Sex-specific substance abuse treatment for female healthcare professionals: implications.

Science.gov (United States)

Koos, Erin; Brand, Michael; Rojas, Julio; Li, Ji

2014-01-01

Gender plays a significant role in the development and treatment of substance abuse disorders. Sex-specific treatment for girls and women has recurrently proven more effective, with better outcomes than traditional treatment. Research on impaired healthcare professionals (HCPs) has largely focused on men, garnering little attention for women and sex differences. With the increasing numbers of female HCPs, it is imperative to identify potential sex differences that may have implications for treatment. Our study compared a convenience sample of male and female HCPs with substance abuse disorders treated in an outpatient program to identify sex differences that may have implications for treatment. Our sample consisted of 96 HCPs (54 men, 42 women) and 17 non-healthcare professional (N-HCP) women. All of the participants were evaluated using the program's clinical interview and the Personality Assessment Inventory (PAI). Chart review data contained categorical variables, qualitative variables, diagnoses, and psychological test scores. A second analysis was conducted through two separate comparisons: the PAI results of comparing impaired female HCPs with impaired male HCPs and the PAI results of comparing impaired female HCPs with impaired female N-HCPs. Statistically significant differences indicated more male participants received prior treatment and more intensive treatment than female participants. More female subjects reported being diagnosed as having a comorbid psychiatric condition and taking psychotropic medications. Several statistically significant differences in the PAI scores were found. Among female HCPs, elevations were found in anxiety, depression, paranoia, and borderline personality disorder. Substantive differences, although not statistically significant, were elevations in somatic complaints and anxiety disorders in female HCPs. In the comparison of female HCPs and N-HCPs, the only statistically significant difference was the significantly higher

Modeling economic implications of alternative treatment strategies for acute bacterial skin and skin structure infections.

Science.gov (United States)

Revankar, Nikhil; Ward, Alexandra J; Pelligra, Christopher G; Kongnakorn, Thitima; Fan, Weihong; LaPensee, Kenneth T

2014-10-01

The economic implications from the US Medicare perspective of adopting alternative treatment strategies for acute bacterial skin and skin structure infections (ABSSSIs) are substantial. The objective of this study is to describe a modeling framework that explores the impact of decisions related to both the location of care and switching to different antibiotics at discharge. A discrete event simulation (DES) was developed to model the treatment pathway of each patient through various locations (emergency department [ED], inpatient, and outpatient) and the treatments prescribed (empiric antibiotic, switching to a different antibiotic at discharge, or a second antibiotic). Costs are reported in 2012 USD. The mean number of days on antibiotic in a cohort assigned to a full course of vancomycin was 11.2 days, with 64% of the treatment course being administered in the outpatient setting. Mean total costs per patient were $8671, with inpatient care accounting for 58% of the costs accrued. The majority of outpatient costs were associated with parenteral administration rather than drug acquisition or monitoring. Scenarios modifying the treatment pathway to increase the proportion of patients receiving the first dose in the ED, and then managing them in the outpatient setting or prescribing an oral antibiotic at discharge to avoid the cost associated with administering parenteral therapy, therefore have a major impact and lower the typical cost per patient by 11-20%. Since vancomycin is commonly used as empiric therapy in clinical practice, based on these analyses, a shift in treatment practice could result in substantial savings from the Medicare perspective. The choice of antibiotic and location of care influence the costs and resource use associated with the management of ABSSSIs. The DES framework presented here can provide insight into the potential economic implications of decisions that modify the treatment pathway.

A case study of chiropractic management of pregnancy-related heartburn with postulated fetal epigenome implications.

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Peterson, Caroline

2012-01-01

This case study reports on chiropractic care for pregnancy-related heartburn. The purpose of this article is to relate the benefit of chiropractic treatment for one individual, to contrast chiropractic management with the biomedical standard of care for pregnancy-related heartburn, and to point to potential epigenetic implications of the standard of care. A 32-year-old woman who was 24 weeks pregnant presented with persistent heartburn that she was treating with ranitidine (Zantac®) and calcium carbonate (Tums®) daily at the initiation of chiropractic care. Findings of the initial examination were thoracic intersegmental dysfunction and pain upon palpation of the diaphragm, with hypertonicity noted. Therapy localization was positive for reflexes associated with the esophagus and lower esophageal sphincter, suggesting spasms. Emotional components also were identified in association with the symptoms by the use of a mind-body therapy called NeuroEmotional Technique. The patient was treated by adjusting the thoracic spine, manually releasing the diaphragm spasms, and releasing the esophageal spasm with an activator (a small hand-held instrument that creates a percussive force). The patient was symptom-free and did not use medication after the fifth treatment. She was followed throughout the remainder of her pregnancy and was asymptomatic and required no further treatment. A larger study should investigate the effectiveness of chiropractic care for the treatment of pregnancy-related heartburn. Copyright © 2012 Elsevier Inc. All rights reserved.

Hemiplegic shoulder pain: implications for occupational therapy treatment.

Science.gov (United States)

Gilmore, Paula E; Spaulding, Sandi J; Vandervoort, Anthony A

2004-02-01

Hemiplegic shoulder pain is common after stroke causing hemiplegia. It adversely affects the recovery of arm function and independence in activities of daily living. Subluxation, abnormal tone and limited range of motion or capsular constrictions have been reported as potential causes. Other factors such as rotator cuff tears, brachial plexus injury, shoulder-hand syndrome and other pre-existing pathological conditions may also be associated with hemiplegic shoulder pain. The etiology remains unclear, but hemiplegic shoulder pain may result from a combination of the above factors. This literature review examines the possible causes of hemiplegic shoulder pain and discusses the implications for occupational therapy treatment. Occupational therapy interventions include proper positioning, facilitation of movement through purposeful therapeutic activities, increasing passive range of motion, implementation of external supports and treatment of shoulder-hand syndrome. Understanding the processes involved will assist with effective assessment, treatment and prevention of hemiplegic shoulder pain. This will facilitate clients' participation in rehabilitation programs and move them towards attainment of optimal function.

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review.

Science.gov (United States)

Rutstein, Sarah E; Ananworanich, Jintanat; Fidler, Sarah; Johnson, Cheryl; Sanders, Eduard J; Sued, Omar; Saez-Cirion, Asier; Pilcher, Christopher D; Fraser, Christophe; Cohen, Myron S; Vitoria, Marco; Doherty, Meg; Tucker, Joseph D

2017-06-28

The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI - evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective

Relating DSM-5 section II and section III personality disorder diagnostic classification systems to treatment planning.

Science.gov (United States)

Morey, Leslie C; Benson, Kathryn T

2016-07-01

Beginning with DSM-III, the inclusion of a "personality" axis was designed to encourage awareness of personality disorders and the treatment-related implications of individual differences, but since that time there is little accumulated evidence that the personality disorder categories provide substantial treatment-related guidance. The DSM-5 Personality and Personality Disorders Work Group sought to develop an Alternative Model for personality disorder, and this study examined whether this model is more closely related to clinicians' decision-making processes than the traditional categorical personality disorder diagnoses. A national sample of 337 clinicians provided complete personality disorder diagnostic information and several treatment-related clinical judgments about one of their patients. The dimensional concepts of the DSM-5 Alternative Model for personality disorders demonstrated stronger relationships than categorical DSM-IV/DSM-5 Section II diagnoses to 10 of 11 clinical judgments regarding differential treatment planning, optimal treatment intensity, and long-term prognosis. The constructs of the DSM-5 Alternative Model for personality disorders may provide more clinically useful information for treatment planning than the official categorical personality disorder diagnostic system retained in DSM-5 Section II. Copyright © 2016 Elsevier Inc. All rights reserved.

Treatment of ventriculostomy-related infections

DEFF Research Database (Denmark)

Gerner-Smidt, P; Stenager, E; Kock-Jensen, C

1988-01-01

The results of the treatment of 15 cases of ventriculitis related to the use of external ventricular drainage are presented. A review of the literature on the treatment of cerebrospinal fluid shunt infections combined with our data suggest the following treatment of ventriculostomy-related ventri...

The evolution of the female sexual response concept: Treatment implications

Directory of Open Access Journals (Sweden)

Damjanović Aleksandar

2013-01-01

Full Text Available Sexual dysfunctions have been the most prevalent group of sexual disorders and include a large number of populations of both sexes. The research of sexual behavior and treatment of women with sexual distress arises many questions related to differences in sexual response of men and women. The conceptualization of this response in modern sexology has changed over time. The objective of our paper was to present the changes and evolution of the female’s sexual response concept in a summarized and integrated way, to analyze the expanded and revised definitions of the female sexual response as well as implications and recommendations of new approaches to diagnostics and treatment according to the established changes. The lack of adequate empirical basis of the female sexual response model is a critical question in the literature dealing with this issue. Some articles report that linear models demonstrate more correctly and precisely the sexual response of women with normal sexual functions in relation to women with sexual dysfunction. Modification of this model later resulted in a circular model which more adequately presented the sexual response of women with sexual function disorder than of women with normal sexual function. The nonlinear model of female sexual response constructed by Basson incorporates the value of emotional intimacy, sexual stimulus and satisfaction with the relationship. Female functioning is significantly affected by multiple psychosocial factors such as satisfaction with the relationship, self-image, earlier negative sexual experience, etc. Newly revised, expanded definitions of female sexual dysfunction try to contribute to new knowledge about a highly contextual nature of woman’s sexuality so as to enhance clinical treatment of dysfunctions. The definitions emphasize the evaluation of the context of women’s problematic sexual experiences.

Clinical psychology of Internet addiction: a review of its conceptualization, prevalence, neuronal processes, and implications for treatment

Directory of Open Access Journals (Sweden)

Pontes HM

2015-05-01

Full Text Available Halley M Pontes, Daria J Kuss, Mark D Griffiths International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham, UK Abstract: Research into Internet addiction (IA has grown rapidly over the last decade. The topic has generated a great deal of debate, particularly in relation to how IA can be defined conceptually as well as the many methodological limitations. The present review aims to further elaborate and clarify issues that are relevant to IA research in a number of areas including: definition and characterization, incidence and prevalence rates, associated neuronal processes, and implications for treatment, prevention, and patient-specific considerations. It is concluded that there is no consensual definition for IA. Prevalence rates among nationally representative samples across several countries vary greatly (from 1% to 18.7%, most likely reflecting the lack of methodological consistency and conceptual rigor of the studies. The overlaps between IA and other more traditional substance-based addictions and the possible neural substrates implicated in IA are also highlighted. In terms of treatment and prevention, both psychological and pharmacological treatments are examined in light of existing evidence alongside particular aspects inherent to the patient perspective. Based on the evidence analyzed, it is concluded that IA may pose a serious health hazard to a minority of people. Keywords: Internet addiction, review, behavioral addictions, prevalence, neuronal processes, treatment

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

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Jennifer Gerdts

2011-01-01

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

Definitive radiotherapy for early glottic carcinoma: prognostic factors and implications for treatment

International Nuclear Information System (INIS)

Burke, Lisa S.; Greven, Kathryn M.; McGuirt, Wyman T.; Case, Douglas; Hoen, Helena M.; Raben, Milton

1997-01-01

Purpose: Treatment and disease-related factors were analyzed for their influence on the outcome of patients treated definitively with irradiation (RT) for early glottic carcinoma. Methods and Materials: One hundred two patients with stage T1 or T2 glottic carcinomas were treated definitively with RT from December 1983 through September 1993. Median follow-up time was 63 months. Factors analyzed for each patient included age, sex, stage, anterior commissure involvement, surgical alternative, histologic differentiation, field size, total dose, fraction size, and total treatment time. Survival analysis methods were employed to assess the effects of these factors on local control and complication rates. Results: The 5-year local control rates by stage were as follows: T1a, 92%; T1b, 80%; T2a, 94%; and T2b, 23%. By univariate analysis, factors found to have a significant impact on local control were stage, surgical alternative, fraction size, anterior commissure involvement, and overall treatment time. By multivariate analysis, stage, field size, and fraction size were the only significant factors that independently influenced local control. Conclusion: The inferior control rate for stage T2b lesions has implications for treatment. Our study supports the conclusion of reports in the literature showing that low fraction size negatively influences outcome in patients with early glottic cancer

Definitive radiotherapy for early glottic carcinoma: prognostic factors and implications for treatment

International Nuclear Information System (INIS)

Burke, Lisa S.; Greven, Kathryn M.; McGuirt, Wyman T.; Case, Douglas; Hoen, Helena M.; Raben, Milton

1997-01-01

Purpose: Treatment and disease-related factors were analyzed for their influence on the outcome of patients treated definitively with irradiation (RT) for early glottic carcinoma. Methods and Materials: One hundred two patients with stage T1 or T2 glottic carcinomas were treated definitively with RT from December 1983 through September 1993. Median follow-up time was 63 months. Factors analyzed for each patient included age, sex, stage, anterior commissure involvement, surgical alternative, histologic differentiation, field size, total dose, fraction size, and total treatment time. Survival analysis methods were employed to assess the effects of these factors on local control and complication rates. Results: The 5-year local control rates by stage were as follows: T1a, 92%; T1b, 80%; T2a, 94%; and T2b, 23%. By univariate analysis, factors found to have a significant impact on local control were stage, surgical alternative, fraction size, anterior commissure involvement, and overall treatment time. By multivariate analysis, stage, field size, and fraction size were the only significant factors that independently influenced local control. Conclusions: The inferior control rate for stage T2b lesions has implications for treatment. Our study supports the conclusions of reports in the literature showing that low fraction size negatively influences outcome in patients with early glottic cancer

Intersect between self-esteem and emotion regulation in narcissistic personality disorder - implications for alliance building and treatment.

Science.gov (United States)

Ronningstam, Elsa

2017-01-01

Building an alliance with patients with pathological narcissism or narcissistic personality disorder, NPD, can be challenging and include avoidance, negative reactivity and disruptions. A main contributing factor can be the complex interaction between emotion and self-esteem regulation, which affects patients' ability to engage in a therapeutic alliance and treatment. Recent studies, especially in neuroscience have identified functional characteristic and compromises in self-esteem and emotion regulation related to NPD. Self-enhancement, hyper reactivity and need for control, which patients within the range of disordered narcissism often present, can have different roots and underpinnings that require thorough exploration in the process of building the therapeutic alliance and promote change in treatment. Clinical examples with treatment implications and strategies will be discussed to highlight both internal fluctuations and external features and shifts in narcissistic personality functioning.

Reassessing carbamazepine in the treatment of bipolar disorder: clinical implications of new data.

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Akiskal, Hagop S; Fuller, Matthew A; Hirschfeld, Robert M A; Keck, Paul E; Ketter, Terence A; Weisler, Richard H

2005-06-01

This monograph summarizes the proceedings of a roundtable meeting convened to discuss the role of carbamazepine in the treatment of bipolar disorder, in light of new data and the recent indication of carbamazepine extended-release capsules (CBZ ERC) for use in the treatment of acute manic and mixed episodes. Two lectures were presented, followed by a panel discussion among all 6 participants. A summary of the two pivotal trials of CBZ ERC and their pooled data along with other relevant data is presented first. Next, historical trends of carbamazepine and the agent's use in acute mania, bipolar depression, and maintenance are reviewed, emphasizing clinical implications of efficacy, safety, tolerability, and drug interactions. Finally, the panel discussion provides recommendations for the use of carbamazepine in different phases of the illness, taking into account adverse effects and drug-drug interactions. Panel discussants agree that current data confirm the utility of CBZ ERC as an effective treatment for acute manic and mixed episodes in bipolar disorder. Carbamazepine may also prove to be an option for maintenance treatment. Tolerability of the drug is related to dose and titration, and overall safety limitations regarding carbamazepine usage are comparable to other medications. For some patients, the main challenges to use of carbamazepine may be common drug-drug interactions and increased side effects related to aggressive introduction during treatment of acute manic and mixed episodes. Thus, carbamazepine may be a lower priority option for patients who are taking multiple medications, such as elderly individuals with medical comorbidity, due to the potential for drug interactions. Important benefits of carbamazepine include the low propensity toward weight gain and evidence of good tolerability with long-term treatment. (At present there are no available data from long-term, placebo-controlled studies evaluating the effects of carbamazepine or CBZ ERC on

Human Laboratory Settings for Assessing Drug Craving; Implications for the Evaluation of Treatment Efficacy

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Zahra Alam Mehrjerdi

2011-04-01

Full Text Available Research on assessing craving in laboratory settings often involves inducing and then measuring craving in subjects. Cue-induced craving is studied in laboratory settings using the cue reactivity paradigm, in which drug-related photos, videos, evocative scripts, olfactory cues, and paraphernalia may induce craving. Cue-induced craving evoked by drug-related stimuli could be associated with relapse and recurrence of drug addiction. In this article, the authors review different methods of assessing craving in laboratory settings and explain how human laboratory settings can bridge the gap between randomized clinical trials (RCTs and animal models on pharmacological treatments for drug dependence. The brief reviewed literature provides strong evidence that laboratory-based studies of craving may improve our understanding of how subjective reports of drug craving are related to objective measures of drug abuse and laboratory settings provide an opportunity to measure the degree to which they co-vary during pharmacological interventions. This issue has important implications inclinical studies.

Human Laboratory Settings for Assessing Drug Craving Implications for the Evaluation of Treatment Efficacy

Directory of Open Access Journals (Sweden)

Zahra Alam Mehrjerdi

2011-04-01

Full Text Available Research on assessing craving in laboratory settings often involves inducing and then measuring craving in subjects. Cue-induced craving is studied in laboratory settings using the cue reactivity paradigm, in which drug-related photos, videos, evocative scripts, olfactory cues, and paraphernalia may induce craving. Cue-induced craving evoked by drug-related stimuli could be associated with relapse and recurrence of drug addiction. In this article, the authors review different methods of assessing craving in laboratory settings and explain how human laboratory settings can bridge the gap between randomized clinical trials (RCTs and animal models on pharmacological treatments for drug dependence. The brief reviewed literature provides strong evidence that laboratory-based studies of craving may improve our understanding of how subjective reports of drug craving are related to objective measures of drug abuse and laboratory settings provide an opportunity to measure the degree to which they co-vary during pharmacological interventions. This issue has important implications inclinical studies.

Impact of Treatment Integrity on Intervention Effectiveness

Science.gov (United States)

Fryling, Mitch J.; Wallace, Michele D.; Yassine, Jordan N.

2012-01-01

Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity…

Skeletal-related events among breast and prostate cancer patients: towards new treatment initiation in Malaysia's hospital setting.

Science.gov (United States)

Ezat, Sharifa Wan Puteh; Syed Junid, Syed Mohamed Aljunid; Noraziani, Khamis; Zafar, Ahmed; Saperi, Sulong; Nur, Amrizal Muhammad; Aizuddin, Azimatun Noor; Ismail, Fuad; Abdullah, Norlia; Zainuddin, Zulkifli Md; Mohd Kassim, Abdul Yazid; Haflah, Nor Hazla Mohamed

2013-01-01

The human skeleton is the most common organ to be affected by metastatic cancer and bone metastases are a major cause of cancer morbidity. The five most frequent cancers in Malaysia among males includes prostate whereas breast cancer is among those in females, both being associated with skeletal lesions. Bone metastases weaken bone structure, causing a range of symptoms and complications thus developing skeletal-related events (SRE). Patients with SRE may require palliative radiotherapy or surgery to bone for pain, having hypercalcaemia, pathologic fractures, and spinal cord compression. These complications contribute to a decline in patient health- related quality of life. The multidimensional assessment of health-related quality of life for those patients is important other than considering a beneficial treatment impact on patient survival, since the side effects of treatment and disease symptoms can significantly impact health-related quality of life. Cancer treatment could contribute to significant financial implications for the healthcare system. Therefore, it is essential to assess the health-related quality of life and treatment cost, among prostate and breast cancer patients in countries like Malaysia to rationalized cost-effective way for budget allocation or utilization of health care resources, hence helping in providing more personalized treatment for cancer patients.

U.S.-Mexico Economic Relations: Trends, Issues, and Implications

Science.gov (United States)

2012-01-25

Time,” Economia , Fall 2003. 49 Esquivel, Gerardo, and José Antonio Rodríguez-López, “Technology, trade, and wage inequality in Mexico before and after...CRS Report for Congress Prepared for Members and Committees of Congress U.S.- Mexico Economic Relations: Trends, Issues, and Implications...25 JAN 2012 2. REPORT TYPE 3. DATES COVERED 00-00-2012 to 00-00-2012 4. TITLE AND SUBTITLE U.S.- Mexico Economic Relations: Trends, Issues, and

Management of treatment-related toxicities in advanced medullary thyroid cancer.

Science.gov (United States)

Brose, Marcia S; Bible, Keith C; Chow, Laura Q M; Gilbert, Jill; Grande, Carolyn; Worden, Francis; Haddad, Robert

2018-04-22

Progress in the treatment of advanced medullary thyroid cancer (MTC) has resulted from the approval of 2 drugs within the past 5 years, vandetanib and cabozantinib. These multikinase inhibitors (MKIs) possess overlapping specificities for multiple kinase targets implicated in the progression of MTC. Both drugs are associated with toxicities, including hypertension, hemorrhage/perforation, diarrhea and other gastrointestinal events, several dermatologic events, and hypothyroidism. In addition, vandetanib is uniquely associated with QTc prolongation through interaction with myocardial potassium channels, and cabozantinib is uniquely associated with hand-foot skin reaction. Treatment-related toxicities occur frequently and can be severe or life-threatening, and patients undergoing long-term treatment will likely experience adverse events (AEs). Here we offer specific practical recommendations for managing AEs commonly occurring with vandetanib and cabozantinib. The recommended approach relies on early recognition and palliation of symptoms, dose interruption, and dose reduction as necessary in order for the patient to maintain the highest tolerable dose for as long as possible and optimal quality of life. Treatment guidelines do not specify a recommended sequence for treating with vandetanib and cabozantinib; however, most patients will receive both drugs during their lifetime. The choice for first-line therapy is individualized after a risk-benefit assessment and depends on physician preference and patient-related factors, such as comorbid conditions. Because most generalist practices may not be familiar with the intricacies of agents such as vandetanib and cabozantinib, we commend that patients with advanced MTC be managed and treated by a thyroid cancer specialist with coordination of care within a multidisciplinary team. Copyright © 2018. Published by Elsevier Ltd.

Household-food market relations and its implications for food ...

African Journals Online (AJOL)

Household-food market relations and its implications for food security of farm ... of this relationship and how it affects the dietary supply of the household needs to be ... the rural areas of Imo state using a multi-stage random sampling technique. ... and transportation facilities will in the long run improve market efficiency and ...

Intimate partner violence offenders: Generating a data-based typology of batterers and implications for treatment

Directory of Open Access Journals (Sweden)

Olga Cunha

2013-07-01

Full Text Available Different studies have proposed that batterers can be classified into distinct groups according topsychopathology, violence severity and frequency. The aim of the current study was to define a data-basedbatterer’s typology and its implications for rehabilitation. Data were collected from 187 male sentenced forintimate partner violence –111 of them to prison and 76 to community service. A cluster analysis supporteda three-cluster solution: non-pathological (NP, 40%, antisocial/violent (AV, 27% and disturbed batterers(DB, 33%. Subsequent analysis showed that AV batterers were profiled through the perpetration of physicaland psychological violence, antisocial behaviour, deviant lifestyle, criminal records, inter parental violenceand drug abuse; DB batterers, were profiled through behaviours of psychological violence, physicalaggression and hostility, clinical symptomatology (e.g., somatisation, depression, anxiety, paranoidideation, criminal records, antisocial behaviour, and a deviant lifestyle; and NP batterers were not profiledthrough any of the variables related to criminality and recidivism. Multinomial logistic regressionsupported different logistic models for batterer types in terms of psychopathological, antisocial andperpetrated violence-type variables. Implications of batterer typology on treatment are discussed.

Exosomes: novel implications in diagnosis and treatment of gastrointestinal cancer.

Science.gov (United States)

Rahbari, Mohammad; Rahbari, Nuh; Reissfelder, Christoph; Weitz, Juergen; Kahlert, Christoph

2016-12-01

Amongst all cancer subtypes, gastrointestinal tumours are responsible for most cancer-related deaths. In most of the cases, the limitation of the prognosis of patients with malignant gastrointestinal tumours can be attributed to delayed diagnosis of the disease. In the last decade, secondary prevention strategies, in particular tumour screenings, have been identified to significantly improve the identification of patients with early-stage disease, leading to more effective therapeutic interventions. Therefore, new screening methods and further innovative treatment approaches may lead to an increase in progression-free and overall survival rates. Exosomes are small microvesicles with a size of 50-150 nm. They are formed in the endosomal system of many different cell types, where they are packed with nucleotides and proteins from the parental cell. After their release into the extracellular space, exosomes can deliver their cargo into recipient cells. By this mechanism, tumour cells can recruit and manipulate the adjacent and systemic microenvironment in order to support invasion and dissemination. Cancer-derived exosomes in the blood may provide detailed information about the tumour biology of each individual patient. Moreover, tumour-derived exosomes can be used as targetable factors and drug delivery agents in clinical practice. In this review, we summarise new aspects about novel implications in the diagnosis and treatment of gastrointestinal cancer and show how circulating exosomes have come into the spotlight of research as a high potential source of 'liquid biopsies'.

The Relation Between Antisocial and Borderline Personality Symptoms and Early Maladaptive Schemas in a Treatment Seeking Sample of Male Substance Users

Science.gov (United States)

Shorey, Ryan C.; Anderson, Scott; Stuart, Gregory L.

2014-01-01

Individuals with substance use disorders are more likely to have antisocial and borderline personality disorder than non-substance abusers. Recently, research has examined the relations between early maladaptive schemas and personality disorders, as early maladaptive schemas are believed to underlie personality disorders. However, there is a dearth of research on the relations between early maladaptive schemas and personality disorders among individuals seeking treatment for substance abuse. The current study examined the relations among early maladaptive schemas and antisocial and borderline personality within in a sample of men seeking substance abuse treatment (n = 98). Results demonstrated that early maladaptive schema domains were associated with antisocial and borderline personality symptoms. Implications of these findings for substance use treatment and research are discussed. PMID:23650153

Towards a neurobiological understanding of pain in chronic pancreatitis: mechanisms and implications for treatment

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Søren S. Olesen

2017-12-01

Conclusion:. Chronic pancreatitis is associated with abnormal processing of pain at the peripheral and central level of the pain system. This neurobiological understanding of pain has important clinical implications for treatment and prevention of pain chronification.

The relation between trait mindfulness and aggression in men seeking residential substance use treatment.

Science.gov (United States)

Shorey, Ryan C; Anderson, Scott; Stuart, Gregory L

2015-06-01

There has been an abundance of research in recent years on mindfulness, including mindfulness within individuals seeking substance use treatment. However, to date, there has been no research on whether trait mindfulness is associated with increased aggression among individuals seeking substance use treatment. Past research has demonstrated that individuals in substance use treatment evidence higher levels of aggression than non-substance abusers, and preliminary research has shown that trait mindfulness is inversely associated with aggression in non-substance-use treatment-seeking populations. The current study examined whether trait mindfulness was associated with aggression among men seeking residential substance use treatment (N = 116). Results demonstrated that lower trait mindfulness was associated with increased aggression (physical, verbal, and aggressive attitude). Moreover, this relation held for both verbal aggression and aggressive attitude after controlling for alcohol use, drug use, and age, all known predictors of aggression. Findings provide the first evidence that mindfulness is negatively associated with aggression among men in substance use treatment, which could have important implications for intervention. That is, mindfulness-based interventions may prove helpful for the treatment of both substance use and aggression. © The Author(s) 2014.

Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications

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Askin Dogan

2016-06-01

Full Text Available Our aim was to evaluate the relationship between the success of methotrexate treatment and β-hCG levels in progressive tubal ectopic pregnancies. We defined a retrospective cohort of 394 progressive tubal ectopic pregnancy patients treated with methotrexate. A single-dose methotrexate protocol using 50 mg/m2 was administered to patients with progressive tubal ectopic pregnancy. Surgery was performed in patients who exhibited signs of acute abdomen due to tubal rupture. Of 394 patients that received methotrexate treatment, 335 (84.6% responded to medical treatment, while the remaining 59 (15.36% underwent surgery due to treatment failure. β-hCG levels in the failure group were significantly higher as compared with the success group at Day 1, Day 4, and Day 7 (2116±3157 vs. 4178±3422, 2062±3551 vs. 4935±4103, and 1532±3007 vs. 3900±4783, respectively. The receiver operating characteristics curve for β-hCG levels at Day 1 was 0.738, with a cutoff value of 1418 mIU/mL, while sensitivity and specificity values reached the optimum for treatment success (83.1% and 59.4%, respectively. Medical treatment with methotrexate achieved an 85.02% success rate for the treatment of progressive tubal ectopic pregnancy, while success rates for medical treatment decreased significantly when initial β-hCG levels were >1418 mIU/mL.

Military Dissent: What are the Ethical Implications of Tensions in U.S. Civil-Military Relations?

Science.gov (United States)

2013-06-14

ethical , and political. 22 Pfaff 1999, 8). The beliefs of egoism and post-modern relativism can be...MILITARY DISSENT: WHAT ARE THE ETHICAL IMPLICATIONS OF TENSIONS IN U.S. CIVIL-MILITARY RELATIONS? A thesis presented to the...JUN 2013 4. TITLE AND SUBTITLE Military Dissent: What are the Ethical Implications of Tensions in U.S. Civil-Military Relations? 5a. CONTRACT

Role of Sleep Deprivation in Fear Conditioning and Extinction: Implications for Treatment of PTSD

Science.gov (United States)

2015-10-01

mechanism underlying the most successful treatment for PTSD, Prolonged Exposure. In animal models, sleep deprivation has been shown to impair extinction ...2. 3. 9 +Sleep and Extinction Learning  Animal models show fear conditioning:  Disrupts sleep  Disrupted sleep, in turn  Impairs extinction ...Award Number: W81XWH-11-2-0001 TITLE: “Role of Sleep Deprivation in Fear Conditioning and Extinction : Implications for Treatment of PTSD

On the accuracy, uniqueness and implication of dimensionless accidental relations between fundamental constants

International Nuclear Information System (INIS)

Bahran, M.; Univ. of Oklahoma, Norman-OK,

2002-01-01

Ibrahim et al(1) found an accidental formula relating the gravitational coupling constant, the electromagnetic fine structure constant and the proton to electron mass ratio. This work comments on such relation, in particular it studies the accuracy, uniqueness and unification implication of such accidental relation.(author)

Role of Sleep Deprivation in Fear Conditioning and Extinction: Implications for Treatment of PTSD

Science.gov (United States)

2015-12-01

1 Award Number: W81XWH-11-2-0001 TITLE: Role of Sleep Deprivation in Fear Conditioning and Extinction: Implications for Treatment of PTSD...REPORT TYPE Final 3. DATES COVERED (From - To) 1 Oct 2010 – 30 Sep 2015 4. TITLE AND SUBTITLE Role of Sleep Deprivation in Fear Conditioning and...especially adequate REM during exposure therapy may enhance efficacy and reduce remission after treatment. 15. SUBJECT TERMS PTSD, sleep deprivation , fear

The Molecular Immunology of Mucositis: Implications for Evidence-Based Research in Alternative and Complementary Palliative Treatments

Directory of Open Access Journals (Sweden)

Francesco Chiappelli

2005-01-01

Full Text Available The terms ‘mucositis’ and ‘stomatitis’ are often used interchangeably. Mucositis, however, pertains to pharyngeal-esophago-gastrointestinal inflammation that manifests as red, burn-like sores or ulcerations throughout the mouth. Stomatitis is an inflammation of the oral tissues proper, which can present with or without sores, and is made worse by poor dental hygiene. Mucositis is observed in a variety of immunosuppressed patients, but is most often consequential to cancer therapy. It appears as early as the third day of intervention, and is usually established by Day 7 of treatment. Mucositis increases mortality and morbidity and contributes to rising health care costs. The precise immune components involved in the etiology of mucositis are unclear, but evidence-based research (EBR data has shown that applications of granulocyte–macrophage-colony stimulating factor prevent the onset or the exacerbation of oropharyngeal mucositis. The molecular implications of this observation are discussed from the perspective of future developments of complementary and alternative treatments for this condition. It must be emphasized that this article is meant to be neither a review on mucositis and the various treatments for it, nor a discussion paper on its underlying molecular immunology. It is a statement of the implications of EBR for CAM-based interventions for mucositis. It explores and discusses the specific domain of molecular immunology in the context of mucositis and its direct implications for EBR research in CAM-based treatments for mucositis.

