    2013-01-01

    Background. Although cognitive subtypes have been suggested in schizophrenia patients, similar analyses have not been carried out in their non-affected siblings. Subtype classification may provide more insight into genetically driven variation in cognitive function. We investigated cognitive

  7. A systematic study on factors affecting patient dose, 2

    International Nuclear Information System (INIS)

    Otsuka, Akiyoshi; Higashida, Yoshiharu; Utsumi, Hiromoto; Ota, Masaji; Nakanishi, Takashi

    1979-01-01

    In the preceding report, we dealt with the field size and the tube voltage. This paper covers the differences in patient dose due to the focus to film distance (FFD), the patient thickness and whether the grid is used or not. Regarding the FFD, 100 cm is most commonly employed except in X-ray examinations of the chest, but from the viewpoint of the patient dose, this requires special consideration as to whether there is any theoretical basis for it. The patient thickness has a great bearing on the patient dose, but there is an individual difference, and it is almost impossible to change it artificially. However, there has been no detailed report on the relation between the patient thickness and the patient dose, therefore, this report treats of such relationship as well. Concerning the grid, consideration is given to the exposure times (Bucky factor). (author)

  8. Implicit and Explicit Memory for Affective Passages in Temporal Lobectomy Patients

    Science.gov (United States)

    Burton, Leslie A.; Rabin, Laura; Vardy, Susan Bernstein; Frohlich, Jonathan; Porter, Gwinne Wyatt; Dimitri, Diana; Cofer, Lucas; Labar, Douglas

    2008-01-01

    Eighteen temporal lobectomy patients (9 left, LTL; 9 right, RTL) were administered four verbal tasks, an Affective Implicit Task, a Neutral Implicit Task, an Affective Explicit Task, and a Neutral Explicit Task. For the Affective and Neutral Implicit Tasks, participants were timed while reading aloud passages with affective or neutral content,…

  9. Factors affecting smoking cessation in patients with cancer

    Directory of Open Access Journals (Sweden)

    Eleni Kokkotou

    2017-05-01

    Smoking cessation in patients with cancer is accompanied by significant success, although this outcome is poorer compared with non-cancer smokers. Cancer patients must follow well-organized smoking cessation programs as soon as diagnosis is made, in order to have a successful and prolong smoking cessation.

  10. Thematic Analysis: How do patient diaries affect survivors' psychological recovery?

    Science.gov (United States)

    Teece, Angela; Baker, John

    2017-08-01

    This review aims to use thematic analysis to explore and synthesise evidence of the actual or potential reported effects of diaries on the psychological rehabilitation and recovery of discharged critical care patients. Evidence suggests that whilst admission to critical care may save patient lives, the psychological aftermath can damage a patient's recovery and these needs must be met. Patient diaries are one potential intervention to aid patients understand their critical illness and fill memory gaps caused by sedation, thus reducing psychological distress post-discharge. Prospective patient diaries are increasing in popularity amongst critical care units in the United Kingdom, however there is little evidence base to support their use or understand their effects. A literature review using systematic methods was undertaken of studies relating to the effects of diaries on discharged patients. Thematic analysis enabled the generation and synthesis of themes. Three themes arose from the generated codes: 1) Reclaiming ownership of lost time. 2) Emphasising personhood. 3) Fear and frustration. The diary intervention was shown to have a largely positive impact on survivors' psychological rehabilitation. However, caution should be exercised as recipients could find the contents painful and emotional. Diaries should be embedded within a robust critical care follow-up plan. This review suggests that diaries have the potential to form one aspect of rehabilitation and make a positive impact on patients' recovery. More research is indicated to fully evaluate the effects of diaries on their recipients. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  11. Factors affecting patients' ratings of health-care satisfaction

    DEFF Research Database (Denmark)

    Thygesen, Marianne K; Fuglsang, Marie; Miiller, Max Mølgaard

    2015-01-01

    INTRODUCTION: Surveys that include rating scales are commonly used to collect data about patients' experiences. We studied how patients associated their ratings with their experiences of care. METHODS: A survey and a qualitative study were conducted at a Danish hospital. Initially, 19 female pati...

  12. Religious convictions in patients with epilepsy-associated affective disorders

    DEFF Research Database (Denmark)

    Vaaler, Arne E; Kondziella, Daniel; Morken, Gunnar

    2015-01-01

    Patients with epilepsy often have different mood symptoms and behavioral trait characteristics compared to the non-epileptic population. In the present prospective study, we aimed to assess differences in behavioral trait characteristics between acutely admitted, psychiatric in-patients with epil...... characteristics at admission or in clinical history should alert the psychiatrist and lead to closer examination for a possible convulsive disorder....

  13. Association between Interleukin-15 and Obesity: Interleukin-15 as a Potential Regulator of Fat Mass

    DEFF Research Database (Denmark)

    Nielsen, Anders Rinnov; Hojman, Pernille; Erikstrup, Christian

    2008-01-01

    Objective: IL-15 decreases lipid deposition in preadipocytes and decreases the mass of white adipose tissue in rats, indicating that IL-15 may take part in regulating this tissue. IL-15 is expressed in human skeletal muscle and skeletal muscle may be a source of plasma IL-15 and in this way...

  14. Review: Psychological Factors Affecting Rehabilitation of Neurologic Patients

    Directory of Open Access Journals (Sweden)

    Mahshid Foroughan

    2001-01-01

    Full Text Available Psychological factors imply their negative effects on neurologic patients in two ways. Directly, through pathogenic processes of central nervous system, and indirectly, through maladaptive reactions toward disability. Depression: is a common finding in many neurologic diseases and may interfere with rehabilitation process. Correcting patient's attitude toward disability, reducing environmental stresses and potentiating social support network along with antidepressant drugs often help these patients remain in rehabilitation program. Chronic fatigue: decreases the activity levels of patients and the possibility for them to achieve set goals of rehabilitation in proper times. Support, reassurance and sometimes antidepressant drugs may help. Conversion reactions: often accompany chronic illnesses and disabilities and make evaluation and diagnosis difficult. Application of behavioral Techniques may lead to better results. Altered self image: is a prominent feature in patients with spinal cord injury. Counseling and Free discussion on altered self image and sexual problems are essential and other forms of sexual expression must be taught to these patients. Chronic pain: is a disabling condition. Usually physical findings are minor and it seems psychological factors play a more important role in causing it. Antidepressant drugs are effective in most cases. Intensive physical and occupational therapy must be avoided. Excessive emotionality: is a consequence of executive dysfunction arising from frontal lobe injury and mostly seen in stroke, brain injured, and demented patients, Impulsivity and disinhibition may lead to aggressive behavior and socially inappropriate forms of sexual expression. Judicious administration of psychotherapy drugs, behavioral techniques and short-term hospitalization may be helpful. Altered cognition: is a common feature of many pathological conditions of brain. Attention deficit, slowed information processing, disturbed

  15. Factors affecting mortality of critical care trauma patients | Hefny ...

    African Journals Online (AJOL)

    The most common mechanism of injury was road traffic collisions (72.3 %). The overall mortality was 13.9%. A direct logistic regression model has shown that factors that affected mortality were decreased GCS (p < 0.0001), mechanism of injury (p = 0.004) with burns having the highest mortality, increased age (p = 0.004), ...

  16. Marital adjustment of patients with substance dependence, schizophrenia and bipolar affective disorder

    Directory of Open Access Journals (Sweden)

    Shital S Muke

    2014-01-01

    Full Text Available Background: Marital adjustment is considered as a part of social well-being. Disturbed marital relationship can directly affect the disease adjustment and the way they face disease outcomes and complications. It may adversely affect physical health, mental health, the quality-of-life and even economic status of individuals. Aim: The aim of this study was to compare the marital adjustment among patients with substance dependence, schizophrenia and bipolar affective disorder. Materials and Methods: The sample consisted of each 30 patients with substance dependence, bipolar affective disorder and schizophrenia, diagnosed as per international classification of diseases-10 diagnostic criteria for research with a minimum duration of illness of 1 year were evaluated using marital adjustment questionnaire. The data was analyzed using parametric and non-parametric statistics. Results: Prevalence of poor marital adjustment in patients with schizophrenia, bipolar affective disorder and substance dependence was 60%, 70% and 50% respectively. There was a significant difference on overall marital adjustment among substance dependence and bipolar affective disorder patients. There was no significant difference on overall marital adjustment among patients with substance dependence and schizophrenia as well as among patients with schizophrenia and bipolar affective disorder. On marital adjustment domains, schizophrenia patients had significantly poor sexual adjustment than substance dependence patients while bipolar affective disorder patients had significantly poor sexual and social adjustment compared with substance dependence patients. Conclusion: Patients with substance dependence have significant better overall marital adjustment compared with bipolar affective disorder patients. Patients with substance dependence have significantly better social and sexual adjustment than patients with bipolar affective disorder as well as significantly better sexual

  17. Does age affect prognosis in salivary gland carcinoma patients?

    DEFF Research Database (Denmark)

    Bjørndal, Kristine; Larsen, Stine R; Therkildsen, Marianne H

    2016-01-01

    in the young group were WHO performance status 0 and in disease stage I + II, and they presented with significantly more histological low grade tumors. In multivariate analysis, chronological age seemed to be of no prognostic significance to salivary gland carcinoma patients as opposed to performance status......, disease stage and histological grade. CONCLUSIONS: Salivary gland carcinoma patients over the age of 70 years have a poor prognosis compared to younger patients, which can be explained by higher disease stages, more histological high grade subtypes and a poorer performance status at the time of diagnosis.......AIM: To compare incidence, histology, treatment modalities, disease stages, and outcome in elderly patients (≥70 years) compared to younger (

  18. Pharmacists' Roles and Factors Affecting Patient Care in Korea

    Directory of Open Access Journals (Sweden)

    Monica J. Hwang

    2015-01-01

    Full Text Available Objectives: This study was conducted to explore Korean community pharmacists' perceptions of their roles in providing care to patients after the implementation of the Separation of Prescribing and Dispensing Act (SPD Act and to investigate pharmacists' perceptions about factors that impact their patient care. Methods: Eight community pharmacists participated in semi-structured, face-to-face, in-depth interviews in Korea. A snowball sampling technique was used to obtain participants. Interviews were audio-recorded and transcribed. Interviews were analyzed using a summative content analysis procedure. Key findings: Participants' perceptions of their roles centered on dispensing prescriptions, educating and counseling patients, and helping patients with OTC products. Participants perceived time constraints due to prescription volume and patient expectations as factors influencing their provision of patient care. Conclusion: This study suggests that the SPD Act was successful in changing pharmacists' roles in the Korean health care system. None of the participants perceived their role to include prescribing, while all of the participants indicated that their primary role was to dispense medications. Future research should examine the pervasiveness of the themes identified in this study across Korean community pharmacy practice in order to generalize the impact of the SPD Act.   Type: Original Research

  19. Patient and Provider Factors Affecting Clinical Inertia in Patients With Type 2 Diabetes on Metformin Monotherapy.

    Science.gov (United States)

    Mahabaleshwarkar, Rohan; Gohs, Frank; Mulder, Holly; Wilkins, Nick; DeSantis, Andrea; Anderson, William E; Ejzykowicz, Flavia; Rajpathak, Swapnil; Norton, H James

    2017-08-01

    Our aim was to determine the extent of clinical inertia and the associated patient and provider factors in patients with type 2 diabetes on metformin monotherapy (MM) at a large integrated health care system in the United States. The study cohort included patients with type 2 diabetes aged 18 to 85 years, on MM between January 2009 and September 2013, who experienced MM failure (had an uncontrolled glycosylated hemoglobin [HbA 1c ] reading (≥8.0% [64 mmol/mol]) after at least 90 days of MM). Clinical inertia was defined as absence of treatment intensification with an add-on therapy within 180 days after the MM failure (index date). The impact of patient and provider factors on clinical inertia was determined using generalized estimating equations. The study cohort consisted of 996 patients; 58% were men and 59% were white, with a mean age of 53 (11.8) years. Of these, 49.8% experienced clinical inertia. Lower HbA 1c at index date, absence of liver diseases, absence of renal diseases, and greater provider age were associated with clinical inertia. The clinical inertia rate in a secondary analysis considering HbA 1c inertia. Considerable clinical inertia rates were observed in our real-world patient population, suggesting the need of interventions to reduce clinical inertia in clinical practice. Information about patient and provider factors affecting clinical inertia provided by this study could help healthcare policymakers plan and implement such interventions. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

  20. Treating depression in HIV-positive patients affects adherence

    Directory of Open Access Journals (Sweden)

    M Y H Moosa

    2012-08-01

    Full Text Available Aim. To determine changes in adherence to antiretroviral therapy (ART in HIV-positive patients with depression, following treatment with an antidepressant or psychotherapy. Methods. The study was prospective, randomised and controlled. Consenting volunteers aged ≥18 years and stable on ART for ≥6 months were included in the study. Sociodemographic data were obtained, and a clinical diagnostic evaluation and the Hamilton Depression rating scale (HAMD were performed on all subjects at entry to and at the end of the study. Participants found to be depressed were randomly assigned antidepressant treatment (20 mg citalopram or interpersonal psychotherapy (IPT (5 sessions. Medication was dispensed at each visit and patients were asked to return all unused medication to determine ART adherence. The study was approved by the University of the Witwatersrand. Results. Sixty-two HIV-positive persons receiving ART participated; 30 were not depressed (control group and 32 were depressed (patient group. No significant differences in demographic characteristics existed between the control and patient groups. Mean ART adherence at the start of the study was 99.5% (standard error (SE ±0.46 and 92.1% (SE ±1.69 in the control and patients groups, respectively. Mean ART adherence at the end of the study changed marginally in the control group (99.7%; SE ±0.46 and increased significantly in the patient group (99.5%; SE± 0.13 (p>0.05. The mean ART adherence rate of patients who received pharmacotherapy increased from 92.8% to 99.5%, and of those who received psychotherapy increased from 91.1% to 99.6% (p>0.05. There was no significant association between the increased adherence in the patient group and baseline demographic and clinical characteristics, irrespective of antidepressant therapy or IPT (p>0.05. Conclusion. Successful treatment of depression with an antidepressant or psychotherapy was associated with improved ART adherence, independent of the type

  1. Factors affecting dental biofilm in patients wearing fixed orthodontic appliances.

    Science.gov (United States)

    Mei, Li; Chieng, Joyce; Wong, Connie; Benic, Gareth; Farella, Mauro

    2017-12-01

    The aim of this study is to investigate the amount and the distribution of biofilm in patients wearing fixed appliances and its relation with age, gender, frequency of tooth brushing, and patient motivation. The sample comprised 52 patients (15.5 ± 3.6 years old, 30 females and 22 males) wearing fixed orthodontic appliances. Dental biofilm was assessed using a modified plaque index (PI). A questionnaire was used to collect patient's information, including gender, age, treatment motivation, and frequency of tooth brushing. Gingival (PI score = 0.9 ± 0.7), mesial (0.8 ± 0.6), and distal (0.8 ± 0.5) areas accumulated more biofilm than occlusal areas (0.3 ± 0.3) (P appliances have the highest biofilm accumulation on the maxillary lateral incisors and maxillary canines, particularly in the gingival area and areas behind arch wires. Less biofilm was observed in female and adult patients and in those who were self-motivated and brushed their teeth more often.

  2. Psychological Resilience, Affective Mechanisms, and Symptom Burden in a Tertiary Care Sample of Patients with Fibromyalgia

    Science.gov (United States)

    McAllister, Samantha J; Vincent, Ann; Hassett, Afton L; Whipple, Mary O; Oh, Terry H; Benzo, Roberto P; Toussaint, Loren L

    2014-01-01

    Research demonstrates that patients with fibromyalgia who have higher positive and lower negative affect have lower symptom burden. Affect has been shown to be associated with resilience. This study examined the relationship between affect, resilience, and fibromyalgia symptom burden in a clinical sample of patients with fibromyalgia. We hypothesized that (a) positive and negative affect would be associated with fibromyalgia symptom burden; (b) resilience would be associated with positive and negative affect; (c) resilience would be associated with fibromyalgia symptom burden; and (d) the connection between resilience and fibromyalgia symptom burden would be mediated by both positive and negative affect. A sample of 858 patients with fibromyalgia completed questionnaires. Mediation modeling revealed statistically significant direct effects of resilience on fibromyalgia symptom burden (β =−.10, P fibromyalgia symptom burden through affect (β =−.36, P fibromyalgia symptom burden. Our results suggest that improving affect through resiliency training could be studied as a modality for improving fibromyalgia symptom burden. PMID:24376184

  3. Does the sex of a simulated patient affect CPR?

    Science.gov (United States)

    Kramer, Chelsea E; Wilkins, Matthew S; Davies, Jan M; Caird, Jeff K; Hallihan, Gregory M

    2015-01-01

    While males and females are equally at risk of sudden cardiac arrest (SCA), females are less likely to be resuscitated. Cardiopulmonary Resuscitation (CPR) may be inhibited by socio-cultural norms about exposing female victims' chests. Empirically confirming this hypothesis is limited by lack of patient simulators modeling realistic female physiques. A commercially-available patient simulator was transformed to evaluate how physical attributes of a patient's sex might influence lay participants who were asked to resuscitate a female versus a male during simulated cardiac arrest. Sixty-nine participants consented to be in the study. Participants were randomly assigned to provide CPR and defibrillation as instructed by a commercially-available automated external defibrillator on a patient simulator presented as either a male or female experiencing cardiac arrest. Rescuers removed significantly more clothing from the male than the female, with men removing less clothing from the female. More rescuers' initial hand placements for CPR were centered between the female's breasts compared to the male, on which placement was distributed across the chest towards the nipples. While rescuers had better hand placement for CPR on the female, both men and women rescuers were reluctant to remove the female's clothing, with men significantly more hesitant. Reticence to remove clothing was often articulated relative to social norms during structured interviews. We suggest that using only male simulators will not allow trainees to experience social differences associated with the care of a female simulated patient. Realistic female patient simulators are needed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Comparison of QOL between patients with different degenerative dementias, focusing especially on positive and negative affect.

    Science.gov (United States)

    Kurisu, Kairi; Terada, Seishi; Oshima, Etsuko; Horiuchi, Makiko; Imai, Nao; Yabe, Mayumi; Yokota, Osamu; Ishihara, Takeshi; Yamada, Norihito

    2016-08-01

    Quality of life (QOL) has become an important outcome measure in the care of dementia patients. However, there have been few studies focusing on the difference in QOL between different dementias. Two-hundred seventy-nine consecutive outpatients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB) or frontotemporal dementia (FTD) were recruited. The QOL was evaluated objectively using the QOL Questionnaire for Dementia (QOL-D).The QOL-D comprises six domains: positive affect, negative affect and actions, communication, restlessness, attachment to others, and spontaneity. General cognition, daily activities, and behavioral and psychological symptoms of dementia were also evaluated. The scores of positive affect of QOL-D of AD patients were significantly higher than those of patients with DLB or FTD (AD 3.1 ± 0.8, DLB 2.6 ± 0.9, FTD 2.6 ± 0.7). The scores of negative affect and action of QOL-D of FTD patients were significantly higher than those of patients with AD or DLB (FTD 2.0 ± 0.8, AD 1.4 ± 0.5, DLB 1.5 ± 0.6). The apathy scores of FTD and DLB patients were significantly higher than those of patients with AD. The disinhibition scores of FTD patients were significantly higher than those of patients with AD or DLB. The apathy of FTD and DLB patients and depression of DLB patients might affect the lower positive affect of FTD and DLB patients compared to AD patients. The disinhibition of FTD patients might affect the abundance of negative affect & actions in FTD patients compared to AD and DLB patients.

  5. Increased risk of developing dementia in patients with major affective disorders compared to patients with other medical illnesses

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Nilsson, Flemming Mørkeberg

    2003-01-01

    BACKGROUND: The association between affective disorder and subsequent dementia is unclear. Our aim was to investigate whether patients with unipolar or bipolar affective disorder have an increased risk of developing dementia compared to patients with other chronic illnesses. METHOD: By linkage...... of the psychiatric and somatic nation-wide registers of all hospitalised patients in Denmark, 2007 patients with mania, 11741 patients with depression, 81380 patients with osteoarthritis and 69149 patients with diabetes were identified according to diagnosis at first-ever discharge from a psychiatric or somatic...... hospital between 1 January 1977 and 31 December 1993. The risk of receiving a diagnosis of dementia on subsequent re-admission was estimated with the use of survival analyses. RESULTS: Patients with unipolar or bipolar affective disorder had a greater risk of receiving a diagnosis of dementia than patients...

  6. How patient positioning affects radiographic signs of canine lung disease

    International Nuclear Information System (INIS)

    Steyn, P.F.; Green, R.W.

    1990-01-01

    A single radiographic projection risks missing signs of lung disease. Four case reports of dogs are given to emphasize inadequate visualization with just one or two radiographs. It is advisable to take both right and left lateral views along with a dorsoventral view in a patient, that might have lung disease

  7. How does coconut oil affect cognitive performance in alzheimer patients?

    Science.gov (United States)

    De la Rubia Ortí, José Enrique; Sánchez Álvarez, Carmen; Selvi Sabater, Pablo; Bueno Cayo, Alma María; Sancho Castillo, Sandra; Rochina, Mariano Julián; Hu Yang, Iván

    2017-03-30

    Introduction: Alzheimer’s disease is one of the most prevalent neurodegenerative dementia in developed world. This fact, coupled with the lack cure, makes new no pharmacological therapeutic strategies such as nutrient management to investigate. In this regard, it stresses the possible influence of coconut oil as alternative energy source capable of stopping the progressively neuronal death that occurs in this disease. Objectives: To assess the cognitive impact of coconut oil in Alzheimer’s patients, and specifically in orientation, language-building, fixing, calculation-concentration and memory areas. Methods: Prospective, longitudinal, qualitative, analytical and experimental study through a clinical trial where 44 patients with Alzheimer’s in region of Ribera (Valencia), of which half was selected to receive during 21 days, 40 ml coconut oil daily divided between breakfast (20 ml) and food (20 ml). Before and after administration of the oil, they were evaluated through cognitive test Mini-Mental State Examination to determine possible changes. Results: It was observed in patients who received coconut oil, that cognitive improvement after completion of the intervention, statistically significant improved in the orientation and language-construction areas. Conclusions: Coconut oil appears to improve cognitive abilities of Alzheimer’s patients, with different intensity depending on the cognitive area.

  8. Risk factors affecting survival in heart transplant patients.

    Science.gov (United States)

    Almenar, L; Cardo, M L; Martínez-Dolz, L; García-Palomar, C; Rueda, J; Zorio, E; Arnau, M A; Osa, A; Palencia, M

    2005-11-01

    Certain cardiovascular risk factors have been linked to morbidity and mortality in heart transplant (HT) patients. The sum of various risk factors may have a large cumulative negative effect, leading to a substantially worse prognosis and the need to consider whether HT is contraindicated. The objective of this study was to determine whether the risk factors usually available prior to HT result in an excess mortality in our setting that contraindicates transplantation. Consecutive patients who underwent heart transplantation from November 1987 to January 2004 were included. Heart-lung transplants, retransplants, and pediatric transplants were excluded. Of the 384 patients, 89% were men. Mean age was 52 years (range, 12 to 67). Underlying disease included ischemic heart disease (52%), idiopathic dilated cardiomyopathy (36%), valvular disease (8%), and other (4%). Variables considered risk factors were obesity (BMI >25), dyslipidemia, hypertension, prior thoracic surgery, diabetes, and history of ischemic heart disease. Survival curves by number of risk factors using Kaplan-Meier and log-rank for comparison of curves. Overall patient survival at 1, 5, 10, and 13 years was 76%, 68%, 54%, and 47%, respectively. Survival at 10 years, if fewer than two risk factors were present, was 69%; 59% if two or three factors were present; and 37% if more than three associated risk factors were present (P = .04). The presence of certain risk factors in patients undergoing HT resulted in lower survival rates. The combination of various risk factors clearly worsened outcomes. However, we do not believe this should be an absolute contraindication for transplantation.

  9. Factors affecting affect cardiovascular health in Indonesian HIV patients beginning ART.

    Science.gov (United States)

    Karim, Birry; Wijaya, Ika Praseya; Rahmaniyah, Rizky; Ariyanto, Ibnu; Waters, Shelley; Estiasari, Riwanti; Price, Patricia

    2017-08-31

    We present a small longitudinal study of how demographic factors and persistent burdens of HIV and cytomegalovirus (CMV) influence cardiovascular health in young adults beginning ART in an inner-city clinic in Jakarta, Indonesia. ART-naïve HIV patients [n = 67; aged 31 (19 to 48) years] were enrolled in the JakCCANDO Project. Echocardiography and carotid Doppler ultrasonography were performed before ART (V0) and after 3, 6, and 12 months (V3-12). Antibodies reactive with CMV lysate or IE-1 protein were assessed at each timepoint and CMV DNA was identified at V0. Markers of adverse cardiovascular prognosis [left ventricular mass index, ejection fraction and carotid intimal media thickness (cIMT)] were similar to healthy controls, but increased at V12. Internal diameters of the carotid arteries and systolic blood pressure correlated with HIV disease severity at V0, but cardiac parameters and cIMT did not. E/A ratios (left ventricular diastolic function) were lower in patients with CMV DNA at V0, but this effect waned by V6. Levels of antibody reactive with CMV IE-1 correlated inversely with CD4 T cell counts at V0, and levels at V6-V12 correlated directly with the right cIMT. Overall the severity of HIV disease and the response to ART have only subtle effects on cardiovascular health in this young Asian population. CMV replication before ART may have a transient effect on cardiac health, whilst antibody reactive with CMV IE-1 may mark a high persistent CMV burden with cumulative effects on the carotid artery.

  10. Pulmonary affectation in a patient with typhoid fever

    International Nuclear Information System (INIS)

    Duenas C, Carmelo; Martinez, Adel; Maza, Augusto

    1997-01-01

    Typhoid fever is a rare disease in the USA with no more of 500 cases per year. In Latin America, it occurs four to five times more frequently. Pulmonary symptoms are found in less than 20% of the cases. The development of pneumonia is more common in immunocompromised patients. In last 10 years, the frequency of typhoid pneumonia has increased because of the HIV epidemic and the advance of other forms of immunosuppression. We presented the case of a young adult male with typhoid multilobar pneumonia who did not have VIH infection or any demonstrated immunosuppression

  11. Factors affecting patients' online health information-seeking behaviours: The role of the Patient Health Engagement (PHE) Model.

    Science.gov (United States)

    Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea; Riva, Giuseppe

    2017-10-01

    To identify the variables affecting patients' online health information-seeking behaviours by examining the relationships between patient participation in their healthcare and online health information-seeking behaviours. A cross-sectional survey of Italian chronic patients (N=352) was conducted on patient's online health information-seeking behaviours and patient participation-related variables. Structural equation modeling analysis was conducted to test the hypothesis. This study showed how the healthcare professionals' ability to support chronic patients' autonomy affect patients' participation in their healthcare and patient's online health information-seeking behaviours. However, results do not confirm that the frequency of patients' online health-information seeking behavior has an impact on their adherence to medical prescriptions. Assuming a psychosocial perspective, we have discussed how patients' engagement - conceived as the level of their emotional elaboration of the health condition - affects the patients' ability to search for and manage online health information. To improve the effectiveness of patients' online health information-seeking behaviours and to enhance the effectiveness of technological interventions in this field, healthcare providers should target assessing and improving patient engagement and patient empowerment in their healthcare. It is important that health professionals acknowledge patients' online health information-seeking behaviours that they discuss the information offered by patients and guide them to reliable and accurate web sources. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Comparison of factors affecting orthodontic treatment motivation of Taiwanese and Thai patients in two hospitals

    Directory of Open Access Journals (Sweden)

    Wariya Laothong

    2017-12-01

    Full Text Available Background/purpose: Many factors, including economic, psychosocial statuses and ethnicity, affect patients' decision to seek orthodontic treatment. The present study compared orthodontic patients' motivation, attitude and the factors affecting this motivation in Taiwanese and Thai patients. We investigated the association between the aforementioned variables and patient characteristics. Materials and methods: We enrolled 250 Thai and 250 Taiwanese patients (age ≥ 20 years from Sunprasitthiprasong and Taipei Medical University Hospitals, respectively, by using self-administered questionnaires. Demographic characteristics were analyzed using Pearson's chi-square test, patients' motivation, attitude and the factors affecting this motivation were analyzed using the sample t-test. The association among the variables was investigated by multiple regression analysis. Results: In both hospitals, the main motivation for seeking orthodontic treatment was esthetic concerns; the patients believed that treatment could make them more beautiful. Taiwanese and Thai patients rejected treatment because of high treatment costs and long treatment periods, respectively. A significant association was observed between household income and Thai patients' motivation (p < 0.05. Sex was significantly associated with Thai patients' attitude (p < 0.05. Age, sex, active treatment duration, and marital status were associated with Taiwanese attitude toward treatment (p < 0.05. In addition, age, household income, and information resources were significantly associated with the factors affecting Taiwanese patients' motivation (p < 0.05. Conclusion: Ethnicity influenced patients' motivation. Economic status was the main factor affecting Thai patients, whereas many factors affected Taiwanese patients' decision to seek orthodontic treatment. However, esthetic concerns were a crucial motivation for both groups. Keywords: factors affecting

  13. Affect recognition across manic and euthymic phases of bipolar disorder in Han-Chinese patients.

    Science.gov (United States)

    Pan, Yi-Ju; Tseng, Huai-Hsuan; Liu, Shi-Kai

    2013-11-01

    Patients with bipolar disorder (BD) have affect recognition deficits. Whether affect recognition deficits constitute a state or trait marker of BD has great etiopathological significance. The current study aims to explore the interrelationships between affect recognition and basic neurocognitive functions for patients with BD across different mood states, using the Diagnostic Analysis of Non-Verbal Accuracy-2, Taiwanese version (DANVA-2-TW) as the index measure for affect recognition. To our knowledge, this is the first study examining affect recognition deficits of BPD across mood states in the Han Chinese population. Twenty-nine manic patients, 16 remitted patients with BD, and 40 control subjects are included in the study. Distinct association patterns between affect recognition and neurocognitive functions are demonstrated for patients with BD and control subjects, implicating alternations in emotion associated neurocognitive processing. Compared to control subjects, manic patients but not remitted subjects perform significantly worse in the recognition of negative emotions as a whole and specifically anger, after adjusting for differences in general intellectual ability and basic neurocognitive functions. Affect recognition deficit may be a relatively independent impairment in BD rather than consequences arising from deficits in other basic neurocognition. The impairments of manic patients in the recognition of negative emotions, specifically anger, may further our understanding of core clinical psychopathology of BD and have implications in treating bipolar patients across distinct mood phases. © 2013 Elsevier B.V. All rights reserved.

  14. Factors Affecting the Outcome of Bronchiectasis in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Nemat Bilan

    2014-12-01

    Full Text Available Introduction: Bronchiectasis is a common problem in children and early diagnosis can lead to early treatment and prevent of its complications. This study was aimed to evaluate factors effective on outcome of bronchiectasis in children. Methods: In an analytical cross-sectional study, 347 children with bronchiectasis Underwent the study. the patients were diagnosed based on chronic suppurative cough and CT scan findings. . Results: Disease etiology was asthma in 55.6%, Gastroesophagial reflux (GERD in 7.8%, Cystic fibrosis (CF in 4.8%, other causes in 11.2% and idiopathic in 20.6%. All cases complained of chronic cough. The most common sign was daily sputum production (79.1% and common symptoms were ral/crackle in 47.1% and wheezing in 25.4%. Mean treatment period was 32.82±11.56 months. At the end of follow-up, complete improvement occurred in 35.6%, partial improvement in 40.9% and no improvement in 23.5%. Conclusion: In children with chronic cough and crackle in physical examination, consideration of bronchiectasis could be helpful in early diagnosis and complementary evaluations and treatment initiation. Treating the underlying disease could prevent the occurrence and increase the response to treatment of bronchiectasis.

  15. Characteristics of psychiatric patients for whom financial considerations affect optimal treatment provision.

    Science.gov (United States)

    West, Joyce C; Pingitore, David; Zarin, Deborah A

    2002-12-01

    This study assessed characteristics of psychiatric patients for whom financial considerations affected the provision of "optimal" treatment. Psychiatrists reported that for 33.8 percent of 1,228 patients from a national sample, financial considerations such as managed care limitations, the patient's personal finances, and limitations inherent in the public care system adversely affected the provision of optimal treatment. Patients were more likely to have their treatment adversely affected by financial considerations if they were more severely ill, had more than one behavioral health disorder or a psychosocial problem, or were receiving treatment under managed care arrangements. Patients for whom financial considerations affect the provision of optimal treatment represent a population for whom access to treatment may be particularly important.

  16. On the increased risk of developing late-onset epilepsy for patients with major affective disorder

    DEFF Research Database (Denmark)

    Nilsson, Flemming Mørkeberg; Kessing, Lars Vedel; Bolwig, Tom Gert

    2003-01-01

    for the control groups. However, the increased risk seemed to be due to the effect of comorbid alcohol or drug abuse and not to the effect of the affective illness itself. LIMITATIONS: The results only apply to hospitalised patients. Diagnoses are not validated for research purposes. CONCLUSION: Patients...... with a diagnosis of affective disorder have an increased risk of developing epilepsy in later life. In patients with affective disorder, comorbid alcoholism/drug abuse seriously increased the risk of a subsequent diagnosis of epilepsy....

  17. Personal Factors that Affect the Satisfaction of Female Patients Undergoing Esthetic Suture after Typical Thyroidectomy.

    Science.gov (United States)

    Kim, Hyo Young; Kim, Jung Won; Park, Jin Hyung; Kim, Jung Hun; Han, Yea Sik

    2013-07-01

    In esthetic surgery, understanding the factors that influence patient satisfaction is important for successful practice. We hypothesize that the factors that influence patient satisfaction include not only aesthetic and functional outcomes, but also personal factors such as the level of familiarity with factors affecting wound healing and expectations regarding aesthetic outcome. One hundred patients who underwent esthetic closure after thyroidectomy were included in this study. In order to evaluate the individual characteristics of the patients, a preoperative survey was administered to the patients. We estimated the patient satisfaction six months postoperatively and assessed the aesthetic and functional outcomes using the Patient and Observer Scar Assessment Scale. According to the results of correlation analysis, level of familiarity with wound healing factors had a positive correlation with satisfaction. High expectations, pain, itching, and high observer scale score had negative correlations with satisfaction. The factors that were correlated with satisfaction were included in the multiple regression analysis. Level of familiarity with wound healing factors was found to have a positive relationship with satisfaction, while itching and observer scale were found to have a negative relationship with satisfaction. After excluding 10 patients who had hypertrophic scars, only level of familiarity with wound healing factors and expectations affected satisfaction. The level of familiarity with factors affecting wound healing and expectations were found to independently affect satisfaction. Improving patients' level of familiarity with wound healing factors and reducing their expectations by providing suitable preoperative education has the potential to improve patient satisfaction.

  18. Intensive Blood Pressure Control Affects Cerebral Blood Flow in Type 2 Diabetes Mellitus Patients

    NARCIS (Netherlands)

    Kim, Yu-Sok; Davis, Shyrin C. A. T.; Truijen, Jasper; Stok, Wim J.; Secher, Niels H.; van Lieshout, Johannes J.

    2011-01-01

    Type 2 diabetes mellitus is associated with microvascular complications, hypertension, and impaired dynamic cerebral autoregulation. Intensive blood pressure (BP) control in hypertensive type 2 diabetic patients reduces their risk of stroke but may affect cerebral perfusion. Systemic hemodynamic

  19. Seasonal difference in brain serotonin transporter binding predicts symptom severity in patients with seasonal affective disorder

    DEFF Research Database (Denmark)

    Mc Mahon, Brenda; Andersen, Sofie B.; Madsen, Martin K.

    2016-01-01

    controls with low seasonality scores and 17 patients diagnosed with seasonal affective disorder were scanned in both summer and winter to investigate differences in cerebral serotonin transporter binding across groups and across seasons. The two groups had similar cerebral serotonin transporter binding...... between summer and winter (Psex-(P = 0.02) and genotype-(P = 0.04) dependent. In the patients with seasonal affective disorder, the seasonal change in serotonin transporter binding was positively associated with change in depressive symptom...

  20. Positive Affect and Suicide Ideation in Older Adult Primary Care Patients

    OpenAIRE

    Hirsch, Jameson K.; Duberstein, Paul R.; Chapman, Benjamin; Lyness, Jeffrey M.

    2007-01-01

    Suicide is a significant public health problem for older adults. Identification of protective factors associated with reduced risk is important. The authors examined the association of positive affect and suicide ideation in 462 primary care patients ages 65 and older. Positive affect distinguished suicide ideators from nonideators, after controlling for age, gender, depression, negative affect, illness burden, activity, sociability, cognitive functioning, and physical functioning. There was ...

  1. Depressed mood, positive affect, and heart rate variability in patients with suspected coronary artery disease.

    Science.gov (United States)

    Bhattacharyya, Mimi R; Whitehead, Daisy L; Rakhit, Roby; Steptoe, Andrew

    2008-11-01

    To test associations between heart rate variability (HRV), depressed mood, and positive affect in patients with suspected coronary artery disease (CAD). Depression is associated with impaired HRV post acute cardiac events, but evidence in patients with stable coronary artery disease (CAD) is inconsistent. Seventy-six patients (52 men, 24 women; mean age = 61.1 years) being investigated for suspected CAD on the basis of symptomatology and positive noninvasive tests, completed 24-hour electrocardiograms. The Beck Depression Inventory (BDI) was administered, and positive and depressed affect was measured over the study period with the Day Reconstruction Method (DRM). A total of 46 (60.5%) patients were later found to have definite CAD. HRV was analyzed, using spectral analysis. Typical diurnal profiles of HRV were observed, with greater normalized high frequency (HF) and lower normalized low frequency (LF) power in the night compared with the day. BDI depression scores were not consistently associated with HRV. But positive affect was associated with greater normalized HF power (p = .039) and reduced normalized LF power (p = .007) independently of age, gender, medication with beta blockers, CAD status, body mass index, smoking, and habitual physical activity level. In patients with definite CAD, depressed affect assessed using the DRM was associated with reduced normalized HF power and heightened normalized LF power (p = .007) independently of covariates. Relationships between depression and HRV in patients with CAD may depend on affective experience over the monitoring period. Enhanced parasympathetic cardiac control may be a process through which positive affect protects against cardiovascular disease.

  2. Patient affect experiencing following therapist interventions in short-term dynamic psychotherapy.

    Science.gov (United States)

    Town, Joel M; Hardy, Gillian E; McCullough, Leigh; Stride, Chris

    2012-01-01

    The aim of this research was to examine the relationship between therapist interventions and patient affect responses in Short-Term Dynamic Psychotherapy (STDP). The Affect Experiencing subscale from the Achievement of Therapeutic Objectives Scale (ATOS) was adapted to measure individual immediate affect experiencing (I-AES) responses in relation to therapist interventions coded within the preceding speaking turn, using the Psychotherapy Interaction Coding (PIC) system. A hierarchical linear modelling procedure was used to assess the change in affect experiencing and the relationship between affect experiencing and therapist interventions within and across segments of therapy. Process data was taken from six STDP cases; in total 24 hours of video-taped sessions were examined. Therapist interventions were found to account for a statistically significant amount of variance in immediate affect experiencing. Higher levels of immediate affect experiencing followed the therapist's use of Confrontation, Clarification and Support compared to Questions, Self-disclosure and Information interventions. Therapist Confrontation interventions that attempted to direct pressure towards either the visceral experience of affect or a patient's defences against feelings led to the highest levels of immediate affect experiencing. The type of therapist intervention accounts for a small but significant amount of the variation observed in a patient's immediate emotional arousal. Empirical findings support clinical theory in STDP that suggests strategic verbal responses promote the achievement of this specific therapeutic objective.

  3. Effect of Positive Psychotherapy in Depression Symptoms and Character Strengths in Cancer Affected Patients

    Directory of Open Access Journals (Sweden)

    R Khodabakhash

    2015-05-01

    Full Text Available The purpose of this research was to study the effect of positive psychotherapy on depression symptoms and character strengths in cancer affected patients. Based on a quasi-experimental design by available sampling, 58 cancer patients were investigated. 30 patients were assigned in two groups: 15 patients in positive psychotherapy group (treatment and 15 patients as control group. In the present research, Oxford Happiness-Depression Questionnaire (OHDQ and Values In Action Inventory of Strengths (VIA-IS were used. The results showed that the positive psychotherapy was effective in reducing depression, increasing the character strengths and virtues, improving meaningful, pleasant and engaged life of cancer patients.

  4. Perceived health in lung cancer patients: the role of positive and negative affect.

    Science.gov (United States)

    Hirsch, Jameson K; Floyd, Andrea R; Duberstein, Paul R

    2012-03-01

    To examine the association of affective experience and health-related quality of life in lung cancer patients, we hypothesized that negative affect would be positively, and positive affect would be negatively, associated with perceived health. A sample of 133 English-speaking lung cancer patients (33% female; mean age = 63.68 years old, SD = 9.37) completed a battery of self-report surveys. Results of our secondary analysis indicate that trait negative affect was significantly associated with poor physical and social functioning, greater role limitations due to emotional problems, greater bodily pain, and poor general health. Positive affect was significantly associated with adaptive social functioning, fewer emotion-based role limitations, and less severe bodily pain. In a full model, positive affect was significantly associated with greater levels of social functioning and general health, over and above the effects of negative affect. Reduction of negative affect is an important therapeutic goal, but the ability to maintain positive affect may result in greater perceived health. Indeed, engagement in behaviors that result in greater state positive affect may, over time, result in dispositional changes and enhancement of quality of life.

  5. Difficulties in emotion regulation mediate negative and positive affects and craving in alcoholic patients.

    Science.gov (United States)

    Khosravani, Vahid; Sharifi Bastan, Farangis; Ghorbani, Fatemeh; Kamali, Zoleikha

    2017-08-01

    The aim of this study was to assess the mediating effects of difficulties in emotion regulation (DER) on the relations of negative and positive affects to craving in alcoholic patients. 205 treatment-seeking alcoholic outpatients were included. DER, positive and negative affects as well as craving were evaluated by the Difficulties in Emotion Regulation Scale (DERS), the Positive/Negative Affect Scales, and the Obsessive Compulsive Drinking Scale (OCDS) respectively. Clinical factors including depression and severity of alcohol dependence were investigated by the Alcohol Use Disorders Identification Test (AUDIT) and the Beck Depression Inventory-II (BDI-II) respectively. Results revealed that both increased negative affect and decreased positive affect indirectly influenced craving through limited access to emotion regulation strategies. It was concluded that limited access to emotion regulation strategies may be important in predicting craving for alcoholics who experience both increased negative affect and decreased positive affect. This suggests that treatment and prevention efforts focused on increasing positive affect, decreasing negative affect and teaching effective regulation strategies may be critical in reducing craving in alcoholic patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Increased relative risk of subsequent affective disorders in patients with a hospital diagnosis of obesity

    DEFF Research Database (Denmark)

    Thomsen, A F; Kvist, T K; Andersen, P K

    2006-01-01

    OBJECTIVE: To investigate the risk of clinical affective disorders of patients who were hospitalized because of obesity in the study period 1 January 1977 to 31 December 1999. METHOD: Using data from Danish hospital registers, three study cohorts were identified by their diagnoses at discharge from...... discharged with an index diagnosis was identified. In total, 1081 events occurred in the observation period. An index diagnosis of obesity was associated with an increased risk of affective-disorders hospitalization when compared with patients with osteoarthritis (Rate ratio: 1.35 (95% CI: 1.......09-1.67)) and tended to be associated with an increased risk when compared to patients with non-toxic goiter (Rate ratio: 1.23 (95% CI: 0.99-1.53)). Patients with obesity diagnoses who did not have additional hospital diagnoses of substance- or alcohol abuse had a risk of affective disorders that was 1.55 (95% CI: 1...

  7. Listening to motivational music while walking elicits more positive affective response in patients with cystic fibrosis.

    Science.gov (United States)

    Calik-Kutukcu, Ebru; Saglam, Melda; Vardar-Yagli, Naciye; Cakmak, Aslihan; Inal-Ince, Deniz; Bozdemir-Ozel, Cemile; Sonbahar-Ulu, Hazal; Arikan, Hulya; Yalcin, Ebru; Karakaya, Jale

    2016-05-01

    The purpose of this study was to investigate the effects of motivational and relaxation music on affective responses during exercise in patients with cystic fibrosis (CF). Thirty-seven patients with CF performed the 6-min walk test (6MWT) under three experimental conditions: listening to no music, relaxation music, and motivational music. 6-min distance × body weight product (6MWORK) was calculated for each trial. Patients' affective responses during exercise was evaluated with Feeling Scale (FS). The motivational qualities of music were evaluated with the Brunel Music Rating Inventory-2 (BMRI-2). 6MWORK was significantly lower while listening to relaxation music compared to 6MWORK without music (p motivational music than 6MWT with relaxation music (p motivational music can lead to positive affective response during exercise and increase the enjoyment of patients from exercises in CF. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Hashimoto's Thyroiditis: Lingual and Labial Capillary Microcirculation in Patients Affected by Macroglossia

    OpenAIRE

    Scardina, G. A.; Messina, P.

    2007-01-01

    The aim of this study is to estudy lingual and labial microcirculation differences among healthy subjects and those with Hashimoto's thyroiditis affected by macroglossia. Twenty healthy patients and 20 patients suffering from Hashimoto's thyroiditis were examined. Labial and lingual capiUaroscopy were used to investigate the characteristics of microcirculation. For each patient we evaluated visibility, course, tortuosity and the possible presence of microhaemorrhages, average calibre of capil...

  9. Influenza and Pneumonia Vaccination Rates and Factors Affecting Vaccination among Patients with Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Aka Akt?rk, ?lk?; G?rek Dilekta?l?, Asl?; ?eng?l, Aysun; Musaffa Salep?i, Banu; Oktay, Nuray; D?ger, Mustafa; Ar?k Ta?y?kan, Hale; Durmu? Ko?ak, Nagihan

    2017-01-01

    Background: Influenza and pneumococcal vaccinations are recommended in chronic obstructive pulmonary disease patients to decrease associated risks at all stages. Although the prevalence of chronic obstructive pulmonary disease is high in our country, as previously reported, vaccination rates are low. Aims: To assess the vaccination rates of chronic obstructive pulmonary disease patients and factors that may affect these. Study Design: Multi-centre cross-sectional study. Methods: Patients admi...

  10. Does pre-operative psychological distress affect patient satisfaction after primary total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Nolan John

    2011-06-01

    Full Text Available Abstract Background There are concerns that pre-operative psychological distress might be associated with reduced patient satisfaction after total hip replacement (THR. Methods We investigated this in a multi-centre prospective study between January 1999 and January 2002. We dichotomised the patients into the mentally distressed (MHS ≤ 56 and the not mentally distressed (MHS > 56 groups based on their pre-operative Mental Health Score (MHS of SF36. Results 448 patients (340 not distressed and 108 distressed completed the patient satisfaction survey. Patient satisfaction rate at five year was 96.66% (415/448. There was no difference in patient satisfaction or willingness to have the surgery between the two groups. None of pre-operative variables predicted five year patient satisfaction in logistic regression. Conclusions Patient satisfaction after surgery may not be adversely affected by pre-operative psychological distress.

  11. Factors affecting satisfaction of patients after orthognathic surgery at a University Hospital

    International Nuclear Information System (INIS)

    Al-Ahmad, Hazem T.; Al-Omari, Iyad K.; Eldurini, Laila N.; Suleiman, Ahmad A.

    2008-01-01

    The objective was to analyze factors that influence patient's satisfaction with orthognathic treatment and evaluate patient's perception of changes in physical and psychosocial aspects. In a retrospective clinical study conducted at Jordan University Hospital, Amman, Jordan between December 2006 and December 2007, we examined 38 patients who had orthognathic surgery after an average follow-up of 20 months. Examination included evaluation of nerve function and temporomandibular function with Helkimo index. Patients filled out a questionnaire on treatment satisfaction and perception of physical and psychosocial changes after treatment. Patients were generally satisfied with the result, 82% agreed they would undergo treatment again. They were divided into very satisfied n=25 and less satisfied n=13 groups according to satisfaction score, with statistically significant differences found between them concerning diagnosis and follow-up period, with all vertical maxillary excess patients very satisfied and 75% of asymmetrical deformities patients less satisfied, and less satisfaction by patients more than one year postoperatively, p=0.006. Patients perceived improvement oral function, general health, appearance and interpersonal skills. Lower rates of joint and muscular pain and increased mobility of lower jaw correlated with better patient's perception of health and appearance. Although patient's report high satisfaction levels, several factors such as the temporomandibular joint function could affect patient's psychosocial adjustment after treatment. Sufficient information for patient on the treatment course is required to improve satisfaction. Controlling these factors could improve patient's quality of life. (author)

  12. Neural correlates of emotion regulation in patients with schizophrenia and non-affected siblings.

    Directory of Open Access Journals (Sweden)

    Lisette van der Meer

    Full Text Available BACKGROUND: Patients with schizophrenia often experience problems regulating their emotions. Non-affected relatives show similar difficulties, although to a lesser extent, and the neural basis of such difficulties remains to be elucidated. In the current paper we investigated whether schizophrenia patients, non-affected siblings and healthy controls (HC exhibit differences in brain activation during emotion regulation. METHODS: All subjects (n = 20 per group performed an emotion regulation task while they were in an fMRI scanner. The task contained two experimental conditions for the down-regulation of emotions (reappraise and suppress, in which IAPS pictures were used to generate a negative affect. We also assessed whether the groups differed in emotion regulation strategies used in daily life by means of the emotion regulation questionnaire (ERQ. RESULTS: Though the overall negative affect was higher for patients as well as for siblings compared to HC for all conditions, all groups reported decreased negative affect after both regulation conditions. Nonetheless, neuroimaging results showed hypoactivation relative to HC in VLPFC, insula, middle temporal gyrus, caudate and thalamus for patients when reappraising negative pictures. In siblings, the same pattern was evident as in patients, but only in cortical areas. CONCLUSIONS: Given that all groups performed similarly on the emotion regulation task, but differed in overall negative affect ratings and brain activation, our findings suggest reduced levels of emotion regulation processing in neural circuits in patients with schizophrenia. Notably, this also holds for siblings, albeit to a lesser extent, indicating that it may be part and parcel of a vulnerability for psychosis.

  13. The Relationship Between Brain-Behavioral Systems and Negative and Positive Affect in Patients With Migraine

    Directory of Open Access Journals (Sweden)

    Jovharifard

    2015-08-01

    Full Text Available Background Migraine is a chronic headache disorder that affects approximately 12% of the general population. Migraine is known as recurrent headache, pulsating, moderate with severe power, which lasts for 4 to 72 hours, aggravated by daily physical activity along with nausea, vomiting, photophobia or photophobia. Objectives The purpose of this study was to investigate the relationship between brain-behavioral systems and negative and positive affects in patients with migraine. Patients and Methods The research population included patients, who had referred to neurology clinics. One hundred and twenty cases were selected by accessible sampling based on the neurologist’s diagnosis of migraine headaches. They completed the Gray-Wilson (1989 Personality Questionnaire as well as Watson, Clark and Telligent (1988 positive and negative affect scale. The data were analyzed using the SPSS 19 software, correlation and stepwise regression. Results The results showed that positive affect had a significant positive correlation with active avoidance parameters and negative significant correlation with passive avoidance and extinction parameters. The findings also indicated that negative affect had a positive and significant relationship with passive avoidance and extinction. Conclusions It can be concluded that brain-behavioral systems may be the foundation of behavioral and emotional tendencies in patients with migraine headaches.

  14. Oral Myiasis Affecting Gingiva in a Child Patient: An Uncommon Case Report

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    Fareedi Mukram Ali

    2016-01-01

    Full Text Available Certain dipteran flies larvae causing invasion of the tissues and organs of the humans or other vertebrates are called as myiasis, which feed on hosts dead or living tissues. It is well documented in the skin and hot climate regions; underdeveloped countries are affected more commonly. Oral cavity is affected rarely and it can be secondary to serious medical conditions. Poor oral hygiene, alcoholism, senility, or suppurating lesions can be associated with the oral myiasis. Inflammatory and allergic reactions are the commonest clinical manifestations of the disease. In the present case, gingiva of maxillary anterior region was affected by larval infection in a 13-year-old mentally retarded patient.

  15. Patient gender affects the referral and recommendation for total joint arthroplasty.

    Science.gov (United States)

    Borkhoff, Cornelia M; Hawker, Gillian A; Wright, James G

    2011-07-01

    Rates of use of total joint arthroplasty among appropriate and willing candidates are lower in women than in men. A number of factors may explain this gender disparity, including patients' preferences for surgery, gender bias influencing physicians' clinical decision-making, and the patient-physician interaction. We propose a framework of how patient gender affects the patient and physician decision-making process of referral and recommendation for total joint arthroplasty and consider potential interventions to close the gender gap in total joint arthroplasty utilization. The process involved in the referral and recommendation for total joint arthroplasty involves eight discrete steps. A systematic review is used to describe the influence of patient gender and related clinical and nonclinical factors at each step. WHERE ARE WE NOW?: Patient gender plays an important role in the process of referral and recommendation for total joint arthroplasty. Female gender primarily affects Steps 3 through 8, suggesting barriers unique to women exist in the patient-physician interaction. WHERE DO WE NEED TO GO?: Developing and evaluating interventions that improve the quality of the patient-physician interaction should be the focus of future research. HOW DO WE GET THERE?: Potential interventions include using decision support tools that facilitate shared decision-making between patients and their physicians and promoting cultural competency and shared decision-making skills programs as a core component of medical education. Increasing physicians' acceptance and awareness of the unconscious biases that may be influencing their clinical decision-making may require additional skills programs.

  16. Lamotrigine use in patients with binge eating and purging, significant affect dysregulation, and poor impulse control.

    Science.gov (United States)

    Trunko, Mary Ellen; Schwartz, Terry A; Marzola, Enrica; Klein, Angela S; Kaye, Walter H

    2014-04-01

    Some patients with symptoms of binge eating and purging are successfully treated with specific serotonin reuptake inhibitors (SSRIs), but others experience only partial or no benefit. Significant affect dysregulation and poor impulse control may be characteristics that limit responsiveness. We report on the treatment of five patients with bulimia nervosa (BN), anorexia nervosa-binge/purge type (AN-B/P) or eating disorder not otherwise specified (EDNOS), using the anticonvulsant lamotrigine after inadequate response to SSRIs. Following addition of lamotrigine to an antidepressant in four cases, and switch from an antidepressant to lamotrigine in one case, patients experienced substantial improvement in mood reactivity and instability, impulsive drives and behaviors, and eating-disordered symptoms. These findings raise the possibility that lamotrigine, either as monotherapy or as an augmenting agent to antidepressants, may be useful in patients who binge eat and purge, and have significant affect dysregulation with poor impulse control. Copyright © 2013 Wiley Periodicals, Inc.

  17. Data on cardiac defects, morbidity and mortality in patients affected by RASopathies. CARNET study results

    OpenAIRE

    Giulio Calcagni; Giuseppe Limongelli; Angelo D'Ambrosio; Francesco Gesualdo; Maria Cristina Digilio; Anwar Baban; Sonia B. Albanese; Paolo Versacci; Enrica De Luca; Giovanni B. Ferrero; Giuseppina Baldassarre; Gabriella Agnoletti; Elena Banaudi; Jan Marek; Juan P. Kaski

    2018-01-01

    A comprehensive description of morbidity and mortality in patients affected by mutations in genes encoding for signal transducers of the RAS-MAPK cascade (RASopathies) was performed in our study recently published in the International Journal of Cardiology. Seven European cardiac centres participating to the CArdiac Rasopathy NETwork (CARNET), collaborated in this multicentric, observational, retrospective data analysis and collection. In this study, clinical records of 371 patients with conf...

  18. Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities

    OpenAIRE

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed u...

  19. Custom rotating hinge total knee arthroplasty in patients with poliomyelitis affected limbs.

    Science.gov (United States)

    Rahman, Jeeshan; Hanna, Sammy A; Kayani, Babar; Miles, Jonathan; Pollock, Robin C; Skinner, John A; Briggs, Timothy W; Carrington, Richard W

    2015-05-01

    Total knee arthroplasty (TKA) in limbs affected by poliomyelitis is a technically challenging procedure. These patients often demonstrate acquired articular and metaphyseal angular deformities, bone loss, narrowness of the intramedullary canals, impaired quadriceps strength, flexion contractures and ligamentous laxity producing painful hyperextension. Thus, using condylar knee designs in these patients will likely result in early failure because of instability and abnormal load distribution. The aim of this study was to assess the outcomes associated with use of the customised (SMILES) rotating-hinge knee system at our institution for TKA in poliomyelitis-affected limbs. We retrospectively reviewed the outcome of 14 TKAs using the (SMILES) prosthesis in 13 patients with limbs affected by poliomyelitis. All patients had painful unstable knees with hyperextension. There were ten females and three males with a mean age of 66 years (range 51-84) at time of surgery. Patients were followed up clinically, radiologically and functionally with the Oxford knee score (OKS). Mean follow-up was 72 months (16-156). There were no immediate or early complications. One patient fell and sustained a peri-prosthetic fracture at seven months requiring revision to a longer stem. Radiological evaluation showed satisfactory alignment with no signs of loosening in all cases. Mean OKS improved from 11.6 (4-18) to 31.5 (18-40) postoperatively (p poliomyelitis. The device compensates well for ligamentous insufficiency as well as for any associated bony deformity.

  20. Er:YAG Laser Dental Treatment of Patients Affected by Epidermolysis Bullosa

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    Angela Galeotti

    2014-01-01

    Full Text Available Aim. The purpose of this study was to evaluate the efficacy of Er:YAG laser used for treating hard dental tissue in patients with epidermolysis bullosa (EB. Methods. We report two cases of EB in which an Er:YAG laser was used for conservative treatments. In the first case, the Er:YAG laser (2,940 μm, 265 mJ, 25 Hz was used to treat caries on a deciduous maxillary canine in an 8-year-old male patient affected by dystrophic EB. In the second case, we treated a 26-year-old female patient, affected by junctional EB, with generalized enamel hypoplasia, and an Er:YAG laser (2,940 μm, 265 mJ, 25 Hz was used to remove the damaged enamel on maxillary incisors. Results. The use of the Er:YAG laser, with the appropriate energy, was effective in the selective removal of carious tissue and enamel hypoplasia. During dental treatment with the Er:YAG laser, patients required only a few interruptions due to the absence of pain, vibration, and noise. Conclusions. Laser treatment of hard dental tissues is a valuable choice for patients affected by EB since it is less invasive compared to conventional treatment, resulting in improved patient compliance.

  1. Intermittent targeted therapies and stochastic evolution in patients affected by chronic myeloid leukemia

    Science.gov (United States)

    Pizzolato, N.; Persano Adorno, D.; Valenti, D.; Spagnolo, B.

    2016-05-01

    Front line therapy for the treatment of patients affected by chronic myeloid leukemia (CML) is based on the administration of tyrosine kinase inhibitors, namely imatinib or, more recently, axitinib. Although imatinib is highly effective and represents an example of a successful molecular targeted therapy, the appearance of resistance is observed in a proportion of patients, especially those in advanced stages. In this work, we investigate the appearance of resistance in patients affected by CML, by modeling the evolutionary dynamics of cancerous cell populations in a simulated patient treated by an intermittent targeted therapy. We simulate, with the Monte Carlo method, the stochastic evolution of initially healthy cells to leukemic clones, due to genetic mutations and changes in their reproductive behavior. We first present the model and its validation with experimental data by considering a continuous therapy. Then, we investigate how fluctuations in the number of leukemic cells affect patient response to the therapy when the drug is administered with an intermittent time scheduling. Here we show that an intermittent therapy (IT) represents a valid choice in patients with high risk of toxicity, despite an associated delay to the complete restoration of healthy cells. Moreover, a suitably tuned IT can reduce the probability of developing resistance.