The psychological development of panic disorder: implications for neurobiology and treatment.

Science.gov (United States)

Cosci, Fiammetta

2012-06-01

The aim of this study was to survey the available literature on psychological development of panic disorder with or without agoraphobia [PD(A)] and its relationship with the neurobiology and the treatment of panic. Both a computerized (PubMed) and a manual search of the literature were performed. Only English papers published in peer-reviewed journals and referring to PD(A) as defined by the diagnostic classifications of the American Psychiatric Association or of the World Health Organization were included. A staging model of panic exists and is applicable in clinical practice. In a substantial proportion of patients with PD(A), a prodromal phase and, despite successful treatment, residual symptoms can be identified. Both prodromes and residual symptoms allow the monitoring of disorder evolution during recovery via the rollback phenomenon. The different stages of the disorder, as well as the steps of the rollback, have a correspondence in the neurobiology and in the treatment of panic. However, the treatment implications of the longitudinal model of PD(A) are not endorsed, and adequate interventions of enduring effects are missing.

Internet addiction: coping styles, expectancies, and treatment implications.

Science.gov (United States)

Brand, Matthias; Laier, Christian; Young, Kimberly S

2014-01-01

Internet addiction (IA) has become a serious mental health condition in many countries. To better understand the clinical implications of IA, this study tested statistically a new theoretical model illustrating underlying cognitive mechanisms contributing to development and maintenance of the disorder. The model differentiates between a generalized Internet addiction (GIA) and specific forms. This study tested the model on GIA on a population of general Internet users. The findings from 1019 users show that the hypothesized structural equation model explained 63.5% of the variance of GIA symptoms, as measured by the short version of the Internet Addiction Test. Using psychological and personality testing, the results show that a person's specific cognitions (poor coping and cognitive expectations) increased the risk for GIA. These two factors mediated the symptoms of GIA if other risk factors were present such as depression, social anxiety, low self-esteem, low self-efficacy, and high stress vulnerability to name a few areas that were measured in the study. The model shows that individuals with high coping skills and no expectancies that the Internet can be used to increase positive or reduce negative mood are less likely to engage in problematic Internet use, even when other personality or psychological vulnerabilities are present. The implications for treatment include a clear cognitive component to the development of GIA and the need to assess a patient's coping style and cognitions and improve faulty thinking to reduce symptoms and engage in recovery.

Internet addiction: coping styles, expectancies, and treatment implications

Science.gov (United States)

Brand, Matthias; Laier, Christian; Young, Kimberly S.

2014-01-01

Internet addiction (IA) has become a serious mental health condition in many countries. To better understand the clinical implications of IA, this study tested statistically a new theoretical model illustrating underlying cognitive mechanisms contributing to development and maintenance of the disorder. The model differentiates between a generalized Internet addiction (GIA) and specific forms. This study tested the model on GIA on a population of general Internet users. The findings from 1019 users show that the hypothesized structural equation model explained 63.5% of the variance of GIA symptoms, as measured by the short version of the Internet Addiction Test. Using psychological and personality testing, the results show that a person’s specific cognitions (poor coping and cognitive expectations) increased the risk for GIA. These two factors mediated the symptoms of GIA if other risk factors were present such as depression, social anxiety, low self-esteem, low self-efficacy, and high stress vulnerability to name a few areas that were measured in the study. The model shows that individuals with high coping skills and no expectancies that the Internet can be used to increase positive or reduce negative mood are less likely to engage in problematic Internet use, even when other personality or psychological vulnerabilities are present. The implications for treatment include a clear cognitive component to the development of GIA and the need to assess a patient’s coping style and cognitions and improve faulty thinking to reduce symptoms and engage in recovery. PMID:25426088

Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications.

Science.gov (United States)

Brewin, Chris R; Gregory, James D; Lipton, Michelle; Burgess, Neil

2010-01-01

Involuntary images and visual memories are prominent in many types of psychopathology. Patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis frequently report repeated visual intrusions corresponding to a small number of real or imaginary events, usually extremely vivid, detailed, and with highly distressing content. Both memory and imagery appear to rely on common networks involving medial prefrontal regions, posterior regions in the medial and lateral parietal cortices, the lateral temporal cortex, and the medial temporal lobe. Evidence from cognitive psychology and neuroscience implies distinct neural bases to abstract, flexible, contextualized representations (C-reps) and to inflexible, sensory-bound representations (S-reps). We revise our previous dual representation theory of posttraumatic stress disorder to place it within a neural systems model of healthy memory and imagery. The revised model is used to explain how the different types of distressing visual intrusions associated with clinical disorders arise, in terms of the need for correct interaction between the neural systems supporting S-reps and C-reps via visuospatial working memory. Finally, we discuss the treatment implications of the new model and relate it to existing forms of psychological therapy.

Gender-related clinical and neurocognitive differences in individuals seeking treatment for pathological gambling

DEFF Research Database (Denmark)

Grant, Jon E; Chamberlain, Samuel R; Schreiber, Liana R N

2012-01-01

Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for selecting appropriate prevention and treatment strategies. The aim of this study was to investigate clinical and cogn...... and cognitive differences in treatment-seeking people with pathological gambling as a function of gender....

Healing environments in cancer treatment and care. Relations of space and practice in hematological cancer treatment.

Science.gov (United States)

Høybye, Mette Terp

2013-02-01

Given the growing attention to the importance of design in shaping healing hospital environments this study extends the understanding of healing environments, beyond causal links between environmental exposure and health outcome by elucidating how environments and practices interrelate. The study was conducted as an ethnographic fieldwork from March 2011 to September 2011 at the Department of Haematology at Odense University Hospital, Denmark, systematically using participant observation and interviews as research strategies. It included 20 patients, four of who were followed closely over an extended time period. Through thematic analysis five key concepts emerged about the social dynamics of hospital environments: practices of self; creating personal space; social recognition; negotiating space; and ambiguity of space and care. Through these concepts, the study demonstrates how the hospital environment is a flow of relations between space and practice that changes and challenges a structural idea of design and healing. Patients' sense of healing changes with the experience of progression in treatment and the capacity of the hospital space to incite an experience of homeliness and care. Furthermore, cancer patients continuously challenge the use and limits of space by individual objects and practices of privacy and home. Healing environments are complex relations between practices, space and care, where recognition of the individual patient's needs, values and experiences is key to developing the environment to support the patient quality of life. The present study holds implications for practice to inform design of future hospital environments for cancer treatment. The study points to the importance for being attentive to the need for flexible spaces in hospitals that recognize the dynamics of healing, by providing individualized care, relating to the particular and changing needs of patients supporting their potential and their challenged condition with the best

Internet addiction: Coping Styles, Expectancies, and Treatment Implications

Directory of Open Access Journals (Sweden)

Matthias eBrand

2014-11-01

Full Text Available Internet addiction has become a serious mental health condition in many countries. To better understand the clinical implications of Internet addiction, this study tested statistically a new theoretical model illustrating underlying cognitive mechanisms contributing to development and maintenance of the disorder. The model differentiates between a generalized Internet addiction (GIA and specific forms. This study tested the model on GIA on a population of general Internet users. The findings from 1019 users showed that the hypothesized structural equation model explained 63.5% of the variance of GIA symptoms, as measured by the short version of the Internet Addiction Test (s-IAT. Using psychological and personality testing, the results show that a person’s specific cognitions (poor coping and cognitive expectations increased the risk for generalized Internet addiction. These two factors mediated the symptoms of GIA if other risk factors were present such as depression, social anxiety, low self-esteem, low self-efficacy, and high stress vulnerability to name a few areas that were measured in the study. The model shows that individuals with high coping skills and no expectancies that the Internet can be used to increase positive or reduce negative mood are less likely to engage in problematic Internet use, even when other personality or psychological vulnerabilities are present. The implications for treatment include a clear cognitive component to the development of generalized Internet addiction and the need to assess a patient’s coping style and cognitions and improve faulty thinking to reduce symptoms and engage in recovery.

The relation between antisocial and borderline personality symptoms and early maladaptive schemas in a treatment seeking sample of male substance users.

Science.gov (United States)

Shorey, Ryan C; Anderson, Scott; Stuart, Gregory L

2014-01-01

Individuals with substance use disorders are more likely to have antisocial and borderline personality disorder than non-substance abusers. Recently, research has examined the relations between early maladaptive schemas and personality disorders, as early maladaptive schemas are believed to underlie personality disorders. However, there is a dearth of research on the relations between early maladaptive schemas and personality disorders among individuals seeking treatment for substance abuse. The current study examined the relations among early maladaptive schemas and antisocial and borderline personality within in a sample of men seeking substance abuse treatment (n = 98). Results demonstrated that early maladaptive schema domains were associated with antisocial and borderline personality symptoms. Implications of these findings for substance use treatment and research are discussed. Antisocial (ASPD) and Borderline (BPD) personality disorder symptoms are prevalence among individuals seeking substance abuse treatment. Early maladaptive schemas are believed to underlie the development of ASPD and BPD symptoms, and are also prevalence among individuals seeking substance use treatment. Findings from the current study suggest that specific early maladaptive schema domains predict ASPD and BPD symptoms in a substance abuse treatment seeking sample of adult males. The treatment of ASPD and BPD among men seeking substance use treatment may want to focus on early maladaptive schemas. Copyright © 2013 John Wiley & Sons, Ltd.

Implications of Infliximab Treatment Failure and Influence of Personalized Treatment on Patient-reported Health-related Quality of Life and Productivity Outcomes in Crohn's Disease

DEFF Research Database (Denmark)

Steenholdt, Casper; Brynskov, Jørn; Thomsen, Ole Ø

2015-01-01

regimen (n = 36) or personalized treatment defined by IFX and anti-IFX antibodies (n = 33). Health-related quality of life evaluated with the Short Inflammatory Bowel Disease Questionnaire (IBDQ) and productivity evaluated with the Work Productivity and Activity Impairment Questionnaire (WPAI:CD) were...... (increase of median 4, p absenteeism was negligible during the entire study period...

Treatment-related amenorrhea and sexual functioning in young breast cancer survivors.

Science.gov (United States)

Rosenberg, Shoshana M; Tamimi, Rulla M; Gelber, Shari; Ruddy, Kathryn J; Bober, Sharon L; Kereakoglow, Sandra; Borges, Virginia F; Come, Steven E; Schapira, Lidia; Partridge, Ann H

2014-08-01

Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and an important determinant of quality of life. However, few studies have explored how treatment and other factors affect sexual functioning in young breast cancer survivors. Four hundred sixty-one premenopausal women with stage 0 through III breast cancer were surveyed an average of 1 year after diagnosis as part of a prospective cohort study of women who were aged ≤40 years at diagnosis. Sexual interest and dysfunction were assessed using the Cancer Rehabilitation Evaluation System (CARES). Mean CARES scores were compared and multiple regression models were fit to assess treatment and a range of menopausal and somatic symptoms in relation to sexual functioning. Mean CARES sexual interest and dysfunction scores were both highest (indicating poorer functioning) among women who received chemotherapy and were amenorrheic from treatment. After accounting for menopausal and somatic symptoms, treatment-associated amenorrhea remained associated with decreased interest but was no longer an independent predictor of dysfunction. In the multivariable analysis, independent predictors of dysfunction included vaginal pain symptoms, poorer body image, and fatigue. Sexual interest was associated with vaginal pain symptoms, body image, and weight problems. Factors associated with decreased sexual functioning in young breast cancer survivors can often be ameliorated. The current findings have implications for premenopausal women with other types of cancer who might be experiencing amenorrhea because of chemotherapy or surgery. Increased awareness and early intervention is essential to help improve sexual functioning and associated quality of life for all young cancer survivors. © 2014 American Cancer Society.

Parkinsonian motor impairment predicts personality domains related to genetic risk and treatment outcomes in schizophrenia.

Science.gov (United States)

Molina, Juan L; Calvó, María; Padilla, Eduardo; Balda, Mara; Alemán, Gabriela González; Florenzano, Néstor V; Guerrero, Gonzalo; Kamis, Danielle; Rangeon, Beatriz Molina; Bourdieu, Mercedes; Strejilevich, Sergio A; Conesa, Horacio A; Escobar, Javier I; Zwir, Igor; Cloninger, C Robert; de Erausquin, Gabriel A

2017-01-01

Identifying endophenotypes of schizophrenia is of critical importance and has profound implications on clinical practice. Here we propose an innovative approach to clarify the mechanims through which temperament and character deviance relates to risk for schizophrenia and predict long-term treatment outcomes. We recruited 61 antipsychotic naïve subjects with chronic schizophrenia, 99 unaffected relatives, and 68 healthy controls from rural communities in the Central Andes. Diagnosis was ascertained with the Schedules of Clinical Assessment in Neuropsychiatry; parkinsonian motor impairment was measured with the Unified Parkinson's Disease Rating Scale; mesencephalic parenchyma was evaluated with transcranial ultrasound; and personality traits were assessed using the Temperament and Character Inventory. Ten-year outcome data was available for ~40% of the index cases. Patients with schizophrenia had higher harm avoidance and self-transcendence (ST), and lower reward dependence (RD), cooperativeness (CO), and self-directedness (SD). Unaffected relatives had higher ST and lower CO and SD. Parkinsonism reliably predicted RD, CO, and SD after correcting for age and sex. The average duration of untreated psychosis (DUP) was over 5 years. Further, SD was anticorrelated with DUP and antipsychotic dosing at follow-up. Baseline DUP was related to antipsychotic dose-years. Further, 'explosive/borderline', 'methodical/obsessive', and 'disorganized/schizotypal' personality profiles were associated with increased risk of schizophrenia. Parkinsonism predicts core personality features and treatment outcomes in schizophrenia. Our study suggests that RD, CO, and SD are endophenotypes of the disease that may, in part, be mediated by dopaminergic function. Further, SD is an important determinant of treatment course and outcome.

Forensic investigation of medical treatment related deaths.

Science.gov (United States)

Ibrahim, Joseph E; Ranson, David L; O'Brien, Adam; Charles, Amanda; Young, Carmel

2009-04-01

Patients suffer preventable harm from their medical treatment. The traditional approaches to investigating medical treatment related deaths are the 'hospital mortality audit' and legal or coroners investigation. The aim is to describe how the patient safety movement in the late 1990s is changing traditional approaches to the investigation. The prevention of medical treatment related death involves an investigation as one of five major stages. These are Stage I Preparedness; Stage II Recognition and reporting; Stage III Investigation and analysis; Stage IV Findings and recommendations; and Stage V Response. The influence of the patient safety approach is considered at each stage with a particular focus on Stage I. It is at this stage that the concepts of clinical governance, culture and systems of care have a major influence on the nature of an investigation. The genesis of the modern forensic investigation into medical treatment related deaths in Victoria, Australia is described. The formation of the Clinical Liaison Service incorporates concepts from the patient safety approach with clinical staff to transform the traditional Coroner's investigation. Benefits of a modern forensic investigation include improving appropriateness of cases proceeding to investigation and a focus on prevention. Achieving a reduction in medical treatment related death requires substantial shifts towards an approach consistent with the patient safety.

Improving consistency and quality of service delivery: implications for the addiction treatment field.

Science.gov (United States)

Knott, Anne Marie; Corredoira, Rafael; Kimberly, John

2008-09-01

Addiction treatment providers face serious problems in delivering consistent, high-quality services over time. Among those providers with multiple treatment sites, there is also intersite variability. This is a serious problem in the addiction field, likely to be made worse as new technologies are introduced and/or as there is industry consolidation (Corredoira, R., Kimberly, J. (2006) Industry evolution through consolidation: Implications for addiction treatment. Journal of Substance Abuse Treatment 31, 255-265.). Although serious, these problems in managing and monitoring to assure consistent service quality have been faced by many other industries. Here, we review evidence from research in other industries regarding three different forms of management (vertical integration, franchising, and licensing) across a chain of individual service providers. We show how each management form affects the level, consistency, and improvement of service delivery over time. In addition, we discuss how such performance advantages affect customer demand as well as regulatory endorsement of the consolidated firm and its approach.

Resource utilization implications of treatment were able to be assessed from appropriately reported clinical trial data

NARCIS (Netherlands)

Poole-Wilson, Philip A.; Kirwan, Bridget-Anne; Voko, Zoltan; de Brouwer, Sophie; Dunselman, Peter H. J. M.; van Dalen, Frederik J.; Lubsen, Jacobus

Background and Objective: Published clinical trial data rarely allow assessment of the health care resource utilization implications of treatment. We give an example of how these can be assessed given appropriate tabulation of data. Methods: Data from a trial comparing long-acting nifedipine

Cancer-related fatigue--mechanisms, risk factors, and treatments.

Science.gov (United States)

Bower, Julienne E

2014-10-01

Fatigue is one of the most common adverse effects of cancer that might persist for years after treatment completion in otherwise healthy survivors. Cancer-related fatigue causes disruption in all aspects of quality of life and might be a risk factor of reduced survival. The prevalence and course of fatigue in patients with cancer have been well characterized and there is growing understanding of the underlying biological mechanisms. Inflammation seems to have a key role in fatigue before, during, and after cancer-treatment. However, there is a considerable variability in the presentation of cancer-related fatigue, much of which is not explained by disease-related or treatment-related characteristics, suggesting that host factors might be important in the development and persistence of this symptom. Indeed, longitudinal studies have identified genetic, biological, psychosocial, and behavioural risk factors associated with cancer-related fatigue. Although no current gold-standard treatment for fatigue is available, a variety of intervention approaches have shown beneficial effects in randomized controlled trials, including physical activity, psychosocial, mind-body, and pharmacological treatments. This Review describes the mechanisms, risk factors, and possible interventions for cancer-related fatigue, focusing on recent longitudinal studies and randomized trials that have targeted fatigued patients.

Treatment of Menstrual-Related Migraine

Directory of Open Access Journals (Sweden)

J Gordon Millichap

2008-05-01

Full Text Available A review and meta-analysis of therapy trials for menstrual-related migraine headache (MRM and evidence-based recommendations for acute and short-term preventive treatment are reported from Toronto Western Hospital, ON, Canada.

Examination and Treatment of Hamstring Related Injuries

Science.gov (United States)

2012-01-01

Context: There is a wide spectrum of hamstring-related injuries that can occur in the athlete. Accurate diagnosis is imperative to prevent delayed return to sport, injury recurrence, and accurate clinical decision making regarding the most efficacious treatment. Evidence Acquisition: This review highlights current evidence related to the diagnosis and treatment of hamstring-related injuries in athletes. Data sources were limited to peer-reviewed publications indexed in MEDLINE from 1988 through May 2011. Results: An accurate diagnostic process for athletes with posterior thigh–related complaints should include a detailed and discriminative history, followed by a thorough clinical examination. Diagnostic imaging should be utilized when considering hamstring avulsion or ischial apophyseal avulsion. Diagnostic imaging may also be needed to further define the cause of referred posterior thigh pain. Conclusions: Differentiating acute hamstring strains, hamstring tendon avulsions, ischial apophyseal avulsions, proximal hamstring tendinopathies, and referred posterior thigh pain is critical in determining the most appropriate treatment and expediting safe return to play. PMID:23016076

Cancer-related fatigue: Mechanisms, risk factors, and treatments

Science.gov (United States)

Bower, Julienne E.

2015-01-01

Fatigue is one of the most common and distressing side effects of cancer and its treatment, and may persist for years after treatment completion in otherwise healthy survivors. Cancer-related fatigue causes disruption in all aspects of quality of life and may be a risk factor for reduced survival. The prevalence and course of fatigue in cancer patients has been well characterized, and there is growing understanding of underlying biological mechanisms. Inflammation has emerged as a key biological pathway for cancer-related fatigue, with studies documenting links between markers of inflammation and fatigue before, during, and particularly after treatment. There is considerable variability in the experience of cancer-related fatigue that is not explained by disease- or treatment-related characteristics, suggesting that host factors may play an important role in the development and persistence of this symptom. Indeed, longitudinal studies have begun to identify genetic, biological, psychosocial, and behavioral risk factors for cancer-related fatigue. Given the multi-factorial nature of cancer-related fatigue, a variety of intervention approaches have been examined in randomized controlled trials, including physical activity, psychosocial, mind-body, and pharmacological treatments. Although there is currently no gold standard for treating fatigue, several of these approaches have shown beneficial effects and can be recommended to patients. This report provides a state of the science review of mechanisms, risk factors, and interventions for cancer-related fatigue, with a focus on recent longitudinal studies and randomized trials that have targeted fatigued patients. PMID:25113839

Relative age effect: implications for effective practice.

Science.gov (United States)

Andronikos, Georgios; Elumaro, Adeboye Israel; Westbury, Tony; Martindale, Russell J J

2016-01-01

Physical and psychological differences related to birthdate amongst athletes of the same selection year have been characterised as the "relative age effects" (RAEs). RAEs have been identified in a variety of sports, both at youth and adult level, and are linked with dropout of athletes and a reduction of the talent pool. This study examined the existence, mechanisms and possible solutions to RAEs using qualitative methodology. Seven experts in the field of talent identification and development were interviewed. Inductive analysis of the data showed that, while there was mixed evidence for the existence of RAEs across sports, the eradication of RAEs was attributed to controllable features of the development environment. The factors reported included the structure of "categories" used to group athletes within the sport (e.g. age, weight, size, skills), recognition and prioritisation of long-term development over "short term win focus." Education of relevant parties (e.g. coaches, scouts, clubs) about RAEs and the nature of "talent" within a long-term context was suggested, along with careful consideration of the structure of the development environment (e.g. delayed selection, provision for late developers, focus on skills not results, use of challenge). Implications for research and practice are discussed.

CDC staging based on absolute CD4 count and CD4 percentage in an HIV-1-infected Indian population: treatment implications

Science.gov (United States)

Vajpayee, M; Kaushik, S; Sreenivas, V; Wig, N; Seth, P

2005-01-01

CD4+ T-cell levels are an important criterion for categorizing HIV-related clinical conditions according to the CDC classification system and are therefore important in the management of HIV by initiating antiretroviral therapy and prophylaxis for opportunistic infections due to HIV among HIV-infected individuals. However, it has been observed that the CD4 counts are affected by the geographical location, race, ethnic origin, age, gender and changes in total and differential leucocyte counts. In the light of this knowledge, we classified 600 HIV seropositive antiretroviral treatment (ART)-naïve Indian individuals belonging to different CDC groups A, B and C on the basis of CDC criteria of both CD4% and CD4 counts and receiver operating characteristic (ROC) curves were generated. Importantly, CDC staging on the basis of CD4% indicated significant clinical implications, requiring an early implementation of effective antiretroviral treatment regimen in HIV-infected individuals deprived of treatment when classified on the basis of CD4 counts. PMID:16045738

Mode of administration of dulaglutide: implications for treatment adherence

Directory of Open Access Journals (Sweden)

Amblee A

2016-06-01

Full Text Available Ambika Amblee1,2 1Department of Internal Medicine, Division of Endocrinology, John Stroger Hospital of Cook County, 2Rush University Medical Center, Chicago, IL, USA Background: Medication complexity/burden can be associated with nonadherence in patients with type 2 diabetes mellitus (T2DM. Patients’ satisfaction with their treatment is an important consideration for physicians. Strategies like using longer acting efficacious agents with less frequent dosing may help adherence. Objective: To explore the mode of administration of dulaglutide and its implications for treatment adherence in T2DM. Methods: PubMed search using the term “Dulaglutide” through October 31, 2015 was conducted. Published articles, press releases, and abstracts presented at national/international meetings were considered. Results/conclusion: Dulaglutide is a once-weekly glucagon like peptide-1 analog with a low intraindividual variability. Phase III trials demonstrated significant improvements in glycemia and weight, with a low hypoglycemia risk similar to liraglutide/exenatide, but with substantially fewer injections. A significant improvement was observed in the total Diabetes Treatment Satisfaction Questionnaire score, Impact of Weight on Self-Perception, and perceived frequency of hyperglycemia with dulaglutide when compared with placebo, exenatide, liraglutide, or metformin. Treatment satisfaction scores showed an improvement with dulaglutide (34%–39% when compared with exenatide (31%. A positive experience with a high initial (97.2% and final (99.1% injection success rate along with a significant reduction in patients’ fear of self-injecting, as measured by the modified self-injecting subscale of the Diabetes Fear of Injecting and Self-Testing Questionnaire and Medication Delivery Device Assessment Battery, was found. Its acceptance was high (>96% among a variety of patients including patients who fear injections and injection-naïve users. Dulaglutide is

The Media's Influence on Female Relational Aggression and Its Implications for Schools

Science.gov (United States)

Virtanen, Crystal

2013-01-01

The author of this paper explores the media's role in the normalization of relational aggression of females and the implications this can have in schools. It is important that those who teach, support, and develop curricula for students be aware of the media's role in the use, and the effects, of indirect aggression and have information on how to…

Mobile phones in residential treatment: implications for practice.

Science.gov (United States)

Collier, Scott; Gavriel, Mardell

2015-08-01

A nonprofit primary care, substance abuse and mental health treatment provider that operates nine separate residential treatment facilities in both northern and southern California began allowing clients to keep their mobile phones while in treatment. From the advent of mobile phone technology and its widespread adoption through early 2013, the organization prohibited clients from having phones while in treatment. Calls to and from clients needed to be made and received at the house phone. After years of enforcing the policy with diminished success as phones became cheaper, smaller, and more prevalent, agency leadership decided to experiment with allowing the clients to keep their phones while in treatment. Elopement data as they relate to the policy are examined along with data from staff interviews about its implementation and impact. Results show that elopements resulting from being caught with a mobile phone were eliminated and some clients were able to be returned to treatment using the devices. All seven (100%) of the interviewees were supportive of the new policy and thought it should be continued. The impact of the policy on clinical disruptions, lost/stolen property liability, and confidentiality issues are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

Treatment of Hereditary Hemorrhagic Telangiectasia-Related Epistaxis.

Science.gov (United States)

Sautter, Nathan B; Smith, Timothy L

2016-06-01

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease with an incidence of 1:5000. Recurrent, spontaneous epistaxis is the most common presenting symptom. Severity of epistaxis varies widely, from mild, self-limited nosebleeds to severe, life-threatening nasal hemorrhage. Treatment of HHT-related epistaxis presents a challenge to the otolaryngologist due to the recurrent, persistent nature of epistaxis often requiring multiple treatments. Treatment modalities range from conservative topical therapies to more aggressive surgical treatments. Copyright © 2016 Elsevier Inc. All rights reserved.

Treatment response in HCV related chronic hepatitis

International Nuclear Information System (INIS)

Hussain, A.B.; Hussain, T.; Hussain, S.; Masood, A.; Kazmi, Y.; Tariq, W.Z.; Karamat, K.A.

2004-01-01

Objective: To evaluate the virological response to treatment with interferon and ribavirin in-patients with hepatitis C related liver disease. Material and Methods: Two hundred seventy-nine patients were included in the study. These patients had taken interferon and ribavirin treatment for HCV related chronic hepatitis, and were referred to AFIP for HCV RNA testing by polymerase chain reaction (PCR) between January 2002 and September 2002. Out of 279 cases, 229 had taken the treatment for 06 or 12 months and were tested for end-of-treatment response (ETR). Fifty patients had completed there treatment regimens of 6 or 12 months treatment, at least 24 weeks before their PCR test and were having follow-up testing for sustained viral response (SVR). The sera of these patients were tested for HCV RNA by PCR, using a commercial kit of Amplicor (Roche) for qualitative detection of HCV RNA. Results: Out of 229 cases tested for end-of-treatment response, 198 (86.5%) had no detectable HCV RNA (responders) and 31 (13.50%) were PCR positive (non-responders). Thirty-eight out of 50 cases, tested for a sustained viral response, had a negative result for HCV PCR thus showing sustained response rate of 76%. Conclusion: The viral remission/response to interferon and ribavirin combination therapy in our patients was better than that quoted in other regions. (author)

Treatment, material, care, and patient-related factors in contact lens-related dry eye.

Science.gov (United States)

Ramamoorthy, Padmapriya; Sinnott, Loraine T; Nichols, Jason J

2008-08-01

To examine the effect of general contact lens and material characteristics, care solutions, treatment, and patient-related factors on contact lens-related dry eye. The data were derived from the Contact Lens and Dry Eye Study, designed as a cross-sectional and nested case-control study including 360 subjects. In separate statistical models, logistic regression was used to examine general contact lens characteristics, specific hydrogel lens materials, care solutions, and patient-related factors associated with dry eye status (controlled for age, gender, and current treatments). Several factors were significantly associated with dry eye, including treatment factors such as a recent contact lens refitting (odds ratios [OR] = 5.75, 95% confidence intervals [CI] = 2.14 to 15.46) and use of artificial tears/rewetting drops (OR = 1.09, 95% CI = 1.02 to 1.16), in addition, currently worn materials including Food and Drug Administration (FDA) group II (OR = 2.98, 95% CI = 1.14 to 6.19) and IV (OR = 1.87, 95% CI = 1.08 to 3.24). Significant patient-related factors included decreased overall satisfaction (OR = 3.57, 95% CI = 2.08 to 5.88,), dry eye in the absence of contact lens wear (OR = 6.54, 95% CI = 2.57 to 16.62), reduced daily lens wear duration (OR = 1.16, 95% CI = 1.06 to 1.26), and reduced ability to wear lenses as long as desired (OR = 2.44, 95% CI = 1.30 to 4.54). Care solutions were not associated with contact lens-related dry eye. The strong association of common treatment factors with dry eye status in contact lens wearers suggests that these treatments are not entirely effective. The use of high water content materials was strongly related to dry eye in lens wearers, whereas care solutions were not. Contact lens-related dry eye was also associated with several patient-related factors such as greater ocular discomfort (without lenses), dissatisfaction, and inability to wear lenses for desired durations.

Surgical treatment of polymicrogyria-related epilepsy.

Science.gov (United States)

Cossu, Massimo; Pelliccia, Veronica; Gozzo, Francesca; Casaceli, Giuseppe; Francione, Stefano; Nobili, Lino; Mai, Roberto; Castana, Laura; Sartori, Ivana; Cardinale, Francesco; Lo Russo, Giorgio; Tassi, Laura

2016-12-01

The role of resective surgery in the treatment of polymicrogyria (PMG)-related focal epilepsy is uncertain. Our aim was to retrospectively evaluate the seizure outcome in a consecutive series of patients with PMG-related epilepsy who received, or did not receive, surgical treatment, and to outline the clinical characteristics of patients who underwent surgery. We evaluated 64 patients with epilepsy associated with magnetic resonance imaging (MRI)-documented PMG. After presurgical evaluation, 32 patients were excluded from surgical treatment and 32 were offered surgery, which was declined by 8 patients. Seizure outcome was assessed in the 40 nonsurgical and 24 surgical patients. Of 40 nonsurgical patients, 8 (20%) were seizure-free after a mean follow-up of 91.7 ± (standard deviation) 59.5 months. None of the eight patients who declined surgical treatment was seizure-free (mean follow-up: 74.3 ± 60.6 months). These seizure outcomes differ significantly (p = 0.000005 and p = 0.0003, respectively) from that of the 24 surgical patients, 18 of whom (66.7%) were Engel's class I postoperatively (mean follow-up: 66.5 ± 54.0 months). Of the eight patients excluded from surgery for seizure control at first visit, two had seizure recurrence at last contact. At last contact, antiepileptic drugs (AEDs) had been withdrawn in 6 of 24 surgical and in one of 40 nonsurgical cases (p = 0.0092). The present study indicates that, at least in a subset of adequately selected patients with PMG-related epilepsy, surgery may provide excellent seizure outcomes. Furthermore, it suggests that surgery is superior to AEDs for achieving seizure freedom in these cases. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

The implications of household greywater treatment and reuse for municipal wastewater flows and micropollutant loads

DEFF Research Database (Denmark)

Revitt, Michael; Eriksson, Eva; Donner, Erica

2011-01-01

An increasing worldwide interest in water recycling technologies such as greywater treatment and reuse suggests that additional research to elucidate the fate of xenobiotics during such practices would be beneficial. In this paper, scenario analyses supported by empirical data are used...... for highlighting the potential fate of a election of xenobiotic micropollutants in decentralised greywater treatment systems, and for investigation of the possible implications of greywater recycling for the wider urban water cycle. Potential potable water savings of up to 43% are predicted for greywater recycling...... based on Danish water use statistics and priority substance monitoring at a greywater treatment plant in Denmark. Adsorption represents an important mechanism for the removal of cadmium, nickel, lead and nonylphenol from influent greywater and therefore the disposal route adopted for the generated...