  2. Are affective temperaments determinants of quality of life in euthymic patients with bipolar disorder?

    Science.gov (United States)

    Costa, Julio; García-Blanco, Ana; Cañada, Yolanda; García-Portilla, María P; Safont, Gemma; Arranz, Belén; Sanchez-Autet, Mónica; Livianos, Lorenzo; Fornés-Ferrer, Victoria; Sierra, Pilar

    2018-04-01

    Bipolar disorder (BD) is a disabling illness that is associated with low quality of life (QoL). This low QoL goes further than mood episodes, which suggests that stable traits, such as affective temperaments, can cause functional impairment. Our study analyses the impact of affective temperaments on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of QoL in euthymic BD patients. A multicentre study was conducted in 180 euthymic BD patients and 95 healthy controls. Firstly, statistical analyses were performed to compare QoL and affective temperaments between the two groups. Secondly, Adaptive Lasso Analysis was carried out to identify the potential confounding variables and select the affective temperaments as potential predictors on the PCS and MCS of QoL in BD patients, as well as the control group. QoL scores in terms of PCS and MCS in BD patients were significantly lower than in healthy individuals. Whereas anxious temperament, anxiety disorder comorbidity, and age were the best predictors of PCS impairment in BD patients, anxious temperament, subclinical depressive symptoms, and age were the best predictors of MCS impairment. Further longitudinal studies with unaffected high-risk relatives are needed to examine the potential interaction between affective temperament and psychopathology. Anxious temperament has an impact on QoL in BD in terms of both the physical component and the mental component. Systematic screening of temperament in BD would give clinicians better knowledge of QoL predictors. Further research should allow more individualized treatment of BD patients based on temperamental factors. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Does hospital ownership affect patient experience? An investigation into public-private sector differences in England.

    Science.gov (United States)

    Pérotin, Virginie; Zamora, Bernarda; Reeves, Rachel; Bartlett, Will; Allen, Pauline

    2013-05-01

    Using patient experience survey data, the paper investigates whether hospital ownership affects the level of quality reported by patients whose care is funded by the National Health Service in areas other than clinical quality. We estimate a switching regression model that accounts for (i) some observable characteristics of the patient and the hospital episode; (ii) selection into private hospitals; and (iii) unmeasured hospital characteristics captured by hospital fixed effects. We find that the experience reported by patients in public and private hospitals is different, i.e. most dimensions of quality are delivered differently by the two types of hospitals, with each sector offering greater quality in certain specialties or to certain groups of patients. However, the sum of all ownership effects is not statistically different from zero at sample means. In other words, hospital ownership in and of itself does not affect the level of quality of the average patient's reported experience. Differences in mean reported quality levels between the private and public sectors are entirely attributable to patient characteristics, the selection of patients into public or private hospitals and unobserved characteristics specific to individual hospitals, rather than to hospital ownership. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. Service design attributes affecting diabetic patient preferences of telemedicine in South Korea.

    Science.gov (United States)

    Park, Hayoung; Chon, Yucheong; Lee, Jongsu; Choi, Ie-Jung; Yoon, Kun-Ho

    2011-01-01

    Attempts to introduce telemedicine in South Korea have failed mostly, leaving critical questions for service developers and providers about whether patients would be willing to pay for the service and how the service should be designed to encourage patient buy-in. In this study, we explore patients' valuations and preferences for each attribute of telemedicine service for diabetes management and evaluate patient willingness to pay for specific service attributes. We conducted a conjoint survey to collect data on patients' stated preferences among telemedicine service alternatives. The alternatives for diabetes-related service differed in 10 attributes, including those related to price, type of service provider, and service scope. To estimate the relative importance of attributes, patients' willingness to pay for each attribute, and their probable choice of specific alternatives, we used a rank-ordered logit model. A total of 118 respondents participated in the survey. All 10 attributes significantly affected patients' valuations and preferences, and demographic and disease characteristics, such as existence of complications and comorbidities, significantly affected patients' valuations of the attributes. Price was the most important attribute, followed by comprehensive scope of service, the availability of mobile phone-based delivery, and large general-hospital provided services. The study findings have significant implications for adoption policy and strategy of telemedicine in diabetes management care. Further, the methodology presented in this study can be used to draw knowledge needed to formulate effective policy for adoption of the necessary technology and for the design of services that attract potential beneficiaries.

  5. The appearance of ADCs in the non-affected areas of the patients with MELAS

    International Nuclear Information System (INIS)

    Liu, Zhenghua; Liu, Xiwei; Hui, Lihong; Xie, Sheng; Xiao, Jiangxi; Jiang, Xuexiang; Zhao, Danhua; Wang, Xiaoying

    2011-01-01

    The exact mechanism of the mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) remain unclear. Diffusion-weighted imaging (DWI) is a magnetic resonance (MR) imaging technique for studying the pathophysiologic change of the MELAS. The purpose of the study is to see whether the apparent diffusion coefficient (ADC) of MELAS in the non-affected areas is different from the ADC of the normal subjects and to speculate the pathophysiological mechanisms of the MELAS. Sixteen cases of MELAS were retrospectively analyzed. Thirty healthy subjects were chosen to constitute the control group. All of them were performed on the 3.0T whole-body MR scanner with axial view T2 fluid attenuated inversion recovery (flair), T2-weighted imaging, T1flair, and DWI. An ADC map was reconstructed in the workstation. Two to five regions of interest were put in the non-affected frontal lobe and basal ganglia. All data took statistical analysis. There were significant differences between the ADC of the patients with MELAS and the controls in the non-affected areas, including the superior frontal gyrus, precentral gyrus, corpus striatum, thalamus, and white matter of the semi-oval centrum. ADCs in the non-affected areas of the patients with MELAS are higher than those of the normal subjects. Pathological changes take place in the non-affected areas of the patients with MELAS. (orig.)

  6. Factors Affecting Quality of Life and Fatigue in Gynaecologic Cancer Patients

    Directory of Open Access Journals (Sweden)

    Güngör İ

    2017-06-01

    Full Text Available Background: Cancer-related fatigue (CRF is the most commonly reported and most distressing symptom in cancer patients. Health-related quality of life (QOL is an important outcome in cancer management, the authors sought to better understand its determinants. Aim: This study aims to identify quality of life and fatigue levels and the affecting factors in gynaecologic cancer patients. Method: This descriptive and cross-sectional study was conducted with 154 volunteer women with gynaecologic cancer. The data were collected through the interview form, functional assessment of cancer therapy-general (FACT-G Quality of Life Scale, and Piper Fatigue Scale. Results: The mean score of total quality of life in gynaecologic cancer patients was low, 53.4 ± 15.4. Physical and emotional states were found to be the mostly affected states in the quality of life. According to the Piper Fatigue Scale, the total fatigue score was mild, 3.5 ± 2.4. Total fatigue scores were found to be high in metastatic cancers. Multivariate analyses indicate that the most important factor affecting the quality of life is economic condition, and the most important variables affecting fatigue are the level of activity and use of medicine. Conclusion: This study found that quality of life dimensions in women with gynaecologic cancer was affected by factors such as cancer type, time of diagnosis, and stage and spread of the cancer.

  7. The appearance of ADCs in the non-affected areas of the patients with MELAS

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Zhenghua; Liu, Xiwei; Hui, Lihong; Xie, Sheng; Xiao, Jiangxi; Jiang, Xuexiang [Peking University First Hospital, Center for Functional Imaging, Peking University, The Department of Radiology, Beijing (China); Zhao, Danhua [Peking University First Hospital, The Department of Neurology, Beijing (China); Wang, Xiaoying [Peking University First Hospital, Center for Functional Imaging, Peking University, The Department of Radiology, Beijing (China); Peking University First Hospital, The Department of Radiology, 8, Xishiku Street, Xicheng District, Beijing (China)

    2011-04-15

    The exact mechanism of the mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) remain unclear. Diffusion-weighted imaging (DWI) is a magnetic resonance (MR) imaging technique for studying the pathophysiologic change of the MELAS. The purpose of the study is to see whether the apparent diffusion coefficient (ADC) of MELAS in the non-affected areas is different from the ADC of the normal subjects and to speculate the pathophysiological mechanisms of the MELAS. Sixteen cases of MELAS were retrospectively analyzed. Thirty healthy subjects were chosen to constitute the control group. All of them were performed on the 3.0T whole-body MR scanner with axial view T2 fluid attenuated inversion recovery (flair), T2-weighted imaging, T1flair, and DWI. An ADC map was reconstructed in the workstation. Two to five regions of interest were put in the non-affected frontal lobe and basal ganglia. All data took statistical analysis. There were significant differences between the ADC of the patients with MELAS and the controls in the non-affected areas, including the superior frontal gyrus, precentral gyrus, corpus striatum, thalamus, and white matter of the semi-oval centrum. ADCs in the non-affected areas of the patients with MELAS are higher than those of the normal subjects. Pathological changes take place in the non-affected areas of the patients with MELAS. (orig.)

  8. Does Intellectual Disability Affect the Development of Dental Caries in Patients with Cerebral Palsy?

    Science.gov (United States)

    Moreira, Rafaela Nogueira; Alcantara, Carlos Eduardo Pinto; Mota-Veloso, Isabella; Marinho, Sandra Aparecida; Ramos-Jorge, Maria L.; Oliveira-Ferreira, Fernanda

    2012-01-01

    The aim of this study was to evaluate if the severity of intellectual disability is a factor that affects the development of dental cavities in patients with cerebral palsy. This cross-sectional study was conducted on 165 individuals who were selected from a physical rehabilitation center, a special public school and a regular public school. Of…

  9. Factors affecting time of access of in-patient care at Webuye District hospital, Kenya

    Directory of Open Access Journals (Sweden)

    Maxwell M. Lodenyo

    2016-10-01

    Conclusion: Ten-year increment in age, perception of a supernatural cause of illness(predisposing factors, having an illness that is considered bearable and belief in the effectiveness of treatment offered in-hospital (need factors affect time of access of in-patient healthcare services in the community served by Webuye District hospital and should inform interventions geared towards improving access.

  10. Continuous event recorders did not affect anxiety or quality of life in patients with palpitations

    NARCIS (Netherlands)

    Hoefman, Emmy; Boer, Kimberly R.; van Weert, Henk C. P. M.; Reitsma, Johannes B.; Koster, Rudolf W.; Bindels, Patrick J. P.

    2007-01-01

    OBJECTIVES: Palpitations can generate feelings of anxiety and decrease quality of life (QoL) due to fear of a cardiac abnormality. Continuous event recorders (CERs) have proven to be successful in diagnosing causes of palpitations but may affect patient QoL and anxiety. The aim is to determine

  11. Delusion of pregnancy in a patient with bipolar affective disorder: A ...

    African Journals Online (AJOL)

    Delusion of pregnancy is when one believes that one is pregnant despite contrary evidence and it is most times accompanied with classical symptoms of pregnancy. This rare disorder appears to be on the increase in Nigeria. We here report a case of delusion of pregnancy seen in a patient with bipolar affective disorder.

  12. The value of physicians' affect-oriented communication for patients' recall of information

    NARCIS (Netherlands)

    Visser, Leonie N. C.; Tollenaar, Marieke S.; de Haes, Hanneke C. J. M.; Smets, Ellen M. A.

    2017-01-01

    Objective: The aim of this paper is to discuss experimental research investigating the effect of physicians' affect-oriented communication on patients' recall of information provided during medical consultations, with a special focus on the mediating role of emotional stress in that relation.

  13. Positive affect and negative affect correlate differently with distress and health-related quality of life in patients with cardiac conditions: Validation of the Danish Global Mood Scale

    DEFF Research Database (Denmark)

    Spindler, Helle; Denollet, Johan; Kruse, Charlotte

    2009-01-01

    The Global Mood Scale (GMS), assessing negative affect (NA) and positive affect (PA), is sensitive to tapping treatment-related changes in patients with cardiac conditions. We examined the psychometric properties of the Danish GMS and the influence of NA and PA on distress and health-related qual...

  14. Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis : a meta-analysis

    NARCIS (Netherlands)

    Azevedo, R. de Miranda; Roest, A. M.; Hoen, P. W.; de Jonge, P.

    2014-01-01

    Background. Several prospective longitudinal studies have suggested that somatic/affective depressive symptoms, but not cognitive/affective depressive symptoms, are related to prognosis in patients with heart disease, but findings have been inconsistent. The aim of this study was to investigate the

  15. A review of factors affecting patient satisfaction with nurse led triage in emergency departments.

    Science.gov (United States)

    Rehman, Salma Abdul; Ali, Parveen Azam

    2016-11-01

    To determine the factors that affect patient satisfaction with nurse-led-triage in EDs using a systematic review. Nurses' involvement in the triage services provided in the Emergency Department has been an integral part of practice for several decades in some countries. Although studies exploring patient satisfaction with nurse-led ED triage exist, no systematic review of this evidence is available. MEDLINE, CINAHL, PsycInfo, EMBASE, the Cochrane Library, Joanna Briggs Library and Google Scholar were searched (January 1980-June 2013). Eighteen studies that met the inclusion criteria were reviewed. Factors that affect patient satisfaction with nurse-led-triage include nurses' abilities to provide patient centred care, communication skills, nurses' caring abilities, concern for the patient and competence in diagnosing and treating the health problem. Other factors include availability and visibility of nurses, provision of appropriate health related information in a jargon-free language, nurses' ability to answer questions, and an ability to provide patients with an opportunity to ask questions. There is continued scope for nurse-led-triage services in the ED. Patients are generally satisfied with the service provided by nurses in EDs and report a willingness to see the same professional again in the future if needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. PHYSIOTHERAPISTS ATTIRE: DOES IT AFFECT PATIENTS COMFORT, CONFIDENCE AND OVERALL PATIENT-THERAPIST RELATIONSHIP

    Directory of Open Access Journals (Sweden)

    Adamu Ahmad Rufa'i

    2015-10-01

    Full Text Available Background: Attire is one of the major determinants of appearance and a key element of non-verbal communication that plays a critical role in the establishment and sustainability of therapeutic relationships. This study aimed to determine the patients’ preferred physiotherapists’ attire and the effect of physiotherapists’ attire on patients’ confidence, comfort and patient-therapists relationship. Methods: A questionnaire was used to collect data in this cross sectional study design. Patients (N=281 attending outpatients physiotherapy clinics in six selected tertiary health institutions in North-eastern Nigeria completed a questionnaire consisting of two sections. Section one solicited sociodemographic information while in section two patients rated their level of confidence and comfort with physiotherapists based on a photo pictures of a male and a female physiotherapists models in four different attires. Descriptive statistics were performed to characterize participants and the differences in patients’ confidence and comfort level by different types of attire were assessed using chi-square. The correlation between physiotherapists’ attire and patient-physiotherapist relationship was determined using spearman rank correlation. Results: Overwhelming majority of the participants were more comfortable (91.1% and more confident (89.0% with the physiotherapists dressed in white coat, while they were less comfortable and less confident when their therapists are dressed in suit, native or casual wear. Positive patient-therapist relationship was observed with white coat dressed physiotherapists; while the relationship with business, native and casual wears were inverse. Conclusion: The study supports for continuing recommendation of lab coat as a professional dressing for physiotherapists in Nigeria and affirms the importance of professional dressing in patient-therapists relationship.

  17. Applications of Text Messaging, and Bibliotherapy for Treatment of Patients Affected by Depressive Symptoms.

    Science.gov (United States)

    Taleban, Roya; Zamani, Ahmadreza; Moafi, Mohammad; Jiryaee, Nasrin; Khadivi, Reza

    2016-01-01

    Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, text messaging. Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment.

  18. A history of arterial hypertension does not affect mortality in patients hospitalised with congestive heart failure

    DEFF Research Database (Denmark)

    Gustafsson, F; Torp-Pedersen, C; Seibaek, M

    2006-01-01

    OBJECTIVES: To evaluate the importance of a history of hypertension on long-term mortality in a large cohort of patients hospitalised with congestive heart failure (CHF). DESIGN: Retrospective analysis of 5491 consecutive patients, of whom 24% had a history of hypertension. 60% of the patients had...... non-systolic CHF, and 57% had ischaemic heart disease. SETTING: 38 primary, secondary and tertiary hospitals in Denmark. MAIN OUTCOME MEASURES: Total mortality 5-8 years after inclusion in the registry. RESULTS: Female sex and preserved left ventricular systolic function was more common among patients...... with a history of hypertension. 72% of the patients died during follow up. A hypertension history did not affect mortality risk (hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.92 to 1.07). Correction for differences between the normotensive and hypertensive groups at baseline in a multivariate model did...

  19. Intensive blood pressure control affects cerebral blood flow in type 2 diabetes mellitus patients

    DEFF Research Database (Denmark)

    Kim, Yu-Sok; Davis, Shyrin C A T; Truijen, Jasper

    2011-01-01

    Type 2 diabetes mellitus is associated with microvascular complications, hypertension, and impaired dynamic cerebral autoregulation. Intensive blood pressure (BP) control in hypertensive type 2 diabetic patients reduces their risk of stroke but may affect cerebral perfusion. Systemic hemodynamic...... variables and transcranial Doppler-determined cerebral blood flow velocity (CBFV), cerebral CO2 responsiveness, and cognitive function were determined after 3 and 6 months of intensive BP control in 17 type 2 diabetic patients with microvascular complications (T2DM+), in 18 diabetic patients without (T2DM......-) microvascular complications, and in 16 nondiabetic hypertensive patients. Cerebrovascular reserve capacity was lower in T2DM+ versus T2DM- and nondiabetic hypertensive patients (4.6±1.1 versus 6.0±1.6 [P

  20. Dendritic cell chimerism in oral mucosa of transplanted patients affected by graft-versus-host disease.

    Science.gov (United States)

    Pérez, Claudio A; Rabanales, Ramón; Rojas-Alcayaga, Gonzalo; Larrondo, Milton; Escobar, Alejandro F; López, Mercedes N; Salazar-Onfray, Flavio; Alfaro, Jorge I; González, Fermín E

    2016-02-01

    Graft-versus-host disease (GVHD) is one of the main complications after haematopoietic stem cell transplantation. Clinical features of GVHD include either an acute (aGVHD) or a chronic (cGVHD) condition that affects locations such as the oral mucosa. While the involvement of the host's dendritic cells (DCs) has been demonstrated in aGVHD, the origin (donor/host) and mechanisms underlying oral cGVHD have not been completely elucidated. In this study, we intend to determine the origin of DCs present in mucosal tissue biopsies from the oral cavity of transplanted patients affected by cGVHD. We purified DCs, from oral biopsies of three patients with cGVHD, through immunobeads and subsequently performed DNA extraction. The origin of the obtained DCs was determined by PCR amplification of 13 informative short tandem repeat (STR) alleles. We also characterised the DCs phenotype and the inflammatory infiltrate from biopsies of two patients by immunohistochemistry. Clinical and histological features of the biopsies were concordant with oral cGVHD. We identified CD11c-, CD207- and CD1a-positive cells in the epithelium and beneath the basal layer. Purification of DCs from the mucosa of patients affected by post-transplantation cGVHD was >95%. PCR-STR data analysis of DCs DNA showed that 100% of analysed cells were of donor origin in all of the evaluated patients. Our results demonstrate that resident DCs isolated from the oral tissue of allotransplanted patients affected by cGVHD are originated from the donor. Further research will clarify the role of DCs in the development and/or severity of oral cGVHD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Patients' perspectives on how idiopathic pulmonary fibrosis affects the quality of their lives

    Directory of Open Access Journals (Sweden)

    Gould Michael K

    2005-10-01

    Full Text Available Abstract Background Idiopathic pulmonary fibrosis (IPF is a debilitating lung disease with a survival of only three to five years from the time of diagnosis. Due to a paucity of studies, large gaps remain in our understanding of how IPF affects the quality of patients' lives. In only one other study did investigators ask patients directly for their perspectives on this topic. Further, currently there is no disease-specific instrument to measure health-related quality of life (HRQL in patients with IPF. A carefully constructed measurement instrument, sensitive to underlying change, is needed for use in clinical trials and longitudinal studies of patients with IPF. Before developing such an instrument, researchers must improve their understanding of the relevant effects of IPF on patients' lives. On a broader scale, to provide the best care for people with IPF, clinicians must appreciate – from patients' perspectives – how this disease affects various aspects of their lives. Methods We used focus groups and individual in-depth interviews with 20 IPF patients to collect their perspectives on how IPF affects their lives (with a focus on the quality of their lives. We then analyzed these perspectives and organized them into a conceptual framework for describing HRQL in patients with IPF. Next, we examined how well certain existing measurement instruments – which have been administered to IPF patients in prior studies – covered the domains and topics our patients identified. Results In our framework, we identified 12 primary domains: symptoms, IPF therapy, sleep, exhaustion, forethought, employment and finances, dependence, family, sexual relations, social participation, mental and spiritual well-being, mortality. Each domain is composed of several topics, which describe how IPF affects patients' lives. When we compared the content of our conceptual framework with the existing instruments, we found the coverage of the existing instruments to

  2. Do submucous myoma characteristics affect fertility and menstrual outcomes in patients underwent hysteroscopic myomectomy?

    Directory of Open Access Journals (Sweden)

    Ahmed Namazov

    2015-06-01

    Full Text Available Background: Submucous myomas may be associated with menorrhagia, infertility and dysmenorrhea. Objective: The aim of this study was to determine the long term effects of submucousal myoma resection on menorrhagia and infertility; also to detect whether the type, size, and location of myoma affect the surgical success. Materials and Methods: .Totally 98 women referred to hysteroscopy for symptomatic submucousal fibroids (menorrhagia (n=51 and infertility (n=47 between 2005- 2010 were enrolled in this historical cohort study Pregnancy rates and menstrual improvement rates were compared according to myoma characteristics (size, type and location. Results: After a mean postoperative period of 23±10 months in 51 patients with excessive bleeding, 13 had recurrent menorrhagia (25%. In Other 38 patients excessive bleeding was improved (75%. The improvement rates by location and myoma type: lower segment 100%, fundus 92%, and corpus 63%; type 0 70%, type 1 78%, type 2 80%. The mean sizes of myoma in recurred and improved patients were 23.33 mm and 29.88 mm respectively. 28 of 47 infertile women spontaneously experienced thirty pregnancies (60%. Pregnancy rates according to myoma location and type: lower segment 50%, fundus 57%, and corpus 80%; type 0 75%, type 1 62%, type 2 50%. The mean myoma size in patients who became pregnant was 30.38 mm; in patients who did not conceive was 29.95 mm. Conclusion: The myoma characetesitics do not affect improvement rates after hysteroscopic myomectomy in patients with unexplained infertility or excessive uterine bleeding.

  3. Patient Involvement Can Affect Clinicians’ Perspectives and Practices of Infection Prevention and Control

    Directory of Open Access Journals (Sweden)

    Mary Wyer

    2017-01-01

    Full Text Available This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnography (VRE to engage patients and clinicians in an exploration of the practical and relational complexities of patient involvement in infection prevention and control (IPC. This study included individual reflexive sessions with eight patients and six group reflexive sessions with 35 nurses. VRE usually involves participants reflecting on video footage of their own (and colleagues’ practices in group reflexive sessions. We extended the method here by presenting, to nurses, video clips of their clinical interactions with patients, in conjunction with footage of the patients themselves analyzing the videos of their own care, for infection risks. We found that this novel approach affected the nurses’ capacities to recognize, support, and enable patient involvement in IPC and to reflect on their own, sometimes inconsistent, IPC practices from patients’ perspectives. As a “post-qualitative” approach, VRE prioritizes participants’ roles, contributions, and learning. Invoking affect as an explanatory lens, we theorize that a “safe space” was created for participants in our study to reflect on and reshape their assumptions, positionings, and practices.

  4. Influence of Sex on Suicidal Phenotypes in Affective Disorder Patients with Traumatic Childhood Experiences.

    Directory of Open Access Journals (Sweden)

    Alexandra Bernegger

    Full Text Available In the current study, we aimed to investigate the impact of childhood trauma on suicidal behaviour phenotypes in a group of patients with diagnosed affective disorder (unipolar or bipolar affective disorder.Patients with and without a history of childhood abuse, measured by Childhood Trauma Questionnaire (CTQ, were assessed to explore risks for suicidal behaviour (including suicide attempt, self-harm and non-suicidal self-injury. The tested sample consisted of 258 patients (111 males and 147 females, in-patients and out-patients at the Department of Psychiatry and Psychotherapy, Medical University of Vienna and University Hospital Tulln, Lower Austria. Psychiatric diagnoses were derived from the SCAN (Schedules for Clinical Assessment in Neuropsychiatry interview. In addition, patients were administered the Lifetime Parasuicidal Count (LPC, Suicidal Behaviour Questionnaire (SBQ-R, and Viennese Suicide Risk Assessment Scale (VISURIAS questionnaires.In contrast to male suicide attempters, female suicide attempters showed both significantly higher total CTQ scores (p<0.001, and higher CTQ subscores (emotional, physical and sexual abuse, as well as emotional and physical neglect in comparison to the non-suicidal control group. Besides, females with a history of self-harming behaviour (including suicidal intention and Non-Suicidal-Self Injury (NSSI had significantly higher CTQ total scores (p<0.001 than the control group.These findings suggest gender differences in suicidal behaviour after being exposed to childhood trauma.

  5. Association between olfactory identification and parkinsonism in patients with non-affective psychosis.

    Science.gov (United States)

    Meijer, Julia H; van Harten, Peter; Meijer, Carin J; Koeter, Maarten W; Bruggeman, Richard; Cahn, Wiepke; Kahn, René S; de Haan, L

    2016-10-01

    Olfactory identification deficits (OIDs) are seen in schizophrenia patients and individuals at increased risk for psychosis but its pathophysiology remains unclear. Although dopaminergic imbalance is known to lie at the core of schizophrenia symptomatology, its role in the development of OIDs has not been elucidated yet. This study investigated the association between OIDs and symptoms of parkinsonism as a derivative of dopaminergic functioning. In 320 patients diagnosed with non-affective psychosis, olfactory identification performance was assessed by means of the Sniffin' Sticks task. Level of parkinsonian symptoms was assessed by means of the Unified Parkinson's Disease Rating Scale (UPDRS-III). By means of multiple linear regression with bootstrapping, the association between UPDRS and Sniffin' Sticks score was investigated while correcting for potential confounders. A Bonferroni corrected P-value of 0.007 was used. Higher UPDRS scores significantly predicted worse olfactory identification in patients with non-affective psychosis with an unadjusted b = -0.07 (95% CI -0.10 to -0.04) and an adjusted b = -0.04 (95% CI -0.07 to -0.01). Results provide preliminary evidence that the same vulnerability may underlie the development of parkinsonism and OIDs in patients with non-affective psychosis. Further investigation should evaluate the clinical value of OIDs as a marker of dopaminergic vulnerability that may predict psychosis. © 2014 Wiley Publishing Asia Pty Ltd.

  6. Factors affecting mortality in older trauma patients-A systematic review and meta-analysis.

    Science.gov (United States)

    Sammy, Ian; Lecky, Fiona; Sutton, Anthea; Leaviss, Joanna; O'Cathain, Alicia

    2016-06-01

    Major trauma in older people is a significant health burden in the developed world. The aging of the population has resulted in larger numbers of older patients suffering serious injury. Older trauma patients are at greater risk of death from major trauma, but the reasons for this are less well understood. The aim of this review was to identify the factors affecting mortality in older patients suffering major injury. A systematic review of Medline, Cinhal and the Cochrane database, supplemented by a manual search of relevant papers was undertaken, with meta-analysis. Multi-centre cohort studies of existing trauma registries that reported risk-adjusted mortality (adjusted odds ratios, AOR) in their outcomes and which analysed patients aged 65 and older as a separate cohort were included in the review. 3609 papers were identified from the electronic databases, and 28 from manual searches. Of these, 15 papers fulfilled the inclusion criteria. Demographic variables (age and gender), pre-existing conditions (comorbidities and medication), and injury-related factors (injury severity, pattern and mechanism) were found to affect mortality. The 'oldest old', aged 75 and older, had higher mortality rates than younger patients, aged 65-74 years. Older men had a significantly higher mortality rate than women (cumulative odds ratio 1.51, 95% CI 1.37-1.66). Three papers reported a higher risk of death in patients with pre-existing conditions. Two studies reported increased mortality in patients on warfarin (cumulative odds ratio 1.32, 95% CI 1.05-1.66). Higher mortality was seen in patients with lower Glasgow coma scores and systolic blood pressures. Mortality increased with increased injury severity and number of injuries sustained. Low level falls were associated with higher mortality than motor vehicle collisions (cumulative odds ratio 2.88, 95% CI 1.26-6.60). Multiple factors contribute to mortality risk in older trauma patients. The relation between these factors and

  7. Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments

    Science.gov (United States)

    Vigil, Jacob M.; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S.; Strenth, Chance; Parshall, Mark; Cichowski, Sara B.

    2016-01-01

    Abstract Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment. The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses. A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans). This study provides evidence for systemic differences in how patients’ vital signs are applied for determining ESI scores for different ethnic groups. Additional prospective research will be needed to determine how this specific person-level mechanism affects healthcare quality and outcomes. PMID:27057847

  8. The internalising and externalising dimensions of affective symptoms in depressed (unipolar) and bipolar patients

    DEFF Research Database (Denmark)

    Bech, P; Hansen, H V; Kessing, L V

    2006-01-01

    for the measurement of both the internalising dimension of affective symptoms (depression including suicidal ideas, anxiety and asthenia) and the externalising dimension (mania). To supplement the latter dimension, the WHO-5 questionnaire was included. These questionnaires were mailed to a large population...... of patients with depressive (unipolar) or bipolar disorders, representative of patients treated in hospital settings in Denmark, approximately 2 years after discharge from hospital. RESULTS: In total, 244 unipolars and 214 bipolars were included in the study. Mokken analysis showed that depressive (unipolar...... hospitals in Denmark, depressive (unipolar) patients scored significantly higher than bipolar patients on the internalising dimension and suicidal ideas, and significantly lower on the externalising dimension of psychological well-being....

  9. THE FACTORS AFFECTING SATISFACTION LEVELS IN HOSPITALIZED PATIENTS: AN APPLICATION IN PUBLIC HOSPITAL

    Directory of Open Access Journals (Sweden)

    Neşe ACAR

    2017-09-01

    Full Text Available This study was conducted to determine the factors that affect the level of satisfaction of services provided by public hospitals. Patients' satisfaction levels were measured by interviewing 156 patients in a public hospital. Factor analysis of the data obtained from the research resulted in five factors called nurses 'behaviors, physical conditions, doctors' behavior, technical staff behaviors, food and beverage. MANOVA analysis was conducted to determine the differences in the perception of factors with respect to the demographic characteristics of the patients and differences were found in terms of profession. It has been seen that it is important that public hospitals have specialist doctors and modern equipment and that they have qualities such as the quality of the health personnel in preferring patients to public hospitals.

  10. Does direct-to-consumer advertising affect patients' choice of pain medications?

    Science.gov (United States)

    Liu, Yifei; Doucette, William R

    2008-04-01

    In the United States, direct-to-consumer advertising (DTCA) has grown rapidly to promote prescription medications, including analgesics. Few studies in the literature directly examine the association between DTCA and patients' choice of pain medications. This article discusses how DTCA affects such choice from a behavioral perspective, because DTCA-prompted behaviors are important indicators of DTCA's influence. After DTCA exposure, patients may request prescriptions, seek further medication information, and ask about advertised conditions. Patients who suffer from pain may seek more communication with their health care providers because they are cautious about the information quality of DTCA, mainly because of the recall of rofecoxib (Vioxx; Merck, Whitehouse Station, NJ). However, the availability and DTCA of over-the-counter analgesics complicate their treatment choice. Patients could use DTCA as a tool to launch health communication and make an informed treatment choice with the guidance of their health care providers.

  11. Effect of recombinant erythropoietin on inflammatory markers in patients with affective disorders

    DEFF Research Database (Denmark)

    Vinberg, Maj; Weikop, Pia; Olsen, Niels Vidiendal

    2016-01-01

    Aim: This study investigated the effect of repeated infusions of recombinant human erythropoietin (EPO) on markers of inflammation in patients with affective disorders and whether any changes in inflammatory markers were associated with improvements on verbal memory. Methods: In total, 83 patients......). In both sub-studies, patients were randomised in a double-blind, parallel-group design to receive eight weekly intravenous infusions of EPO (Eprex; 40,000 IU/ml) or saline (0.9% NaCl). Plasma concentrations of interleukin 6 (IL-6), interleukin 18 (IL-18) and high sensitive c-reactive protein (hsCRP) were...... and change in verbal memory. Conclusions: Repeated EPO infusions had no effect on IL-6 and IL-18 levels but produced a modest increase in hsCRP levels in patients with TRD. Changes over time in inflammatory markers were not correlated with changes in cognition suggesting that modulation of the inflammatory...

  12. Factors affecting the success of weaning in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Turgut Teke

    2011-09-01

    Full Text Available Objectives: Weaning failure rate was higher in patients with chronic obstructive pulmonary disease (COPD and many factors affect it. The aim of this study was to investigate the factors affecting the success of weaning in COPD patients receiving invasive mechanical ventilation (IMV.Materials and methods: Totally 43 COPD patients who received IMV in intensive care unit were included. Clinical and laboratory results and Acute Physiology Assessment and Chronic Health Evaluation (APACHE II scores were recorded and affecting factors on weaning success were investigated.Results: In 43 patients, 25 had successful weaning (58.1%. Patients with high APACHE II score prior to intubation was found as associated with weaning failure. High Glasgow coma scale (GCS scores before entubation and weaning are associated with weaning success. Pre-weaning anxiety, positive endotracheal aspirate culture, pulmonary arterial pressure value, enteral feeding, pre-weaning tachycardia, pre-weaning cuff leaking and FiO2 values were found to be associated with weaning failure. Pre-weaning cortisol levels were associated with weaning success. In successful weaning group, measured NIF and VT in spontaneous mode were found as higher and f/VT ratio was lower compared with unsuccessful group. T-tube during the 15th and 30th minutes of the symptoms of fatigue (sweating assets were associated with weaning failure. IMV duration and longer extubation duration of weaning, and more number of t-tube insertion attempts were found as associated with failure of weaning.Conclusions: Infection in patients with COPD, the presence of anxiety, and hemodynamic and respiratory instability significantly increases the weaning failure.

  13. Prevalence of coeliac disease in Italian patients affected by Addison's disease.

    Science.gov (United States)

    Biagi, Federico; Campanella, Jonia; Soriani, Alessandra; Vailati, Alberto; Corazza, Gino R

    2006-03-01

    It is well known that coeliac disease is associated with autoimmune endocrine diseases, such as autoimmune thyroid disease and insulin-dependent diabetes mellitus. Recently, coeliac disease has been shown in approximately 10% of patients with autoimmune Addison's disease. Addison's disease is the most common cause of primary adrenocortical insufficiency and it shares several clinical features with coeliac disease. Although hyperpigmentation and hypotension are the most specific signs, gastrointestinal symptoms are common and can be the first complaints of the patients. The aim of our study was to investigate the prevalence of coeliac disease in Italian patients with Addison's disease. Seventeen consecutive patients affected by Addison's disease (14 F, mean age 53.9 years, range 26-79 years) were enrolled in the study. Eleven of them were affected by Addison's disease associated with autoimmune thyroid disease and/or insulin-dependent diabetes mellitus; the other 6 patients were suffering from isolated Addison's disease. Diagnosis had been performed at the age of 40.5 years (range 23-55). Steroid treatment had already been started in 16 of the patients. Endomysial antibodies were tested in all of them and a duodenal biopsy was taken in those found to be positive for antiendomysial antibody (EMA). One out of 17 patients was found to be EMA positive. Duodenal biopsy confirmed the diagnosis of coeliac disease by showing subtotal villous atrophy. Although we studied only a small sample, our preliminary results confirmed that Addison's disease is associated with coeliac disease, being present in 5.9% of patients with Addison's disease. Since the symptoms can be similar and treatment of Addison's disease can mask coeliac disease, this association should always be actively investigated.

  14. Clinical factors affecting the outcome in postradioactive iodine (RAI) therapy patients - Philippine Heart Center experience

    International Nuclear Information System (INIS)

    Quinon, A.; Oabel, E.; Jimeno, C.

    2007-01-01

    Full text: Clinical factors such as patient's age, duration of the underlying autoimmune thyroid stimulus and anti-thyroid drug therapy may affect the outcome of patients who underwent RAI therapy. Objective: To evaluate the clinical factors affecting the outcome of RAI therapy. Methodology: Patients (n=41) with Graves' disease treated with anti-thyroid drugs were followed up after Radioactive Iodine therapy treatment. Thyroid scan, 2 and 24 hours radioactive iodine uptake were taken to compute for the therapy dose (120 uci) (computed thyroid weight in gms) (24-hour I 131 uptake). Patients were then divided into groups (Group 1= hypothyroid, Group 2= euthyroid, Group 3 hyperthyroid) based on their thyroid function results (FT3, FT4, TSH) after 2, 4, 6, 12 months post-therapy. Clinical and physiologic factors were then correlated with the outcome. Results: The population consisted of 41 patients (male=8, female=33) with an overall incidence of Group 1= 17%, Group 2= 54% and Group 3= 29% posttherapy. Factors such as age, with their means (Groups 134, 2= 39, 3=39 p= 0.42) and gland uptake (24-hour Groups 1= 53, 2= 61 358, p= 0.41) were not associated with the remission rate. Other factors that were related to the length of the disease such as duration of symptoms (Groups 121, 2=24, 3= 29 months p0.68), duration of medicine prior to RAI therapy (Group 1= 10, 2= 15, 3= 18 months p=0.306) and gland weight (Groups 1=40 2=42 3=46 grams p=0.78) tends to have a higher mean values in therapy failure patients. Conclusion: Clinical factors studied showed no significant differences among patients developing hypothyroid, euthyroid or hyperthyroid state. The data suggested that treatment failures in patients with Graves' disease could be improved by lessening the time interval between the diagnosis and radioactive iodine therapy. (author)

  15. Patient-ventilator asynchrony affects pulse pressure variation prediction of fluid responsiveness.

    Science.gov (United States)

    Messina, Antonio; Colombo, Davide; Cammarota, Gianmaria; De Lucia, Marta; Cecconi, Maurizio; Antonelli, Massimo; Corte, Francesco Della; Navalesi, Paolo

    2015-10-01

    During partial ventilatory support, pulse pressure variation (PPV) fails to adequately predict fluid responsiveness. This prospective study aims to investigate whether patient-ventilator asynchrony affects PPV prediction of fluid responsiveness during pressure support ventilation (PSV). This is an observational physiological study evaluating the response to a 500-mL fluid challenge in 54 patients receiving PSV, 27 without (Synch) and 27 with asynchronies (Asynch), as assessed by visual inspection of ventilator waveforms by 2 skilled blinded physicians. The area under the curve was 0.71 (confidence interval, 0.57-0.83) for the overall population, 0.86 (confidence interval, 0.68-0.96) in the Synch group, and 0.53 (confidence interval, 0.33-0.73) in the Asynch group (P = .018). Sensitivity and specificity of PPV were 78% and 89% in the Synch group and 36% and 46% in the Asynch group. Logistic regression showed that the PPV prediction was influenced by patient-ventilator asynchrony (odds ratio, 8.8 [2.0-38.0]; P < .003). Of the 27 patients without asynchronies, 12 had a tidal volume greater than or equal to 8 mL/kg; in this subgroup, the rate of correct classification was 100%. Patient-ventilator asynchrony affects PPV performance during partial ventilatory support influencing its efficacy in predicting fluid responsiveness. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. [Perception of social support in the aspect of a cognitive style of patients with affective disorders].

    Science.gov (United States)

    Poradowska-Trzos, Magdalena; Dudek, Dominika; Rogoz, Monika; Zieba, Andrzej

    2008-01-01

    According to Aaron Beck, dysfunctional thinking patterns appear also in euthymic patients, after withdrawal of acute diseases symptoms. Patients have a disordered, negative image of themselves, of their future and the surrounding world. It has been shown that a way a man perceives possessed social support has a basic meaning for him. The purpose of the research was to analyze the relationship between perceived social support and the patient's cognitive style. The study group consisted of euthymic outpatients diagnosed with recurrent depressive disorder (UID) or bipolar affective disorder (BID). Assessment of a cognitive style was made according to the Rosenberg Scale, Hopelessness Scale HS-20 and Automatique Thoughts Questionnaire ATQ 30, assessment of the amount of received support - according to Cohen's ISEL. The presented study revealed that, in both groups of patients, a thinking style is disturbed and that there is a link between a cognitive style and the perception of the level of received support. The link was stronger in the group of patients with unipolar affective disorder. In both groups, correlations concerning emotional support were the highest.

  17. The strange case of a patient affected by acromegaly with osteoporomalacia without hypogonadism

    Directory of Open Access Journals (Sweden)

    S. Caprio

    2011-09-01

    Full Text Available Acromegaly is a rare disease that, in the majority of cases, is due to the presence of a benign growth hormone (GH- producing tumor of the pituitary. Growth hormone has profound effects on linear bone growth, bone metabolism, and bone mass. In acromegaly, the skeletal effects of chronic GH excess have been mainly addressed by evaluating bone mineral density (BMD. Most data were obtained in patients with active acromegaly, and apparently high or normal BMD was observed in the absence of hypogonadism. The Autors describe a case of patient affected by acromegaly without hypogonadism with serious osteoporosis and biological signs of osteomalacia.

  18. Increased Risk of Developing Affective Disorder in Patients with Hypothyroidism: A Register-Based Study

    DEFF Research Database (Denmark)

    Thomsen, Anders F.; Kvist, Tine Kajsa; Andersen, Per Kragh

    2005-01-01

    BACKGROUND: Links between thyroid function and depression have been noted in many contexts. We assessed whether hospitalization with hypothyroidism was a risk factor for developing affective disorder. METHODS: We conducted a prospective cohort study using historical data from Danish registers....... The observational period was 1977-1999. Three study cohorts were identified: all patients with a first hospital admittance with the resulting index discharge diagnoses hypothyroidism, osteoarthritis, or nontoxic goiter. A later hospitalization with a resulting discharge diagnosis of affective disorder was used...... as event of interest, and rates of readmission were estimated and compared using competing risk models in survival analyses. FINDINGS: We identified 165,307 patients discharged with an index diagnosis. In the observational period, 1041 events occurred. An index diagnosis of hypothyroidism was associated...

  19. Can Video Self-Modeling Improve Affected Limb Reach and Grasp Ability in Stroke Patients?

    Science.gov (United States)

    Steel, Kylie Ann; Mudie, Kurt; Sandoval, Remi; Anderson, David; Dogramaci, Sera; Rehmanjan, Mohammad; Birznieks, Ingvars

    2018-01-01

    The authors examined whether feedforward video self-modeling (FF VSM) would improve control over the affected limb, movement self-confidence, movement self-consciousness, and well-being in 18 stroke survivors. Participants completed a cup transport task and 2 questionnaires related to psychological processes pre- and postintervention. Pretest video footage of the unaffected limb performing the task was edited to create a best-of or mirror-reversed training DVD, creating the illusion that patients were performing proficiently with the affected limb. The training yielded significant improvements for the forward movement of the affected limb compared to the unaffected limb. Significant improvements were also seen in movement self-confidence, movement self-consciousness, and well-being. FF VSM appears to be a viable way to improve motor ability in populations with movement disorders.

  20. Electroconvulsive therapy and risk of dementia in patients with affective disorders: a cohort study.

    Science.gov (United States)

    Osler, Merete; Rozing, Maarten Pieter; Christensen, Gunhild Tidemann; Andersen, Per Kragh; Jørgensen, Martin Balslev

    2018-04-01

    Electroconvulsive therapy (ECT) is the most effective treatment for severe episodes of mood disorders. Temporary memory loss is a common side-effect, but ongoing discussions exist regarding potential long-term adverse cognitive outcomes. Only a few studies have examined the frequency of dementia in patients after ECT. The aim of this study was to examine the association between ECT and risk of subsequent dementia in patients with a first-time hospital diagnosis of affective disorder. We did a cohort study of patients aged 10 years and older in Denmark with a first-time hospital contact for an affective disorder from Jan 1, 2005, through Dec 31, 2015, identified in the Danish National Patient Registry with ICD-10 codes F30.0 to F39.9. From the registry we retrieved information on all ECTs registered for patients and followed up patients for incidental dementia (defined by hospital discharge diagnoses or acetylcholinesterase inhibitor use) until Oct 31, 2016. We examined the association between ECT and dementia using Cox regression analyses with multiple adjustments and propensity-score matching on sociodemographic and clinical variables. Of 168 015 patients included in the study, 5901 (3·5%) patients had at least one ECT. During the median follow-up of 4·9 years (IQR 2·4-7·8) and 872 874 person years, the number of patients who developed dementia was 111 (0·1%) of 99 045 patients aged 10-49 years, 965 (2·7%) of 35 945 aged 50-69 years, and 4128 (12·5%) of 33 025 aged 70-108 years. 217 (3·6%) of the 5901 patients treated with ECT developed dementia, whereas of 162 114 patients not treated with ECT 4987 (3·1%) developed dementia. The corresponding incidences were 70·4 cases per 10 000 person-years (95% CI 61·6-80·5) and 59·2 per 10 000 person-years (57·6-60·8). In patients younger than 50 years and 50-69 years, ECT was not associated with a risk of dementia compared with age-matched patients who were not given ECT (age-adjusted hazard

  1. Diagnostic and therapeutic hardships with mixed affective state presenting as catatonia in a patient with intellectual disability

    Directory of Open Access Journals (Sweden)

    Karthick Subramanian

    2017-01-01

    Full Text Available Mixed affective episodes can be misdiagnosed, especially in patients with intellectual disability (ID. We describe the case of an 18-year-old girl with mild ID, who presented with features of catatonia during the first mixed episode. These symptoms responded well to electroconvulsive therapy, following which clear affective symptoms emerged. Her affective episode did not respond adequately to olanzapine but improved significantly after the addition of sodium valproate. The difficulties of diagnosing affective episodes in persons with intellectual disabilities are discussed. This case suggests that mixed affective episodes should be considered in the differential diagnosis when poorly elaborated affective and psychotic symptoms are present in a patient with ID.

  2. Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20

    Directory of Open Access Journals (Sweden)

    Thulesius Hans O

    2010-06-01

    Full Text Available Abstract Background Alexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain. Methods The AS-intervention, with 8 weekly group sessions and 10 individual sessions, was offered to 59 patients with chronic non-malignant pain at a pain rehabilitation clinic in Sweden 2004-2005. Pre and post intervention assessments were done with the Hospital Anxiety and Depression scale (HAD, the Toronto Alexithymia Scale-20 (TAS-20, the Visual Analogue Scale for pain assessment (VAS-pain, the European Quality of Life health barometer (EQoL and the Stress and Crisis Inventory-93 (SCI-93. After the group sessions we used Bergdahl's Questionnaire for assessing changes in interpersonal relations, general well-being and evaluation of AS. Results The AS intervention was completed by 54 out of 59 (92% patients. Significant reductions in total TAS-20 post-test scores (p = 0.0006 as well as TAS-20 DIF and DDF factors (Difficulties Identifying Feelings, and Difficulties Describing Feelings were seen (p = 0.0001, and p = 0.0008 while the EOT factor (Externally Oriented Thinking did not change. Improvements of HAD-depression scores (p = 0.04, EQoL (p = 0.02 and self-assessed changes in relations to others (p Conclusions This pilot study involving 59 patients with chronic benign pain indicates that the alexithymia DIF and DDF, as well as depression, social relations and quality of life may be improved by the Affect School therapeutic intervention.

  3. Reduction of common motoneuronal drive on the affected side during walking in hemiplegic stroke patients

    DEFF Research Database (Denmark)

    Nielsen, Jens Bo; Brittain, John-Stuart; Halliday, David M.

    2008-01-01

    walking in eight subjects with unilateral stroke. RESULTS: On the unaffected side, short-term synchronization was evident from the presence of a narrow central peak in cumulant densities and from the presence of significant coherence between these signals in the 10-25 Hz band. Such indicators of short...... on the affected side in hemiplegic patients during walking. SIGNIFICANCE: This is of importance for understanding the mechanisms responsible for reduced gait ability and development of new strategies for gait restoration....

  4. Heterogeneity of change in state affect following insulin therapy initiation in type 2 diabetic patients

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    Gruszczyńska Ewa

    2017-09-01

    Full Text Available The aim of the study was to explore heterogeneity of change in state affect following the introduction of insulin therapy in patients with type 2 diabetes. State affect was assessed twice among 305 patients: just before the introduction of insulin therapy and at 1-month follow-up. Latent class growth modeling showed that negative affect (NA increased in 78% of the sample, whereas positive affect (PA improved in only 17% of the participants. On the basis of cross-tabulation of these changes a 4-class model of emotional response to the new treatment was obtained. The largest subgroup of participants (57% manifested “threat response”, i.e. moderate-stable PA with increase in NA. Participants in the “challenge response” subgroup (11.8% showed increases in both NA and PA. The third class (10.2% characterized by “no response”, had low-stable NA and moderate-stable PA. The smallest “stress response” subgroup (9.8% showed increase in NA and high-stable PA. Gender, age and education level were significant covariates of group membership. Thus, the findings revealed heterogeneous emotional response to the new treatment, which may be of clinical relevance for improving diabetic patients’ adjustment through a more individual, person-centered approach.

  5. Socio-cultural parameters in Yoruba Nigerian patients with affective disorders.

    Science.gov (United States)

    Makanjuola, R O

    1989-09-01

    One hundred and ten consecutive new patients presenting with major affective disorders were divided into five categories according to pattern of presentation: recurrent manic disorder, recurrent depressive disorder, bipolar disorder, single episodes of manic disorder, and single episodes of major depressive disorder. Manic patients predominated, and recurrent manic disorder was much more frequent than either recurrent depressive or bipolar disorder. The manic and bipolar patients were younger. Females predominated in all five groups of patients. The two manic groups were less likely to be married, but this was probably a reflection of their younger age. No differences were demonstrated with regard to educational status or occupation. There were no significant differences with regard to sibship position, family size, or polygamous/monogamous parents. Manic patients were more likely to have suffered permanent separation from one or both parents before the age of 12 years. A relatively low proportion of the patients had a positive history of mental disorder among first- or second-degree relatives. Manic and bipolar patients tended to present in hospital relatively early in their illness.

  6. Contextual factors affecting autonomy for patients in Iranian hospitals: A qualitative study.

    Science.gov (United States)

    Ebrahimi, Hossein; Sadeghian, Efat; Seyedfatemi, Naeimeh; Mohammadi, Eesa; Crowley, Maureen

    2016-01-01

    Consideration of patient autonomy is an essential element in individualized, patient-centered, ethical care. Internal and external factors associated with patient autonomy are related to culture and it is not clear what they are in Iran. The aim of this study was to explore contextual factors affecting the autonomy of patients in Iranian hospitals. This was a qualitative study using conventional content analysis methods. Thirty-four participants (23 patients, 9 nurses, and 2 doctors) from three Iranian teaching hospitals, selected using purposive sampling, participated in semi-structured interviews. Unstructured observation and filed notes were other methods for data collection. The data were subjected to qualitative content analysis and analyzed using the MAXQDA-10 software. Five categories and sixteen subcategories were identified. The five main categories related to patient autonomy were: Intrapersonal factors, physical health status, supportive family and friends, communication style, and organizational constraints. In summary, this study uncovered contextual factors that the care team, managers, and planners in the health field should target in order to improve patient autonomy in Iranian hospitals.

  7. Contextual factors affecting autonomy for patients in Iranian hospitals: A qualitative study

    Science.gov (United States)

    Ebrahimi, Hossein; Sadeghian, Efat; Seyedfatemi, Naeimeh; Mohammadi, Eesa; Crowley, Maureen

    2016-01-01

    Background: Consideration of patient autonomy is an essential element in individualized, patient-centered, ethical care. Internal and external factors associated with patient autonomy are related to culture and it is not clear what they are in Iran. The aim of this study was to explore contextual factors affecting the autonomy of patients in Iranian hospitals. Materials and Methods: This was a qualitative study using conventional content analysis methods. Thirty-four participants (23 patients, 9 nurses, and 2 doctors) from three Iranian teaching hospitals, selected using purposive sampling, participated in semi-structured interviews. Unstructured observation and filed notes were other methods for data collection. The data were subjected to qualitative content analysis and analyzed using the MAXQDA-10 software. Results: Five categories and sixteen subcategories were identified. The five main categories related to patient autonomy were: Intrapersonal factors, physical health status, supportive family and friends, communication style, and organizational constraints. Conclusions: In summary, this study uncovered contextual factors that the care team, managers, and planners in the health field should target in order to improve patient autonomy in Iranian hospitals. PMID:27186203

  8. Use of Compounded Dextromethorphan-Quinidine Suspension for Pseudobulbar Affect in Hospice Patients.

    Science.gov (United States)

    Wahler, Robert G; Reiman, Alfred T; Schrader, Joshua V

    2017-03-01

    Pseudobulbar affect (PBA) consists of unprovoked and uncontrollable episodes of laughing and/or crying. In end-of-life situations, PBA symptoms can be especially distressing to family and friends during an already heightened emotional time. Although a commercial product combining dextromethorphan and quinidine (DMQ) is FDA approved for use in PBA, many hospice patients are unable to swallow any solids or semisolids. An alternative formulation for these patients is needed. We present here two cases in which we used a compounded DMQ suspension successfully to treat PBA symptoms in the weeks before the patients' death. A retrospective chart review was completed on the two cases where the DMQ suspension was used. A description of the DMQ suspension formula is described. Both patients were under the care of a hospice program; one in home care and one in a skilled nursing facility. Episodes of PBA symptoms were summarized in a narrative of the patients' symptom relief. Both patients tolerated the administration of the DMQ suspension and there were noted improvements in PBA symptoms. DMQ suspension is an effective alternative for PBA symptoms in patients who cannot swallow oral solid medication.

  9. EEG indices correlate with sustained attention performance in patients affected by diffuse axonal injury.

    Science.gov (United States)

    Coelli, Stefania; Barbieri, Riccardo; Reni, Gianluigi; Zucca, Claudio; Bianchi, Anna Maria

    2018-06-01

    The aim of this study is to assess the ability of EEG-based indices in providing relevant information about cognitive engagement level during the execution of a clinical sustained attention (SA) test in healthy volunteers and DAI (diffused axonal injury)-affected patients. We computed three continuous power-based engagement indices (P β /P α , 1/P α , and P β / (P α + P θ )) from EEG recordings in a control group (n = 7) and seven DAI-affected patients executing a 10-min Conners' "not-X" continuous performance test (CPT). A correlation analysis was performed in order to investigate the existence of relations between the EEG metrics and behavioral parameters in both the populations. P β /P α and 1/P α indices were found to be correlated with reaction times in both groups while P β / (P α + P θ ) and P β /P α also correlated with the errors rate for DAI patients. In line with previous studies, time course fluctuations revealed a first strong decrease of attention after 2 min from the beginning of the test and a final fading at the end. Our results provide evidence that EEG-derived indices extraction and evaluation during SA tasks are helpful in the assessment of attention level in healthy subjects and DAI patients, offering motivations for including EEG monitoring in cognitive rehabilitation practice. Graphical abstract Three EEG-derived indices were computed from four electrodes montages in a population of seven healthy volunteers and a group of seven DAI-affected patients. Results show a significant correlation between the time course of the indices and behavioral parameters, thus demonstrating their usefulness in monitoring mental engagement level during a sustained attention task.

  10. Fibrillin levels in a severely affected Marfan syndrome patient with a null allele

    Energy Technology Data Exchange (ETDEWEB)

    Boxer, M.; Withers, A.P.; Al-Ghaban, Z. [Univ. of Wales, Cardiff (United Kingdom)]|[Ninewells Hospital and Medical School, Dundee (United Kingdom)] [and others

    1994-09-01

    Marfan syndrome is an autosomal dominantly inherited connective tissue disorder characterized by defects in the cardiovascular, skeletal and ocular systems. A patient was first examined in 1992 having survived an acute sortic dissection with subsequent composite repair and insertion of a prosthetic aortic valve. Clinical examination revealed arachnodactyly, narrow, high arched palate with dental crowding, an arm span exceeding her height by 10.5 cm, joint laxity and bilateral lens subluxation. Analysis of the family showed affected members in three generations and the fibrillin gene, FBN1, was shown to segregate with the disease when using polymorphic markers including an RsaI polymorphism in the 3{prime}-untranslated region of the gene. Analysis of patient mRNA for this RsaI polymorphism by RT-PCR (reverse transcriptase-PCR) amplification and restriction enzyme digestion of the PCR products showed that the copy of the gene segregating with the disease was not transcribed. No low level expression of this allele was observed despite RT-PCR amplification incorporating radioactively labelled dCTP, thus revealing a null allele phenotype. Western blotting analysis of fibrillin secreted by the patient`s dermal fibroblasts using fibrillin-specific antibodies showed only normal sized fibrillin protein. However, immunohistochemical studies of the patient`s tissue and fibroblasts showed markedly lowered levels in staining of microfibrillar structures compared with age-matched controls. This low level of expression of the protein affected in Marfan syndrome in a patient with such severe clinical manifestations is surprising since current understanding would suggest that this molecular phenotype should lead to a mild clinical disorder.

  11. Sociodemographic factors affecting the quality of life of patients with asthma

    Directory of Open Access Journals (Sweden)

    Uchmanowicz B

    2016-03-01

    Full Text Available Bartosz Uchmanowicz,1 Bernard Panaszek,2 Izabella Uchmanowicz,1 Joanna Rosinczuk3 1Department of Clinical Nursing, 2Department and Clinic of Internal Diseases, Geriatry and Allergology, 3Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland Background: In recent years, there has been an increased interest in the subjective quality of life (QoL of patients with bronchial asthma. Patients diagnosed with asthma experience a number of problems with regard to everyday activities and functions, which adversely affects their health-related QoL. Aim: The aim of this study is to analyze the sociodemographic factors affecting the QoL of patients with asthma. Patients and methods: The study comprised of 100 patients (73 females and 27 males aged 18–84 years (mean age 45.7 years treated in the Department and Clinic of Internal Diseases, Geriatrics and Allergology, Wroclaw Medical University. All patients with asthma who met the inclusion criteria participated in the study. We used medical record analysis and two questionnaires: the asthma quality of life questionnaire (AQLQ and the asthma control test. Up-to-date sociodemographic data were collected from all participants, including sex, age, marital status, education, and sources of income. Results: The sociodemographic variables that correlated positively with QoL in all domains of the AQLQ were professional activity and higher education level of respondents. Factors that negatively influenced the AQLQ domains were older age and lack of professional activity. Conclusion: This study shows that age, physical work, and lack of professional activity decreased the QoL in this patient group. It was found that higher education contributes to better QoL scores. Keywords: bronchial asthma, health related quality of life, sociodemographic factors

  12. I219V polymorphism in hMLH1 gene in patients affected with ulcerative colitis.

    Science.gov (United States)

    Vietri, Maria Teresa; Riegler, Gabriele; De Paola, Marialaura; Simeone, Serena; Boggia, Maria; Improta, Alessia; Parisi, Mariarita; Molinari, Anna Maria; Cioffi, Michele

    2009-04-01

    hMLH1 gene, lying on chromosome 3p21-23, is a key factor of the mismatch repair (MMR) complex, which amends DNA replication errors. MMR alterations are involved in the development of both hereditary and sporadic forms of colorectal carcinoma related to ulcerative colitis (UC). I219V Polymorphism is located on exon 8 of hMLH1 and provides an aminoacidic substitution of isoleucine to valine, on the protein codon 219. This may affect the speed and fidelity of protein synthesis because of a tRNA paucity or changes in the mRNA secondary structure. Most of the hereditary nonpolyposis colon cancer-associated missense mutations of hMLH1 cause structural changes of the amino- or carboxy-terminal regions, involving the domains that interact with ATP and hPMS2. In this study, we analyzed the hMLH1 I219V polymorphism frequency in colectomized patients with UC. Venous blood from 100 ulcerative patients and 97 apparently healthy subjects has been collected. Out of 100 patients affected with UC, 75 noncolectomized showed an alternating course of disease, while 25 did not respond to the common drugs, and underwent colectomy. Genotyping was performed by polymerase chain reaction and following enzymatic digestion by BccI. No significant differences were found between patients with UC and controls both for genotype and allele frequencies. However, our data show a significant association when colectomized and noncolectomized patients are compared. The frequencies of G homozygosity were 28% in colectomized and 10.7% in noncolectomized patients (p < 0.05, chi(2) = 4.4, Odds ratio = 3.3). The allele frequencies of allele A were 52% in colectomized and 68% in noncolectomized patients; while those of allele G were 48% and 32%, respectively. I219V polymorphism in hMLH1 could influence the clinical course of the disease and lead to resistance to therapy.