Charged shells in Lovelock gravity: Hamiltonian treatment and physical implications

International Nuclear Information System (INIS)

Dias, Goncalo A. S.; Gao, Sijie; Lemos, Jose P. S.

2007-01-01

Using a Hamiltonian treatment, charged thin shells, static and dynamic, in spherically symmetric spacetimes, containing black holes or other specific types of solutions, in d dimensional Lovelock-Maxwell theory are studied. The free coefficients that appear in the Lovelock theory are chosen to obtain a sensible theory, with a negative cosmological constant appearing naturally. Using an Arnowitt-Deser-Misner (ADM) description, one then finds the Hamiltonian for the charged shell system. Variation of the Hamiltonian with respect to the canonical coordinates and conjugate momenta, and the relevant Lagrange multipliers, yields the dynamic and constraint equations. The vacuum solutions of these equations yield a division of the theory into two branches, namely d-2k-1>0 (which includes general relativity, Born-Infeld type theories, and other generic gravities) and d-2k-1=0 (which includes Chern-Simons type theories), where k is the parameter giving the highest power of the curvature in the Lagrangian. There appears an additional parameter χ=(-1) k+1 , which gives the character of the vacuum solutions. For χ=1 the solutions, being of the type found in general relativity, have a black hole character. For χ=-1 the solutions, being of a new type not found in general relativity, have a totally naked singularity character. Since there is a negative cosmological constant, the spacetimes are asymptotically anti-de Sitter (AdS), and AdS when empty (for zero cosmological constant the spacetimes are asymptotically flat). The integration from the interior to the exterior vacuum regions through the thin shell takes care of a smooth junction, showing the power of the method. The subsequent analysis is divided into two cases: static charged thin shell configurations, and gravitationally collapsing charged dust shells (expanding shells are the time reversal of the collapsing shells). In the collapsing case, into an initially nonsingular spacetime with generic character or an empty

Parental representations and dimensions of personality: empirical relations and assessment implications.

Science.gov (United States)

Pincus, A L; Ruiz, M A

1997-04-01

Research on the relations between parental representations, personality traits, and psychopathology was discussed with reference to their integration for clinical personality assessment. Empirical results linking parental representations assessed by the Structural Analysis of Social Behavior and the Five-Factor Model of personality traits in a young adult population supported the position that parental representations significantly relate to adult personality. Individuals whose parental representations were generally affiliative described themselves as less prone to emotional distress (lower neuroticism); more interpersonally oriented and experiencing of positive emotions (higher extraversion); more peaceable and trustworthy (higher agreeableness); and more dutiful, resourceful, and dependable (higher conscientiousness). Parental representations colored by autonomy granting and autonomy taking were related to higher levels of openness to experience but lower levels of conscientiousness and extraversion in self-descriptions. Assessment implications and an integrative assessment strategy were presented along with a clinical case example.

Classification of treatment-related mortality in children with cancer

DEFF Research Database (Denmark)

Alexander, Sarah; Pole, Jason D; Gibson, Paul

2015-01-01

Treatment-related mortality is an important outcome in paediatric cancer clinical trials. An international group of experts in supportive care in paediatric cancer developed a consensus-based definition of treatment-related mortality and a cause-of-death attribution system. The reliability and va...

Treatment Option Overview (AIDS Related-Lymphoma)

Science.gov (United States)

... and treatment options. AIDS-related lymphoma is a disease in which malignant (cancer) cells form in the ... cord. The sample may also be checked for Epstein-Barr virus . This procedure is also called an LP ...

Status Concern and Relative Deprivation in China: Measures, Empirical Evidence and Economic and Policy Implications

Science.gov (United States)

Xi, CHEN

2017-01-01

Status concern and feelings of relative deprivation affect individual behaviour and well-being. Traditional norms and the alarming inequality in China have made relative deprivation increasingly intense for the Chinese population. This article reviews empirical literature on China that attempts to test the relative deprivation hypothesis, and also reviews the origins and pathways of relative deprivation, compares its economic measures in the literature and summarises the scientific findings. Drawing from solid empirical evidence, the author discusses the important policy implications on redistribution, official regulations and grassroots sanctions, and relative poverty alleviation. PMID:29033479

Considerations related to the decontamination of houses in Goiania: Limitations and implications

International Nuclear Information System (INIS)

da Silva, C.J.; Delgado, J.U.; Luiz, M.T.; Cunha, P.G.; Barros, P.D.

1991-01-01

We are considering some aspects related to the decontamination activities of about 50 houses affected by 137 Cs in Goiania. We describe the way these contaminations occurred, the instruments used, and the procedures. We also discuss the dose limits established for decontamination and the consequences resulting from this action. We call attention to the importance of not only the technical aspects in such activities but also the psycho-social implications resulting from them

Relational energy at work: Implications for job engagement and job performance.

Science.gov (United States)

Owens, Bradley P; Baker, Wayne E; Sumpter, Dana McDaniel; Cameron, Kim S

2016-01-01

Energy is emerging as a topic of importance to organizations, yet we have little understanding of how energy can be useful at an interpersonal level toward achieving workplace goals. We present the results of 4 studies aimed at developing, validating, and testing the relational energy construct. In Study 1, we report qualitative insights from 64 individuals about the experience and functioning of relational energy in the workplace. Study 2 draws from 3 employee samples to conduct exploratory and confirmatory factor analyses on a measure of relational energy, differentiating relational energy from related constructs. To test the predictive validity of the new relational energy scale, Study 3 comprises data from employees rating the level of relational energy they experienced during interactions with their leaders in a health services context. Results showed that relational energy employees experienced with their leaders at Time 1 predicted job engagement at Time 2 (1 month later), while controlling for the competing construct of perceived social support. Study 4 shows further differentiation of relational energy from leader-member exchange (LMX), replicates the positive relationship between relational energy (Time 1) and job engagement (Time 2), and shows that relational energy is positively associated with employee job performance (Time 3) through the mechanism of job engagement. We discuss the theoretical implications of our findings and highlight areas for future research. (c) 2016 APA, all rights reserved).

Economic implications of resistance to antimalarial drugs.

Science.gov (United States)

Phillips, M; Phillips-Howard, P A

1996-09-01

The widespread evolution of drug resistance in malarial parasites has seriously hampered efforts to control this debilitating disease. Chloroquine, the mainstay of malaria treatment for many decades, is now proving largely ineffective in many parts of the world, particularly against the most severe form of malaria--falciparum. Alternative drugs have been developed, but they are frequently less safe and are all between 50 and 700% more expensive than chloroquine. Choice of drug clearly has important budgetary implications and national malaria control programmes need to weigh up the costs and benefits in deciding whether to change to more effective but more expensive drugs. The growth in drug resistance also has implications for the choice of diagnostic tool. Clinical diagnosis of malaria is relatively cheap, but less specific than some technological approaches. As more expensive drugs are employed, the cost of wasted treatment on suspected cases who do not in fact have malaria rises and the more worthwhile it becomes to invest in more specific diagnostic techniques. This paper presents an economic framework for analysing the various malaria drug and diagnostic tool options available. It discusses the nature of the key factors that need to be considered when making choices of malaria treatment (including treatment costs, drug resistance, the costs of treatment failure and compliance) and diagnosis (including diagnosis cost and accuracy, and the often overlooked costs associated with delayed treatment), and uses some simple equations to illustrate the impact of these on the relative cost effectiveness of the alternatives being considered. On the basis of some simplifying assumptions and illustrative calculations, it appears that in many countries more effective drugs and more specific and rapid diagnostic approaches will be worth adopting even although they imply additional expense.

Obesity and PCOS: Implications for Diagnosis and Treatment

Science.gov (United States)

Legro, Richard S.

2013-01-01

There appears to be an epidemic of both obesity and polycystic ovary syndrome (PCOS) in the world today. However, obesity per se is not a part of the phenotype in many parts of the world. Obesity is likely not a cause of PCOS, as the high prevalence of PCOS among relatively thin populations demonstrates. However, obesity does exacerbate many aspects of the phenotype, especially cardiovascular risk factors such as glucose intolerance and dyslipidemia. It is also associated with a poor response to infertility treatment and likely an increased risk for pregnancy complications in those women who do conceive. Although most treatments of obesity, with the exception of bariatric surgery, achieve modest reductions in weight and improvements in the PCOS phenotype, encouraging weight loss in the obese patient remains one of the front-line therapies. However, further studies are needed to identify the best treatments, and the role of lifestyle therapies in women of normal weight with PCOS is uncertain. PMID:23074008

Extracellular tumor-related mRNA in plasma of lymphoma patients and survival implications.

Directory of Open Access Journals (Sweden)

Vanesa Garcia

Full Text Available BACKGROUND: We studied anomalous extracellular mRNAs in plasma from patients with diffuse large B-cell lymphoma (DLBCL and their survival implications. mRNAs studied have been reported in the literature as markers of poor (BCL2, CCND2, MYC and favorable outcome (LMO2, BCL6, FN1 in tumors. These markers were also analyzed in lymphoma tissues to test possible associations with their presence in plasma. METHODOLOGY/PRINCIPAL FINDINGS: mRNA from 42 plasma samples and 12 tumors from patients with DLBCL was analyzed by real-time PCR. Samples post-treatment were studied. The immunohistochemistry of BCL2 and BCL6 was defined. Presence of circulating tumor cells was determined by analyzing the clonality of the immunoglobulin heavy-chain genes by PCR. In DLBCL, MYC mRNA was associated with short overall survival. mRNA targets with unfavorable outcome in tumors were associated with characteristics indicative of poor prognosis, with partial treatment response and with short progression-free survival in patients with complete response. In patients with low IPI score, unfavorable mRNA targets were related to shorter overall survival, partial response, high LDH levels and death. mRNA disappeared in post-treatment samples of patients with complete response, and persisted in those with partial response or death. No associations were found between circulating tumor cells and plasma mRNA. Absence of BCL6 protein in tumors was associated with presence of unfavorable plasma mRNA. CONCLUSIONS/SIGNIFICANCE: Through a non-invasive procedure, tumor-derived mRNAs can be obtained in plasma. mRNA detected in plasma did not proceed from circulating tumor cells. In our study, unfavorable targets in plasma were associated with poor prognosis in B-cell lymphomas, mainly MYC mRNA. Moreover, the unfavorable targets in plasma could help us to classify patients with poor outcome within the good prognosis group according to IPI.

Treatment-related mortality in relapsed childhood acute lymphoblastic leukemia

DEFF Research Database (Denmark)

Oskarsson, Trausti; Söderhäll, Stefan; Arvidson, Johan

2018-01-01

BACKGROUND: Treatment of relapsed childhood acute lymphoblastic leukemia (ALL) is particularly challenging due to the high treatment intensity needed to induce and sustain a second remission. To improve results, it is important to understand how treatment-related toxicity impacts survival...

Bidirectional relations between parenting practices and child externalizing behavior: a cross-lagged panel analysis in the context of a psychosocial treatment and 3-year follow-up.

Science.gov (United States)

Shaffer, Anne; Lindhiem, Oliver; Kolko, David J; Trentacosta, Christopher J

2013-02-01

In the current study, we examined longitudinal changes in, and bidirectional effects between, parenting practices and child behavior problems in the context of a psychosocial treatment and 3-year follow-up period. The sample comprised 139 parent-child dyads (child ages 6-11) who participated in a modular treatment protocol for early-onset ODD or CD. Parenting practices and child behavior problems were assessed at six time-points using multiple measures and multiple reporters. The data were analyzed using cross-lagged panel analyses. Results indicated robust temporal stabilities of parenting practices and child behavior problems, in the context of treatment-related improvements, but bidirectional effects between parenting practices and child behavior were less frequently detected. Our findings suggest that bidirectional effects are relatively smaller than the temporal stability of each construct for school-age children with ODD/CD and their parents, following a multi-modal clinical intervention that is directed at both parents and children. Implications for treatment and intervention are discussed.

Female science teacher beliefs and attitudes: implications in relation to gender and pedagogical practice

Science.gov (United States)

Zapata, Mara; Gallard, Alejandro J.

2007-10-01

Beliefs and attitudes resulting from the unique life experiences of teachers frame interactions with learners promoting gender equity or inequity and the reproduction of social views about knowledge and power as related to gender. This study examines the enactment of a female science teacher's pedagogy (Laura), seeking to understand the implications of her beliefs and attitudes, as framed by her interpretations and daily manifestations, as she interacts with students. Distinct influences inform the conceptual framework of this study: (a) the social organization of society at large, governed by understood and unspoken patriarchy, present both academically and socially; (b) the devaluing of women as "knowers" of scientific knowledge as defined by a western and male view of science; (c) the marginalization or "feminization" of education and pedagogical knowledge. The findings reflect tensions between attitudes and beliefs and actual teacher practice suggesting the need for awareness within existing or new teachers about their positions as social agents and the sociological implications related to issues of gender within which we live and work, inclusive of science teaching and learning.

The effect of cigarette smoking on cancer treatment-related side effects.

Science.gov (United States)

Peppone, Luke J; Mustian, Karen M; Morrow, Gary R; Dozier, Ann M; Ossip, Deborah J; Janelsins, Michelle C; Sprod, Lisa K; McIntosh, Scott

2011-01-01

Cigarette smoking has long been implicated in cancer development and survival. However, few studies have investigated the impact of smoking on symptom burden in cancer survivors during treatment and at survivorship stage. This study examines the influence of cigarette smoking on side effects among 947 cancer patients during and 6 months following treatment. Patients diagnosed with cancer and scheduled to receive chemotherapy and/or radiation therapy reported on current smoking status (yes, no) and total symptom burden [the sum of 12 common symptoms (fatigue, hair loss, memory, nausea, depression, sleep, pain, concentration, hot flashes, weight loss, skin problems, and dyspnea) scored on an 11-point scale ranging from 0 = "not present" to 10 = "as bad as you can imagine"] during treatment and at 6-month follow-up. The adjusted mean total symptom burden by smoking status was determined by analysis of covariance controlling for age, gender, race, education, occupation, treatment, cancer site, and Karnofsky performance score. During treatment, smokers (S) had a significantly higher total symptom burden than nonsmokers (NS) (S = 46.3 vs. NS = 41.2; p < 0.05). At 6-month follow-up, smokers continued to report a higher total symptom burden than nonsmokers (S = 27.7 vs. NS = 21.9; p < 0.05). Participants who quit smoking before treatment levels had a total symptom burden similar to nonsmokers. Smoking was associated with an increased symptom burden during and following treatments for cancer. Targeted cessation efforts for smokers to decrease symptom burden may limit the likelihood of treatment interruptions and increase quality of life following treatment.

Stakeholders' perspective on issues and challenges associated with care and treatment of aging-related cognitive impairment disorders in Singapore.

Science.gov (United States)

Setia, Monika; Islam, Amina M; Thompson, James P; Matchar, David B

2011-11-01

An expanding elderly population poses challenges for the provision of care and treatment for age-related physical and mental disorders. Cognitive impairment (CI)/dementia is one such mental disorder that is on the rise in Singapore and has concomitant implications for social and health systems. The objective of this study is to understand the perspectives of prominent stakeholders about current and future issues and challenges associated with CI/dementia among the elderly in Singapore. Using indepth interviews, this qualitative study obtained the views of multiple stakeholders on issues and challenges associated with CI/dementia in Singapore. The 30 individuals interviewed as part of the study included clinicians, policy-makers, researchers, community workers, administrators, and caregivers. Using a framework approach, interview texts were indexed into domains and issues by utilizing NVivo 9.0 software. The stakeholders expressed concerns related to multiple domains of the CI/dementia care system: attitude and awareness, economics, education, family caregiving, inputs to care system, living arrangements, prevention, screening and diagnosis, and treatment and management of care. Within each domain, multiple issues and challenges were identified by respondents. The study identifies a complex set of inter-related issues and challenges that are associated with the care and treatment of people with CI/dementia. The results suggest that CI and dementia profoundly affect patients, families, and communities and that the issues related to the two disorders are truly system-wide. These findings lay the foundation for utilization of a systems approach to studying CI/dementia and provide an analytic framework for future research on complex health care issues.

Obesity and PCOS: implications for diagnosis and treatment.

Science.gov (United States)

Legro, Richard S

2012-12-01

There appears to be an epidemic of both obesity and polycystic ovary syndrome (PCOS) in the world today. However, obesity per se is not a part of the phenotype in many parts of the world. Obesity is likely not a cause of PCOS, as the high prevalence of PCOS among relatively thin populations demonstrates. However, obesity does exacerbate many aspects of the phenotype, especially cardiovascular risk factors such as glucose intolerance and dyslipidemia. It is also associated with a poor response to infertility treatment and likely an increased risk for pregnancy complications in those women who do conceive. Although most treatments of obesity, with the exception of bariatric surgery, achieve modest reductions in weight and improvements in the PCOS phenotype, encouraging weight loss in the obese patient remains one of the front-line therapies. However, further studies are needed to identify the best treatments, and the role of lifestyle therapies in women of normal weight with PCOS is uncertain. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hormone levels in radiotherapy treatment related fatigue

International Nuclear Information System (INIS)

Biswal, B.M.; Mallik, G.S.

2003-01-01

Radiotherapy is known to cause debilitating treatment related fatigue. Fatigue in general is a conglomeration of psychological, physical, hematological and unknown factors influencing the internal milieu of the cancer patient. Radiotherapy can add stress at the cellular and somatic level to aggravate further fatigue in cancer patients undergoing radiotherapy. Stress related hormones might be mediating in the development of fatigue. This is an ongoing prospective study to evaluate if the hormonal profile related to stress is influenced by radiotherapy treatment related fatigue. The study was conducted from September 2002 onwards in the division of Radiotherapy and Oncology of our Medical School. Previously untreated patients with histopathology proof of malignancy requiring external beam radiotherapy were considered for this study. Selection criteria were applied to exclude other causes of fatigue. Initial fatigue score was obtained using Pipers Fatigue Score questionnaire containing 23 questions, subsequently final fatigue score was obtained at the end of radiotherapy. Blood samples were obtained to estimate the levels of ACTH, TSH, HGH, and cortisol on the final assessment. The hormone levels were compared with resultant post radiotherapy fatigue score. At the time of reporting 50 patients were evaluable for the study. The total significant fatigue score was observed among 12 (24%) patients. The individual debilitating fatigue score were behavioral severity 14 (28%), affective meaning 14(28%), Sensory 13 (26%) and cognitive mood 10 (20%) respectively. From the analysis of hormonal profile, growth hormone level > 1 ng/mL and TSH <0.03 appears to be associated with high fatigue score (though statistically not significant); whereas there was no correlation with ACTH and serum cortisol level. In our prospective study severe radiotherapy treatment related fatigue was found among our patient population. Low levels of TSH and high levels of GH appear to be associated

Efficacy of letrozole in treatment of endometriosis-related pain

Directory of Open Access Journals (Sweden)

Elham Hussein Madny

2014-03-01

Conclusion: Letrozole (aromatase inhibitor has shown to be effective in the treatment of endometriosis-related pain with substantial improvement of pain with no recurrence of pain for 6 months after completion of treatment.

Relative thinking in consumer choice between differentiated goods and services and its implications for business strategy

Directory of Open Access Journals (Sweden)

Ofer H. Azar

2011-02-01

Full Text Available The article shows that when people consider differentiated goods or services that differ in price and quality, they exhibit a decision-making bias of ``relative thinking'': relative price differences affect them even when economic theory suggests that only absolute price differences matter. This result is obtained in four different consumption categories. Sometimes subjects are affected only by relative price differences (``full relative thinking'' and sometimes also by absolute price differences (``partial relative thinking''. This behavior has implications for various disciplines, and it is particularly relevant in models dealing with horizontal or vertical differentiation, optimal pricing, competitive strategy, or advertising.

Brain iron accumulation affects myelin-related molecular systems implicated in a rare neurogenetic disease family with neuropsychiatric features.

Science.gov (United States)

Heidari, M; Johnstone, D M; Bassett, B; Graham, R M; Chua, A C G; House, M J; Collingwood, J F; Bettencourt, C; Houlden, H; Ryten, M; Olynyk, J K; Trinder, D; Milward, E A

2016-11-01

The 'neurodegeneration with brain iron accumulation' (NBIA) disease family entails movement or cognitive impairment, often with psychiatric features. To understand how iron loading affects the brain, we studied mice with disruption of two iron regulatory genes, hemochromatosis (Hfe) and transferrin receptor 2 (Tfr2). Inductively coupled plasma atomic emission spectroscopy demonstrated increased iron in the Hfe -/- × Tfr2 mut brain (P=0.002, n ≥5/group), primarily localized by Perls' staining to myelinated structures. Western immunoblotting showed increases of the iron storage protein ferritin light polypeptide and microarray and real-time reverse transcription-PCR revealed decreased transcript levels (Pgross myelin structure and integrity appear unaffected (P>0.05). Overlap (P0.05). These results implicate myelin-related systems involved in NBIA neuropathogenesis in early responses to iron loading. This may contribute to behavioral symptoms in NBIA and hemochromatosis and is relevant to patients with abnormal iron status and psychiatric disorders involving myelin abnormalities or resistant to conventional treatments.

[Ubiquinone: metabolism and functions. Ubiquinone deficiency and its implication in mitochondrial encephalopathies. Treatment with ubiquinone].

Science.gov (United States)

Artuch, R; Colomé, C; Vilaseca, M A; Pineda, M; Campistol, J

Review of ubiquinone-10 metabolism and functions in humans, focusing its implication in the pathogenesis and physiopathology of mitochondrial encephalomyopathies. Ubiquinone-10 is an endogenously synthesized lipid with a wide distribution in tissues. Tyrosine and acetil-CoA are involved in ubiquinone biosynthesis. This molecule has several biological functions in cells: it is a movil electron carrier in the mitochondrial respiratory chain and also acts as antioxidant. Owing to its implication in these functions, ubiquinone deficiency may cause important deletereous effects in tissues. Several authors reported ubiquinone deficient status in some physiological and pathological conditions. Mitochondrial encephalomyopathies may be related to a primary or secondary ubiquinone deficient status, or even to an altered function of ubiquinone in the respiratory chain. Moreover, some relevant aspects about ubiquinone therapy in mitochondrial disorders are reported. According to recent reports about ubiquinone implication in several diseases, its determination in different biological samples seems very useful to elucidate the physiopathological mechanisms involved and even the to start a therapy in cases with ubiquinone deficiency.

Dependency and self-criticism in treatments for depression.

Science.gov (United States)

Chui, Harold; Zilcha-Mano, Sigal; Dinger, Ulrike; Barrett, Marna S; Barber, Jacques P

2016-07-01

Dependency and self-criticism are vulnerability factors for depression. How these personality factors change with treatment for depression and how they relate to symptom change across different types of treatment require further research. In addition, cultural differences that interact with the dependency/self-criticism-depression relation remain underinvestigated. We randomly assigned 149 adults with major depression to receive active medication (MED; n = 50), supportive-expressive therapy (SET; n = 49), or placebo pill (PBO; n = 50). Participants completed the Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) before and after treatment and completed the Hamilton Rating Scale for Depression (Hamilton, 1967) throughout the course of treatment. Self-criticism as measured on the DEQ decreased with treatment similarly across conditions. DEQ Dependency decreased in MED but remained unchanged in SET and PBO. Higher initial dependency, but not higher initial self-criticism, predicted poor treatment response across conditions. Greater reduction in self-criticism was associated with greater reduction in depressive symptoms, but the effect was weaker for racial minorities (vs. White). Increase in connectedness, an adaptive form of dependency, was associated with symptom improvement in SET but not MED. Hence, different pathways of change seem to be implicated in the treatment of depression depending on culture and type of intervention. Implications for future research are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Gender-related clinical and neurocognitive differences in individuals seeking treatment for pathological gambling.

Science.gov (United States)

Grant, Jon E; Chamberlain, Samuel R; Schreiber, Liana R N; Odlaug, Brian L

2012-09-01

Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for selecting appropriate prevention and treatment strategies. The aim of this study was to investigate clinical and cognitive differences in treatment-seeking people with pathological gambling as a function of gender. 501 adult subjects (n = 274 [54.7%] females) with DSM-IV pathological gambling presenting for various clinical research trials over a 9-year period were assessed in terms of sociodemographics and clinical characteristics. A subset (n = 77) had also undertaken neuropsychological assessment with the Stop-signal and set-shift tasks. PG in females was associated with significantly worse disease severity, elevated mood and anxiety scores, and history of affective disorders, later age of study presentation, later age of disease onset, and elevated risk of having a first-degree relative with gambling or alcohol problems. These findings were of small effect size (0.20-0.35). Additionally, PG in females was associated with proportionately more non-strategic gambling with medium effect size (0.61). In contrast, PG in males was associated with a significantly greater lifetime history of an alcohol use disorder and any substance use disorder (small effect sizes 0.22-0.38); and slower motoric reaction times (medium effect size, 0.50). Response inhibition and cognitive flexibility were similar between the groups. These data suggest that important differences exist in the features of pathological gambling in women and men. Findings are of considerable relevance to clinicians and in terms of targeted treatments. Copyright © 2012 Elsevier Ltd. All rights reserved.

Stress-related factors in cannabis use and misuse: implications for prevention and treatment.

Science.gov (United States)

Hyman, Scott M; Sinha, Rajita

2009-06-01

We examined the role of stress as a risk factor and motivation for cannabis use/misuse. A systematic review of studies gathered from PsychINFO and MEDLINE databases was conducted. Findings suggest that cannabis is commonly used as a stress-coping strategy. Negative life events, trauma, and maladaptive coping were all related to consumption. Cannabis use for stress-coping purposes was most evident when examining chronic as compared with experimental use. Although many individuals may be able to use cannabis without consequences, there appears to be a subset of individuals who experience greater life stress and who may be more likely to use for stress-coping purposes. These individuals may be at greatest risk for addiction. Chronic use may potentiate stress-related motivation to use/abuse cannabis and is associated with decision-making deficits and alterations in brain-stress pathways that may exacerbate compulsive drug seeking and sensitize individuals to stress-related drug use. Overall, stress-coping interventions and harm reduction focused on reducing the amount ingested may facilitate prevention and recovery efforts.

Sleep Disturbances, TBI and PTSD: Implications for Treatment and Recovery

Science.gov (United States)

Gilbert, Karina Stavitsky; Kark, Sarah M.; Gehrman, Philip; Bogdanova, Yelena

2015-01-01

Post-Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), and sleep problems significantly affect recovery and functional status in military personnel and Veterans returning from combat. Despite recent attention, sleep is understudied in the Veteran population. Few treatments and rehabilitation protocols target sleep, although poor sleep remains at clinical levels and continues to adversely impact functioning even after the resolution of PTSD or mild TBI symptoms. Recent developments in non-pharmacologic sleep treatments have proven efficacious as stand-alone interventions and have potential to improve treatment outcomes by augmenting traditional behavioral and cognitive therapies. This review discusses the extensive scope of work in the area of sleep as it relates to TBI and PTSD, including pathophysiology and neurobiology of sleep; existing and emerging treatment options; as well as methodological issues in sleep measurements for TBI and PTSD. Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes while offering a non-stigmatizing entry in mental health services and make current treatments more comprehensive by helping to address a broader spectrum of difficulties. PMID:26164549

Clinical Implications of Measuring Drug and Anti-Drug Antibodies by Different Assays When Optimizing Infliximab Treatment Failure in Crohn's Disease

DEFF Research Database (Denmark)

Steenholdt, Casper; Bendtzen, Klaus; Brynskov, Jørn

2014-01-01

OBJECTIVES: Cost-effective guidance of therapeutic strategy in Crohn's disease patients with secondary infliximab (IFX) treatment failure may be achieved by serum IFX and anti-IFX antibody (Ab) measurements by radioimmunoassay (RIA). This study investigated implications of using other techniques...... on classification of underlying mechanism for treatment failure in most cases (79-94%). The majority (74-88%) failed IFX owing to pharmacodynamic problems, or had noninflammatory pathophysiology for symptoms resembling relapse. Applied threshold for therapeutic vs. subtherapeutic IFX level influenced...

God, design, and naturalism: Implications of methodological naturalism in science for science-religion relation

OpenAIRE

Piotr Bylica; Dariusz Sagan

2015-01-01

The aim of this paper is to analyze the implications flowing from adopting methodological naturalism in science, with special emphasis on the relation between science and religion. Methodological naturalism, denying supernatural and teleological explanations, influences the content of scientific theories, and in practice leads to vision of science as compatible with ontological naturalism and in opposition to theism. Ontological naturalism in turn justifies the acceptance of methodological na...

Towards a cognitive-learning formulation of youth anxiety: A narrative review of theory and evidence and implications for treatment.

Science.gov (United States)

Waters, Allison M; Craske, Michelle G

2016-12-01

The tendency to disproportionately allocate attention to threat stimuli, to evaluate ambiguous or benign situations as overly threatening, and to exhibit overgeneralised and indiscriminate conditioned fear responses to threat and safe stimuli are hallmark clinical correlates of pathological anxiety. Investigation of these processes in children and adolescents suggests that anxiety-related differences increase with age, and that the specific conditions under which anxious children differ from non-anxious peers are poorly understood. Furthermore, research on cognitive biases and fear conditioning in anxious children and adolescents has progressed as quite distinct lines of investigation. Greater integration of key tenets from each perspective could advance knowledge and provide new directions for improving treatments. The purpose of this paper is threefold. First, we provide a qualitative review of the key principles from cognitive and conditioning theories of anxiety and the associated empirical research, including the underlying neurophysiological basis of these processes in anxious children and adolescents, in order to delineate the conditions under which anxiety-specific differences in threat-related cognitive biases and overgeneralised conditioned fear manifest in children and adolescents. Second, we synthesize these theoretical and empirical insights to propose a cognitive-learning formulation of anxiety in children and adolescents. We propose that conditioning and cognitive factors linked to differences in engagement of underlying neural circuits across development contribute to an internal representation of a wide range of stimuli as threatening, to which anxious children and adolescents adopt maladaptive attention regulation patterns of predominantly threat monitoring or threat avoidance. These maladaptive attention regulation patterns differentiate anxious children and adolescents in terms of predominantly high cognitive distress (e.g., worry and rumination

The treatment of sleep-related painful erections

NARCIS (Netherlands)

van Driel, Mels F.; Beck, Jack J.; Elzevier, Henk W.; van der Hoeven, Johannes H.; Nijman, J. M.

Introduction. As specialists in male genital problems, urologists and sexologists will most likely to be involved in the treatment of males presenting with sleep-related painful erections (SRPEs). This means that this phenomenon needs to be recognized by urologists and sexologists, and that they

Alexithymia in eating disorders: therapeutic implications

Directory of Open Access Journals (Sweden)

Pinna F

2014-12-01

Full Text Available Federica Pinna, Lucia Sanna, Bernardo Carpiniello Department of Public Health, Clinical and Molecular Medicine - Unit of Psychiatry, University of Cagliari, Cagliari, Italy Abstract: A high percentage of individuals affected by eating disorders (ED achieve incomplete recovery following treatment. In an attempt to improve treatment outcome, it is crucial that predictors of outcome are identified, and personalized care approaches established in line with new treatment targets, thus facilitating patient access to evidence-based treatments. Among the psychological factors proposed as predictors of outcome in ED, alexithymia is of outstanding interest. The objective of this paper is to undertake a systematic review of the literature relating to alexithymia, specifically in terms of the implications for treatment of ED. In particular, issues concerning the role of alexithymia as a predictor of outcome and as a factor to be taken into account in the choice of treatment will be addressed. The effect of treatments on alexithymia will also be considered. A search of all relevant literature published in English using PubMed, PsycINFO, and Scopus databases was carried out on the basis of the following keywords: alexithymia, anorexia nervosa, bulimia nervosa, eating disorders, and treatment; no time limits were imposed. Despite the clinical relevance of alexithymia, the number of studies published on the above cited aspects is somewhat limited, and these studies are largely heterogeneous and feature significant methodological weaknesses. Overall, data currently available mostly correlate higher levels of alexithymia with a less favorable outcome in ED. Accordingly, alexithymia is seen as a relevant treatment target with the aim of achieving recovery of these patients. Treatments focusing on improving alexithymic traits, and specifically those targeting emotions, seem to show greater efficacy, although alexithymia levels often remain high even after specific

Disease-related mortality exceeds treatment-related mortality in patients with chronic myeloid leukemia on second-line or later therapy.

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Pearson, Edward; McGarry, Lisa; Gala, Smeet; Nieset, Christopher; Nanavaty, Merena; Mwamburi, Mkaya; Levy, Yair

2016-04-01

Treatment of newly-diagnosed patients with chronic-phase chronic myeloid leukemia (CP-CML) with tyrosine kinase inhibitors (TKIs) results in near-normal life expectancy. However, CP-CML patients resistant to initial TKIs face a poorer prognosis and significantly higher CML-related mortality. We conducted a systematic literature review to evaluate the specific causes of deaths (diseases progression versus drug-related) in CP-CML patients receiving second- or third-line therapy. We identified eight studies based on our criteria that reported causes of death. Overall, 5% of second-line and 10% of third-line patients died during the study follow-up period. For second-line, (7 studies, n=1926), mortality was attributed to disease progression for 41% of deaths, 2% to treatment-related causes, 3% were treatment-unrelated, and 50% were unspecified adverse events (AEs), not likely related to study drug. In third-line, (2 studies, n=144), 71% deaths were attributed to disease progression, 7% treatment-related AEs, 14% treatment-unrelated and 7% unspecified AEs. Annual death rates for second- and third-line therapy were significantly higher than for general population in similar age group. Our findings suggest death attributed to disease progression is approximately 10 times that due to treatment-related AEs in patients with CP-CML receiving second- or third-line therapy. Therefore, the potential benefits of effective treatment for these patients with the currently available TKIs outweigh the risks of treatment-induced AEs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Factors related to treatment refusal in Taiwanese cancer patients.

Science.gov (United States)

Chiang, Ting-Yu; Wang, Chao-Hui; Lin, Yu-Fen; Chou, Shu-Lan; Wang, Ching-Ting; Juang, Hsiao-Ting; Lin, Yung-Chang; Lin, Mei-Hsiang

2015-01-01

Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (prefuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

The role of family meals in the treatment of eating disorders: a scoping review of the literature and implications.

Science.gov (United States)

Cook-Darzens, Solange

2016-09-01

Family meal research is a fast growing field that has significant implications for the prevention and treatment of eating disorders (ED). Using a scoping review procedure, this article overviewed major historical and clinical trends that have guided the use of family meals or lunch sessions in adolescent ED family therapy over the past 40 years, and synthesized essential findings from current therapeutic family meal research. The relevant body of literature is reported within the framework of three models of family therapy (Maudsley model, family-based treatment, multi-family therapy), with a focus on their specific use of family lunch sessions and related empirical evidence. Although promising, current evidence remains contradictory, tentative and colored by therapists' convictions, resistance and fears. Future research priorities are discussed, including the need for a more direct examination of the impact of the family meal practice on therapeutic change, as well as a better understanding of its active ingredients and of the characteristics of patients/families that may benefit most from it. This review of the literature may help clinicians and family therapists (1) adhere more reliably and confidently to ED-focused treatment protocols that include a strong family meal component, and (2) make more informed decisions regarding the inclusion or exclusion of family meals in their practice. When feasibility or acceptability issues preclude their use, alternatives to family meals are also discussed, including family meal role-plays and drawings, coaching of home-based family meals and manual/DVD-based guidance.

Pelvi-ureteric junction obstruction related to crossing vessels: vascular anatomic variations and implication for surgical approaches.

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Panthier, Frédéric; Lareyre, Fabien; Audouin, Marie; Raffort, Juliette

2018-03-01

Pelvi-ureteric junction obstruction corresponds to an impairment of urinary transport that can lead to renal dysfunction if not treated. Several mechanisms can cause the obstruction of the ureter including intrinsic factors or extrinsic factors such as the presence of crossing vessels. The treatment of the disease relies on surgical approaches, pyeloplasty being the standard reference. The technique consists in removing the pathologic ureteric segment and renal pelvis and transposing associated crossing vessels if present. The vascular anatomy of the pelvi-ureteric junction is complex and varies among individuals, and this can impact on the disease development and its surgical treatment. In this review, we summarize current knowledge on vascular anatomic variations in the pelvi-ureteric junction. Based on anatomic characteristics, we discuss implications for surgical approaches during pyeloplasty and vessel transposition.

Antiretroviral treatment knowledge and stigma--implications for programs and HIV treatment interventions in rural Tanzanian populations.

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Abela Mpobela Agnarson

Full Text Available OBJECTIVE: To analyse antiretroviral treatment (ART knowledge and HIV- and ART-related stigma among the adult population in a rural Tanzanian community. DESIGN: Population-based cross-sectional survey of 694 adults (15-49 years of age. METHODS: Latent class analysis (LCA categorized respondents' levels of ART knowledge and of ART-related stigma. Multinomial logistic regression assessed the association between the levels of ART knowledge and HIV- and ART-related stigma, while controlling for the effects of age, gender, education, marital status and occupation. RESULTS: More than one-third of men and women in the study reported that they had never heard of ART. Among those who had heard of ART, 24% were east informed about ART, 8% moderately informed, and 68% highly informed. Regarding ART-related stigma, 28% were least stigmatizing, 41% moderately stigmatizing, and 31% highly stigmatizing toward persons taking ART. Respondents that had at least primary education were more likely to have high levels of knowledge about ART (OR 3.09, 95% CI 1.61-5.94. Participants highly informed about ART held less HIV- and ART-related stigma towards ART patients (OR 0.26, 95% CI 0.09-0.74. CONCLUSION: The lack of ART knowledge is broad, and there is a strong association between ART knowledge and individual education level. These are relevant findings for both HIV prevention and HIV treatment program interventions that address ART-related stigma across the entire spectrum of the community.

Recent advances in treatment of wet age-related macular degeneration

Directory of Open Access Journals (Sweden)

Ming Li

2015-02-01

Full Text Available Age-related macular degeneration(AMDis one of the important eye diseases of the WHO present three big blindness, is one of the main blinding eye disease in people over the age of 50, people over the age of 65, about 2% of the disease caused by monocular blindness, as the population ages, AMD prevalence is increasing in our country. AMD with respect to its clinical manifestations can be divided into dry AMD and wet AMD, wet AMD is the most harmful for the vision of patients, at present there are many treatments for AMD(mainly for wet age-related macular degeneration, mainly including laser treatment, drug therapy, surgical treatment, gene therapy,etc. The treatments of AMD would be illuminated in this article.

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences.

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van der Molen, Thys

2010-12-01

In the Western world, chronic obstructive pulmonary disease (COPD) is predominantly caused by long-term smoking, which results in pulmonary inflammation that is often associated with systemic inflammation. A number of co-morbid conditions, such as cardiovascular disease, muscle wasting, type 2 diabetes and asthma, may coexist with COPD; these and other co-morbidities not directly related to COPD are major causes of excess morbidity and mortality. This review sets out to explore the most frequent co-morbidities in COPD and their implications for treatment. Review of the literature on co-morbidities of COPD. Co-morbidities are frequent, but often remain undiagnosed in the COPD patient. In order to provide the best possible care for people with COPD, the physician should be aware of all potential co-morbidities that may arise, and the critical role that effective management of these co-morbidities can play in improving patient outcomes. Increased awareness of the potential co-morbidities of COPD, although potentially adding to the general practitioner's work burden, may provide insights into this difficult disease state and possibly improve each individual's prospects for effective management.

Factors related to the effect of radiation treatment for age-related macular degeneration

International Nuclear Information System (INIS)

Mandai, Michiko; Takahashi, Masayo; Matsumura, Miyo; Sasai, Keisuke; Honda, Yoshihito; Ogura, Yuichiro

2000-01-01

We treated 31 eyes of 30 patients with age-related macular degeneration by 10 sessions of radiation totalling 20 Gy. One year after treatment, 21 eyes (68%) showed improvement in the score of fundus lesions based on funduscopic and fluorescein angiographic findings. The visual acuity, expressed as LogMAR, improved in 20% and remained stationary in 50% of eyes. Improvement in visual acuity was significantly better in eyes with greater amount of exudate before treatment (p<0.01). Posttreatment visual acuity was correlated neither with the amount of subretinal fluid, presence of retinal hemorrhage, the size of subfoveal vascular membrane, nor its type as classified into classic, mainly occult or occult type. Above findings show that radiation is more effective in eyes of age-related macular degeneration with massive exudate. (author)

Factors related to the effect of radiation treatment for age-related macular degeneration

Energy Technology Data Exchange (ETDEWEB)

Mandai, Michiko; Takahashi, Masayo; Matsumura, Miyo; Sasai, Keisuke; Honda, Yoshihito [Kyoto Univ. (Japan). Graduate School of Medicine; Ogura, Yuichiro

2000-04-01

We treated 31 eyes of 30 patients with age-related macular degeneration by 10 sessions of radiation totalling 20 Gy. One year after treatment, 21 eyes (68%) showed improvement in the score of fundus lesions based on funduscopic and fluorescein angiographic findings. The visual acuity, expressed as LogMAR, improved in 20% and remained stationary in 50% of eyes. Improvement in visual acuity was significantly better in eyes with greater amount of exudate before treatment (p<0.01). Posttreatment visual acuity was correlated neither with the amount of subretinal fluid, presence of retinal hemorrhage, the size of subfoveal vascular membrane, nor its type as classified into classic, mainly occult or occult type. Above findings show that radiation is more effective in eyes of age-related macular degeneration with massive exudate. (author)

AIDS-Related Lymphoma Treatment (PDQ®)—Health Professional Version

Science.gov (United States)

AIDS-related lymphoma presents and is treated differently compared to lymphoma in non-HIV patients. Treatments include chemotherapy, radiation therapy, high-dose chemotherapy with stem cell transplant, and targeted therapy. Get detailed information about HIV-related lymphoma in this summary for clinicians.

International Education Management: Implications of Relational Perspectives and Ethnographic Insights to Nurture International Students' Academic Experience

Science.gov (United States)

Shams, S. M. Riad

2017-01-01

Purpose: International students, who have a non-English speaking background (NESB), encounter many difficulties, in comparison to their local fellows of an English-speaking country. Literature demonstrates that leveraging various relational perspectives in a multicultural teaching environment has favourable implications to manage the NESB…

Substance Use Disorders in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Implications for Treatment and the Role of the Primary Care Physician

OpenAIRE

Upadhyaya, Himanshu P.

2008-01-01

Objectives: Review the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) in children and adolescents. Discuss treatment implications and the role of the primary care physician in the management of this comorbidity.

Quality of life issues relating to endocrine treatment options

DEFF Research Database (Denmark)

Iversen, P

1999-01-01

Recent interest has focused on the use of hormone therapy in prostate cancer for both the management of patients with non-metastatic disease and as a neoadjuvant or adjuvant to curative therapies. This has resulted in patients with fewer symptoms being treated for longer periods of time. Endocrine...... treatments for prostate cancer, such as castration, combined androgen blockade and non-steroidal antiandrogen monotherapy, have shown similar results in terms of time to progression and survival. The main difference between these treatments is their impact on patients' quality of life. Instruments...... for measuring health-related quality of life should assess both overall and disease-specific quality of life. Data from two large studies of bicalutamide monotherapy show that this non-steroidal antiandrogen is associated with significant health-related quality of life advantages in the treatment of patients...

Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.

Science.gov (United States)

Conelea, Christine A; Walther, Michael R; Freeman, Jennifer B; Garcia, Abbe M; Sapyta, Jeffrey; Khanna, Muniya; Franklin, Martin

2014-12-01

Prior research has shown that youth with co-occurring tic disorders and obsessive-compulsive disorder (OCD) may differ from those with non-tic-related OCD in terms of clinical characteristics and treatment responsiveness. A broad definition of "tic-related" was used to examine whether children with tics in the Pediatric OCD Treatment Study II differed from those without tics in terms of demographic and phenomenological characteristics and acute treatment outcomes. Participants were 124 youth aged 7 to 17 years, inclusive, with a primary diagnosis of OCD who were partial responders to an adequate serotonin reuptake inhibitor (SRI) trial. Participants were randomized to medication management, medication management plus instructions in cognitive-behavioral therapy (CBT), or medication management plus full CBT. Tic status was based on the presence of motor and/or vocal tics on the Yale Global Tic Severity Scale. Tics were identified in 53% of the sample. Those with tic-related OCD did not differ from those with non-tic-related OCD in terms of age, family history of tics, OCD severity, OCD-related impairment, or comorbidity. Those with tics responded equally in all treatment conditions. Tic-related OCD was very prevalent using a broad definition of tic status. Results suggest that youth with this broad definition of tic-related OCD do not have increased OCD severity or inference, higher comorbidity rates or severity, or worsened functioning, and support the use of CBT in this population. This highlights the importance of not making broad assumptions about OCD symptoms most likely to occur in an individual with comorbid tics. Clinical trial registration information-Treatment of Pediatric OCD for SRI Partial Responders; http://clinicaltrials.gov; NCT00074815. Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

The impact of social relations among men and women in fertility treatment on the decision to terminate treatment

DEFF Research Database (Denmark)

Vassard, Ditte; Lund, Rikke; Pinborg, Anja

2012-01-01

STUDY QUESTION: Do social support and social strain from social relations have an impact on the decision to terminate fertility treatment among men and women after 1 year of unsuccessful treatment? SUMMARY ANSWER: Several functional aspects of social relations show an impact on the probability to...

Implication of microRNAs in the development and potential treatment of radiation-induced heart disease.

Science.gov (United States)

Kura, Branislav; Babal, Pavel; Slezak, Jan

2017-10-01

Radiotherapy is the most commonly used methodology to treat oncological disease, one of the most widespread causes of death worldwide. Oncological patients cured by radiotherapy applied to the mediastinal area have been shown to suffer from cardiovascular disease. The increase in the prevalence of radiation-induced heart disease has emphasized the need to seek new therapeutic targets to mitigate the negative impact of radiation on the heart. In this regard, microRNAs (miRNAs) have received considerable interest. miRNAs regulate post-transcriptional gene expression by their ability to target various mRNA sequences because of their imperfect pairing with mRNAs. It has been recognized that miRNAs modulate a diverse spectrum of cardiac functions with developmental, pathophysiological, and clinical implications. This makes them promising potential targets for diagnosis and treatment. This review summarizes the recent findings about the possible involvement of miRNAs in radiation-induced heart disease and their potential use as diagnostic or treatment targets in this respect.

Quality of life issues relating to endocrine treatment options

DEFF Research Database (Denmark)

Iversen, P

1999-01-01

for measuring health-related quality of life should assess both overall and disease-specific quality of life. Data from two large studies of bicalutamide monotherapy show that this non-steroidal antiandrogen is associated with significant health-related quality of life advantages in the treatment of patients...

Tonsillary carcinoma after temozolomide treatment for glioblastoma multiforme: treatment-related or dual-pathology?

Science.gov (United States)

Binello, E; Germano, I M

2009-08-01

Glioblastoma multiforme is a primary malignant brain tumor with a prognosis of typically less than 2 years. Standard treatment paradigms include surgery, radiation therapy and temozolomide. Little data exists for temozolomide recommendations after the first 6 months. We present a case of a patient with glioblastoma multiforme treated with surgery, radiation and chronic temozolomide for 6 years. He continues to survive glioblastoma-recurrence-free, but developed tonsillary carcinoma. This case raises the question of whether this secondary solid-organ malignancy is treatment-related or dual pathology.

New approaches and potential treatments for dry age-related macular degeneration

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Francisco Max Damico

2012-02-01

Full Text Available Emerging treatments for dry age-related macular degeneration (AMD and geographi c atrophy focus on two strategies that target components involved in physiopathological pathways: prevention of photoreceptors and retinal pigment epithelium loss (neuroprotection induction, oxidative damage prevention, and visual cycle modification and suppression of inflammation. Neuroprotective drugs, such as ciliary neurotrophic factor, brimonidine tartrate, tandospirone, and anti-amyloid β antibodies, aim to prevent apoptosis of retinal cells. Oxidative stress and depletion of essential micronutrients are targeted by the Age-Related Eye Disease Study (AREDS formulation. Visual cycle modulators reduce the activity of the photoreceptors and retinal accumulation of toxic fluorophores and lipofuscin. Eyes with dry age-related macular degeneration present chronic inflammation and potential treatments include corticosteroid and complement inhibition. We review the current concepts and rationale of dry age-related macular degeneration treatment that will most likely include a combination of drugs targeting different pathways involved in the development and progression of age-related macular degeneration.

Is Inconsistent Pre-treatment Bedtime Related to CPAP Non-Adherence?

Science.gov (United States)

Sawyer, Amy M.; King, Tonya S.; Sawyer, Douglas A.; Rizzo, Albert

2014-01-01

Lack of adherence to continuous positive airway pressure therapy (CPAP) limits the effectiveness of treatment of obstructive sleep apnea (OSA). We hypothesized that an irregular bedtime would be negatively related to regular use of CPAP treatment. If so, modifying bedtime schedule may address the persistent problem of inconsistent CPAP use in adults with OSA. In a prospective longitudinal study, we examined whether inconsistent self-reported bedtime before initiation of CPAP treatment, operationalized as bedtime variability, was (1) different among those adherent (≥ 4 hours per night) and non-adherent to CPAP treatment at one week and one month; and/or (2) was related to one-week and one-month CPAP use when other variables were accounted for. Consecutively-recruited newly-diagnosed OSA adults (N=79) completed sleep diaries prior to CPAP treatment. One-week and one-month objective CPAP use data were collected. Pre-treatment bedtime variability was different among CPAP non-adherers and adherers at one month and was a significant predictor of non-adherence at one month in multivariate analyses. The odds of one-month CPAP non-adherence were 3.5 times greater in those whose pre-treatment bedtimes varied by >75 minutes. Addressing sleep schedule prior to CPAP initiation may be an opportunity to improve CPAP adherence. PMID:25353159

Treatment-related fluctuation in Guillain-Barre syndrome

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Thirunavukkarasu Thivakaran

2011-01-01

Full Text Available Guillain-Barre syndrome (GBS is usually a monophasic illness but relapses occur. A 55-year-old female with hypertension and vitiligo presented with acute inflammatory demyelinating polyradiculoneuropathy. She improved with immunoglobulin treatment started on day 6 of illness, but relapsed on day 14 warranting repeat immunoglobulin therapy. Thereafter recovery was complete. Her relapse was due to treatment-related fluctuation (TRF. TRF is improvement in the GBS disability scale of at least one grade after completion of immunotherapy followed by worsening of the disability scale of at least one grade within the first 2 months after disease onset. Recurrent GBS and chronic inflammatory demyelinating polyradiculoneuropathy were excluded. During the peak of the illness ANA titres were transiently high. The presence of other medical conditions, predominant proximal weakness and the absence of preceding diarrhea are predictors for TRF seen in this patient. Early treatment and evidence of ongoing immune activation have contributed toward TRF.

Age-related macular degeneration: epidemiology and optimal treatment

DEFF Research Database (Denmark)

la Cour, Morten; Kiilgaard, Jens Folke; Nissen, Mogens Holst

2002-01-01

Age-related macular degeneration (AMD) is a common macular disease affecting elderly people in the Western world. It is characterised by the appearance of drusen in the macula, accompanied by choroidal neovascularisation (CNV) or geographic atrophy. The disease is more common in Caucasian....... Smoking is probably also a risk factor. Preventive strategies using macular laser photocoagulation are under investigation, but their efficacy in preventing visual loss is as yet unproven. There is no treatment with proven efficacy for geographic atrophy. Optimal treatment for exudative AMD requires...

Calcitonin gene-related peptide promotes cellular changes in trigeminal neurons and glia implicated in peripheral and central sensitization

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Cady Ryan J

2011-12-01

Full Text Available Abstract Background Calcitonin gene-related peptide (CGRP, a neuropeptide released from trigeminal nerves, is implicated in the underlying pathology of temporomandibular joint disorder (TMD. Elevated levels of CGRP in the joint capsule correlate with inflammation and pain. CGRP mediates neurogenic inflammation in peripheral tissues by increasing blood flow, recruiting immune cells, and activating sensory neurons. The goal of this study was to investigate the capability of CGRP to promote peripheral and central sensitization in a model of TMD. Results Temporal changes in protein expression in trigeminal ganglia and spinal trigeminal nucleus were determined by immunohistochemistry following injection of CGRP in the temporomandibular joint (TMJ capsule of male Sprague-Dawley rats. CGRP stimulated expression of the active forms of the MAP kinases p38 and ERK, and PKA in trigeminal ganglia at 2 and 24 hours. CGRP also caused a sustained increase in the expression of c-Fos neurons in the spinal trigeminal nucleus. In contrast, levels of P2X3 in spinal neurons were only significantly elevated at 2 hours in response to CGRP. In addition, CGRP stimulated expression of GFAP in astrocytes and OX-42 in microglia at 2 and 24 hours post injection. Conclusions Our results demonstrate that an elevated level of CGRP in the joint, which is associated with TMD, stimulate neuronal and glial expression of proteins implicated in the development of peripheral and central sensitization. Based on our findings, we propose that inhibition of CGRP-mediated activation of trigeminal neurons and glial cells with selective non-peptide CGRP receptor antagonists would be beneficial in the treatment of TMD.

Cognitive behaviour therapy and inflammation: A systematic review of its relationship and the potential implications for the treatment of depression.

Science.gov (United States)

Lopresti, Adrian L

2017-06-01

There is growing evidence confirming increased inflammation in a subset of adults with depression. The impact of this relationship has mostly been considered in biologically based interventions; however, it also has potential implications for psychological therapies. Cognitive behaviour therapy is the most commonly used psychological intervention for the treatment of depression with theories around its efficacy primarily based on psychological mechanisms. However, cognitive behaviour therapy may have an effect on, and its efficacy influenced by, physiological processes associated with depression. Accordingly, the purpose of this systematic review was to examine the relationship between cognitive behaviour therapy and inflammation. Studies examining the anti-inflammatory effects of cognitive behaviour therapy in people with depression and other medical conditions (e.g. cancer, diabetes and heart disease) were examined. In addition, the relationship between change in inflammatory markers and change in depressive symptoms following cognitive behaviour therapy, and the influence of pre-treatment inflammation on cognitive behaviour therapy treatment response were reviewed. A total of 23 studies investigating the anti-inflammatory effects of cognitive behaviour therapy were identified. In 14 of these studies, at least one reduction in an inflammatory marker was reported, increases were identified in three studies and no change was found in six studies. Three studies examined the relationship between change in inflammation and change in depressive symptoms following cognitive behaviour therapy. In two of these studies, change in depressive symptoms was associated with a change in at least one inflammatory marker. Finally, three studies examined the influence of pre-treatment inflammation on treatment outcome from cognitive behaviour therapy, and all indicated a poorer treatment response in people with higher premorbid inflammation. Preliminary evidence suggests

A review of the clinical implications of bisphosphonates in dentistry.

Science.gov (United States)

Borromeo, G L; Tsao, C E; Darby, I B; Ebeling, P R

2011-03-01

Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate associated jaw osteonecrosis (ONJ) is a potentially debilitating, yet poorly understood condition. A literature review was undertaken to review the dental clinical implications of bisphosphonates. The present paper briefly describes the postulated pathophysiology of ONJ and conditions with similar clinical presentations. The implications of bisphosphonates for implantology, periodontology, orthodontics and endodontics are reviewed. Whilst bisphosphonates have potential positive applications in some clinical settings, periodontology particularly, further clinical research is limited by the risk of ONJ. Prevention and management are reviewed, including guidelines for reducing cumulative intravenous bisphosphonate dose, cessation of bisphosphonates prior to invasive dental treatment or after ONJ development, and the use of serum beta-CTX-1 in assessing risk. In the context of substantial uncertainty, the implications of bisphosphonate use in the dental clinical setting are still being determined. © 2010 Australian Dental Association.

TREATMENT OF IgG4-RELATED DISEASE

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E. V. Sokol

2016-01-01

Full Text Available IgG4-related disease (IgG4-RD is a fibroinflammatory condition characterized by the occurrence of tumor-like foci in different organs with a unique histological pattern (moirо-like fibrosis, obvious lymphoplasmacytic infiltration with large numbers of IgG4+ plasma cells, and obliterating phlebitis and elevated serum IgG4 levels in the majority of patients. Its first-line therapy is glucocorticoids at a starting dose of 0.6 mg/kg/day (equivalent to prednisolone; however, this treatment entails a great number of adverse events and high recurrence rates. The paper provides a review of today's literature on the treatment of IgG4-RD; particular emphasis is laid on the description of therapy with glucocorticoids and rituximab.

Background characteristics and treatment-related factors associated with treatment success or failure in a non-pharmacological intervention for dementia caregivers.

Science.gov (United States)

Rose, Karen C; Gitlin, Laura N

2017-06-01

Non-pharmacological interventions for persons with dementia often rely on family caregivers for implementation. However, caregivers differ in their readiness to use strategies. This study examines dyadic characteristics and treatment-related mechanisms associated with treatment success (high readiness to use strategies) and failure (low readiness to use strategies) at the conclusion of the Advancing Caregiver Training (ACT) intervention. Caregiver and person with dementia characteristics and treatment-related variables (treatment participation, number and type of strategies introduced and enacted) were examined in 110 caregivers in intervention. Interventionists rated readiness (1=precontemplation; 2=contemplation; 3=preparation; 4=action) of caregivers to use strategies at the final ACT session. Univariate analyses examined dyadic characteristics, and Multiple Analysis of Covariance (MANCOVA) and Analyses of Covariance (ANCOVA) examined treatment-related factors associated with readiness to use strategies at treatment completion. At treatment completion, 28.2% (N=31) scored in pre-action and 71.8% (N=79) at action. Caregivers at pre-action readiness levels were more likely than those at action to be a spouse, report greater financial difficulties and be managing fewer problem behaviors. Although both groups were introduced an equivalent number of non-pharmacological strategies, caregivers at pre-action were less likely than those at action to report enacting strategies. Certain dyadic characteristics and treatment-related factors were associated with treatment failure including financial strain and lack of strategy integration. Findings suggest that developing intervention components to address financial concerns and increase opportunities for practicing strategies and then using them between treatment sessions may be important for caregivers at risk of treatment failure.

Expression of IL-23/Th17-related cytokines in basal cell carcinoma and in the response to medical treatments.

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Cristina Pellegrini

Full Text Available Several immune-related markers have been implicated in basal cell carcinoma (BCC pathogenesis. The BCC inflammatory infiltrate is dominated by Th2 cytokines, suggesting a specific state of immunosuppression. In contrast, regressing BCC are characterized by a Th1 immune response with IFN-γ promoting a tumor suppressive activity. IL-23/Th17-related cytokines, as interleukin (IL-17, IL-23 and IL-22, play a significant role in cutaneous inflammatory diseases, but their involvement in skin carcinogenesis is controversial and is poorly investigated in BCC. In this study we investigated the expression of IFN-γ, IL-17, IL-23 and IL-22 cytokines in BCC at the protein and mRNA level and their modulation during imiquimod (IMQ treatment or photodynamic therapy (PDT. IFN-γ, IL-17, IL-23 and IL-22 levels were evaluated by immunohistochemistry and quantitative Real Time PCR in 41 histopathologically-proven BCCs (28 superficial and 13 nodular from 39 patients. All BCC samples were analyzed at baseline and 19 of 41 also during medical treatment (9 with IMQ 5% cream and 10 with MAL-PDT. Association between cytokines expression and clinico-pathological variables was evaluated. Higher levels of IFN-γ, IL-17, IL-23 and IL-22 were found in BCCs, mainly in the peritumoral infiltrate, compared to normal skin, with the expression being correlated to the severity of the inflammatory infiltrate. IFN-γ production was higher in superficial BCCs compared to nodular BCCs, while IL-17 was increased in nodular BCCs. A significant correlation was found between IFN-γ and IL-17 expression with both cytokines expressed by CD4+ and CD8+ T-cells. An increase of all cytokines occurred during the inflammatory phase induced by IMQ and at the early time point of PDT treatment, with significant evidence for IFN-γ, IL-23, and IL-22. Our results confirm the role of IFN-γ and support the involvement of IL-23/Th17-related cytokines in BCC pathogenesis and in the inflammatory response

Prevention and treatment of radiotherapy-induced oral mucositis: a literature review

International Nuclear Information System (INIS)

Albuquerque, Ieda Lessa de Souza; Camargo, Teresa Caldas

2007-01-01

The prevention and treatment of radiotherapy-induced oral mucositis have still not been fully defined. The current study thus involved a literature search aimed at identifying preventive and therapeutic measures in relation to oral mucositis in patients submitted to radiotherapy, analyzing the level of evidence in the selected studies, identifying which indications for prevention and treatment in the literature pertain to the field of nursing, and critically analyzing the results and their implications for nursing care. This was a systematic literature survey without a meta analysis, consulting the following databases: BIREME, Medline, CancerLit, Scirus, CAPES, Free medical journal, High wire press, SCIELO, and Medscape, from 2000 to 2005. According to observations, nursing care was capable of improving patient's quality of life, promoting education of patients, implementing and supervising oral care programs, and providing guidance on hygiene, prevention, and treatment of oral mucositis, including pain management. However, no Brazilian nursing publications were found on the subject. Research and publications focusing on nursing experience in the prevention and treatment of radiotherapy-related oral mucositis and the implications for patients and nurses are important to provide evidence-based nursing guidelines. (author)

Panel 7: Otitis Media: Treatment and Complications.

Science.gov (United States)

Schilder, Anne G M; Marom, Tal; Bhutta, Mahmood F; Casselbrant, Margaretha L; Coates, Harvey; Gisselsson-Solén, Marie; Hall, Amanda J; Marchisio, Paola; Ruohola, Aino; Venekamp, Roderick P; Mandel, Ellen M

2017-04-01

Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.

QUALITY OF LIFE AND TREATMENT COMPLIANCE IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY UNDER HEMODIALYSIS TREATMENT

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FRANCOISE CONTRERAS

2006-10-01

Full Text Available The purpose of this study was to describe the quality of life among 33 patients with chronic kidney disease inhaemodialysis treatment and to establish whether there were differences features between them, due to adherencebehavior. Health Survey SF-36 was used, biochemical and clinical data was registered, as medical support for theadherence criteria. Significant decline in quality of life was evidenced in these patients; nevertheless the social functionwas preserved. The results of the t-student for independent samples showed significant differences in physical function,between the groups of patients with and without adherence to treatment (n = 19 and n = 13 respectively. Likewise,the first group reveal better quality of life related with mental health while the another group was related with physicalaspects. The implications of these results are discussed.

Factors Related to Medicaid Payment Acceptance at Outpatient Substance Abuse Treatment Programs

Science.gov (United States)

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

2011-01-01

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

Assisted reproductive technology (ART) treatment in women with schizophrenia or related psychotic disorder

DEFF Research Database (Denmark)

Ebdrup, Ninna H; Assens, Maria; Hougaard, Charlotte O

2014-01-01

To determine the prevalence rate of women with a diagnosis of schizophrenia or related psychotic disorder in assisted reproductive technology (ART) treatment and to study these women's fertility treatment outcome in comparison to women with no psychotic disorders.......To determine the prevalence rate of women with a diagnosis of schizophrenia or related psychotic disorder in assisted reproductive technology (ART) treatment and to study these women's fertility treatment outcome in comparison to women with no psychotic disorders....

Internet addiction: coping styles, expectancies, and treatment implications

OpenAIRE

Brand, Matthias; Laier, Christian; Young, Kimberly S.

2014-01-01

Internet addiction has become a serious mental health condition in many countries. To better understand the clinical implications of Internet addiction, this study tested statistically a new theoretical model illustrating underlying cognitive mechanisms contributing to development and maintenance of the disorder. The model differentiates between a generalized Internet addiction (GIA) and specific forms. This study tested the model on GIA on a population of general Internet users. The findings...