  13. Does the Age of Donor Kidneys Affect Nocturnal Polyuria in Patients With Successful Real Transplantation?

    Science.gov (United States)

    Mitsui, T; Morita, K; Iwami, D; Kitta, T; Kanno, Y; Moriya, K; Takeda, M; Shinohara, N

    We investigated whether the age of donor kidneys influences the incidence of nocturnal polyuria in patients with successful renal transplantation (RTX). Eighty-five patients (45 men and 40 women) undergoing RTX (median age, 47 years) were included in this study. Twenty-four-hour bladder diaries were kept for 3 days, and nocturnal polyuria was defined as a nocturnal polyuria index (nocturnal urine volume/24-hour urine volume) of >0.33. Risk factors for nocturnal polyuria were analyzed in patients with RTX by means of the Mann-Whitney U test, χ 2 test, and a logistic regression analysis. End-stage renal disease (ESRD) developed from diabetes mellitus in 16 patients (19%). Sixty-five patients (76%) received pre-transplant dialysis, with a median duration of 5 years. The median serum creatinine level and body mass index at the most recent visit were 1.2 mg/dL and 21.2 kg/m 2 , respectively. On the basis of the 24-hour bladder diaries, nocturnal polyuria was identified in 48 patients (56%). A logistic regression analysis revealed that diabetes mellitus as the original disease for ESRD was the only risk factor for nocturnal polyuria (odds ratio, 8.95; 95% confidence interval, 2.01-65.3; P = .0028). The age of donor kidneys at examination did not affect the incidence of nocturnal polyuria (P = .9402). Nocturnal polyuria was not uncommon in patients with successful RTX. Diabetes mellitus as the original disease for ESRD was the only risk factor for nocturnal polyuria, whereas the age of donor kidneys at examination did not affect the incidence of nocturnal polyuria. Thus, nocturnal polyuria is caused by recipient factors but not donor factors. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. A Non-randomized Controlled Trial of EMDR on Affective Symptoms in Patients With Glioblastoma Multiforme

    Directory of Open Access Journals (Sweden)

    Monika Szpringer

    2018-05-01

    Full Text Available Glioblastoma multiforme (GBM is a highly aggressive brain cancer and its survival after diagnosis is less than 2 years. Therefore, GBM patients are especially prone to co-occurring psychological conditions such as anxiety and depressive disorders. Furthermore, aggressive medical therapies affect patients’ lives, undermining their sense of meaning and coherence. The main aim of this study was to determine the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR therapy on anxiety, depression and sense of coherence in patients with GBM. Thirty-seven GBM-diagnosed women were included in this trial and received standard medical care. Of those, 18 patients were treated during 4 months with 10–12 individual EMDR sessions (60–90 minutes each. Nineteen GBM patients were used as a non-randomized control group as they consented to psychological evaluations but not to a psychotherapeutic intervention. The groups were homogeneous in terms of gender, age, educational level and treatment, but not in anxiety and depressive levels at baseline. All patients were evaluated at baseline, after treatment (4 months and at follow-up (further 4 months by the Hospital Anxiety and Depression Scale (HADS-M and the Sense of Coherence Scale (SOC-29. Caregivers in both groups were interviewed by the Patient Caregiver Questionnaire after 4 months follow-up. Statistical analyses were conducted using ANOVA statistics, correlation and regression analysis. Results showed a statistically significant decrease in the EMDR group in anxiety, depression and anger, when compared to the experimental group. EMDR therapy also had a positive impact upon the sense of coherence level in the experimental group, whereas in the control group this declined. Finally, the caregivers reported beneficial outcomes of the EMDR therapy with less anxiety- and anger-related behaviors in patients in the experimental group compared to the control group. This study is the first to show

  15. Do windows or natural views affect outcomes or costs among patients in ICUs?

    Science.gov (United States)

    Kohn, Rachel; Harhay, Michael O; Cooney, Elizabeth; Small, Dylan S; Halpern, Scott D

    2013-07-01

    To determine whether potential exposure to natural light via windows or to more pleasing views through windows affects outcomes or costs among critically ill patients. Retrospective cohort study. An academic hospital in Philadelphia, PA. Six thousand one hundred thirty-eight patients admitted to a 24-bed medical ICU and 6,631 patients admitted to a 24-bed surgical ICU from July 1, 2006, to June 30, 2010. Assignment to medical ICU rooms with vs. without windows and to surgical ICU rooms with natural vs. industrial views based on bed availability. In primary analyses adjusting for patient characteristics, medical ICU patients admitted to rooms with (n = 4,093) versus without (n = 2,243) windows did not differ in rates of ICU (p = 0.25) or in-hospital (p = 0.94) mortality, ICU readmissions (p = 0.37), or delirium (p = 0.56). Surgical ICU patients admitted to rooms with natural (n = 3,072) versus industrial (n = 3,588) views experienced slightly shorter ICU lengths of stay and slightly lower variable costs. Instrumental variable analyses based on initial bed assignment and exposure time did not show any differences in any outcomes in either the medical ICU or surgical ICU cohorts, and none of the differences noted in primary analyses remained statistically significant when adjusting for multiple comparisons. In a prespecified subgroup analysis among patients with ICU length of stay greater than 72 hours, MICU windows were associated with reduced ICU (p = 0.02) and hospital mortality (p = 0.04); these results did not meet criteria for significance after adjustment for multiple comparisons. ICU rooms with windows or natural views do not improve outcomes or reduce costs of in-hospital care for general populations of medical and surgical ICU patients. Future work is needed to determine whether targeting light from windows directly toward patients influences outcomes and to explore these effects in patients at high risk for adverse outcomes.

  16. Detection of total hip prostheses at airport security checkpoints: how has heightened security affected patients?

    Science.gov (United States)

    Johnson, Aaron J; Naziri, Qais; Hooper, Hasan A; Mont, Michael A

    2012-04-04

    The sensitivity of airport security screening measures has increased substantially during the past decade, but few reports have examined how this affects patients who have undergone hip arthroplasty. The purpose of this study was to determine the experiences of patients who had hip prostheses and who passed through airport security screenings. A consecutive series of 250 patients who presented to the office of a high-volume surgeon were asked whether they had had a hip prosthesis for at least one year and, if so, whether they had flown on a commercial airline within the past year. Patients who responded affirmatively to both questions were asked to complete a written survey that included questions about which joint(s) had been replaced, the number of encounters with airport security, the frequency and location of metal detector activation, any additional screening procedures that were utilized, whether security officials requested documentation regarding the prosthesis, the degree of inconvenience, and other relevant information. Of the 143 patients with hip replacements who traveled by air, 120 (84%) reported triggering the alarm and required wanding with a handheld detector. Twenty-five of these patients reported subsequently having to undergo further inspection, including additional wanding, being patted down, and in two cases having to undress in a private room to show the incision. Ninety-nine (69%) of the 143 patients reported that the prosthetic joint caused an inconvenience while traveling. This study provides interesting and critical information that allows physicians to understand the real-world implications of implanted orthopaedic devices for patients who are traveling where there has been heightened security since September 11, 2001. Patients should be counseled that they should expect delays and be prepared for such inconveniences, but that these are often only momentary. This information could relieve some anxiety and concerns that patients may have

  17. Clinical and cognitive factors affecting psychosocial functioning in remitted patients with bipolar disorder.

    Science.gov (United States)

    Konstantakopoulos, G; Ioannidi, N; Typaldou, M; Sakkas, D; Oulis, P

    2016-01-01

    Impaired interpersonal, social, and occupational functioning is very often observed in patients with bipolar disorder, not only at the acute stages of the illness but in remission as well. This finding raises the question of multiple factors that might affect psychosocial functioning in bipolar patients, such as residual subsyndromal symptoms and neuropsychological deficits. Social cognition impairment, especially impaired Theory of Mind (ToM), might also play an important role in bipolar patients' every-day functioning, similarly to what was found in patients with schizophrenia. The present study aimed to investigate the potential effect of clinical and cognitive factors on the psychosocial functioning of patients with bipolar disorder during remission, assessing ToM along with a broad range of basic cognitive functions. Forty-nine patients with bipolar disorder type I in remission and 53 healthy participants were assessed in general intelligence, working memory, attention, speed processing, verbal learning and memory, and executive functions using a comprehensive battery of neuropsychological tests. The Faux Pas Recognition Test was used to assess ToM. The two groups were matched for gender, age and education level. The Hamilton Rating Scale for Depression (HDRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS) were also administered to the patients. Every-day functioning was assessed with the Global Assessment of Functioning (GAF). In order to examine the contribution of many factors in psychosocial functioning, we used hierarchical multiple regression analysis. Bipolar patients presented significant impairment compared to healthy participants in all the basic cognitive functions tested with the exception of verbal memory. Moreover, patients had significant poorer performance than healthy controls in overall psyand cognitive ToM but not in affective ToM as measured by Faux Pas. Psychosocial functioning in patient group was

  18. [Cortical Release Signs in Patients with Schizophrenia, Depressive Disorders, and Bipolar Affective Disorder].

    Science.gov (United States)

    de la Espriella, Ricardo Andrés; Hernández, José Fernando; Espejo, Lina María

    2013-12-01

    Determining the presence of cortical release signs associated with white matter damage, is a clinically easy method to perform. The objective of this study is to determine the presence of cortical release signs in patients with mental illnesses and cerebrovascular disease, as well as its clinical usefulness, given that it indicates cortical damage. A review was made of cortical release signs in patients hospitalized in clinical psychiatry and general hospitals with bipolar affective disorder (40), depression (37), schizophrenia (33), cardiovascular disease (33) and dementia (37). The signs of cortical release do not have the same importance as cortical damage. For example, the glabellar reflex was found in all the groups, that of paratonia, particularly in the group with schizophrenia, and others signs in the group of patients with dementia. It is suggested that these signs imply subcortical white matter damage. The appearance of these signs shows the need for a follow up of patients diagnosed with bipolar affective disorder, depression and schizophrenia. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  19. Factors Affecting Quality of Life of the Homebound Elderly Hemiparetic Stroke Patients

    Science.gov (United States)

    Takemasa, Seiichi; Nakagoshi, Ryoma; Murakami, Masahito; Uesugi, Masayuki; Inoue, Yuri; Gotou, Makoto; Koeda, Hideki; Naruse, Susumu

    2014-01-01

    [Purpose] This study examined the quality of life (QOL) of homebound elderly hemiparetic stroke patients and factors that affect it. [Subjects] The subjects of the study were 21 homebound elderly hemiparetic stroke patients who were 65 years old or over and required care for daily living (12 males and 9 females, average age: 79.3 ± 8.4 years old). Their physical and psychological conditions, QOL, and other characteristics were researched. [Methods] The Functional Independence Measure (FIM) was used for the activities of daily living (ADL) assessment, and the MOS 36-Item Short-Form Health Survey (SF-36, Japanese version 1.2) was used for the QOL assessment. [Results] No correlations were observed between the QOL of homebound elderly hemiparetic stroke patients and their age and gender. However, the results showed that their QOL was affected by their independence in ADL, bedridden degree, and care-need level. [Conclusion] These results suggest that in order to improve the QOL of homebound elderly hemiparetic stroke patients, ongoing rehabilitation to improve independence in ADL and lower the bedridden degree and care-need level is required. PMID:24648653

  20. [Factors affecting residual stones after percutaneous nephrolithotomy in patients with renal calculus].

    Science.gov (United States)

    Qiao, Mingzhou; Zhang, Haifang; Zhou, Chenlong

    2015-11-24

    To explore the factors affecting the residual stones after percutaneous nephrolithotomy (PCNL) in patients with renal calculus. A retrospective analysis was performed for 1 200 patients who were affected by renal calculus and treated with PCNL between Jan 2008 and May 2014 in People's Hospital of Anyang City. Among those patients, 16 were diagnosed as bilateral renal stone and had two successive operations. The size, location and number of stones, previous history of surgery, the degree of hydronephrosis, urinary infection were included in the univariate analysis. Significant factors in univariate analysis were included in the multivariate analysis to determine factors affecting stone residual. A total of 385 cases developed stone residual after surgery. The overall residual rate was 31.7%. In univariate analysis, renal pelvis combined with caliceal calculus (P=0.006), stone size larger than 4 cm (P=0.005), stone number more than 4 (P=0.002), the amount of bleeding more than 200 ml (P=0.025), operation time longer than 120 minutes (P=0.028) were associated with an increased rate of stone residual. When subjected to the Cox multivariate analysis, the independent risk factors for residual stones were renal pelvis combined with caliceal calculus (P=0.049), stone size larger than 4 cm (P=0.038) and stone number more than 4 (P=0.018). Factors affecting the incidence of residual stones after PCNL are the size, location and number of stones. Larger size stone and the presence of renal pelvis combined with caliceal calculus are significantly associated with residual stones. Nevertheless, stone number less than 4 indicates an increased stone clearance rate.

  1. Phytosterol supplementation does not affect plasma antioxidant capacity in patients with metabolic syndrome.

    Science.gov (United States)

    Sialvera, Theodora-Eirini; Koutelidakis, Antonios E; Richter, Dimitris J; Yfanti, Georgia; Kapsokefalou, Maria; Micha, Renata; Goumas, Giorgos; Diamantopoulos, Emmanouil; Zampelas, Antonis

    2013-02-01

    Several studies have observed decreased levels of lipophilic antioxidants after supplementation with phytosterols and stanols. The aim of this study was to examine the effect of phytosterol supplementation on plasma total antioxidant capacity in patients with metabolic syndrome. In a parallel arm, randomized placebo-controlled design, 108 patients with metabolic syndrome were assigned to consume yogurt beverage which provided 4 g of phytosterols per day or yogurt beverage without phytosterols. The duration of the study was 2 months and the patients in both groups followed their habitual westernized type diet. Blood samples were drawn at baseline and after 2 months, and the total antioxidant capacity of plasma was measured using the ferric reducing antioxidant power of plasma and oxygen radical absorbance capacity assays. After 2 months of intervention, plasma total antioxidant capacity did not differ between and within the intervention and the control groups. Phytosterol supplementation does not affect plasma antioxidant status.

  2. Sexual behavior in a cohort of patient affected by fibromyalgia and/or vulvodynia

    Directory of Open Access Journals (Sweden)

    Anna Ghizzani

    2015-08-01

    Full Text Available Fibromyalgia, characterized by widespread musculoskeletal pain, negatively impacts sexuality by provoking dispareunia, and loss of desire and of dyadic gratification. Chronic pain syndromes tend to associate and FM women have a higher probability to develop vulvodynia than women not affected by fibromyalgia. Vulvodynia, characterized by burning pain that interferes with sexual penetration, is classified as Genitopelvic/Penetration Disorders in DSM 5. The association between Fibromyalgia and vulvodynia is difficult to recognize because patients tend to attribute all symptoms to disease spread and not think that dyspareunia may have different origins. To establish the necessary criteria for the differential diagnosis between the two syndromes, we evaluated the characteristics of dyspareunia and sexual behavior of fibromyalgia patients versus vulvodynia patients and we found significant differences on the onset of burning pain, orgasmic capability, and sexual frequency.

  3. Increased risk of developing stroke for patients with major affective disorder--a registry study

    DEFF Research Database (Denmark)

    Nilsson, Flemming M; Kessing, Lars V

    2004-01-01

    and cerebrovascular diseases in hospitalised patients. The main finding of this study was that patients with depression severe enough to be hospitalised, seem to be at an increased risk of developing cerebrovascular disease. The hazard ratio of getting a diagnosis of stroke after initially having been discharged......Only a few studies have evaluated depressive disorder as a risk factor for cerebrovascular disease. In a hospital discharge register with nation-wide coverage of all hospitals in Denmark we used linkage between the somatic and psychiatric registries to study comorbidity between affective disorders...... with a diagnosis of depression was found to be 1.22 (95% Confidence Interval: 1.06-1.41). In the group of patients with manic/bipolar disorder no association was found concerning development of stroke. In elderly with first time depression admitted to hospital, neurological disorders should be carefully evaluated...

  4. Factors affecting the dental erosion severity of patients with eating disorders.

    Science.gov (United States)

    Otsu, Mitsuhiro; Hamura, Akira; Ishikawa, Yuiko; Karibe, Hiroyuki; Ichijyo, Tomoyasu; Yoshinaga, Yoko

    2014-01-01

    Intraoral disease is a common occurrence in patients with eating disorders, particularly dental erosion, which frequently becomes severe and may hinder daily life. The severity varies from patient to patient. Understanding the underlying mechanisms may help prevent dental erosion in these patients. Accordingly, we investigated the relationship between the severity of erosion and the behavior of patients with eating disorders, with a focus on daily diet and vomiting behavior. A total 71 female eating disorder outpatients from the Clinical Center of Psychosomatic Dentistry of Nippon Dental University Hospital and the Psychosomatic Internal Medicine Department of Kudanzaka Hospital or who were hospitalized at Hasegawa Hospital were enrolled. Dental erosion severity and location were determined by oral examination. Patients who induced vomiting were queried on their behavior during vomiting and on routine diet habits. Patients with dental erosion were further divided into mild and severe groups based on the lesion severity and the groups compared. Dental erosion was observed in 43 of 50 subjects who induced vomiting. Dental erosion was most frequent on the palatal side of the anterior maxillary teeth, occurring in 81.3% of the subjects. There were significant differences observed between the mild and severe groups according to post-vomiting oral hygiene. Significantly more subjects in the mild group consumed large amounts of water before vomiting, and significantly more subjects in the severe group routinely consumed carbonated beverages or sweetened food. While self-induced vomiting is the main cause of dental erosion in eating disorder patients, the erosion severity may be affected by behavior when inducing vomiting or by routine consumption of certain foods and beverages. Addressing these factors may help prevent severe dental erosion in patients who chronically induce vomiting.

  5. Evaluation of Clinical Gait Analysis parameters in patients affected by Multiple Sclerosis: Analysis of kinematics.

    Science.gov (United States)

    Severini, Giacomo; Manca, Mario; Ferraresi, Giovanni; Caniatti, Luisa Maria; Cosma, Michela; Baldasso, Francesco; Straudi, Sofia; Morelli, Monica; Basaglia, Nino

    2017-06-01

    Clinical Gait Analysis is commonly used to evaluate specific gait characteristics of patients affected by Multiple Sclerosis. The aim of this report is to present a retrospective cross-sectional analysis of the changes in Clinical Gait Analysis parameters in patients affected by Multiple Sclerosis. In this study a sample of 51 patients with different levels of disability (Expanded Disability Status Scale 2-6.5) was analyzed. We extracted a set of 52 parameters from the Clinical Gait Analysis of each patient and used statistical analysis and linear regression to assess differences among several groups of subjects stratified according to the Expanded Disability Status Scale and 6-Minutes Walking Test. The impact of assistive devices (e.g. canes and crutches) on the kinematics was also assessed in a subsample of patients. Subjects showed decreased range of motion at hip, knee and ankle that translated in increased pelvic tilt and hiking. Comparison between the two stratifications showed that gait speed during 6-Minutes Walking Test is better at discriminating patients' kinematics with respect to Expanded Disability Status Scale. Assistive devices were shown not to significantly impact gait kinematics and the Clinical Gait Analysis parameters analyzed. We were able to characterize disability-related trends in gait kinematics. The results presented in this report provide a small atlas of the changes in gait characteristics associated with different disability levels in the Multiple Sclerosis population. This information could be used to effectively track the progression of MS and the effect of different therapies. Copyright © 2017. Published by Elsevier Ltd.

  6. Investigation into the use of complementary and alternative medicine and affecting factors in Turkish asthmatic patients.

    Science.gov (United States)

    Tokem, Yasemin; Aytemur, Zeynep Ayfer; Yildirim, Yasemin; Fadiloglu, Cicek

    2012-03-01

    The purpose of this study was to examine the frequency of complementary and alternative medicine usage in asthmatic patients living in the west of Turkey, the most frequently used complementary and alternative medicine methods and socio-demographic factors affecting this and factors related to the disease. While the rate of complementary and alternative medicine usage in asthmatic patients and the reasons for using it vary, practices specific to different countries and regions are of interest. Differing cultural and social factors even in geographically similar regions can affect the type of complementary and alternative medicine used. Two hundred asthmatic patients registered in the asthma outpatient clinic of a large hospital in Turkey and who had undergone pulmonary function tests within the previous six months were included in this study, which was planned according to a descriptive design. The patients filled out a questionnaire on their demographic characteristics and complementary and alternative medicine usage. The proportion of patients who reported using one or more of the complementary and alternative medicine methods was 63·0%. Of these patients, 61·9% were using plants and herbal treatments, 53·2% were doing exercises and 36·5% said that they prayed. The objectives of their use of complementary and alternative medicine were to reduce asthma-related complaints (58%) and to feel better (37·8%). The proportion of people experiencing adverse effects was 3·3% (n = 4). Factors motivating asthmatic patients to use complementary and alternative medicine were the existence of comorbid diseases and a long period since diagnosis (p complementary and alternative medicine and the severity of the disease, pulmonary function test parameters, the number of asthma attacks or hospitalisations because of asthma within the last year (p > 0·05). Understanding by nurses of the causes and patterns of the use of complementary and alternative medicine in asthmatic

  7. Successful neuropsychological rehabilitation in a patient with Cerebellar Cognitive Affective Syndrome.

    Science.gov (United States)

    Ruffieux, N; Colombo, F; Gentaz, E; Annoni, J-M; Chouiter, L; Roulin Hefti, S; Ruffieux, A; Bihl, T

    2017-01-01

    The objective of this case study was to describe the neuropsychological rehabilitation of a 16-year-old patient who presented a Cerebellar Cognitive Affective Syndrome (CCAS) following a bilateral cerebellar hemorrhage. The patient presented severe and diffuse cognitive deficits, massive behavioral disorders, and emotion regulation difficulties. The cognitive rehabilitation was performed in the chronic phase (one year after the onset of the hemorrhage) using a transdisciplinary neurobehavioral approach based on the patient's favorite interest (soccer). A significant behavioral and cognitive improvement was observed. The patient became progressively independent in all activities of daily living and was discharged home. The Functional Independence Measure at discharge was 124/126 (vs. 37/126 at entry). The patient was able to complete his schooling despite the mild cognitive and behavioral sequelae. This first description of the use of neurobehavioral therapy in a case of chronic CCAS suggests that (a) major clinical improvement can occur more than one year after the onset of the CCAS, showing the importance of long-term and intensive neurorehabilitation; and (b) when the cerebellum cannot properly play its regulator role in cognition, neuropsychological intervention through a behavioral and cognitive approach can be of great help by acting as an external modulator to help the patient regain control over himself.

  8. Factors Affecting Health Related Quality of Life in Hospitalized Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Georgia Audi

    2017-01-01

    Full Text Available This study identified factors affecting health related quality of life (HRQOL in 300 hospitalized patients with heart failure (HF. Data were collected by the completion of a questionnaire which included patients’ characteristics and the Minnesota Living with Heart Failure Questionnaire (MLHFQ. Analysis of data showed that the median of the total score of MLHFQ was 46 and the median of the physical and mental state was 22 and 6, respectively. Also, participants who were householders or had “other” professions had lower score of 17 points and therefore better quality of life compared to patients who were civil/private employees (p<0.001 and p<0.001, resp.. Patients not receiving anxiolytics and antidepressants had lower quality of life scores of 6 and 15.5 points, respectively, compared to patients who received (p=0.003 and p<0.001, resp.. Patients with no prior hospitalization had lower score of 7 points compared to those with prior hospitalization (p=0.002, whereas patients not retired due to the disease had higher score of 7 points (p=0.034. Similar results were observed for the physical and mental state. Improvement of HF patients’ quality of life should come to the forefront of clinical practice.

  9. [The possibility of acute inflammatory reaction affects the development of pressure ulcers in bedridden elderly patients].

    Science.gov (United States)

    Matsuyama, N; Takano, K; Mashiko, T; Jimbo, S; Shimetani, N; Ohtani, H

    1999-11-01

    To test the hypothesis that acute inflammatory reaction associates with the development of pressure ulcers in bedridden elderly patients, 40 hospitalized elderly patients suffering from bacterial pneumonia, cerebrovascular disease, and femoral bone fracture were enrolled in this study. All of them were divided into two groups with pressure ulcers (group P; 17 patients) and without one (group N; 23 patients). The blood samples were taken from them within 5 days after the patients being bedridden. Although no significant difference exist in pressure ulcer risk factors (age, gender, Braden scale, underlying diseases, blood pressure, and heart rate) between the two groups, white blood cell, plasma C-reactive protein and fibrinogen in group P increased significantly as compared with those in group N. Besides number of platelets and maximum platelet aggregation rate were significantly higher in group P than in group N. Serum albumin and hemoglobin of both groups decreased after being bedridden, especially hemoglobin in group P was significantly lower than that in group N. While the concentration of serum IL-6 did not indicate a significant difference between both the groups, serum IL-1 beta increased significantly in group P. In conclusion, we suggested that acute inflammatory reaction releasing proinflammatory cytokines affected the development of pressure ulcer in bedridden elderly patients.

  10. Emotion Risk-Factor in Patients With Cardiac Diseases: The Role of Cognitive Emotion Regulation Strategies, Positive Affect and Negative Affect (A Case-Control Study)

    Science.gov (United States)

    Bahremand, Mostafa; Alikhani, Mostafa; Zakiei, Ali; Janjani, Parisa; Aghaei, Abbas

    2016-01-01

    Application of psychological interventions is essential in classic treatments for patient with cardiac diseases. The present study compared cognitive emotion regulation strategies, positive affect, and negative affect for cardiac patients with healthy subjects. This study was a case-control study. Fifty subjects were selected using convenient sampling method from cardiac (coronary artery disease) patients presenting in Imam Ali medical center of Kermanshah, Iran in the spring 2013. Fifty subjects accompanied the patients to the medical center, selected as control group, did not have any history of cardiac diseases. For collecting data, the cognitive emotion regulation questionnaire and positive and negative affect scales were used. For data analysis, multivariate analysis of variance (MANOVA) was applied using the SPSS statistical software (ver. 19.0). In all cognitive emotion regulation strategies, there was a significant difference between the two groups. A significant difference was also detected regarding positive affect between the two groups, but no significant difference was found regarding negative affect. We found as a result that, having poor emotion regulation strategies is a risk factor for developing heart diseases. PMID:26234976

  11. Emotion Risk-Factor in Patients with Cardiac Diseases: The Role of Cognitive Emotion Regulation Strategies, Positive Affect and Negative Affect (A Case-Control Study).

    Science.gov (United States)

    Bahremand, Mostafa; Alikhani, Mostafa; Zakiei, Ali; Janjani, Parisa; Aghei, Abbas

    2015-05-17

    Application of psychological interventions is essential in classic treatments for patient with cardiac diseases. The present study compared cognitive emotion regulation strategies, positive affect, and negative affect for cardiac patients with healthy subjects. This study was a case-control study. Fifty subjects were selected using convenient sampling method from cardiac (coronary artery disease) patients presenting in Imam Ali medical center of Kermanshah, Iran in the spring 2013. Fifty subjects accompanied the patients to the medical center, selected as control group, did not have any history of cardiac diseases. For collecting data, the cognitive emotion regulation questionnaire and positive and negative affect scales were used. For data analysis, multivariate analysis of variance (MANOVA) Was applied using the SPSS statistical software (ver. 19.0). In all cognitive emotion regulation strategies, there was a significant difference between the two groups. A significant difference was also detected regarding positive affect between the two groups, but no significant difference was found regarding negative affect. We found as a result that, having poor emotion regulation strategies is a risk factor for developing heart diseases.

  12. Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use.

    Science.gov (United States)

    Wilson, Michael P; Brennan, Jesse J; Modesti, Lucia; Deen, James; Anderson, Laura; Vilke, Gary M; Castillo, Edward M

    2015-04-01

    Psychiatric patients experience longer treatment times (length of stay [LOS]) in the emergency department (ED) compared to nonpsychiatric patients. Although patients on involuntary mental health holds are relatively understudied, common wisdom would hold that times for these patients can only be affected by addressing systems issues because they are not free to leave. The objective of this study was to determine whether both selected ED and patient-specific factors were associated with longer LOS. We hypothesized that nonmodifiable factors (age, sex, agitation, presentation during evenings/nights, presentation during weekends, suicidal ideation) would prolong LOS but that potentially modifiable factors (such as use of medication) would reduce LOS. A historical cohort of patients (January 1, 2009-August 16, 2010) placed on involuntary mental health holds was studied in 2 general EDs. A regression model was used to calculate the effects of modifiable and nonmodifiable factors on LOS. Six hundred forty patient visits met all inclusion/exclusion criteria. Longer LOSs were significantly associated with suicidal ideation, use of antipsychotics, and use of benzodiazepines, although agitation did not predict longer LOSs. Longer LOSs were also longer with presentation on the weekends. Lengths of stay for patients on involuntary mental health holds are associated with several factors outside the control of the typical ED clinician such as the ability to clear holds quickly due to day of week or placement of the hold for suicidal ideation. Lengths of stay are also increased by factors within the control of the typical ED clinician, such as administration of calming medication. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Pedersen, Susanne S.; Erdman, Ruud A M

    2009-01-01

    We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents.......We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents....

  14. Qualitative analysis of interviews of future non-affective psychotic disorder patients and non-psychiatric controls: preliminary results

    Directory of Open Access Journals (Sweden)

    Katya Rubinstein

    2014-03-01

    Conclusions: The findings of this unique historical-prospective qualitative analysis of interviews performed before the onset of psychosis, confirmed previous findings of premorbid abnormality of future non-affective psychosis patients. Using qualitative analysis enabled obtaining a more in-depth understanding of the real-life experience of the premorbid period among patients with non-affective psychotic disorders.

  15. Influenza and Pneumonia Vaccination Rates and Factors Affecting Vaccination among Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Ülkü Aka Aktürk

    2017-06-01

    Full Text Available Background: Influenza and pneumococcal vaccinations are recommended in chronic obstructive pulmonary disease patients to decrease associated risks at all stages. Although the prevalence of chronic obstructive pulmonary disease is high in our country, as previously reported, vaccination rates are low. Aims: To assess the vaccination rates of chronic obstructive pulmonary disease patients and factors that may affect these. Study Design: Multi-centre cross-sectional study. Methods: Patients admitted to the chest diseases clinics of six different centres between 1 February 2013 and 1 January 2014 with a pre-diagnosis of Chronic obstructive pulmonary disease according to the Global initiative for chronic obstructive lung disease criteria, who were in a stable condition were included in the study. The survey, which included demographic characteristics, socio-economic status, severity of disease and vaccination information, was first tested on a small patient population before the study. The survey was completed by the investigators after obtaining written informed consent. Results: The average age of the 296 included patients was 66.3±9.3 years and 91.9% were male. Of these, 36.5% had the influenza vaccination and 14.1% had the pneumococcal vaccination. The most common reason for not being vaccinated was ‘no recommendation by doctors’: 57.2% in the case of influenza vaccinations, and 46.8% in the case of pneumococcal vaccinations. Both vaccination rates were significantly higher in those patients with comorbidities (influenza vaccination p0.05. Vaccination rates were significantly higher in those with a white-collar occupation and higher education level, and who presented to a university hospital (p<0.001. Conclusion: Medical professionals do not request vaccinations as often as the International Guidelines suggest for chronic obstructive pulmonary disease patients. Awareness of the importance of these vaccinations among both doctors and patients

  16. Influencing factors affecting the retinal blood vessel morphology in patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Xiao-Lu Kong

    2017-03-01

    Full Text Available AIM: To analyze the influencing factors affecting retinal blood vessel morphology in patients with diabetes mellitus. METHODS: Totally 312 patients with type 2 diabetes mellitus in our hospital from January 2012 to September 2016 were selected as study subjects. The patients were examined by fundus photography and related laboratory. As grouping factors in the patients'age, sex, disease duration, smoking, drinking, hypertension, hyperlipidemia or diabetic nephropathy, we compared the incidence of retinal vascular changes in different groups. The meaningful factors were introduced into the Logistic regression equation again. Independent risk factors for retinal vascular changes in patients with diabetes mellitus were screened out. RESULTS:In 312 cases of patients with type 2 diabetes mellitus,169 cases were accompanied with retinal vascular abnormalities, and 143 cases were not associated with retinal vascular abnormalities. Univariate analysis showed that age, duration of disease, hypertension, hyperlipidemia or diabetes nephropathy were significantly correlated with retinal vascular morphological changes(PP>0.05. Retinal vascular abnormalities were used as the dependent variable, and the above mentioned factors were grouped as independent variables. By Logistic stepwise regression analysis showed that the course of disease, patients with hypertension or diabetic nephropathy were the independent risk factors of abnormal retinal vascular morphology(PCONCLUSION: The independent risk factors for the occurrence of retinal vascular changes in patients with diabetes mellitus are increased course of disease, hypertension or diabetic nephropathy. Early diagnosis and intervention, to take measures and control blood pressure, reduce kidney damage can reduce the incidence of diabetic retinopathy, and macrovascular disease caused by diabetes, the incidence of adverse cardiovascular and cerebrovascular events.

  17. Visualization of nasal airflow patterns in a patient affected with atrophic rhinitis using particle image velocimetry

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, G J M [Hamner Institutes for Health Sciences, NC (United States); Mitchell, G [The Queens University of Belfast, Belfast (United Kingdom); Bailie, N [The Queens University of Belfast, Belfast (United Kingdom); Thornhill, D [The Queens University of Belfast, Belfast (United Kingdom); Watterson, J [The Queens University of Belfast, Belfast (United Kingdom); Kimbell, J S [Hamner Institutes for Health Sciences, NC (United States)

    2007-10-15

    The relationship between airflow patterns in the nasal cavity and nasal function is poorly understood. This paper reports an experimental study of the interplay between symptoms and airflow patterns in a patient affected with atrophic rhinitis. This pathology is characterized by mucosal dryness, fetor, progressive atrophy of anatomical structures, a spacious nasal cavity, and a paradoxical sensation of nasal congestion. A physical replica of the patient's nasal geometry was made and particle image velocimetry (PIV) was used to visualize and measure the flow field. The nasal replica was based on computed tomography (CT) scans of the patient and was built in three steps: three-dimensional reconstruction of the CT scans; rapid prototyping of a cast; and sacrificial use of the cast to form a model of the nasal passage in clear silicone. Flow patterns were measured by running a water-glycerol mixture through the replica and evaluating the displacement of particles dispersed in the liquid using PIV. The water-glycerol flow rate used corresponded to an air flow rate representative of a human breathing at rest. The trajectory of the flow observed in the left passage of the nose (more affected by atrophic rhinitis) differed markedly from what is considered normal, and was consistent with patterns of epithelial damage observed in cases of the condition. The data are also useful for validation of computational fluid dynamics predictions.

  18. Cognitive, Affective Problems and Renal Cross Ectopy in a Patient with 48,XXYY/47,XYY Syndrome

    Directory of Open Access Journals (Sweden)

    Sefa Resim

    2015-01-01

    Full Text Available Klinefelter syndrome is the most common sex chromosome abnormality (SCA in infertile patients and 47,XXY genomic configuration constitutes most of the cases. However, additional Xs and/or Y such as 48,XXYY, 48,XXXY, and 47,XYY can occur less frequently than 47,XXY. Those configurations were considered as variants of Klinefelter syndrome. In this report, we present an infertile man with tall stature and decreased testicular volume. Semen analysis and hormonal evaluation supported the diagnosis of nonobstructive azoospermia. Genetic investigation demonstrated an abnormal male karyotype with two X chromosomes and two Y chromosomes consistent with 48,XXYY(17/47,XYY (13. Additionally, the patient expressed cognitive and affective problems which were documented by psychomotor retardation and borderline intelligence measured by an IQ value between 70 and 80. Systemic evaluation also revealed cross ectopy and malrotation of the right kidney in the patient. The couple was referred to microtesticular sperm extraction (micro-TESE/intracytoplasmic sperm injection (ICSI cycles and preimplantation genetic diagnosis (PGD. To the best of our knowledge, this is the first report of combination of XYY and XXYY syndromes associated with cognitive, affective dysfunction and renal malrotation.

  19. Mechanical and Controlled PRP Injections in Patients Affected by Androgenetic Alopecia.

    Science.gov (United States)

    Gentile, Pietro; Garcovich, Simone; Scioli, Maria Giovanna; Bielli, Alessandra; Orlandi, Augusto; Cervelli, Valerio

    2018-01-27

    23 patients (18 male and 5 female) aged 21-70 years who displayed male pattern hair loss (MPHL) in Stage 1 to Stage 5 as determined by the Norwood-Hamilton classification scale, and female pattern hair loss (FPHL) in Stage 1 to Stage 2 as determined by the Ludwig classification scale, were treated with non-activated autologous platelet-rich plasma (A-PRP). Autologous blood (55 mL) was harvested using sodium citrate as an anticoagulant. A-PRP (23 mL) was produced for all cases using a closed system according to the transfusion service protocol. Following centrifugation (260 x g for 10 min) the A-PRP was inserted in a laser light selector device, and after the centrifugation, 9 mL of A-PRP was collected. The scalp of the patients affected by androgenetic alopecia (AGA) was divided into four areas (frontal, parietal, vertex, and occipital); local anesthesia was not performed. Interfollicular A-PRP injections (0.2 mL x cm 2 ) were performed by controlled and mechanical injections scheduled at a depth of 5 mm using a medical injector gun. Treatment sessions were performed with a 30-day interval. For each patient, three treatment sessions were performed. PRP was injected in the androgen-related areas of scalp affected by hair loss. Placebo (normal saline solution) was loaded in another syringe (10 mL) and injected on the adjacent side in a similar fashion.

  20. Factors Affecting the Success Rate of Percutaneous Nephrolithotomy in Paediatric Patients

    Directory of Open Access Journals (Sweden)

    Hikmat Jabrayilov

    2018-03-01

    Full Text Available In this study, we aimed to determine factors affecting the success rate of percutaneous nephrolithotomy (PNL in children. The series consisted of 41 consecutive children operated on by the same surgical team for renal calculi with PNL between June 2002 and May 2015 in our institution. A single calyx or pelvic stone was described as simple, while calculi located in more than one location (calyx and pelvis or more than one calices or staghorn stones were described as complex. The procedure was deemed successful if the patient was completely stone-free (SF or had residual fragments <4 mm. Thirty-four patients were found to be SF or had residual fragments <4 mm on the postoperative first day, thus the success rate was 82.9%. In complex stones, the success rate was significantly lower (45.5% than simple stones (96.7% (p < 0.001. The grade of hydronephrosis (Grade 0–1 vs. Grade 2–3 also had a negative impact on the success, with rates of 92.6% vs. 64.3%, respectively (p = 0.022. Previous urological procedure history on the same side yielded a success rate of 58.3%, whereas the success rate in the primary patients was 93.1% (p < 0.001. The localization of the stone (complex vs. simple, degree of hydronephrosis, and history of previous urological procedures were found to be the factors that affected the success of the paediatric PNL.

  1. Factors affecting reading speed in patients with diabetic macular edema treated with laser photocoagulation.

    Directory of Open Access Journals (Sweden)

    Elizabeth Pearce

    Full Text Available PURPOSE: To study the factors that may affect reading speed in patients with diabetic macular edema previously treated with laser photocoagulation. METHODS: Consecutive patients with type II diabetes treated with laser photocoagulation for diabetic macular edema (DME at least twelve months previously, with best corrected visual acuity of better than 65 letters (approximately 20/40 measured with Early Treatment Diabetic Retinopathy Study (ETDRS charts were included in this study. Patients previously treated with pan-retinal photocoagulation, vitrectomy, intravitreal steroid or anti-VEGF therapy were excluded. Any other ocular co-morbidities that may influence reading ability such as cataract, glaucoma or macular degeneration were also excluded. All patients were refracted by a certified examiner, the following measurements were collected: best corrected visual acuity (BCVA, contrast sensitivity with Pelli-Robson chart, reading speed with MNREAD chart, microperimetry with Nidek MP1, and central subfield thickness with Zeiss spectral domain optical coherent topography. RESULTS: The slow reading group had poorer contrast sensitivity (p = 0.001, reduced retinal sensitivity (p = 0.027 and less stable fixation (p = 0.013. Most interestingly the reduced retinal sensitivity findings were driven by the microperimetry value on the right subfield (p = 0.033, (nasal to the fovea in the right eye and temporal to the fovea in the left eye. Multiple linear regression analysis showed that contrast sensitivity is probably the most important factor that affects reading speed (p = 0.001. CONCLUSION: Reduced retinal sensitivity after laser treatment is associated with reduced reading speed in patients with diabetic macular edema.

  2. Factors affecting use of word-of-mouth by dental patients.

    Science.gov (United States)

    Jung, Yun-Sook; Yang, Hae-Young; Choi, Youn-Hee; Kim, Eun-Kyong; Jeong, Seong-Hwa; Cho, Min-Jeong; Nam, Soon-Hyeun; Song, Keun-Bae

    2018-03-23

    Word-of-mouth (WOM) refers to communication among consumers, which greatly influences the marketing strategies of dental clinics. This study aimed to explore factors that affect use of WOM by dental patients and to analyse their pathways. The participants were 520 outpatients from four private dental clinics. Data were obtained from a survey using self-reported questionnaires, which included questions regarding seven latent variables: five exogenous variables, including medical service quality (physical environment, customer service, patient relationship quality) and individual characteristic variables (opinion leader tendency, social hub tendency); and two endogenous variables (intention to recommend, WOM experience). Statistical analysis was performed using structural equation modelling. Significant associations were found in the pathways between relationship quality and intention to recommend, intention to recommend and WOM, and opinion leader tendency and WOM (P < 0.001). Higher patient relationship quality and higher intention to recommend were related to positive WOM, as was higher opinion leader tendency. Improving patient relationship quality can promote positive WOM for dental clinics. Strategies are needed to promote a positive perception of dental clinics by effectively responding to the views of patients with strong opinion leader tendencies. © 2018 FDI World Dental Federation.

  3. Time-dependent irisin concentration changes in patients affected by overt hypothyroidism.

    Science.gov (United States)

    Zybek-Kocik, Ariadna; Sawicka-Gutaj, Nadia; Wrotkowska, Elżbieta; Sowiński, Jerzy; Ruchała, Marek

    2016-01-01

    Irisin, a cleaved and secreted part of the transmembrane protein FNDC5, is a recently discovered adipo-myokine that is said to have a significant influence on body metabolism. Changes in thyrometabolic state may also alter the serum irisin level. Since already reported data are not fully consistent, the aim of the present research is to evaluate the time-dependent changes in serum irisin level in patients affected by overt hypothyroidism. The study involved 36 subjects - two groups of 12 patients with long-lasting (AITD) and short-term (TC) overt hypothyroidism, and a control group (CG) of 12 subjects, matched for age and gender. Serum irisin level, thyrometabolic state, creatine kinase (CK - muscle damage marker), glucose, and insulin concentration were assessed and compared between groups. The irisin level was significantly lower in AITD than in TC and CG (p = 0.02; p 0.05). There was no significant difference between free triiodothyronine and free thyroxine levels in AITD and TC patients (p > 0.05). CK concentration was significantly higher in AITD than in CG patients (p 0.05) as well as TC and CG patients (p > 0.05). Additionally, the CK level negatively correlated with the irisin level (r = -0.58; p hypothyroidism have lower irisin levels that those with short-term disorder. (Endokrynol Pol 2016; 67 (5): 476-480).

  4. Mapping the Factors Affecting Household Food Security of Tuberculosis Patients in Coastal Region of Surabaya

    Science.gov (United States)

    Susilaningrum, D.; Ulama, B. S. S.; Lathifah, R.

    2018-04-01

    Food security is a condition of a person who has access to adequate, safe, and nutritious food to meet the needs of a healthy life. Affordability of food is determined by the aggregate purchasing power. It is also can be measured by the amount of poverty in Indonesia which reached 28,07 million in 2014. According to data from the health department, the largest TB cases in Indonesia were in East Java Province and Surabaya accounted for the largest number, there are 48379 cases in 2015. This study mapping the factors that affect household food security of TB patients in the coastal areas of Surabaya. This study used secondary data sources from 11 clinics i.e. TB patient's addres and primary data source to survey patients about food security. Variables used in this study are variables related to socioeconomic factors and sanitary factors. Those variables will be analyzed descriptively and mapping using biplot analysis. Biplot generated based on socio-economic factors, sanitary factors, and status of households in 11 districts Surabaya that near the beach geographically. The result shows that 64% of TB patient households are food insecure than the left are food secure. More than 50% of TB patient households have a good house physically. From the result of mapping between sub-districts and factors, formed five groups consisting of: 1) Benowo and Mulyorejo; 2) Asemrowo, Gunung Anyar, Sukolilo and Pabean Cantikan; 3) Semampir, Krembangan and Bulak; 4) Kenjeran; and 5) Rungkut.

  5. Introduction of helical computed tomography affects patient selection for V/Q lung scan

    International Nuclear Information System (INIS)

    Zettinig, G.; Baudrexel, S.; Leitha, Th.

    2002-01-01

    Aim: Retrospective analysis for determination of the effect of helical computed tomography (HCT) on utilization of V/Q lung scanning to diagnose pulmonary embolism (PE) in a large general hospital. Methods: A total number of 2676 V/Q scans of in- and out-patients referred to our department between March 1992 and December 1998 and between April 1997 and December 1998 were analyzed by an identical group of nuclear physicians. Results: Neither the total number of annually performed V/Q scans (446 ± 135) nor the mean age of patients (56 years ± 17) changed significantly since the introduction of HCT. However, the referral pattern was different. The percentage of patients with high and intermediate probability for PE decreased significantly from 15.2% to 9.4% (p <0.01) and from 10.2% to 7.3% (p <0.05), respectively. Low probability scans significantly increased from 37.8% to 42.7% (p <0.05). The percentage of normal scans did not change significantly, however, there was a highly significant increase summarizing patients with normal and low probability scans (74.6% to 83.3%; p <0.01). Conclusion: The introduction of HCT affected the selection of patients referred for V/Q lung scanning since V/Q scanning was primarily used to exclude rather to confirm PE. (orig.)

  6. Does protein energy malnutrition affect the outcome in Tunisian cirrhotic patients?

    Science.gov (United States)

    Ennaifer, Rym; Cheikh, Myriam; Romdhane, Haifa; Sabbagh, Safa; Ben Nejma, Houda; Bougassas, Wassila; Bel Hadj, Najet

    2016-02-01

    Malnutrition is commonly seen in cirrhotic patients and has been shown to adversely affect outcome. However, it remains associated with the severity of cirrhosis. Therefore, its role as an independent prognostic factor is still under debate. The aims of our study were to determine the prevalence of malnutrition in cirrhotic patients and determine whether this condition was an independent prognostic factor. We prospectively analyzed the nutritional status of 104 consecutive patients with cirrhosis Subjective global nutritional assessment (SGA) and anthropometry [dry body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC)] were used for the evaluation of the nutritional status. Complications of cirrhosis during follow-up and patient's survival were recorded. Global survival and survival without complications was studied by Kaplan Meier method and using Log Rank test. Prevalence of malnutrition ranged from 16.3 and 62.5% according to the method of nutritional assessment used. Survival without complications was reduced in malnourished patients. This difference was significant when assessing malnutrition by dry BMI (p=0.001). In multivariate analysis, malnutrition defined by dry BMImalnutrition was an independent predictor of complications in cirrhosis. However, it did not appear as an independent prognostic factor for global survival. These results raise again difficulties to clarify whether malnutrition influence itself the prognosis of cirrhosis or if it is only related to the severity of cirrhosis.

  7. Comprehensive assessment of variables affecting metabolic control in patients with type 2 diabetes mellitus in Jordan.

    Science.gov (United States)

    Qteishat, Rola Reyad; Ghananim, Abdel Rahman Al

    2016-01-01

    The aim of the study was to identify variables affecting metabolic control among diabetic patients treated at diabetes and endocrine clinic in Jordan. A total of 200 patients were studied by using a cross sectional study design. Data were collected from patients' medical records, glycemic control tests and prestructured questionnaires about variables that were potentially important based on previous researches and clinical judgment: Adherence evaluation, Patients' knowledge about drug therapy and non-pharmacological therapy, Anxiety and depression, Beliefs about diabetes treatment (benefits and barriers of treatment), Knowledge about treatment goals, Knowledge about diabetes, Self efficacy, and Social support. The mean (±SD) age was 53.5 (±10.38) years and mean HbA1c was 8.4 (±1.95). In the multivariate analysis, education level, and self efficacy found to have significantly independent association with metabolic control (Pknowledge and high self efficacy was significant in patients with good metabolic control. Emphasizing the importance of continuous educational programs and improving the self efficacy as well, could warrant achieving good metabolic control. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  8. Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

    Science.gov (United States)

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

  9. Factors affecting dermatological manifestations in patients with end stage renal disease

    International Nuclear Information System (INIS)

    Anees, M.; Gull, S.; Nazeer, A.

    2018-01-01

    To determine skin changes in patients of End Stage Renal Disease (ESRD) on maintenance hemodialysis (MHD) and factors affecting these changes. Study Design:Cross-sectional observational study. Place and Duration of Study:Nephrology Department, Mayo Hospital, Lahore in collaboration with Dermatology Department, King Edward Medical University, Lahore, from October 2015 to January 2016. Methodology:Two hundred patients who were undergoing MHD for more than three months were included in the study. Patients' demographic data, laboratory reports and dialysis records were noted in a predesigned questionnaire. Skin examination was carried out by consultant dermatologist after patient's permission. Results:Among 200 patients included in study, 105 were males and rest of them were females. Major causes of ESRD were Diabetes Mellitus (n=83, 41.5%, followed by Hypertension (n=80, 40%), Nephrolithiasis (n=15, 7.5%) and Chronic glomerulonephritis (n=5, 2.5%). At least one cutaneous finding was present in every patient. Common skin findings observed were pigmentation (86%), xerosis (83%), pallor (79%), pruritus (69%), acquired ichthyosis (50.5%), and bacterial skin infections (18.5%). Among them, nail manifestations were half-and-half nails (52%), nychomycosis (30.5%), onycholysis (20.5%), subungual hyperkeratosis (23.5%), and Mee's lines (7.5). Among hair changes were sparse scalp hair (38.5%), brittle and lustreless hair (28%). The factors contributing to skin changes were patient's age, cause of ESRD, anti HCV positivity, high urea and creatinine levels, duration and frequency of hemodialysis, hemoglobin levels, calcium phosphate product and socioeconomic status. Some skin manifestations were interrelated with each other like xerosis with pruritus (p<0.001), pruritus with bacterial infection (p<0.022), acquired Ichthyosis (p=0.008) and hair changes (p=0.035). Conclusion:ESRD patients on hemodialysis develop various skin changes during the course of disease

  10. Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention.

    Science.gov (United States)

    Versteeg, Henneke; Pedersen, Susanne S; Erdman, Ruud A M; van Nierop, Josephine W I; de Jaegere, Peter; van Domburg, Ron T

    2009-10-01

    We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents. Consecutive PCI patients (n = 562) completed the Global Mood Scale at baseline to assess affect and the EuroQoL-5D (EQ-5D) at baseline and 12-month follow-up to assess health status. Negative affect [F(1, 522) = 17.14, P positive affect [F(1, 522) = 5.11, P = .02] at baseline were independent associates of overall health status at 12-month follow-up, adjusting for demographic and clinical factors. Moreover, there was a significant interaction for negative by positive affect [F(1, 522) = 6.11, P = .01]. In domain-specific analyses, high negative affect was associated with problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with the risk being two to fivefold. Low positive affect was only associated with problems in self-care (OR: 8.14; 95% CI: 1.85-35.9; P = .006) and usual activities (OR: 1.87; 95% CI: 1.17-3.00; P = .009). Baseline negative and positive affect contribute independently to patient-reported health status 12 months post PCI. Positive affect moderated the detrimental effects of negative affect on overall health status. Enhancing positive affect might be an important target to improve patient-centered outcomes in coronary artery disease.

  11. Metabolic Syndrome as a Factor Affecting Systemic Inflammation in Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Rubinsztajn, R; Przybyłowski, T; Maskey-Warzęchowska, M; Paplińska-Goryca, M; Nejman-Gryz, P; Karwat, K; Chazan, R

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is a systemic disease which may be associated with other comorbidities. The aim of the study was to estimate the incidence of metabolic syndrome (MS) in COPD patients and to assess its impact on systemic inflammation and lung function. MS was diagnosed in accordance with the recommendations of the Polish Forum for the Prevention of Cardiovascular Diseases. The study group consisted of 267 patients with stable COPD in all stages of severity. All patients underwent spirometry with bronchial reversibility testing and 6 min walk test (6MWT). The following blood tests were evaluated: lipid profile, glucose and C-reactive protein as well as serum concentration of IL-6, leptin, adiponectin, and endothelin. MS was diagnosed in 93 patients (35.8%). No differences were observed in the incidence of MS in relation to airflow limitation severity (mild; moderate; severe and very severe: 38.9; 36.3; 35.2 and 25.0%, respectively). FEV 1 (% predicted), FVC (% predicted), 6MWT distance (6MWD), age, and the number of pack-years were similar in patients with and without MS. MS was more frequent in males than females (38.7 vs. 28.4%, p > 0.05). Serum concentrations of IL-6, endothelin, leptin, and CRP were higher in the MS group, contrary to adiponectin concentration which was lower (p < 0.01). MS was more frequent in male COPD patients, but there were no differences in its frequency between patients with different severity of airflow limitation. We conclude that MS, as a comorbidity, occurs in all COPD stages and affects systemic inflammation. MS incidence does not depend on COPD severity.

  12. Differences in psychopathology and behavioral characteristics of patients affected by conversion motor disorder and organic dystonia

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    Pastore A

    2018-05-01

    Full Text Available Adriana Pastore, Grazia Pierri, Giada Fabio, Silvia Ferramosca, Angelo Gigante, Maria Superbo, Roberta Pellicciari, Francesco Margari Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy Purpose: Typically, the diagnosis of conversion motor disorder (CMD is achieved by the exclusion of a wide range of organic illnesses rather than by applying positive criteria. New diagnostic criteria are highly needed in this scenario. The main aim of this study was to explore the use of behavioral features as an inclusion criterion for CMD, taking into account the relationship of the patients with physicians, and comparing the results with those from patients affected by organic dystonia (OD. Patients and methods: Patients from the outpatient Movement Disorder Service were assigned to either the CMD or the OD group based on Fahn and Williams criteria. Differences in sociodemographics, disease history, psychopathology, and degree of satisfaction about care received were assessed. Patient–neurologist agreement about the etiological nature of the disorder was also assessed using the k-statistic. A logistic regression analysis estimated the discordance status as a predictor to case/control status. Results: In this study, 31 CMD and 31 OD patients were included. CMD patients showed a longer illness life span, involvement of more body regions, higher comorbidity with anxiety, depression, and borderline personality disorder, as well as higher negative opinions about physicians’ delivering of proper care. Contrary to our expectations, CMD disagreement with neurologists about the etiological nature of the disorder was not statistically significant. Additional analysis showed that having at least one personality disorder was statistically associated with the discordance status. Conclusion: This study suggests that CMD patients show higher conflicting behavior toward physicians. Contrary to our

  13. Oral health conditions affect functional and social activities of terminally-ill cancer patients

    Science.gov (United States)

    Fischer, D.J.; Epstein, J.B.; Yao, Y.; Wilkie, D.J.

    2013-01-01

    Purpose Oral conditions are established complications in terminally-ill cancer patients. Yet despite significant morbidity, the characteristics and impact of oral conditions in these patients are poorly documented. The study objective was to characterize oral conditions in terminally-ill cancer patients to determine the presence, severity, and the functional and social impact of these oral conditions. Methods This was an observational clinical study including terminally-ill cancer patients (2.5–3 week life expectancy). Data were obtained via the Oral Problems Scale (OPS) that measures the presence of subjective xerostomia, orofacial pain, taste change, and the functional/social impact of oral conditions and a demographic questionnaire. A standardized oral examination was used to assess objective salivary hypofunction, fungal infection, mucosal erythema, and ulceration. Regression analysis and t test investigated the associations between measures. Results Of 104 participants, most were ≥50 years of age, female, and high-school educated; 45% were African American, 43% Caucasian, and 37% married. Oral conditions frequencies were: salivary hypofunction (98%), mucosal erythema (50%), ulceration (20%), fungal infection (36%), and other oral problems (46%). Xerostomia, taste change, and orofacial pain all had significant functional impact; poral ulcerations had significantly more orofacial pain with a social impact than patients without ulcers (p=.003). Erythema was significantly associated with fungal infection and with mucosal ulceration (pOral conditions significantly affect functional and social activities in terminally-ill cancer patients. Identification and management of oral conditions in these patients should therefore be an important clinical consideration. PMID:24232310

  14. Differences in psychopathology and behavioral characteristics of patients affected by conversion motor disorder and organic dystonia.

    Science.gov (United States)

    Pastore, Adriana; Pierri, Grazia; Fabio, Giada; Ferramosca, Silvia; Gigante, Angelo; Superbo, Maria; Pellicciari, Roberta; Margari, Francesco

    2018-01-01

    Typically, the diagnosis of conversion motor disorder (CMD) is achieved by the exclusion of a wide range of organic illnesses rather than by applying positive criteria. New diagnostic criteria are highly needed in this scenario. The main aim of this study was to explore the use of behavioral features as an inclusion criterion for CMD, taking into account the relationship of the patients with physicians, and comparing the results with those from patients affected by organic dystonia (OD). Patients from the outpatient Movement Disorder Service were assigned to either the CMD or the OD group based on Fahn and Williams criteria. Differences in sociodemographics, disease history, psychopathology, and degree of satisfaction about care received were assessed. Patient-neurologist agreement about the etiological nature of the disorder was also assessed using the k -statistic. A logistic regression analysis estimated the discordance status as a predictor to case/control status. In this study, 31 CMD and 31 OD patients were included. CMD patients showed a longer illness life span, involvement of more body regions, higher comorbidity with anxiety, depression, and borderline personality disorder, as well as higher negative opinions about physicians' delivering of proper care. Contrary to our expectations, CMD disagreement with neurologists about the etiological nature of the disorder was not statistically significant. Additional analysis showed that having at least one personality disorder was statistically associated with the discordance status. This study suggests that CMD patients show higher conflicting behavior toward physicians. Contrary to our expectations, they show awareness of their psychological needs, suggesting a possible lack of recognition of psychological distress in the neurological setting.

  15. Stress and depression in informal caregivers of patients with bipolar affective disorder

    Directory of Open Access Journals (Sweden)

    Ximena Palacios-Espinosa

    2009-10-01

    Full Text Available This study aims to establish the stress and depression´s prevalence in informal primary caregivers of patients with bipolar affective disorder of the Clínica de Nuestra Señora de la Paz (Bogotá, Colombia. The sample consisted of 40 informal primary caregivers who were tested by several tools: a survey filter, a sociodemographic record, the Beck Depression Inventory (BDI and the Daily Stress Questionnaire. Results indicate that there is much more presence of depression than of daily stress in the sample.

  16. When does subliminal affective image priming influence the ability of schizophrenic patients to perceive face emotions?