Management of Work–Related Injuries Leading to Amputation and Its Relation with Treatment Outcome

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Iravan Masoudi-Asl

2011-04-01

Full Text Available Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal" mso-tstyle-rowband-size:0 mso-tstyle-colband-size:0 mso-style-noshow:yes mso-style-priority:99 mso-style-parent:"" mso-padding-alt:0mm 5.4pt 0mm 5.4pt mso-para-margin-top:0mm mso-para-margin-right:0mm mso-para-margin-bottom:10.0pt mso-para-margin-left:0mm line-height:115% mso-pagination:widow-orphan font-size:11.0pt font-family:"Calibri","sans-serif" mso-ascii-font-family:Calibri mso-ascii-theme-font:minor-latin mso-hansi-font-family:Calibri mso-hansi-theme-font:minor-latin mso-bidi-font-family:Arial mso-bidi-theme-font:minor-bidi}   Objective: Work related accidents are considered as a significant health problem of working population. The goal of this study was to determine relation of treatment management with treatment outcome of Work-Related injuries leading to amputation.   Materials & Methods: current study was based on correlation method which was evidence based and was based on actual data of medical records of occupational accidents leading to amputations. Study population included all injuries that suffered limb amputation due to work and were referred to Laleh hospital during 2005 to 2009 (N=135. The data were collected by check list and analyzed by descriptive and inferential Statistics.   Results: Taking care method had a considerable effect on success of replant operation of that limb (P<0.001 so that in 95.23% of injuries whom principles of primary care had been done for them during transportation of amputated limb to hospital, had a successful operation. Treatment results of injuries in large limbs have had a strong relation to interval of incident occurrence to start of operation (P=0.038 How to refer injuries to hospital has not had a meaningful impact on treatment outcome (P=0.469 although referring injuries from health centers of workplace directly to hospital had more successful result comparing to

Study Protocol: Screening and Treatment of Alcohol-Related Trauma (START – a randomised controlled trial

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Jayaraj Rama

2012-10-01

Full Text Available Abstract Background The incidence of mandibular fractures in the Northern Territory of Australia is very high, especially among Indigenous people. Alcohol intoxication is implicated in the majority of facial injuries, and substance use is therefore an important target for secondary prevention. The current study tests the efficacy of a brief therapy, Motivational Care Planning, in improving wellbeing and substance misuse in youth and adults hospitalised with alcohol-related facial trauma. Methods and design The study is a randomised controlled trial with 6 months of follow-up, to examine the effectiveness of a brief and culturally adapted intervention in improving outcomes for trauma patients with at-risk drinking admitted to the Royal Darwin Hospital maxillofacial surgery unit. Potential participants are identified using AUDIT-C questionnaire. Eligible participants are randomised to either Motivational Care Planning (MCP or Treatment as Usual (TAU. The outcome measures will include quantity and frequency of alcohol and other substance use by Timeline Followback. The recruitment target is 154 participants, which with 20% dropout, is hoped to provide 124 people receiving treatment and follow-up. Discussion This project introduces screening and brief interventions for high-risk drinkers admitted to the hospital with facial trauma. It introduces a practical approach to integrating brief interventions in the hospital setting, and has potential to demonstrate significant benefits for at-risk drinkers with facial trauma. Trial Registration The trial has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR and Trial Registration: ACTRN12611000135910.

Cost-effectiveness of anti-oxidant vitamins plus zinc treatment to prevent the progression of intermediate age-related macular degeneration. A Singapore perspective.

Science.gov (United States)

Saxena, Nakul; George, Pradeep Paul; Heng, Bee Hoon; Lim, Tock Han; Yong, Shao Onn

2015-06-01

To determine if providing high dose anti-oxidant vitamins and zinc treatment age-related eye disease study (AREDS formulation) to patients with intermediate age-related macular degeneration (AMD) aged 40-79 years from Singapore is cost-effective in preventing progression to wet AMD. A hypothetical cohort of category 3 and 4 AMD patients from Singapore was followed for 5 calendar years to determine the number of patients who would progress to wet AMD given the following treatment scenarios: (a) AREDS formulation or placebo followed by ranibizumab (as needed) for wet AMD. (b) AREDS formulation or placebo followed by bevacizumab (monthly) for wet AMD. (c) AREDS formulation or placebo followed by aflibercept (VIEW I and II trial treatment regimen). Costs were estimated for the above scenarios from the providers' perspective, and cost-effectiveness was measured by cost per disability-adjusted life year (DALY) averted with a disability weight of 0.22 for wet AMD. The costs were discounted at an annual rate of 3%. Over 5400 patients could be prevented from progressing to wet AMD cumulatively if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab was cost-effective compared to placebo-ranibizumab or placebo-aflibercept combinations (cost per DALY averted: SGD$23,662.3 and SGD$21,138.8, respectively). However, bevacizumab (monthly injections) alone was more cost-effective compared to AREDS formulation followed by bevacizumab. Prophylactic treatment with AREDS formulation for intermediate AMD patients followed by ranibizumab or for patients who progressed to wet AMD was found to be cost-effective. These findings have implications for intermediate AMD screening, treatment and healthcare planning in Singapore.

Threat-Related Selective Attention Predicts Treatment Success in Childhood Anxiety Disorders

NARCIS (Netherlands)

J.S. Legerstee (Jeroen); J.H.M. Tulen (Joke); V.L. Kallen (Victor); G.C. Dieleman (Gwen); P.D.A. Treffers (Philip); F.C. Verhulst (Frank); E.M.W.J. Utens (Elisabeth)

2009-01-01

textabstractAbstract OBJECTIVE: The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders

Threat-related selective attention predicts treatment success in childhood anxiety disorders

NARCIS (Netherlands)

Legerstee, Jeroen S.; Tulen, Joke H. M.; Kallen, Victor L.; Dieleman, Gwen C.; Treffers, Philip D. A.; Verhulst, Frank C.; Utens, Elisabeth M. W. J.

2009-01-01

The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. Participants

Asthma in Sickle Cell Disease: Implications for Treatment

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Kathryn Blake

2011-01-01

Full Text Available Objective. To review issues related to asthma in sickle cell disease and management strategies. Data Source. A systematic review of pertinent original research publications, reviews, and editorials was undertaken using MEDLlNE, the Cochrane Library databases, and CINAHL from 1947 to November 2010. Search terms were [asthma] and [sickle cell disease]. Additional publications considered relevant to the sickle cell disease population of patients were identified; search terms included [sickle cell disease] combined with [acetaminophen], [pain medications], [vitamin D], [beta agonists], [exhaled nitric oxide], and [corticosteroids]. Results. The reported prevalence of asthma in children with sickle cell disease varies from 2% to approximately 50%. Having asthma increases the risk for developing acute chest syndrome , death, or painful episodes compared to having sickle cell disease without asthma. Asthma and sickle cell may be linked by impaired nitric oxide regulation, excessive production of leukotrienes, insufficient levels of Vitamin D, and exposure to acetaminophen in early life. Treatment of sickle cell patients includes using commonly prescribed asthma medications; specific considerations are suggested to ensure safety in the sickle cell population. Conclusion. Prospective controlled trials of drug treatment for asthma in patients who have both sickle cell disease and asthma are urgently needed.

HIV in Indian prisons: Risk behaviour, prevalence, prevention & treatment

OpenAIRE

Dolan, Kate; Larney, Sarah

2010-01-01

Background & Objectives: HIV is a major health challenge for prison authorities. HIV in prisons has implications for HIV in the general community. The aim of this paper was to gather information on HIV risk, prevalence, prevention and treatment in prisons in India. Methods: Relevant published and unpublished reports and information were sought in order to provide a coherent picture of the current situation relating to HIV prevention, treatment and care in prisons in India. Information covered...

Clinical implications and treatment of dengue.

Science.gov (United States)

Chawla, Pooja; Yadav, Amrita; Chawla, Viney

2014-03-01

Dengue is a common pathogenic disease often proving fatal, more commonly affecting the tropics. Aedes mosquito is the vector for this disease, and outbreaks of dengue often cause mass damage to life. The current review is an effort to present an insight into the causes, etiology, symptoms, transmission, diagnosis, major organs affected, mitigation and line of treatment of this disease with special emphasis on drugs of natural origin. The disease has a potential to spread as an endemic, often claiming several lives and thus requires concerted efforts to work out better treatment options. Traditional medicine offers an alternative solution and could be explored as a safer treatment option. Development of a successful vaccine and immunization technique largely remains a challenge and a better antiviral approach needs to be worked out to complement the supportive therapy. No single synthetic molecule has found to be wholly effective enough to offer curative control and the line of treatment mostly utilizes a combination of fluid replacement and antipyretics-analgesics like molecules to provide symptomatic relief. Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

REELIN-RELATED DISTURBANCES IN DEPRESSION: IMPLICATIONS FOR TRANSLATIONAL STUDIES

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Hector J eCaruncho

2016-02-01

Full Text Available The finding that reelin expression is significantly decreased in mood and psychotic disorders, together with evidence that reelin can regulate key aspects of hippocampal plasticity in the adult brain, brought our research group and others to study the possible role of reelin in the pathogenesis of depression. This review describes recent progress on this topic using an animal model of depression that makes use of repeated corticosterone injections. This methodology produces depression-like symptoms in both rats and mice that are reversed by antidepressant treatment. We have reported that corticosterone causes a decrease in the number of reelin-immunopositive cells in the dentate gyrus subgranular zone, where adult hippocampal neurogenesis takes place; that down-regulation of the number of reelin-positive cells closely parallels the development of a depression-like phenotype during repeated corticosterone treatment; that reelin downregulation alters the co-expression of reelin with neuronal nitric oxide synthase; that deficits in reelin might also create imbalances in glutamatergic and GABAergic circuits within the hippocampus and other limbic structures; and that co-treatment with antidepressant drugs prevents both reelin deficits and the development of a depression-like phenotype. We also observed alterations in the pattern of membrane protein clustering in peripheral lymphocytes in animals with low levels of reelin. Importantly, we found parallel changes in membrane protein clustering in depression patients, which differentiated two subpopulations of naïve depression patients that showed a different therapeutic response to antidepressant treatment. Here we review these findings and develop the hypothesis that restoring reelin-related function could represent a novel approach for antidepressant therapies.

Clinical implications of the anisotropic analytical algorithm for IMRT treatment planning and verification

International Nuclear Information System (INIS)

Bragg, Christopher M.; Wingate, Katrina; Conway, John

2008-01-01

Purpose: To determine the implications of the use of the Anisotropic Analytical Algorithm (AAA) for the production and dosimetric verification of IMRT plans for treatments of the prostate, parotid, nasopharynx and lung. Methods: 72 IMRT treatment plans produced using the Pencil Beam Convolution (PBC) algorithm were recalculated using the AAA and the dose distributions compared. Twenty-four of the plans were delivered to inhomogeneous phantoms and verification measurements made using a pinpoint ionisation chamber. The agreement between the AAA and measurement was determined. Results: Small differences were seen in the prostate plans, with the AAA predicting slightly lower minimum PTV doses. In the parotid plans, there were small increases in the lens and contralateral parotid doses while the nasopharyngeal plans revealed a reduction in the volume of the PTV covered by the 95% isodose (the V 95% ) when the AAA was used. Large changes were seen in the lung plans, the AAA predicting reductions in the minimum PTV dose and large reductions in the V 95% . The AAA also predicted small increases in the mean dose to the normal lung and the V 20 . In the verification measurements, all AAA calculations were within 3% or 3.5 mm distance to agreement of the measured doses. Conclusions: The AAA should be used in preference to the PBC algorithm for treatments involving low density tissue but this may necessitate re-evaluation of plan acceptability criteria. Improvements to the Multi-Resolution Dose Calculation algorithm used in the inverse planning are required to reduce the convergence error in the presence of lung tissue. There was excellent agreement between the AAA and verification measurements for all sites

A NEW LUMINOSITY RELATION FOR GAMMA-RAY BURSTS AND ITS IMPLICATION

International Nuclear Information System (INIS)

Qi Shi; Lu Tan

2010-01-01

Gamma-ray bursts (GRBs) are the most luminous astrophysical events observed so far. They are conventionally classified into long and short ones depending on their time duration, T 90 . Because of the advantage that their high redshifts offer, many efforts have been made to apply GRBs to cosmology. The key to this is to find correlations between some measurable properties of GRBs and the energy or the luminosity of GRBs. These correlations are usually referred to as luminosity relations and are helpful in understanding the GRBs themselves. In this paper, we explored such correlations in the X-ray emission of GRBs. The X-ray emission of GRBs observed by Swift has the exponential functional form in the prompt phase and relaxes to a power-law decay at time T p . We have assumed a linear relation between log L X,p (with L X,p being the X-ray luminosity at T p ) and log [T p /(1 + z)], but there is some evidence for curvature in the data and the true relationship between L X,p and T p /(1 + z) may be a broken power law. The limited GRB sample used in our analysis is still not sufficient for us to conclude whether the break is real or just an illusion caused by outliers. We considered both cases in our analysis and discussed the implications of the luminosity relation, especially on the time duration of GRBs and their classification.

Distinct Neural-Functional Effects of Treatments With Selective Serotonin Reuptake Inhibitors, Electroconvulsive Therapy, and Transcranial Magnetic Stimulation and Their Relations to Regional Brain Function in Major Depression: A Meta-analysis.

Science.gov (United States)

Chau, David T; Fogelman, Phoebe; Nordanskog, Pia; Drevets, Wayne C; Hamilton, J Paul

2017-05-01

Functional neuroimaging studies have examined the neural substrates of treatments for major depressive disorder (MDD). Low sample size and methodological heterogeneity, however, undermine the generalizability of findings from individual studies. We conducted a meta-analysis to identify reliable neural changes resulting from different modes of treatment for MDD and compared them with each other and with reliable neural functional abnormalities observed in depressed versus control samples. We conducted a meta-analysis of studies reporting changes in brain activity (e.g., as indexed by positron emission tomography) following treatments with selective serotonin reuptake inhibitors (SSRIs), electroconvulsive therapy (ECT), or transcranial magnetic stimulation. Additionally, we examined the statistical reliability of overlap among thresholded meta-analytic SSRI, ECT, and transcranial magnetic stimulation maps as well as a map of abnormal neural function in MDD. Our meta-analysis revealed that 1) SSRIs decrease activity in the anterior insula, 2) ECT decreases activity in central nodes of the default mode network, 3) transcranial magnetic stimulation does not result in reliable neural changes, and 4) regional effects of these modes of treatment do not significantly overlap with each other or with regions showing reliable functional abnormality in MDD. SSRIs and ECT produce neurally distinct effects relative to each other and to the functional abnormalities implicated in depression. These treatments therefore may exert antidepressant effects by diminishing neural functions not implicated in depression but that nonetheless impact mood. We discuss how the distinct neural changes resulting from SSRIs and ECT can account for both treatment effects and side effects from these therapies as well as how to individualize these treatments. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Sexual orientation and sexual behavior among Latino and Asian Americans: implications for unfair treatment and psychological distress.

Science.gov (United States)

Chae, David H; Ayala, George

2010-09-01

Research on the sexuality of Asians and Latinos in the United States has been sparse, and the studies that have been done suffer from a number of limitations. Using data from the National Latino and Asian American Study (2002-2003), this study examined self-identified sexual orientation and self-reported sexual behavior among Latinos (n = 2,554; age: M = 38.1, SE = 0.5) and Asians (n = 2,095; age: M = 41.5, SE = 0.8). This study also investigated implications for unfair treatment and psychological distress among sexual minorities identified in the sample. Results indicated heterogeneity in responses to items assessing sexual orientation and sexual behavior including differences in the adoption of lesbian, gay, or bisexual (LGB) identity by gender, ethnicity, nativity, and socioeconomic status. LGB sexual minorities reported higher levels of unfair treatment and psychological distress compared to their non-LGB-identified sexual minority counterparts, and unfair treatment was positively associated with psychological distress. Results highlight the need to consider multiple demographic factors in assessing sexuality, and also suggest that measures of both self-identified sexual orientation and sexual behavior should be collected. In addition, findings provide support for the deleterious influence of unfair treatment among Asians and Latinos in the United States.

Microbiological implications of the food irradiation process

International Nuclear Information System (INIS)

Teufel, P.

1981-01-01

The Joint FAO/IAEA/WHO Expert Committee on the wholesomeness of irradiated food which met in 1976 concluded after a detailed and critical review of the available information, that the microbiological aspects of food irradiation were fully comparable to those of conventional processes used in modern food technology. Processing of food by irradiation may be considered from the microbiological point of view as separate procedures: high dose treatment (> 10 kGy), for sterilisation (radappertization) and low dose treatment (< 10 kGy) for pasteurisation (radicidation, radurization), (for definitions see p. 43), disinfestation, or inhibition of sprouting. No public health hazards related to micro-organisms arise from high dose irradiation because this process results in commercially sterile products. On the other hand, it is important to consider the possible microbiological hazards when food is irradiated with a low dose. The microbiological implications relate to the natural radiation resistance of bacteria, yeasts, fungi and viruses or to the mutagenic effects of ionising radiation in micro-organisms. Both areas of concern were reviewed in detail by Ingram and Ingram and Farkas. (orig.)

A novel source of methylglyoxal and glyoxal in retina: implications for age-related macular degeneration.

Science.gov (United States)

Yoon, Kee Dong; Yamamoto, Kazunori; Ueda, Keiko; Zhou, Jilin; Sparrow, Janet R

2012-01-01

Aging of retinal pigment epithelial (RPE) cells of the eye is marked by accumulations of bisretinoid fluorophores; two of the compounds within this lipofuscin mixture are A2E and all-trans-retinal dimer. These pigments are implicated in pathological mechanisms involved in some vision-threatening disorders including age-related macular degeneration (AMD). Studies have shown that bisretinoids are photosensitive compounds that undergo photooxidation and photodegradation when irradiated with short wavelength visible light. Utilizing ultra performance liquid chromatography (UPLC) with electrospray ionization mass spectrometry (ESI-MS) we demonstrate that photodegradation of A2E and all-trans-retinal dimer generates the dicarbonyls glyoxal (GO) and methylglyoxal (MG), that are known to modify proteins by advanced glycation endproduct (AGE) formation. By extracellular trapping with aminoguanidine, we established that these oxo-aldehydes are released from irradiated A2E-containing RPE cells. Enzyme-linked immunosorbant assays (ELISA) revealed that the substrate underlying A2E-containing RPE was AGE-modified after irradiation. This AGE deposition was suppressed by prior treatment of the cells with aminoguanidine. AGE-modification causes structural and functional impairment of proteins. In chronic diseases such as diabetes and atherosclerosis, MG and GO modify proteins by non-enzymatic glycation and oxidation reactions. AGE-modified proteins are also components of drusen, the sub-RPE deposits that confer increased risk of AMD onset. These results indicate that photodegraded RPE bisretinoid is likely to be a previously unknown source of MG and GO in the eye.

Female labour force participation in MENA's manufacturing sector: The implications of firm-related and national factors

OpenAIRE

Fakih, Ali; Ghazalian, Pascal L.

2013-01-01

The Middle East and North Africa (MENA) region falls behind several other geo-economic regions in terms of women's participation rates in the labour market. This paper examines the implications of firm-related and national factors for Female Labour Force Participation (FLFP) rates in manufacturing firms located in the MENA region. The empirical investigation uses data derived from the World Bank's Enterprise Surveys database and applies fractional logit models to carry out the estimations. Th...

Clinical efficacy of Ranibizumab in the treatment of wet age-related macular degeneration

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Ling-Jun Wei

2017-12-01

Full Text Available AIM:To analyze the clinical efficacy of Ranibizumab in the treatment of wet age-related macular degeneration(ARMD.METHODS: Clinical data of patients with wet age-related macular degeneration received treatment of ranibizumab at our hospital from 2015 to 2017 were analyzed. At 1mo after treatment, the clinical efficacy, ocular hemodynamics and ocular inflammation were evaluated. RESULTS: A total of 41 patients were analyzed. After treatment, patients got significantly increased in LogMAR(0.651±0.067 vs 0.321±0.049; t=25.460, Pvs 452.9±69.8μm; t=15.740, Pvs 16.1±3.5ng/L; t=3.563, Pvs 13.8±2.5ng/L; t=3.467, PP>0.05. CONCLUSION: In the treatment of wet age-related macular degeneration, the ranibizumab shows a good therapeutic effect without serious adverse drug reactions.

Implications of DSM-5 for Health Care Organizations and Mental Health Policy.

Science.gov (United States)

Castillo, Richard J; Guo, Kristina L

2016-01-01

The American Psychiatric Association (APA) has made major changes in the way mental illness is conceptualized, assessed, and diagnosed in its new diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, and has far reaching implications for health care organizations and mental health policy. This paper reviews the four new principles in DSM-5: 1) A spectrum (also called "dimensional") approach to the definition of mental illness; 2) recognition of the role played by environmental risk factors related to stress and trauma in predisposing, precipitating, and perpetuating mental illness; 3) cultural relativism in diagnosis and treatment of mental illness; and 4) recognizing the adverse effects of psychiatric medications on patients. Each of these four principles will be addressed in detail. In addition, four major implications for health care organizations and mental health policy are identified as: 1) prevention; 2) client-centered psychiatry; 3) mental health workers retraining; and 4) medical insurance reform. We conclude that DSM- 5's new approach to diagnosis and treatment of mental illness will have profound implications for health care organizations and mental health policy, indicating a greater emphasis on prevention and cure rather than long-term management of symptoms.

Systematically evaluating the impact of diagnosis-related groups (DRGs) on health care delivery: a matrix of ethical implications.

Science.gov (United States)

Fourie, Carina; Biller-Andorno, Nikola; Wild, Verina

2014-04-01

Swiss hospitals were required to implement a prospective payment system for reimbursement using a diagnosis-related groups (DRGs) classification system by the beginning of 2012. Reforms to a health care system should be assessed for their impact, including their impact on ethically relevant factors. Over a number of years and in a number of countries, questions have been raised in the literature about the ethical implications of the implementation of DRGs. However, despite this, researchers have not attempted to identify the major ethical issues associated with DRGs systematically. To address this gap in the literature, we have developed a matrix for identifying the ethical implications of the implementation of DRGs. It was developed using a literature review, and empirical studies on DRGs, as well as a review and analysis of existing ethics frameworks. The matrix consists of the ethically relevant parameters of health care systems on which DRGs are likely to have an impact; the ethical values underlying these parameters; and examples of specific research questions associated with DRGs to illustrate how the matrix can be applied. While the matrix has been developed in light of the Swiss health care reform, it could be used as a basis for identifying the ethical implications of DRG-based systems worldwide and for highlighting the ethical implications of other kinds of provider payment systems (PPS). Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Current knowledge and trends in age-related macular degeneration: today's and future treatments.

Science.gov (United States)

Velez-Montoya, Raul; Oliver, Scott C N; Olson, Jeffrey L; Fine, Stuart L; Mandava, Naresh; Quiroz-Mercado, Hugo

2013-09-01

To address the most dynamic and current issues concerning today's treatment options and promising research efforts regarding treatment for age-related macular degeneration. This review is aimed to serve as a practical reference for more in-depth reviews on the subject. An online review of the database PubMed and Ovid were performed, searching for the key words age-related macular degeneration, AMD, VEGF, treatment, PDT, steroids, bevacizumab, ranibizumab, VEGF-trap, radiation, combined therapy, as well as their compound phrases. The search was limited to articles published since 1985. All returned articles were carefully screened, and their references were manually reviewed for additional relevant data. The web page www.clinicaltrials.gov was also accessed in search of relevant research trials. A total of 363 articles were reviewed, including 64 additional articles extracted from the references. At the end, only 160 references were included in this review. Treatment for age-related macular degeneration is a very dynamic research field. While current treatments are mainly aimed at blocking vascular endothelial growth factor, future treatments seek to prevent vision loss because of scarring. Promising efforts have been made to address the dry form of the disease, which has lacked effective treatment.

Stress, glucocorticoids and memory: implications for treating fear-related disorders.

Science.gov (United States)

de Quervain, Dominique; Schwabe, Lars; Roozendaal, Benno

2017-01-01

Glucocorticoid stress hormones are crucially involved in modulating mnemonic processing of emotionally arousing experiences. They enhance the consolidation of new memories, including those that extinguish older memories, but impair the retrieval of information stored in long-term memory. As strong aversive memories lie at the core of several fear-related disorders, including post-traumatic stress disorder and phobias, the memory-modulating properties of glucocorticoids have recently become of considerable translational interest. Clinical trials have provided the first evidence that glucocorticoid-based pharmacotherapies aimed at attenuating aversive memories might be helpful in the treatment of fear-related disorders. Here, we review important advances in the understanding of how glucocorticoids mediate stress effects on memory processes, and discuss the translational potential of these new conceptual insights.

An integrative view of mechanisms underlying generalized spike-and-wave epileptic seizures and its implication on optimal therapeutic treatments.

Directory of Open Access Journals (Sweden)

Boyuan Yan

Full Text Available Many types of epileptic seizures are characterized by generalized spike-and-wave discharges. In the past, notable effort has been devoted to understanding seizure dynamics and various hypotheses have been proposed to explain the underlying mechanisms. In this paper, by taking an integrative view of the underlying mechanisms, we demonstrate that epileptic seizures can be generated by many different combinations of synaptic strengths and intrinsic membrane properties. This integrative view has important medical implications: the specific state of a patient characterized by a set of biophysical characteristics ultimately determines the optimal therapeutic treatment. Through the same view, we further demonstrate the potentiation effect of rational polypharmacy in the treatment of epilepsy and provide a new angle to resolve the debate on polypharmacy. Our results underscore the need for personalized medicine and demonstrate that computer modeling and simulation may play an important role in assisting the clinicians in selecting the optimal treatment on an individual basis.

The melatonergic system: effects on sleep and implications for the treatment of psychiatric disorders

Directory of Open Access Journals (Sweden)

De Berardis D

2011-12-01

Full Text Available Domenico De Berardis1,2, Tiziano Acciavatti1, Giuseppe Di Iorio1, Mariangela Corbo1, Nicola Serroni2, Daniela Campanella2, Fabiola Di Emidio2, Monica Piersanti3, Marilde Cavuto4, Giovanni Martinotti5, Francesco Saverio Moschetta2, Massimo Di Giannantonio11Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D'Annunzio”, Chieti; 2NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”; 3NHS, Pharmaceutical Service, Hospital “G. Mazzini”, Teramo; 4IASM, L'Aquila; 5Institute of Psychiatry, Catholic University Medical School, Rome, ItalyAbstract: The circadian pacemaker or biological clock, located in the hypothalamic suprachiasmatic nucleus, is the generation site of circadian rhythms. The light/dark cycle is the circadian pacemaker's dominant synchronizing agent, though it is also influenced by neurotransmitters and the phase-shifting effects of various chemical and pharmacological components, of which melatonin (N-acetyl-5-methoxytryptamine is the most well established. In recent years, melatonin and melatonin analogs have been commercialized in many countries, mainly with hypnotic purposes. A new compound, agomelatine, has been recently synthesized and studied. Among melatonin analogs, this drug possesses unique pharmacological and clinical features; it is an antagonist at 5-HT2B and 5-HT2C receptors and has well established antidepressant and anxiolytic properties. Agomelatine opens new perspectives in the chronobiotic treatment of depression. The purpose of the present review was to elucidate the effects of the melatonergic system on sleep and the implications for the treatment of psychiatric disorders.Keywords: melatonin, agomelatine, circadian rhythms, depression

Treatment of addiction and addiction-related behavior

Energy Technology Data Exchange (ETDEWEB)

Dewey, Stephen L.; Brodie, Jonathan D.; Ashby, Jr., Charles R.

2004-12-07

The present invention provides a highly efficient method for treating substance addiction and for changing addiction-related behavior of a mammal suffering from substance addiction. The method includes administering to a mammal an effective amount of gamma vinylGABA or a pharmaceutically acceptable salt thereof. The present invention also provides a method of treatment of cocaine, morphine, heroin, nicotine, amphetamine, methamphetamine, or ethanol addiction by treating a mammal with an effective amount of gamma vinylGABA or a pharmaceutically acceptable salt thereof.

Threat-related selective attention predicts treatment success in childhood anxiety disorders.

Science.gov (United States)

Legerstee, Jeroen S; Tulen, Joke H M; Kallen, Victor L; Dieleman, Gwen C; Treffers, Philip D A; Verhulst, Frank C; Utens, Elisabeth M W J

2009-02-01

The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. Participants consisted of 131 children with anxiety disorders (aged 8-16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dot-probe task was administered to assess selective attention. Both at pretreatment and posttreatment, diagnostic status of the children was evaluated with a semistructured clinical interview (the Anxiety Disorders Interview Schedule for Children). Selective attention for severely threatening pictures at pretreatment assessment was predictive of treatment success. Examination of the specific components of selective attention revealed that nonresponders showed difficulties to disengage their attention away from severe threat. Treatment responders showed a tendency not to engage their attention toward severe threat. Age was not associated with selective attention and treatment success. Threat-related selective attention is a significant predictor of treatment success in children with anxiety disorders. Clinically anxious children with difficulties disengaging their attention away from severe threat profit less from cognitive-behavioral therapy. For these children, additional training focused on learning to disengage attention away from anxiety-arousing stimuli may be beneficial.

Gambling disorder in financial markets: Clinical and treatment-related features.

Science.gov (United States)

Shin, Young-Chul; Choi, Sam-Wook; Ha, Juwon; Choi, Jung-Seok; Kim, Dai-Jin

2015-12-01

To date, few studies have examined the clinical manifestation of disordered gamblers in financial markets. This study examined the differences in the clinical and treatment-related features of gambling disorder between financial markets and horse races. Subjects who met the DSM-IV criteria for pathological gambling (PG) and who sought treatment were assessed by retrospective chart review. One hundred forty-four subjects were included in this sample, which consisted of the following groups: financial markets (n = 45; 28.6%) and horse races (n = 99; 71.4%). Multiple similar manifestations were found between the groups, including severity of PG, age of PG onset, amounts of gambling debts, drinking days per week, depressive mood, duration of seeking treatment after the onset of PG, and treatment follow-up duration. However, disordered gamblers who invested in the financial market were significantly more likely to be educated (p = 0.003), live with their spouses (p = 0.007), have full-time jobs (p = 0.006), and they were more likely to participate in the first type of gambling than the horse races group (pfinancial markets group received the anti-craving medication less often than the horse races group (p = 0.04). These findings suggest that disordered gamblers in financial markets show different socio-demographic, clinical and treatment-related features compared with the horse race gamblers, despite a similar severity of gambling disorder. Understanding these differential manifestations may provide insight into prevention and treatment development for specific types of gambling.

PALLIATIVE TREATMENT FOR HIV-RELATED KAPOSrS SARCOMA

African Journals Online (AJOL)

HIV AND CANCER. P Ilarnardt, ME CkE, Dip On

TREATMENT FOR HIV-RELATED. KAPOSrS SARCOMA. NOVEMBER ~003. METHODS. Our study included 54 males and 46 females with HIV ...

1. Identification of Mycobacterial Genes Involved in Antibiotic Sensitivity: Implications for the Treatment of Tuberculosis with β-Lactam-Containing Regimens

   Science.gov (United States)

   Viswanathan, Gopinath; Yadav, Sangya

   2017-01-01

   ABSTRACT In a Mycobacterium smegmatis mutant library screen, transposon mutants with insertions in fhaA, dprE2, rpsT, and parA displayed hypersusceptibility to antibiotics, including the β-lactams meropenem, ampicillin, amoxicillin, and cefotaxime. Sub-MIC levels of octoclothepin, a psychotic drug inhibiting ParA, phenocopied the parA insertion and enhanced the bactericidal activity of meropenem against Mycobacterium tuberculosis in combination with clavulanate. Our study identifies novel factors associated with antibiotic resistance, with implications in repurposing β-lactams for tuberculosis treatment. PMID:28438925

2. Treatment Fidelity: Its Importance and Reported Frequency in Aphasia Treatment Studies

   Science.gov (United States)

   Hinckley, Jacqueline J.; Douglas, Natalie F.

   2013-01-01

   Purpose: Treatment fidelity is a measure of the reliability of the administration of an intervention in a treatment study. It is an important aspect of the validity of a research study, and it has implications for the ultimate implementation of evidence-supported interventions in typical clinical settings. Method: Aphasia treatment studies…

3. Factors related to orthodontic treatment time in adult patients

   Directory of Open Access Journals (Sweden)

   Ana Camila Esteves de Oliveira Melo

   2013-10-01

   Full Text Available INTRODUCTION: The length of time that it takes an orthodontist to treat adult patients varies widely. OBJECTIVE: The aim of this study was to investigate how different variables influence treatment time. METHODS: Seventy clinical case reports of successfully treated adult patients were examined. The patients were selected from 4,723 records held by three experienced orthodontists. The influence exerted by the following variables on treatment time was assessed: age, sex, facial pattern, severity of malocclusion (measured by the PAR index, sagittal relationship of canines, type of brackets (ceramic or metal, tooth extractions, missed appointments and orthodontic appliance issues/breakages, the latter being the dependent variable. Assessment was performed by multiple linear regression analysis, followed by the stepwise method with P < 0.05. RESULTS: The number of times a patient missed their appointment (no-show (R² = 14.4%, p < 0.0001 and the number of appliance issues/breakages (R² = 29.71%, p = 0.0037 significantly affected variability in treatment time, and these two variables together can predict 43.75% (R² total of the overall variability in treatment time. Other factors, such as canine relationship at the beginning of treatment, bracket type (metal or ceramic, tooth extractions, age at start of treatment, severity of the initial malocclusion, sex and facial pattern had no significant bearing on treatment time. CONCLUSIONS: The duration of orthodontic treatment in adults, when performed by experienced orthodontists, is mainly influenced by factors related to patient compliance. However, several factors which were not included in this study may contribute to variability in orthodontic treatment time.

4. Pain related to cancer treatments and diagnostic procedures: a no man's land?

   Science.gov (United States)

   Ripamonti, C I; Bossi, P; Santini, D; Fallon, M

   2014-06-01

   While guidelines are available for the management of cancer-related pain, little attention is given to the assessment and treatment of pain caused by treatments and diagnostic procedures in cancer patients. We evaluated the literature on pain related to cancer treatment and diagnostic procedures within a critical analysis. The data available are sparse, suggesting that little attention has been directed at this important aspect of oncology. This points to potentially suboptimal patient management. Appropriate studies are necessary in order to understand the incidence and appropriate management of pain, both during and/or after oncological treatments and diagnostic procedures. At the same time, Health Care Professionals should have heightened awareness of the causes and treatment of pain with the aim of anticipating and managing pain most appropriately for each individual patient. This is clearly an important component of holistic patient care before, during, and after oncological treatment. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

5. Effectiveness of short-term specialized inpatient treatment for war-related posttraumatic stress disorder: a role for adventure-based counseling and psychodrama.

   Science.gov (United States)

   Ragsdale, K G; Cox, R D; Finn, P; Eisler, R M

   1996-04-01

   Psychological tests were administered to 24 participants of an inpatient posttraumatic stress disorder (PTSD) treatment program both immediately before and following completion of treatment. Responses were compared to a treatment/wait list comparison group composed of 24 subjects awaiting entry into the program. All treatment/wait list comparison group subjects received weekly PTSD outpatient group therapy. Significant improvements were found in the inpatient treatment group in areas of hopelessness, feelings of guilt and shame, loneliness, and emotional expressiveness. Other indices of psychological functional, including interpersonal skills, gender role stress, anxiety, anger, and PTSD symptomatology did not change significantly in response to treatment. No positive changes in any area of psychological function occurred in the treatment/wait list comparison group. Implications for PTSD and areas of future research are discussed.

6. Primary health care physicians' treatment of psychosocial problems: implications for social work.

   NARCIS (Netherlands)

   Gross, R.; Rabinowitz, J.; Feldman, D.; Boerma, W.

   1996-01-01

   This study explores the extent to which primary care physicians serve as gatekeepers for the treatment of psychosocial problems and the extent to which they have contact with social workers. We also attempted to identify physician variables related to gatekeeping and amount of contact with social

7. Analysis of FEV1 decline in relatively healthy heavy smokers: implications of expressing changes in FEV1 in relative terms.

   Science.gov (United States)

   Thomsen, Laura H; Dirksen, Asger; Shaker, Saher B; Skovgaard, Lene T; Dahlbäck, Magnus; Pedersen, Jesper H

   2014-02-01

   Progressive decline in lung function has been widely accepted as the hallmark of chronic obstructive pulmonary disease (COPD); however, recent evidence indicates that the rate of decline measured as decline in forced expiratory volume in one second (FEV1) is higher in mild to moderate COPD than in severe COPD. Usually changes in FEV1 are measured in ml that is "absolute"; however, changes can also be measured "relative" as a percentage of the actual FEV1. We hypothesize that relative measurements could be more appropriate than absolute measurements for describing changes in lung function. We analyzed data from 3,218 relatively healthy heavy smokers who participated in the Danish Lung Cancer Screening Trial. The influences of age, sex, height, body mass index, smoking, and severity of airflow limitation on FEV1 were analyzed in mixed effects models. In absolute terms those with the best lung function consistently showed the steepest decline, whereas in relative terms most fast decliners are found among those with low lung function. Measuring changes in relative terms implied statistically significant acceleration of decline with advancing age, smoking (pack-years) and severity of airflow limitation. Relative measurements may lead to a better understanding of changes in lung function. Smoking and severity of airflow limitation speed up the loss of lung function, and this emphasizes the importance of abstaining from smoking the sooner the better. Measuring changes in relative terms could have important implications for the interpretation of results from clinical trials where FEV1 is the primary outcome. DLCST; www.ClinicalTrials.org , registration number: NCT00496977.

8. Proton therapy for pediatric cranial tumors: preliminary report on treatment and disease-related morbidities

   International Nuclear Information System (INIS)

   McAllister, Bruce; Archambeau, John O.; Nguyen, M. Connie; Slater, Jerry D.; Loredo, Lilia; Schulte, Reinhard; Alvarez, Ofelia; Bedros, Antranik A.; Kaleita, Thomas; Moyers, Michael; Miller, Daniel; Slater, James M.

   1997-01-01

   Purpose: Accelerated protons were used in an attempt to limit treatment-related morbidity in children with tumors in or near the developing brain, by reducing the integral dose to adjacent normal tissues. Methods and Materials: Children treated with protons at Loma Linda University Medical Center between August 1991 and December 1994 were analyzed retrospectively. Twenty-eight children, aged 1 to 18 years, were identified as at risk for brain injury from treatment. Medical records, physical examinations, and correspondence with patients, their parents, and referring physicians were analyzed. The investigators tabulated post-treatment changes in pre-treatment signs and symptoms and made judgments as to whether improvement, no change, or worsening related to disease or treatment had supervened. Magnetic resonance images were correlated with clinical findings and radiographic impressions were tabulated. Results: Follow-up ranged from 7 to 49 months (median 25 months). Four instances of treatment-related morbidity were identified. Forty-one instances of site-specific, disease-related morbidity were identified: 15 improved or resolved and 26 remained unchanged after treatment. Four patients had radiographic evidence of local failure. Three of these patients, including two with high-grade glioma, have died. Conclusion: Early treatment-related morbidity associated with proton therapy is low. Tumor progression remains a problem when treating certain histologies such as high-grade glioma. Escalating the dose delivered to target volumes may benefit children with tumors associated with poor rates of local control. Long-term follow-up, including neurocognitive testing, is in progress to assess integral-dose effects on cognitive, behavioral and developmental outcomes in children with cranial tumors

9. Locally advanced oral cavity squamous cell carcinoma: Barriers related to effective treatment

   Directory of Open Access Journals (Sweden)

   K C Lakshmaiah

   2015-01-01

   Full Text Available Background: Oral cavity cancer is a significant health problem in India. Majority of patients present with locally advanced disease requiring multimodality treatment. Compliance to recommended treatment is an important factor affecting outcome. Aims: The aim was to evaluate the outcome of locally advanced oral cavity cancer patients with regards to treatment adherence and to assess reasons of noncompliance. Materials and Methods: This was a prospective observational study. We included patients referred to Department of Medical Oncology for induction chemotherapy in view of locally advanced oral cavity cancer. Results: Only 15 (26% patients completed planned treatment schedule. Their 1 year overall survival was 93%. The remaining 43 patients who received inadequate treatment had a dismal 21% 1 year overall survival. Illiteracy, poverty, long waiting list for surgery, prolonged delay for health scheme treatment plan approval and dissatisfaction with attitude of hospital staffs are major barriers related to effective treatment of these patients. Conclusions: A detailed discussion with patient and their relatives regarding recommended treatment, proper implementation of health schemes, increasing trained manpower to avoid long waiting list for surgery, provision of additional financial support for family member accompanying the patient and a sympathetic approach toward patients are needed to help these patients overcome the battle.

Transplantation of retinal pigment epithelial cells - a possible future treatment for age-related macular degeneration

DEFF Research Database (Denmark)

Wiencke, Anne Katrine

2001-01-01

ophthalmology, age-related macular degeneration, transplantation, retinal pigment epithelial cells, treatment......ophthalmology, age-related macular degeneration, transplantation, retinal pigment epithelial cells, treatment...

Transplantation of retinal pigment epithelial cells - a possible future treatment for age-related macular degeneration

DEFF Research Database (Denmark)

Wiencke, Anne Katrine

2001-01-01

ophthalmology, age-related macular degeneration, retinal pigment epithelial cells, transplantation, treatment......ophthalmology, age-related macular degeneration, retinal pigment epithelial cells, transplantation, treatment...

Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress.

Science.gov (United States)

Gutner, Cassidy A; Galovski, Tara; Bovin, Michelle J; Schnurr, Paula P

2016-10-01

Both theoretical and empirical findings have demonstrated similarities across diagnoses, leading to a growing interest in transdiagnostic interventions. Most of the evidence supporting transdiagnostic treatment has accumulated for depression, anxiety, and eating disorders, with minimal attention given to posttraumatic stress disorder and other reactions to traumatic stressors. Although single-diagnosis protocols are effective for posttraumatic stress disorder (PTSD) and other trauma-related disorders, in principle, transdiagnostic approaches may have beneficial applications within a traumatized population. This paper defines different types of transdiagnostic treatments, reviews transdiagnostic approaches used in related disorders, and discusses their applicability to PTSD. Examples are drawn from existing transdiagnostic treatments in order to provide a framework for the application of such interventions to the field of traumatic stress. Implications for implementation and dissemination are also discussed.

Multiple Sclerosis-related Uveitis: Does MS Treatment Affect Uveitis Course?

Science.gov (United States)

Jouve, Léa; Benrabah, Rabah; Héron, Emmanuel; Bodaghi, Bahram; Le Hoang, Phuc; Touitou, Valérie

2017-06-01

Few data are available regarding the optimal treatment of multiple sclerosis (MS)-related uveitis. The aim of this study was to describe clinical features of MS-associated uveitis and determine how MS treatment affects the course of uveitis. Retrospective, multicenter study. Patients were divided into two groups according to the use (group 2) or not (group 1) of immunomodulatory drugs. Characteristics of uveitis and treatment were reviewed. A total of 68 eyes from 36 patients (17 in group 1 and 19 in group 2) were included. All patients were treated with topical and/or systemic steroids for uveitis. Uveitis occurred 1-17 years prior to neurologic symptoms in 78% of patients. Uveitis was more severe in group 2 (puveitis (p = 0.06). MS-related uveitis has often a favorable evolution. Patients on interferon-beta have more severe and chronic uveitis. As far as we are concerned, interferon-beta given on the sole indication of uveitis is not recommended. If steroid-sparing agent is required for intraocular inflammation, immunosuppressive drugs should be considered.

Cognitive behavior therapy with Internet addicts: treatment outcomes and implications.

Science.gov (United States)

Young, Kimberly S

2007-10-01

Research over the last decade has identified Internet addiction as a new and often unrecognized clinical disorder that impact a user's ability to control online use to the extent that it can cause relational, occupational, and social problems. While much of the literature explores the psychological and social factors underlying Internet addiction, little if any empirical evidence exists that examines specific treatment outcomes to deal with this new client population. Researchers have suggested using cognitive behavioral therapy (CBT) as the treatment of choice for Internet addiction, and addiction recovery in general has utilized CBT as part of treatment planning. To investigate the efficacy of using CBT with Internet addicts, this study investigated 114 clients who suffered from Internet addiction and received CBT at the Center for Online Addiction. This study employed a survey research design, and outcome variables such as client motivation, online time management, improved social relationships, improved sexual functioning, engagement in offline activities, and ability to abstain from problematic applications were evaluated on the 3rd, 8th, and 12th sessions and over a 6-month follow-up. Results suggested that Caucasian, middle-aged males with at least a 4-year degree were most likely to suffer from some form of Internet addiction. Preliminary analyses indicated that most clients were able to manage their presenting complaints by the eighth session, and symptom management was sustained upon a 6-month follow-up. As the field of Internet addiction continues to grow, such outcome data will be useful in treatment planning with evidenced-based protocols unique to this emergent client population.

Voice-related of quality of life after treatment for laryngeal cancer

International Nuclear Information System (INIS)

Oridate, Nobuhiko; Furuta, Yasushi; Homma, Akihiro; Suzuki, Seigo; Suzuki, Fumiyuki; Hatakeyama, Hiromitsu; Taki, Shigenari; Sakashita, Tomohiro; Fukuda, Satoshi

2007-01-01

There are many methods of treating laryngeal cancers: definitive irradiation with or without concurrent chemotherapy, endoscopic laser surgery, partial surgery techniques, and total laryngectomy. Few studies have been reported on vocal function and quality of life of patients after the definitive treatment for laryngeal cancer, using single voice related QOL measures. The aim of this study was to examine voice related QOL in patients treated with various modalities using a Voice-Related Quality of Life (V-RQOL) questionnaire as well as Voice Handicap Index-10 (VHI-10) questionnaire. Between August 2006 and May 2007, survey data on voice utilizing the V-RQOL and VHI-10 were obtained from a total of 130 patients who had received definitive treatment for laryngeal cancers with follow-up at the Hokkaido University Hospital, and who were alive with no evidence of malignancy at the time of survey. Mean V-RQOL scores of the patients who received radiation therapy (n=63), chemoradiotherapy (n=29), laser resection (n=14) and total laryngectomy (n=27) as the final treatment for laryngeal cancer were 92.6, 92.9, 85.5, and 68.4, respectively. Mean VHI-10 values were 2.87, 2.34, 5.43, and 11.26. Such measures of quality of life are important endpoints to help judge the overall effectiveness of treatment options for laryngeal cancers. (author)

NEOFLAVONOIDS WITH IMPLICATIONS IN NEGLECTED DISEASES: AN TECNOLOGICA FORECASTING

Directory of Open Access Journals (Sweden)

George Laylson Da Silva Oliveira

2014-09-01

Full Text Available The present work aimed to make a technological forecasting about the neoflavonoids and its implications in treatment of neglected diseases (NDs. Thus, this research was carried out through a comprehensive and systematic bibliographic search in articles and patents. The articles were searched in the database of the Periodical of CAPES, Science Direct, Scopus, Pub Med, Web of Science and ACS Publications. The patent research was performed in bases of the INPI, EPO, WIPO, USPTO and SIPO. According to the results obtained, it was possible to observe that the neoflavonoids may be a new source of medications for the treatment of NDs, since were found studies that attributed activity for the treatment of malaria, trypanosomiasis and leishmaniasis. Large part of published documents was in the form of scientific articles and a small part in the form of deposit of record of patent applications. In this way, this work can serve as an incentive of technological innovation for the development of new research involving neoflavonoids, seen that the record number of deposits of patent applications is still relatively insufficient to meet the current demand for technological and scientific innovation with relation to NDs.

Industrial implications of hydrogen

International Nuclear Information System (INIS)

Pressouyre, G.M.

1982-01-01

Two major industrial implications of hydrogen are examined: problems related to the effect of hydrogen on materials properties (hydrogen embrittlement), and problems related to the use and production of hydrogen as a future energy vector [fr

Striatal dopamine D2/3 receptor-mediated neurotransmission in major depression: Implications for anhedonia, anxiety and treatment response.

Science.gov (United States)

Peciña, Marta; Sikora, Magdalena; Avery, Erich T; Heffernan, Joseph; Peciña, Susana; Mickey, Brian J; Zubieta, Jon-Kar

2017-10-01

Dopamine (DA) neurotransmission within the brain's reward circuit has been implicated in the pathophysiology of depression and in both, cognitive and pharmacological mechanisms of treatment response. Still, a direct relationship between measures of DA neurotransmission and reward-related deficits in patients with depression has not been demonstrated. To gain insight into the symptom-specific alterations in the DA system in patients with depression, we used positron emission tomography (PET) and the D 2/3 receptor-selective radiotracer [ 11 C]raclopride in twenty-three non-smoking un-medicated Major Depressive Disorder (MDD) patients and sixteen healthy controls (HC). We investigated the relationship between D 2/3 receptor availability and baseline measures of depression severity, anxiety, anhedonia, and cognitive and pharmacological mechanisms of treatment response. We found that, compared to controls, patients with depression showed greater D 2/3 receptor availability in several striatal regions, including the bilateral ventral pallidum/nucleus accumbens (vPAL/NAc), and the right ventral caudate and putamen. In the depressed sample, D 2/3 receptor availability in the caudal portion of the ventral striatum (NAc/vPAL) correlated with higher anxiety symptoms, whereas D 2/3 receptor availability in the rostral area of the ventral striatum correlated negatively with the severity of motivational anhedonia. Finally, MDD non-remitters showed greater baseline anxiety, greater D 2/3 availability in the NAc/vPAL, and greater placebo-induced DA release in the bilateral NAc. Our results demonstrate abnormally high D 2/3 receptor availability in the ventral striatum of patients with MDD, which seem to be associated with comorbid anxiety symptoms and lack of response to antidepressants. Copyright © 2017 Elsevier B.V. and ECNP. All rights reserved.

Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders.

Science.gov (United States)

Ollendick, Thomas H; Ost, Lars-Göran; Reuterskiöld, Lena; Costa, Natalie

2010-09-01

The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and "other" types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon. 2010 Elsevier Ltd. All rights reserved.

The impact of stroke-related dysarthria on social participation and implications for rehabilitation.

Science.gov (United States)

Brady, Marian C; Clark, Alexander M; Dickson, Sylvia; Paton, Gillian; Barbour, Rosaline S

2011-01-01

Each year an estimated 30,000-45,000 UK individuals experience stroke-related dysarthria (impairment of movements required to produce speech). Many will experience persistent dysarthria long after discharge from stroke services. Although we have some insight into the impact of other communication impairments, we have very limited information on the impact of dysarthria on social participation. To explore the impact of dysarthria on social participation following stroke. We report data from in-depth semi-structured interviews with 24 individuals with stroke-related dysarthria. Our findings suggest a complex association between the severity of an individual's dysarthria and the impact on their social participation. Participants' descriptions highlighted their experiences of social participation and isolation. We further suggest that, in some cases, the coping strategies adopted by the participants could be seen to further exacerbate this isolation. These results have important implications for the prioritisation, planning and delivery of therapeutic interventions for people with dysarthria. The impact of stroke-related dysarthria transcends the physiological impairment to impact upon individuals' social participation, which is key to the process of rehabilitation. The development and evaluation of the effectiveness of an intervention that addresses these impacts is the next challenge for therapists and researchers working in this area.

Translational Implication of Galectin-9 in the Pathogenesis and Treatment of Viral Infection

Directory of Open Access Journals (Sweden)

Jenn-Haung Lai

2017-10-01

Full Text Available The interaction between galectin-9 and its receptor, Tim-3, triggers a series of signaling events that regulate immune responses. The expression of galectin-9 has been shown to be increased in a variety of target cells of many different viruses, such as hepatitis C virus (HCV, hepatitis B virus (HBV, herpes simplex virus (HSV, influenza virus, dengue virus (DENV, and human immunodeficiency virus (HIV. This enhanced expression of galectin-9 following viral infection promotes significant changes in the behaviors of the virus-infected cells, and the resulting events tightly correlate with the immunopathogenesis of the viral disease. Because the human immune response to different viral infections can vary, and the lack of appropriate treatment can have potentially fatal consequences, understanding the implications of galectin-9 is crucial for developing better methods for monitoring and treating viral infections. This review seeks to address how we can apply the current understanding of galectin-9 function to better understand the pathogenesis of viral infection and better treat viral diseases.

Provider-agency fit in substance abuse treatment organizations: implications for learning climate, morale, and evidence-based practice implementation.

Science.gov (United States)

Ramsey, Alex T; van den Berk-Clark, Carissa

2015-05-12

current research benefits from a strong theoretical framework, consistent findings, and significant practical implications for substance abuse treatment agencies. Comprehensive attempts to strengthen outcomes related to EBP implementation must consider both provider- and agency-level characteristics regarding EBP use. Organizational efforts to more closely align provider attitudes and agency priorities will likely constitute a key strategy in fostering the implementation of EBPs in substance abuse treatment organizations.

Non-commercial surrogacy among close relatives in Vietnam: policy and ethical implications.

Science.gov (United States)

Hibino, Yuri

2018-04-19

Altruistic surrogacy among close relatives has been legal in Vietnam since the beginning of 2015. Following the revision of the Marriage and Family Law, there have been dozens of cases of surrogacy, and instances of successful pregnancy and childbirth have also been reported. Although surrogacy was completely prohibited in 2003, numerous local brokers offered commercial surrogacy services. Today, surrogacy is permitted under very limited conditions, and commercial surrogacy is prohibited. However, brokers continue to offer illegal commercial surrogacy services, and some even present its incidence may be increasing. In terms of women's roles, Vietnamese society places the highest value on motherhood, and childless couples are stigmatized. Thus, the demand for surrogates is high in Vietnam, rendering it difficult for family members to meet the needs of all those seeking these services. This article considers the consequences and implications of the new surrogacy policy in Vietnam based on field research.

Pattern of Presentation and Treatment of Dental Caries - Related ...

African Journals Online (AJOL)

This study was carried out to assess the pattern of presentation and treatment of Dental Caries- related cases among children and adolescence presenting in Paediatric Dentistry clinic of the University of Benin Teaching Hospital. The clinical records of enrolled 1251 patients aged 16 years and below who presented with ...

Attitudes of psychology students to depression and its treatment: Implications for clinical practice.

Science.gov (United States)

Economou, M; Peppou, L E; Geroulanou, K; Kontoangelos, K; Prokopi, A; Pantazi, A; Zervakaki, A; Stefanis, C N

2017-01-01

. The core misconception espoused pertains to the view that major depression is not a medical illness; a finding which can also be interpreted in light of the lingering controversy on the medicalization of normal sadness and human predicament. The clinical implications of these findings are substantial. Mental health professionals-educators should reflect on their own beliefs and attitudes towards depression, as they may convey stigmatizing messages to their students and thus perpetuate the stigmatization of the illness. Concomitantly, psychology students' attitudes to depression and its treatment might render them incapable of understanding their patients, responding to their needs and providing them with appropriate help, while they may hinder their effective collaboration with psychiatrists.

Topic Modeling of Smoking- and Cessation-Related Posts to the American Cancer Society's Cancer Survivor Network (CSN): Implications for Cessation Treatment for Cancer Survivors Who Smoke.

Science.gov (United States)

Westmaas, J Lee; McDonald, Bennett R; Portier, Kenneth M

2017-08-01

Smoking is a risk factor in at least 18 cancers, and approximately two-thirds of cancer survivors continue smoking following diagnosis. Text mining of survivors' online posts related to smoking and quitting could inform strategies to reduce smoking in this vulnerable population. We identified posts containing smoking/cessation-related keywords from the Cancer Survivors Network (CSN), an online cancer survivor community of 166 000 members and over 468 000 posts since inception. Unsupervised topic model analysis of posts since 2000 using Latent Dirichlet Allocation extracted 70 latent topics which two subject experts inspected for themes based on representative terms. Posterior analysis assessed the distribution of topics within posts, and the range of themes discussed across posts. Less than 1% of posts (n = 3998) contained smoking/cessation-related terms, and covered topics related to cancer diagnoses, treatments, and coping. The most frequent smoking-related topics were quit smoking methods (5.4% of posts), and the environment for quitters (2.9% of posts), such as the stigma associated with being a smoker diagnosed with cancer and lack of empathy experienced compared to nonsmokers. Smoking as a risk factor for one's diagnosis was a primary topic in only 1.7% of smoking/cessation-related posts. The low frequency of smoking/cessation-related posts may be due to expected criticism/stigma for smoking but may also suggests a need for health care providers to address smoking and assist with quitting in the diagnostic and treatment process. Topic model analysis revealed potential barriers that should be addressed in devising clinical or population-level interventions for cancer survivors who smoke. Although smoking is a major risk factor for cancer, little is known about cancer patients' or survivors' views or concerns about smoking and quitting. This study used text mining of posts to an online community of cancer patients and survivors to investigate contexts in which

Management of hepatitis B virus infection during treatment for hepatitis B virus-related hepatocellular carcinoma

Science.gov (United States)

Kubo, Shoji; Takemura, Shigekazu; Tanaka, Shogo; Shinkawa, Hiroji; Nishioka, Takayoshi; Nozawa, Akinori; Kinoshita, Masahiko; Hamano, Genya; Ito, Tokuji; Urata, Yorihisa

2015-01-01

Although liver resection is considered the most effective treatment for hepatocellular carcinoma (HCC), treatment outcomes are unsatisfactory because of the high rate of HCC recurrence. Since we reported hepatitis B e-antigen positivity and high serum hepatitis B virus (HBV) DNA concentrations are strong risk factors for HCC recurrence after curative resection of HBV-related HCC in the early 2000s, many investigators have demonstrated the effects of viral status on HCC recurrence and post-treatment outcomes. These findings suggest controlling viral status is important to prevent HCC recurrence and improve survival after curative treatment for HBV-related HCC. Antiviral therapy after curative treatment aims to improve prognosis by preventing HCC recurrence and maintaining liver function. Therapy with interferon and nucleos(t)ide analogs may be useful for preventing HCC recurrence and improving overall survival in patients who have undergone curative resection for HBV-related HCC. In addition, reactivation of viral replication can occur after liver resection for HBV-related HCC. Antiviral therapy can be recommended for patients to prevent HBV reactivation. Nevertheless, further studies are required to establish treatment guidelines for patients with HBV-related HCC. PMID:26217076

Risk factors for treatment related mortality in childhood acute lymphoblastic leukaemia

DEFF Research Database (Denmark)

Lund, Bendik; Åsberg, Ann; Heyman, Mats

2011-01-01

-cell disease (HR: 1.9, 95% CI: 1.01-3.7), Down syndrome (HR: 7.3, 95% CI: 3.6-14.9) and haematopoietic stem cell transplantation in CR1 (HR: 8.0, 95% CI: 3.3-19.5) were identified as independent risk factors for TRD. CONCLUSION: Several TRDs were potentially preventable and future efforts should be directed......BACKGROUND: In spite of major improvements in the cure rate of childhood acute lymphoblastic leukaemia (ALL), 2-4% of patients still die from treatment related complications. PROCEDURE: We investigated the pattern of treatment related deaths (TRDs) and possible risk factors in the NOPHO ALL-92...

Radiation treatment for age-related macular degeneration

Energy Technology Data Exchange (ETDEWEB)

Taniguchi, Tomoko; Mandai, Michiko; Honjo, Megumi; Matsuda, Naoko; Miyamoto, Hideki; Takahashi, Masayo; Ogura, Yuichiro; Sasai, Keisuke [Kyoto Univ. (Japan). Faculty of Medicine

1996-11-01

Fifteen eyes of age-related macular degeneration were treated by low-dose radiation. All the affected eyes had subfoveal neovascular membrane. Seventeen nontreated eyes with similar macular lesion served as control. Radiation was performed using photon beam at 6MV. Each eye received daily dose of 2 Gy for 5 consecutive days. When evaluated 9 to 12 months after treatment, the size of neovascular membrane had decreased in 47% of treated eyes and 7% of control eyes. The visual acuity improved by 2 lines or more in 13% of treated eyes and in none of control eyes. When the initial neovascular membrane was less than 1.5 disc diameter in size, the visual acuity had improved or remained stationary in 90% of treated eyes and in 36% of control eyes. The findings show the potential beneficial effect of radiation for age-related macular degeneration. (author)

Treatment of dry age-related macular degeneration with dobesilate

OpenAIRE

Cuevas, P; Outeiriño, L A; Angulo, J; Giménez-Gallego, G

2012-01-01

The authors present anatomical and functional evidences of dry age-macular degeneration improvement, after intravitreal treatment with dobesilate. Main outcomes measures were normalisation of retinal structure and function, assessed by optical coherence tomography, fundus-monitored microperimetry, electrophysiology and visual acuity. The effect might be related to the normalisation of the outer retinal architecture.

Clinical features and treatment prognosis of pathological gamblers with and without recent gambling-related illegal behavior.

Science.gov (United States)

Ledgerwood, David M; Weinstock, Jeremiah; Morasco, Benjamin J; Petry, Nancy M

2007-01-01

A substantial proportion of pathological gamblers engage in gambling-related illegal behavior. We examined differences in baseline characteristics and treatment outcomes in two groups: pathological gamblers who did and did not commit gambling-related illegal acts in the year before treatment. Participants were 231 pathological gamblers enrolled in a randomized study of treatment that included cognitive behavior therapy and referral to Gamblers Anonymous (GA). Participants reporting recent illegal behavior (n = 63) endorsed more severe lifetime and recent (past-year) gambling disorder symptoms and higher gambling-related debt than did gamblers who denied illegal behavior (n = 168). Those who reported illegal behavior also maintained a significantly higher severity of gambling disorder throughout treatment, although both groups experienced similar improvements in gambling symptoms over time. While pathological gamblers with or without gambling-related illegal behavior appeared to improve at a similar rate regardless of the treatment provided, more intensive treatment may be warranted for individuals with gambling-related illegal behavior, as they demonstrated greater gambling severity throughout treatment and follow-up.

Clinical errors and therapist discomfort with client disclosure of troublesome pornography use: Implications for clinical practice and error reduction.

Science.gov (United States)

Walters, Nathan T; Spengler, Paul M

2016-09-01

Mental health professionals are increasingly aware of the need for competence in the treatment of clients with pornography-related concerns. However, while researchers have recently sought to explore efficacious treatments for pornography-related concerns, few explorations of potential clinical judgment issues have occurred. Due to the sensitive, and at times uncomfortable, nature of client disclosures of sexual concerns within therapy, therapists are required to manage their own discomfort while retaining fidelity to treatment. The present paper explores clinician examples of judgment errors that may result from feelings of discomfort, and specifically from client use of pornography. Issues of potential bias, bias management techniques, and therapeutic implications are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications

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Grilo, C. M.; White, M. A.; Wilson, G. T.; Gueorguieva, R.; Masheb, R. M.

2011-01-01

Background We examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method Altogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as ≥70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes. Results Rapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss. Conclusions Rapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment. PMID:21923964

Social ‘wanting’ dysfunction in autism: neurobiological underpinnings and treatment implications

Directory of Open Access Journals (Sweden)

Kohls Gregor

2012-06-01

clearly point towards problems with incentive-based motivation and learning, with clear and important implications for treatment. Given the reliance of behavioral interventions on reinforcement-based learning principles, we believe that a systematic focus on the integrity of the reward system in ASD promises to yield many important clues, both to the underlying mechanisms causing ASD and to enhancing the efficacy of existing and new interventions.

Metabolic Memory and Implications for Treatment of Diabetes in Africa

African Journals Online (AJOL)

Essentially it is thought that mitochondrial AGE formation is an irreversible process which explains the sustained nature of metabolic memory. A major implication for clinical practice is that poor glycaemic control in the early years of diabetes will most probably lead to increased onset and severity of complications even if ...

Does chaos theory have major implications for philosophy of medicine?

Science.gov (United States)

Holm, S

2002-12-01

In the literature it is sometimes claimed that chaos theory, non-linear dynamics, and the theory of fractals have major implications for philosophy of medicine, especially for our analysis of the concept of disease and the concept of causation. This paper gives a brief introduction to the concepts underlying chaos theory and non-linear dynamics. It is then shown that chaos theory has only very minimal implications for the analysis of the concept of disease and the concept of causation, mainly because the mathematics of chaotic processes entail that these processes are fully deterministic. The practical unpredictability of chaotic processes, caused by their extreme sensitivity to initial conditions, may raise practical problems in diagnosis, prognosis, and treatment, but it raises no major theoretical problems. The relation between chaos theory and the problem of free will is discussed, and it is shown that chaos theory may remove the problem of predictability of decisions, but does not solve the problem of free will. Chaos theory may thus be very important for our understanding of physiological processes, and specific disease entities, without having any major implications for philosophy of medicine.

Error-related brain activity predicts cocaine use after treatment at 3-month follow-up.

Science.gov (United States)

Marhe, Reshmi; van de Wetering, Ben J M; Franken, Ingmar H A

2013-04-15

Relapse after treatment is one of the most important problems in drug dependency. Several studies suggest that lack of cognitive control is one of the causes of relapse. In this study, a relative new electrophysiologic index of cognitive control, the error-related negativity, is investigated to examine its suitability as a predictor of relapse. The error-related negativity was measured in 57 cocaine-dependent patients during their first week in detoxification treatment. Data from 49 participants were used to predict cocaine use at 3-month follow-up. Cocaine use at follow-up was measured by means of self-reported days of cocaine use in the last month verified by urine screening. A multiple hierarchical regression model was used to examine the predictive value of the error-related negativity while controlling for addiction severity and self-reported craving in the week before treatment. The error-related negativity was the only significant predictor in the model and added 7.4% of explained variance to the control variables, resulting in a total of 33.4% explained variance in the prediction of days of cocaine use at follow-up. A reduced error-related negativity measured during the first week of treatment was associated with more days of cocaine use at 3-month follow-up. Moreover, the error-related negativity was a stronger predictor of recent cocaine use than addiction severity and craving. These results suggest that underactive error-related brain activity might help to identify patients who are at risk of relapse as early as in the first week of detoxification treatment. Copyright © 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects.