    Science.gov (United States)

    Vaina, Lucia Maria; Rana, Kunjan D; Cotos, Ionela; Li-Yang, Chen; Huang, Melissa A; Podea, Delia

    2014-12-24

    Deficits in face emotion perception are among the most pervasive aspects of schizophrenia impairments which strongly affects interpersonal communication and social skills. Schizophrenic patients (PSZ) and healthy control subjects (HCS) performed 2 psychophysical tasks. One, the SAFFIMAP test, was designed to determine the impact of subliminally presented affective or neutral images on the accuracy of face-expression (angry or neutral) perception. In the second test, FEP, subjects saw pictures of face-expression and were asked to rate them as angry, happy, or neutral. The following clinical scales were used to determine the acute symptoms in PSZ: Positive and Negative Syndrome (PANSS), Young Mania Rating (YMRS), Hamilton Depression (HAM-D), and Hamilton Anxiety (HAM-A). On the SAFFIMAP test, different from the HCS group, the PSZ group tended to categorize the neutral expression of test faces as angry and their response to the test-face expression was not influenced by the affective content of the primes. In PSZ, the PANSS-positive score was significantly correlated with correct perception of angry faces for aggressive or pleasant primes. YMRS scores were strongly correlated with PSZ's tendency to recognize angry face expressions when the prime was a pleasant or a neutral image. The HAM-D score was positively correlated with categorizing the test-faces as neutral, regardless of the affective content of the prime or of the test-face expression (angry or neutral). Despite its exploratory nature, this study provides the first evidence that conscious perception and categorization of facial emotions (neutral or angry) in PSZ is directly affected by their positive or negative symptoms of the disease as defined by their individual scores on the clinical diagnostic scales.

  17. Contribution of computed tomography (CT) in affections of the lung parenchyma in HIV positive patients

    International Nuclear Information System (INIS)

    Neuwirth, J.; Stankova, M.; Spala, J.; Strof, J.

    1996-01-01

    CT findings in HIV positive patients with respiratory complaints were analyzed. The predominant morphological type of changes is a 'ground glass' increased density. Minimal changes of the lung parenchyma were recorded on high resolution computed tomography (HRCT) even in patients with a negative or doubtful finding on plain chest radiographs. Also the range of affections on HRCT scans was wider than on simple scans. The morphological changes on HRCT scans alone, however, are not an adequate basis for differentiation of various infectious agents in inflammatory changes of the lung parenchyma, and frequently mixed infections are involved. When at the same time clinical symptoms are considered, it frequently is possible to considerably reduce the number of possible pathogenic organisms and to start treatment. (author) 4 figs., 11 refs

  18. Late-onset Tay-Sachs disease: the spectrum of peripheral neuropathy in 30 affected patients.

    Science.gov (United States)

    Shapiro, Barbara E; Logigian, Eric L; Kolodny, Edwin H; Pastores, Gregory M

    2008-08-01

    Late-onset Tay-Sachs (LOTS) disease is a chronic, progressive, lysosomal storage disorder caused by a partial deficiency of beta-hexosaminidase A (HEXA) activity. Deficient levels of HEXA result in the intracellular accumulation of GM2-ganglioside, resulting in toxicity to nerve cells. Clinical manifestations primarily involve the central nervous system (CNS) and lower motor neurons, and include ataxia, weakness, spasticity, dysarthria, dysphagia, dystonia, seizures, psychosis, mania, depression, and cognitive decline. The prevalence of peripheral nervous system (PNS) involvement in LOTS has not been well documented, but it has traditionally been thought to be very low. We examined a cohort of 30 patients with LOTS who underwent clinical and electrophysiologic examination, and found evidence of a predominantly axon loss polyneuropathy affecting distal nerve segments in the lower and upper extremities in eight patients (27%).

  19. Factors affecting anastomotic leak after colorectal anastomosis in patients without protective stoma in tertiary care hospital

    International Nuclear Information System (INIS)

    Sultan, R.; Chawla, T.; Zaidi, M.

    2014-01-01

    Objective: To determine the factors associated with clinically significant anastomotic leak in patients having undergone large intestinal anastomosis. Method: The retrospective study at the Aga Khan University Hospital, Karachi, comprised data between January 2000 and March 2010, related to patients who underwent colorectal anastomosis. Demographic details of the patients, as well as preop, intraop and postop risk factors were recorded. Anastomotic leak was identified as per the defined criteria. Outcome of patients was recorded as postop hospital stay and mortality. Univariate and Multivariate analyses were applied to identify risk factors for anastomotic leakage. Results: Among the total 127 patients in the study, anastomotic leak occurred in 19 (15%) patients (Group 1), while there was no clinical leak in 108 (85%) patients (Group 2). Univariate analysis showed 8 factors to be affecting the anastomotic leak: operation time (p=0.003), intraoperative blood loss (p=0.006), intraoperative blood transfusion (p=0.013), indication of surgery malignancy vs. benign (p=0.049), type of surgery elective vs. emergency (p=0.037), intraop use of vasopressor (p=0.019), segment of bowel anastomosed left side vs. right side (p=0.012), and drain placement vs. no drain placed (p=0.035). Preop immunosuppressive therapy was borderline significant (p=0.089). Multivariate analysis showed that left vs. right sided anastomosis (p=0.068), blood transfusion >2 pack cells (p=0.028), smoker vs. non-smoker (p=0.049), elective vs. emergency surgery (p=0.012) were the independent risk factors which significantly affected the outcome of bowel anastomosis. Mortality rate was 15.79% (n=3/19) in Group 1, while it was 1.85% (n=2/108) in Group 2 (p=0.02). The postop hospital stay was 15+-5.44 days in Group 1, while it was 7.51+-4.04 days in Group 2 (p>0.001). Conclusion: In colorectal anastomotic surgeries temporary diversion stoma formation needs to be considered on the basis of risk factors to

  20. 68Ga-DOTANOC: biodistribution and dosimetry in patients affected by neuroendocrine tumors

    International Nuclear Information System (INIS)

    Pettinato, C.; Sarnelli, A.; Di Donna, M.; Civollani, S.; Marengo, M.; Bergamini, C.; Nanni, C.; Montini, G.; Di Pierro, D.; Ferrari, M.

    2008-01-01

    The aim of this work was the evaluation of biodistribution and radiation dosimetry of 68 Ga-DOTANOC in patients affected by neuroendocrine tumors. We enrolled nine patients (six male and three female) affected by different types of neuroendocrine tumors (NETs). Each patient underwent four whole body positron emission tomography (PET) scans, respectively, at 5, 20, 60, and 120 min after the intravenous injection of about 185 MBq of 68 Ga-DOTANOC. Blood and urine samples were taken at different time points post injection: respectively, at about 5, 18, 40, 60, and 120 min for blood and every 40-50 min from injection time up to 4 h for urine. The organs involved in the dosimetric evaluations were liver, heart, spleen, kidneys, lungs, pituitary gland, and urinary bladder. Dosimetric evaluations were done using the OLINDA/EXM 1.0 software. A physiological uptake of 68 Ga-DOTANOC was seen in all patients in the pituitary gland, the spleen, the liver, and the urinary tract (kidneys and urinary bladder). Organs with the highest absorbed doses were kidneys (9.0 E-02±3.2 E-02 mSv/Mq). The mean effective dose equivalent (EDE) was 2.5 E-02±4.6 E-03 mSv/MBq. The excretion of the compound was principally via urine, giving dose to the kidney and the urinary bladder wall. As SSTR2 is the most frequently expressed somatostatin receptor and 68 Ga-DOTANOC has high affinity to it, this compound might play an important role in PET oncology in the future. The dosimetric evaluation carried out by our team demonstrated that 68 Ga-DOTANOC delivers a dose to organs comparable to, and even lower than, analogous diagnostic compounds. (orig.)

  1. Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients With Advanced Cancer.

    Science.gov (United States)

    Green, Michael J; Schubart, Jane R; Whitehead, Megan M; Farace, Elana; Lehman, Erik; Levi, Benjamin H

    2015-06-01

    Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P<0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P<0.01) in the Intervention than Control group. Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  2. AFFECTIVE RESPONSES AFTER DIFFERENT INTENSITIES OF EXERCISE IN PATIENTS WITH TRAUMATIC BRAIN INJURY

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    Patricia eRzezak

    2015-06-01

    Full Text Available BACKGROUND: Patients with traumatic brain injury (TBI usually have mood and anxiety symptoms secondary to their brain injury. Exercise may be a cost-effective intervention for the regulation of the affective responses of this population. However, there are no studies evaluating the effects of exercise or the optimal intensity of exercise for this clinical group. METHODS: Twelve male patients with moderate or severe TBI [mean age of 31.83 and SD of 9.53] and 12 age- and gender-matched healthy volunteers [mean age of 30.58 and SD of 9.53] participated in two sessions of exercise of high and moderate intensity. Anxiety and mood was evaluated, and subjective assessment of experience pre- and post-exercise was assessed. A mixed between and within-subjects GLM analysis was conducted to compare groups [TBI, control] over condition [baseline, session 1, session 2] allowing for group by condition interaction to be determined. Planned comparisons were also conducted to test study hypotheses.RESULTS: Although no group by condition interaction was observed, planned comparisons indicated that baseline differences between patients and controls in anxiety (Cohens’ d=1.80, tension (d=1.31, depression (d=1.18, anger (d=1.08, confusion (d=1.70, psychological distress (d=1.28 and physical symptoms (d=1.42 disappear after one session of exercise, independently of the intensity of exercise. CONCLUSIONS: A single-section of exercise, regardless of exercise intensity, had a positive effect on the affective responses of patients with TBI both by increasing positive valence feelings and decreasing negative ones. Exercise can be an easily accessible intervention that may alleviate depressive symptoms related to brain injury.

  3. Effectiveness of mindfulness-based cognitive therapy in patients with bipolar affective disorder: A case series

    Directory of Open Access Journals (Sweden)

    Suvarna Shirish Joshi

    2018-01-01

    Full Text Available The present investigation was undertaken to examine the effects of mindfulness-based cognitive therapy (MBCT on interepisodic symptoms, emotional regulation, and quality of life in patients with bipolar affective disorder (BPAD in remission. The sample for the study comprised a total of five patients with the diagnosis of BPAD in partial or complete remission. Each patient was screened to fit the inclusion and exclusion criteria and later assessed on the Beck Depressive Inventory I, Beck Anxiety Inventory, Difficulties in Emotion Regulation Scale, Acceptance and Action Questionnaire-II, and The World Health Organization Quality of Life Assessment-BREF. Following preassessments, patients underwent 8–10 weeks of MBCT. A single case design with pre- and post-intervention assessment was adopted to evaluate the changes. Improvement was observed in all five cases on the outcome variables. The details of the results are discussed in the context of the available literature. Implications, limitations, and ideas for future investigations are also discussed.

  4. [Analysis of the quality of life in patients affected by scoliosis].

    Science.gov (United States)

    Leal-Hernández, M; Martínez-Monje, F; Pérez-Valencia, M; García-Romero, R; Mena-Poveda, R; Caballero-Cánovas, J

    2017-05-11

    To assess the quality of life using the SRS 22 test in patients with scoliosis of 20 or more degrees Cobb. A prospective descriptive study was conducted between April and May 2016 on patients with scoliosis of at least 20 degrees Cobb and aged between 10 and 20 years. A record was made of weight, height, body mass index, and the SR 22 specific quality of life questionnaire for patients with scoliosis was completed. Patients were divided into two groups for analysis: a) scoliosis between 20 and 29 degrees Cobb (n=44); and b) scoliosis with a Cobb of 30 degrees or greater (n=32). There were significant differences in the dimensions that assess pain, image self-perception, and satisfaction with treatment, being valued worse when the degree of scoliosis Cobb is 30 degrees or higher. There were no significant differences in function/activity or mental health. The overall score of the questionnaire was also worse in the group with the highest degree of scoliosis. The weight, height, and BMI showed no significant differences due to the varying degrees of scoliosis. Scoliosis significantly affects the quality of life of people who suffer it, and there is a negative correlation between the severity of scoliosis measured by degrees Cobb and quality of life. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Parameters affecting the tidal volume during expiratory abdominal compression in patients with prolonged tracheostomy mechanical ventilation.

    Science.gov (United States)

    Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Takahashi, Naoaki

    2015-07-01

    [Purpose] The aim of this study was to clarify physical parameters affecting the tidal volume during expiratory abdominal compression in patients with prolonged tracheostomy mechanical ventilation. [Methods] Eighteen patients with prolonged mechanical ventilation were included in this study. Expiratory abdominal compression was performed on patients lying in a supine position. The abdomen above the navel was vertically compressed in synchronization with expiration and released with inspiration. We measured the tidal volume during expiratory abdominal compression. [Results] The mean tidal volume during expiratory abdominal compression was higher than that at rest (430.6 ± 127.1 mL vs. 344.0 ± 94.3 mL). The tidal volume during expiratory abdominal compression was correlated with weight, days of ventilator support, dynamic compliance and abdominal expansion. Stepwise multiple regression analysis revealed that weight (β = 0.499), dynamic compliance (β = 0.387), and abdominal expansion (β = 0.365) were factors contributing to the tidal volume during expiratory abdominal compression. [Conclusion] Expiratory abdominal compression increased the tidal volume in patients with prolonged tracheostomy mechanical ventilation. The tidal volume during expiratory abdominal compression was influenced by each of the pulmonary conditions and the physical characteristics.

  6. Serum Levels of Tryptophan, 5-Hydroxytryptophan and Serotonin in Patients Affected with Different Forms of Amenorrhea

    Directory of Open Access Journals (Sweden)

    S. Comai

    2010-01-01

    Full Text Available Tryptophan (Trp is present in the serum, partly bound to albumine and in the free form. The unbound portion of circulating tryptophan has the property of crossing the hematoencephalic barrier and being converted within the brain into serotonin (5-HT through the enzymatic processes of hydroxylation and decarboxylation. The serotoninergic system plays an important role in neuroendocrine control of reproductive hormone secretion, and in particular, it may influence GnRH pulsatility, a function essential for reproductive processes. In this study, we analysed serum levels of tryptophan, serotonin and 5-hydroxytryptophan (5-HTP in women with three different forms of amenorrhea: 16 patients were diagnosed with anorexia nervosa, 60 patients with functional hypothalamic amenorrhea, and 14 patients with hyperprolactinemia. Data were compared with those of a group of 25 healthy women. Serum Trp levels were significantly (P ≤ 0.05 lower in the anorexic (11.64 ± 0.53 μg/ml, mean ± S.E. than in the control (12.98 ± 0.37 μg/ml groups. In addition, in the anorexic group a statistical dispersion of Trp values was shown indicating a bimodal data distribution suggesting the existence of two different subgroups of patients. Regarding 5-HTP, an increase of its serum level was observed in all the groups with amenorrhea with the highest value in hyperprolactinemic patients. On the contrary, no statistical differences in serum 5-HT levels among the four analyzed groups were observed. This study shows that women affected by various forms of amenorrhea present an altered metabolism of tryptophan via serotonin and, in particular, markedly high differences are observed between the two subgroups of anorexic patients.

  7. Serum Levels of Tryptophan, 5-Hydroxytryptophan and Serotonin in Patients Affected with Different Forms of Amenorrhea

    Directory of Open Access Journals (Sweden)

    S. Comai

    2010-06-01

    Full Text Available Tryptophan (Trp is present in the serum, partly bound to albumine and in the free form. The unbound portion of circulating tryptophan has the property of crossing the hematoencephalic barrier and being converted within the brain into serotonin (5-HT through the enzymatic processes of hydroxylation and decarboxylation. The serotoninergic system plays an important role in neuroendocrine control of reproductive hormone secretion, and in particular, it may influence GnRH pulsatility, a function essential for reproductive processes. In this study, we analysed serum levels of tryptophan, serotonin and 5-hydroxytryptophan (5-HTP in women with three different forms of amenorrhea: 16 patients were diagnosed with anorexia nervosa, 60 patients with functional hypothalamic amenorrhea, and 14 patients with hyperprolactinemia. Data were compared with those of a group of 25 healthy women. Serum Trp levels were significantly (P ≤ 0.05 lower in the anorexic (11.64 ± 0.53 µg/ml, mean ± S.E. than in the control (12.98 ± 0.37 µg/ml groups. In addition, in the anorexic group a statistical dispersion of Trp values was shown indicating a bimodal data distribution suggesting the existence of two different subgroups of patients. Regarding 5-HTP, an increase of its serum level was observed in all the groups with amenorrhea with the highest value in hyperprolactinemic patients. On the contrary, no statistical differences in serum 5-HT levels among the four analyzed groups were observed. This study shows that women affected by various forms of amenorrhea present an altered metabolism of tryptophan via serotonin and, in particular, markedly high differences are observed between the two subgroups of anorexic patients.

  8. Smoking affects treatment outcome in patients with resected esophageal squamous cell carcinoma who received chemotherapy.

    Directory of Open Access Journals (Sweden)

    Yuzhen Zheng

    Full Text Available Cigarette smoking is reported to decrease survival and induce chemotherapy resistance in patients with various cancers. However, the impact of cigarette smoking on patients with esophageal squamous cell carcinoma (ESCC remains unknown.A total of 1,084 ESCC patients were retrospectively enrolled from a southern Chinese institution. Patients were divided into two groups according to their treatment modalities: the SC group (surgery with chemotherapy (n = 306 and the S group (surgery without chemotherapy (n = 778. Smoking status was quantified as smoking history (non-smoker, ex-smoker, and current smoker and cumulative smoking (0, between 0 and 20, and greater than 20 pack-years. The association between cigarette smoking and overall survival (OS was evaluated using the Kaplan-Meier method and univariate/multivariate regression analysis.Among 1,084 patients, 702 (64.8% reported a cigarette smoking history, and the 5-year OS for non-smokers and smokers was 45.8% and 37.3%, respectively. In the SC group, compared with non-smoker, the adjusted HRs of ex-smoker and current smoker were 1.540 (95% CI, 1.1-2.2 and 2.110 (95% CI, 1.4-3.1, respectively; there is a correlative trend of decreased OS with increased cigarette smoking (Ptrend = 0.001. These associations were insignificant in the S group. In subgroup analysis of the SC group, the lower OS conferred by smoking was not significantly modified by age, gender, body mass index, alcohol drinking, or chemotherapy method (chemotherapy and chemoradiotherapy.Our results suggest that smoking may affect treatment outcome in patients with resected ESCC who received chemotherapy.

  9. Different postconditioning cycles affect prognosis of aged patients undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Zhang, Jie; Zhang, Xin; Cui, Yuqi; Ferdous, Misbahul; Cui, Lianqun; Zhao, Peng

    2017-07-17

    Postconditioning can affect the infarct size in acute myocardial infarction (AMI). However, few studies show an effect of different postconditioning cycles on AMI aged patients. This study sought to assess the effect of different postconditioning cycles on prognosis in aged patients with AMI who underwent primary percutaneous coronary intervention (PCI). 74 aged patients were randomly assigned to three groups. Control group; PC-1 group accepted postconditioning 4 cycles of 30 s inflation and 30 s deflation; PC-2 group accepted postconditioning 4 cycles of 60 s. Creatine kinase MB (CK-MB), troponin I (cTnI), high-sensitive C-reactive protein (hs-CRP) and corrected Thrombolysis in Myocardial Infarction (TIMI) frame counts (CTFC) were analyzed before andafter treatment. All patients received an echocardiographic examination for whole heart function, wall motion score index (WMSI) and single-photon emission computed tomography (SPECT) examination at 7 days and 6 months after treatment. S: The peak of CK-MB, postoperative 72 h cTnI and CTFC were significantly attenuated by postconditioning when compared with the control group. The hs-CRP of the postconditioning group was lower than the control group 24 h postoperative. No difference was observed between PC-1 and PC-2 group about the effect described above. At 7 days, heart function in the postconditioning group was improved when compared with the control group. At 6 months, the WMSI and SPECT score significantly reduced in the PC-2 group compared with the control and PC-1 groups, but there was no difference among the three groups about echo data except the left ventricular end-systolic diameter. Postconditioning is significantly beneficial to prognosis in aged patients with AMI. The cardiac protective effect of 4 cycles of 60 s procedure was observed in WMSI and SPECT. It is favorable to implement this procedure in aged patients with AMI in clinic.

  10. Diversity of the Genes Implicated in Algerian Patients Affected by Usher Syndrome.

    Science.gov (United States)

    Abdi, Samia; Bahloul, Amel; Behlouli, Asma; Hardelin, Jean-Pierre; Makrelouf, Mohamed; Boudjelida, Kamel; Louha, Malek; Cheknene, Ahmed; Belouni, Rachid; Rous, Yahia; Merad, Zahida; Selmane, Djamel; Hasbelaoui, Mokhtar; Bonnet, Crystel; Zenati, Akila; Petit, Christine

    2016-01-01

    Usher syndrome (USH) is an autosomal recessive disorder characterized by a dual sensory impairment affecting hearing and vision. USH is clinically and genetically heterogeneous. Ten different causal genes have been reported. We studied the molecular bases of the disease in 18 unrelated Algerian patients by targeted-exome sequencing, and identified the causal biallelic mutations in all of them: 16 patients carried the mutations at the homozygous state and 2 at the compound heterozygous state. Nine of the 17 different mutations detected in MYO7A (1 of 5 mutations), CDH23 (4 of 7 mutations), PCDH15 (1 mutation), USH1C (1 mutation), USH1G (1 mutation), and USH2A (1 of 2 mutations), had not been previously reported. The deleterious consequences of a missense mutation of CDH23 (p.Asp1501Asn) and the in-frame single codon deletion in USH1G (p.Ala397del) on the corresponding proteins were predicted from the solved 3D-structures of extracellular cadherin (EC) domains of cadherin-23 and the sterile alpha motif (SAM) domain of USH1G/sans, respectively. In addition, we were able to show that the USH1G mutation is likely to affect the binding interface between the SAM domain and USH1C/harmonin. This should spur the use of 3D-structures, not only of isolated protein domains, but also of protein-protein interaction interfaces, to predict the functional impact of mutations detected in the USH genes.

  11. Factors affecting direction and strength of patient preferences for treatment of molar teeth with nonvital pulps.

    Science.gov (United States)

    Vernazza, C R; Steele, J G; Whitworth, J M; Wildman, J R; Donaldson, C

    2015-12-01

    To elicit the factors affecting willingness to pay (WTP) values for the preferred options of participants for dealing with a molar tooth with a nonvital pulp, a common but difficult problem. A total of 503 patients were recruited from dental practices in the North East of England and interviewed. Their preferred treatment option for a molar tooth with a nonvital pulp (endodontics, extraction and various prosthetic restorative options) and WTP for this preferred option were elicited. Factors affecting preferred option and WTP were analysed using econometric modelling. Overall, 53% of the sample wished to save the tooth with a mean WTP of £373. The variance in WTP was high. Of those opting for extraction, the majority chose to leave a gap or have an implant. The preferred option was influenced by previous treatment experience. WTP was only influenced by having a low income. The high level of variance in WTP and its relatively unpredictable nature pose difficult questions for policy makers trying to ensure the delivery of an equitable service. For dentists, it is important not to make assumptions about patient preference and strength of preference when making decisions. Ideally, WTP values should be considered alongside effectiveness data, and those on costs, in policy making. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  12. Factors affecting 18 F FDOPA standardized uptake value in patients with primary brain tumors after treatment

    International Nuclear Information System (INIS)

    Chiaravalloti, Agostino; Fiorentini, Alessandro; Villani, Veronica; Carapella, Carmine; Pace, Andrea; Di Pietro, Barbara; Di Russo, Carmen; Palumbo, Barbara; Floris, Roberto; Schillaci, Orazio

    2015-01-01

    Aim: To investigate the factors affecting 18 F FDOPA uptake in patients with primary brain tumors (PBT) after treatment. Materials and methods: 97 patients with PBT (6 were grade I, 40 were grade II, 29 were grade III and 22 were grade IV) underwent 18 F FDOPA positron emission tomography/computed tomography (PET/CT) after treatment. Intervals from surgery, chemotherapy (CHT) and radiotherapy (RT) were 41.48 (± 42.27), 16.04 (± 29.08) and 28.62 (± 34.49) months respectively. Results: 18 F FDOPA uptake in the site of recurrence was not related to the interval from surgery and CHT while a significant relationship has been found with the interval from RT and tumor grade. Conclusions: The results of our study show that the interval from RT and the grade of PBT should be considered carefully when evaluating brain PET/CT scans since these factors could directly affect 18 F FDOPA uptake

  13. Polydactylous Transverse Erythronychia: Report of a Patient with Multiple Horizontal Red Bands Affecting the Fingernails.

    Science.gov (United States)

    Chang, Carina; Beutler, Bryce D; Cohen, Philip R

    2017-06-01

    Redness of the nail plate-erythronychia-is a common condition involving one or multiple digits. It may affect the entire nail or present as longitudinal red bands that extend from the proximal nail fold to the distal tip of the nail plate. Rarely, red bands may traverse the nail bed horizontally. Although erythronychia is often idiopathic, it has also been associated with amyloidosis, Darier's disease, lichen planus, and various other cutaneous conditions. We describe the clinical features of a 64-year-old Caucasian man who presented with transverse and longitudinal erythronychia affecting his fingernails. In addition, we review the classification of erythronychia and summarize the acute and chronic conditions that have been associated with this clinical finding. The features of a man with polydactylous transverse and longitudinal erythronychia are presented. In addition, PubMed was used to search the following terms: erythronychia, longitudinal erythronychia, red lunulae, and subungual. All papers were reviewed, and relevant articles, along with their references, were evaluated. Informed consent was obtained from the patient for being included in the study. A 64-year-old Caucasian man with a past medical history significant for testicular cancer and pulmonary embolism presented with multiple horizontal pink-red bands affecting his fingernails. The discoloration was most prominent in the region distal to the lunula. In addition, the nails of the fifth digit of his left hand and third digit of his right hand featured longitudinal red bands extending from the distal curvature of the lunula to the free edge of the nail plate. A diagnosis of polydactylous longitudinal and transverse erythronychia, based on the clinical presentation, was established. Our patient's red bands were asymptomatic and he was not concerned about the cosmetic appearance of his nails; therefore, no additional investigation or treatment was required. Polydactylous transverse erythronychia is a

  14. Engaging the Voice of Patients Affected by Gender-Based Violence: Informing Practice and Policy.

    Science.gov (United States)

    Lewis-O'Connor, Annie; Chadwick, Mardi

    2015-01-01

    Evidence regarding the benefits, opportunities, and risks associated with providing health care to patients experiencing gender-based violence (GBV) and, moreover, their satisfaction with health care services is sparse. Using a patient- and trauma-informed relationship-based framework, survivors of GBV who were referred for follow-up care were asked to participate in a quality improvement (QI) initiative in an effort to understand their perspectives of receiving healthcare services. Patients were asked to answer three open-ended questions in regard to their healthcare experience. Individuals who were eligible for evidence collection after sexual assault (<5 days) were asked two additional questions. Of the 353 women and six men (359) referred to the C.A.R.E. (Coordinated Approach to Recovery and Empowerment) Clinic, 327 patients were contacted. Of the participants, 24% (86) had a mental health diagnosis; 41% (145) reported their incident to the police; 8% (28) had comorbidities of substance abuse, mental health, and/or homelessness; and 33% (118) of the incidents involved alcohol or drugs. Most of the patients stated that they were well cared for and felt safe during their visit. However, many reported "long waits," "disjointed," "chaotic," "too many" providers, "conflicting" and "miss-information," and "confusion" about what to do after their acute care visit. Over half (59%) did not report incident to the police. Some reported regrets with reporting to the police (16%) and regrets in having evidence collection (15%). Of the patients who did not have evidence collected (47), none expressed regret over choosing not to have evidence collected. Five patients with mental health problems were hospitalized within 5 days of their emergency department visit for suicidal thoughts. A number of opportunities to improve the healthcare response were identified. Patients affected by GBV require an improved coordinated and trauma-informed approach. Explicit consent related to

  15. Late-onset Tay-Sachs disease: phenotypic characterization and genotypic correlations in 21 affected patients.

    Science.gov (United States)

    Neudorfer, Orit; Pastores, Gregory M; Zeng, Bai J; Gianutsos, John; Zaroff, Charles M; Kolodny, Edwin H

    2005-02-01

    The purpose of this study was to describe the phenotype (and corresponding genotype) of adult patients with late-onset Tay-Sachs disease, a clinical variant of the GM2-gangliosidoses. A comprehensive physical examination, including neurological assessments, was performed to establish the current disease pattern and severity. In addition, the patients' past medical histories were reviewed. The patients' alpha-subunit mutations (beta-Hexosaminidase A genotype) were determined and correlated with their corresponding clinical findings and disease course. Twenty-one patients (current mean age: 27.0 years; range: 14-47 years) were identified. The pedigree revealed a relative with the "classic" infantile or late-onset form of Tay-Sachs disease in four (out of 18) unrelated families. The patients were predominantly male (15/21 individuals) and of Ashkenazi Jewish ancestry (15/18 families). Mean age at onset was 18.1 years; balance problems and difficulty climbing stairs were the most frequent presenting complaints. In several cases, the diagnosis was delayed (mean age at diagnosis: 27.0 years). Analysis of the beta-hex A gene revealed the G269S mutation as the most common disease allele; found in homozygosity (N = 1) or heterozygosity (N = 18; including 2 sib pairs). Disease onset (age 36 years) was delayed and progression relatively slower in the homozygous G269S patient. Two siblings (ages 28 and 31 years), of non-Jewish ancestry, were compound heterozygotes (TATC1278/W474C); their clinical course is dominated by psychiatric problems. Brain imaging studies revealed marked cerebellar atrophy in all patients (N = 18) tested, regardless of disease stage. Late-onset Tay-Sachs disease is an infrequent disorder and the diagnosis is often missed or delayed (by approximately 8 years). Early on, the majority of patients develop signs of either cerebellar or anterior motor neuron involvement. Affected individuals may also develop psychotic episodes. In most cases, the later

  16. Alexithymia and Depression Affect Quality of Life in Patients With Chronic Pain: A Study on 205 Patients With Fibromyalgia

    Directory of Open Access Journals (Sweden)

    Valentina Tesio

    2018-04-01

    Full Text Available Pain in fibromyalgia (FM is accompanied by a heterogeneous series of other symptoms, which strongly affect patients’ quality of life and interfere with social and work performance. The present study aimed to evaluate the effects of alexithymia on both the physical and the psychosocial components of the health-related quality of life (HRQoL of FM patients, controlling for the concomitant effects of depression, anxiety, and pain. In particular, given the strong interconnection between depression and alexithymia, the relationship between alexithymia and HRQoL as mediated by depressive symptoms was further investigated. Data were collected on a consecutive sample of 205 female patients with a main diagnosis of FM. The results showed that about 26% of the patients showed the presence of alexithymia, as assessed by the Toronto Alexithymia Scale (TAS-20. Clinically relevant levels of depressive and anxiety symptoms were present in 61 and 60% of the patients, respectively. The results of the hierarchical multiple regression analyses showed that pain intensity (PI and depressive symptoms explained the 45% of the variance of the physical component of HRQoL (p < 0.001. Regarding the mental component of HRQoL, depressive and anxiety symptoms, alexithymia, and PI significantly explained 61% of the variance (p < 0.001. The mediation analyses confirmed that alexithymia had a direct effect on the mental component of HRQoL and showed a statistically significant indirect effect on both the physical and the mental components, through the mediation of depressive symptoms. In conclusion, the results of the present study suggested the presence of both a direct and an indirect effect of alexithymia, in particular of the difficulty identifying feeling, on the HRQoL of patients with FM. Indeed, even though the concomitant presence of depressive symptoms is responsible of an indirect effect, alexithymia per se seems to directly contribute to worsen the impact that this

  17. In Patients Undergoing Cochlear Implantation, Psychological Burden Affects Tinnitus and the Overall Outcome of Auditory Rehabilitation

    Directory of Open Access Journals (Sweden)

    Petra Brüggemann

    2017-05-01

    Full Text Available Cochlear implantation (CI is increasingly being used in the auditory rehabilitation of deaf patients. Here, we investigated whether the auditory rehabilitation can be influenced by the psychological burden caused by mental conditions. Our sample included 47 patients who underwent implantation. All patients were monitored before and 6 months after CI. Auditory performance was assessed using the Oldenburg Inventory (OI and Freiburg monosyllable (FB MS speech discrimination test. The health-related quality of life was measured with Nijmegen Cochlear implantation Questionnaire (NCIQ whereas tinnitus-related distress was measured with the German version of Tinnitus Questionnaire (TQ. We additionally assessed the general perceived quality of life, the perceived stress, coping abilities, anxiety levels and the depressive symptoms. Finally, a structured interview to detect mental conditions (CIDI was performed before and after surgery. We found that CI led to an overall improvement in auditory performance as well as the anxiety and depression, quality of life, tinnitus distress and coping strategies. CIDI revealed that 81% of patients in our sample had affective, anxiety, and/or somatoform disorders before or after CI. The affective disorders included dysthymia and depression, while anxiety disorders included agoraphobias and unspecified phobias. We also diagnosed cases of somatoform pain disorders and unrecognizable figure somatoform disorders. We found a positive correlation between the auditory performance and the decrease of anxiety and depression, tinnitus-related distress and perceived stress. There was no association between the presence of a mental condition itself and the outcome of auditory rehabilitation. We conclude that the CI candidates exhibit high rates of psychological disorders, and there is a particularly strong association between somatoform disorders and tinnitus. The presence of mental disorders remained unaffected by CI but the

  18. Investigation of patient, tumour and treatment variables affecting residual motion for respiratory-gated radiotherapy

    International Nuclear Information System (INIS)

    George, R; Ramakrishnan, V; Siebers, J V; Chung, T D; Keall, P J

    2006-01-01

    Respiratory gating can reduce the apparent respiratory motion during imaging and treatment; however, residual motion within the gating window remains. Respiratory training can improve respiratory reproducibility and, therefore, the efficacy of respiratory-gated radiotherapy. This study was conducted to determine whether residual motion during respiratory gating is affected by patient, tumour or treatment characteristics. The specific aims of this study were to: (1) identify significant characteristics affecting residual motion, (2) investigate time trends of residual motion over a period of days (inter-session) and (3) investigate time trends of residual motion within the same day (intra-session). Twenty-four lung cancer patients were enrolled in an Institutional Review Board (IRB)-approved protocol. For approximately five sessions, 331 four-minute, respiratory motion traces were acquired with free breathing, audio instructions and audio-visual biofeedback for each patient. The residual motion was quantified by the standard deviation of the displacement within the gating window. The generalized linear model was used to obtain coefficients for each variable within the model and to evaluate the clinical and statistical significance. The statistical significance was determined by a p-value <0.05, while effect sizes of ≥0.1 cm (one standard deviation) were considered clinically significant. This data analysis was applied to patient, tumour and treatment variables. Inter- and intra-session variations were also investigated. The only variable that was significant for both inhale- and exhale-based gating was disease type. In addition, visual-training displacement, breathing type and Karnofsky performance status (KPS) values were significant for inhale-based gating, and dose-per-fraction was significant for exhale-based gating. Temporal respiratory variations within and between sessions were observed for individual patients. However inter- and intra-session analyses did

  19. Investigation of patient, tumour and treatment variables affecting residual motion for respiratory-gated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    George, R [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Ramakrishnan, V [Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (United States); Siebers, J V [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Chung, T D [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Keall, P J [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States)

    2006-10-21

    Respiratory gating can reduce the apparent respiratory motion during imaging and treatment; however, residual motion within the gating window remains. Respiratory training can improve respiratory reproducibility and, therefore, the efficacy of respiratory-gated radiotherapy. This study was conducted to determine whether residual motion during respiratory gating is affected by patient, tumour or treatment characteristics. The specific aims of this study were to: (1) identify significant characteristics affecting residual motion, (2) investigate time trends of residual motion over a period of days (inter-session) and (3) investigate time trends of residual motion within the same day (intra-session). Twenty-four lung cancer patients were enrolled in an Institutional Review Board (IRB)-approved protocol. For approximately five sessions, 331 four-minute, respiratory motion traces were acquired with free breathing, audio instructions and audio-visual biofeedback for each patient. The residual motion was quantified by the standard deviation of the displacement within the gating window. The generalized linear model was used to obtain coefficients for each variable within the model and to evaluate the clinical and statistical significance. The statistical significance was determined by a p-value <0.05, while effect sizes of {>=}0.1 cm (one standard deviation) were considered clinically significant. This data analysis was applied to patient, tumour and treatment variables. Inter- and intra-session variations were also investigated. The only variable that was significant for both inhale- and exhale-based gating was disease type. In addition, visual-training displacement, breathing type and Karnofsky performance status (KPS) values were significant for inhale-based gating, and dose-per-fraction was significant for exhale-based gating. Temporal respiratory variations within and between sessions were observed for individual patients. However inter- and intra-session analyses did

  20. Components of self-esteem in affective patients and non-psychiatric controls.

    Science.gov (United States)

    Serretti, Alessandro; Olgiati, Paolo; Colombo, Cristina

    2005-09-01

    Decrease in self-esteem (SE) is found in all mood disorders during inter-episode phases. This trait was associated with relapse and suicidality but its genetic basis is still undefined, probably because SE has multiple components. The aim of the current study was to ascertain which of those components were altered in a sample of affective patients. Three hundred and thirty-one outpatients with bipolar (N=199) and major depressive MD (N=132) disorders in remission for at least three months and one hundred controls completed the Rosenberg Self-esteem Scale (RSE; [Rosenberg, M., 1965. The measurement of self-esteem, Society and the Adolescent Self-Image. Princeton University Press, pp.16-36]). Principal component analysis was performed to identify RSE factor structure. Extracted factors were compared across case and control groups in the whole sample (N=431) and in a sub-sample (N=301) with low self-esteem (RSE <20). PCA yielded a two-factor solution with self-confidence (SC) and self-deprecation (SD) that was largely consistent with the existing literature. Such factors were both associated with lower scores in affective patients than controls (SC: F=52, p<0.01; SD: F=43, p<0.01). However in the low RSE group only self-confidence was found to be decreased in subjects with mood disorders (SC: F=13.8, p<0.01; SD: F=0.05, p=0.9). These findings suggest that self-esteem deficit in affective disorders might involve specific components. Implications for research and clinical practice are discussed.

  1. The role of Patient Health Engagement Model (PHE-model in affecting patient activation and medication adherence: A structural equation model.

    Directory of Open Access Journals (Sweden)

    Guendalina Graffigna

    Full Text Available Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed.To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model in this pathway.This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i patient activation (Patient Activation Measure 13 -short form; ii Patient Health Engagement model (Patient Health Engagement Scale; iii patient adherence (4 item-Morinsky Medication Adherence Scale; iv the quality of the patients' emotional feelings (Manikin Self Assessment Scale; v the quality of the patient/doctor relationship (Health Care Climate Questionnaire. Structural equation modeling was used to test the hypotheses proposed.According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis.Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in

  2. The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model.

    Science.gov (United States)

    Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea

    2017-01-01

    Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed. To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway. This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 -short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients' emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed. According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis. Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing

  3. FACTORS AFFECTING QUALITY OF LIFE AND LEVEL OF SOCIAL SUPPORT IN CANCER PATIENTS

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    Ayse Berivan Bakan

    2017-04-01

    Full Text Available Background: When people face health problems, their life satisfaction levels and social relations could be ruined. When it comes to an eerie, deadly and chronic disease like cancer, the individual is much more likely to be affected by it. Objective: This descriptive study aims to identify quality of life and level of social support and the affecting factors in cancer patients. Methods: The sample included 170 patients who applied to Internal Diseases, Radiation Oncology, Thorax diseases clinics and Chemotherapy polyclinic in a university hospital in Turkey between March and August, 2005, who met the research criteria, and who volunteered to participate in the study. The sample represented 20 % of the target population. Data were collected through SF-36 Quality of Life Scale and Multidimensional Scale of Perceived Social Support. Results: The patients’ Global Quality of Life mean score was found 38.67 ± 13.64, and mean score for the Perceived Social Support was found 59.19 ± 17.5. Global Quality of Life score was higher in those who underwent an operation and who received ambulatory health care. Although Global Quality of Life was not influenced by the gender variable, male patients’ level of well-being was found to be higher. Perceived Social Support total score was found to be higher in those who knew about their disease. Family support was found to be higher in those who were married and who lived in town; it was found to be low in those who had low socio-economic level and who received inpatient treatment. Friend support was found to be high in those who knew about their disease. Conclusion: There was a linear relationship between Perceived Social Support and Quality of Life. It is recommended that more studies with wider groups of participants would shed more light to the issue of identifying quality of life, social support level and the relationships between them in cancer patients.

  4. Factors Affecting Outcome in Treatment of Chronic Subdural Hematoma in ICU Patients: Impact of Anticoagulation.

    Science.gov (United States)

    Szczygielski, Jacek; Gund, Sina-Maria; Schwerdtfeger, Karsten; Steudel, Wolf-Ingo; Oertel, Joachim

    2016-08-01

    The use of anticoagulants and older age are the main risk factors for chronic subdural hematoma (CSDH). Because the age of the population and use of anticoagulants are increasing, a growing number of CSDH cases is expected. To address this issue, we analyzed the impact of anticoagulants on postsurgical outcome in patients in the intensive care unit (ICU). Demographic data, coagulation parameters, surgical details, radiologic appearance of hematoma, Glasgow Coma Scale (GCS) score on admission, and Glasgow Outcome Scale (GOS) score on discharge were retrieved and retrospectively analyzed in 98 patients with CSDH treated in the neurosurgical ICU using correlation coefficient tests and multivariate analysis test. Overall outcome was good (GOS score 4 and 5) in 55.1% of patients. Overall mortality was 9.1%. There was a correlation between GCS score on admission and GOS score. There was no correlation between hematoma thickness/radiologic appearance and impaired coagulation. Disturbance in thrombocyte function (usually resulting from aspirin intake) correlated with improved outcome, whereas warfarin-related coagulopathy correlated with poor recovery. Nevertheless, patients with thrombocytopathy presented with better initial GCS scores. Neither hematoma size nor recurrence rate affected the outcome. The size of CSDH was not associated with poor outcome and is not necessarily determined by the use of anticoagulants. Coagulopathy does not rule out a good outcome, but the impact of anticoagulation on treatment results in CSDH varies between the main groups of drugs (warfarin vs. antiplatelet drugs). Patients in good neurologic condition on ICU admission have better chances of recovery. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Chronic exposure to dopamine agonists affects the integrity of striatal D2 receptors in Parkinson's patients

    Directory of Open Access Journals (Sweden)

    Marios Politis

    2017-01-01

    Full Text Available We aimed to investigate the integrity and clinical relevance of striatal dopamine receptor type-2 (D2R availability in Parkinson's disease (PD patients. We studied 68 PD patients, spanning from early to advanced disease stages, and 12 healthy controls. All participants received one [11C]raclopride PET scan in an OFF medication condition for quantification of striatal D2R availability in vivo. Parametric images of [11C]raclopride non-displaceable binding potential were generated from the dynamic [11C]raclopride scans using implementation of the simplified reference tissue model with cerebellum as the reference tissue. PET data were interrogated for correlations with clinical data related to disease burden and dopaminergic treatment. PD patients showed a mean 16.7% decrease in caudate D2R and a mean 3.5% increase in putaminal D2R availability compared to healthy controls. Lower caudate [11C]raclopride BPND correlated with longer PD duration. PD patients on dopamine agonist treatment had 9.2% reduced D2R availability in the caudate and 12.8% in the putamen compared to PD patients who never received treatment with dopamine agonists. Higher amounts of lifetime dopamine agonist therapy correlated with reduced D2Rs availability in both caudate and putamen. No associations between striatal D2R availability and levodopa treatment and dyskinesias were found. In advancing PD the caudate and putamen D2R availability are differentially affected. Chronic exposure to treatment with dopamine agonists, but no levodopa, suppresses striatal D2R availability, which may have relevance to output signaling to frontal lobes and the occurrence of executive deficits, but not dyskinesias.

  6. Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer.

    Science.gov (United States)

    Barcelos, Camila Barbosa; Silveira, Paula Angélica Lorenzon; Guedes, Renata Lígia Vieira; Gonçalves, Aline Nogueira; Slobodticov, Luciana Dall'Agnol Siqueira; Angelis, Elisabete Carrara-de

    2017-08-24

    Patients with unilateral vocal fold paralysis may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach. To evaluate the voice therapy effectiveness in the short, medium and long-term in patients with unilateral vocal fold paralysis and determine the risk factors for voice rehabilitation failure. Prospective study with 61 patients affected by unilateral vocal fold paralysis enrolled. Each subject had voice therapy with an experienced speech pathologist twice a week. A multidimensional assessment protocol was used pre-treatment and in three different times after voice treatment initiation: short-term (1-3 months), medium-term (4-6 months) and long-term (12 months); it included videoendoscopy, maximum phonation time, GRBASI scale, acoustic voice analysis and the portuguese version of the voice handicap index. Multiple comparisons for GRBASI scale and VHI revealed statistically significant differences, except between medium and long term (pvocal improvement over time with stabilization results after 6 months (medium term). From the 28 patients with permanent unilateral vocal fold paralysis, 18 (69.2%) reached complete glottal closure following vocal therapy (p=0.001). The logistic regression method indicated that the Jitter entered the final model as a risk factor for partial improvement. For every unit of increased jitter, there was an increase of 0.1% (1.001) of the chance for partial improvement, which means an increase on no full improvement chance during rehabilitation. Vocal rehabilitation improves perceptual and acoustic voice parameters and voice handicap index, besides favor glottal closure in patients with unilateral vocal fold paralysis. The results were also permanent during the period of 1 year. The Jitter value, when elevated, is a risk factor for the voice therapy

  7. Trends in Incidence and Factors Affecting Survival of Patients With Cholangiocarcinoma in the United States.

    Science.gov (United States)

    Mukkamalla, Shiva Kumar R; Naseri, Hussain M; Kim, Byung M; Katz, Steven C; Armenio, Vincent A

    2018-04-01

    Background: Cholangiocarcinoma (CCA) includes cancers arising from the intrahepatic and extrahepatic bile ducts. The etiology and pathogenesis of CCA remain poorly understood. This is the first study investigating both incidence patterns of CCA from 1973 through 2012 and demographic, clinical, and treatment variables affecting survival of patients with CCA. Patients and Methods: Using the SEER database, age-adjusted incidence rates were evaluated from 1973-2012 using SEER*Stat software. A retrospective cohort of 26,994 patients diagnosed with CCA from 1973-2008 was identified for survival analysis. Cox proportional hazards models were used to perform multivariate survival analysis. Results: Overall incidence of CCA increased by 65% from 1973-2012. Extrahepatic CCA (ECC) remained more common than intrahepatic CCA (ICC), whereas the incidence rates for ICC increased by 350% compared with a 20% increase seen with ECC. Men belonging to non-African American and non-Caucasian ethnicities had the highest incidence rates of CCA. This trend persisted throughout the study period, although African Americans and Caucasians saw 50% and 59% increases in incidence rates, respectively, compared with a 9% increase among other races. Median overall survival (OS) was 8 months in patients with ECC compared with 4 months in those with ICC. Our survival analysis found Hispanic women to have the best 5-year survival outcome ( P better survival outcomes compared with ICC ( P better survival outcomes compared with others ( P <.0001). Conclusions: This is the most up-to-date study of CCA from the SEER registry that shows temporal patterns of increasing incidence of CCA across different races, sexes, and ethnicities. We identified age, sex, race, marital status, income, smoking status, anatomic location of CCA, tumor grade, tumor stage, radiation, and surgery as independent prognostic factors for OS in patients with CCA. Copyright © 2018 by the National Comprehensive Cancer Network.

  8. Does the economy affect functional restoration outcomes for patients with chronic disabling occupational musculoskeletal disorders?

    Science.gov (United States)

    Hartzell, Meredith M; Mayer, Tom G; Neblett, Randy; Marquardt, Dennis J; Gatchel, Robert J

    2015-06-01

    To determine how the economy affects psychosocial and socioeconomic treatment outcomes in a cohort of chronic disabling occupational musculoskeletal disorder (CDOMD) patients who completed a functional restoration program (FRP). A cohort of 969 CDOMD patients with active workers' compensation claims completed an FRP (a medically-supervised, quantitatively-directed exercise progression program, with multi-modal disability management). A good economy (GE) group (n = 532) was released to work during a low unemployment period (2005-2007), and a poor economy (PE) group (n = 437) was released during a higher unemployment period (2008-2010). Patients were evaluated upon admission for demographic and psychosocial variables, and were reassessed at discharge. Socioeconomic outcomes, including work return and work retention 1 year post-discharge, were collected. Some significant differences in psychosocial self-report data were found, but most of the effect sizes were small, so caution should be made when interpreting the data. Compared to the PE group, the GE group reported more depressive symptoms and disability at admission, but demonstrated a larger decrease in depressive symptoms and disability and increase in self-reported quality of life at discharge. The PE group had lower rates of work return and retention 1-year after discharge, even after controlling for other factors such as length of disability and admission work status. CDOMD patients who completed an FRP in a PE year were less likely to return to, or retain, work 1-year after discharge, demonstrating that a PE can be an additional barrier to post-discharge work outcomes. A difference in State unemployment rates of <3% (7 vs. 5%) had a disproportionate effect on patients' failure to return to (19 vs. 6%) or retain (28 vs. 15%) work.

  9. Resilience and positive affect contribute to lower cancer-related fatigue among Chinese patients with gastric cancer.

    Science.gov (United States)

    Zou, Guiyuan; Li, Ye; Xu, Ruicai; Li, Ping

    2018-04-01

    To investigate the prevalence of cancer-related fatigue and explore the relationship between resilience, positive affect, and fatigue among Chinese patients with gastric cancer. Cancer-related fatigue is the most distressing symptom reported frequently by cancer patients during both treatment and survival phases. Resilience and positive affect as vital protective factors against cancer-related fatigue have been examined, but the underlying psychological mechanisms are not well understood. A cross-sectional study. Two hundred and three gastric cancer patients were enrolled from three hospitals in China. The Cancer Fatigue Scale, the positive affect subscale of the Positive and Negative Affect Schedule and the Connor-Davidson Resilience Scale (CD-RISC10) were administered. Hierarchical linear regression modelling was conducted to examine the association between resilience and cancer-related fatigue, and the mediating effect of positive affect. The incidence of clinically relevant fatigue among patients with gastric cancer was 91.6%. Regression analysis showed that resilience was negatively associated with cancer-related fatigue, explaining 15.4% of variance in cancer-related fatigue. Mediation analysis showed that high resilience was associated with increased positive affect, which was associated with decreased cancer-related fatigue. Cancer-related fatigue is prevalent among patients with gastric cancer. Positive affect may mediate the relationship between resilience and cancer-related fatigue. Interventions that attend to resilience training and promotion of positive affect may be the focus for future clinical and research endeavours. © 2017 John Wiley & Sons Ltd.

  10. Exercise mediates the association between positive affect and 5-year mortality in patients with ischemic heart disease

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Versteeg, Henneke; Hansen, Tina B

    2013-01-01

    Background- Positive affect has been associated with better prognosis in patients with ischemic heart disease, but the underlying mechanisms remain unclear. We examined whether positive affect predicted time to first cardiac-related hospitalization and all-cause mortality, and whether exercise me...... between positive affect and mortality. Interventions aimed at increasing both positive affect and exercise may have better results with respect to patients' prognosis and psychological well-being than interventions focusing on 1 of these factors alone.......Background- Positive affect has been associated with better prognosis in patients with ischemic heart disease, but the underlying mechanisms remain unclear. We examined whether positive affect predicted time to first cardiac-related hospitalization and all-cause mortality, and whether exercise...... mediated this relationship in patients with established ischemic heart disease. Methods and Results- The sample comprised 607 patients with ischemic heart disease from Holbæk Hospital, Denmark. In 2005, patients completed the Global Mood Scale (GMS) to assess positive affect and a purpose-designed question...

  11. Distraction osteogenesis therapy in patients affected by Goldenhar syndrome: a case series

    Directory of Open Access Journals (Sweden)

    Francesco Grecchi

    2011-06-01

    Full Text Available Background: Hemifacial microsomia (HM is a syndrome characterized by the presence of structural alterations of the skeletal, nervous, vascular, and muscular structures derived from the first and second branchial arch. Goldenhar syndrome (Gs consistisof the triad of craniofacial microsomia, ocular dermoid cysts, and spinal anomalies. When the patient has hypoplasia of the mandible, orthognatic surgery or distraction osteogenesis (DO can be used to correct the asymmetry. Mandibular DO has been applied for many years, but long-term reports showed controversial results. The aim of this paper is to describe three cases of patients affected by Gs in which DO was performed to correct the mandibular asymmetry. Case series: The cases reported show an increasing degree of dismorphism which required a increasing complexity of the surgical approach: a single mandibular DO in the first patient, and a mandibular DO associated with a Le Fort I osteotomy in the second one, a double mandibular DO associated with Le Fort I and surgical disjunction of the middle palatal suture in the third case. Discussion: The effects of DO involve not only the skeletal segment but also all the surrounding soft tissues. DO leads to rapid and remarkable improvement in facial symmetry due to emimandible hypoplasia. When correct spatial repositioning of the maxilla cann ot be expected, mandibular DO can be carried out by associating a Le Fort I osteotomy. In this way DO minimize the need for major osteotomies and allows an earlier treatment in selected cases.

  12. Does the Number of Pharmacies a Patient Frequents Affect Adherence to Statins?

    Science.gov (United States)

    Christie, Russell; Sketris, Ingrid; Andreou, Pantalis; Holbrook, Anne; Levy, Adrian; Tamim, Hala

    2017-05-06

    We hypothesized that medication adherence is affected by the number of pharmacies a patient frequents. The objective was to estimate the strength of association between the number of pharmacies a patient frequents and adherence to statins. Using administrative data from the Nova Scotia Seniors' Pharmacare program, a retrospective cohort study was conducted among subjects aged 65 years and older first dispensed statin between 1998 and 2008. The Usual Provider of Care (UPC), was defined as the number of dispensation days from the most frequented pharmacy divided by the total number of dispensation days. Estimated adherence of over 80% of the Medication Possession Ratio was defined as adherent. Data were analyzed using hierarchical linear regression. The cohort of 25,641 subjects was 59% female with a mean age of 74 years. During follow-up, subjects filled prescriptions in a median of 2 (mean = 2; standard deviation = 0.88) pharmacies and visited pharmacies a median of 28 (mean = 30) times. During that time, 61% of patients used one pharmacy exclusively. Among subjects using 1 pharmacy, 59% were adherent while 58% using more than one pharmacy were adherent. However, upon adjustment for differences in distributions of age, sex, and other confounders, subjects who used more than one pharmacy had 10% decreased odds of statin adherence (odds ratio: 0.90, 95% confidence interval: 0.86-0.96). These results were robust in sensitivity analyses. Among seniors newly starting statin therapy, using a single community pharmacy was modestly associated with adherence.

  13. Data on cardiac defects, morbidity and mortality in patients affected by RASopathies. CARNET study results.

    Science.gov (United States)

    Calcagni, Giulio; Limongelli, Giuseppe; D'Ambrosio, Angelo; Gesualdo, Francesco; Digilio, Maria Cristina; Baban, Anwar; Albanese, Sonia B; Versacci, Paolo; De Luca, Enrica; Ferrero, Giovanni B; Baldassarre, Giuseppina; Agnoletti, Gabriella; Banaudi, Elena; Marek, Jan; Kaski, Juan P; Tuo, Giulia; Russo, Maria Giovanna; Pacileo, Giuseppe; Milanesi, Ornella; Messina, Daniela; Marasini, Maurizio; Cairello, Francesca; Formigari, Roberto; Brighenti, Maurizio; Dallapiccola, Bruno; Tartaglia, Marco; Marino, Bruno

    2018-02-01

    A comprehensive description of morbidity and mortality in patients affected by mutations in genes encoding for signal transducers of the RAS-MAPK cascade (RASopathies) was performed in our study recently published in the International Journal of Cardiology. Seven European cardiac centres participating to the CArdiac Rasopathy NETwork (CARNET), collaborated in this multicentric, observational, retrospective data analysis and collection. In this study, clinical records of 371 patients with confirmed molecular diagnosis of RASopathy were reviewed. Cardiac defects, crude mortality, survival rate of patients with 1) hypertrophic cardiomyopathy (HCM) and age Noonan syndrome and pulmonary stenosis carrying PTPN11 mutations; 3) biventricular obstruction and PTPN11 mutations; 4) Costello syndrome or cardiofaciocutaneous syndrome were analysed. Mortality was described as crude mortality, cumulative survival and restricted estimated mean survival. In particular, with this Data In Brief (DIB) paper, the authors aim to report specific statistic highlights of the multivariable regression analysis that was used to assess the impact of mutated genes on number of interventions and overall prognosis.

  14. The COPD Helplessness Index: a new tool to measure factors affecting patient self-management.

    Science.gov (United States)

    Omachi, Theodore A; Katz, Patricia P; Yelin, Edward H; Iribarren, Carlos; Knight, Sara J; Blanc, Paul D; Eisner, Mark D

    2010-04-01

    Psychologic factors affect how patients with COPD respond to attempts to improve their self-management skills. Learned helplessness may be one such factor, but there is no validated measure of helplessness in COPD. We administered a new COPD Helplessness Index (CHI) to 1,202 patients with COPD. Concurrent validity was assessed through association of the CHI with established psychosocial measures and COPD severity. The association of helplessness with incident COPD exacerbations was then examined by following subjects over a median 2.1 years, defining COPD exacerbations as COPD-related hospitalizations or ED visits. The CHI demonstrated internal consistency (Cronbach alpha = 0.75); factor analysis was consistent with the CHI representing a single construct. Greater CHI-measured helplessness correlated with greater COPD severity assessed by the BODE (Body-mass, Obstruction, Dyspnea, Exercise) Index (r = 0.34; P Controlling for sociodemographics and smoking status, helplessness was prospectively associated with incident COPD exacerbations (hazard ratio = 1.31; P controlling for the BODE Index, helplessness remained predictive of COPD exacerbations among subjects with BODE Index useful tool in analyzing differential clinical responses mediated by patient-centered attributes.

  15. Surgical Orthodontic Treatment of a Patient Affected by Type 1 Myotonic Dystrophy (Steinert Syndrome).

    Science.gov (United States)

    Cacucci, Laura; Ricci, Beatrice; Moretti, Maria; Gasparini, Giulio; Pelo, Sandro; Grippaudo, Cristina

    2017-01-01

    Myotonic dystrophy, or Steinert's disease, is the most common form of muscular dystrophy that occurs in adults. This multisystemic form involves the skeletal muscles but affects also the eye, the endocrine system, the central nervous system, and the cardiac system. The weakness of the facial muscles causes a characteristic facial appearance frequently associated with malocclusions. Young people with myotonic dystrophy, who also have severe malocclusions, have bad oral functions such as chewing, breathing, and phonation. We present a case report of a 15-year-old boy with anterior open bite, upper and lower dental crowding, bilateral crossbite, and constriction of the upper jaw with a high and narrow palate. The patient's need was to improve his quality of life. Because of the severity of skeletal malocclusion, it was necessary to schedule a combined orthodontic and surgical therapy in order to achieve the highest aesthetic and functional result. Although therapy caused an improvement in patient's quality of life, the clinical management of the case was hard. The article shows a balance between costs and benefits of a therapy that challenges the nature of the main problem of the patient, and it is useful to identify the most appropriate course of treatment for similar cases.