Science.gov (United States)

Cormie, Prue; Zopf, Eva M; Zhang, Xiaochen; Schmitz, Kathryn H

2017-01-01

The combination of an increasing number of new cancer cases and improving survival rates has led to a large and rapidly growing population with unique health-care requirements. Exercise has been proposed as a strategy to help address the issues faced by cancer patients. Supported by a growing body of research, major health organizations commonly identify the importance of incorporating exercise in cancer care and advise patients to be physically active. This systematic review comprehensively summarizes the available epidemiologic and randomized controlled trial evidence investigating the role of exercise in the management of cancer. Literature searches focused on determining the potential impact of exercise on 1) cancer mortality and recurrence and 2) adverse effects of cancer and its treatment. A total of 100 studies were reviewed involving thousands of individual patients whose exercise behavior was assessed following the diagnosis of any type of cancer. Compared with patients who performed no/less exercise, patients who exercised following a diagnosis of cancer were observed to have a lower relative risk of cancer mortality and recurrence and experienced fewer/less severe adverse effects. The findings of this review support the view that exercise is an important adjunct therapy in the management of cancer. Implications on cancer care policy and practice are discussed. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Threat-Related Selective Attention Predicts Treatment Success in Childhood Anxiety Disorders

OpenAIRE

Legerstee, Jeroen; Tulen, Joke; Kallen, Victor; Dieleman, Gwen; Treffers, Philip; Verhulst, Frank; Utens, Elisabeth

2009-01-01

textabstractAbstract OBJECTIVE: The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. METHOD: Participants consisted of 131 children with anxiety disorders (aged 8-16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dot-pr...

Patients' Preferences Related to Benefits, Risks, and Formulations of Schizophrenia Treatment.

Science.gov (United States)

Levitan, Bennett; Markowitz, Michael; Mohamed, Ateesha F; Johnson, F Reed; Alphs, Larry; Citrome, Leslie; Bridges, John F P

2015-07-01

The objective of this study was to quantify patients' preferences related to benefits and risks of antipsychotic treatments for schizophrenia and to assess the relative importance of treatment attributes and adherence. Treatment-related preferences among U.S. residents with a self-reported physician diagnosis of schizophrenia were assessed via a discrete-choice experiment. Patients chose between competing hypothetical scenarios characterized by improvements in positive symptoms, negative symptoms, and social functioning; incidence of weight gain, extrapyramidal symptoms (EPS), hyperprolactinemia, and hyperglycemia; and medication formulation. Preferences were estimated by using a random-parameters logit model, and the impact of adherence was estimated with conditional logit models. The final sample consisted of 271 patients. Complete improvement in positive symptoms was the most preferred outcome (relative importance score of 10.0), followed by elimination of hyperglycemia (3.6, 95% confidence interval [CI]=2.6-4.6), improvement in negative symptoms (3.0, CI=1.6-4.3), reduced weight gain (2.6, CI=1.2-4.0), avoidance of hyperprolactinemia (1.7, CI=.9-2.6), improved social functioning (1.5, CI=.4-2.5), and avoidance of EPS (1.0, CI=.3-1.8). Patients judged a daily pill superior to monthly injections (p<.01) and monthly injections superior to injections every three months (p<.01) for adherent patients and monthly injections superior to a daily pill for nonadherent patients (p=.01). Persons who self-identified as having schizophrenia judged improvement in positive symptoms as the most important treatment benefit. Hyperglycemia was identified as the most important adverse event. Patients judged oral formulations to be better than monthly injections for adherent patients and monthly injections to be a better choice for nonadherent patients.

α-Lipoic acid antioxidant treatment limits glaucoma-related retinal ganglion cell death and dysfunction.

Directory of Open Access Journals (Sweden)

Denise M Inman

Full Text Available Oxidative stress has been implicated in neurodegenerative diseases, including glaucoma. However, due to the lack of clinically relevant models and expense of long-term testing, few studies have modeled antioxidant therapy for prevention of neurodegeneration. We investigated the contribution of oxidative stress to the pathogenesis of glaucoma in the DBA/2J mouse model of glaucoma. Similar to other neurodegenerative diseases, we observed lipid peroxidation and upregulation of oxidative stress-related mRNA and protein in DBA/2J retina. To test the role of oxidative stress in disease progression, we chose to deliver the naturally occurring, antioxidant α-lipoic acid (ALA to DBA/2J mice in their diet. We used two paradigms for ALA delivery: an intervention paradigm in which DBA/2J mice at 6 months of age received ALA in order to intervene in glaucoma development, and a prevention paradigm in which DBA/2J mice were raised on a diet supplemented with ALA, with the goal of preventing glaucoma development. At 10 and 12 months of age (after 4 and 11 months of dietary ALA respectively, we measured changes in genes and proteins related to oxidative stress, retinal ganglion cell (RGC number, axon transport, and axon number and integrity. Both ALA treatment paradigms showed increased antioxidant gene and protein expression, increased protection of RGCs and improved retrograde transport compared to control. Measures of lipid peroxidation, protein nitrosylation, and DNA oxidation in retina verified decreased oxidative stress in the prevention and intervention paradigms. These data demonstrate the utility of dietary therapy for reducing oxidative stress and improving RGC survival in glaucoma.

Genetics of rare mesenchymal tumors: implications for targeted treatment in DFSP, ASPS, CCS, GCTB and PEComa.

Science.gov (United States)

Rutkowski, Piotr; Przybył, Joanna; Świtaj, Tomasz

2014-08-01

Soft tissue and bone sarcomas comprise a heterogeneous group of mesenchymal tumors that include roughly 130 distinct diagnostic entities. Many of them are exceptionally rare, with only few cases diagnosed worldwide each year. Development of novel targeted treatment in this group of tumors is of special importance since many sarcoma subtypes are resistant to conventional chemotherapy and the effective therapeutic options are limited. In this review we aim to discuss the molecular implications for targeted therapy in selected rare soft tissue and bone sarcoma subtypes, including dermatofibrosarcoma protuberans (DFSP), alveolar soft part sarcoma (ASPS), clear cell sarcoma (CCS), giant cell tumor of bone (GCTB) and perivascular epithelioid cell neoplasms (PEComas). This article is part of a Directed Issue entitled: Rare cancers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Treatment Effects of a Primary Care Intervention on Parenting Behaviors: Sometimes It's Relative.

Science.gov (United States)

Shaffer, Anne; Lindhiem, Oliver; Kolko, David

2017-04-01

The goal of this brief report is to demonstrate the utility of quantifying parental discipline practices as relative frequencies in measuring changes in parenting behavior and relations to child behavior following intervention. We explored comparisons across methodological approaches of assessing parenting behavior via absolute and relative frequencies in measuring improvements in parent-reported disciplinary practices (increases in positive parenting practices in response to child behavior; decreases in inconsistent discipline and use of corporal punishment) and child behavior problems. The current study was conducted as part of a larger clinical trial to evaluate the efficacy of a collaborative care intervention for behavior problems, ADHD, and anxiety in pediatric primary care practices (Doctor Office Collaborative Care; DOCC). Participants were 321 parent-child dyads (M child age = 8.00, 65 % male children) from eight pediatric practices that were cluster randomized to DOCC or enhanced usual care (EUC). Parents reported on their own discipline behaviors and child behavior problems. While treatment-related decreases in negative parenting were found using both the absolute and relative frequencies of parenting behaviors, results were different for positive parenting behaviors, which showed decreases when measured as absolute frequencies but increases when measured as relative frequencies. In addition, positive parenting was negatively correlated with child behavior problems when using relative frequencies, but not absolute frequencies, and relative frequencies of positive parenting mediated relations between treatment condition and outcomes. Our findings indicate that the methods used to measure treatment-related change warrant careful consideration.

Stem cell terminology: practical, theological and ethical implications.

Science.gov (United States)

Shanner, Laura

2002-01-01

Stem cell policy discussions frequently confuse embryonic and fetal sources of stem cells, and label untested, non-reproductive cloning as "therapeutic." Such misnomers distract attention from significant practical and ethical implications: accelerated research agendas tend to be supported at the expense of physical risks to women, theological implications in a multi-faith community, informed consent for participation in research, and treatment decisions altered by unrealistic expectations.

Substance Abuse Counselors' Recovery Status and Self-Schemas: Preliminary Implications for Empirically Supported Treatment Implementation.

Science.gov (United States)

Nielson, Elizabeth M

2016-01-01

The purpose of this paper is to better understand the relationship between substance abuse counselors' personal recovery status, self-schemas, and willingness to use empirically supported treatments for substance use disorders. A phenomenological qualitative study enrolled 12 practicing substance abuse counselors. Within this sample, recovering counselors tended to see those who suffer from addiction as qualitatively different from those who do not and hence themselves as similar to their patients, while nonrecovering counselors tended to see patients as experiencing a specific variety of the same basic human struggles everyone experiences, and hence also felt able to relate to their patients' struggles. Since empirically supported treatments may fit more or less neatly within one or the other of these viewpoints, this finding suggests that counselors' recovery status and corresponding self-schemas may be related to counselor willingness to learn and practice specific treatments.

Avoidant Coping and Treatment Outcome in Rape-Related Posttraumatic Stress Disorder

Science.gov (United States)

Leiner, Amy S.; Kearns, Megan C.; Jackson, Joan L.; Astin, Millie C.; Rothbaum, Barbara O.

2012-01-01

Objective: This study investigated the impact of avoidant coping on treatment outcome in rape-related posttraumatic stress disorder (PTSD). Method: Adult women with rape-related PTSD (N = 62) received 9 sessions of prolonged exposure (PE) or eye movement desensitization and reprocessing (EMDR). The mean age for the sample was 34.7 years, and race…

LUTS and sexual dysfunction : Implications for management of BPH

NARCIS (Netherlands)

van Moorselaar, J

2003-01-01

Objectives: To summarise currently available data describing the impact of surgical and pharmacological treatments for lower urinary tract symptoms (LUTS) on male sexual function. To compare treatment options and outline implications for the management of this patient group. Methods: Key published

Sialendoscopy-assisted treatment for chronic obstructive parotitis related to Sjogren syndrome.

Science.gov (United States)

Guo, Yong-Feng; Sun, Ning-Ning; Wu, Chuan-Bin; Xue, Lei; Zhou, Qing

2017-03-01

Chronic obstructive parotitis related to Sjogren syndrome is not uncommon, but it is rarely reported in the literature. The aim of this study was to describe our experience in the treatment of chronic obstructive parotitis related to Sjogren syndrome. Seventeen cases of chronic obstructive parotitis related to Sjogren syndrome treated with sialendoscopy from June 2014 to June 2015 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, were retrospectively reviewed. The cohort underwent ultrasonography, salivary gland scintigraphy, and sialography before sialendoscopy. All patients were asked to complete a visual analogue scale (VAS) evaluation before and 6 months after surgery. A paired t test was conducted, and P parotid glands) successfully underwent interventional sialendoscopy under local anesthesia. The mean preoperative VAS score was 6, and the mean VAS score 6 months after sialendoscopy was significantly lower at 4.5 (P < .05). Interventional sialendoscopy plays a significant role in the treatment of chronic obstructive parotitis related to Sjogren syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

Constructive conflict and staff consensus in substance abuse treatment.

Science.gov (United States)

Melnick, Gerald; Wexler, Harry K; Chaple, Michael; Cleland, Charles M

2009-03-01

Previous studies demonstrated the relationship between consensus among both staff and clients with client engagement in treatment and between client consensus and 1-year treatment outcomes. The present article explores the correlates of staff consensus, defined as the level of agreement among staff as to the importance of treatment activities in their program, using a national sample of 80 residential substance abuse treatment programs. Constructive conflict resolution had the largest effect on consensus. Low client-to-staff ratios, staff education, and staff experience in substance abuse treatment were also significantly related to consensus. Frequency of training, an expected correlate of consensus, was negatively associated with consensus, whereas frequency of supervision was not a significant correlate. The implications of the findings for future research and program improvement are discussed.

The Perceptions of Fair Interpersonal Treatment Scale: development and validation of a measure of interpersonal treatment in the workplace.

Science.gov (United States)

Donovan, M A; Drasgow, F; Munson, L J

1998-10-01

The Perceptions of Fair Interpersonal Treatment (PFIT) scale was designed to assess employees' perceptions of the interpersonal treatment in their work environment. Analyses of the factor structure and reliability of this new instrument indicate that the PFIT scale is a reliable instrument composed of 2 factors: supervisor treatment and coworker treatment. It was hypothesized that the PFIT scale would be positively correlated with job satisfaction variables and negatively correlated with work withdrawal, job withdrawal, experiences of sexual harassment, and an organization's tolerance of sexual harassment. Results based on 509 employees in a private-sector organization and 217 female faculty and staff members at a large midwestern university supported these hypotheses. Arguments that common method variance and employees' dispositions are responsible for the significant correlations between the PFIT scale and other job-related variables were eliminated. The implications of these results are discussed.

Color changes in pork in relation to high pressure treatment

DEFF Research Database (Denmark)

Bak, Kathrine Holmgaard

treatment and during a six-day storage period was investigated via surface reflectance. Spectroscopic studies (in the form of surface reflectance, UV-vis, and circular dichroism) on the effect of HP treatment on the soluble protein fraction of porcine LD were conducted attempting to explain the color......-denatured ferric myoglobin species was not similar to the heat-denatured pigment, ferrihemochrome, but instead a closely related species sharing features of denatured gobin, ferric iron, and brown color. The reversibility of the pressure-induced changes often observed for various myoglobin forms in solution were...

The NDE1 genomic locus can affect treatment of psychiatric illness through gene expression changes related to microRNA-484.

Science.gov (United States)

Bradshaw, Nicholas J; Ukkola-Vuoti, Liisa; Pankakoski, Maiju; Zheutlin, Amanda B; Ortega-Alonso, Alfredo; Torniainen-Holm, Minna; Sinha, Vishal; Therman, Sebastian; Paunio, Tiina; Suvisaari, Jaana; Lönnqvist, Jouko; Cannon, Tyrone D; Haukka, Jari; Hennah, William

2017-11-01

Genetic studies of familial schizophrenia in Finland have observed significant associations with a group of biologically related genes, DISC1 , NDE1 , NDEL1 , PDE4B and PDE4D , the 'DISC1 network'. Here, we use gene expression and psychoactive medication use data to study their biological consequences and potential treatment implications. Gene expression levels were determined in 64 individuals from 18 families, while prescription medication information has been collected over a 10-year period for 931 affected individuals. We demonstrate that the NDE1 SNP rs2242549 associates with significant changes in gene expression for 2908 probes (2542 genes), of which 794 probes (719 genes) were replicable. A significant number of the genes altered were predicted targets of microRNA-484 ( p = 3.0 × 10 -8 ), located on a non-coding exon of NDE1 Variants within the NDE1 locus also displayed significant genotype by gender interaction to early cessation of psychoactive medications metabolized by CYP2C19. Furthermore, we demonstrate that miR-484 can affect the expression of CYP2C19 in a cell culture system. Thus, variation at the NDE1 locus may alter risk of mental illness, in part through modification of miR-484, and such modification alters treatment response to specific psychoactive medications, leading to the potential for use of this locus in targeting treatment. © 2017 The Authors.

Narcissism and relational representations among psychiatric outpatients.

Science.gov (United States)

Kealy, David; Ogrodniczuk, John S; Joyce, Anthony S; Steinberg, Paul I; Piper, William E

2015-06-01

Pathological narcissism is associated with maladaptive interpersonal behavior, although less is known regarding the internal relational representations of narcissistic patients. The authors examined the relationship between pathological narcissism and two constructs that reflect internal representations of relational patterns: quality of object relations and attachment style. Patients attending a psychiatric day treatment program (N = 218) completed measures of narcissism, general psychiatric distress, and attachment style in terms of attachment avoidance and anxiety. A semistructured interview was used to assess quality of object relations. Multiple regression analysis was conducted, controlling for general psychiatric distress. Pathological narcissism was associated with anxious attachment, but not with avoidant attachment. Narcissism was also associated with lower levels of quality of object relations. The implications of these results are discussed in terms of internal representations of self-other relations.

Cognitive Behavioral Treatment of Health-Related Anxiety in Youth: A Case Example

Science.gov (United States)

Kahana, Shoshana Y.; Feeny, Norah C.

2005-01-01

Although illness phobias are fairly common disorders, their treatment has been scarcely addressed in the literature. The current article discusses the treatment of a 9-year-old female diagnosed with health-related anxiety--specifically, a phobia of vomiting. A variety of cognitive-behavioral techniques, such as relaxation training (e.g., deep…

Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment.

Science.gov (United States)

Takaki, Jiro; Hibino, Yuri

2014-09-02

The purpose of this study is to investigate how family-related opinions and stressful situations are related to psychological distress in women undergoing infertility treatment. The subjects in this cross-sectional study were recruited from female patients undergoing infertility treatment (n = 2540) at 70 infertility treatment institutions in Japan. Because of non-participation or missing data, the number of subjects included in the analysis was 635 (response rate, 25.0%). The family-related opinions and stressful situations were evaluated using the original questions. Psychological distress was assessed using a self-report measure, the Kessler Six-question Psychological Distress Scale (K6). The K6 scores of the following participants were significantly (p women should devote themselves to their household duties" those who had considered stopping treatment, those without the opinion that "married life without children is favorable" and those who had experienced stressful situations such as inadequate explanation by doctors, frustration of multiple failed attempts, differences of opinion with the partner, and lack of knowledge regarding when to stop treatment. Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment are outlined. The results of this study may contribute to the prevention of and care for psychological distress in female patients undergoing infertility treatment.

First year doctors experience of work related wellbeing and implications for educational provision.

Science.gov (United States)

Goodyear, Helen M

2014-06-01

To explore factors which affect newly qualified doctors' wellbeing and look at the implications for educational provision. Data were collected by free association narrative interviews of nine Foundation doctors and analysed using a grounded theory approach. Two Foundation programme directors were interviewed to verify data validity. Two main themes emerged: newly qualified doctors' wellbeing is affected by 1) personal experience and 2) work related factors. They start work feeling unprepared by medical school, work experience ("shadowing") or induction programmes at the beginning of the post. Senior colleague support and feedback are much valued but often lacking with little discussion of critical incidents and difficult issues. Challenges include sick patients, prescribing, patient/relative communication and no consistent team structure. Working shift patterns affects personal and social life. Enjoyment and reward come from helping patients, feelings of making a difference or teaching medical students. Whilst becoming familiar with their roles, newly qualified doctors search for identity and build up resilience. The support given during this process affects their wellbeing including coping with day to day challenges, whether posts are experienced as rewarding and how work influences their personal and social lives.

Critical Review of Data Evaluation in Teaching Clinics of Traditional Chinese Medicine Outside China: Implications for Education.

Science.gov (United States)

Jiang, Jian; Peng, Wenbo; Gu, Tieguang; King, Catherine; Yin, J Kevin

2016-01-01

The increasing acceptance of traditional Chinese medicine (TCM) worldwide has highlighted the importance of ensuring the provision of high-quality TCM clinical education. This clinical training should be partly guided by a robust assessment of patient data outcomes in TCM teaching clinics. We undertook a comprehensive literature review to examine the data evaluation in TCM teaching clinics outside China and its implications for TCM education. Literature was retrieved via MEDLINE (from 1946 to January 2015), EMBASE (from 1980 to February 2015), and Google Scholar for studies conducted outside China. The search was restricted to English articles reporting empirical findings related to the assessments of patient data in TCM teaching clinics, with implications for TCM education in countries other than China. Only seven articles from six studies met the inclusion criteria. The characteristics and main symptoms of patients who received any TCM treatment in the context of teaching clinics among all included studies were similar. Symptom relief as well as a high level of patient satisfaction with TCM treatment were found in TCM teaching clinics. Conventional healthcare providers and other complementary practitioners were not the main source of referral to TCM practitioners but rather patients׳ friends/relatives. Patients received acupuncture treatment more frequently than treatments utilizing Chinese herbal medicine in teaching clinics. A standardized and consistent framework for patient records within TCM teaching clinics is currently lacking. There was no robust study which "translated" TCM clinic data evaluation findings into implications for TCM education and clinical training. Recognizing that TCM evolves over time and its practice varies in different settings, there is an urgent need to conduct large-scale, rigorous evaluations of TCM clinic data to address the findings of our review, with the purpose of better informing TCM education and clinical training in

The Role of Sympatho-Inhibition in Combination Treatment of Obesity-Related Hypertension.

Science.gov (United States)

Carnagarin, Revathy; Gregory, Cynthia; Azzam, Omar; Hillis, Graham S; Schultz, Carl; Watts, Gerald F; Bell, Damon; Matthews, Vance; Schlaich, Markus P

2017-10-28

Obesity-related hypertension is commonly characterized by increased sympathetic nerve activity and is therefore acknowledged as a predominantly neurogenic form of hypertension. The sustained sympatho-excitation not only contributes to the rise in blood pressure but also elicits a vicious cycle which facilitates further weight gain and progression of associated co-morbidities. While weight loss and exercise remain at the forefront of therapy for obesity and obesity-related hypertension, the difficulties in achieving and maintaining long-term weight loss with lifestyle measures and the variable blood pressure response to weight loss often necessitate prescription of antihypertensive drug therapy. Remarkably, there are no specific recommendations for pharmacologic treatment for obese patients with arterial hypertension in any of the current guidelines and general principles of antihypertensive treatment are applied. The use of β-blockers and diuretics is commonly discouraged as first- or second-line therapy due to their unfavorable metabolic effects. This review explores evolving therapeutic strategies which based on their interference with pathophysiologic mechanism relevant in the context of obesity may guide optimized treatment of obesity-related hypertension.

How are perceived stigma, self-stigma, and self-reliance related to treatment-seeking? A three-path model.

Science.gov (United States)

Jennings, Kristen S; Cheung, Janelle H; Britt, Thomas W; Goguen, Kandice N; Jeffirs, Stephanie M; Peasley, Allison L; Lee, Abigail C

2015-06-01

Many college students may experience mental health problems but do not seek treatment from mental health professionals. The present study examined how perceived stigma and self-stigma toward seeking mental health treatment, as well as perceptions of self-reliance for coping with mental health problems, relate to college student treatment-seeking. In total, 246 students completed a self-report survey that included measures of perceived stigma and self-stigma for treatment-seeking, self-reliance for addressing mental health concerns, self-reported mental health problems, symptoms of depression and alcohol-related problems, attitudes toward treatment-seeking, and treatment-seeking behavior. Regression analyses revealed that higher perceived stigma, self-stigma, and self-reliance were all related to a more negative attitude toward treatment-seeking. In a 3-path mediation model, bootstrapping results indicated an indirect effect where perceived stigma was related to attitude toward treatment-seeking and treatment-seeking behaviors through self-stigma and self-reliance. Specifically, higher perceived stigma was related to higher self-stigma, higher self-stigma was related to higher self-reliance, and higher self-reliance was associated with a more negative attitude toward treatment-seeking in the overall sample, and a decreased probability of having sought treatment among those who screened positive for a mental health problem. Perceived stigma may influence whether or not college students seek treatment for mental health problems by potentially increasing stigmatizing attitudes toward themselves and increasing preferences for handling problems on their own. Researchers and practitioners are recommended to seek a better understanding of the complex treatment barriers to reduce stigma and facilitate treatment-seeking. (c) 2015 APA, all rights reserved).

Facial dynamics and emotional expressions in facial aging treatments.

Science.gov (United States)

Michaud, Thierry; Gassia, Véronique; Belhaouari, Lakhdar

2015-03-01

Facial expressions convey emotions that form the foundation of interpersonal relationships, and many of these emotions promote and regulate our social linkages. Hence, the facial aging symptomatological analysis and the treatment plan must of necessity include knowledge of the facial dynamics and the emotional expressions of the face. This approach aims to more closely meet patients' expectations of natural-looking results, by correcting age-related negative expressions while observing the emotional language of the face. This article will successively describe patients' expectations, the role of facial expressions in relational dynamics, the relationship between facial structures and facial expressions, and the way facial aging mimics negative expressions. Eventually, therapeutic implications for facial aging treatment will be addressed. © 2015 Wiley Periodicals, Inc.

Clinical study of Conbercept intravitreal injection for the treatment of wet age-related macular degeneration

Directory of Open Access Journals (Sweden)

Xu-Ting He

2015-09-01

Full Text Available AIM: To observe the clinical curative effect of conbercept intravitreal injection for the treatment of wet age-related macular degeneration.METHODS: Sixty patients with wet age related macular degeneration were randomly divided into treatment group 30 cases and control group 30 cases according to the random number table. The treatment group was injected with Conbercept 0.05mL, the control group was injected with triamcinolone acetonide 0.1mL. The best corrected visual acuity(BCVAwas performed before and after 1d, 1 and 3mo after treatment, and the thickness of macular was detected by optical coherence tomography(OCT. The complications of patients were observed after 1d, 1 and 3mo,including inflammatory reaction, corneal edema, anterior chamber, high intraocular pressure, etc.RESULTS:In treatment group 1d, 1 and 3mo after treatment, eyesight was improved significantly better than the control group(PPCONCLUSION: Intravitreal injection of Conbercept in the treatment of wet age-related macular degeneration can improve the curative effect.

Health-related quality of life in relation to gender and age in couples planning IVF treatment

NARCIS (Netherlands)

Fekkes, M.; Buitendijk, S.E.; Verrips, G.H.W.; Braat, D.D.M.; Brewaeys, A.M.A.; Dolfing, J.G.; Kortman, M.; Leerentveld, R.A.; Macklon, N.S.

2003-01-01

Background: Specific subgroups of people planning IVF might be at risk of having more psychological or health-related problems. Identification of subgroups at risk may better enable allocation of appropriate counselling. Methods: A group of 425 men and 447 women planning to undergo IVF treatment

Sexually Transmitted Diseases Treatment Guidelines, 2015

Science.gov (United States)

Workowski, Kimberly A.; Bolan, Gail A.

2016-01-01

Summary These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR–12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs. PMID:26042815

Verbal memory functioning moderates psychotherapy treatment response for PTSD-Related nightmares.

Science.gov (United States)

Scott, J Cobb; Harb, Gerlinde; Brownlow, Janeese A; Greene, Jennifer; Gur, Ruben C; Ross, Richard J

2017-04-01

Posttraumatic stress disorder (PTSD) is associated with cognitive deficits in attention, executive control, and memory, although few studies have investigated the relevance of cognitive difficulties for treatment outcomes. We examined whether cognitive functioning and history of traumatic brain injury (TBI) were associated with response to cognitive-behavioral therapy (CBT) for PTSD-related sleep problems. In a randomized controlled trial of Imagery Rehearsal (IR) added to components of CBT for Insomnia (IR + cCBT-I) compared to cCBT-I alone for PTSD-related recurrent nightmares, 94 U.S. veterans completed a battery of cognitive tests. TBI was assessed via structured clinical interview. Mixed-effects models examined main effects of cognitive functioning and interactions with time on primary sleep and nightmare outcomes. Significant verbal immediate memory by time interactions were found for nightmare distress, nightmare frequency, and sleep quality, even after controlling for overall cognitive performance and depression. TBI exhibited main effects on outcomes but no interactions with time. Findings indicated that individuals with lower verbal memory performance were less likely to respond to treatment across two sleep interventions. Veterans with TBI displayed greater symptoms but no altered trajectories of treatment response. Together with prior literature, findings suggest that verbal memory functioning may be important to consider in PTSD treatment implementation. Published by Elsevier Ltd.

Related Services Research for Students With Low-Incidence Disabilities: Implications for Speech-Language Pathologists in Inclusive Classrooms.

Science.gov (United States)

Giangreco, Michael F

2000-07-01

When speech-language pathologists provide educationally related services for students with lowincidence disabilities who are placed in inclusive classrooms, they are asked to work with a variety of other adults. The ways in which these adults make decisions about individualizing a student's educational program, determine related services, and coordinate their activities have an impact on educational outcomes for students as well as on interprofessional interactions. This article summarizes a team process for making related services decisions called VISTA (Vermont Interdependent Services Team Approach) and a series of nine research studies pertaining to the use and impact of VISTA. It also addresses related topics, such as team size, consumer perspectives, and paraprofessional supports. Five major implications from these studies are offered concerning (a) developing a disposition of being an ongoing learner, (b) developing a shared framework among team members, (c) having a research-based process to build consensus, (d) clarifying roles, and (e) increasing involvement of families and general education teachers.

Treatment of contact lens related dry eye with antibacterial honey.

Science.gov (United States)

Wong, Daniel; Albietz, Julie M; Tran, Huan; Du Toit, Cimonette; Li, Anita Hui; Yun, Tina; Han, Jee; Schmid, Katrina L

2017-12-01

Contact lens induced dry eye affects approximately 50% of contact lens wearers. The aim was to assess the effects of Manuka (Leptospermum sp.) honey eye drops (Optimel, Melcare, Australia) on dry eye in contact lens wearers. The safety of the honey eye drops in contact lens wear and contact lens wearers' compliance were also evaluated. Prospective, randomised, cross over study, examiner masked, pilot treatment trial. Twenty-four participants aged 20 to 55 years with contact lens related dry eye were recruited and randomised to two treatment groups; 20 completed the study. One group used Optimel eye drops twice a day for two weeks followed by conventional lubricant (Systane Ultra, Alcon) therapy for two weeks; the other group completed the treatments in the reverse order. Before and after each treatment dry eye symptomology, ocular surface inflammation, and tear quantity and quality were assessed. Participants completed a daily log detailing their usage of treatments and any issues. Dry eye symptoms improved significantly after Optimel treatment. Patients with more severe symptoms at baseline showed a greater improvement in symptoms. No significant differences were observed in the objective signs of dry eye; presumably because of the short treatment duration. Seventy-five% of contact lens wearers reported good adherence to Optimel treatment and 95% reported no issues using this product. Optimel Eye Drops reduce the symptoms of dry eye in contact lens wearers and are safe to use. A longer treatment period to assess the effect on clinical signs of dry eye is required. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Substance Abuse Counselors’ Recovery Status and Self-Schemas: Preliminary Implications for Empirically Supported Treatment Implementation

Science.gov (United States)

Nielson, Elizabeth M.

2016-01-01

Purpose The purpose of this paper is to better understand the relationship between substance abuse counselors’ personal recovery status, self-schemas, and willingness to use empirically supported treatments for substance use disorders. Methods A phenomenological qualitative study enrolled 12 practicing substance abuse counselors. Results Within this sample, recovering counselors tended to see those who suffer from addiction as qualitatively different from those who do not and hence themselves as similar to their patients, while nonrecovering counselors tended to see patients as experiencing a specific variety of the same basic human struggles everyone experiences, and hence also felt able to relate to their patients’ struggles. Discussion Since empirically supported treatments may fit more or less neatly within one or the other of these viewpoints, this finding suggests that counselors’ recovery status and corresponding self-schemas may be related to counselor willingness to learn and practice specific treatments. PMID:28626597

Particularities of the elderly in relation to onco specific treatment

International Nuclear Information System (INIS)

Terradas, M.; Santini, A.; Mara, C.

2004-01-01

The aging population leads to an increase in the proportion of elderly with different oncological diseases. However, the group of the elderly is often poorly represented in the studies which derive many therapeutic recommendations, which worries many specialists and patients usually over 70 years are not included in the clinicians essays which has hampered on decision based on clinical evidence.The elderly patient has a number of features in the structure, organization and function of their body that should always be considered by the oncologist; within them are: psychological changes, the social and family environment, drug addicts due to interactions poly pharmacy often linked to increased co morbid conditions, existing conditions systems related to metabolism and excretion of drugs: liver and kidney. On the other hand, most frequently metabolic disorders affects negatively to the tolerance of treatments. It is also important to evaluate the nutritional status of the patient because are often altered by different causes in elderly patients. In the elderly with cancer task decisions should take into account the hope life and the overall effect of the disease and its treatment on quality of life of patients in relation to the coexistence of other chronic diseases. Therefore, elderly patients with geriatric cancer assessment is useful to help diagnose various diseases of the elderly that can interfere with treatment cancer. In addition, to improve the overall knowledge of the patient, we can try to improve present problems in mental, emotional sphere and the social support network, to improve tolerance to treatment and therefore the quality of life, a concept difficult to define as it varies between individuals and over time and depends on various factors both cultural, religious and personal experiences. In conclusion, in elderly patients with tumor pathology must make an assessment in depth of their overall situation prior to disease and make treatment decisions

Maintaining Unity - relatives in older patients' fast-track treatment programmes. A grounded theory study.