  16. Data on cardiac defects, morbidity and mortality in patients affected by RASopathies. CARNET study results

    Directory of Open Access Journals (Sweden)

    Giulio Calcagni

    2018-02-01

    Full Text Available A comprehensive description of morbidity and mortality in patients affected by mutations in genes encoding for signal transducers of the RAS-MAPK cascade (RASopathies was performed in our study recently published in the International Journal of Cardiology. Seven European cardiac centres participating to the CArdiac Rasopathy NETwork (CARNET, collaborated in this multicentric, observational, retrospective data analysis and collection. In this study, clinical records of 371 patients with confirmed molecular diagnosis of RASopathy were reviewed. Cardiac defects, crude mortality, survival rate of patients with 1 hypertrophic cardiomyopathy (HCM and age <2 years or young adults; 2 individuals with Noonan syndrome and pulmonary stenosis carrying PTPN11 mutations; 3 biventricular obstruction and PTPN11 mutations; 4 Costello syndrome or cardiofaciocutaneous syndrome were analysed. Mortality was described as crude mortality, cumulative survival and restricted estimated mean survival. In particular, with this Data In Brief (DIB paper, the authors aim to report specific statistic highlights of the multivariable regression analysis that was used to assess the impact of mutated genes on number of interventions and overall prognosis.

  17. Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

    Directory of Open Access Journals (Sweden)

    Abbasali Ebrahimian

    2014-01-01

    Full Text Available Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1 patient’s condition’ and (2 the context of the EMS mission’. The patent’s condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics’. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients’ needs for transportation in a prehospital situation.

  18. Eating habits and nutritional status of patients with affective disorders and schizophrenia.

    Science.gov (United States)

    Stefańska, Ewa; Lech, Magdalena; Wendołowicz, Agnieszka; Konarzewska, Beata; Waszkiewicz, Napoleon; Ostrowska, Lucyna

    2017-12-30

    The aim of the study was to assess the nutritional value of the food intake in the group of men and women suffering from recurrent affective disorders and schizophrenia, and also to determine the relation between selected nutritional parameters with anthropometric indices defining the nutritional status of the subjects. 219 persons participated in the study (61 patients with recurrent depressive disorders, 60 patients with schizophrenia and 98 healthy volunteers). A24-hour dietary recall was used in the quantitative assessment of the diet. Anthropometric and biochemical measurements as well as body composition analysis were used to assess the nutritional status. It was shown that women with depression and schizophrenia had a significantly higher content of both visceral adipose tissue and subcutaneous adipose tissue as compared with the control group. A diet with a higher content of energy from protein, a higher supply of calcium promoted a lower fat content in the bodies of women suffering from depression (no such relationship was observed in the group of men). In the group of patients with schizophrenia, a diet with a lower supply of energy promoted a lower BMI value, waist circumference, lower waist-hip ratio and a lower fat content in the body. An improper energy structure and an improper content of nutrients can, in the future, contribute to the development of many somatic diseases, thus leading to deterioration of life quality of subjects and preventing the maintenance of mental health.

  19. Cannabis and alcohol use, affect and impulsivity in psychiatric out-patients' daily lives.

    Science.gov (United States)

    Trull, Timothy J; Wycoff, Andrea M; Lane, Sean P; Carpenter, Ryan W; Brown, Whitney C

    2016-11-01

    Cannabis and alcohol are the most commonly used (il)licit drugs world-wide. We compared the effects of cannabis and alcohol use on within-person changes in impulsivity, hostility and positive affect at the momentary and daily levels, as they occurred in daily life. Observational study involving ecological momentary assessments collected via electronic diaries six random times a day for 28 consecutive days. Out-patients' everyday life contexts in Columbia, MO, USA. Ninety-three adult psychiatric out-patients (85% female; mean = 30.9 years old) with borderline personality or depressive disorders, who reported using only cannabis (n = 3), only alcohol (n = 58) or both (n = 32) at least once during the study period. Real-time, standard self-report measures of impulsivity, hostility and positive affect, as impacted by momentary reports of cannabis and alcohol use. Cannabis use was associated with elevated feelings of impulsivity at the day level [b = 0.83, 95% confidence interval (CI) = 0.17-1.49] and increased hostility at the momentary (b = 0.07, 95% CI = 0.01-0.12) and person (b = 0.81, 95% CI = 0.15-1.47) level. Alcohol use was associated with elevated feelings of impulsivity at the momentary (b = 0.42, 95% CI = 0.13-0.71) and day levels (b = 0.82, 95% CI = 0.22-1.41) and increased positive affect at the momentary (b = 0.12, 95% CI = 0.06-0.18) and day (b = 0.33, 95% CI = 0.16-0.49) levels. Cannabis and alcohol use are associated with increases in impulsivity (both), hostility (cannabis) and positive affect (alcohol) in daily life, and these effects are part of separate processes that operate on different time-scales (i.e. momentary versus daily). © 2016 Society for the Study of Addiction.

  20. Audiological follow-up of 24 patients affected by Williams syndrome.

    Science.gov (United States)

    Barozzi, Stefania; Soi, Daniela; Spreafico, Emanuela; Borghi, Anna; Comiotto, Elisabetta; Gagliardi, Chiara; Selicorni, Angelo; Forti, Stella; Cesarani, Antonio; Brambilla, Daniele

    2013-09-01

    Williams syndrome is a neurodevelopmental disorder associated with cardiovascular problems, facial abnormalities and several behavioural and neurological disabilities. It is also characterized by some typical audiological features including abnormal sensitivity to sounds, cochlear impairment related to the outer hair cells of the basal turn of the cochlea, and sensorineural or mixed hearing loss, predominantly in the high frequency range. The aim of this report is to describe a follow-up study of auditory function in a cohort of children affected by this syndrome. 24 patients, aged 5-14 years, were tested by means of air/bone conduction pure-tone audiometry, immittance test and transient evoked otoacoustic emissions. They were evaluated again 5 years after the first assessment, and 10 of them underwent a second follow-up examination after a further 5 years. The audiometric results showed hearing loss, defined by a pure tone average >15 dB HL, in 12.5% of the participants. The incidence of hearing loss did not change over the 5-year period and increased to 30% in the patients who underwent the 10-year follow-up. Progressive sensorineural hearing loss was detected in 20% of the patients. A remarkable finding of our study regarded sensorineural hearing impairment in the high frequency range, which increased significantly from 25% to 50% of the participants over the 5-year period. The increase became even more significant in the group of patients who underwent the 10-year follow-up, by which time the majority of them (80%) had developed sensorineural hearing loss. Otoacoustic emissions were found to be absent in a high percentage of patients, thus confirming the cochlear fragility of individuals with Williams syndrome. Our study verified that most of the young Williams syndrome patients had normal hearing sensitivity within the low-middle frequency range, but showed a weakness regarding the high frequencies, the threshold of which worsened significantly over time in

  1. Predictive value of social inhibition and negative affectivity for cardiovascular events and mortality in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Denollet, Johan; Pedersen, Susanne S.; Vrints, Christiaan J

    2014-01-01

    Methodological considerations and selected null findings indicate the need to reexamine the Type D construct. We investigated whether associations with cardiac events in patients with coronary artery disease (CAD) involve the specific combination of negative affectivity (NA) and social inhibition...

  2. Activation of less affected corticospinal tract and poor motor outcome in hemiplegic pediatric patients: a diffusion tensor tractography imaging study

    Directory of Open Access Journals (Sweden)

    Jin Hyun Kim

    2015-01-01

    Full Text Available The less affected hemisphere is important in motor recovery in mature brains. However, in terms of motor outcome in immature brains, no study has been reported on the less affected corticospinal tract in hemiplegic pediatric patients. Therefore, we examined the relationship between the condition of the less affected corticospinal tract and motor function in hemiplegic pediatric patients. Forty patients with hemiplegia due to perinatal or prenatal injury (13.7 ± 3.0 months and 40 age-matched typically developing controls were recruited. These patients were divided into two age-matched groups, the high functioning group (20 patients and the low functioning group (20 patients using functional level of hemiplegia scale. Diffusion tensor tractography images showed that compared with the control group, the patient group of the less affected corticospinal tract showed significantly increased fiber number and significantly decreased fractional anisotropy value. Significantly increased fiber number and significantly decreased fractional anisotropy value in the low functioning group were observed than in the high functioning group. These findings suggest that activation of the less affected hemisphere presenting as increased fiber number and decreased fractional anisotropy value is related to poor motor function in pediatric hemiplegic patients.

  3. Which Factors Affect Dental Esthetics and Smile Attractiveness in Orthodontically Treated Patients?

    Science.gov (United States)

    Heravi, Farzin; Rashed, Roozbeh; Zarrabi, Mohammad Javad; Setayesh, Yasin

    2015-01-01

    Objectives: This study aimed to find the factors that affect dental esthetics and smile attractiveness in orthodontically treated patients according to laypeople’s judgment, and to determine whether there is any relationship between dental and smile esthetics. Materials and Methods: Using the Q-sort technique, 60 laypersons (30 males, 30 females) rated dental and smile photographs of 48 orthodontically treated patients based on their degree of attractiveness. Dental and smile parameters of each rated image were measured by Smile Analyzer software. The Student’s t-test and chi-square test were used to compare dental and smile parameters between attractive and unattractive images. The logistic regression was used to assess which variables predicted dental and smile esthetics in treated individuals. Results: The philtral to commissural height ratio and gingival display were significantly different in attractive and unattractive smiles (P=0.003 and P=0.02, respectively). None of the dental variables were found to be a determinant of dental esthetics at the end of the orthodontic treatment (P>0.05). According to the judgment of all raters (female and male) and the male raters’ judgment, smile attractiveness could be predicted by philtral to commissural height ratio and buccal corridor ratio (Pesthetics and smile attractiveness in orthodontically treated patients (P>0.05). Conclusion: The philtral to commissural height ratio and buccal corridor ratio can be considered as predictors of smile attractiveness in orthodontically treated patients. Achieving dental esthetics at the end of orthodontic treatment does not guarantee smile attractiveness. PMID:26877739

  4. Factors affecting high-sensitivity cardiac troponin T elevation in Japanese metabolic syndrome patients

    Directory of Open Access Journals (Sweden)

    Hitsumoto T

    2015-03-01

    Full Text Available Takashi Hitsumoto,1 Kohji Shirai2 1Hitsumoto Medical Clinic, Yamaguchi, Japan; 2Department of Vascular Function (donated, Sakura Hospital, Toho University School of Medicine, Chiba, Japan Purpose: The blood concentration of cardiac troponin T (ie, high-sensitivity cardiac troponin T [hs-cTnT], measured using a highly sensitive assay, represents a useful biomarker for evaluating the pathogenesis of heart failure or predicting cardiovascular events. However, little is known about the clinical significance of hs-cTnT in metabolic syndrome. The aim of this study was to examine the factors affecting hs-cTnT elevation in Japanese metabolic syndrome patients. Patients and methods: We enrolled 258 metabolic syndrome patients who were middle-aged males without a history of cardiovascular events. We examined relationships between hs-cTnT and various clinical parameters, including diagnostic parameters of metabolic syndrome. Results: There were no significant correlations between hs-cTnT and diagnostic parameters of metabolic syndrome. However, hs-cTnT was significantly correlated with age (P<0.01, blood concentrations of brain natriuretic peptide (P<0.01, reactive oxygen metabolites (markers of oxidative stress, P<0.001, and the cardio–ankle vascular index (marker of arterial function, P<0.01. Furthermore, multiple regression analysis revealed that these factors were independent variables for hs-cTnT as a subordinate factor. Conclusion: The findings of this study indicate that in vivo oxidative stress and abnormality of arterial function are closely associated with an increase in hs-cTnT concentrations in Japanese metabolic syndrome patients. Keywords: troponin, metabolic syndrome, risk factor, oxidative stress, cardio–ankle vascular index

  5. Early affective processing in patients with acute posttraumatic stress disorder: magnetoencephalographic correlates.

    Directory of Open Access Journals (Sweden)

    Markus Burgmer

    Full Text Available In chronic PTSD, a preattentive neural alarm system responds rapidly to emotional information, leading to increased prefrontal cortex (PFC activation at early processing stages (<100 ms. Enhanced PFC responses are followed by a reduction in occipito-temporal activity during later processing stages. However, it remains unknown if this neuronal pattern is a result of a long lasting mental disorder or if it represents changes in brain function as direct consequences of severe trauma.The present study investigates early fear network activity in acutely traumatized patients with PTSD. It focuses on the question whether dysfunctions previously observed in chronic PTSD patients are already present shortly after trauma exposure. We recorded neuromagnetic activity towards emotional pictures in seven acutely traumatized PTSD patients between one and seven weeks after trauma exposure and compared brain responses to a balanced healthy control sample. Inverse modelling served for mapping sources of differential activation in the brain.Compared to the control group, acutely traumatized PTSD patients showed an enhanced PFC response to high-arousing pictures between 60 to 80 ms. This rapid prefrontal hypervigilance towards arousing pictorial stimuli was sustained during 120-300 ms, where it was accompanied by a reduced affective modulation of occipito-temporal neural processing.Our findings indicate that the hypervigilance-avoidance pattern seen in chronic PTSD is not necessarily a product of an endured mental disorder, but arises as an almost immediate result of severe traumatisation. Thus, traumatic experiences can influence emotion processing strongly, leading to long-lasting changes in trauma network activation and expediting a chronic manifestation of maladaptive cognitive and behavioral symptoms.

  6. Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study.

    Science.gov (United States)

    Kooij, Laura; Groen, Wim G; van Harten, Wim H

    2018-05-11

    The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators' perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects' positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of reimbursements), and guaranteeing privacy and security

  7. Birthdates of patients affected by mental illness and solar activity: A study from Italy

    Science.gov (United States)

    Ventriglio, Antonio; Borelli, Albacenzina; Bellomo, Antonello; Lepore, Alberto

    2011-04-01

    PurposeThis epidemiologic study tested an hypothesized association between the year of birth of persons with major mental illnesses and solar activity over the past century. MethodsWe collected data on diagnoses and birthdates of psychiatric patients born between 1926 and 1975 (N = 1954) in south Italy for comparison to yearly solar activity as registered by the International Observatories. ResultsWe found a strong inverse correlation between high solar activity (HSA) and incidence of schizophrenia and bipolar disorder in a 20-year period whereas the incidence of non-affective/non-psychotic disorders was moderately associated with HSA in the same period. ConclusionsInterpretation of the observed correlations between HSA during years of birth and the incidence of mental illnesses remains unclear, but the findings encourage further study.

  8. Diversity of the Genes Implicated in Algerian Patients Affected by Usher Syndrome.

    Directory of Open Access Journals (Sweden)

    Samia Abdi

    Full Text Available Usher syndrome (USH is an autosomal recessive disorder characterized by a dual sensory impairment affecting hearing and vision. USH is clinically and genetically heterogeneous. Ten different causal genes have been reported. We studied the molecular bases of the disease in 18 unrelated Algerian patients by targeted-exome sequencing, and identified the causal biallelic mutations in all of them: 16 patients carried the mutations at the homozygous state and 2 at the compound heterozygous state. Nine of the 17 different mutations detected in MYO7A (1 of 5 mutations, CDH23 (4 of 7 mutations, PCDH15 (1 mutation, USH1C (1 mutation, USH1G (1 mutation, and USH2A (1 of 2 mutations, had not been previously reported. The deleterious consequences of a missense mutation of CDH23 (p.Asp1501Asn and the in-frame single codon deletion in USH1G (p.Ala397del on the corresponding proteins were predicted from the solved 3D-structures of extracellular cadherin (EC domains of cadherin-23 and the sterile alpha motif (SAM domain of USH1G/sans, respectively. In addition, we were able to show that the USH1G mutation is likely to affect the binding interface between the SAM domain and USH1C/harmonin. This should spur the use of 3D-structures, not only of isolated protein domains, but also of protein-protein interaction interfaces, to predict the functional impact of mutations detected in the USH genes.

  9. Deconstructing empathy: Neuroanatomical dissociations between affect sharing and prosocial motivation using a patient lesion model.

    Science.gov (United States)

    Shdo, Suzanne M; Ranasinghe, Kamalini G; Gola, Kelly A; Mielke, Clinton J; Sukhanov, Paul V; Miller, Bruce L; Rankin, Katherine P

    2017-02-14

    Affect sharing and prosocial motivation are integral parts of empathy that are conceptually and mechanistically distinct. We used a neurodegenerative disease (NDG) lesion model to examine the neural correlates of these two aspects of real-world empathic responding. The study enrolled 275 participants, including 44 healthy older controls and 231 patients diagnosed with one of five neurodegenerative diseases (75 Alzheimer's disease, 58 behavioral variant frontotemporal dementia (bvFTD), 42 semantic variant primary progressive aphasia (svPPA), 28 progressive supranuclear palsy, and 28 non-fluent variant primary progressive aphasia (nfvPPA). Informants completed the Revised Self-Monitoring Scale's Sensitivity to the Expressive Behavior of Others (RSMS-EX) subscale and the Interpersonal Reactivity Index's Empathic Concern (IRI-EC) subscale describing the typical empathic behavior of the participants in daily life. Using regression modeling of the voxel based morphometry of T1 brain scans prepared using SPM8 DARTEL-based preprocessing, we isolated the variance independently contributed by the affect sharing and the prosocial motivation elements of empathy as differentially measured by the two scales. We found that the affect sharing component uniquely correlated with volume in right>left medial and lateral temporal lobe structures, including the amygdala and insula, that support emotion recognition, emotion generation, and emotional awareness. Prosocial motivation, in contrast, involved structures such as the nucleus accumbens (NaCC), caudate head, and inferior frontal gyrus (IFG), which suggests that an individual must maintain the capacity to experience reward, to resolve ambiguity, and to inhibit their own emotional experience in order to effectively engage in spontaneous altruism as a component of their empathic response to others. Copyright © 2017. Published by Elsevier Ltd.

  10. The association of affective temperaments with smoking initiation and maintenance in adult primary care patients.

    Science.gov (United States)

    Eory, Ajandek; Rozsa, Sandor; Gonda, Xenia; Dome, Peter; Torzsa, Peter; Simavorian, Tatevik; Fountoulakis, Konstantinos N; Pompili, Maurizio; Serafini, Gianluca; Akiskal, Knarig K; Akiskal, Hagop S; Rihmer, Zoltan; Kalabay, Laszlo

    2015-02-01

    Smoking behaviour and its course is influenced by personality factors. Affective temperaments could allow a more specific framework of the role trait affectivity plays in this seriously harmful health-behaviour. The aim of our study was to investigate if such an association exists in an ageing population with a special emphasis on gender differences. 459 primary care patients completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Subjects were characterized according to their smoking behaviour as current, former or never smokers. Univariate analysis ANOVA and logistic regression were performed to analyse differences in the three smoking subgroups to predict smoking initiation and maintenance. Current smokers were younger and less educated than former or never smokers. Males were more likely to try tobacco during their lifetime and were more successful in cessation. Depressive, cyclothymic and irritable temperament scores showed significant differences between the three smoking subgroups. Irritable temperament was a predictor of smoking initiation in females whereas depressive temperament predicted smoking maintenance in males with a small, opposite effect of HAM-A scores independent of age, education, lifetime depression and BDI scores. Whereas smoking initiation was exclusively predicted by a higher BDI score in males, smoking maintenance was predicted by younger age and lower education in females. The cross-sectional nature of the study design may lead to selective survival bias and hinder drawing causal relationships. Affective temperaments contribute to smoking initiation and maintenance independently of age, education, and depression. The significant contribution of depressive temperament in males and irritable temperament in females may highlight the role of gender-discordant temperaments in vulnerable subgroups. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Does burnout among doctors affect their involvement in patients' mental health problems? A study of videotaped consultations.

    NARCIS (Netherlands)

    Zantinge, E.M.; Verhaak, P.F.M.; Bakker, D.H. de; Meer, K. van der; Bensing, J.M.

    2009-01-01

    Background: General practitioners' (GPs') feelings of burnout or dissatisfaction may affect their patient care negatively, but it is unknown if these negative feelings also affect their mental health care. GPs' available time, together with specific communication tools, are important conditions for

  12. Positive Affect and Survival in Patients With Stable Coronary Heart Disease : Findings From the Heart and Soul Study

    NARCIS (Netherlands)

    Hoen, Petra W.; Denollet, Johan; de Jonge, Peter; Whooley, Mary A.

    Objective: Positive affect can improve survival, but the mechanisms responsible for this association are unknown. We sought to evaluate the association between positive affect and mortality in patients with stable coronary heart disease and to determine biological and behavioral factors that might

  13. Positive affect and survival in patients with stable coronary heart disease : Findings from the Heart and Soul Study

    NARCIS (Netherlands)

    Hoen, P.W.; Denollet, J.; de Jonge, P.; Whooley, M.A.

    2013-01-01

    Objective: Positive affect can improve survival, but the mechanisms responsible for this association are unknown. We sought to evaluate the association between positive affect and mortality in patients with stable coronary heart disease and to determine biological and behavioral factors that might

  14. Does burnout among doctors affect their involvement in patients' mental health problems? : A study of videotaped consultations

    NARCIS (Netherlands)

    Zantinge, Else M.; Verhaak, Peter F. M.; de Bakker, Dinny H.; van der Meer, Klaas; Bensing, Jozien M.

    2009-01-01

    Background: General practitioners' (GPs') feelings of burnout or dissatisfaction may affect their patient care negatively, but it is unknown if these negative feelings also affect their mental health care. GPs' available time, together with specific communication tools, are important conditions for

  15. Does pretreatment hemoglobin level affect outcome in patients with T1 glottic cancer?

    International Nuclear Information System (INIS)

    Canaday, Daniel J.; Regine, William F.; Mohiuddin, Mohammed; Zollinger, William; Machtay, Mitchell; Lee, Jason; Schultz, Delray; Rosenthal, David I.; Rudoltz, Marc S.

    1997-01-01

    Purpose/Objective: Recent reports have suggested that pretreatment hemoglobin (Hgb) is significantly associated with local control (LC) and overall survival (OS) in patients with T1 and T2 squamous cell carcinoma of the glottic larynx. This study evaluates the association of pretreatment Hgb level and other factors with outcome in patients limited to T1 squamous cell carcinoma of the glottic larynx treated with external beam radiation. Methods: One hundred fifty-eight patients with T1 squamous cell carcinoma of the glottic larynx were analyzed. Median follow-up was 5 years (range 2-22). Median pretreatment Hgb was 14.4 gm/dl (range 8.2-17.2). The following parameters were analyzed for their impact on LC, OS, and disease specific survival (DSS): age, gender, pretreatment Hgb, tumor grade, anterior commissure involvement, field size, total dose, dose per fraction, and overall treatment time. Results: Five year actuarial LC was 84%. Pretreatment Hgb was not a significant predictor for LC when assessed as a continuous variable (p=0.38). LC was 82% for patients with Hgb >13 vs 92% for Hgb ≤ 13 (p=0.13). No other factor was significant for LC. Five year actuarial OS was 74%. On univariate analysis, pretreatment Hgb ≤ 13 gm/dl was a significant factor for poorer OS (78% vs 68%, p=0.004), as were total dose 61 years (p=0.017). On multivariate analysis, only age >61 (p=0.014) and Hgb ≤ 13 (p=0.001) retained significance for OS. Five year actuarial DSS was 92%. Pretreatment Hgb was not a prognostic factor for DSS, nor were any other analyzed factors. Conclusion: Pretreatment Hgb is not a significant prognostic factor for LC in patients with T1 squamous cell carcinoma of the glottic larynx, but it does predict for a poorer OS without affecting DSS. This suggests that patients with lower pretreatment Hgb may have confounding medical problems which detract from their overall survival

  16. Specificity of Affective Instability in Patients With Borderline Personality Disorder Compared to Posttraumatic Stress Disorder, Bulimia Nervosa, and Healthy Controls

    Science.gov (United States)

    Santangelo, Philip; Mussgay, Lutz; Sawitzki, Günther; Trull, Timothy J.; Reinhard, Iris; Steil, Regina; Klein, Christoph; Bohus, Martin; Ebner-Priemer, Ulrich W.

    2014-01-01

    Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses. PMID:24661176

  17. Involvement of endocrine system in a patient affected by glycogen storage disease 1b: speculation on the role of autoimmunity.

    Science.gov (United States)

    Melis, Daniela; Della Casa, Roberto; Balivo, Francesca; Minopoli, Giorgia; Rossi, Alessandro; Salerno, Mariacarolina; Andria, Generoso; Parenti, Giancarlo

    2014-03-19

    Glycogen storage disease type 1b (GSD1b) is an inherited metabolic defect of glycogenolysis and gluconeogenesis due to mutations of the SLC37A4 gene and to defective transport of glucose-6-phosphate. The clinical presentation of GSD1b is characterized by hepatomegaly, failure to thrive, fasting hypoglycemia, and dyslipidemia. Patients affected by GSD1b also show neutropenia and/or neutrophil dysfunction that cause increased susceptibility to recurrent bacterial infections. GSD1b patients are also at risk for inflammatory bowel disease. Occasional reports suggesting an increased risk of autoimmune disorders in GSD1b patients, have been published. These complications affect the clinical outcome of the patients. Here we describe the occurrence of autoimmune endocrine disorders including thyroiditis and growth hormone deficiency, in a patient affected by GSD1b. This case further supports the association between GSD1b and autoimmune diseases.

  18. Problem gambling: patients affected by their own or another's gambling may approve of help from general practitioners.

    Science.gov (United States)

    Sullivan, Sean; McCormick, Ross; Lamont, Michael; Penfold, Alison

    2007-06-29

    To identify the health effects, including depression, on problem gambling patients and family members, and their perception of their GP as a help provider for problem gambling. 1580 patients from practices in Auckland, Taranaki, and Rotorua completed an anonymous questionnaire containing brief screens for problem gambling, effects on family of gambling, and depression. Patients were asked to assess their GP as a help provider for problem gambling. 7.5% of patients were positive for problem gambling, ranging from 3% of NZ European patients to 24% of Pacific patients; 18% of patients were affected by another's gambling. Less than one in four problem gambling patients, and one in three family positives, did not perceive their GP as a suitable help provider for problem gambling issues. Problem gambling patients were more likely than other patients to approve their GP as a help-provider. Patients affected by problem gambling were more depressed than other patients. No other disease indicators were found. Patients over 54 years are less likely than others to be problem gamblers. Problem gambling is associated with depression in patients. GPs are an important complementary resource for brief interventions for gambling problems, and for some possibly a more acceptable alternative than attending specialist problem gambling treatment providers.

  19. How do demographic transitions and public health policies affect patients with Parkinson's disease in Brazil?

    Science.gov (United States)

    Bovolenta, Tânia M; Felicio, Andre C

    2017-01-01

    Brazil is currently experiencing a significant demographic transition characterized by a decrease in fertility rates and an exponential increase in the number of elderly citizens, which presents a special challenge for the health care professionals. More than other portions of the population, the elderly are most commonly affected by chronic diseases such as Parkinson's disease. Policymakers contend that Brazil is reasonably well-prepared regarding elderly health care, with policies that aim to ensure the quality of life and the well-being of this portion of the population. However, what happens in practice falls short of what the Brazilian Constitution sets forth. Specifically, there is a clear contradiction between what the law recognizes as being a citizen's rights and the implementation of guidelines. Because health financing in Brazil remains relatively low, the civil society tries to fill in the gaps as much as possible in the treatment of elderly patients suffering from chronic diseases such as Parkinson's disease. In this review, we outline the current legislation in Brazil regarding the elderly and in particular, patients with Parkinson's disease, in the context of a rapidly aging population.

  20. The ties that bind: perceived social support, stress, and IBS in severely affected patients.

    Science.gov (United States)

    Lackner, J M; Brasel, A M; Quigley, B M; Keefer, L; Krasner, S S; Powell, C; Katz, L A; Sitrin, M D

    2010-08-01

    This study assessed the association between social support and the severity of irritable bowel syndrome (IBS) symptoms in a sample of severely affected IBS patients recruited to an NIH-funded clinical trial. In addition, we examined if the effects of social support on IBS pain are mediated through the effects on stress. Subjects were 105 Rome II diagnosed IBS patients (F = 85%) who completed seven questionnaires which were collected as part of a pretreatment baseline assessment. Partial correlations were conducted to clarify the relationships between social support and clinically relevant variables with baseline levels of psychopathology, holding constant number of comorbid medical diseases, age, gender, marital status, ethnicity, and education. Analyses indicated that social support was inversely related to IBS symptom severity. Social support was positively related with less severe pain. A similar pattern of data was found for perceived stress but not quality of life impairment. Regression analyses examined if the effects of social support on pain are mediated by stress. The effects of social support on bodily pain were mediated by stress such that the greater the social support the less stress and the less pain. This effect did not hold for symptom severity, quality of life, or psychological distress. This study links the perceived adequacy of social support to the global severity of symptoms of IBS and its cardinal symptom (pain). It also suggests that the mechanism by which social support alleviates pain is through a reduction in stress levels.

  1. Factors that affect infertility patients' decisions about disposition of frozen embryos.

    Science.gov (United States)

    Lyerly, Anne Drapkin; Steinhauser, Karen; Namey, Emily; Tulsky, James A; Cook-Deegan, Robert; Sugarman, Jeremy; Walmer, David; Faden, Ruth; Wallach, Edward

    2006-06-01

    To describe factors that affect infertility patients' decision making regarding their cryopreserved embryos. Forty-six semistructured in-depth interviews of individuals and couples participating in IVF programs. Two major southeastern academic medical centers. Fifty-three individuals, including 31 women, 8 men, and 7 couples. Qualitative analysis of interview transcripts. INTERVENTION (S): None. Seven broad themes informed participants' decisions about embryo disposition: family and personal issues, trust, definition of the embryo, prospective responsibility to the embryo, responsibility to society, adequacy of information, and lack of acceptable disposition options. Many wished for alternative options, such as a ceremony at the time of disposal or placement of embryos in the woman's body when pregnancy was unlikely. Recent debates regarding embryo disposition do not reflect the range of values that infertility patients consider when deciding about frozen embryos. In addition to questions about the embryo's moral status, decision making about embryos is informed by a range of factors in the lives of individuals who created them. These perspectives may have important implications for the content and timing of informed consent, facilitating embryo disposition, and advancing policy debates about the ethics of frozen embryo use.

  2. Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality

    Science.gov (United States)

    2013-01-01

    Introduction Fournier’s gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier’s gangrene and to identify risk factors that affect mortality. Methods The medical records of 50 patients with Fournier’s gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality. Results Ten males and five females were enrolled in the study. The mean age was 54 years (range 23–81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality. Conclusions Fournier’s gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices. PMID:23547796

  3. Factors affecting presentation and delay in patients with testicular cancer: results of a qualitative study.

    Science.gov (United States)

    Gascoigne, P; Mason, M D; Roberts, E

    1999-01-01

    A qualitative study was undertaken with men treated for testicular tumours, to ascertain how they interpreted their symptoms and the factors which influenced a decision to consult a physician. The research was undertaken with six men who had been diagnosed as having testicular tumours. Interviews were also conducted with four wives and one mother. The findings showed that giving men information on testicular cancer may not guarantee early presentation. Symptoms were not generally attributed to cancer and the one patient who practised self-examination had delayed seeking help for 6 months. The extent to which symptoms affected the patient's lifestyle was also a factor in the decision-making process, as was the checking of symptoms with other family members. Wives were often pivotal in persuading men to seek help. The discovery of testicular symptoms produced emotional responses which included embarrassment and fear of both cancer and castration. There was evidence of strong feelings of masculine identity bound up with the appearance of 'normal' genitals. Provider-delay was identified in four cases and was associated with misattribution of symptoms by physicians and the failure to initiate specialist referral. Delay was under-recorded in the hospital notes in all cases where presentation was not immediate.

  4. Exposing physicians to reduced residency work hours did not adversely affect patient outcomes after residency.

    Science.gov (United States)

    Jena, Anupam B; Schoemaker, Lena; Bhattacharya, Jay

    2014-10-01

    In 2003, work hours for physicians-in-training (residents) were capped by regulation at eighty hours per week, leading to the hotly debated but unexplored issue of whether physicians today are less well trained as a result of these work-hour reforms. Using a unique database of nearly all hospitalizations in Florida during 2000-09 that were linked to detailed information on the medical training history of the physician of record for each hospitalization, we studied whether hospital mortality and patients' length-of-stay varied according to the number of years a physician was exposed to the 2003 duty-hour regulations during his or her residency. We examined this database of practicing Florida physicians, using a difference-in-differences analysis that compared trends in outcomes of junior physicians (those with one-year post-residency experience) pre- and post-2003 to a control group of senior physicians (those with ten or more years of post-residency experience) who were not exposed to these reforms during their residency. We found that the duty-hour reforms did not adversely affect hospital mortality and length-of-stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency. However, assessment of the impact of the duty-hour reforms on other clinical outcomes is needed. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Digoxin affects potassium homeostasis during exercise in patients with heart failure.

    Science.gov (United States)

    Schmidt, T A; Bundgaard, H; Olesen, H L; Secher, N H; Kjeldsen, K

    1995-04-01

    The aim was to evaluate whether digitalisation of heart failure patients affects extrarenal potassium handling during and following exercise, and to assess digoxin receptor occupancy in human skeletal muscle in vivo. In a paired study of before versus after digitalisation, 10 patients with congestive heart failure underwent identical exercise sessions consisting of three bouts of increasing work rates, 41-93 W, on a cycle ergometer. The final bouts were followed by exercise to exhaustion. The femoral vessels and brachial artery were catheterised. Arterial blood pressure, heart rate, leg blood flow, cardiac output, plasma potassium, haemoglobin, pH, and skeletal muscle receptor occupancy with digoxin in biopsies were determined. Occupancy of skeletal muscle Na/K-ATPase with digoxin was 9% (P digitalisation femoral venous plasma potassium increased by 0.2-0.3 mmol.litre-1 (P digitalisation the femoral venoarterial difference in plasma potassium increased by 50-100% (P digitalisation on plasma potassium were not the outcome of changes in haemodynamics, because cardiac output and leg blood flow increased by up to 13% and 19% (P < 0.05), nor was it the outcome of changes in haemoconcentration or pH. Extrarenal potassium handling is altered as a result of digoxin treatment. This is likely to reflect a reduced capacity of skeletal muscle Na/K-ATPase for active potassium uptake because of inhibition by digoxin, adding to the reduction of skeletal muscle Na/K-ATPase concentration induced by heart failure per se. In heart failure patients, improved haemodynamics induced by digoxin may, however, increase the capacity for physical conditioning. Thus the impairment of extrarenal potassium homeostasis by heart failure and digoxin treatment may be counterbalanced by training.

  6. Efficacy and Factors Affecting Outcome of Gemcitabine Concurrent Chemoradiotherapy in Patients With Locally Advanced Pancreatic Cancer

    International Nuclear Information System (INIS)

    Huang, P.-I.; Chao, Yee; Li, C.-P.; Lee, R.-C.; Chi, K.-H.; Shiau, C.-Y.; Wang, L.-W.; Yen, S.-H.

    2009-01-01

    Purpose: To evaluate the efficacy and prognostic factors of gemcitabine (GEM) concurrent chemoradiotherapy (CCRT) in patients with locally advanced pancreatic cancer. Methods and Materials: Between January 2002 and December 2005, 55 patients with locally advanced pancreatic cancer treated with GEM (400 mg/m 2 /wk) concurrently with radiotherapy (median dose, 50.4 Gy; range, 26-61.2) at Taipei Veterans General Hospital were enrolled. GEM (1,000 mg/m 2 ) was continued after CCRT as maintenance therapy once weekly for 3 weeks and repeated every 4 weeks. The response, survival, toxicity, and prognostic factors were evaluated. Results: With a median follow-up of 10.8 months, the 1- and 2-year survival rate was 52% and 19%, respectively. The median overall survival (OS) and median time to progression (TTP) was 12.4 and 5.9 months, respectively. The response rate was 42% (2 complete responses and 21 partial responses). The major Grade 3-4 toxicities were neutropenia (22%) and anorexia (19%). The median OS and TTP was 15.8 and 9.5 months in the GEM CCRT responders compared with 7.5 and 3.5 months in the nonresponders, respectively (both p 2 /wk vs. 296 ± 15 mg/m 2 /wk, p = 0.02) than the nonresponders. KPS and serum carbohydrate antigen 19-9 were the most significant prognostic factors of OS and TTP. Conclusion: The results of our study have shown that GEM CCRT is effective and tolerable for patients with locally advanced pancreatic cancer. The KPS and GEM dose correlated with response. Also, the KPS and CA 19-9 level were the most important factors affecting OS and TTP

  7. Does knowledge of diagnosis really affect rates of depression in cancer patients?

    Science.gov (United States)

    Kállay, Éva; Pintea, Sebastian; Dégi, Csaba L

    2016-12-01

    Significant levels of distress usually accompany the entire cancer experience, affecting the patients' general functioning and adaptation to illness. The major objective of the present study was to investigate potential demographic and intrapersonal moderators of the relationship between knowing the cancer diagnosis and the level of depression experienced. The present research has a transversal comparative repeated cross-sectional design (2006-2014), sampling following the proportional quota method. Research was conducted in the four major oncological institutes in Romania, obtaining a national sample of cancer patients, maintaining gender and ethnic rates, and permitting the investigation of the stability of the results from one assessment to the other. Results indicate that in the Romanian context, knowing the diagnosis is associated with a lower level of depression than not knowing the diagnosis, the results being similar in both assessments (2006-2014). Furthermore, from the explored demographic factors (gender, residence, age, and education), only age has a main effect upon depression (depression increasing with age), while education is the only factor from those analyzed, which has a moderator effect. Regarding the analyzed intra-individual variables, only dysfunctional attitudes, emotion-focused coping, and lack of emotional support from the family (loneliness) have main effects upon the level of depression (i.e., higher levels of dysfunctional attitudes, emotion-focused coping, and loneliness are associated with higher levels of depression), while neither of them has a moderator effect on the relationship between knowing the diagnosis and depression. These results are important in the improvement of the doctor-patient relationship, the management of cancer-related distress, and implicitly for the course of illness. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  8. Distinct effects of protracted withdrawal on affect, craving, selective attention and executive functions among alcohol-dependent patients.

    Science.gov (United States)

    Cordovil De Sousa Uva, Mariana; Luminet, Olivier; Cortesi, Marie; Constant, Eric; Derely, Marc; De Timary, Philippe

    2010-01-01

    The present study examined the effects of protracted alcohol withdrawal on affectivity, craving, selective attention and executive functions (EFs) in alcohol-dependent patients. Selective attention (The D2 Cancellation Test), flexibility (Trail Making Test), inhibition (Stroop Task), decision making (Iowa Gambling Task), craving (Obsessive-Compulsive Drinking Scale) and state affectivity (Positive and Negative Affectivity Schedule) were assessed in alcohol-dependent patients (DSM-IV, n = 35) matched to non-alcohol-dependent participants (n = 22) at the onset (T1: day 1 or 2) and at the end (T2: days 14-18) of protracted withdrawal during rehab. Alcohol-dependent patients' abilities to focus their attention on relevant information, to switch from one pattern to another, to inhibit irrelevant information and to make advantageous choices were lower than those of control participants during both times of a withdrawal cure. No effect of time emerged from analyses for selective attention and EF deficits. Conversely, significant differences between T1 and T2 were observed for craving and affect scores indicating a weakening of alcohol craving and negative affect as well as an improvement of positive affect among patients from onset to the end of cure. Control functions of the Supervisory Attentional System (Norman and Shallice, 1986) were impaired and did not improve during a 3-week withdrawal cure, whereas alcohol craving and negative state affectivity significantly improved in parallel during this period. Implications for understanding the clinical processes of withdrawal are discussed.

  9. Prospective Study of Infection, Colonization and Carriage of Methicillin-Resistant Staphylococcus Aureus in an Outbreak Affecting 990 Patients

    NARCIS (Netherlands)

    R. Coello; J. Jimenez (Jose); M. Garcia (Melissa); P. Arroyo; D. Minguez; C. Fernandez; F. Cruzet; C. Gaspar

    1994-01-01

    textabstractIn the three years between November 1989 and October 1992, an outbreak of methicillin-resistantStaphylococcus aureus (MRSA) affected 990 patients at a university hospital. The distribution of patients with carriage, colonization or infection was investigated prospectively. Nosocomial

  10. Factors affecting quality of life in breast cancer patients: A descriptive and cross-sectional study with review of literature

    Directory of Open Access Journals (Sweden)

    Neelam Sharma

    2017-01-01

    Full Text Available Objective: This descriptive and cross-sectional study was undertaken to determine the factors affecting quality of life (QOL in breast cancer patients. Methods: We collected data from 60 patients of carcinoma breast post modified radical mastectomy on radiotherapy in a tertiary care hospital. We included volunteered patients with a signed informed consent and at least 70 Karnofsky Performance Scale points. The data was gathered by interview technique using EORTC QLQ-C30 and QLQ-BR23 (Breast Cancer Module. Results: The mean age at presentation was 47.6 years (range 30-75 years.75% patients were of low socio-economic status and 63.3% belonged to rural areas. Younger Women in the age group of 30-39 years had faired worst on physical, social and emotional scores as compared to older women in the age group of 70-79 years. Other factors which affected Quality of Life of patients during treatment were stage of disease at presentation, performance score of the patients, socioeconomic status of disease at follow up. Conclusion: Age, Education status, Performance Score, Stage of disease at presentation and status of disease at last follow up are few factors which significantly affects QOL in Carcinoma breast patients though the treatment remains same. Advanced studies on individual quality of life factors affecting cancer would empower physicians for better personal care techniques and patients for easily overcoming the disease.

  11. Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention

    NARCIS (Netherlands)

    H. Versteeg (Henneke); S.S. Pedersen (Susanne); R.A.M. Erdman (Ruud); J.W.I. van Nierop; P.P.T. de Jaegere (Peter); R.T. van Domburg (Ron)

    2009-01-01

    textabstractPurpose: We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents. Methods: Consecutive PCI patients (n = 562) completed the Global Mood Scale at baseline to

  12. Annexin A1 is elevated in patients with COPD and affects lung fibroblast function

    Directory of Open Access Journals (Sweden)

    Lai TW

    2018-02-01

    .Conclusion: Annexin A1 expression is upregulated in patients with COPD and affects lung fibroblast function. However, more studies are needed to clarify the role of Annexin A1 in airway fibrosis of COPD. Keywords: COPD, Annexin A1, tissue fibrosis, disease severity

  13. Does outcome of neuropsychological treatment in patients with unilateral spatial neglect after stroke affect functional outcome?

    Science.gov (United States)

    Matano, A; Iosa, M; Guariglia, C; Pizzamiglio, L; Paolucci, S

    2015-12-01

    .039) effectively predict the response to neuropsychological treatment. The outcome of the whole rehabilitation resulted affected by the outcome of neuropsychological treatment in patients with USN, being a low score at Barrage test at the beginning of therapy a negative predictor of USN recovery. Patients with USN after stroke can benefit of a specific training for reducing USN also in terms of functional outcome. Further, the simple use of Barrage test could provide important prognostic information about recovery.

  14. Does whey protein supplementation affect blood pressure in hypoalbuminemic peritoneal dialysis patients?

    Directory of Open Access Journals (Sweden)

    Hassan K

    2017-08-01

    Full Text Available Kamal Hassan,1,2 Fadi Hassan3 1Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, 2Department of Nephrology and Hypertension, Peritoneal Dialysis Unit, 3Department of Internal Medicine E, Galilee Medical Center, Nahariya, Israel Objective: Hypertension and hypoalbuminemia are common risk factors for cardiovascular complications in peritoneal dialysis (PD patients. Data are limited regarding the effects of whey protein consumption on blood pressure in this population. The aim of the present study was to examine if whey protein supplementation for 12 weeks to hypoalbuminemic PD patients affects their blood pressure.Patients and methods: This prospective randomized study included 36 stable PD patients with serum albumin levels <3.8 g/dL. During 12 weeks, 18 patients were instructed to consume 1.2 g/kg/day of protein and an additional whey protein supplement at a dose of 25% of the instructed daily protein (whey protein group. Eighteen patients were instructed to consume protein in the amount of 1.2 g/kg/day and an additional 25%, without whey protein supplementation (control group. Results: Compared to the control group, in the whey protein group, serum albumin levels, oncotic pressure, and dialysate ultrafiltration significantly increased (3.55±0.14 to 4.08±0.15 g/dL, P<0.001; 21.81±2.03 to 24.06±1.54 mmHg, P<0.001; 927.8±120.3 to 1,125.0±125.1 mL/day, P<0.001; respectively and were significantly higher after 12 weeks (4.08±0.15 vs 3.41±0.49 g/dL, P<0.001; 24.06±1.54 vs 22.71±1.77 mmHg, P=0.010; 1,125.0±125.1 vs 930.6±352.8 mL/day, P=0.017; respectively in the whey protein group compared to the control group. Fluid overload, the extracellular to intracellular ratio and mean arterial pressure (MAP significantly decreased (2.46±1.08 to 1.52±0.33, P<0.001; 1.080±0.142 to 0.954±0.124, P<0.001; 102.6±3.80 to 99.83±3.85, P=0.018; respectively and were significantly lower in the whey protein group after 12 weeks (1.52±0

  15. What is the most important factor affecting the cognitive function of obstructive sleep apnea syndrome patients: a single center study

    OpenAIRE

    LI Xiang; LI Yan-peng; WU Hui-juan; ZHANG Lin; ZHAO Zheng-qing; PENG Hua; ZHAO Zhong-xin

    2013-01-01

    Objective Patients with obstructive sleep apnea syndrome (OSAS) usually complain of daytime hypersomnia and decrease in cognitive function, which affects the quality of their work and life. The reason why the cognitive function of OSAS patients decreased remains controversial. The aim of this study is to evaluate the impairment and the main influencing factors of cognitive function in OSAS. Methods There were totally 50 OSAS patients (OSAS group) and 25 volunteers (control group) included i...

  16. Quantitative Analysis of Contributing Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center

    Science.gov (United States)

    2008-06-06

    Predictors of patient satisfaction for Brooke Army Medical Center Family Medicine Service primary care clinics was performed. Data was obtained from...Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center Presented to MAJ Eric Schmacker, Ph.D. In...study. All patients ’ medical information was protected at all times and under no circumstances will be discussed or released to any outside agency

  17. Factors Affecting Canagliflozin-Induced Transient Urine Volume Increase in Patients with Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Tanaka, Hiroyuki; Takano, Kazuhiko; Iijima, Hiroaki; Kubo, Hajime; Maruyama, Nobuko; Hashimoto, Toshio; Arakawa, Kenji; Togo, Masanori; Inagaki, Nobuya; Kaku, Kohei

    2017-02-01

    Sodium glucose co-transporter 2 (SGLT2) inhibitors exhibit diuretic activity, which is a possible mechanism underlying the cardiovascular benefit of these inhibitors. However, the osmotic diuresis-induced increase in urine volume, and the risk of dehydration have been of concern with SGLT2 inhibitor treatment. This study aimed to investigate the mechanism underlying SGLT2 inhibitor canagliflozin-induced diuresis in Japanese type 2 diabetes mellitus (T2DM) patients. Thirteen T2DM patients received a daily oral dose of 100 mg canagliflozin before breakfast for 6 days. Blood and urine samples were collected at predetermined time points. The primary endpoint was evaluation of correlations between changes from baseline in urine volume and factors that are known to affect urine volume and between actual urine volume and these factors. Canagliflozin transiently increased urine volume and urinary sodium excretion on Day 1 with a return to baseline levels thereafter. Canagliflozin administration increased urinary glucose excretion, which was sustained during repeated-dose administration. Plasma atrial natriuretic peptide (ANP) and N-terminal pro-b-type natriuretic peptide (NT-proBNP) levels decreased, while plasma renin activity increased. On Day 1 of treatment, changes in sodium and potassium excretion were closely correlated with changes in urine output. A post hoc multiple regression analysis showed changes in sodium excretion and water intake as factors that affected urine volume change at Day 1. Furthermore, relative to that at baseline, canagliflozin decreased blood glucose throughout the day and increased plasma total GLP-1 after breakfast. Canagliflozin induced transient sodium excretion and did not induce water intake at Day 1; hence, natriuresis rather than glucose-induced osmotic diuresis may be a major factor involved in the canagliflozin-induced transient increase in urine output. In addition, canagliflozin decreased plasma ANP and NT-proBNP levels and

  18. No association between serum cholesterol and death by suicide in patients with schizophrenia, bipolar affective disorder, or major depressive disorder.

    Science.gov (United States)

    Park, Subin; Yi, Ki Kyoung; Na, Riji; Lim, Ahyoung; Hong, Jin Pyo

    2013-12-05

    Previous research on serum total cholesterol and suicidality has yielded conflicting results. Several studies have reported a link between low serum total cholesterol and suicidality, whereas others have failed to replicate these findings, particularly in patients with major affective disorders. These discordant findings may reflect the fact that studies often do not distinguish between patients with bipolar and unipolar depression; moreover, definitions and classification schemes for suicide attempts in the literature vary widely. Subjects were patients with one of the three major psychiatric disorders commonly associated with suicide: schizophrenia, bipolar affective disorder, and major depressive disorder (MDD). We compared serum lipid levels in patients who died by suicide (82 schizophrenia, 23 bipolar affective disorder, and 67 MDD) and non-suicide controls (200 schizophrenia, 49 bipolar affective disorder, and 175 MDD). Serum lipid profiles did not differ between patients who died by suicide and control patients in any diagnostic group. Our results do not support the use of biological indicators such as serum total cholesterol to predict suicide risk among patients with a major psychiatric disorder.

  19. Childhood traumatization by primary caretaker and affect dysregulation in patients with borderline personality disorder and somatoform disorder

    Directory of Open Access Journals (Sweden)

    Annemiek van Dijke

    2011-03-01

    Full Text Available Affect regulation is often compromised as a result of early life interpersonal traumatization and disruption in caregiving relationships like in situations where the caretaker is emotionally, sexually or physically abusing the child. Prior studies suggest a clear relationship between early childhood attachment-related psychological trauma and affect dysregulation. We evaluated the relationship of retrospectively recalled childhood traumatization by primary caretaker(s (TPC and affect dysregulation in 472 adult psychiatric patients diagnosed with borderline personality disorder (BPD, somatoform disorder (SoD, both BPD and SoD, or disorders other than BPD or SoD, using the Bermond-Vorst Alexithymia Questionnaire, the self-report version of the Structured Interview for Disorders of Extreme Stress, the Self-rating Inventory for Posttraumatic Stress Disorder (SRIP and the Traumatic Experiences Checklist. Almost two-thirds of participants reported having experienced childhood TPC, ranging from approximately 50% of patients with SoD or other psychiatric disorders to more than 75% of patients with comorbid BPD + SoD. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch 0–6 years. Over-regulation of affect was associated with physical TPC. Childhood trauma by a primary caretaker is prevalent among psychiatric patients, particularly those with BPD, and differentially associated with underand over-regulation of affect depending on the type of traumatic exposure.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online

  20. Surgical Orthodontic Treatment of a Patient Affected by Type 1 Myotonic Dystrophy (Steinert Syndrome

    Directory of Open Access Journals (Sweden)

    Laura Cacucci

    2017-01-01

    Full Text Available Myotonic dystrophy, or Steinert’s disease, is the most common form of muscular dystrophy that occurs in adults. This multisystemic form involves the skeletal muscles but affects also the eye, the endocrine system, the central nervous system, and the cardiac system. The weakness of the facial muscles causes a characteristic facial appearance frequently associated with malocclusions. Young people with myotonic dystrophy, who also have severe malocclusions, have bad oral functions such as chewing, breathing, and phonation. We present a case report of a 15-year-old boy with anterior open bite, upper and lower dental crowding, bilateral crossbite, and constriction of the upper jaw with a high and narrow palate. The patient’s need was to improve his quality of life. Because of the severity of skeletal malocclusion, it was necessary to schedule a combined orthodontic and surgical therapy in order to achieve the highest aesthetic and functional result. Although therapy caused an improvement in patient’s quality of life, the clinical management of the case was hard. The article shows a balance between costs and benefits of a therapy that challenges the nature of the main problem of the patient, and it is useful to identify the most appropriate course of treatment for similar cases.

  1. Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists

    NARCIS (Netherlands)

    Hifinger, M.; Hiligsmann, M.; Ramiro, S.; Watson, V.; Severens, J. L.; Fautrel, B.; Uhlig, T.; van Vollenhoven, R.; Jacques, P.; Detert, J.; Canas da Silva, J.; Scirè, C. A.; Berghea, F.; Carmona, L.; Péntek, M.; Keat, A.; Boonen, A.

    2017-01-01

    To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with

  2. Identification of Risk Factors Affecting Impaired Fasting Glucose and Diabetes in Adult Patients from Northeast China

    Directory of Open Access Journals (Sweden)

    Yutian Yin

    2015-10-01

    Full Text Available Background: Besides genetic factors, the occurrence of diabetes is influenced by lifestyles and environmental factors as well as trace elements in diet materials. Subjects with impaired fasting glucose (IFG have an increased risk of developing diabetes mellitus (DM. This study aimed to explore risk factors affecting IFG and diabetes in patients from Northeast China. Methods: A population-based, cross-sectional survey of chronic diseases and related risk factors was conducted in Jilin Province of Northeast China. All adult residents, aged 18–79, were invited to participate in this survey using the method of multistage stratified random cluster sampling. One hundred thirty-four patients with IFG or DM and 391 healthy control subjects were recruited. We compared demographic factors, body size measurements, healthy-related behaviors, and hair metallic element contents between IFG/diabetes patients and healthy individuals. Results: IFG/diabetes patients had a greater weight, waist, hip, and body mass index (BMI than control subjects. Significant differences in the content of zinc (Zn, potassium (K, copper (Ca, and sodium (Na as well as Cu/Zn ratios between IFG or DM patients and control subjects (p < 0.05 were also observed. Hair Cu, selenium (Se, and Na contents were positively correlated with blood glucose levels (Cu: rs = 0.135, p = 0.002; Se: rs = 0.110, p = 0.012; Na: rs = 0.091, p = 0.038. Polytomous logistic regression adjusting for age, sex, family history of diabetes and BMI, showed that subjects with high BMI were more likely to develop IFG and DM (IFG: OR = 1.15, OR 95% CI = 1.02–1.29; DM: OR = 1.15, OR 95% CI = 1.01–1.33. Moreover, rarely or never eating fruits was a risk factor for DM (OR = 5.46, OR 95% CI = 1.87–15.98 but not for IFG (OR = 1.70, OR 95% CI = 0.72–4.02. Subjects with abdominal obesity or DM history were more susceptible to DM (abdominal obesity: OR = 2.99, OR 95% CI = 1.07–8.37; DM history: OR = 2.69, OR 95

  3. Pharmacodynamic genetic polymorphisms affect adverse drug reactions of haloperidol in patients with alcohol-use disorder

    Directory of Open Access Journals (Sweden)

    Zastrozhin MS

    2017-07-01

    included 64 male patients (average age 41.38 ± 10.14 years, median age 40 years, lower quintile [LQ] 35 years, upper quintile [UQ] 49 years. Bio-Rad CFX Manager™ software and “SNP-Screen” sets of “Syntol” (Russia were used to determine polymorphisms rs4680, rs1800497, rs1124493, rs2242592, rs2298826 and rs2863170. In every “SNP-Screen” set, two allele-specific hybridizations were used, which allowed to determine two alleles of studied polymorphism separately on two fluorescence channels.Results: Results of this study detected a statistically significant difference in the adverse drug reaction intensity in patients receiving haloperidol with genotypes 9/10 and 10/10 of polymorphic marker SLC6A3 rs28363170. In patients receiving haloperidol in tablets, the increases in the UKU Side-Effect Rating Scale (UKU score of 9.96 ± 2.24 (10/10 versus 13 ± 2.37 (9/10; p < 0.001 and in the Simpson-Angus Scale (SAS score of 5.04 ± 1.59 (10/10 versus 6.41 ± 1.33 (9/10; p = 0.006 were revealed.Conclusion: Polymorphism of the SCL6A3 gene can affect the safety of haloperidol, and this should be taken into account during the choice of drug and its dosage regimen. Keywords: haloperidol, pharmacogenetics, DRD2, COMT, DAT, alcohol addiction, alcohol-use disorder

  4. Is there an association between subjective and objective measures of cognitive function in patients with affective disorders?

    DEFF Research Database (Denmark)

    Svendsen, Anne M; Kessing, Lars V; Munkholm, Klaus

    2012-01-01

    .01) but there were no differences between patient groups (P > 0.1). We found no correlation between subjectively experienced and objectively measured cognitive dysfunction in BD (P = 0.7), and a non-significant trend towards a correlation in UD (P = 0.06), which disappeared when controlling for gender (P = 0......Background: Patients with affective disorders experience cognitive dysfunction in addition to their affective symptoms. The relationship between subjectively experienced and objectively measured cognitive function is controversial with several studies reporting no correlation between subjective...... and objective deficits. Aims: To investigate whether there is a correlation between subjectively reported and objectively measured cognitive function in patients with affective disorders, and whether subjective complaints predict objectively measured dysfunction. Methods: The study included 45 participants; 15...

  5. The temporal interplay of self-esteem instability and affective instability in borderline personality disorder patients' everyday lives.

    Science.gov (United States)

    Santangelo, Philip S; Reinhard, Iris; Koudela-Hamila, Susanne; Bohus, Martin; Holtmann, Jana; Eid, Michael; Ebner-Priemer, Ulrich W

    2017-11-01

    Borderline personality disorder (BPD) is defined by a pervasive pattern of instability. Although there is ample empirical evidence that unstable self-esteem is associated with a myriad of BPD-like symptoms, self-esteem instability and its temporal dynamics have received little empirical attention in patients with BPD. Even worse, the temporal interplay of affective instability and self-esteem instability has been neglected completely, although it has been hypothesized recently that the lack of specificity of affective instability in association with BPD might be explained by the highly intertwined temporal relationship between affective and self-esteem instability. To investigate self-esteem instability, its temporal interplay with affective instability, and its association with psychopathology, 60 patients with BPD and 60 healthy controls (HCs) completed electronic diaries for 4 consecutive days during their everyday lives. Participants reported their current self-esteem, valence, and tense arousal levels 12 times a day in approximately one-hr intervals. We used multiple state-of-the-art statistical techniques and graphical approaches to reveal patterns of instability, clarify group differences, and examine the temporal interplay of self-esteem instability and affective instability. As hypothesized, instability in both self-esteem and affect was clearly elevated in the patients with BPD. In addition, self-esteem instability and affective instability were highly correlated. Both types of instability were related to general psychopathology. Because self-esteem instability could not fully explain affective instability and vice versa and neither affective instability nor self-esteem instability was able to explain psychopathology completely, our findings suggest that these types of instability represent unique facets of BPD. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  6. Is there a relationship between positive affect and other dimensions of quality of life in colorectal cancer patients?

    Directory of Open Access Journals (Sweden)

    André Cardoso Louro

    2015-05-01

    Full Text Available It can be stated from the previous research that positive emotions should allow to better health outcomes in sick populations. The aim of the present work is to know the state-of-the-art of how positive affect (PA relates with quality of life in colorectal cancer (CRC patients, as well as to give some guidelines to develop more efficacious psychological interventions in CRC patients to enhance positive affect. This review describes a search of published literature from January 2001 to March of 2012 on the Medline, ISI Web of Knowledge, Psycho Inf and Cochrane databases using publications that contain positive emotions, positive affect, health outcomes, quality of life, CRC and cancer. These articles were classified into two groups: a "descriptive papers" b "interventional studies". Results from "descriptive papers" suggest that positive affect (PA was significantly associated with greater levels of general health, better social functioning, benefit finding, positive changes, low depression, less anxiety and greather psychological well-being. PA also increases when different activities are developed. The overall results from interventional studies suggest that the interventions described can be recommended for improving patient's levels of positive affect. The present review offers some suggestions which could be useful for CRC patients.

  7. Effectiveness of chemotherapy counselling on self-esteem and psychological affects among cancer patients in Malaysia: Randomized controlled trial.

    Science.gov (United States)

    Mohd-Sidik, Sherina; Akhtari-Zavare, Mehrnoosh; Periasamy, Ummavathy; Rampal, Lekhraj; Fadhilah, Siti Irma; Mahmud, Rozi

    2018-05-01

    The aim of this study was to implement and evaluate the outcomes of chemotherapy counselling based on the "Managing Patients on Chemotherapy" module on self-esteem and psychological affect (anxiety, depression) of cancer patients by pharmacists in ten selected government hospitals in Peninsular Malaysia. A randomized control trial was conducted among 2120 cancer patients from April 2016 to January 2017 in ten selected government hospitals in Peninsular Malaysia. Cancer patients were randomly assigned to intervention and control groups. The intervention group received chemotherapy counselling by pharmacists based on the "Managing Patients on Chemotherapy" module. The outcomes were assessed at baseline, 1st, 2nd and 3rd follow-ups after counselling. In the course of data analysis; independent sample t-test, chi-square and two-way repeated measures ANOVA were conducted. Mean scores of self-esteem in the intervention group had significant difference in comparison with those of the control group in the 1st, 2nd and 3rd follow-ups after counselling (P self-esteem and psychological affect of cancer patients undergoing chemotherapy in Peninsular Malaysia. This module can be used for all Malaysian cancer patients undergoing chemotherapy to improving self-esteem and psychological affect. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality.

    Science.gov (United States)

    Daneshvar, Parham; Roffey, Darren M; Brikeet, Yasser A; Tsai, Eve C; Bailey, Chris S; Wai, Eugene K

    2013-08-01

    Spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population. To determine the mortality rate of elderly patients with SCIs related to C-spine fractures and identify factors that contribute toward a higher risk for negative outcomes. Retrospective cohort study at two Level 1 trauma centers. Thirty-seven consecutive patients aged 60 years and older who had SCIs related to C-spine fractures. Level of injury, injury severity, preinjury medical comorbidities, treatment (operative vs. nonoperative), and cause of death. Hospital medical records were reviewed independently. Baseline radiographs and computed tomography or magnetic resonance imaging scans were examined to permit categorization according to the mechanistic classification by Allen and Ferguson of subaxial C-spine injuries. Univariate logistic regression analyses were performed to identify factors related to in-hospital mortality and ambulation at discharge. There were no funding sources or potential conflicts of interest to disclose. The in-hospital mortality rate was 38%. Respiratory failure was the leading cause of death. Preinjury medical comorbidities, age, and operative versus nonoperative treatment did not affect mortality. Injury level at or above C4 was associated with a 7.1 times higher risk of mortality compared with injuries below C4 (p=.01). Complete SCI was associated with a 5.1 times higher risk of mortality compared with incomplete SCI (p=.03). Neurological recovery was uncommon. Apart from severity of initial SCI, no other factor was related to ambulatory disposition at discharge. In this elderly population, neurological recovery was poor and the in-hospital mortality rate was high. The strongest risk factors for mortality were injury level and severity of SCI. Although each case of SCI

  9. Prospective interepisodal mood monitoring in patients with affective disorders: a feasibility study

    Directory of Open Access Journals (Sweden)

    Van der Watt ASJ

    2018-02-01

    Full Text Available Alberta SJ Van der Watt,1 Alexandra PSP Suryapranata,2 Soraya Seedat1 1Department of Psychiatry, Stellenbosch University, Cape Town, South Africa; 2Internal Medicine, Onze Lieve Vrouwe Gasthuis West, Amsterdam, the Netherlands Objectives: Our primary objective was to assess the feasibility of interepisodal telephonic mood monitoring in patients with affective disorders in a low-resource setting. Secondary objectives included gathering data on longitudinal mood trajectories and assessing patient acceptance of mood monitoring. Methods: Inpatients with a primary mood or anxiety disorder were recruited predischarge. Assessment at intake included demographic information, the Life Events Checklist, and the Childhood Trauma Questionnaire. Participants telephonically completed the Altman Self-Rating Mania Scale (ASRM and Quick Inventory of Depressive Symptomatology (QIDS, weekly, for 26 weeks. Units of alcohol consumed and life events were recorded. Semi-structured interviews were conducted midway through the mood monitoring protocol. Results: Of the 61 eligible participants (77% female; mean age =35.3 years, 28 completed 26 weeks of telephonic mood monitoring. Thirty-three participants (54.1% withdrew prematurely or were lost to follow-up. Males were more likely to terminate study participation prematurely. Despite the significant decline in depression scores over 26 weeks, participants endorsed persistent mild-to-moderate depressive symptoms. Statistically, participants who were married/in a relationship had higher mean depression scores throughout the study compared to participants who were single. Throughout the study, ASRM scores were not indicative of significant mania. Suicidality (as measured by QIDS item 12 was highest at Week 3 and Week 12 postdischarge for those who completed 26 weeks of monitoring. Conclusion: Despite the high attrition rate, interepisodal telephonic mood monitoring was deemed to be feasible and it can provide useful

  10. [The Relationship of Suicide Attempts with Affective Temperament and Relevant Clinical Features in Patients with Mood Disorders].

    Science.gov (United States)

    Ekşioğlu, Sevgin; Güleç, Hüseyin; Şimşek, Gülnihal; Semiz, Ümit Başar

    2015-01-01

    In this study, patients with affective disorders with or without suicide attempts were examined according to whether their disorder was unipolar or bipolar. An analysis was made of their socio-demographic variables, comorbid psychiatric symptoms, and affective temperament dimensions in order to understand the effects of these variables on suicide risk. The study populations consisted of 246 inpatients with affective disorders who had been admitted to the Erenköy Research and Training Hospital for Mental and Neurological Disorders (93 patients with unipolar disorders, 153 with bipolar disorders). The TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire), the Beck Hopelessness Scale (BHS) and the Symptom Checklist-90-Revised (SCL-90-R) psychological symptom screening tests were applied to all patients. In order to determine the affective disorder diagnosis and to identify suicide attempts, a Mini International Neuropsychiatric Interview (MINI) was performed during the first 48 hours of hospitalization. The cyclothymic and anxious temperament dimensions measured using TEMPS-A, somatic symptoms obtained from a symptom checklist, and psychiatric disorders in the family were found to be good indicators of suicide attempts in patients with unipolar disorders in this study. An investigation of predictors of suicide attempts in bipolar patients showed that cyclothymic temperament pattern, paranoid symptoms, evaluated through symptom screening test and having a psychiatric disorder in the family are good predictors of a suicide attempt. The findings are expected to guadiance to preventing suicide in patients with affective disorders. The inclusion in this study of patients with different index episodes of illness, including manic, depressive and mixed periods, can be accepted as a significant limitation of this study.

  11. Variants in TTC25 affect autistic trait in patients with autism spectrum disorder and general population.

    Science.gov (United States)

    Vojinovic, Dina; Brison, Nathalie; Ahmad, Shahzad; Noens, Ilse; Pappa, Irene; Karssen, Lennart C; Tiemeier, Henning; van Duijn, Cornelia M; Peeters, Hilde; Amin, Najaf

    2017-08-01

    Autism spectrum disorder (ASD) is a highly heritable neurodevelopmental disorder with a complex genetic architecture. To identify genetic variants underlying ASD, we performed single-variant and gene-based genome-wide association studies using a dense genotyping array containing over 2.3 million single-nucleotide variants in a discovery sample of 160 families with at least one child affected with non-syndromic ASD using a binary (ASD yes/no) phenotype and a quantitative autistic trait. Replication of the top findings was performed in Psychiatric Genomics Consortium and Erasmus Rucphen Family (ERF) cohort study. Significant association of quantitative autistic trait was observed with the TTC25 gene at 17q21.2 (effect size=10.2, P-value=3.4 × 10 -7 ) in the gene-based analysis. The gene also showed nominally significant association in the cohort-based ERF study (effect=1.75, P-value=0.05). Meta-analysis of discovery and replication improved the association signal (P-value meta =1.5 × 10 -8 ). No genome-wide significant signal was observed in the single-variant analysis of either the binary ASD phenotype or the quantitative autistic trait. Our study has identified a novel gene TTC25 to be associated with quantitative autistic trait in patients with ASD. The replication of association in a cohort-based study and the effect estimate suggest that variants in TTC25 may also be relevant for broader ASD phenotype in the general population. TTC25 is overexpressed in frontal cortex and testis and is known to be involved in cilium movement and thus an interesting candidate gene for autistic trait.

  12. Dental management of pediatric patients affected by pulmonary atresia with ventricular septal defect: A scoping review.

    Science.gov (United States)

    Garrocho-Rangel, A; Echavarría-García, A-C; Rosales-Bérber, M-A; Flores-Velázquez, J; Pozos-Guillén, A

    2017-07-01

    Congenital Heart Diseases (CHD) involves a wide range of pathological conditions, such as Pulmonary Atresia with Ventricle Septal Defect (PA/VSD). This disorder leads to the systemic circulation of oxygen-poor blood (cyanosis), with associated features and consequences in the oral cavity. Using scoping review methodology for screening and article selection, the primary objectives of this paper were as follows: first, to pose a research question; second, to identify relevant studies in order to answer the research question; third, to select and retrieve the studies; fourth, to chart the critical data, and finally, to collate, summarize, and report the results from the most important articles on the dental management of children affected with PA/VSD. Relevant articles (Randomized Controlled Trials [RCT], reviews, observational studies, and clinical case reports) published over a 10-year period were identified and retrieved from four Internet databases: PubMed; Embase/Ovid; Cochrane Library, and Google Scholar. By title and abstract screening and after removing duplicates, 24 articles were finally included in the present scoping review. According to the extracted data, the following are the most important clinical issues to be considered when treating children with PA/VSD in the dental setting: prevalence of dental caries; prevention of dental disease (oral hygiene and diet); bacteremia and infective endocarditis risk, and child behavior control and treatment under general anesthesia. Pediatric Dentists should bear in mind that early diagnosis and treatment, together a long-term follow-up of children with PA/VSD, continue to be the best approaches for achieving enhanced patient psychological well-being and, in consequence, their good quality of life.

  13. Positive Affect and Health Behaviors Across 5 Years in Patients With Coronary Heart Disease: The Heart and Soul Study.

    Science.gov (United States)

    Sin, Nancy L; Moskowitz, Judith Tedlie; Whooley, Mary A

    2015-01-01

    Positive psychological states are linked to superior health and longevity, possibly due to behavioral factors. We evaluated cross-sectional and 5-year associations between positive affect and health behaviors in patients with coronary heart disease (CHD). Outpatients with CHD reported positive affect, physical activity, sleep quality, medication adherence, cigarette smoking, and alcohol use at baseline (n = 1022) and 5 years later (n = 662). Covariates in regression analyses included demographics, cardiac disease severity, and depressive symptoms. At baseline, higher positive affect (per 1 standard deviation) was associated with better health behaviors: physical activity (odds ratio [OR] = 1.52, 95% 95% confidence interval [CI] = 1.30-1.77, p positive affect did not predict health behaviors at follow-up, accounting for baseline behaviors. However, increases in positive affect across 5 years co-occurred with improvements in physical activity (B = 0.023, standard error [SE] = 0.008, p = .002), sleep quality (B = 0.011, SE = 0.005, p = .039), and medication adherence (B = 0.014, SE = 0.004, p Positive affect was associated with health behaviors among patients with CHD. Efforts to sustain or enhance positive affect may be promising for promoting better health behaviors.

  14. Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California

    NARCIS (Netherlands)

    Meltem Daysal, N.

    2012-01-01

    In this paper, I examine the impact of uninsured patients on the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999–2006). My results indicate that uninsured patients have an economically

  15. Does patient-provider gender concordance affect mental health care received by primary care patients with major depression?

    Science.gov (United States)

    Chan, Kitty S; Bird, Chloe E; Weiss, Robert; Duan, Naihua; Meredith, Lisa S; Sherbourne, Cathy D

    2006-01-01

    We sought to determine whether patient-provider gender concordance influences the detection and care of depression and comorbid anxiety and substance use in patients with major depression Cross-sectional analyses of baseline patient survey data linked with provider data were performed. Data based on routine primary care visits in clinics from a variety of health systems serving diverse patient populations across the United States. Participants all had major depression. Depression care was examined in the Quality Improvement for Depression (QID) Collaboration sample (n patients = 1,428, n providers = 389). In a subanalysis of data solely from 714 patients and 157 providers from Partners-In-Care, one of the projects participating in QID, we also examined detection of anxiety disorder and alcohol or drug problems. Rates of detection and care of mental health problems in primary care were low even among patients with major depression. Except for anxiety counseling in female patients, patient-provider gender concordance did not improve care as hypothesized. However, female providers were more likely to counsel on anxiety and less likely to counsel on alcohol or drug use than male providers. Female patients were less likely to be counseled on alcohol or drug use compared with male patients. Detection and care of mental health and substance use problems for patients with major depression is not influenced by patient-provider gender concordance. However, depressed female patients may have greater unmet needs for alcohol and drug use counseling than their male counterparts.

  16. Personality characteristics and affective status related to cognitive test performance and gender in patients with memory complaints.

    Science.gov (United States)

    Vestberg, Susanna; Passant, Ulla; Risberg, Jarl; Elfgren, Christina

    2007-11-01

    The aims are to study personality characteristics of patients with memory complaints and to assess the presence of objective (OMI) versus subjective (SMI) memory impairment, the affective status, as well as potential gender differences. The patients were assessed by means of a neuropsychiatric examination and a neuropsychological test-battery. The Swedish version of the revised NEO Personality Inventory (NEO PI-R) and the Hospital Anxiety and Depression Scale (HADS) were used. The 57 patients (38 women, 19 men, mean age 56.9) differed from the Swedish normative group in three of the five personality factors: neuroticism, extraversion and agreeableness. This was mainly because of the scores of the female patients. Approximately half of the patients had OMI. No differences regarding personality factors or affective status were found between OMI and SMI patients. The female patients scored significantly higher than the male patients on symptoms of anxiety and depression. Neuroticism and symptoms of depression interacted with memory performance and gender. Our findings demonstrate the importance of applying an objective assessment of memory functions and a gender perspective when studying patients with memory complaints.

  17. Gender-associated differences in the psychosocial and developmental outcome in patients affected with the bladder exstrophy-epispadias complex.

    Science.gov (United States)

    Lee, Celine; Reutter, Heiko M; Grässer, Melanie F; Fisch, Margit; Noeker, Meinolf

    2006-02-01

    To identify problems in the long-term psychosocial and developmental outcome specific to patients with the bladder exstrophy-epispadias complex (BEEC), using a self-developed semi-structured questionnaire, as there are various techniques of reconstruction to repair BEEC but to date neither patients nor surgeons have a clear answer about which type gives the most acceptable long-term results. Increasingly many patients with BEEC reach adulthood and wish to have sexual relationships and families. To date, no studies have used disease-specific psychological instruments to measure the psychosocial status of patients with BEEC. Thus we contacted 208 patients with BEEC, and 122 were enrolled, covering the complete spectrum of the BEEC. The data assessed included the surgical reconstruction, subjective assessment of continence, developmental milestones, school performance and career, overall satisfaction in life, disease-specific fears and partnership experiences in patients aged >18 years. We compared affected females and males to assess gender-associated differences in quality of life. Affected females had more close friendships, fewer disadvantages in relation to healthy female peers and more partnerships than the males. Family planning seemed to be less of a problem in affected females. There were no gender differences in the adjustments within school and professional career, which was very good in general. Future studies are needed to assess the disease-specific anxieties, considering gender-specific differences.

  18. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    DEFF Research Database (Denmark)

    Jakobsen, Klaus Damgaard; Hansen, Thomas Folkmann; Dam, Henrik

    2008-01-01

    investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT) were used. The sensitivity, specificity, positive and negative predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical...

  19. The workload of general practitioners does not affect their awareness of patients' psychological problems.

    NARCIS (Netherlands)

    Zantinge, E.M.; Verhaak, P.F.M.; Bakker, D.H. de; Kerssens, J.J.; Meer, K. van der; Bensing, J.M.

    2007-01-01

    OBJECTIVE: To investigate if general practitioners (GPs) with a higher workload are less inclined to encourage their patients to disclose psychological problems, and are less aware of their patients' psychological problems. METHODS: Data from 2095 videotaped consultations from a representative

  20. Automatic processing of facial affects in patients with borderline personality disorder: associations with symptomatology and comorbid disorders.

    Science.gov (United States)

    Donges, Uta-Susan; Dukalski, Bibiana; Kersting, Anette; Suslow, Thomas

    2015-01-01

    Instability of affects and interpersonal relations are important features of borderline personality disorder (BPD). Interpersonal problems of individuals suffering from BPD might develop based on abnormalities in the processing of facial affects and high sensitivity to negative affective expressions. The aims of the present study were to examine automatic evaluative shifts and latencies as a function of masked facial affects in patients with BPD compared to healthy individuals. As BPD comorbidity rates for mental and personality disorders are high, we investigated also the relationships of affective processing characteristics with specific borderline symptoms and comorbidity. Twenty-nine women with BPD and 38 healthy women participated in the study. The majority of patients suffered from additional Axis I disorders and/or additional personality disorders. In the priming experiment, angry, happy, neutral, or no facial expression was briefly presented (for 33 ms) and masked by neutral faces that had to be evaluated. Evaluative decisions and response latencies were registered. Borderline-typical symptomatology was assessed with the Borderline Symptom List. In the total sample, valence-congruent evaluative shifts and delays of evaluative decision due to facial affect were observed. No between-group differences were obtained for evaluative decisions and latencies. The presence of comorbid anxiety disorders was found to be positively correlated with evaluative shifting owing to masked happy primes, regardless of baseline-neutral or no facial expression condition. The presence of comorbid depressive disorder, paranoid personality disorder, and symptoms of social isolation and self-aggression were significantly correlated with response delay due to masked angry faces, regardless of baseline. In the present affective priming study, no abnormalities in the automatic recognition and processing of facial affects were observed in BPD patients compared to healthy individuals

  1. Health care practitioners’ use of wireless phones in hospital settings can affect interprofessional communication and patient encounters

    DEFF Research Database (Denmark)

    Paasch, Bettina Sletten

    practitioners contact each other, using the phone although physical close. They tend to prioritize the wireless phone above the situation in which they are engaged, using nonverbal gestures to retract, and then have a conversation on the phone in front of the patient. Repeated calls were seen to affect...

  2. A haplotype-based study of lithium responding patients with bipolar affective disorder on the Faroe Islands

    DEFF Research Database (Denmark)

    Ewald, Henrik; Wang, August G; Vang, Maria

    1999-01-01

    , the Faroese population is perhaps the most valuable European population for genetic mapping of complex disease genes. The present study searched for haplotype sharing on chromosome 18 among eight lithium responding patients with bipolar affective disorder related, on average, 6.2 generations ago, using 30 DNA...

  3. Affective alterations in patients with Cushing's syndrome in remission are associated with decreased BDNF and cortisone levels.

    Science.gov (United States)

    Valassi, E; Crespo, I; Keevil, B G; Aulinas, A; Urgell, E; Santos, A; Trainer, P J; Webb, S M

    2017-02-01

    Affective alterations and poorer quality of life often persist in patients with Cushing's syndrome (CS) in remission. Brain-derived neurotrophic factor (BDNF) regulates the hypothalamic-pituitary-adrenal axis (HPA) and is highly expressed in brain areas controlling mood and response to stress. Our aims were to assess affective alterations after long-term remission of CS and evaluate whether they are associated with serum BDNF, salivary cortisol (SalF) and/or cortisone (SalE) concentrations. Thirty-six CS patients in remission (32 females/4 males; mean age (±s.d.), 48.8 ± 11.8 years; median duration of remission, 72 months) and 36 gender-, age- and BMI-matched controls were included. Beck Depression Inventory-II (BDI-II), Center for Epidemiological Studies Depression Scale (CES-D), Positive Affect Negative Affect Scale (PANAS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and EuroQoL and CushingQoL questionnaires were completed and measured to evaluate anxiety, depression, stress perception and quality of life (QoL) respectively. Salivary cortisol was measured using liquid chromatography/tandem mass spectrometry (LC/TMS). BDNF was measured in serum using an ELISA. Remitted CS patients showed worse scores in all questionnaires than controls: STAI (P BDNF was observed in CS vs controls (P = 0.038), and low BDNF was associated with more anxiety (r = -0.247, P = 0.037), depression (r = -0.249, P = 0.035), stress (r = -0.277, P = 0.019) and affective balance (r = 0.243, P = 0.04). Morning salivary cortisone was inversely associated with trait anxiety (r = -0.377, P = 0.040) and depressed affect (r = -0.392, P = 0.032) in CS patients. Delay to diagnosis was associated with depressive symptoms (BDI-II: r = 0.398, P = 0.036 and CES-D: r = 0.449, P = 0.017) and CushingQoL scoring (r = -0.460, P BDNF levels are associated with affective alterations in 'cured' CS patients, including depression, anxiety and impaired stress perception. Elevated levels of

  4. Initial Depressive Episodes Affect the Risk of Suicide Attempts in Korean Patients with Bipolar Disorder

    OpenAIRE

    Ryu, Vin; Jon, Duk-In; Cho, Hyun Sang; Kim, Se Joo; Lee, Eun; Kim, Eun Joo; Seok, Jeong-Ho

    2010-01-01

    Purpose Suicide is a major concern for increasing mortality in bipolar patients, but risk factors for suicide in bipolar disorder remain complex, including Korean patients. Medical records of bipolar patients were retrospectively reviewed to detect significant clinical characteristics associated with suicide attempts. Materials and Methods A total of 579 medical records were retrospectively reviewed. Bipolar patients were divided into two groups with the presence of a history of suicide attem...

  5. TH-C-18A-09: Exam and Patient Parameters Affecting the DNA Damage Response Following CT Studies

    International Nuclear Information System (INIS)

    Elgart, S; Adibi, A; Bostani, M; Ruehm, S; Enzmann, D; McNitt-Gray, M; Iwamoto, K

    2014-01-01

    Purpose: To identify exam and patient parameters affecting the biological response to CT studies using in vivo and ex vivo blood samples. Methods: Blood samples were collected under IRB approval from 16 patients undergoing clinically-indicated CT exams. Blood was procured prior to, immediately after and 30minutes following irradiation. A sample of preexam blood was placed on the patient within the exam region for ex vivo analysis. Whole blood samples were fixed immediately following collection and stained for γH2AX to assess DNA damage response (DDR). Median fluorescence of treated samples was compared to non-irradiated control samples for each patient. Patients were characterized by observed biological kinetic response: (a) fast — phosphorylation increased by 2minutes and fell by 30minutes, (b) slow — phosphorylation continued to increase to 30minutes and (c) none — little change was observed or irradiated samples fell below controls. Total dose values were normalized to exam time for an averaged dose-rate in dose/sec for each exam. Relationships between patient biological responses and patient and exam parameters were investigated. Results: A clearer dose response at 30minutes is observed for young patients (<61yoa; R2>0.5) compared to old patients (>61yoa; R 2 <0.11). Fast responding patients were significantly younger than slow responding patients (p<0.05). Unlike in vivo samples, age did not significantly affect the patient response ex vivo. Additionally, fast responding patients received exams with significantly smaller dose-rate than slow responding patients (p<0.05). Conclusion: Age is a significant factor in the biological response suggesting that DDR may be more rapid in a younger population and slower as the population ages. Lack of an agerelated response ex vivo suggests a systemic response to radiation not present when irradiated outside the body. Dose-rate affects the biological response suggesting that patient response may be related to scan

  6. Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients

    Directory of Open Access Journals (Sweden)

    Hızlı Sayar G

    2014-03-01

    Full Text Available Gökben Hizli Sayar, Gül Eryilmaz, Siban Şemieoğlu, Eylem Özten, Işil Göğcegöz Gül Uskudar University, Neuropsychiatry Istanbul Hospital, Istanbul, Turkey Background: Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT. In recent studies, propofol was shown to possess significant seizure-shortening properties during ECT. "Valproate" is a mood stabilizer used mainly in the treatment of bipolar affective disorder. It is reported that valproate, being an anticonvulsant, raises the seizure threshold, thus decreases the efficacy of ECT treatment. Aim: The purpose of our study was to compare the dose of propofol in valproate-using patients and valproate-free patients. Methods: In an open design, 17 patients with bipolar affective disorder manic episodes who were to be treated with valproate and ECT in combination, were compared with 16 manic-episode patients who were to be treated with ECT but not valproate. The two groups were compared on the basis of electroencephalography-registered seizure duration and the propofol dosage required to induce anesthesia. Results: Valproate, compared with no valproate treatment, results in a decrease in the propofol dose required to induce anesthesia. In the valproate group of study participants, seizure duration was significantly shorter than in the valproate-free group. Conclusion: The results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episodes. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. When the clinician needs to prolong seizure duration in patients treated with valproate, interruption of the valproate treatment or an anesthetic agent other than propofol should be considered. Keywords: bipolar affective disorder, ECT, anticonvulsant, mood

  7. Factors affecting the willingness to pay for implants: A study of patients in Riyadh, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Bishi Al Garni

    2012-01-01

    Conclusion: The majority of the patients surveyed were willing to pay the median price for an implant. Willingness to pay (WTP is a multifactorial variable which is significantly influenced by the income of the patient, the setting of the clinic and the gender; the most significant factor being the acceptability of the implant to the patient.

  8. Does Uninsurance Affect the Health Outcomes of the Insured? Evidence from Heart Attack Patients in California

    NARCIS (Netherlands)

    Meltem Daysal, N.

    2012-01-01

    Abstract: In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome - the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California

  9. Metabolic syndrome in a cohort of affectively ill patients, a naturalistic study

    DEFF Research Database (Denmark)

    Vinberg, Maj; Madsen, Maiken; Breum, Leif

    2012-01-01

    at a Mood Disorder Clinic. Methods: Patients were evaluated for the presence of metabolic syndrome (MeS) according to modified NCEP ATP III criteria. Results: Of the 143 patients eligible for participation, 100 patients participated in the study (32% male, mean age 43.6 ± 14.2); the prevalence of MeS was 26...

  10. Caregivers' attentional bias to pain : does it affect caregiver accuracy in detecting patient pain behaviors?

    NARCIS (Netherlands)

    Mohammadi, Somayyeh; Dehghani, Mohsen; Khatibi, Ali; Sanderman, Robbert; Hagedoorn, Mariet

    Attentional bias to pain among family caregivers of patients with pain may enhance the detection of pain behaviors in patients. However, both relatively high and low levels of attentional bias may increase disagreement between patients and caregivers in reporting pain behaviors. This study aims to

  11. Knowledge and affective traits of physiotherapy students to provide care for patients living with AIDS.

    Directory of Open Access Journals (Sweden)

    Oyeyemi Y. Adetoyeje

    2010-02-01

    Full Text Available Purpose: This  study  aimed  to  assess  Nigerian physiotherapy students’ knowledge and their affective traits in caring for patients living with AIDS (PWA.Methods: Nigerian students (N=104 in four training programs were surveyed using a 43-item questionnaire that elicited information on the  students’  demographics  characteristics,  knowledge  levels  on AIDS transmission, universal precaution and pathophysiology, their feeling  of  preparedness,  comfort,  ethical  disposition  for  PWA  and their  willingness  to  evaluate  and  provide  care  to  PWA  in  different clinical scenarios.Results: Overall  the  students  showed  unsatisfactory  know ledge  of universal  precaution  and  AIDS  pathophysiology  and  did  not  feel comfortable or prepared to care for PWA. The students did not also show  satisfactory  ethical  disposition  and  may  be  unwilling  to  care for PWA. The students’ knowledge levels on AIDS transmission and willingness were influenced by religious affiliation while feeling of comfort and ethical disposition were influenced by gender and knowing someone living with AIDS. They were more unwilling to provide whirlpool wound care procedures and chest physiotherapy compared to providing gait training, therapeutic exercise and activities of daily living training for PWA.Conclusion: The study identified the need to improve the curriculum on AIDS and recommends clinical clerkship and a methodical and sequential exposure of students to cases during clinical rotations.

  12. Somatic and cognitive-affective depressive symptoms among patients with heart disease: differences by sex and age

    Directory of Open Access Journals (Sweden)

    Carina Aparecida Marosti Dessotte

    2015-04-01

    Full Text Available OBJECTIVE: this study investigated the association of somatic and cognitive-affective symptoms with sex and age, among patients hospitalized with heart disease. METHOD: this study was a secondary analysis of two previous observational studies totaling 531 patients with heart disease, hospitalized from 2005 to 2011 in two public hospitals in Ribeirão Preto, state of São Paulo, Brazil. Somatic and cognitive-affective symptoms were assessed using the subscales of the Beck Depression Inventory - I (BDI-I. RESULTS: of 531 participants, 62.7% were male, with a mean age 57.3 years (SD= 13.0 for males and 56.2 years (SD= 12.1 for females. Analyses of variance showed an effect of sex (p<0.001 for somatic and p=0.005 for cognitive-affective symptoms, but no effect of age. Women presented with higher mean values than men in both BDI-I subscales: 7.1 (4.5 vs. 5.4 (4.3 for somatic, and 8.3 (7.9 vs. 6.7 (7.2 for cognitive-affective symptoms. There were no differences by age for somatic (p=0.84 or cognitive-affective symptoms (p=0.84. CONCLUSION: women hospitalized with heart disease had more somatic and cognitive-affective symptoms than men. We found no association of somatic and cognitive-affective symptoms with age. Future research for these patients could reveal whether these differences according to sex continue throughout the rehabilitation process.

  13. Factors affecting patients' knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan.

    Science.gov (United States)

    Saqib, Anum; Atif, Muhammad; Ikram, Raazeyah; Riaz, Fatima; Abubakar, Muhammad; Scahill, Shane

    2018-01-01

    Patients' knowledge about their prescribed medicines is one of the most important antecedents of successful therapy. Poor knowledge about medicines can lead to serious consequences such as non-adherence and misunderstanding of the significance of adverse events. The objective of this study is to understand the factors that are responsible for a patients' lack of knowledge regarding their medicines, by taking the perspective of the patient as well as that of healthcare professionals. Much of the work in this area has been undertaken in the setting of developed or semi-developed countries, and there is a scarcity of information from developing nations such as Pakistan. This was a large qualitative study set in the hospital outpatient environment in a teaching hospital in the Punjab province of Pakistan. Data were collected from dialogue with patients (n = 19) and healthcare providers (n = 16) i.e., doctors and dispensers (where a dispenser is a person who merely dispenses medicines; i.e. is not a pharmacist) through in-depth semi-structured interviews. Patients having limited knowledge about their dispensed medicines were assessed using a checklist. The healthcare providers were recruited through a convenience sampling strategy, based on their availability and willingness to participate in the study. Based on the objectives of the study, a pilot tested interview protocol was developed, and used to conduct the interviews. The sample size was controlled by using saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis. The analysis of data yielded 31 categories (patients = 19, healthcare professionals = 12), 10 subthemes and three themes. The major themes were healthcare professional-related factors, patient-related factors and system-related factors. The health professional related subthemes included: behaviour and attitude and professional liabilities

  14. Hypercoagulable states in patients with multiple myeloma can affect the thalidomide-associated venous thromboembolism.

    Science.gov (United States)

    Talamo, Giampaolo P; Ibrahim, Sulfi; Claxton, David; Tricot, Guido J; Fink, Louis M; Zangari, Maurizio

    2009-07-01

    The therapeutic use of thalidomide in patients with multiple myeloma is often complicated by the development of venous thromboembolism. The objective of the present study was to identify hypercoagulable states associated with development of venous thromboembolism in thalidomide-treated multiple myeloma patients. We screened 49 consecutive multiple myeloma patients treated with thalidomide at baseline for hypercoagulability. With a median follow-up of 11 months, 10 of 49 multiple myeloma patients developed a thrombotic episode. Laboratory assays revealed an underlying abnormality in nine of the 10 patients; hypercoagulable screenings were normal in 36 of the 39 patients who did not develop venous thromboembolism (P < 0.0001). Our retrospective study results suggest that the multiple myeloma patients with thromboembolic complications during treatment with thalidomide have a frequent concomitant underlying thrombophilic state.

  15. Effects of emotionally affect adult and baby' photographs in healthy controls and schizophrenic patients evaluating by exploratory eye movements.

    Science.gov (United States)

    Kawabe, Chizuko; Morita, Kiichiro; Shoji, Yoshihisa; Fujiki, Ryo; Yamamoto, Atsushi; Asaumi, Yasue; Uchimura, Naohisa

    2011-01-01

    The relationship between mother and baby is of fundamental importance in the development of cognitive function and emotion. In this study we investigated the effects of affective photographs of a mother and baby (crying or smiling faces) and other stimuli (neutral mother or baby faces) on visual cognitive function in schizophrenic patents. We recorded exploratory eye movements in 22 healthy controls and 22 age-matched schizophrenic patients. Total number of right and left field gaze points (right TNGP, left TNGP) in the visual fields were determined using an eye-mark recorder as subjects viewed affectively charged or neutral photographs (crying, smiling or neutral faces). Left TNGP for all mother photographs (crying, smiling or neutral) were significantly larger in controls than patients, and right TNGP for neutral mother photographs were significantly larger in controls than in patients. Right TNGP for photographs of smiling babies were significantly larger in controls than patients, and left TNGP for photographs of both smiling and crying babies were significantly larger in controls than patients. Within the patient group, right TNGP were significantly larger than left TNGP for all mother photographs (crying, smiling or neutral). Left TNGP for photographs of mothers and babies correlated negatively with negative symptom scores. These results suggest that exploratory eye movements when viewing emotionally laded twin stimuli such as photographs of a mother and baby are a useful marker of visual cognitive function in both healthy controls and schizophrenic patients.

  16. Modifier 22 for acetabular fractures in morbidly obese patients: does it affect reimbursement?

    Science.gov (United States)

    Bergin, Patrick F; Kneip, Christopher; Pierce, Christine; Hendrix, Stephen T; Porter, Scott E; Graves, Matthew L; Russell, George V

    2014-11-01

    Modifier 22 in the American Medical Association's Current Procedural Terminology (CPT®) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined. We asked whether (1) the use of Modifier 22 increased reimbursements in morbidly obese patients and (2) there was any difference between private insurance and governmental payer sources in treatment of Modifier 22. Over a 4-year period, we requested immediate adjudication with payers when using Modifier 22 for morbidly obese patients with acetabular fractures. We provided payers with evidence of the increased time and effort required in treating this population. Reimbursements were calculated for morbidly obese and nonmorbidly obese patients. Of the 346 patients we reviewed, 57 had additional CPT® codes or modifiers appended to their charges and were excluded, leaving 289 patients. Thirty (10%) were morbidly obese and were billed with Modifier 22. Fifty-three (18%) were insured by our largest private insurer and 69 (24%) by governmental programs (Medicare/Medicaid). Eight privately insured patients (15%) and seven governmentally insured patients (10%) were morbidly obese and were billed with Modifier 22. For our primary question, we compared reimbursement rates between patients with and without Modifier 22 for obesity within the 289 patients. We then performed the same comparison for the 53 privately insured patients and the 69 governmentally insured patients. Overall, there was no change in mean reimbursement when using Modifier 22 in morbidly obese patients, compared to nonmorbidly obese patients (USD 2126 versus USD 2149, p Level IV, economic and decision analyses. See Instructions

  17. Is blinking of the eyes affected in extrapyramidal disorders? An interesting observation in a patient with Wilson disease.

    Science.gov (United States)

    Verma, Rajesh; Lalla, Rakesh; Patil, Tushar B

    2012-11-27

    Blinking of eye is a routine human activity which seldom attracts any attention of clinicians in health and disease. There is experimental evidence that blink rate is affected in extrapyramidal disorders affecting the balance of these neurotransmitters. However, no observations regarding blink rate in Wilson disease (WD) have been reported previously. We report a patient of WD with an increased spontaneous blink rate. A 24-year-old lady presented complaining of tremulousness of both upper limbs and head for 2 years, dysphagia and difficulty in speaking for 1.5 years and abnormal behaviour for last 1 year. We observed that her blink rate at rest was 32/min. Serum ceruloplasmin level was low (0.08 g/l). The patient was started on therapy with D-penicillamine, zinc sulphate, levodopa-carbidopa and trihexiphenidyl. At 1-month follow-up, patient's tremors were markedly decreased and blink rate at rest was decreased to 12/min.

  18. Safety of transrectal ultrasound-guided prostate biopsy in patients affected by Crohn’s disease

    Directory of Open Access Journals (Sweden)

    Lucio Dell'Atti

    2017-06-01

    Full Text Available Purpose: Crohn’s disease (CD is a chronic inflammatory condition of the gastrointestinal tract. It is usually considered a contraindication to transrectal ultrasound-guided prostate biopsy (TRUSBx. The aim of this study was to investigate the safety of TRUSBx in a small cohort of patients with CD. Methods: We queried our institutional database clinical data of patients with a diagnosis of CD undergoing TRUSBx, and a retrospective prospective study of 5 patients was planned. All patients enrolled were in the remission phase of CD and asymptomatic. They received the same antibiotic prophylaxis and a povidone-iodine aqueous solution enema before the procedure. A standardized reproducible technique was used with using a ultrasound machine equipped with a 5-9 MHz multifrequency convex probe “end-fire”. The patients were treated under local anaesthesia, and a 14-core biopsy scheme was performed in each patient as first intention. After the procedure each patient was given a verbal numeric pain scale to evaluate tolerability of TRUSBx. Results: TRUSBx was successfully completed in all patients. The number of biopsy cores was 14 (12-16. Of the 5 biopsy procedures performed 40% revealed prostatic carcinoma (PCa with a Gleason score 6 (3+3. No patients required catheterization or admission to the hospital for adverse events after the procedure. The most frequent adverse event was hematospermia (60%, while hematuria was present in 20% of patients and a minimal rectal bleeding in 20% of the patients. No patients reported severe or unbearable pain (score ≥ 8. Conclusions: This study suggests that CD may not be an absolute contraindication to TRUSBx for prostate cancer detection, but still requires a careful patients selection.

  19. How do voice restoration methods affect the psychological status of patients after total laryngectomy?

    Science.gov (United States)

    Saltürk, Z; Arslanoğlu, A; Özdemir, E; Yıldırım, G; Aydoğdu, İ; Kumral, T L; Berkiten, G; Atar, Y; Uyar, Y

    2016-03-01

    This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients. The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically. Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary. Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

  20. Detection of total hip arthroplasties at airport security checkpoints - how do updated security measures affect patients?

    Science.gov (United States)

    Issa, Kimona; Pierce, Todd P; Gwam, Chukwuweieke; Festa, Anthony; Scillia, Anthony J; Mont, Michael A

    2018-03-01

    There have been historical reports on the experiences of patients with total hip arthroplasty (THA) passing through standard metal detectors at airports. The purpose of this study was to analyse those who had recently passed through airport security and the incidence of: (i) triggering of the alarm; (ii) extra security searches; and (iii) perceived inconvenience. A questionnaire was given to 125 patients with a THA during a follow-up appointment. Those who had passed through airport security after January 2014 met inclusion criteria. A survey was administered that addressed the number of encounters with airport security, frequency of metal detector activation, additional screening procedures utilised, whether security officials required prosthesis documentation, and perceived inconvenience. 51 patients met inclusion criteria. 10 patients (20%) reported triggered security scanners. 4 of the 10 patients stated they had surgical hardware elsewhere in the body. 13 of the 51 patients (25%) believed that having their THA increased the inconvenience of traveling. This is different from the historical cohort with standard metal detectors which patients reported a greater incidence of alarm triggering (n = 120 of 143; p = 0.0001) and perceived inconvenience (n = 99 of 143; p = 0.0001). The percentage of patients who have THA triggering security alarms has decreased. Furthermore, the number of patients who feel that their prosthesis caused traveling inconvenience has decreased. We feel that this decrease in alarms triggered and improved perceptions about inconvenience are related to the increased usage of new technology.

  1. Autoantibodies Affect Brain Density Reduction in Nonneuropsychiatric Systemic Lupus Erythematosus Patients

    Directory of Open Access Journals (Sweden)

    Jian Xu

    2015-01-01

    Full Text Available This study explores the relationship between autoantibodies and brain density reduction in SLE patients without major neuropsychiatric manifestation (NPSLE. Ninety-five NPSLE patients without obvious cerebral deficits, as determined by conventional MRI, as well as 89 control subjects, underwent high-resolution structural MRI. Whole-brain density of grey matter (GMD and white matter (WMD were calculated for each individual, and correlations between the brain density, symptom severity, immunosuppressive agent (ISA, and autoantibody levels were assessed. The GMD and WMD of the SLE group decreased compared to controls. GMD was negatively associated with SLE activity. The WMD of patients who received ISA treatment were higher than that in the patients who did not. The WMD of patients with anticardiolipin (ACL or anti-SSB/La antibodies was lower than in patients without these antibodies, while the GMD was lower in patients with anti-SM or anti-U1RNP antibodies. Thus, obvious brain atrophy can occur very early even before the development of significant symptoms and specific autoantibodies might contribute to the reduction of GMD or WMD in NPSLE patients. However, ISAs showed protective effects in minimizing GMD and WMD reduction. The presence of these specific autoantibodies might help identify early brain damage in NPSLE patients.

  2. Renal artery anatomy affects the blood pressure response to renal denervation in patients with resistant hypertension.

    Science.gov (United States)

    Hering, Dagmara; Marusic, Petra; Walton, Antony S; Duval, Jacqueline; Lee, Rebecca; Sata, Yusuke; Krum, Henry; Lambert, Elisabeth; Peter, Karlheinz; Head, Geoff; Lambert, Gavin; Esler, Murray D; Schlaich, Markus P

    2016-01-01

    Renal denervation (RDN) has been shown to reduce blood pressure (BP), muscle sympathetic nerve activity (MSNA) and target organ damage in patients with resistant hypertension (RH) and bilateral single renal arteries. The safety and efficacy of RDN in patients with multiple renal arteries remains unclear. We measured office and 24-hour BP at baseline, 3 and 6 months following RDN in 91 patients with RH, including 65 patients with single renal arteries bilaterally (group 1), 16 patients with dual renal arteries on either one or both sides (group 2) and 10 patients with other anatomical constellations or structural abnormalities (group 3). Thirty nine out of 91 patients completed MSNA at baseline and follow-up. RDN significantly reduced office and daytime SBP in group 1 at both 3 and 6 months follow-up (Pkidney function in any group. While RDN can be performed safely irrespective of the underlying renal anatomy, the presence of single renal arteries with or without structural abnormalities is associated with a more pronounced BP and MSNA lowering effect than the presence of dual renal arteries in patients with RH. However, when patients with dual renal arteries received renal nerve ablation in all arteries there was trend towards a greater BP reduction. Insufficient renal sympathetic nerve ablation may account for these differences. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Lichen planus affecting the female genitalia: A retrospective review of patients at Mayo Clinic.

    Science.gov (United States)

    Fahy, Caoimhe M R; Torgerson, Rochelle R; Davis, Mark D P

    2017-12-01

    Genital or vulval lichen planus (VLP) may have a disabling effect on a patient's quality of life. Evidence-based management guidelines are lacking for VLP. We sought to review clinical presentation and treatment of patients who received a diagnosis of VLP. The 100 consecutive patients who received a diagnosis of VLP at Mayo Clinic between January 1, 1997, and December 31, 2015, were reviewed retrospectively. Descriptive statistics were used for data analysis. Fisher's exact test and the Wilcoxon rank sum test were used for analysis of categorical and continuous variables, respectively. All statistical tests were 2 sided, with the α level set at .05 for statistical significance. The time to diagnosis for 49% of patients was more than 1 year. Three patients (3%) had vulval dysplasia, including invasive squamous cell carcinoma. Sixty-eight patients (68%) had multisite lichen planus disease. Eleven patients (11%) had disease remission. Dermatology was the lead specialty for 9 of these cases of remission. This was a retrospective, small-cohort study. A low frequency of disease remission was seen in patients with VLP. Patients with lichen planus benefit considerably from dermatology consultation. Further research is warranted to establish high-quality, evidence-based guidelines for multidisciplinary management of this challenging disease. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus A Case-Control Pilot Study.

    Science.gov (United States)

    Knox, Andrew F; Bryant, Alan R

    2016-05-01

    Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ(2) tests: P > .05). No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

  5. Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery.

    Science.gov (United States)

    El-Sayed, H L; Nassar, M F; Habib, N M; Elmasry, O A; Gomaa, S M

    2006-04-01

    The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation. The present study was carried out on 30 PEM infants (16 nonedematous - 14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were re-evaluated using the same preinterventional parameters. The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between

  6. Does Insight Affect the Efficacy of Antipsychotics in Acute Mania?: An Individual Patient Data Regression Meta-Analysis.

    Science.gov (United States)

    Welten, Carlijn C M; Koeter, Maarten W J; Wohlfarth, Tamar D; Storosum, Jitschak G; van den Brink, Wim; Gispen-de Wied, Christine C; Leufkens, Hubert G M; Denys, Damiaan A J P

    2016-02-01

    Patients having an acute manic episode of bipolar disorder often lack insight into their condition. Because little is known about the possible effect of insight on treatment efficacy, we examined whether insight at the start of treatment affects the efficacy of antipsychotic treatment in patients with acute mania. We used individual patient data from 7 randomized, double-blind, placebo-controlled registration studies of 4 antipsychotics in patients with acute mania (N = 1904). Insight was measured with item 11 of the Young Mania Rating Scale (YMRS) at baseline and study endpoint 3 weeks later. Treatment outcome was defined by (a) mean change score, (b) response defined as 50% or more improvement on YMRS, and (c) remission defined as YMRS score less than 8 at study endpoint. We used multilevel mixed effect linear (or logistic) regression analyses of individual patient data to assess the interaction between baseline insight and treatment outcomes. At treatment initiation, 1207 (63.5%) patients had impaired or no insight into their condition. Level of insight significantly modified the efficacy of treatment by mean change score (P = 0.039), response rate (P = 0.033), and remission rate (P = 0.043), with greater improvement in patients with more impaired insight. We therefore recommend that patients experiencing acute mania should be treated immediately and not be delayed until patients regain insight.

  7. Cardiac Autoantibodies from Patients Affected by a New Variant of Endemic Pemphigus Foliaceus in Colombia, South America

    Science.gov (United States)

    Howard, Michael S.; Jiao, Zhe; Gao, Weiqing; Yi, Hong; Grossniklaus, Hans E.; Duque-Ramírez, Mauricio; Dudley, Samuel C.

    2012-01-01

    Several patients affected by a new variant of endemic pemphigus foliaceus in El Bagre, Colombia (El Bagre-EPF) have experienced a sudden death syndrome, including persons below the age of 50. El Bagre-EPF patients share several autoantigens with paraneoplastic pemphigus patients, such as reactivity to plakins. Further, paraneoplastic pemphigus patients have autoantibodies to the heart. Therefore, we tested 15 El Bagre-EPF patients and 15 controls from the endemic area for autoreactivity to heart tissue using direct and indirect immunofluorescence, confocal microscopy, immunohistochemistry, immunoblotting, and immunoelectron microscopy utilizing heart extracts as antigens. We found that 7 of 15 El Bagre patients exhibited a polyclonal immune response to several cell junctions of the heart, often colocalizing with known markers. These colocalizing markers included those for the area composita of the heart, such as anti-desmoplakins I and II; markers for gap junctions, such as connexin 43; markers for tight junctions, such as ezrin and junctional adhesion molecule A; and adherens junctions, such pan-cadherin. We also detected colocalization of the patient antibodies within blood vessels, Purkinje fibers, and cardiac sarcomeres. We conclude that El Bagre-EPF patients display autoreactivity to multiple cardiac epitopes, that this disease may resemble what is found in patients with rheumatic carditis, and further, that the cardiac pathophysiology of this disorder warrants further evaluation. PMID:21796504

  8. Co-occurring Attention Deficit Hyperactivity Disorder symptoms in adults affected by heroin dependence: Patients characteristics and treatment needs.

    Science.gov (United States)

    Lugoboni, Fabio; Levin, Frances Rudnick; Pieri, Maria Chiara; Manfredini, Matteo; Zamboni, Lorenzo; Somaini, Lorenzo; Gerra, Gilberto; Gruppo InterSert Collaborazione Scientifica Gics

    2017-04-01

    Attention Deficit Hyperactivity Disorder (ADHD) is a risk for substance use disorders. The aim of this study was to investigate the association between adult ADHD symptoms, opioid use disorder, life dysfunction and co-occurring psychiatric symptoms. 1057 heroin dependent patients on opioid substitution treatment participated in the survey. All patients were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale (ASRS-v1.1). 19.4% of the patients screened positive for concurrent adult ADHD symptoms status and heroin dependence. Education level was lower among patients with ADHD symptoms, but not significant with respect to non-ADHD patients. Patients with greater ADHD symptoms severity were less likely to be employed. A positive association was observed between ADHD symptoms status and psychiatric symptoms. Patients with ADHD symptoms status were more likely to be smokers. Patients on methadone had a higher rate of ADHD symptoms status compared to buprenorphine. Those individuals prescribed psychoactive drugs were more likely to have ADHD symptoms. In conclusion, high rate of ADHD symptoms was found among heroin dependent patients, particularly those affected by the most severe form of addiction. These individuals had higher rates of unemployment, other co-morbid mental health conditions, heavy tobacco smoking. Additional psychopharmacological interventions targeting ADHD symptoms, other than opioid substitution, is a public health need. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  9. EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF IN IMPROVING SENSORIMOTOR FUNCTION IN PATIENTS WITH DIABETIC NEUROPATHY AFFECTING LOWER LIMBS

    Directory of Open Access Journals (Sweden)

    Kamaljeet Singh

    2016-06-01

    Full Text Available Background: Diabetic Mellitus is a group of metabolic disease characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. Distal Sensorimotor Polyneuropathy is the most common complication of diabetes which mainly affects the lower limbs. Most of the studies aimed at individually increasing muscle strength or sensation but not on overall performance enhancements of the diabetic lower limbs. The evidence supporting the effectiveness of PNF in diabetic neuropathic patients is scarce. Methods: 30 patients, with age between 50 to 70 years, diagnosed with Diabetic Sensorimotor Polyneuropathy (DSP were selected from the department of Medicine and department of Neurosurgery Guru Gobind Singh Medical College and Hospital. Patients were evaluated at the beginning and at the end of the intervention using Diabetic Neuropathy Examination scores. Patients received 3 sets of exercises one hour/day with 3 days/week for 3 months. Each set of exercises consists of 5 repetitions of PNF patterns (alternate day and techniques. Results: D1 & D2 patterns of PNF are effective in improving both motor and sensory functions of diabetic patients with neuropathic symptoms. Improvement in muscle strength, reflex and sensations occurred to a greater extent after the treatment of three months in these subjects. This study shows that PNF patterns were effective at enhancing sensorimotor problems of lower limbs. Conclusion: This study concluded that PNF is found to be effective in improving sensorimotor functions of diabetic neuropathic patients affecting lower limbs.

  10. GENDER-RELATED CHARACTERISTICS OF AFFECTIVE DISORDERS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    S. Yu. Mukhtarenko

    2017-01-01

    Full Text Available The study objective is to investigate characteristics of mixed anxiety-depressive disorders (MADD and the level of subjective self-control  in relation to health (SSCh, as well as the effect of affective disorder severity on clinical course and prognosis of the disease in men and women with acute myocardial infarction (AMI.Materials and methods. The study included 124 patients with AMI aged between 30 and 85 years (mean age 58.6  ±  12.1 years, who were divided into 2 groups: the 1st group contained 88 (71 % men, the 2nd group – 36 (29 % women.Results. Per the screening test, MADD was more frequently diagnosed in the female group (91.7 % compared to the male group (56.8 %,  р <0.001. Absence of anxiety symptoms per the Hospital Anxiety and Depression Scale (HADS was more frequently observed in the male group (77.3 % vs. 52.8 %, р <0.01; relative risk (RR 1.46; 95 % confidence interval (CI 1.05–2.03, and significant level of anxiety per HADS was more frequently diagnosed in the female group (4.5 % vs. 27.8 %, р <0.01; RR 0.16; 95 % CI 0.05–0.48. Absence of depression symptoms per HADS was more frequently observed in the male group (68.2 % vs. 30.6 %, р <0.01; RR 2.23; 95 % CI 1.33–3.72, and moderate (14.8 % vs. 33.3 %, р <0.05; RR 0.44; 95 % CI 0.22–0.87 and severe (17.0 % vs. 36.1 %, р <0.05; RR 0.47; 95 % CI 0.25– 0.88 levels of depression per HADS were more common in the female group. Absence of depression symptoms per the Beck Depression Inventory (BDI was more frequently observed in the male group (42.1 % vs. 11.1 % women, р <0.01; RR 3.78; 95 % CI 1.45–9.84. In the female group, moderate (27.8 % vs. 10.2 %, р <0.05; RR 0.36; 95 % CI 0.16–0.83 and severe (13.9 % vs. 3.4 %, р <0.05; RR 0.24; 95 % CI 0.06–0.97 levels of depression per this scale were more common than in the male group. Left ventricular ejection fraction was lower  in the female group (41.4 ± 11.4 % compared to the male group (45.8 ± 10

  11. Factors affecting patients' knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan.

    Directory of Open Access Journals (Sweden)

    Anum Saqib

    Full Text Available Patients' knowledge about their prescribed medicines is one of the most important antecedents of successful therapy. Poor knowledge about medicines can lead to serious consequences such as non-adherence and misunderstanding of the significance of adverse events. The objective of this study is to understand the factors that are responsible for a patients' lack of knowledge regarding their medicines, by taking the perspective of the patient as well as that of healthcare professionals. Much of the work in this area has been undertaken in the setting of developed or semi-developed countries, and there is a scarcity of information from developing nations such as Pakistan.This was a large qualitative study set in the hospital outpatient environment in a teaching hospital in the Punjab province of Pakistan. Data were collected from dialogue with patients (n = 19 and healthcare providers (n = 16 i.e., doctors and dispensers (where a dispenser is a person who merely dispenses medicines; i.e. is not a pharmacist through in-depth semi-structured interviews. Patients having limited knowledge about their dispensed medicines were assessed using a checklist. The healthcare providers were recruited through a convenience sampling strategy, based on their availability and willingness to participate in the study. Based on the objectives of the study, a pilot tested interview protocol was developed, and used to conduct the interviews. The sample size was controlled by using saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis.The analysis of data yielded 31 categories (patients = 19, healthcare professionals = 12, 10 subthemes and three themes. The major themes were healthcare professional-related factors, patient-related factors and system-related factors. The health professional related subthemes included: behaviour and attitude and professional

  12. Non-selective β-blockers do not affect mortality in cirrhosis patients with ascites

    DEFF Research Database (Denmark)

    Bossen, Lars; Krag, Aleksander; Vilstrup, Hendrik

    2016-01-01

    , variceal bleeding, bacterial infection, and/or development of the hepatorenal syndrome. CONCLUSION: This large and detailed dataset on worldwide non-protocol use of NSBBs in cirrhosis patients with ascites shows that NSBBs did not increase the patients' mortality. The decision to stop NSBB treatment...

  13. Initial depressive episodes affect the risk of suicide attempts in Korean patients with bipolar disorder.

    Science.gov (United States)

    Ryu, Vin; Jon, Duk-In; Cho, Hyun Sang; Kim, Se Joo; Lee, Eun; Kim, Eun Joo; Seok, Jeong-Ho

    2010-09-01

    Suicide is a major concern for increasing mortality in bipolar patients, but risk factors for suicide in bipolar disorder remain complex, including Korean patients. Medical records of bipolar patients were retrospectively reviewed to detect significant clinical characteristics associated with suicide attempts. A total of 579 medical records were retrospectively reviewed. Bipolar patients were divided into two groups with the presence of a history of suicide attempts. We compared demographic characteristics and clinical features between the two groups using an analysis of covariance and chi-square tests. Finally, logistic regression was performed to evaluate significant risk factors associated with suicide attempts in bipolar disorder. The prevalence of suicide attempt was 13.1% in our patient group. The presence of a depressive first episode was significantly different between attempters and nonattempters. Logistic regression analysis revealed that depressive first episodes and bipolar II disorder were significantly associated with suicide attempts in those patients. Clinicians should consider the polarity of the first mood episode when evaluating suicide risk in bipolar patients. This study has some limitations as a retrospective study and further studies with a prospective design are needed to replicate and evaluate risk factors for suicide in patients with bipolar disorder.

  14. Correlation between ELISA and ML Flow assays applied to 60 Brazilian patients affected by leprosy

    NARCIS (Netherlands)

    Da Silva, Rozana C.; Lyon, Sandra; Lyon, Ana C.; Grossi, Maria A. F.; Lyon, Silvia H.; Bührer-Sékula, Samira; Antunes, Carlos M. F.

    2010-01-01

    Serological tests can be helpful in classifying leprosy patients as having either the paucibacillary or the multibacillary form. The aim of this study was to evaluate the concordance between two serological assays, i.e. ML Flow and ELISA, in a population of leprosy patients in Brazil. The

  15. Success/failure condition influences attribution of control, negative affect, and shame among patients with depression in Singapore.

    Science.gov (United States)

    Yeo, Si-Ning; Zainal, Hani; Tang, Catherine S; Tong, Eddie M; Ho, Cyrus S; Ho, Roger C

    2017-08-02

    There remains a paucity of research on control attribution and depression within Asian populations. This study examines: (1) Success/Failure condition as a moderator between depression and negative affect or shame, and (2) differences in control attribution between patients with depression and healthy controls in Singapore. Seventy one patients with depression and 71 healthy controls went through a digit-span memory task where they were randomized into either the Success or Failure condition. Participants in the Success condition had to memorize and recall 5-digit strings, while participants in the Failure condition did the same for 12-digit strings. They then completed self-report measures of negative affect, shame, and attribution of control. One-way ANCOVA was performed to examine task condition as a moderator of association between mental health status and post-task negative affect or shame. Test of simple effects was carried out on significant interactions. Sign test and Mann-Whitney U test were employed to investigate differences in attribution of control. Mental health status and Success/Failure condition had significant effects on reported negative affect and shame. Healthy controls reported less post-task negative affect and shame in the Success than in the Failure condition while patients with depression reported similar levels of post-task negative affect and shame in both conditions. However, these differences were not significant in the test of simple effects. In addition, healthy controls felt a stronger sense of personal control in success than in failure and were more likely to blame external factors in failure than in success. Conversely, patients with depression were more inclined to credit external factors in success than in failure and ascribed greater personal control in failure than in success. The results suggest that successful conditions may not necessitate the reduction of negative affect in Asians with depression, indicating possible

  16. Suppression of negative affect in cancer patients. Trauma and defensiveness of self-esteem as predictors of depression and anxiety

    Directory of Open Access Journals (Sweden)

    Fila-Jankowska Aleksandra

    2016-09-01

    Full Text Available The results of the work show that the relatively small differences in declared, negative emotional states (such as depression or anxiety between people suffering and not suffering from cancer can be explained by the suppression of negative affect in the former. It was assumed that the suppression is related to a compensation of an automatic, affective self-assessment - i.e. implicit self-esteem, lower in cancer patients. The results confirmed that the connection of cancer and depression (similarly cancer and anxiety became significantly stronger while the self-esteem defensiveness and past stress are statistically controlled.

  17. EFFICACY OF CAGE PLACEMENT WITHOUT PLATE IN PATIENTS WITH CERVICAL MYELOPATHY WITH SINGLE-LEVEL AFFECTION

    Directory of Open Access Journals (Sweden)

    CARLOS ALBERTO ZUÑIGA-MAZÓN

    Full Text Available ABSTRACT Objective: To determine the efficacy of PEEK (Poly-ether-ether-ketone cage without plate for the treatment of single-level cervical spondylosis. Methods: Ten patients with cervical myelopathy data, with a single-level root condition, seen at the outpatient clinic of the Neurosurgery Service, operated in 2016, mean age 53 years, 6 (60% female, 4 (40% obese, 3 (30% smokers. The Cloward technique was used by anterior approach, discectomy, and PEEK cage placement. Results: At six months of surgery, 100% of the patients had increased intervertebral space, with a 100% reduction in osteophytes; only one patient had dysphagia, no patient had lesion of the adjacent segment and 10% had persistent root pathology. Cervical lordosis was observed in 90% of the patients and arthrodesis in 100% of the cases. Conclusions: Anterior approach arthrodesis using PEEK cage without cervical plate is effective as a treatment of cervical myelopathy in a single level.

  18. Factors affecting colonoscope insertion time in patients with or without a colostomy after left-sided colorectal resection.

    Science.gov (United States)

    Jang, Hui Won; Kim, Yoon Nam; Nam, Chung Mo; Lee, Hyun Jung; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, Jae Hee

    2012-12-01

    We examined whether the insertion time for colonoscopies performed after left-sided resection was different in patients with a colostomy from that in patients without a colostomy and identified factors that could impact colonoscopy performance. We included consecutive patients who underwent colonoscopy between July 2005 and March 2011 after left-sided colorectal resection for colorectal cancer. We classified surgical methods according to the presence or absence of a colostomy and evaluated colonoscope insertion time retrospectively. Furthermore, we analyzed factors that might affect insertion time. A total of 1,041 patients underwent colonoscopy after left-sided colorectal resection during the study period. The colonoscopy completion rate was 98.6 %, and the mean insertion time was 6.1 ± 4.6 min (median 4.7 min, range 0.3-35.8 min). A shorter resection length of colon, the presence of a colostomy, and a lower endoscopist case volume were found to be independent factors associated with prolonged insertion time in patients with left-sided colorectal resection. Among experienced colonoscopists, no colonoscopy-associated or clinical factors were found to affect insertion time. However, a shorter resection length of colon, the presence of a colostomy, and poor bowel preparation were associated with prolonged insertion time among inexperienced endoscopists. We identified three factors that affect colonoscope insertion time after left-sided colorectal resection, including the presence of a colostomy. Inexperienced endoscopists were much more affected by the presence of a colostomy after left-sided colorectal resection. These findings have implications for the practice and teaching of colonoscopy after left-sided colorectal resection.

  19. Altered molecular profile in thyroid cancers from patients affected by the Three Mile Island nuclear accident.

    Science.gov (United States)

    Goldenberg, David; Russo, Mariano; Houser, Kenneth; Crist, Henry; Derr, Jonathan B; Walter, Vonn; Warrick, Joshua I; Sheldon, Kathryn E; Broach, James; Bann, Darrin V

    2017-07-01

    In 1979, Three Mile Island (TMI) nuclear power plant experienced a partial meltdown with release of radioactive material. The effects of the accident on thyroid cancer (TC) in the surrounding population remain unclear. Radiation-induced TCs have a lower incidence of single nucleotide oncogenic driver mutations and higher incidence of gene fusions. We used next generation sequencing (NGS) to identify molecular signatures of radiation-induced TC in a cohort of TC patients residing near TMI during the time of the accident. Case series. We identified 44 patients who developed papillary thyroid carcinoma between 1974 and 2014. Patients who developed TC between 1984 and 1996 were at risk for radiation-induced TC, patients who developed TC before 1984 or after 1996 were the control group. We used targeted NGS of paired tumor and normal tissue from each patient to identify single nucleotide oncogenic driver mutations. Oncogenic gene fusions were identified using quantitative reverse transcription polymerase chain reaction. We identified 15 patients in the at-risk group and 29 patients in the control group. BRAF V600E mutations were identified in 53% patients in the at-risk group and 83% patients in the control group. The proportion of patients with BRAF mutations in the at-risk group was significantly lower than predicted by the The Cancer Genome Atlas cohort. Gene fusion or somatic copy number alteration drivers were identified in 33% tumors in the at-risk group and 14% of tumors in the control group. Findings were consistent with observations from other radiation-exposed populations. These data raise the possibility that radiation released from TMI may have altered the molecular profile of TC in the population surrounding TMI. 4 Laryngoscope, 127:S1-S9, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Factors that affect functional capacity in patients with musculoskeletal pain : a Delphi study among scientists, clinicians, and patients

    NARCIS (Netherlands)

    Jorna-Lakke, Sandra; Wittink, Harriët; Geertzen, Jan H; van der Schans, Cees; Reneman, Michiel F

    OBJECTIVE: To reach consensus on the most important biopsychosocial factors that influence functional capacity results in patients with chronic nonspecific musculoskeletal pain, arranged in the framework of the International Classification of Functioning, Disability and Health. DESIGN: Three-round,

  1. Disease progression and health care resource consumption in patients affected by hepatitis C virus in real practice setting

    Directory of Open Access Journals (Sweden)

    Perrone V

    2016-10-01

    Full Text Available Valentina Perrone, Diego Sangiorgi, Stefano Buda, Luca Degli Esposti CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy Introduction: Hepatitis C virus (HCV infection represents serious health problems worldwide and is a major contributor to end-stage liver disease including cirrhosis and hepatocellular carcinoma (HCC. In Italy, ~2% of subjects are infected with HCV. The objective of this study was to describe treatment patterns, disease progression, and resource use in HCV.Methods: An observational retrospective cohort analysis based on four Local Health Units administrative and laboratory databases was conducted. HCV-positive patients between January 1, 2009 and December 31, 2010 were included and followed-up for 1 year. To explore which covariates were associated to disease progression (cirrhosis, HCC, death for any cause, Cox proportional hazards models were performed.Results: A total of 9,514 patients were analyzed of which 55.6% were male, aged 58.1±16.1, and prevalence 0.4%; 5.8% were positive to human immunodeficiency virus (HIV infection, 3.0% to hepatitis B virus (HBV, and 1.6% to HCV+HBV+HIV; 26.1% had cirrhosis and 4.3% HCC. The majority of patients (76% did not receive an antiviral treatment; the main factors affecting this decision were age, 44.1% of untreated patients being aged >65 years; 31% were affected by cirrhosis, 6.6% had ongoing substance or alcohol abuse, and 5.5% were affected by HCC. Disease progression in the observed timeframe was less frequent among treated patients (incidence rate per 100 patients/year: cirrhosis 2.1±0.7 vs 13.0±1.0, HCC 0.5±0.3 vs 3.6±0.5, death 0.5±0.3 vs 6.4±0.7. The annual expenditure for HCV management (drugs, hospitalizations, outpatient services was €4,700 per patient.Conclusion: This observational, real-life study shows that only a small proportion of patients received antiviral therapy in the territorial services investigated; among patients who were not treated

  2. How nurses and their work environment affect patient experiences of the quality of care: a qualitative study

    Science.gov (United States)

    2014-01-01

    Background Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences. Methods A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis. Results The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care. Conclusions According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and

  3. Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care.

    Science.gov (United States)

    Fakhri, Shoaib; Engelberg, Ruth A; Downey, Lois; Nielsen, Elizabeth L; Paul, Sudiptho; Lahdya, Alexandria Z; Treece, Patsy D; Curtis, J Randall

    2016-09-01

    Discussions about end-of-life care are often difficult for patients and clinicians, and inadequate communication poses a barrier to patients receiving the care they desire. To understand factors that facilitate end-of-life care discussions that guide interventions to improve care. We examined baseline data from an ongoing randomized trial to evaluate associations between patients' self-reported desire for, and occurrence of, discussions about end-of-life care and factors influencing these discussions. Factors included emotional symptoms and barriers and facilitators to discussions. The sample included patients with serious illness (n = 473) and their primary or specialty care clinicians (n = 128). Regression analyses were adjusted for confounders and clustered patients under clinicians. Patients who endorsed each of three barriers to discussions were less likely to have had a discussion with their clinician (P-values ranging from communication about end-of-life care is associated with patient factors including communication barriers and facilitators and symptoms of depression and anxiety. Understanding these factors may facilitate design of effective communication interventions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. Time-motion analysis of factors affecting patient throughput in an MR imaging center

    International Nuclear Information System (INIS)

    O'Donohue, J.; Enzmann, D.R.

    1986-01-01

    The high cost of MR imaging makes efficient use essential. In an effort to increase patient throughput, attention has been focused on shortening the imaging time through reductions in matrix size and number of excitations, and through the use of newer ''fast imaging'' techniques. Less attention has been given to other time-consuming aspects not directly related to imaging time. The authors undertook a time-motion study using a daily log of minute-by-minute activities associated with an MR imaging examination. The times required for the following components of the examination were measured: total study time, examination set-up time, intrastudy physician ''image review'' time, and interstudy patient turnover time. The time lost to claustrophobic reactions, patients' failure to appear for scheduled examinations, unanticipated patient care (sedation, reassurance), and equipment malfunction was also analyzed. Actual imaging time accounted for a relatively small proportion (42%) of total study time. Other factors such as intrastudy image review time (15%), interstudy patient turnover time (11%), and time lost due to claustrophobic reactions, patients' failure to appear for scheduled examinations, and equipment malfunction contributed significantly to the total study time. Simple solutions to these problems can contribute greatly to increasing patient throughput

  5. Positive affect and survival in patients with stable coronary heart disease: findings from the Heart and Soul Study.

    Science.gov (United States)

    Hoen, Petra W; Denollet, Johan; de Jonge, Peter; Whooley, Mary A

    2013-07-01

    Positive affect can improve survival, but the mechanisms responsible for this association are unknown. We sought to evaluate the association between positive affect and mortality in patients with stable coronary heart disease and to determine biological and behavioral factors that might explain this association. The Heart and Soul Study is a prospective cohort study of 1,018 outpatients with stable coronary heart disease. Participants were recruited between September 11, 2000, and December 20, 2002, and were followed up to June 2011. Baseline positive affect was assessed by using the 10-item positive affect subscale of the Positive and Negative Affect Schedule. Cox proportional hazards regression was used to estimate the risk of mortality (primary outcome measure) and cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack) associated with positive affect, adjusting for baseline cardiac disease severity and depression. We also evaluated the extent to which these associations were explained by potential biological and behavioral mediators. A total of 369 patients (36%) died during a mean ± SD follow-up period of 7.1 ± 2.5 years. Positive affect was not significantly associated with cardiovascular events (hazard ratio [HR]: 0.89; 95% CI, 0.79-1.00; P = .06). However, each standard deviation (8.8-point) increase in positive affect score was associated with a 16% decreased risk of all-cause mortality (HR: 0.84; 95% CI, 0.76-0.92; P = .001). After adjustment for cardiac disease severity and depressive symptoms, positive affect remained significantly associated with improved survival (HR: 0.87; 95% CI, 0.78-0.97; P = .01). The association was no longer significant after adjustment for behavioral factors, and particularly physical activity (HR: 0.92; 95% CI, 0.82-1.03; P = .16). Further adjustment for C-reactive protein and omega-3 fatty acids did not result in any meaningful changes (HR: 0.94; 95% CI, 0.84-1.06; P = .31). In this

  6. Colonic epithelial ion transport is not affected in patients with diverticulosis

    DEFF Research Database (Denmark)

    Osbak, Philip S; Bindslev, Niels; Poulsen, Steen S

    2007-01-01

    BACKGROUND: Colonic diverticular disease is a bothersome condition with an unresolved pathogenesis. It is unknown whether a neuroepithelial dysfunction is present. The aim of the study was two-fold; (1) to investigate colonic epithelial ion transport in patients with diverticulosis and (2) to adapt...... a miniaturized Modified Ussing Air-Suction (MUAS) chamber for colonic endoscopic biopsies. METHODS: Biopsies were obtained from the sigmoid part of the colon. 86 patients were included. All patients were referred for colonoscopy on suspicion of neoplasia and they were without pathological findings at colonoscopy...... with diverticulosis and that the MUAS chamber can be adapted for studies of human colonic endoscopic biopsies. Udgivelsesdato: 2007-null...

  7. Putting the Focus Back on the Patient: How Privacy Concerns Affect Personal Health Information Sharing Intentions.

    Science.gov (United States)

    Abdelhamid, Mohamed; Gaia, Joana; Sanders, G Lawrence

    2017-09-13

    Health care providers are driven by greater participation and systemic cost savings irrespective of benefits to individual patients derived from sharing Personal Health Information (PHI). Protecting PHI is a critical issue in the sharing of health care information systems; yet, there is very little literature examining the topic of sharing PHI electronically. A good overview of the regulatory, privacy, and societal barriers to sharing PHI can be found in the 2009 Health Information Technology for Economic and Clinical Health Act. This study investigated the factors that influence individuals' intentions to share their PHI electronically with health care providers, creating an understanding of how we can represent a patient's interests more accurately in sharing settings, instead of treating patients like predetermined subjects. Unlike privacy concern and trust, patient activation is a stable trait that is not subject to change in the short term and, thus, is a useful factor in predicting sharing behavior. We apply the extended privacy model in the health information sharing context and adapt this model to include patient activation and issue involvement to predict individuals' intentions. This was a survey-based study with 1600+ participants using the Health Information National Trends Survey (HINTS) data to validate a model through various statistical techniques. The research method included an assessment of both the measurement and structural models with post hoc analysis. We find that privacy concern has the most influence on individuals' intentions to share. Patient activation, issue involvement, and patient-physician relationship are significant predictors of sharing intention. We contribute to theory by introducing patient activation and issue involvement as proxies for personal interest factors in the health care context. Overall, this study found that although patients are open to sharing their PHI, they still have concerns over the privacy of their PHI

  8. Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists.

    Science.gov (United States)

    Hifinger, M; Hiligsmann, M; Ramiro, S; Watson, V; Severens, J L; Fautrel, B; Uhlig, T; van Vollenhoven, R; Jacques, P; Detert, J; Canas da Silva, J; Scirè, C A; Berghea, F; Carmona, L; Péntek, M; Keat, A; Boonen, A

    2017-01-01

    To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists. Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients' preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK. Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  9. Loss of lean body mass affects low bone mineral density in patients with rheumatoid arthritis - results from the TOMORROW study.

    Science.gov (United States)

    Okano, Tadashi; Inui, Kentaro; Tada, Masahiro; Sugioka, Yuko; Mamoto, Kenji; Wakitani, Shigeyuki; Koike, Tatsuya; Nakamura, Hiroaki

    2017-11-01

    Osteoporosis is one of the complications for patients with rheumatoid arthritis (RA). Rheumatoid cachexia, the loss of lean body mass, is another. However, the relationship between decreased lean body mass and reduced bone mineral density (BMD) in patients with RA has not been well studied. This study included 413 participants, comprising 208 patients with RA and 205 age- and sex-matched healthy volunteers. Clinical data, BMD, bone metabolic markers (BMM) and body composition, such as lean body mass and percent fat, were collected. Risk factors for osteoporosis in patients with RA including the relationship BMD and body composition were analyzed. Patients with RA showed low BMD and high BMM compared with controls. Moreover, lean body mass was lower and percent fat was higher in patients with RA. Lean body mass correlated positively and percent fat negatively with BMD. Lean body mass was a positive and disease duration was a negative independent factor for BMD in multivariate statistical analysis. BMD and lean body mass were significantly lower in patients with RA compared to healthy controls. Lean body mass correlated positively with BMD and decreased lean body mass and disease duration affected low BMD in patients with RA. [UMIN Clinical Trials Registry, http://www.umin.ac.jp/ctr/ , UMIN000003876].

  10. Do dental procedures affect lung function and arterial oxygen saturation in asthmatic patients?

    Directory of Open Access Journals (Sweden)

    Magdy Mahmoud Emara

    2013-04-01

    Conclusion: Asthmatic patients may be at a higher risk of developing oxygen desaturation after dental procedures regardless of their type with and without local anesthesia and a decrease in PEF after dental procedures with local anesthesia.

  11. How virtual admission affects coping – telemedicine for patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Emme, Christina; Rydahl-Hansen, Susan; Østergaard, Birte

    2014-01-01

    To describe what characterises chronic obstructive pulmonary disease patients' coping of physical, emotional and social problems before, during and after virtual admission, in interaction with health professionals and relatives....

  12. Risk factors affecting seroconversion after influenza A/H1N1 vaccination in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Moon Sung Jin

    2012-12-01

    Full Text Available Abstracts Background Hemodialysis (HD patients have multiple causes of immune dysfunction and poor immune response to influenza vaccination. We investigated the antibody response rate to a pandemic H1N1/2009 influenza vaccination and clinical parameters influencing the induction of antibody responses in HD patients. Methods A total of 114 HD patients were vaccinated with a monovalent adjuvanted H1N1 inactivated influenza vaccine. Titers of neutralizing antibodies were evaluated by hemagglutination inhibition (HI assay at pre- and 4 weeks after vaccination. Seroconversion was defined as either a pre-vaccination HI titer  1:40 or a pre-vaccination HI titer ≥ 1:10 and a minimum four-fold rise in post-vaccination HI antibody titer. Seventeen out of 114 HD patients (14.9% tested positive for antibodies against influenza A/H1N1/2009 before vaccination. The remaining 97 baseline sero-negative patients were included in the analysis. Results Only 30 (30.9% HD patients had seroconversion 4 weeks after vaccination. The elderly patients, those over 65 years of age, showed significantly lower seroconversion rate compared to younger HD patients (20.5% vs. 39.6%, p = 0.042. Furthermore, patients with hemoglobin values less than 10 g/dL had a significantly lower seroconversion rate compared to those with higher hemoglobin values (20.0 vs. 38.6%, p = 0.049. By multivariate logistic regression analysis, only age ≥65 years (OR = 0.336, 95% confidence interval (CI 0.116-0.971, p = 0.044 and hemoglobin levels Conclusions Our data show that HD patients, especially who are elderly with low hemoglobin levels, are at increased risk for lower seroconversion rate after influenza A/H1N1 vaccination. Further studies are needed to improve the efficacy of vaccination in these high risk patients.

  13. Case report: long-term survival of an infant syndromic patient affected by atypical teratoid-rhabdoid tumor

    International Nuclear Information System (INIS)

    Modena, Piergiorgio; Maestro, Roberta; Giangaspero, Felice; Massimino, Maura; Sardi, Iacopo; Brenca, Monica; Giunti, Laura; Buccoliero, Anna Maria; Pollo, Bianca; Biassoni, Veronica; Genitori, Lorenzo; Antonelli, Manila

    2013-01-01

    Atypical teratoid rhabdoid tumor (ATRT) patients display a dismal median overall survival of less than 1 year. A consistent fraction of cases carries de-novo SMARCB1/INI1 constitutional mutations in the setting of the “rhabdoid tumor predisposition syndrome” and the outcome is worst in infant syndromic ATRT patients. We here describe a patient affected by mosaic Klinefelter syndrome and by rhabdoid tumor predisposition syndrome caused by constitutional SMARCB1/INI1 heterozygous mutation c.118C>T (Arg40X). Patient’s ATRT primary tumor occurred at 2 years of age concurrent with metastatic lesions. The patient was rendered without evidence of disease by combined surgery, high-dose poli-chemotherapy and craniospinal irradiation, followed by autologous hematopoietic stem cell transplantation. At the onset of a spinal lesion 5.5 years later, both tumors were pathologically and molecularly evaluated at the national central pathology review board and defined as ATRT in a syndromic patient, with strong evidence of a clonal origin of the two lesions. The patient was then treated according to SIOP guidelines and is now alive without evidence of disease 24 months after the detection of metastatic disease and 90 months after the original diagnosis. The report underscores the current utility of multiple comprehensive approaches for the correct diagnosis and clinical management of patients affected by rare and atypical brain neoplasms. Successful local control of disease and achievement of long-term survival is possible in ATRT patients even in the setting of rhabdoid tumor predisposition syndrome, infant age at diagnosis and metastatic spread of disease, thus justifying the efforts for the management of this severe condition

  14. Factors affecting the willingness to pay for implants: A study of patients in Riyadh, Saudi Arabia.

    Science.gov (United States)

    Al Garni, Bishi; Pani, Sharat Chandra; Almaaz, Adel; Al Qeshtaini, Ehsan; Abu-Haimed, Hamad; Al Sharif, Khalid

    2012-11-01

    One of the factors that dissuade patients needing tooth replacement from choosing dental implants is the prohibitive cost. Willingness to pay (WTP) is a useful tool to determine the ideal cost of an expensive procedure. The aim of this study was to study the factors that influence the willingness to pay (WTP) among patients attending a private clinic and compare them to those attending a government setup. A total of 100 patients (38 male, 62 female) who had one or more missing teeth were presented with different cost-benefit scenarios and then asked if they were willing to pay the median cost of a single implant in Riyadh city. The mean WTP price was compared using the one way-ANOVA, factors which could possibly influence patients' WTP were grouped together in a Binomial logistic regression model. Of the 100 individuals surveyed 67% said they would be willing to pay the median price for the placement of an implant. A comparison of socio-demographic factors showed that significant differences were found between gender, income groups and setting of the clinic in the mean WTP price of the patients (P difference in the mean WTP price between groups with regard to the area of the missing tooth, the patients' perception of their oral health and the their desire to want an implant (P pay the median price for an implant. Willingness to pay (WTP) is a multifactorial variable which is significantly influenced by the income of the patient, the setting of the clinic and the gender; the most significant factor being the acceptability of the implant to the patient.

  15. Factors affecting the use of patient survey data for quality improvement in the Veterans Health Administration

    Directory of Open Access Journals (Sweden)

    Davies Elizabeth A

    2011-12-01

    Full Text Available Abstract Background Little is known about how to use patient feedback to improve experiences of health care. The Veterans Health Administration (VA conducts regular patient surveys that have indicated improved care experiences over the past decade. The goal of this study was to assess factors that were barriers to, or promoters of, efforts to improve care experiences in VA facilities. Methods We conducted case studies at two VA facilities, one with stable high scores on inpatient reports of emotional support between 2002 and 2006, and one with stable low scores over the same period. A semi-structured interview was used to gather information from staff who worked with patient survey data at the study facilities. Data were analyzed using a previously developed qualitative framework describing organizational, professional and data-related barriers and promoters to data use. Results Respondents reported more promoters than barriers to using survey data, and particularly support for improvement efforts. Themes included developing patient-centered cultures, quality improvement structures such as regular data review, and training staff in patient-centered behaviors. The influence of incentives, the role of nursing leadership, and triangulating survey data with other data on patients' views also emerged as important. It was easier to collect data on current organization and practice than those in the past and this made it difficult to deduce which factors might influence differing facility performance. Conclusions Interviews with VA staff provided promising examples of how systematic processes for using survey data can be implemented as part of wider quality improvement efforts. However, prospective studies are needed to identify the most effective strategies for using patient feedback to improve specific aspects of patient-centered care.

  16. Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study.

    Science.gov (United States)

    Hogan, Alice; Bonney, Mary-Ann; Brien, Jo-Anne; Karamy, Rita; Aslani, Parisa

    2015-02-01

    Nebulised medicines contribute to the high treatment burden experienced by patients with cystic fibrosis (CF). This study explored experiences of adult patients with CF when using nebulised medicines, factors impacting on their adherence to nebulised therapy and strategies they used to facilitate adherence. Community setting, in Sydney, Australia. Ten patients with CF were recruited through a CF patient organisation. Semi-structured face-to-face interviews were conducted, addressing the study objectives. Interviews were audio-recorded, transcribed verbatim and content analysed for anticipated and emergent themes. Experiences with using nebulised medicines; and barriers and facilitators of adherence to nebulised medicines. Participants' age ranged from 22 to 45 years, with half being male. Four broad themes (with more specific sub-themes) were identified from the interviews: experiences with using nebulised medicines (cleaning nebuliser, time taken to use nebuliser medicine, flexibility in use of nebuliser); feelings about using nebulised medicines (necessary/important, dislike, part of life); factors impacting non-adherence (time consuming therapy, side effects/effects of medicine, work/social demands, lack of perceived importance); factors and strategies facilitating adherence (perceived medicine importance, habit/routine, support, health benefits, technology/medicine dose form, timetabling). Nebulised therapy for cystic fibrosis patients takes a substantial amount of time, with patients trying to alter their routine to incorporate nebulising into their daily lives. However there are still many factors that lead to low adherence, including work/social demands and travelling. Patients balance the necessity for nebulised therapy against the barriers, and engage in intentional non-adherence at times. Future strategies and resources should target and address specific factors identified by patients with CF as being important and impacting their adherence to nebulised

  17. Cognitive profile and disorders affecting higher brain functions in paediatric patients with neurofibromatosis type 1.

    Science.gov (United States)

    Vaucheret Paz, E; López Ballent, A; Puga, C; García Basalo, M J; Baliarda, F; Ekonen, C; Ilari, R; Agosta, G

    2017-04-18

    Neurofibromatosis type 1 (NF1) is a common neurocutaneous syndrome often associated with specific cognitive deficits that are rarely monitored during follow-up of these patients. The purpose of our study is two-fold. First, we aimed to describe the cognitive profile of patients with NF1 and detect disorders in higher brain functions associated with the disease. Second, we identified the reasons for consultation associated with school performance in these patients. We conducted a descriptive cross-sectional study of 24 paediatric patients (ages 5 to 16) with NF1 who underwent neuropsychological assessment. The most frequent reasons for consultation were attention deficits (58.33%), learning disorders (25%), poor motor coordination (25%), and language impairment (0.8%). Although 96% of the patients displayed impairments in at least one of the assessed areas, only 83.34% of the parents had reported such impairments. Attention-deficit/hyperactivity disorder was present in 58.33% of the patients, whereas 33.33% had nonverbal learning disabilities, 20.83% had expressive language disorder, 8.33% had borderline intellectual functioning, 4.16% had mental retardation, and only 4.16% showed no cognitive impairment. Higher brain functions are frequently impaired in paediatric patients with NF1. Although many parents report such disorders, they can go undetected in some cases. Neuropsychological assessment is recommended for all paediatric patients with NF1 to detect cognitive impairment and provide early, effective rehabilitation treatment. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Assisted care as a baseline patient risk characteristic affecting the outcome of transcatheter aortic valve insertion.

    Science.gov (United States)

    Traynor, Megan M; Greason, Kevin L; Nkomo, Vuyisile T; Pochettino, Alberto; Holmes, David R; Rihal, Charanjit S; Reeder, Guy S; Bresnahan, John F; Mathew, Verghese

    2017-06-01

    Objective measures of frailty have not been well defined as risk factors for a poor outcome after transcatheter aortic valve insertion. We hypothesized that assisted care as a baseline patient characteristic was a simple objective measure of frailty. We reviewed our experience to assess for an association between assisted care and outcome of operation. We retrospectively reviewed the records of 597 patients operated with transcatheter aortic valve insertion from November 2008 through July 2015. The study cohort included patients with a dichotomous baseline characteristic of receiving assisted care (AC group, n = 60, 10.1%) or not receiving assisted care (NC group, n = 537, 89.9%). The endpoints of the study were operative stroke/death and 1-year survival. The age of the patients was 80.6 ± 9.0 years, male sex was present in 349 (58.5%), and STS predicted risk of mortality was 9.2 ± 6.2%. Alternate access was used in 26 (43.3%) patients in the AC care group and in 220 (41.0%) in the NC group (P = 0.724). Operative stroke/death occurred in 4 (6.7%) patients in the AC group and in 25 (4.7%) in the NC group (P = 0.492). Mortality at 1 year in the AC group was 14.8 ± 5.2% and in the NC group was 12.9 ± 1.7%; (P = 0. 250). Assisted care as a baseline patient characteristic does not result in increased operative stroke/death or 1-year mortality in patients following transcatheter aortic valve insertion. Assisted care should not by itself preclude operation. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  19. Expression of cell cycle proteins according to HPV status in oral squamous cell carcinoma affecting young patients: a pilot study.

    Science.gov (United States)

    Miranda Galvis, Marisol; Freitas Jardim, Juscelino; Kaminagakura, Estela; Santos-Silva, Alan Roger; Paiva Fonseca, Felipe; Paes Almeida, Oslei; Ajudarte Lopes, Marcio; Lópes Pinto, Clóvis; Kowalski, Luiz Paulo

    2018-04-01

    Tobacco and alcohol consumption are considered the main risk factors for oral squamous cell carcinoma (OSCC); however, the role of these factors in patients younger than 40 years is controversial, so it has been suggested that genomic instability and high-risk human papillomavirus (HR-HPV) infection may be contributing factors to oral carcinogenesis at a young age. Therefore, the aim of this study was to evaluate the immunoexpression of cell cycle proteins according HPV status in OSCC affecting young patients. A tissue microarray construction based on 34 OSCC samples from young patients (factor receptor, p53, and p16 antibodies. The clinicopathologic features and the immunoexpression of all tested proteins were similar in both groups. Patients with HPV-related OSSC tended to have better cancer-specific survival (CSS; 39% vs 60% 5-y CSS), and overall survival (OS; 29.2% vs 60% 5-year OS). However, this difference was not statistically significant. No significant difference exists in the expression of cell cycle proteins studied between HR-HPV DNA-positive and HR-HPV DNA-negative OSCC affecting young patients. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke

    Directory of Open Access Journals (Sweden)

    Clarissa B. Oliveira

    2011-01-01

    Full Text Available OBJECTIVE: Impairments in balance can be a consequence of changes in the motor, sensory, and integrative aspects of motor control. Abnormal sensory reweighting, i.e., the ability to select the most appropriate sensory information to achieve postural stability, may contribute to balance impairment. The Sensory Organization Test is a component of Computerized Dynamic Posturography that evaluates the impact of visual, vestibular, and somatosensory inputs, as well as sensory reweighting, under conditions of sensory conflict. The aim of this study is to compare balance control in hemiparetic patients during the first year post-stroke and in age-matched neurologically normal subjects using the Berg Balance Scale and Computerized Dynamic Posturography. METHODS: We compared the Berg Balance Scale and Sensory Organization Test scores in 21 patients with hemiparesis after first-ever ischemic stroke and in 21 age-matched, neurologically normal subjects. An equilibrium score was defined for each Sensory Organization Test condition. RESULTS: Berg Balance Scale scores were significantly lower in the patients than in the neurologically normal subjects. Equilibrium scores were significantly lower in the patients than in the neurologically normal subjects for those Sensory Organization Test conditions that did not provide appropriate somatosensory information and under conditions of sensory conflict. A history of falls was more frequent in patients with lower equilibrium scores. CONCLUSION: During the first year after a stroke, defective sensory reweighting significantly impacts balance control in hemiparetic patients. These results are important for the planning of effective rehabilitation interventions.

  1. Transcranial magnetotherapy in the complex treatment of affective disorders in patients with alcoholism.

    Science.gov (United States)

    Staroverov, A T; Vil'yanov, V B; Raigorodskii, Yu M; Rogozina, M A

    2009-06-01

    Transcranial magnetotherapy (TMT) was used in 32 patients with alcoholism (study group) on the background of basal treatment (nootropes, hepatoprotectors, vitamin/mineral formulations, etc.). The influence of this treatment was compared with a control group (30 subjects), in which TMT was replaced with an appropriate (placebo) procedure. All patients, who were aged from 35 to 64 years, had second-degree alcoholism with disease durations of 4-12 years. Patients were in a post-abstinence state during the treatment period. Courses of TMT consisted of 10 daily procedures with exposures of 10-20 min. Somatic, neurological, and laboratory studies were performed before and after treatment and included cardiointervalography, electroencephalography, assessments of the state of the autonomic nervous system, and use of psychometric scales to evaluate levels of anxiety and depression. TMT was followed by improvements in wellbeing, mood, and sleep, with increases in physical exercise tolerance and decreases in alcohol craving in 75% of patients in the study group and 30% of patients in the control group. Improvements in patients' status were supported by paraclinical investigations (electrophysiological, measures of the state of the autonomic nervous system, etc.) and psychometric scales.

  2. Zinc Status Affects Glucose Homeostasis and Insulin Secretion in Patients with Thalassemia

    Directory of Open Access Journals (Sweden)

    Ellen B. Fung

    2015-06-01

    Full Text Available Up to 20% of adult patients with Thalassemia major (Thal live with diabetes, while 30% may be zinc deficient. The objective of this study was to explore the relationship between zinc status, impaired glucose tolerance and insulin sensitivity in Thal patients. Charts from thirty subjects (16 male, 27.8 ± 9.1 years with Thal were reviewed. Patients with low serum zinc had significantly lower fasting insulin, insulinogenic and oral disposition indexes (all p < 0.05 and elevated glucose response curve, following a standard 75 g oral load of glucose compared to those with normal serum zinc after controlling for baseline (group × time interaction p = 0.048. Longitudinal data in five patients with a decline in serum zinc over a two year follow up period (−19.0 ± 9.6 μg/dL, showed consistent increases in fasting glucose (3.6 ± 3.2 mg/dL and insulin to glucose ratios at 120 min post glucose dose (p = 0.05. Taken together, these data suggest that the frequently present zinc deficiency in Thal patients is associated with decreased insulin secretion and reduced glucose disposal. Future zinc trials will require modeling of oral glucose tolerance test data and not simply measurement of static indices in order to understand the complexities of pancreatic function in the Thal patient.

  3. Does burnout among doctors affect their involvement in patients' mental health problems? A study of videotaped consultations

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    de Bakker Dinny H

    2009-08-01

    Full Text Available Abstract Background General practitioners' (GPs' feelings of burnout or dissatisfaction may affect their patient care negatively, but it is unknown if these negative feelings also affect their mental health care. GPs' available time, together with specific communication tools, are important conditions for providing mental health care. We investigated if GPs who feel burnt out or dissatisfied with the time available for their patients, are less inclined to encourage their patients to disclose their distress, and have shorter consultations, in order to gain time and energy. This may result in less psychological evaluations of patients' complaints. Methods We used 1890 videotaped consultations from a nationally representative sample of 126 Dutch GPs to analyse GPs' communication and the duration of their consultations. Burnout was subdivided into emotional exhaustion, depersonalisation and reduced accomplishment. Multilevel regression analyses were used to investigate which subgroups of GPs differed significantly. Results GPs with feelings of exhaustion or dissatisfaction with the available time have longer consultations compared to GPs without these feelings. Exhausted GPs, and GPs with feelings of depersonalisation, talk more about psychological or social topics in their consultations. GPs with feelings of reduced accomplishment are an exception: they communicate less affectively, are less patient-centred and have less eye contact with their patients compared to GPs without reduced accomplishment. We found no relationship between GPs' feelings of burnout or dissatisfaction with the available time and their psychological evaluations of patients' problems. Conclusion GPs' feelings of burnout or dissatisfaction with the time available for their patients do not obstruct their diagnosis and awareness of patients' psychological problems. On the contrary, GPs with high levels of exhaustion or depersonalisation, and GPs who are dissatisfied with the

  4. Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA).

    Science.gov (United States)

    De Lucia, Orazio; Ravagnani, Viviana; Pregnolato, Francesca; Hila, Arvena; Pontikaki, Irene; Gattinara, Maurizio; Romano, Micol; Gerloni, Valeria; Pieropan, Sara; Murgo, Antonella; Rossini, Maurizio; Cimaz, Rolando; Meroni, Pier Luigi

    2018-02-06

    To define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares. 88 consecutive patients with JIA-46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months-underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years. US was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18). US abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Efficacy of spermatic vein ligation in patients affected by high grade left varicocele

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    Marco Grasso

    2014-01-01

    Full Text Available Purpose: To study the effect of high grade varicocele treatment in infertile patients. Materials and Methods: Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the subject’s partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period. Results: Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple. The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012. Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10 6 /mL compared to 19.7x10 6 /mL in the postoperative period (p < 0.0001. Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001. Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001. Conclusion: Surgical treatment of high grade varicocele proved to effectively treat associated infertility by improving seminal parameters and pregnancy rate in our patient cohort.

  6. Detection of Total Knee Arthroplasties at Airport Security Checkpoints: How Do Updated Security Measures Affect Patients?

    Science.gov (United States)

    Issa, Kimona; Pierce, Todd P; Gwam, Chukwuweieke; Goljan, Peter; Festa, Anthony; Scillia, Anthony J; Mont, Michael A

    2017-07-01

    Airport security measures continue to be updated with the incorporation of the new body scanners and automatic target recognition software. The purpose of this study was analyze the incidence of: (1) triggering the security alarm; (2) extra security searches; (3) perceived inconvenience; and (4) presence of other surgical hardware in those who underwent total knee arthroplasty (TKA) and passed through airport security. A questionnaire was given to 125 consecutive patients with a TKA. Those who passed through airport security after January 2014 were considered for inclusion. A questionnaire was administered that addressed the number of encounters with airport security, metal detector activation, additional screening procedures, and perceived inconvenience. Out of the 125 patients, 53 met inclusion criteria. Out of the 53 patients, 20 (38%) reported that their prosthesis triggered a metal detector. Out of the 20 patients, 8 (40%) who reported triggering of metal detectors also reported the presence of surgical hardware elsewhere in the body. Eighteen of the 53 patients (34%) believed having a TKA was inconvenient for airplane travel. Compared with the historical cohort, alarms were triggered in 70 of 97 patients ( p  = 0.0001) and 50 of 97 reported inconvenience when traveling ( n  = 50 of 97 patients; p  = 0.04). The incidences of those who underwent TKA triggering alarms and perceiving inconvenience when passing through airport security have decreased from previously published studies. This is most likely due to the recent updates and modifications to screening. As these security measures are modified and implant designs continue to evolve, this is an area of investigation that should continue. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  7. Clonorchis sinensis Co-infection Could Affect the Disease State and Treatment Response of HBV Patients.

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    Wenfang Li

    2016-06-01

    Full Text Available Clonorchis sinensis (C. sinensis is considered to be an important parasitic zoonosis because it infects approximately 35 million people, while approximately 15 million were distributed in China. Hepatitis B virus (HBV infection is a major public health issue. Two types of pathogens have the potential to cause human liver disease and eventually hepatocellular carcinoma. Concurrent infection with HBV and C. sinensis is often observed in some areas where C. sinensis is endemic. However, whether C. sinensis could impact HBV infection or vice versa remains unknown.Co-infection with C. sinensis and HBV develops predominantly in males. Co-infected C. sinensis and HBV patients presented weaker liver function and higher HBV DNA titers. Combination treatment with antiviral and anti-C. sinensis drugs in co-infected patients could contribute to a reduction in viral load and help with liver function recovery. Excretory-secretory products (ESPs may, in some ways, increase HBV viral replication in vitro. A mixture of ESP and HBV positive sera could induce peripheral blood mononuclear cells (PBMCs to produce higher level of Th2 cytokines including IL-4, IL-6 and IL-10 compared to HBV alone, it seems that due to presence of ESP, the cytokine production shift towards Th2. C. sinensis/HBV co-infected patients showed higher serum IL-6 and IL-10 levels and lower serum IFN-γ levels.Patients with concomitant C. sinensis and HBV infection presented weaker liver function and higher HBV DNA copies. In co-infected patients, the efficacy of anti-viral treatment was better in patients who were prescribed with entecavir and praziquantel than entecavir alone. One possible reason for the weaker response to antiviral therapies in co-infected patients was the shift in cytokine production from Th1 to Th2 that may inhibit viral clearance. C. sinensis/HBV co-infection could exacerbate the imbalance of Th1/Th2 cytokine.

  8. Clonorchis sinensis Co-infection Could Affect the Disease State and Treatment Response of HBV Patients.

    Science.gov (United States)

    Li, Wenfang; Dong, Huimin; Huang, Yan; Chen, Tingjin; Kong, Xiangzhan; Sun, Hengchang; Yu, Xinbing; Xu, Jin

    2016-06-01

    Clonorchis sinensis (C. sinensis) is considered to be an important parasitic zoonosis because it infects approximately 35 million people, while approximately 15 million were distributed in China. Hepatitis B virus (HBV) infection is a major public health issue. Two types of pathogens have the potential to cause human liver disease and eventually hepatocellular carcinoma. Concurrent infection with HBV and C. sinensis is often observed in some areas where C. sinensis is endemic. However, whether C. sinensis could impact HBV infection or vice versa remains unknown. Co-infection with C. sinensis and HBV develops predominantly in males. Co-infected C. sinensis and HBV patients presented weaker liver function and higher HBV DNA titers. Combination treatment with antiviral and anti-C. sinensis drugs in co-infected patients could contribute to a reduction in viral load and help with liver function recovery. Excretory-secretory products (ESPs) may, in some ways, increase HBV viral replication in vitro. A mixture of ESP and HBV positive sera could induce peripheral blood mononuclear cells (PBMCs) to produce higher level of Th2 cytokines including IL-4, IL-6 and IL-10 compared to HBV alone, it seems that due to presence of ESP, the cytokine production shift towards Th2. C. sinensis/HBV co-infected patients showed higher serum IL-6 and IL-10 levels and lower serum IFN-γ levels. Patients with concomitant C. sinensis and HBV infection presented weaker liver function and higher HBV DNA copies. In co-infected patients, the efficacy of anti-viral treatment was better in patients who were prescribed with entecavir and praziquantel than entecavir alone. One possible reason for the weaker response to antiviral therapies in co-infected patients was the shift in cytokine production from Th1 to Th2 that may inhibit viral clearance. C. sinensis/HBV co-infection could exacerbate the imbalance of Th1/Th2 cytokine.

  9. Magnesium sulfate therapy affects attention and working memory in patients undergoing preterm labor.

    Science.gov (United States)

    Ghia, N; Spong, C Y; Starbuck, V N; Scialli, A R; Ghidini, A

    2000-10-01

    Patients commonly consent to undergoing invasive procedures while receiving magnesium sulfate therapy. This study evaluated the effects of magnesium sulfate on attention, comprehension, and memory in patients undergoing preterm labor. Consenting patients were studied while receiving(study) and not receiving (control) intravenous magnesium sulfate tocolysis for preterm labor. Excluded were patients with possible preeclampsia, imminent delivery, sedative administration, or prior mental illness. Patient comprehension was assessed with the Boston Diagnostic Aphasia Examination. Level of attention and working memory were evaluated with the Paced Auditory Serial Addition Test. Verbal learning, short-term memory, and recognition were determined with the Hopkins Verbal Learning Test. Gross mental-neurologic deficits were evaluated with the Mini-Mental Status Examination. The tests were administered by the same examiner. Control testing was performed >24 hours after intravenous magnesium sulfate was discontinued. Magnesium levels were obtained at the time of testing. The primary outcome measure was the Paced Auditory Serial Addition Test score because of its ability to elicit subtle differences in attention capacity. Statistical analysis included the paired t test and the McNemar test. Fifteen patients completed the study. Paced Auditory Serial Addition Test scores were significantly higher (ie, more errors were made) during magnesium sulfate therapy than periods without therapy (14 +/- 8 vs 7 +/- 7; P term memory (Hopkins Verbal Learning Test) or gross mental-neurologic deficits between the 2 groups (all P >.1). Magnesium sulfate therapy appears to have an effect on attention and working memory but not on long-term memory or comprehension. The significant differences in Paced Auditory Serial Addition Test scores reveal deficits in information-processing ability in patients on a regimen of magnesium sulfate therapy.

  10. Factors affecting the purpose suppressive antiviral therapy for patients with recurrent genital herpes

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    I. S. Коlova

    2017-01-01

    Full Text Available Objective: To study the factors that influence the destination of suppressive antiviral therapy in patients with recurrent genital herpes doctors of different specialties.Material and Methods: The study was conducted based on an anonymous survey of professionals providing medical care to patients with genital herpes. The survey involved 67 experts – 44 dermatologist, 13 obstetricians and 10 urologists working in Skin and Venereal Diseases, Women’s consuitation post and Saint Petersburg clinics.Results: Most respondents indicated that among patients with genital herpes, seeking an appointment, dominated by patients with relapsing nature of the disease. Suppressive antiviral therapy is recommended 68,7% of specialists, including dermatologists 61,3%, 84,6% of obstetricians and gynecologists, and 80% of urologists. The main indications for its experts consider high frequency of relapses, the patient’s tendency to promiscuity, the desire of the patient with fewer relapses, and the emotional response of the patient for the presence of the disease. Do not prescribe suppressive therapy for recurrent genital herpes 31,4% of the doctors surveyed. Among the reasons for which are not appointed by the type of treatment, the patient is dominated by the rejection of this type of treatment, the lack of experience of the destination suppressive therapy, as well as the uncertainty of specialists in its effectiveness.Conclusion: Suppressive antiviral therapy is recommended 68,7% of specialists. Do not prescribe this type of treatment for recurrent genital herpes 31,4% of the doctors surveyed. The proportion of professionals who refuse the appointment of suppressive antiviral therapy, the highest among dermatologists (38,7% compared with 15,4% among obstetricians and 20% of urologists. The most frequent grounds for refusal from this type of treatment is the lack of confidence in its effectiveness. 

  11. Pseudoxanthoma Elasticum - Also a Lung Disease? The Respiratory Affection of Patients with Pseudoxanthoma Elasticum.

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    Simon Pingel

    Full Text Available Pseudoxanthoma elasticum (PXE is an autosomal-recessive mineralisation disorder caused by loss of function mutations in the ABCC6 Gen. Histological findings and data of an autopsy of a PXE-patient suggest a possible pulmonal calcification. So far, there exists no clinical data whether PXE patients actually are at high risk of developing pulmonary disorder.In a cross-sectional study, 35 PXE patients and 15 healthy controls underwent a pulmonary function testing, including spirometry, body plethysmography and carbon monoxide diffusing test. Additionally, PXE patients completed a COPD-Assessment-Test (CAT.We observed in PXE patients normal values for predicted vital capacity (VC%; 96.0±13.0%, predicted total lung capacity (TLC%; 98.2±12.0% and predicted forced expiration volume (FEV1%; 102.5±15.6%, whereas compared to healthy controls the PXE group showed significant diminished values for carbon monoxide diffusing capacity (DLCO, 7.2 ±1.4mmol/min/kPa vs. 8.6 ±1.5 mmol/min/kPa; p = 0.008 and predicted carbon monoxide diffusing capacity (DLCO%; 79.7±11.5% vs. 87.2±6.6%; p = 0.008. 11/35 (31.4% PXE patients showed pathological DLCO% values under 75% (68.5%±5.4%.PXE patients demonstrated a regular lung function testing, but nevertheless they had impaired CO diffusing parameters, which might be associated with a preclinical state of an interstitial lung disease and a risk for restrictive ventilation disorders.

  12. Oxytocin prolongs the gastric emptying time in patients with diabetes mellitus and gastroparesis, but does not affect satiety or volume intake in patients with functional dyspepsia

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    Borg Julia

    2012-03-01

    Full Text Available Abstract Background Oxytocin is released in response to a fatty meal. Blockage of the oxytocin receptor led to slower gastric emptying whereas stimulation resulted in less satiety in healthy volunteers. Patients with diabetes mellitus and gastroparesis lack oxytocin elevation, and dyspepsia is partly caused by reduced fundus accommodation causing early satiety and related symptoms. The aim of this study was thus to examine the effect of oxytocin on gastric emptying, satiety and volume intake in patients with gastrointestinal pathology. Results Gastric emptying scintigraphy was performed twice in 12 patients with diabetic gastroparesis, once with oxytocin and once with saline as intravenous infusions. The patients scored their sensation of satiety using a visual analogue scale (VAS. The gastric emptying in patients with gastroparesis was prolonged during oxytocin infusion (p = 0.034 without affecting satiety. A slow satiety drinking test was performed in 14 patients with functional dyspepsia. The patients scored their satiety every five minutes until maximal satiety was reached, and the total volume was determined. The VAS was also completed 30 minutes afterwards. The test was performed twice, once with oxytocin and once with saline as intravenous infusions. There was no difference in satiety scores or volume of nutrient intake between saline and oxytocin infusions, either before, during or after the meal. Conclusions Oxytocin prolongs gastric emptying in patients with diabetes mellitus and gastroparesis, but has no effect on volume of nutrient intake or satiety and other related symptoms in patients with functional dyspepsia.

  13. Surgical Orthodontic Treatment of a Patient Affected by Type 1 Myotonic Dystrophy (Steinert Syndrome)

    OpenAIRE

    Cacucci, Laura; Ricci, Beatrice; Moretti, Maria; Gasparini, Giulio; Pelo, Sandro; Grippaudo, Cristina

    2017-01-01

    Myotonic dystrophy, or Steinert’s disease, is the most common form of muscular dystrophy that occurs in adults. This multisystemic form involves the skeletal muscles but affects also the eye, the endocrine system, the central nervous system, and the cardiac system. The weakness of the facial muscles causes a characteristic facial appearance frequently associated with malocclusions. Young people with myotonic dystrophy, who also have severe malocclusions, have bad oral functions such as chewin...

  14. Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears.

    Science.gov (United States)

    Potter, Michael Q; Wylie, James D; Greis, Patrick E; Burks, Robert T; Tashjian, Robert Z

    2014-12-01

    In many areas of orthopaedics, patients with greater levels of psychological distress report inferior self-assessments of pain and function. This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychological component. This study attempts to answer the following questions: (1) Are higher levels of psychological distress associated with clinically important differences in baseline scores on the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair? (2) Does psychological distress remain a negative predictor of baseline shoulder scores when other clinical variables are controlled? Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire. Patients completed baseline self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Age, sex, BMI, smoking status, American Society of Anesthesiologists classification, tear size, and tear retraction were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function. Distressed patients reported higher baseline VAS scores (6.7 [95% CI, 4.4-9.0] versus 2.9 [95% CI, 2.3-3.6], p = 0.001) and lower baseline Simple Shoulder Test (3.7 [95% CI, 2.9-4.5] versus 5.7 [95% CI 5.0-6.4], p = 0.001) and American Shoulder and Elbow Surgeons scores (39 [95% CI, 34-45] versus 58 [95% CI, 53-63], p psychological distress are associated with inferior baseline patient self-assessment of shoulder pain and function using the VAS, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Longitudinal followup is

  15. Use of multiple methods to determine factors affecting quality of care of patients with diabetes.

    Science.gov (United States)

    Khunti, K

    1999-10-01

    The process of care of patients with diabetes is complex; however, GPs are playing a greater role in its management. Despite the research evidence, the quality of care of patients with diabetes is variable. In order to improve care, information is required on the obstacles faced by practices in improving care. Qualitative and quantitative methods can be used for formation of hypotheses and the development of survey procedures. However, to date few examples exist in general practice research on the use of multiple methods using both quantitative and qualitative techniques for hypothesis generation. We aimed to determine information on all factors that may be associated with delivery of care to patients with diabetes. Factors for consideration on delivery of diabetes care were generated by multiple qualitative methods including brainstorming with health professionals and patients, a focus group and interviews with key informants which included GPs and practice nurses. Audit data showing variations in care of patients with diabetes were used to stimulate the brainstorming session. A systematic literature search focusing on quality of care of patients with diabetes in primary care was also conducted. Fifty-four potential factors were identified by multiple methods. Twenty (37.0%) were practice-related factors, 14 (25.9%) were patient-related factors and 20 (37.0%) were organizational factors. A combination of brainstorming and the literature review identified 51 (94.4%) factors. Patients did not identify factors in addition to those identified by other methods. The complexity of delivery of care to patients with diabetes is reflected in the large number of potential factors identified in this study. This study shows the feasibility of using multiple methods for hypothesis generation. Each evaluation method provided unique data which could not otherwise be easily obtained. This study highlights a way of combining various traditional methods in an attempt to overcome the

  16. Colonic epithelial ion transport is not affected in patients with diverticulosis

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    Tilotta Maria C

    2007-09-01

    Full Text Available Abstract Background Colonic diverticular disease is a bothersome condition with an unresolved pathogenesis. It is unknown whether a neuroepithelial dysfunction is present. The aim of the study was two-fold; (1 to investigate colonic epithelial ion transport in patients with diverticulosis and (2 to adapt a miniaturized Modified Ussing Air-Suction (MUAS chamber for colonic endoscopic biopsies. Methods Biopsies were obtained from the sigmoid part of the colon. 86 patients were included. All patients were referred for colonoscopy on suspicion of neoplasia and they were without pathological findings at colonoscopy (controls except for diverticulosis in 22 (D-patients. Biopsies were mounted in MUAS chambers with an exposed area of 5 mm2. Electrical responses to various stimulators and inhibitors of ion transport were investigated together with histological examination. The MUAS chamber was easy to use and reproducible data were obtained. Results Median basal short circuit current (SCC was 43.8 μA·cm-2 (0.8 – 199 for controls and 59.3 μA·cm-2 (3.0 – 177.2 for D-patients. Slope conductance was 77.0 mS·cm-2 (18.6 – 204.0 equal to 13 Ω·cm2 for controls and 96.6 mS·cm-2 (8.4 – 191.4 equal to 10.3 Ω·cm2 for D-patients. Stimulation with serotonin, theophylline, forskolin and carbachol induced increases in SCC in a range of 4.9 – 18.6 μA·cm-2, while inhibition with indomethacin, bumetanide, ouabain and amiloride decreased SCC in a range of 6.5 – 27.4 μA·cm-2, and all with no significant differences between controls and D-patients. Histological examinations showed intact epithelium and lamina propria before and after mounting for both types of patients. Conclusion We conclude that epithelial ion transport is not significantly altered in patients with diverticulosis and that the MUAS chamber can be adapted for studies of human colonic endoscopic biopsies.

  17. A study of complications affecting surgery performance: an ISM-based roadmap to patient flow.

    Science.gov (United States)

    Dev, Navin K; Shankar, Ravi; Arvind, Kamal

    2013-01-01

    The aim of this study is to highlight the value of the success rate performance of a surgery while planning patient flow within a supply chain of a health care organization/hospital. The paper has considered one of the common surgeries, cataract, and the complications that subsequently result from this surgery. The study employs interpretive structural modeling (ISM) approach to draw a roadmap to study various complications causing cataract that subsequently help in planning and coordination of patient flow. The study finds that there is a hierarchy of causes and certain complications, the persistence of which gives a higher success rate performance in cataract surgery as compared to others. The paper provides leverage to the decision maker while organizing the patient flow depending upon the information of hierarchy of complication of a disease, and accordingly ensures the availability of resources to the patient. The study is of value in identifying the degree of complications from cataract surgery. Given the degree of complication, the patient logistics can be planned myopically in a health care organization which largely depends upon the degree of success rate. The paper attempts to suggest that the hierarchy obtained through ISM can be implemented in the modules of an enterprise resource planning (ERP) set up.

  18. [Transcranial magnetic therapy in the complex treatment of affective disorders in patients with alcoholism].

    Science.gov (United States)

    Staroverov, A T; Vil'ianov, V B; Raĭgorodskiĭ, Iu M; Rogozina, M A

    2008-01-01

    A main group--32 patients receiving transcranial magnetic therapy (TMT) in addition to the basic treatment (nootrops, hepatoprotectors, vitamins/minerals etc)--was compared to a control group (30 patients) receiving placebo instead of TMT. All patients, aged from 35 to 64 years, had the second stage of alcoholism with illness duration from 4 to 12 years and were in the postabstinent state at the moment of treatment. The TMT course included 10 daily sessions with a 10-20 min exposure. A somatic, neurological and instrumental study, including cardiointervalography, electroencephalography, assessment of autonomic system state and psychometric scales for depression and anxiety, was conducted before, during and after the therapy. The improvement of health, mood and sleep, increase of tolerability to physical loading and reduction of alcohol craving were observed after TMT in 75% of patients in the main group and in 30% in the control one. The improvement of patient's state was correlated with the data of the paraclinical study (electrophysiological parameters of the autonomic nervous system and psychometric scales scores).

  19. Does the patient's inherent rating tendency influence reported satisfaction scores and affect division ranking?

    Science.gov (United States)

    Francis, Patricia; Agoritsas, Thomas; Chopard, Pierre; Perneger, Thomas

    2016-04-01

    To determine the impact of adjusting for rating tendency (RT) on patient satisfaction scores in a large teaching hospital and to assess the impact of adjustment on the ranking of divisions. Cross-sectional survey. Large 2200-bed university teaching hospital. All adult patients hospitalized during a 1-month period in one of 20 medical divisions. None. Patient experience of care measured by the Picker Patient Experience questionnaire and RT scores. Problem scores were weakly but significantly associated with RT. Division ranking was slightly modified in RT adjusted models. Division ranking changed substantially in case-mix adjusted models. Adjusting patient self-reported problem scores for RT did impact ranking of divisions, although marginally. Further studies are needed to determine the impact of RT when comparing different institutions, particularly across inter-cultural settings, where the difference in RT may be more substantial. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  20. Electroconvulsive therapy and risk of dementia in patients with affective disorders

    DEFF Research Database (Denmark)

    Osler, Merete; Rozing, Maarten Pieter; Christensen, Gunhild Tidemann

    2018-01-01

    included in the study, 5901 (3·5%) patients had at least one ECT. During the median follow-up of 4·9 years (IQR 2·4-7·8) and 872 874 person years, the number of patients who developed dementia was 111 (0·1%) of 99 045 patients aged 10-49 years, 965 (2·7%) of 35 945 aged 50-69 years, and 4128 (12·5%) of 33...... 025 aged 70-108 years. 217 (3·6%) of the 5901 patients treated with ECT developed dementia, whereas of 162 114 patients not treated with ECT 4987 (3·1%) developed dementia. The corresponding incidences were 70·4 cases per 10 000 person-years (95% CI 61·6-80·5) and 59·2 per 10 000 person-years (57......BACKGROUND: Electroconvulsive therapy (ECT) is the most effective treatment for severe episodes of mood disorders. Temporary memory loss is a common side-effect, but ongoing discussions exist regarding potential long-term adverse cognitive outcomes. Only a few studies have examined the frequency...

  1. Does bladder outlet obstruction affect distance between the ureteric orifices in patients with benign prostate hyperplasia?

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    Cüneyt Özden

    2009-01-01

    Full Text Available Objectives: Many morphological changes occur in the bladder due to bladder outlet obstruction (BOO in pa-tients with benign prostate hyperplasia (BPH. In the present study we evaluated the relationship between in-terureteric distance (IUD of the orifices and BOO in BPH patients.Materials and methods: Thirty-seven consecutive pa-tients with lower urinary tract symptoms at the urology polyclinic included in the study. Patients divided into 2 groups according to maximal flow rate (Qmax. The first group constituted of 18 patients with Qmax 15ml/s. The IUD measurement was performed with Doppler ultrasonography.Results: There was no significant difference between the groups regarding mean age and prostate volume. Mean IUD in the first group was 32.7±5.4 mm and mean IUD in the second group was 31.5±5.1 mm. There was no statistically significant difference between the groups regarding the IUD.Conclusions: Data obtained from the study revealed that measurement of IUD with Doppler ultrasonography not significantly related to BOO.

  2. Motivation as a factor affecting the efficiency of cognitive processes in elderly patients with hypertension

    Directory of Open Access Journals (Sweden)

    Zinchenko, Yury P.

    2013-12-01

    Full Text Available The main purpose of the present study was to assess the role of motivation in the effective cognitive activity of elderly hypertension (HTN patients provided with antihypertensive treatment; 25 patients with HTN took part in the study, stage 1-2; their mean age was 67.6±6.1. The psychological examination program embraced a quantitative measurement of intelligence quotient (IQ with the Wechsler Adult Intelligence Scale, and an investigation into the qualitative features of their cognitive processes, applying a pathopsychological study procedure (Zeigarnik, 1962, 1972 and the principles of psychological syndrome analysis (Vygotsky-Luria-Zeigarnik school. The results showed that within the psychological syndrome structure of cognitive disorders in HTN patients, the leading part is played by two syndrome-generating factors: a neurodynamic factor and a motivational factor. The patients with reduced motivation would achieve poor general test results, if compared with the group of highly motivated participants. A correlation analysis of the data revealed the interconnection between frequency disturbances in motivation and the frequency in occurrence of various signs of cognitive decline, such as low efficiency in memorization and delayed recall, as well as lower IQ test results. The data provide a strong argument to support the hypothesis that motivation is of particular importance as a factor in the generation of cognitive disorders in HTN patients.

  3. Bronchoalveolar lavage in patients with interstitial lung diseases: side effects and factors affecting fluid recovery.

    Science.gov (United States)

    Dhillon, D P; Haslam, P L; Townsend, P J; Primett, Z; Collins, J V; Turner-Warwick, M

    1986-05-01

    One hundred and seventy patients with interstitial lung diseases undergoing bronchoalveolar lavage (BAL), were contrasted with 51 patients undergoing fibreoptic bronchoscopy alone to define the factors which predispose to post-lavage side-effects. Transient post-bronchoscopy fall in the peak expired flow (PEF) greater than or equal to 20% occurred in both groups (24% and 23% respectively), and thus was probably related to the bronchoscopy procedure. Post-lavage pyrexia (greater than or equal to 1 degree C) occurred only in the patients undergoing BAL (26%), p less than 0.001. Only 4% with pyrexia required antibiotics, and only 2% with falls in PEF needed bronchodilator therapy. The only significant clinical association was more frequent pyrexia in patients on treatment with prednisolone, particularly in women (p less than 0.01). Pyrexia was also associated with higher lavage fluid introduction volumes (greater than 240 ml). Side effects did not relate to the percentages of lavage fluid recovered, although smokers had lower recoveries and, recoveries tended to be higher in sarcoidosis than cryptogenic fibrosing alveolitis. Serial lavages in 25 patients caused no significant increase in side effects.

  4. Does joint alignment affect the T2 values of cartilage in patients with knee osteoarthritis?

    International Nuclear Information System (INIS)

    Friedrich, Klaus M.; Shepard, Timothy; Chang, Gregory; Wang, Ligong; Babb, James S.; Regatte, Ravinder; Schweitzer, Mark

    2010-01-01

    To assess the relationship between T2 values of femorotibial cartilage and knee alignment in patients with clinical symptoms of medial osteoarthritis (OA). Twenty-four patients (mean age ± standard deviation, 62.5 ± 9.9 years) with clinical symptoms of medial knee OA, 12 with varus and 12 with valgus alignment of the femorotibial joint, were investigated on 3T MR using a 2D multi-echo spin echo (MESE) sequence for T2 mapping. Analysis of covariance, Spearman correlation coefficients, exact Mann-Whitney tests, and Fisher's exact tests were used for statistical analysis. Overall the T2 values of cartilage in the medial compartment (median ± interquartile-range, 49.44 ± 6.58) were significantly higher (P = 0.0043) than those in the lateral compartment (47.15 ± 6.87). Patients with varus alignment (50.83 ± 6.30 ms) had significantly higher T2 values of cartilage (P < 0.0001) than patients with valgus alignment (46.20 ± 6.00 ms). No statistically significant association between the T2 values of cartilage (in either location) and the Kellgren Lawrence score was found in the varus or in the valgus group. T2 measurements were increased in medial knee OA patients with varus alignment, adding support to the theory of an association of OA and joint alignment. (orig.)

  5. Does joint alignment affect the T2 values of cartilage in patients with knee osteoarthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Friedrich, Klaus M. [Medical University of Vienna, Department of Radiology, Vienna (Austria); Shepard, Timothy; Chang, Gregory; Wang, Ligong; Babb, James S.; Regatte, Ravinder [New York University Langone Medical Center, Department of Radiology, New York, NY (United States); Schweitzer, Mark [Ottawa Hospital, Diagnostic Imaging, Ottawa, ON (Canada)

    2010-06-15

    To assess the relationship between T2 values of femorotibial cartilage and knee alignment in patients with clinical symptoms of medial osteoarthritis (OA). Twenty-four patients (mean age {+-} standard deviation, 62.5 {+-} 9.9 years) with clinical symptoms of medial knee OA, 12 with varus and 12 with valgus alignment of the femorotibial joint, were investigated on 3T MR using a 2D multi-echo spin echo (MESE) sequence for T2 mapping. Analysis of covariance, Spearman correlation coefficients, exact Mann-Whitney tests, and Fisher's exact tests were used for statistical analysis. Overall the T2 values of cartilage in the medial compartment (median {+-} interquartile-range, 49.44 {+-} 6.58) were significantly higher (P = 0.0043) than those in the lateral compartment (47.15 {+-} 6.87). Patients with varus alignment (50.83 {+-} 6.30 ms) had significantly higher T2 values of cartilage (P < 0.0001) than patients with valgus alignment (46.20 {+-} 6.00 ms). No statistically significant association between the T2 values of cartilage (in either location) and the Kellgren Lawrence score was found in the varus or in the valgus group. T2 measurements were increased in medial knee OA patients with varus alignment, adding support to the theory of an association of OA and joint alignment. (orig.)

  6. The DSM-5 effect: psychological characteristics of new patients affected by Binge Eating Disorder following the criteria of the DSM-5 in a sample of severe obese patients.

    Science.gov (United States)

    Vinai, Piergiuseppe; Da Ros, Annalisa; Cardetti, Silvia; Casey, Halpern; Studt, Stacia; Gentile, Nicola; Tagliabue, Anna; Vinai, Luisa; Vinai, Paolo; Bruno, Cecilia; Mansueto, Giovanni; Palmieri, Sara; Speciale, Maurizio

    2016-03-01

    The current study evaluated whether or not there were significant differences in psychopathological traits between three groups of individuals. The first was a group of patients seeking bariatric surgery diagnosed as being affected by Binge Eating Disorder (BED), according to the new criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This group (NEW BED group) did not meet BED diagnosis following the previous criteria listed in the DSM-IV-TR. The second group of individuals was composed of severely obese patients seeking bariatric surgery not affected by an eating disorder, according to the diagnostic criteria of the DSM-5 (OB group). The third group was composed of individuals within a healthy weight range (Control group). 94 severely obese patients (33 in the NEW BED group and 61 in the OB group) were compared to the Control group including 41 participants on depression, anxiety and eating habits. The NEW BED scored significantly higher than the OB group on the Beck Depression Inventory, both the subscales of the State Trait Anxiety Inventory, on disinhibition and hunger subscales of the Three-Factor Eating Questionnaire and on many subscales of the Eating Disorders Inventory. The new, less restrictive diagnostic criteria for BED of the DSM-5 are useful in identifying obese patients affected by severe psychopathology and dysfunctional eating habits.

  7. Quantification of chemical elements in blood of patients affected by multiple sclerosis.

    Science.gov (United States)

    Forte, Giovanni; Visconti, Andrea; Santucci, Simone; Ghazaryan, Anna; Figà-Talamanca, Lorenzo; Cannoni, Stefania; Bocca, Beatrice; Pino, Anna; Violante, Nicola; Alimonti, Alessandro; Salvetti, Marco; Ristori, Giovanni

    2005-01-01

    Although some studies suggested a link between exposure to trace elements and development of multiple sclerosis (MS), clear information on their role in the aetiology of MS is still lacking. In this study the concentrations of Al, Ba, Be, Bi, Ca, Cd, Co, Cr, Cu, Fe, Hg, Li, Mg, Mn, Mo, Ni, Pb, Sb, Si, Sn, Sr, Tl, V, W, Zn and Zr were determined in the blood of 60 patients with MS and 60 controls. Quantifications were performed by inductively coupled plasma (ICP) atomic emission spectrometry and sector field ICP mass spectrometry. When the two groups were compared, an increased level of Co, Cu and Ni and a decrement of Be, Fe, Hg, Mg, Mo, Pb and Zn in blood of patients were observed. In addition, the discriminant analysis pointed out that Cu, Be, Hg, Co and Mo were able to discriminate between MS patients and controls (92.5% of cases correctly classified).

  8. miRNAs in the vitreous humor of patients affected by idiopathic epiretinal membrane and macular hole.

    Directory of Open Access Journals (Sweden)

    Andrea Russo

    Full Text Available The aim of the present study was to assess the expression of miRNAs in the Vitreous Humor (VH of patients with Macular Hole (MH and Epiretinal Membrane (ERM compared to a control group.In this prospective, comparative study, 2-ml of VH was extracted from the core of the vitreous chamber in consecutive patients who underwent standard vitrectomy for ERM and MH. RNA was extracted and TaqMan® Low Density Arrays (TLDAs were used to profile the transcriptome of 754 miRNAs. Results were validated by single TaqMan® assays. Finally, we created a biological network of differentially expressed miRNA targets and their nearest neighbors.Overall 10 eyes with MH, 16 eyes with idiopathic ERM and 6 controls were enrolled in the study. Profiling data identified 5 miRNAs differentially expressed in patients affected by MH and ERM with respect to controls. Four were downregulated (miR-19b, miR-24, miR-155, miR-451 and 1 was downregulated (miR-29a; TaqMan® assays of the VH of patients affected by MH and ERM, with respect to controls, showed that the most differentially expressed were miR-19b (FC -9.13, p:<0.00004, mir-24 (FC -7.52, p:<0.004 and miR-142-3p (FC -5.32, p:<0.011. Our network data showed that deregulation of differentially expressed miRNAs induces an alteration of several pathways associated with genes involved in both MH and ERM.The present study suggests that disregulation of miR-19b, miR-24 and miR-142-3p, might be related to the alterations that characterize patients affected by MH and ERM.

  9. Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study.

    Science.gov (United States)

    Girard, Ariane; Hudon, Catherine; Poitras, Marie-Eve; Roberge, Pasquale; Chouinard, Maud-Christine

    2017-05-01

    To describe nursing activities in primary care with patients affected by physical chronic disease and common mental disorders. Patients in primary care who are affected by physical chronic disease and common mental disorders such as anxiety and depression require care and follow-up based on their physical and mental health condition. Primary care nurses are increasingly expected to contribute to the care and follow-up of this growing clientele. However, little is known about the actual activities carried out by primary care nurses in providing this service in the Province of Quebec (Canada). A qualitative descriptive study was conducted. Data were obtained through semistructured individual interviews with 13 nurses practising among patients with physical chronic disease in seven Family Medicine Groups in Quebec (Canada). Participants described five activity domains: assessment of physical and mental health condition, care planning, interprofessional collaboration, therapeutic relationship and health promotion. The full potential of primary care nurses is not always exploited, and some activities could be improved. Evidence for including nurses in collaborative care for patients affected by physical chronic disease and common mental disorders has been shown but is not fully implemented in Family Medicine Groups. Future research should emphasise collaboration among mental health professionals, primary care nurses and family physicians in the care of patients with physical chronic disease and common mental disorders. Primary care nurses would benefit from gaining more knowledge about common mental disorders and from identifying the resources they need to contribute to managing them in an interdisciplinary team. © 2016 John Wiley & Sons Ltd.

  10. Radiation dose exposure in patients affected by lymphoma undergoing repeat CT examinations: how to manage the radiation dose variability.

    Science.gov (United States)

    Paolicchi, Fabio; Bastiani, Luca; Guido, Davide; Dore, Antonio; Aringhieri, Giacomo; Caramella, Davide

    2018-03-01

    To assess the variability of radiation dose exposure in patients affected by lymphoma undergoing repeat CT (computed tomography) examinations and to evaluate the influence of different scan parameters on the overall radiation dose. A series of 34 patients (12 men and 22 women with a median age of 34.4 years) with lymphoma, after the initial staging CT underwent repeat follow-up CT examinations. For each patient and each repeat examination, age, sex, use of AEC system (Automated Exposure Control, i.e. current modulation), scan length, kV value, number of acquired scans (i.e. number of phases), abdominal size diameter and dose length product (DLP) were recorded. The radiation dose of just one venous phase was singled out from the DLP of the entire examination. All scan data were retrieved by our PACS (Picture Archiving and Communication System) by means of a dose monitoring software. Among the variables we considered, no significant difference of radiation dose was observed among patients of different ages nor concerning tube voltage. On the contrary the dose delivered to the patients varied depending on sex, scan length and usage of AEC. No significant difference was observed depending on the behaviour of technologists, while radiologists' choices had indirectly an impact on the radiation dose due to the different number of scans requested by each of them. Our results demonstrate that patients affected by lymphoma who undergo repeat whole body CT scanning may receive unnecessary overexposure. We quantified and analyzed the most relevant variables in order to provide a useful tool to manage properly CT dose variability, estimating the amount of additional radiation dose for every single significant variable. Additional scans, incorrect scan length and incorrect usage of AEC system are the most relevant cause of patient radiation exposure.

  11. Merkel Cell Carcinomas Arising in Autoimmune Disease Affected Patients Treated with Biologic Drugs, Including Anti-TNF.

    Science.gov (United States)

    Rotondo, John Charles; Bononi, Ilaria; Puozzo, Andrea; Govoni, Marcello; Foschi, Valentina; Lanza, Giovanni; Gafà, Roberta; Gaboriaud, Pauline; Touzé, Françoise Antoine; Selvatici, Rita; Martini, Fernanda; Tognon, Mauro

    2017-07-15

    Purpose: The purpose of this investigation was to characterize Merkel cell carcinomas (MCC) arisen in patients affected by autoimmune diseases and treated with biologic drugs. Experimental Design: Serum samples from patients with MCC were analyzed for the presence and titer of antibodies against antigens of the oncogenic Merkel cell polyomavirus (MCPyV). IgG antibodies against the viral oncoproteins large T (LT) and small T (ST) antigens and the viral capsid protein-1 were analyzed by indirect ELISA. Viral antigens were recombinant LT/ST and virus-like particles (VLP), respectively. MCPyV DNA sequences were studied using PCR methods in MCC tissues and in peripheral blood mononuclear cells (PBMC). Immunohistochemical (IHC) analyses were carried out in MCC tissues to reveal MCPyV LT oncoprotein. Results: MCPyV DNA sequences identified in MCC tissues showed 100% homology with the European MKL-1 strain. PBMCs from patients tested MCPyV-negative. Viral DNA loads in the three MCC tissues were in the 0.1 to 30 copy/cell range. IgG antibodies against LT/ST were detected in patients 1 and 3, whereas patient 2 did not react to the MCPyV LT/ST antigen. Sera from the three patients with MCC contained IgG antibodies against MCPyV VP1. MCC tissues tested MCPyV LT-antigen-positive in IHC assays, with strong LT expression with diffuse nuclear localization. Normal tissues tested MCPyV LT-negative when employed as control. Conclusions: We investigated three new MCCs in patients affected by rheumatologic diseases treated with biologic drugs, including TNF. A possible cause-effect relationship between pharmacologic immunosuppressive treatment and MCC onset is suggested. Indeed, MCC is associated with MCPyV LT oncoprotein activity. Clin Cancer Res; 23(14); 3929-34. ©2017 AACR . ©2017 American Association for Cancer Research.

  12. Factors Affecting Myocardial Infarction in Cervical Cancer Patients: A Population-Based Study

    Science.gov (United States)

    Hsieh, Chen-Hsi; Chiou, Wen-Yen; Lee, Ching-Chih; Lee, Moon-Sing; Lin, Hon-Yi; Su, Yu-Chieh; Hung, Shih-Kai

    2013-01-01

    Background Radiotherapy (RT) or concurrent chemoradiation therapy has been suggested to increase the risk of coronary heart disease for cervical cancer patients, but the results of studies have been inconsistent. Therefore, we aimed to investigate the factors which influence the risk of developing myocardial infarction (MI) in cervical cancer patients with a large, nationwide cohort. Methods The study analyzed data from the 1996 to 2010 National Health Insurance Research Database provided by the National Health Research Institutes in Taiwan. The assessed number of patients with cervical cancer with radiotherapy only, surgery with bilateral oophorectomy only, and with appendectomy were 308, 323 and 229, respectively. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the risk of myocardial infarction. Results The adjusted hazard ratio for cervical cancer in patients with MI was 1.97 (95% CI, 0.97 - 3.91; P = 0.05) for the group that received RT alone, and 2.13 (95% CI, 1.11 - 3.75; P = 0.01) for the surgery group when compared with controls. The more risk comorbidities they have, the higher the risk of myocardial infarction would be for the patients. Conclusion The incidence of MI was significantly higher among cervical cancer patients with RT alone or surgery with bilateral oophorectomy alone than among general populations. RT might be as a factor to increase risk as bilateral oophorectomy. Whether RT itself triggers menopause or impairs the ovarian hormone production that increases the risk of MI needs to be further investigated. PMID:24171059

  13. Organizational Factors Affecting the Likelihood of Cancer Screening Among VA Patients.

    Science.gov (United States)

    Chou, Ann F; Rose, Danielle E; Farmer, Melissa; Canelo, Ismelda; Yano, Elizabeth M

    2015-12-01

    Preventive service delivery, including cancer screenings, continues to pose a challenge to quality improvement efforts. Although many studies have focused on person-level characteristics associated with screening, less is known about organizational influences on cancer screening. This study aims to understand the association between organizational factors and adherence to cancer screenings. This study employed a cross-sectional design using organizational-level, patient-level, and area-level data. Dependent variables included breast, cervical, and colorectal cancer screening. Organizational factors describing resource sufficiency were constructed using factor analyses from a survey of 250 Veterans Affairs primary care directors. We conducted random-effects logistic regression analyses, modeling cancer screening as a function of organizational factors, controlling for patient-level and area-level factors. Overall, 87% of the patients received mammograms, 92% received cervical and 78% had colorectal screening. Quality improvement orientation increased the odds of cervical [odds ratio (OR): 1.27; 95% confidence interval (CI), 1.03-1.57] and colorectal cancer screening (OR: 1.10; 95% CI, 1.00-1.20). Authority in determining primary care components increased the odds of mammography screening (OR: 1.23; 95% CI, 1.03-1.51). Sufficiency in clinical staffing increased the odds of mammography and cervical cancer screenings. Several patient-level factors, serving as control variables, were associated with achievement of screenings. Resource sufficiency led to increased odds of screening possibly because they promote excellence in patient care by conveying organizational goals and facilitate goal achievement with resources. Complementary to patient-level factors, our findings identified organizational processes associated with better performance, which offer concrete strategies in which facilities can evaluate their capabilities to implement best practices to foster and

  14. Bone involvement in adult patients affected with Ehlers-Danlos syndrome.

    Science.gov (United States)

    Eller-Vainicher, C; Bassotti, A; Imeraj, A; Cairoli, E; Ulivieri, F M; Cortini, F; Dubini, M; Marinelli, B; Spada, A; Chiodini, I

    2016-08-01

    The Ehlers-Danlos syndrome is characterized by abnormal connective tissue but bone involvement is debated. We found a reduced BMD and bone quality and increased prevalence of asymptomatic vertebral fractures in eugonadal patients with Ehlers-Danlos syndrome. These findings suggest the need of a bone health evaluation in these patients. The Ehlers-Danlos (EDS) syndrome is characterized by abnormalities of the connective tissue leading to ligamentous laxity and skin and tissue fragility. We evaluated the bone metabolism, bone mineral density (BMD) and bone quality (measured by trabecular bone score, TBS), and the prevalence of vertebral fractures (VFx) in a group of eugonadal adult EDS patients. Fifty consecutive Caucasian patients, aged 30-50 years (36 females, 14 males) with classical or hypermobility EDS and 50 age-, gender-, and body mass index (BMI)-matched control subjects were enrolled. In all subjects' calcium-phosphorous metabolism, bone turnover, BMD at the lumbar spine (LS) and femur (femoral neck, FN and total femur, FT) and TBS by dual-energy X-ray absorptiometry, and the VFx presence by spine radiograph were assessed. Patients showed reduced BMD (Z-scores LS -0.45 ± 1.00, FN -0.56 ± 1.01, FT -0.58 ± 0.92) and TBS (1.299 ± 0.111) and increased prevalence of morphometric VFx (32 %) than controls (Z-scores LS 0.09 ± 1.22, FN 0.01 ± 0.97, FT 0.08 ± 0.89; TBS 1.382 ± 0.176; VFx 8 %, p <0.05 for all comparisons), while vitamin D levels, calcium-phosphorous metabolism, and bone turnover were comparable. Fractured EDS patients showed lower TBS values than non-fractured ones (1.245 ± 0.138 vs 1.325 ± 0.086, p < 0.05), despite comparable BMD. In EDS patients, the VFx presence was significantly associated with TBS even after adjusting for sex, age, BMD, EDS type, and falls frequency. EDS patients have reduced BMD and bone quality (as measured by TBS) and increased prevalence of VFx.

  15. Treatment of scoliosis in patients affected with Prader-Willi syndrome using various techniques

    Directory of Open Access Journals (Sweden)

    Cioni Alfredo

    2010-06-01

    Full Text Available Abstract Background The incidence of spinal deformity in children with Prader-Willi syndrome (PWS is high, with 86% of these patients found to have a significant structural scoliosis; however, there are very few case reports describing surgical treatment for this deformity. Methods The authors reviewed a case series consisting of 6 patients who underwent spine surgery for scoliosis. Children's mean age at index surgery was 12 years and 10 months (range, 10 to 15 yrs. Clinical evaluation revealed the typical phenotypic features of the PWS in all of the patients; 4 subjects had a karyotype confirmation of PWS. Major structural curves showed preoperative mean Cobb angles of 80.8° (range, 65° to 96°. Hybrid instrumentation with sublaminar wires, hooks and screws was used in the first 2 patients, while the remaining 4 were treated with titanium pedicle screw constructs. Results The mean clinical and radiological follow-up was 3 years and 10 months (range, 2 years to 9 years. Major complication rate was 50%. One patient who developed a major intraoperative complication (paraparesis prevented spinal fusion to be obtained: the neurologic deficit resolved completely after instrumentation removal. Solid arthrodesis and deformity correction in both coronal and sagittal plane was, however, achieved in the other 5 cases and no significant curve progression was observed at follow-up. Another major short-term complication was encountered 3 months after surgery in a patient who experienced the detachment of a distally located rod and required correction through revision surgery and caudal extension by one level. Cervico-thoracic kyphosis was seen in 1 patient who did not require revision surgery. Conclusions Spine reconstructive surgery in patients with PWS is rare and highly demanding. The best method of reconstruction is posterior multilevel pedicle screw fixation. Moreover, even with modern techniques, the risk of complications is still high. These new

  16. Situation awareness and documentation of changes that affect patient outcomes in progress notes.

    Science.gov (United States)

    Tower, Marion; Chaboyer, Wendy

    2014-05-01

    To report on registered nurses' situation awareness as a precursor to decision-making when recording changes in patients' conditions. Progress notes are important to communicate patients' progress and detail changes in patients' conditions. However, documentation is often poorly completed. There is little work that examines nurses' decision-making during documentation. This study focused on describing situation awareness as a precursor to decision-making during documentation. This study used Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) work on situation awareness to guide and conceptualise information. The study was situated in a naturalistic paradigm to provide an interpretation of nurses' decision-making. Think-aloud research methods and semi-structured interviews were employed to illuminate decision-making processes. Audio recordings and interview texts were individually examined for evidence of cues, informed by Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) descriptions of situation awareness. As patients' conditions changed, nurses used complex mental models and pattern-matching of information, drawing on all 3 levels of situation awareness during documentation. Level 1 situation awareness provided context, level 2 situation awareness signified a change in condition and its significance for the patient, and level 3 situation awareness was evident when nurses thought aloud about what this information indicated. Three themes associated with changes in patients' conditions emerged: deterioration in condition, not responding to prescribed treatments as expected and issues related to professional practice that impacted on patients' conditions. Nurses used a complex mental model for decision-making, drawing on 3 levels of situation awareness. Hamm's cognitive continuum theory, when related to situation awareness, is a useful decision-making theory to provide a

  17. Nutrition care-related practices and factors affecting nutritional intakes in hospital patients at risk of pressure ulcers.

    Science.gov (United States)

    Roberts, S; Chaboyer, W; Desbrow, B

    2015-08-01

    Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group. The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24 h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses. Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed meals. Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers. © 2014 The British Dietetic Association Ltd.

  18. A Simple Network to Remove Interference in Surface EMG Signal from Single Gene Affected Phenylketonuria Patients for Proper Diagnosis

    Science.gov (United States)

    Mohanty, Madhusmita; Basu, Mousumi; Pattanayak, Deba Narayan; Mohapatra, Sumant Kumar

    2018-04-01

    Recently Autosomal Recessive Single Gene (ARSG) diseases are highly effective to the children within the age of 5-10 years. One of the most ARSG disease is a Phenylketonuria (PKU). This single gene disease is associated with mutations in the gene that encodes the enzyme phenylalanine hydroxylase (PAH, Gene 612349). Through this mutation process, PAH of the gene affected patient can not properly manufacture PAH as a result the patients suffer from decreased muscle tone which shows abnormality in EMG signal. Here the extraction of the quality of the PKU affected EMG (PKU-EMG) signal is a keen interest, so it is highly necessary to remove the added ECG signal as well as the biological and instrumental noises. In the Present paper we proposed a method for detection and classification of the PKU affected EMG signal. Here Discrete Wavelet Transformation is implemented for extraction of the features of the PKU affected EMG signal. Adaptive Neuro-Fuzzy Inference System (ANFIS) network is used for the classification of the signal. Modified Particle Swarm Optimization (MPSO) and Modified Genetic Algorithm (MGA) are used to train the ANFIS network. Simulation result shows that the proposed method gives better performance as compared to existing approaches. Also it gives better accuracy of 98.02% for the detection of PKU-EMG signal. The advantages of the proposed model is to use MGA and MPSO to train the parameters of ANFIS network for classification of ECG and EMG signal of PKU affected patients. The proposed method obtained the high SNR (18.13 ± 0.36 dB), SNR (0.52 ± 1.62 dB), RE (0.02 ± 0.32), MSE (0.64 ± 2.01), CC (0.99 ± 0.02), RMSE (0.75 ± 0.35) and MFRE (0.01 ± 0.02), RMSE (0.75 ± 0.35) and MFRE (0.01 ± 0.02). From authors knowledge, this is the first time a composite method is used for diagnosis of PKU affected patients. The accuracy (98.02%), sensitivity (100%) and specificity (98.59%) helps for proper clinical treatment. It can help for readers

  19. Differences in oral habit and lymphocyte subpopulation affect malignant transformation of patients with oral precancer

    Directory of Open Access Journals (Sweden)

    Chien-Yang Yeh

    2016-04-01

    Conclusion: These results suggest that age, alcohol consumption, and early activation of T cells, B cells, and natural killer cells are crucial in the malignant transformation of oral precancer. Analysis of patient's lymphocyte populations may help predict the malignant transformation of oral precancer.

  20. A retrospective analysis to identify the factors affecting infection in patients undergoing chemotherapy.

    Science.gov (United States)

    Park, Ji Hyun; Kim, Hyeon-Young; Lee, Hanna; Yun, Eun Kyoung

    2015-12-01

    This study compares the performance of the logistic regression and decision tree analysis methods for assessing the risk factors for infection in cancer patients undergoing chemotherapy. The subjects were 732 cancer patients who were receiving chemotherapy at K university hospital in Seoul, Korea. The data were collected between March 2011 and February 2013 and were processed for descriptive analysis, logistic regression and decision tree analysis using the IBM SPSS Statistics 19 and Modeler 15.1 programs. The most common risk factors for infection in cancer patients receiving chemotherapy were identified as alkylating agents, vinca alkaloid and underlying diabetes mellitus. The logistic regression explained 66.7% of the variation in the data in terms of sensitivity and 88.9% in terms of specificity. The decision tree analysis accounted for 55.0% of the variation in the data in terms of sensitivity and 89.0% in terms of specificity. As for the overall classification accuracy, the logistic regression explained 88.0% and the decision tree analysis explained 87.2%. The logistic regression analysis showed a higher degree of sensitivity and classification accuracy. Therefore, logistic regression analysis is concluded to be the more effective and useful method for establishing an infection prediction model for patients undergoing chemotherapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Does Lipid Profile Affect Thrombin Generation During Ramadan Fasting in Patients With Cardiovascular Risks?

    Science.gov (United States)

    Sassi, Mouna; Chakroun, Taher; Chouchène, Saoussen; Hellara, Ilhem; Boubaker, Hamdi; Grissa, Mohamed Habib; Khochtali, Ines; Hassine, Mohsen; Addad, Faouzi; Elalamy, Ismail; Nouira, Semir

    2017-11-01

    There is evidence that diet and variation in lipid metabolism can influence blood coagulation, but little is known about the effect of Ramadan fasting on plasmatic coagulation pattern. We investigated the effect of Ramadan fasting on thrombin generation (TG) in patients with cardiovascular disease (CVD) risks, and we aimed to assess the effect of lipid profile on TG parameters. The study was conducted in 36 adults having at least 2 CVD risks and in 30 healthy controls. Coagulation pattern was assessed by both classical clotting times and TG test. A complete lipid profile was performed simultaneously. Patients were invited 2 times: 1 week before Ramadan and during the last week of the Ramadan. The TG parameters were not different in patients with CVD risks compared to healthy controls. Fasting had no effect on plasmatic coagulation parameters and on TG profile. Individual analysis of the mean rate index (MRI) of TG revealed 3 groups: group 1 with no modification of MRI, group 2 with a significant increase in MRI (81.64 nM/min vs 136.07 nM/min; P fasting did not influence the global coagulation pattern in patients with CVD risks. Whereas, a significant increase in the propagation phase of TG was associated with a significant increase in cholesterol levels, which was not found with the other TG parameters.

  2. Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium

    NARCIS (Netherlands)

    Fanjul, M.; Samuk, I.; Bagolan, P.; Leva, E.; Sloots, C.; Gine, C.; Aminoff, D.; Midrio, P.; Blaauw, I. de; Marcelis, C.L.M.; Rooij, I.A.L.M. van; Wester, T.; Zwink, N.

    2017-01-01

    PURPOSE: The goal of this study was to determine the degree of consensus in the management of spinal cord tethering (TC) in patients with anorectal malformation (ARM) in a large cohort of European pediatric centers. METHODS: A survey was sent to pediatric surgeons (one per center) members of the

  3. The affective value of faces in patients achieving long-term seizure freedom after temporal lobectomy.

    Science.gov (United States)

    Meletti, Stefano; Picardi, Angelo; De Risi, Marco; Monti, Giulia; Esposito, Vincenzo; Grammaldo, Liliana G; Di Gennaro, Giancarlo

    2014-07-01

    We investigated different aspects of facial expression evaluation in a homogeneous cohort of 42 seizure-free patients with 5 or more years of follow-up after temporal lobectomy (TL), with the aim of further characterizing the impairment in emotion and social cognition among patients. A group of healthy subjects matched for sex, age, and education served as controls. Four tasks of facial expression evaluation were used: (a) facial expression recognition, (b) rating of the intensity of facial expression, and (c) rating of valence (pleasantness) and (d) rating of arousal induced by facial expressions. Patients had a worse performance in the recognition task for all negative emotions, while no differences in intensity ratings were found. They also reported lower arousal ratings than controls for faces showing fear, anger, disgust, and neutral expressions, as well as lower valence ratings for all facial expressions except those showing happiness. Longer epilepsy duration before TL was negatively associated with ratings of arousal and intensity and positively associated with valence ratings for fearful facial expressions. This study showed that patients who become seizure-free after TL present long-term deficits in several aspects of facial expression evaluation. Longitudinal, prospective studies are needed to evaluate if social cognition improves or declines after TL. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Anxiety state affects information processing speed in patients with multiple sclerosis.

    Science.gov (United States)

    Goretti, Benedetta; Viterbo, R G; Portaccio, E; Niccolai, C; Hakiki, B; Piscolla, E; Iaffaldano, P; Trojano, M; Amato, M P

    2014-04-01

    The aim of this study was to investigate the impact of anxiety on the cognitive performance of a clinical sample of relapsing-remitting (RR) MS patients. One hundred ninety patients (140 females) were included in the study and assessed through the beck depression inventory, the state-trait anxiety inventory and the Rao's brief repeatable battery which assesses cognitive domains most frequently impaired in MS. As for neuropsychological performance, a total of 76 (40%) subjects fulfilled our criterion for cognitive impairment. Tests most frequently failed by cognitive impairment (CI) patients were those assessing complex attention and information processing speed [Simbol Digit Modalities Test (SDMT), Paced Auditory Serial Auditory Test (PASAT) 3 and 2] and verbal memory. In the univariate analysis, state anxiety was related to failure on the SDMT (p = 0.042), and marginally, to failure on the PASAT-3 (p = 0.068), and to the presence of CI (p = 0.082). Moderate/severe depression was detected in 38 (20%) patients and fatigue in 109 (57%). Higher depression scores were related to impairment on the ST (OR = 1.05; 95% CI 1.01-1.10; p = 0.029).

  5. Geographic inequities in liver allograft supply and demand: does it affect patient outcomes?

    Science.gov (United States)

    Rana, Abbas; Kaplan, Bruce; Riaz, Irbaz B; Porubsky, Marian; Habib, Shahid; Rilo, Horacio; Gruessner, Angelika C; Gruessner, Rainer W G

    2015-03-01

    Significant geographic inequities mar the distribution of liver allografts for transplantation. We analyzed the effect of geographic inequities on patient outcomes. During our study period (January 1 through December 31, 2010), 11,244 adult candidates were listed for liver transplantation: 5,285 adult liver allografts became available, and 5,471 adult recipients underwent transplantation. We obtained population data from the 2010 United States Census. To determine the effect of regional supply and demand disparities on patient outcomes, we performed linear regression and multivariate Cox regression analyses. Our proposed disparity metric, the ratio of listed candidates to liver allografts available varied from 1.3 (region 11) to 3.4 (region 1). When that ratio was used as the explanatory variable, the R(2) values for outcome measures were as follows: 1-year waitlist mortality, 0.23 and 1-year posttransplant survival, 0.27. According to our multivariate analysis, the ratio of listed candidates to liver allografts available had a significant effect on waitlist survival (hazards ratio, 1.21; 95% confidence interval, 1.04-1.40) but was not a significant risk factor for posttransplant survival. We found significant differences in liver allograft supply and demand--but these differences had only a modest effect on patient outcomes. Redistricting and allocation-sharing schemes should seek to equalize regional supply and demand rather than attempting to equalize patient outcomes.

  6. Temazepam 10mg does not affect breathing and gas exchange in patients with severe normocapnic COPD.

    NARCIS (Netherlands)

    Stege, G.; Heijdra, Y.F.; Elshout, F.J.J. van den; Ven, M.J.T. van de; Bruijn, P.J. de; Sorge, A.A. van; Dekhuijzen, P.N.R.; Vos, P.J.E.

    2010-01-01

    BACKGROUND: Benzodiazepines can improve sleep quality, but are also thought to cause respiratory depression in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to assess the effects of temazepam on indices of circadian respiratory function, dyspnea, sleep

  7. Oxidation products are increased in patients affected by non-segmental generalized vitiligo.

    Science.gov (United States)

    Vaccaro, Mario; Bagnato, Gianluca; Cristani, Mariateresa; Borgia, Francesco; Spatari, Giovanna; Tigano, Valeria; Saja, Antonina; Guarneri, Fabrizio; Cannavò, Serafinella P; Gangemi, Sebastiano

    2017-08-01

    Several lines of evidence support the relevance of reactive oxygen species (ROS) in vitiligo, but the exact role of glycation and oxidation of macromolecules needs to be better addressed. To investigate the involvement of advanced oxidation protein products (AOPPs) and advanced glycation end-products (AGEs), we performed a case-control association study by spectrofluorimetry and spectrophotometry, in 47 patients with non-segmental generalized vitiligo and 47 age- and sex-matched controls. Significantly higher levels of both AOPPs (p vitiligo patients compared to healthy controls. In vitiligo patients, AGEs and AOPPs serum levels were directly associated with extension, duration of vitiligo, and disease activity. ROS, and in particular AGEs and AOPPs, could represent one of the main biomarkers to assess the onset and progression of vitiligo, due to the potential role as direct inducers of cell damage and also as autoimmunity triggers. Further longitudinal studies involving larger cohorts of patients are required to elucidate the role of oxidation products in the pathogenesis of vitiligo.

  8. Nutritional status evaluation in patients affected by bethlem myopathy and ullrich congenital muscular dystrophy.

    Science.gov (United States)

    Toni, Silvia; Morandi, Riccardo; Busacchi, Marcello; Tardini, Lucia; Merlini, Luciano; Battistini, Nino Carlo; Pellegrini, Massimo

    2014-01-01

    Collagen VI mutations lead to disabling myopathies like Bethlem myopathy (BM) and Ullrich congenital muscular dystrophy (UCMD). We have investigated the nutritional and metabolic status of one UCMD and seven BM patients (five female, three male, mean age 31 ± 9 years) in order to find a potential metabolic target for nutritional intervention. For this study, we used standard anthropometric tools, such as BMI evaluation and body circumference measurements. All results were compared to dual-energy X-ray absorptiometry (DXA), considered the "gold standard" method. Energy intake of each patient was evaluated through longitudinal methods (7-day food diary) while resting energy expenditure (REE) was predicted using specific equations and measured by indirect calorimetry. Clinical evaluation included general and nutritional blood and urine laboratory analyses and quantitative muscle strength measurement by hand-held dynamometry. BM and UCMD patients showed an altered body composition, characterized by low free fat mass (FFM) and high fat mass (FM), allowing us to classify them as sarcopenic, and all but one as sarcopenic-obese. Another main result was the negative correlation between REE/FFM ratio (basal energy expenditure per kilograms of fat-free mass) and the severity of the disease, as defined by the muscle megascore (correlation coefficient -0.955, P-value nutritional intervention in these patients.

  9. Visual encoding impairment in patients with schizophrenia: contribution of reduced working memory span, decreased processing speed, and affective symptoms.

    Science.gov (United States)

    Brébion, Gildas; Stephan-Otto, Christian; Huerta-Ramos, Elena; Ochoa, Susana; Usall, Judith; Abellán-Vega, Helena; Roca, Mercedes; Haro, Josep Maria

    2015-01-01

    Previous research has revealed the contribution of decreased processing speed and reduced working memory span in verbal and visual memory impairment in patients with schizophrenia. The role of affective symptoms in verbal memory has also emerged in a few studies. The authors designed a picture recognition task to investigate the impact of these factors on visual encoding. Two types of pictures (black and white vs. colored) were presented under 2 different conditions of context encoding (either displayed at a specific location or in association with another visual stimulus). It was assumed that the process of encoding associated pictures was more effortful than that of encoding pictures that were presented alone. Working memory span and processing speed were assessed. In the patient group, working memory span was significantly associated with the recognition of the associated pictures but not significantly with that of the other pictures. Controlling for processing speed eliminated the patients' deficit in the recognition of the colored pictures and greatly reduced their deficit in the recognition of the black-and-white pictures. The recognition of the black-and-white pictures was inversely related to anxiety in men and to depression in women. Working memory span constrains the effortful visual encoding processes in patients, whereas processing speed decrement accounts for most of their visual encoding deficit. Affective symptoms also have an impact on visual encoding, albeit differently in men and women. PsycINFO Database Record (c) 2015 APA, all rights reserved.

  10. The Impact of Sex Differences on Odor Identification and Facial Affect Recognition in Patients with Schizophrenia Spectrum Disorders.

    Science.gov (United States)

    Mossaheb, Nilufar; Kaufmann, Rainer M; Schlögelhofer, Monika; Aninilkumparambil, Thushara; Himmelbauer, Claudia; Gold, Anna; Zehetmayer, Sonja; Hoffmann, Holger; Traue, Harald C; Aschauer, Harald

    2018-01-01

    Social interactive functions such as facial emotion recognition and smell identification have been shown to differ between women and men. However, little is known about how these differences are mirrored in patients with schizophrenia and how these abilities interact with each other and with other clinical variables in patients vs. healthy controls. Standardized instruments were used to assess facial emotion recognition [Facially Expressed Emotion Labelling (FEEL)] and smell identification [University of Pennsylvania Smell Identification Test (UPSIT)] in 51 patients with schizophrenia spectrum disorders and 79 healthy controls; furthermore, working memory functions and clinical variables were assessed. In both the univariate and the multivariate results, illness showed a significant influence on UPSIT and FEEL. The inclusion of age and working memory in the MANOVA resulted in a differential effect with sex and working memory as remaining significant factors. Duration of illness was correlated with both emotion recognition and smell identification in men only, whereas immediate general psychopathology and negative symptoms were associated with emotion recognition only in women. Being affected by schizophrenia spectrum disorder impacts one's ability to correctly recognize facial affects and identify odors. Converging evidence suggests a link between the investigated basic and social cognitive abilities in patients with schizophrenia spectrum disorders with a strong contribution of working memory and differential effects of modulators in women vs. men.

  11. The Impact of Sex Differences on Odor Identification and Facial Affect Recognition in Patients with Schizophrenia Spectrum Disorders

    Directory of Open Access Journals (Sweden)

    Nilufar Mossaheb

    2018-01-01

    Full Text Available BackgroundSocial interactive functions such as facial emotion recognition and smell identification have been shown to differ between women and men. However, little is known about how these differences are mirrored in patients with schizophrenia and how these abilities interact with each other and with other clinical variables in patients vs. healthy controls.MethodsStandardized instruments were used to assess facial emotion recognition [Facially Expressed Emotion Labelling (FEEL] and smell identification [University of Pennsylvania Smell Identification Test (UPSIT] in 51 patients with schizophrenia spectrum disorders and 79 healthy controls; furthermore, working memory functions and clinical variables were assessed.ResultsIn both the univariate and the multivariate results, illness showed a significant influence on UPSIT and FEEL. The inclusion of age and working memory in the MANOVA resulted in a differential effect with sex and working memory as remaining significant factors. Duration of illness was correlated with both emotion recognition and smell identification in men only, whereas immediate general psychopathology and negative symptoms were associated with emotion recognition only in women.ConclusionBeing affected by schizophrenia spectrum disorder impacts one’s ability to correctly recognize facial affects and identify odors. Converging evidence suggests a link between the investigated basic and social cognitive abilities in patients with schizophrenia spectrum disorders with a strong contribution of working memory and differential effects of modulators in women vs. men.

  12. Immunofluorescence in multiple tissues utilizing serum from a patient affected by systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Piotr Brzezinski

    2012-01-01

    Full Text Available Introduction: Lupus erythematosus is a chronic, inflammatory autoimmune disease that can affect multiple organs. Lupus can affect many parts of the body, especially in systemic lupus erythematosus (SLE; affected tissues may include the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Case report: A 46-year-old female presented with pruritus, photosensitivity and edema of the cheeks of about 2 years duration, and was evaluated by a dermatologist. On examination, multiple telangiectasias were present on the cheeks, with erythema, edema and a malar rash observed. A review of systems documented breathing difficulty and pleuitic pain, joint pain and joint edema, photosensitivity, cardiac dysrhythmia, and periodic pain in the back close to the kidneys. Methods: Skin biopsies for hematoxylin and eosin testing, as well for direct and indirect immunofluorescence were performed, in addition to multiple diagnostic blood tests, chest radiography and directed immunologic testing. Results: The blood testing showed elevated C-reactive protein. Direct and indirect immunofluorescence testing utilizing monkey esophagus, mouse and pig heart and kidney, normal human eyelid skin and veal brain demonstrated strong reactivity to several components of smooth muscle, nerves, blood vessels, skin basement membrane zone and sweat gland ducts and skin meibomian glands. Anti-endomysium antibodies were detected as well as others, especially using FITC conjugated Complement/C1q, FITC conjugated anti-human immunoglobulin IgG and FITC conjugated anti-human fibrinogen. Conclusions: We conclude that both direct and indirect immunofluorescence using several substrates can unveil previously undocumented autoantibodies in multiple organs in lupus erythematosus, and that these findings could be utilized to complement existing diagnostic testing for this disorder.

  13. High Resource Utilization Does Not Affect Mortality in Acute Respiratory Failure Patients Managed With Tracheostomy

    Science.gov (United States)

    Freeman, Bradley D; Stwalley, Dustin; Lambert, Dennis; Edler, Joshua; Morris, Peter E; Medvedev, Sofia; Hohmann, Samuel F; Kymes, Steven M

    2015-01-01

    BACKGROUND Tracheostomy practice in patients with acute respiratory failure (ARF) varies greatly among institutions. This variability has the potential to be reflected in the resources expended providing care. In various healthcare environments, increased resource expenditure has been associated with a favorable effect on outcome. OBJECTIVE To examine the association between institutional resource expenditure and mortality in ARF patients managed with tracheostomy. METHODS We developed analytic models employing the University Health Systems Consortium (Oakbrook, Illinois) database. Administrative coding data were used to identify patients with the principal diagnosis of ARF, procedures, complications, post-discharge destination, and survival. Mean resource intensity of participating academic medical centers was determined using risk-adjusted estimates of costs. Mortality risk was determined using a multivariable approach that incorporated patient-level demographic and clinical variables and institution-level resource intensity. RESULTS We analyzed data from 44,124 ARF subjects, 4,776 (10.8%) of whom underwent tracheostomy. Compared to low-resource-intensity settings, treatment in high-resource-intensity academic medical centers was associated with increased risk of mortality (odds ratio 1.11, 95% CI 1.05–1.76), including those managed with tracheostomy (odds ratio high-resource-intensity academic medical center with tracheostomy 1.10, 95% CI 1.04 –1.17). We examined the relationship between complication development and outcome. While neither the profile nor number of complications accumulated differed comparing treatment environments (P > .05 for both), mortality for tracheostomy patients experiencing complications was greater in high-resource-intensity (95/313, 30.3%) versus low-resource-intensity (552/2,587, 21.3%) academic medical centers (P tracheostomy. PMID:23650434

  14. Factors affecting institutionalization in older Hong Kong Chinese patients after recovery from acute medical illnesses.

    Science.gov (United States)

    Luk, James Ka Hay; Chiu, Patrick Ka Chun; Chu, Leung Wing

    2009-01-01

    Older patients with medical illnesses are at risk of institutionalization. The purpose of this study is to investigate the factors leading to institutionalization in older patients after recovery from medical illnesses. We studied 535 older patients in two convalescence hospitals in Hong Kong. Of them, 116 patients (21.7%) needed to move to nursing homes upon discharge. Univariate analysis showed that age, single/divorced/widowed status, longer length of stay, pressure sores, urinary incontinence, urinary catheterization, falls, dementia, diabetes mellitus, Barthel index (100), Elderly Mobility Score (EMS), Chinese version of the mini-mental state examination (C-MMSE) and albumin levels were significant factors associated with institutionalization. Multivariate analysis showed that being single/divorced/widowed (odds ratio=OR=2.74, 95% confidence interval=CI=1.36-5.53, p=0.0048), having urinary incontinence on discharge (OR=5.13, CI=2.66-10.6, p<0.001) and admission due to falls (OR=2.4, CI=1.03-5.57, p=0.04) were independent risk factors for nursing home admission. Higher admission EMS (OR=0.91, CI=0.84-0.97, p=0.009), admission C-MMSE (OR=0.93, CI=0.87-0.98, p=0.019), and discharge albumin levels (OR=0.93, CI=0.88-0.99, p=0.02) were independent protecting factors against nursing home admission. Knowledge of these factors can allow us to predict accommodation outcome and develop intervention strategy to reduce institutionalization in the older patients.

  15. Does high intensity exercise affects irisin plasma levels in hemodialysis patients? A pilot study

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    Marta Gormicho Boavida Marques Esgalhado

    2018-04-01

    Full Text Available ABSTRACT Background: Irisin is a recently identified exercise-induced hormone that stimulates the "browning" of the white adipose tissue, at least in mice. In chronic kidney disease (CKD patients, irisin regulation is not fully understood, and little attention has been given to the effects of exercise on irisin levels in these patients. The purpose of this study was to assess the effects of high intensity exercise on irisin plasma levels in CKD patients under hemodialysis (HD. Methods: Fifteen HD patients (5 men, 44.4 ± 15.1 years old were studied and served as their own controls. High intensity (single session intradialytic strength exercises consisted of three sets of ten repetitions with four different movements in both lower limbs during 30 minutes. Blood samples were collected on different days (exercise and non-exercise day at exactly the same time (30 and 60 minutes after the start of dialysis session. Plasma irisin levels were measured by ELISA assay and anthropometric and biochemical parameters were evaluated. Results: Irisin plasma levels were significantly reduced in both exercise day (125.0 ± 18.5 to 117.4 ± 15.0 ng/mL, p=0.02 and non-exercise day (121.5 ± 13.7 to 115.4 ± 17.2 ng/mL, p=0.02 after 60 minutes of dialysis. Conclusion: These data suggest that intense intradialytic strength exercise was unable to increase the circulating concentration of irisin in HD patients. Moreover, our data show that after one hour of dialysis session, irisin plasma levels may be reduced.

  16. Elastic properties of the aorta and factors affecting aortic stiffness in patients with

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    Derya Tok

    2012-09-01

    Full Text Available Objectives: In this study, we evaluated aortic stiffnessand echocardiographic and laboratory factors affectingaortic stiffness in patients with metabolic syndrome(MetS.Materials and methods: Forty-six patients (25 male,mean age 47.3±6.5 years with the diagnosis of MetS accordingto the Adult Treatment Panel III Final Report criteriawere included. Forty-four age and gender matchedhealthy subjects (18 male, mean age 46.0±6.1 yearswere recruited as the control group. Aortic strain, distensibilityand stiffness index were calculated by M-modeechocardiography and diastolic parameters were measured.Results: Left ventricular mass index (LVMI, decelerationtime (DT, isovolumic relaxation time (IVRT wereincreased and mitral E/A ratio was decreased in patientswith MetS compared to controls. In the MetS patients,aortic distensibility was significantly decreased (10.4±3.5cm2.dyn-1.10-6 vs. 12.7±3.4 cm2.dyn-1.10-6, p=0.002,and ASI was significantly increased (6.5±2.0 vs. 3.2±0.8,p<0.001. ASI was positively correlated with triglycerides,fasting glucose, uric acid, hsCRP, LVMI, DT, IVRT andsystolic blood pressure level, and was negatively correlatedwith HDL-cholesterol and mitral E/A ratio. In regressionanalysis, hsCRP (p=0.05 and systolic blood pressurelevel (p<0.001 were independent predictors of ASI.Conclusions: ASI is increased in patients with MetS. Inthese patients; decrease in aortic elasticity properties wasassociated with left ventricular diastolic dysfunction. Highsystolic pressure and hsCRP levels were found to be independentpredictors of ASI.Key words: Metabolic syndrome, Echocardiography,elastic properties of aorta, hsCRP

  17. Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System: A Cross-sectional Study in Nanjing, China.

    Science.gov (United States)

    Li, Wen Zhen; Gan, Yong; Zhou, Yan Feng; Chen, Ya Wen; Li, Jing; Kkandawire, Naomiem; Hu, Sai; Qiao, Yan; Lu, Zu Xun

    2017-09-01

    The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy. Copyright © 2017 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

  18. Factors Affecting Professional Autonomy of Japanese Nurses Caring for Culturally and Linguistically Diverse Patients in a Hospital Setting in Japan.

    Science.gov (United States)

    Kuwano, Noriko; Fukuda, Hiromi; Murashima, Sachiyo

    2016-11-01

    The study aimed to analyze the professional autonomy of Japanese nurses when caring for non-Japanese patients and to identify its contributing factors. A descriptive cross-sectional design was used. Participants included 238 clinical nurses working at 27 hospitals in Japan. The Intercultural Sensitivity Scale (Chen and Starosta), and the Scale for Professional Autonomy in Nursing (Kikuchi and Harada) were used to measure intercultural sensitivity and professional autonomy. Stepwise multiple regression analysis was used to identify the most significant factors affecting professional autonomy. Professional autonomy of Japanese nurses caring for non-Japanese patients was significantly lower than when caring for Japanese patients (142.84 vs. 172.85; p autonomy of Japanese nurses by promoting intercultural sensitivity. © The Author(s) 2015.

  19. Olanzapine-induced neuroleptic malignant syndrome in a patient with bipolar affective disorder: Does quetiapine holds the solution?

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    Praveen Tripathi

    2013-01-01

    Full Text Available Neuroleptic Malignant Syndrome (NMS is a rare, severe and life threatening condition induced by antipsychotic medications. It is commonly encountered with the use of first generation antipsychotics, however cases of NMS have been reported with the use of second generation antipsychotics like Olanzapine, Risperidone, Paliperidone, Aripiprazole, Ziprasidone, Amisulpride, Quetiapine and Clozapine, though the incidence of such reports is rare. Due to decreased use of first generation antipsychotics, NMS is reported less frequently now a days. In this case report- we highlight the management issues of a patient suffering from bipolar affective disorder, who had developed NMS following intramuscular injection of haloperidol, which was withdrawn and olanzapine was given later on. The patient had again developed NMS with olanzapine. Finally the patient was managed with modified electroconvulsive therapy and discharged on Lithium carbonate and Quetiapine.

  20. Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients.

    Science.gov (United States)

    Arduino, P G; Lopetuso, E; Carcieri, P; Giacometti, S; Carbone, M; Tanteri, C; Broccoletti, R

    2012-05-01

    The aim of this prospective case series was to assess the clinical efficiency of an oral hygiene protocol in patients affected by mucous membrane pemphigoid (MMP) with specific gingival localization, before starting any medical treatment. Patients received oral hygiene instruction followed by non-surgical periodontal therapy including oral hygiene instructions in a 3-week cohort study. Clinical outcome variables were recorded at baseline and 5 weeks after intervention and included, as periodontal parameters, full mouth plaque (FMPS) and bleeding (FMBS) scores and patient-related outcomes (visual analogue score of pain). A total of 12 patients were recruited. The mean age at presentation was 59.5 ± 14.52 years. Five weeks after finishing the oral hygiene and periodontal therapy protocol, a statistical significant reduction was observed for FMPS (P = 0.001), FMBS (P = 0.022) and reported pain (P = 0.0028). Professional oral hygiene procedures and non-surgical periodontal therapy are connected with improvement of gingival status and decrease in gingival-related pain, in female patients affected by MMP with specific gingival localization. © 2011 John Wiley & Sons A/S.

  1. Circulating TFH subset distribution is strongly affected in lupus patients with an active disease.

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    Carole Le Coz

    Full Text Available Follicular helper T cells (TFH represent a distinct subset of CD4(+ T cells specialized in providing help to B lymphocytes, which may play a central role in autoimmune diseases having a major B cell component such as systemic lupus erythematosus. Recently, TFH subsets that share common phenotypic and functional characteristics with TFH cells from germinal centers, have been described in the peripheral blood from healthy individuals. The aim of this study was to analyze the distribution of such populations in lupus patients. Circulating TFH cell subsets were defined by multicolor flow cytometry as TFH17 (CXCR3(-CCR6(+, TFH1 (CXCR3 (+ CCR6(- or TFH2 (CXCR3(-CCR6(- cells among CXCR5 (+ CD45RA(-CD4(+ T cells in the peripheral blood of 23 SLE patients and 23 sex and age-matched healthy controls. IL-21 receptor expression by B cells was analyzed by flow cytometry and the serum levels of IL-21 and Igs were determined by ELISA tests. We found that the TFH2 cell subset frequency is strongly and significantly increased in lupus patients with an active disease (SLEDAI score>8, while the TFH1 cell subset percentage is greatly decreased. The TFH2 and TFH1 cell subset frequency alteration is associated with the presence of high Ig levels and autoantibodies in patient's sera. Moreover, the TFH2 cell subset enhancement correlates with an increased frequency of double negative memory B cells (CD27(-IgD(-CD19(+ cells expressing the IL-21R. Finally, we found that IgE levels in lupus patients' sera correlate with disease activity and seem to be associated with high TFH2 cell subset frequency. In conclusion, our study describes for the first time the distribution of circulating TFH cell subsets in lupus patients. Interestingly, we found an increased frequency of TFH2 cells, which correlates with disease activity. Our results suggest that this subset might play a key role in lupus pathogenesis.

  2. Biochemical and clinical profiles of 52 Tunisian patients affected by Zellweger syndrome

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    Fahmi Nasrallah

    2017-12-01

    Full Text Available Background: Zellweger syndrome (ZS is a peroxisome biogenesis disorder attributed to a mutation of the PEX genes family. The incidence of this disease in Africa and the Arab world remains unknown. This contribution is aimed at describing the clinical phenotype and biochemical features in Tunisian patients with ZS in order to improve the detection and management of this severe disorder. Methods: A total of 52 patients diagnosed with ZS and 60 age- and sex-matched healthy controls were included in this study. Patients were recruited during the past 21 years, and the diagnosis of ZS was based on clinical and biochemical characteristics. Plasma very long chain fatty acids (VLCFA were analyzed using capillary gas chromatography. The estimated incidence of ZS was calculated using the Hardy–Weinberg formula. Results: The estimated incidence of ZS is 1/15,898 in Tunisia. Age at diagnosis varied between 3 days and 18 months. Severe neurological syndrome, polymalformative features, and hepatodigestive signs were observed in 100%, 67.9%, and 32% of patients, respectively. Values for plasma C26:0 and C26:0/C22:0 and C24:0/C22:0 ratios were noticeably higher in ZS patients than in controls. Distributions of values were completely different for C26:0 (0.10–0.37 vs. 0.001–0.009, C26:0/C22:0 ratio (0.11–1.29 vs. 0.003–0.090, and C24:0/C22:0 ratio (1.03–3.18 vs. 0.4–0.90 in ZS patients versus controls, respectively. Conclusions: This study highlights the high incidence of ZS in Tunisia and the possibility of simple and reliable biochemical diagnosis, thus permitting early genetic counseling for families at risk. Key Words: gas chromatography, hypotonia, peroxisomal disorder, very long chain fatty acids, Zellweger syndrome

  3. Appropriateness of hospitalization for CAP-affected pediatric patients: report from a Southern Italy General Hospital

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    Antonelli Fabio

    2009-09-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP is a common disease, responsible for significant healthcare expenditures, mostly because of hospitalization. Many practice guidelines on CAP have been developed, including admission criteria, but a few on appropriate hospitalization in children. The aim of this study was to evaluate appropriate hospital admission for CAP in a pediatric population. Methods We evaluated appropriate admission to a Pediatric Unit performing a retrospective analysis on CAP admitted pediatric patients from a Southern Italy area. Diagnosis was made based on clinical and radiological signs. Appropriate hospital admission was evaluated following clinical and non-clinical international criteria. Family ability to care children was assessed by evaluating social deprivation status. Results In 2 winter seasons 120 pediatric patients aged 1-129 months were admitted because of CAP. Median age was 28.7 months. Raised body temperature was scored in 68.3% of patients, cough was present in 100% of cases, and abdominal pain was rarely evidenced. Inflammatory indices (ESR and CRP were found elevated in 33.3% of cases. Anti-Mycoplasma pneumoniae antibodies were found positive in 20.4%. Trans-cutaneous (TC SaO2 was found lower than 92% in 14.6%. Dyspnoea was present in 43.3%. Dehydration requiring i.v. fluid supplementation was scored in 13.3%. Evaluation of familial ability to care their children revealed that 76% of families (derived from socially depressed areas were "at social risk", thus not able to appropriately care their children. Furthermore, analysis of CAP patients revealed that "at social risk" people accessed E.D. and were hospitalized more frequently than "not at risk" patients (odds ratio = 3.59, 95% CI: 1,15 to 11,12; p = 0.01, and that admitted "at social risk" people presented without clinical signs of severity (namely dyspnoea, and/or SaO2 ≤ 92%, and/or dehydration more frequently than "not at risk" population

  4. Does prehospital time affect survival of major trauma patients where there is no prehospital care?

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    S B Dharap

    2017-01-01

    Full Text Available Background: Survival after major trauma is considered to be time dependent. Efficient prehospital care with rapid transport is the norm in developed countries, which is not available in many lower middle and low-income countries. The aim of this study was to assess the effect of prehospital time and primary treatment given on survival of major trauma patients in a setting without prehospital care. Materials and Methods: This prospective observational study was carried out in a university hospital in Mumbai, from January to December 2014. The hospital has a trauma service but no organized prehospital care or defined interhospital transfer protocols. All patients with life- and/or limb-threatening injuries were included in the study. Injury time and arrival time were noted and the interval was defined as “prehospital time” for the directly arriving patients and as “time to tertiary care” for those transferred. Primary outcome measure was in-hospital death (or discharge. Results: Of 1181 patients, 352 were admitted directly from the trauma scene and 829 were transferred from other hospitals. In-hospital mortality was associated with age, mechanism and mode of injury, shock, Glasgow Coma Score <9, Injury Severity Score ≥16, need for intubation, and ventilatory support on arrival; but neither with prehospital time nor with time to tertiary care. Transferred patients had a significantly higher mortality (odds ratio = 1.869, 95% confidence interval = 1.233–2.561, P = 0.005 despite fewer patients with severe injury. Two hundred and ninety-four (35% of these needed airway intervention while 108 (13% needed chest tube insertion on arrival to the trauma unit suggesting inadequate care at primary facility. Conclusion: Mortality is not associated with prehospital time but with transfers from primary care; probably due to deficient care. To improve survival after major trauma, enhancement of resources for resuscitation and capacity building of on