Science.gov (United States)

Berthelsen, Connie Bøttcher; Lindhardt, Tove; Frederiksen, Kirsten

2014-12-01

To generate a substantive grounded theory of relatives' pattern of behaviour in older patients' fast-track treatment programmes during total hip or knee replacement. Fast-track treatment programmes are designed to make total hip and knee replacements more efficient through recovery improvements. The support of relatives during older patients' trajectory is important. However, knowledge is needed on the relatives' pattern of behaviour to strengthen their involvement in fast-track treatment programmes. We used a Glaserian grounded theory approach based on a systematic generation of theory from data to explain the latent pattern of behaviour of relatives. Data were collected from 2010-2011 in orthopaedic wards at two Danish university hospitals and consisted of 14 non-participant observations, 14 postobservational interviews and five interviews. Seven relatives of patients over 70 years of age participated. The constant comparative method was the guiding principle for simultaneous data collection, data analysis and coding, while theoretically sampling and writing memos. Maintaining Unity emerged as the relatives' pattern of behaviour through which they resolved their main concern: preventing the patients from feeling alone. The relatives resolved their main concern through three interchangeable behavioural modes: Protecting Mode, by providing loving and respectful support; Substituting Mode, with practical and cognitive support; and an Adapting Mode, by trying to fit in with the patients' and health professionals' requirements. The substantive theory of Maintaining Unity offers knowledge of relatives' strong desire to provide compassionate and loving support for the older patients during fast-track treatment programmes. © 2014 John Wiley & Sons Ltd.

The frequencies and clinical implications of mutations in 33 kinase-related genes in locally advanced rectal cancer: a pilot study.

LENUS (Irish Health Repository)

Abdul-Jalil, Khairun I

2014-08-01

Locally advanced rectal cancer (LARC: T3\\/4 and\\/or node-positive) is treated with preoperative\\/neoadjuvant chemoradiotherapy (CRT), but responses are not uniform. The phosphatidylinositol 3-kinase (PI3K), MAP kinase (MAPK), and related pathways are implicated in rectal cancer tumorigenesis. Here, we investigated the association between genetic mutations in these pathways and LARC clinical outcomes.

Improvements in or relating to the treatment of substances

International Nuclear Information System (INIS)

Hardwick, W.H.; Gayler, R.

1981-01-01

This relates to the treatment of substances, one application being the solidification and vitrification of radioactive wastes for the purposes of handling and storage. The process includes the use of microwave radiation to produce a fusible dried product from solution or slurry or to fuse this product or for both stages. Uranium, transuranium elements and fission products from reprocessing procedures can be incorporated into ceramic and glass-like solid materials using this method. Radioactive wastes containing neutron poisons can also be treated. An example given is for the treatment of a magnesium compound from fuel element cooling pond waters. Several variations, including drying the solution on a glass fibre tape or wick or in a stainless steel vessel are detailed. (U.K.)

Gastroesophageal reflux disease-related and functional heartburn: pathophysiology and treatment.

Science.gov (United States)

Miwa, Hiroto; Kondo, Takashi; Oshima, Tadayuki

2016-07-01

Patients who continue to experience heartburn symptoms despite adequate-dose proton pump inhibitor therapy have unmet clinical needs. In this review, we focus on the most recent findings related to the mechanism of heartburn symptom generation, and on the treatment of gastroesophageal reflux disease-related and functional heartburn. The immunological mechanism in the esophageal mucosa has been addressed as a potential mechanism of the onset of esophageal mucosa damage and the generation of heartburn symptoms. Peripheral or central hypersensitivity in viscera is a potentially unifying pathophysiological concept in functional heartburn. Vonoprazan, a novel and potent first-in-class potassium-competitive acid blocker, is expected to prove useful in the treatment of reflux disease. New findings in the mechanisms of heartburn symptom generation are emerging, including the immunological mediation of esophageal mucosal damage and the development of visceral hypersensitivity in functional heartburn. In the future, we anticipate the emergence of new and specific therapeutic options based on these mechanisms, with less dependence on acid-suppressing agents.

Poor survival of treatment-related acute nonlymphocytic leukemia

International Nuclear Information System (INIS)

Neugut, A.I.; Nieves, J.; Murray, T.; Tsai, Weiyann; Robinson, E.

1990-01-01

Population-based data on more than 1 million patients registered in the Surveillance, Epidemiology, and End-Results Program of the National Cancer Institute, 1973-1984, were analyzed to determine the survival of patients with de novo acute nonlymphocytic leukemia (ANLL) and following a first primary tumor treated (with chemotherapy and/or radiation therapy) or untreated. Cases that occurred within 12 months of the first malignant neoplasm were excluded. Survival was estimated using Cox proportional-hazards modeling, with age, sex, and specific type of ANLL as covariates. The 6,271 patients with de novo ANLL had an estimated 12-month survival of 30%, while the 107 patients with treatment-related ANLL had an estimated 12-month survival of 10%. The authors conclude that ANLL that occurs after chemotherapy or radiation therapy is biologically more aggressive and/or resistant to therapy than spontaneous ANLL. This provides a rationale for current studies on treatment-induced cellular changes and on more aggressive therapy for these patients

Inpatient and Day Hospital Treatment of Patients with Depression and Job-related Burnout.

Science.gov (United States)

Meyer, Lisa Kristin; Lange, Sabine; Behringer, Johanna; Söllner, Wolfgang

Burnout is a process of physical and emotional exhaustion that often results in clinical depression. Detailed descriptions and evaluations of specialized psychosomatic treatment are rare. This pilot study investigates the feasibility of inpatient and day hospital treatment of patients with burnout syndrome. Additionally, we present results of an initial, noncontrolled, pre-post-evaluation of changes in symptoms and individual work-related risk factors for burnout. Sixty-four consecutive patients with burnout syndrome were assessed before and after specialized multimodal treatment using a clinical symptom checklist (ICD-10 Symptom Rating) and burnout-specific instruments (Maslach Burnout Inventory, Occupational Stress & Coping Inventory). Patients' average age was 45 (range 23 to 61), 70% were currently employed, 24% in managerial positions or self-employed, and 89% diagnosed with an affective disorder. The average length of time off work due to illness in the past year was 13 weeks. Treatment lasted five weeks on average. After treatment, depression (p work (p = 0.001; d = 0.36) decreased, while emotional distancing (p balance and mental stability (p life satisfaction (p work-related risk factors. Controlled studies are necessary to establish treatment efficacy.

77 FR 76797 - To Extend Nondiscriminatory Treatment (Normal Trade Relations Treatment) to the Products of the...

Science.gov (United States)

2012-12-28

... Marrakesh Agreement Establishing the World Trade Organization (the ``WTO Agreement'') with respect to the... Act'') (19 U.S.C. 2431 et seq.) since 1994. The Russian Federation acceded to the World Trade Organization (WTO) on August 22, 2012. The extension of permanent normal trade relations treatment to the...

Technology Addiction among Treatment Seekers for Psychological Problems: Implication for Screening in Mental Health Setting.

Science.gov (United States)

Das, Aswathy; Sharma, Manoj Kumar; Thamilselvan, P; Marimuthu, P

2017-01-01

Technology usage has seen an increase among users. The usage varies from social, personal, and psychological reasons. Users are frequently using to overcome mood states as well as to manage the other psychological states. This work is going to explore the information technology use among subjects with a psychiatric disorder. A total of 75 subjects were assessed using background data sheet, internet addiction impairment index, video game use pattern, pornography addiction screening tool and screening for mobile phone use, from in-patient and out-patient setting of tertiary mental health setting. It showed the presence of addiction to mobile, internet, video game, and pornography. Age was found to be negatively correlated with this addiction. Average usage time had been associated with management of mood states. The addiction to information technology had been associated with a delay in initiation of sleep. This work has implication for screening technology addiction among subjects seeking treatment for psychological problems and motivate them to develop the healthy use of technology.

Treatment Options for AIDS-Related Lymphoma

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... nervous system is not primary CNS lymphoma. Treatment Option Overview Key Points There are different types of ...

A Cross-Lagged Panel Study of Dissociation and Posttraumatic Stress in a Treatment-Seeking Sample of Survivors of Childhood Sexual Abuse

DEFF Research Database (Denmark)

Murphy, Siobhan; Elklit, Ask; Murphy, Jamie

2017-01-01

Objective: The current prospective study assessed the temporal relations between dissociation and posttraumatic stress (PTS) in a sample of treatment-seeking female survivors of childhood sexual abuse. PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence...... clinical implications that may affect their treatment and trauma recovery....

Current and emerging therapies for the treatment of age-related macular degeneration

Directory of Open Access Journals (Sweden)

M Vaughn Emerson

2008-06-01

Full Text Available M Vaughn Emerson, Andreas K LauerCasey Eye Institute, Oregon Health and Science University, Portland, OR, USAAbstract: Age-related macular degeneration (AMD is the leading cause of vision loss in the industrialized world. In the last few decades, the mainstay of treatment for choroidal neovascularization (CNV due to AMD has been thermal laser photocoagulation. In the last decade, photodynamic therapy with verteporfin extended treatment for more patients. While both of these treatments have prevented further vision loss in a subset of patients, improvement in visual acuity is rare. Anti-vascular endothelial growth factor A (VEGF therapy has revolutionized the treatment of AMD-related CNV. Pegaptanib, an anti-VEGF aptamer prevents vision loss in CNV, although the performance is similar to that of photodynamic therapy. Ranibizumab, an antibody fragment and bevacizumab, a full-length humanized monoclonal antibody against VEGF have both shown promising results with improvements in visual acuity with either agent. VEGF trap, a modified soluble VEGF receptor analogue, binds VEGF more tightly than all other anti-VEGF agents and has also shown promising results in early trials. Other treatment strategies to decrease the effect of VEGF have used small interfering ribonucleic acid (RNA to inhibit VEGF production and VEGF receptor production. Steroids, including anecortave acetate in the treatment and prevention of CNV, have shown promise in controlled trials. Receptor tyrosine kinase inhibitors, such as vatalanib, inhibit downstream effects of VEGF, and have been effective in the treatment of CNV in early studies. Squalamine lactate inhibits plasma membrane ion channels with downstream effects on VEGF, and has shown promising results with systemic administration. Other growth factors, including pigment epithelium-derived growth factor that has been administered via an adenoviral vector has shown promising initial results. In some patients ciliary

Treatment of polycystic ovary syndrome in adolescence.

Science.gov (United States)

Vitek, Wendy; Hoeger, Kathleen M

2014-05-01

Adolescence is a time of rapidly changing reproductive hormones and menstrual patterns making diagnosis of polycystic ovary syndrome (PCOS) challenging in this population. Nonetheless, there is significant concern that the metabolic and reproductive abnormalities that emerge at adolescence associated with a diagnosis of PCOS have lifelong implications for the individual. There are limited data available on the best treatments for the adolescent with PCOS. The focus of treatment is often best served by attention to the individual abnormalities such as menstrual dysfunction, symptoms of androgen excess such as hirsutism and acne, possible metabolic dysfunction primarily seen with concurrent obesity, and concerns related to self-image and mood disorders. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Oral health-related quality of life and complications after treatment with partial removable dental prosthesis

DEFF Research Database (Denmark)

Al-Imam, H; Özhayat, E B; Benetti, A R

2016-01-01

and inflammation of the oral mucosa, followed less frequently by fractures of the clasps. Treatment with RDPs improved OHRQoL, but denture-related problems partly remained, and new problems related to RDPs occurred 1-5 years after treatment. The two most frequent complications were ill-fitting RDPs...

Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases

DEFF Research Database (Denmark)

Hald, Marianne; Arendrup, Maiken C; Svejgaard, Else L

2015-01-01

Internationally approved guidelines for the diagnosis and management of Malassezia-related skin diseases are lacking. Therefore, a panel of experts consisting of dermatologists and a microbiologist under the auspices of the Danish Society of Dermatology undertook a data review and compiled...... guidelines for the diagnostic procedures and management of pityriasis versicolor, seborrhoeic dermatitis and Malassezia folliculitis. Main recommendations in most cases of pityriasis versicolor and seborrhoeic dermatitis include topical treatment which has been shown to be sufficient. As first choice....... Maintenance therapy is often necessary to prevent relapses. In the treatment of Malassezia folliculitis systemic antifungal treatment is probably more effective than topical treatment but a combination may be favourable....

TAX AND ACCOUNTING TREATMENT ON THE REVALUATION OF TANGIBLE ASSETS IN ROMANIA

Directory of Open Access Journals (Sweden)

NICOLAE ECOBICI

2017-02-01

Full Text Available According to the regulations in force, the revaluation is an alternative treatment to the cost method, tangible assets to be presented in accounting to the fair/ reassessed value. In this paper we aim to capture the accounting treatment established under the laws in force in 2017. We will present ways of determining the reassessment differences and their implications on determining the tax on buildings (only tangible assets as buildings. We will also present the way to register the added value (revaluation surplus or minus value (amortization on reassessment and the treatment of the revaluation reserve (surplus from reassessment recorded in account the 105 “Reserve from reassessment” in accounting. Comparing the laws in force and those of IAS 16, we conclude that the accounting treatment related to the revaluation of tangible assets is similar. There remain unusable for the entities that do not apply IFRS in Romania: permanent reassessment of the duration of use and amortization method. Throughout the paper we will present the tax treatment of reassessment through corporate tax implications. Therefore, we will consider that the entities to which we refer are in the category of corporate tax payers and not in that of microenterprises. They no longer feel the influence of corporate tax because are taxed on income and not at the fiscal result (1% for those with at least 1 employee and 3% others. The main findings focus on the issue of identifying the exact moment when the reassessment reserve is taxed and on what are included in items similar to income, corporate tax implications.

Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications.

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Rice-Townsend, Samuel; Hall, Matthew; Barnes, Jeff N; Baxter, Jessica K; Rangel, Shawn J

2012-06-01

The purpose of this study was to characterize epidemiologic trends and cost implications of hospital readmission after treatment of pediatric appendicitis. We conducted a 5-year retrospective cohort analysis of 30-day readmission rates for 52,054 patients admitted with appendicitis at 38 children's hospitals participating in the Pediatric Health Information System database. Patients were categorized as "uncomplicated" (postoperative length of stay [LOS] ≤ 2 days) or "complicated" (LOS ≥ 3 days and ≥ 4 consecutive days of antibiotics) and analyzed for demographic data, treatment received during the index admission, readmission rates, and excess LOS and hospital-related costs attributable to readmission encounters. The aggregate 30-day readmission rate was 8.7%, and this varied significantly by disease severity and management approach (uncomplicated appendectomy, 5.6%; complicated appendectomy, 12.8%; drainage, 22.6%; antibiotics only, 24.6%; P management approach (uncomplicated appendectomy, $1946 [31% relative increase]; complicated appendectomy, $6524 [53% increase]; drainage, $6827 [48% increase]; antibiotics only, $5835 [58% increase]; P < .0001). In freestanding children's hospitals, readmission after treatment of pediatric appendicitis is a relatively common and costly occurrence. Collaborative efforts are needed to characterize patient, treatment, and hospital-related risk factors as a basis for developing preventative strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

The Energy, Greenhouse Gas Emissions, and Cost Implications of Municipal Water Supply & Wastewater Treatment

Science.gov (United States)

Rodriguez-Winter, Thelma

All man-made structures and materials have a design life. Across the United States there is a common theme for our water and wastewater treatment facilities and infrastructure. The design life of many of our mid 20 th century water and wastewater infrastructures in the United States have reached or are reaching life expectancy limits (ASCE, 2010). To compound the financial crisis of keeping up with the degradation, meeting and exceeding quality standards has never been more important in order to protect local fresh water supplies. This thesis analyzes the energy consumption of a municipal water and wastewater treatment system from a Lake Erie intake through potable treatment and back through wastewater treatment then discharge. The system boundary for this thesis includes onsite energy consumed by the treatment system and distribution/reclamation system as well as the energy consumed by the manufacturing of treatment chemicals applied during the study periods. By analyzing energy consumption, subsequent implications from greenhouse gas emissions and financial expenditures were quantified. Through the segregation of treatment and distribution processes from non-process energy consumption, such as heating, lighting, and air handling, this study identified that the potable water treatment system consumed an annual average of 2.42E+08 kBtu, spent 5,812,144 for treatment and distribution, and emitted 28,793 metric tons of CO2 equivalent emissions. Likewise, the wastewater treatment system consumed an annual average of 2.45E+08 kBtu, spent 3,331,961 for reclamation and treatment, and emitted 43,780 metric tons of CO2 equivalent emissions. The area with the highest energy usage, financial expenditure, and greenhouse gas emissions for the potable treatment facility and distribution system was from the manufacturing of the treatment chemicals, 1.10E+08 kBtu, 3.7 million, and 17,844 metric tons of CO2 equivalent, respectively. Of the onsite energy (1.4E-03 kWh per gallon

Implications of lower risk thresholds for statin treatment in primary prevention: analysis of CPRD and simulation modelling of annual cholesterol monitoring.

Science.gov (United States)

McFadden, Emily; Stevens, Richard; Glasziou, Paul; Perera, Rafael

2015-01-01

To estimate numbers affected by a recent change in UK guidelines for statin use in primary prevention of cardiovascular disease. We modelled cholesterol ratio over time using a sample of 45,151 men (≥40years) and 36,168 women (≥55years) in 2006, without statin treatment or previous cardiovascular disease, from the Clinical Practice Research Datalink. Using simulation methods, we estimated numbers indicated for new statin treatment, if cholesterol was measured annually and used in the QRISK2 CVD risk calculator, using the previous 20% and newly recommended 10% thresholds. We estimate that 58% of men and 55% of women would be indicated for treatment by five years and 71% of men and 73% of women by ten years using the 20% threshold. Using the proposed threshold of 10%, 84% of men and 90% of women would be indicated for treatment by 5years and 92% of men and 98% of women by ten years. The proposed change of risk threshold from 20% to 10% would result in the substantial majority of those recommended for cholesterol testing being indicated for statin treatment. Implications depend on the value of statins in those at low to medium risk, and whether there are harms. Copyright © 2014. Published by Elsevier Inc.

Investigations into quantum theory and relativity theory

International Nuclear Information System (INIS)

Cox, I.D.

1982-03-01

This thesis falls into two parts. The first is concerned with damping theory as a particular approach to the description of the dynamical evolution of non-closed systems. Appealing ultimately to the Liouville/Von-Neuman equation in the weak coupling regime, the current-voltage characteristics of both the normal and Josephson tunnelling junctions, treated as open systems are obtained. It is then shown that the same results may be obtained via the combined scattering and density matrix formalism (which does not appeal to the Liouville/Von-Neuman equation), and that this method has certain advantages over the conventional formalism. In the second part an extended (non-quantum) theory of relativity in a five dimensional space is developed and a number of interesting consequences thereof obtained. In particular a generalised set of Maxwell equations for electro-dynamics is derived, and some of the implications of the new set of equations are described. Furthermore a treatment of the five-dimensional analogue of the Schwarzschild problem in general relativity is given, together with the resulting implications for planetary motion. (author)

Positive Implicative Ideals of BCK-Algebras Based on Intersectional Soft Sets

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Eun Hwan Roh

2013-01-01

Full Text Available The aim of this paper is to lay a foundation for providing a soft algebraic tool in considering many problems that contain uncertainties. In order to provide these soft algebraic structures, the notion of int-soft positive implicative ideals is introduced, and related properties are investigated. Relations between an int-soft ideal and an int-soft positive implicative ideal are established. Characterizations of an int-soft positive implicative ideal are obtained. Extension property for an int-soft positive implicative ideal is constructed. The ∧-product and ∨-product of int-soft positive implicative ideals are considered, and the soft intersection (resp., union of int-soft positive implicative ideals is discussed.

Mental Health-Related Outcomes of Robin Williams' Death: The Role of Parasocial Relations and Media Exposure in Stigma, Help-Seeking, and Outreach.

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Hoffner, Cynthia A; Cohen, Elizabeth L

2017-10-19

This study explores responses to the death of actor/comedian Robin Williams, focusing on the role of celebrity attachment and exposure to media coverage following his suicide. A total of 350 respondents recruited on Mechanical Turk completed an online survey. Participants who had a stronger parasocial relationship with Williams reported lower social distance from people with depression, greater willingness to seek treatment for depression, and more frequent outreach to other people with depression or suicidal thoughts following his death. Exposure to media coverage of suicide/depression - both informational and stigmatizing - was associated with more frequent outreach to others, but only informational coverage was related to greater willingness to seek treatment. Stigmatizing media exposure was related to greater depression stereotypes. Seeing more media stories celebrating Williams' life and career was associated with reduced depression stigma but also with less willingness to seek treatment for depression and less outreach to others. Implications of the findings for media and mental health are discussed.

Prime implicants in dynamic reliability analysis

International Nuclear Information System (INIS)

Tyrväinen, Tero

2016-01-01

This paper develops an improved definition of a prime implicant for the needs of dynamic reliability analysis. Reliability analyses often aim to identify minimal cut sets or prime implicants, which are minimal conditions that cause an undesired top event, such as a system's failure. Dynamic reliability analysis methods take the time-dependent behaviour of a system into account. This means that the state of a component can change in the analysed time frame and prime implicants can include the failure of a component at different time points. There can also be dynamic constraints on a component's behaviour. For example, a component can be non-repairable in the given time frame. If a non-repairable component needs to be failed at a certain time point to cause the top event, we consider that the condition that it is failed at the latest possible time point is minimal, and the condition in which it fails earlier non-minimal. The traditional definition of a prime implicant does not account for this type of time-related minimality. In this paper, a new definition is introduced and illustrated using a dynamic flowgraph methodology model. - Highlights: • A new definition of a prime implicant is developed for dynamic reliability analysis. • The new definition takes time-related minimality into account. • The new definition is needed in dynamic flowgraph methodology. • Results can be represented by a smaller number of prime implicants.

Effect of treatment with fixed and removable dental prostheses. An oral health-related quality of life study

DEFF Research Database (Denmark)

Øzhayat, Esben Boeskov; Gotfredsen, Klaus

2012-01-01

The aim of the study was to evaluate patient-reported effects of treatment with fixed dental prostheses (FDP) and removable dental prostheses (RDP) and relate the change in Oral Health Related Quality of Life (OHRQoL) to the type of treatment and objective dental variables of aesthetics and masti......The aim of the study was to evaluate patient-reported effects of treatment with fixed dental prostheses (FDP) and removable dental prostheses (RDP) and relate the change in Oral Health Related Quality of Life (OHRQoL) to the type of treatment and objective dental variables of aesthetics...... were obtained. The participants completed the Oral Health Impact Profile 49 (OHIP-49) before and after treatment. A control group with no need for dental treatment also completed the OHIP-49. All participants had a significant improvement in OHRQoL. The improvement was higher for the RDP group than...

Molecular Mechanisms Linking Exercise to Cancer Prevention and Treatment

DEFF Research Database (Denmark)

Hojman, Pernille; Gehl, Julie; Christensen, Jesper F.

2018-01-01

The benefits of exercise training for cancer patients are becoming increasingly evident. Physical exercise has been shown to reduce cancer incidence and inhibit tumor growth. Here we provide the status of the current molecular understanding of the effect of exercise on cancer. We propose...... that exercise has a role in controlling cancer progression through a direct effect on tumor-intrinsic factors, interplay with whole-body exercise effects, alleviation of cancer-related adverse events, and improvement of anti-cancer treatment efficacy. These findings have wide-ranging societal implications......, as this understanding may lead to changes in cancer treatment strategies. Hojman et al. discuss the role of exercise in controlling cancer progression through direct effects on tumor-intrinsic factors, interplay with whole-body exercise effects, alleviation of cancer-related adverse events, and improvement of cancer...

Clinical Characteristics and Current Treatment of Age-Related Macular Degeneration

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Yonekawa, Yoshihiro; Kim, Ivana K.

2015-01-01

Age-related macular degeneration (AMD) is a multifactorial degeneration of photoreceptors and retinal pigment epithelium. The societal impact is significant, with more than 2 million individuals in the United States alone affected by advanced stages of AMD. Recent progress in our understanding of this complex disease and parallel developments in therapeutics and imaging have translated into new management paradigms in recent years. However, there are many unanswered questions, and diagnostic and prognostic precision and treatment outcomes can still be improved. In this article, we discuss the clinical features of AMD, provide correlations with modern imaging and histopathology, and present an overview of treatment strategies. PMID:25280900

Electrophysiological Evidence in Schizophrenia in Relation to Treatment Response

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Kazuki Sueyoshi

2018-06-01

Full Text Available Several domains of cognitive function, e.g., verbal memory, information processing, fluency, attention, and executive function are impaired in patients with schizophrenia. Cognitive impairments in schizophrenia have attracted interests as a treatment target, because they are considered to greatly affect functional outcome. Electrophysiological markers, including electroencephalogram (EEG, particularly, event-related potentials, have contributed to psychiatric research and clinical practice. In this review, we provide a summary of studies relating electrophysiological findings to cognitive performance in schizophrenia. Electrophysiological indices may provide an objective marker of cognitive processes, contributing to the development of effective interventions to improve cognitive and social outcomes. Further efforts to understand biological mechanisms of cognitive disturbances, and develop effective therapeutics are warranted.

Sexual orientation, treatment utilization, and barriers for alcohol related problems: Findings from a nationally representative sample.

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Allen, Junior Lloyd; Mowbray, Orion

2016-04-01

Gay, lesbian, and bisexual (GLB) individuals appear to have an increased likelihood of alcohol use disorders and treatment utilization for alcohol related problems compared to heterosexual individuals. Despite this increase, treatment utilization rates among GLB individuals remain low. In an effort to address this, our paper examined whether or not GLB individuals encounter unique barriers when pursuing treatment for alcohol related problems. Using data from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), we examined service sector specific factors, some of which included (a) utilization rates, (b) self-reported treatment barriers, and (c) whether or not there were emergent differences among GLB individuals, after controlling for socio-demographic and clinical characteristics. Findings indicated that GLB individuals reported higher severity rates for alcohol use disorders when compared to heterosexual individuals, and were significantly more likely to utilize treatment services for alcohol related problems, however, not across all treatment sectors. While similar patterns were observed when examining barriers to treatment, bisexual individuals reported significantly more barriers than heterosexual and gay/lesbian individuals. These findings underscored the importance of identifying and developing interventions that addresses treatment barriers associated with alcohol use service utilization among GLB populations, and creating improved outreach and education programs to better address stigmas associated with substance use and sexuality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Clinical and ethical implications of placebo effects: enhancing patients' benefits from pain treatment.

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Klinger, Regine; Flor, Herta

2014-01-01

Expectancy and learning are the core psychological mechanisms of placebo analgesia. They interact with further psychological processes such as emotions and motivations (e.g., anxiety, desire for relief), somatic focus, or cognitions (e.g., attitudes toward the treatment). The development of placebo responsiveness and the actual placebo response in a person is the result of the complex interaction between factors traced back to the individual learning history related to analgesic drugs or treatments and factors of the current context referring to the analgesic or placebo treatment. The aim of this chapter is to depict these complex interactions in a new model of analgesic placebo effects. It joins aspects of the learning history (preexisting experiences and preexisting expectations) of a patient with aspects of the current context (current expectation as a result of external and internal situation in which a pain medication/treatment/placebo is taken, e.g., current information about pain medication, current specific context/cues, desire for pain relief, certainty about upcoming pain relief, current expectation about pain reducing course, current selective attention, increased pain experience, or decreased pain experience). In order to exploit placebo efficacy for an analgesic treatment it is worthwhile to assess in which direction each of these factors exerts its influence in order to maximize placebo effects for a specific patient. By applying placebo mechanisms in this differentiated way, the efficacy of pain treatment can be deliberately boosted.

Phase I/II study of proton beam irradiation for the treatment of subfoveal choroidal neovascularization in age-related macular degeneration: treatment techniques and preliminary results

International Nuclear Information System (INIS)

Yonemoto, Leslie T.; Slater, Jerry D.; Friedrichsen, Eric J.; Loredo, Lilia N.; Ing, Jeffrey; Archambeau, John O.; Teichman, Sandra; Moyers, Michael F.; Blacharski, Paul A.; Slater, James M.

1996-01-01

Purpose: Age-related macular degeneration is the prevalent etiology of subfoveal choroidal neovascularization (CNV). The only effective treatment is laser photocoagulation, which is associated with decreased visual acuity following treatment in most patients. This study assessed both the response of subfoveal CNV to proton beam irradiation and treatment-related morbidity. We evaluated preliminary results in patients treated with an initial dose of 8 Cobalt Gray Equivalents (CGE) using a relative biological effectiveness (RBE) of 1.1. Methods and Materials: Twenty-one patients with subfoveal CNV received proton irradiation to the central macula with a single fraction of 8 CGE; 19 were eligible for evaluation. Treatment-related morbidity was based on Radiation Therapy Oncology Group (RTOG) criteria; response was evaluated by Macular Photocoagulation Study (MPS) guidelines. Fluorescein angiography was performed; visual acuity, contrast sensitivity, and reading speed were measured at study entry and at 3-month intervals after treatment. Follow-up ranged from 6 to 15 months. Results: No measurable treatment-related morbidity was seen during or after treatment. Of 19 patients evaluated at 6 months, fluorescein angiography demonstrated treatment response in 10 (53%); 14 (74%) patients had improved or stable visual acuity. With a mean follow-up of 11.6 months, 11 (58%) patients have demonstrated improved or stable visual acuity. Conclusion: A macular dose of 8 CGE yielded no measurable treatment morbidity in patients studied. Fluorescein nagiography demonstrated that regressed or stabilized lesions were associated with improved visual acuity as compared with MPS results. In the next phase, a dose of 14 CGE in a single fraction will be used to further define the optimal dose fractionation schedule

Prognostic implication of human papillomavirus types and species in cervical cancer patients undergoing primary treatment.

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Yat Ming Lau

Full Text Available High-risk human papillomavirus (HPV types are associated with cervical cancer. It is well established that individual HPV types vary in oncogenicity, but current data on their prognostic implication remain controversial. We examined the association between HPV types/species and the survival of 236 Chinese women aged 26-87 (mean 54.4 years after receiving primary treatment for cervical cancer. Overall, 45.8% were of FIGO stage I, 41.9% stage II, and 12.3% stage III. The four most prevalent types found were HPV-16 (60.2%, HPV-18 (21.6%, HPV-52 (11.9%, and HPV-58 (9.3%. Overall, 19.5% of patients had multiple-type infections, 78.4% harboured one or more alpha-9 species, and 28.8% harboured one or more alpha-7 species. After a median follow-up of 8.0 years, 156 (66.1% patients survived. The 3-year overall survival rate was 75.5%. Factors independently associated with a poorer 3-year overall survival were age >60 years, tumour size >4 cm, lymph node involvement and treatment with radiotherapy+/-chemotherapy. Univariate analysis showed HPV-16 single-type infection was associated with a marginally poorer disease-specific survival (71.6% vs. 87.0%, HR: 1.71, 95% CI = 1.01-2.90, whereas non-HPV-16 alpha-9 species was associated with a better disease-specific survival (90.0% vs. 76.2%, HR: 0.36, 95% CI = 0.16-0.79. However, on multivariate analysis, HPV infection status irrespective of different grouping methods, including individual types, species, single-type or co-infection, did not carry any significant prognostic significance. In conclusion, we did not observe any association between infection with a particular HPV type/species and survival. An HPV type-based stratification in treatment and follow-up plan could not be recommended.

The philosophy of quarantine treatment as related to low-dose radiation

International Nuclear Information System (INIS)

Ouye, M.T.; Gilmore, J.E.

1985-01-01

The purpose for quarantine treatment is to prevent establishment of exotic pest populations from quarantined areas to nonquarantined areas through movement of host commodities. Quarantine treatment schedules approved by the Animal Plant Health Inspection Service (APHIS), U.S. Dept. of Agriculture (USDA), appear in its ''Plant Protection and Quarantine Programs Treatment Manual.'' These treatment schedules were developed through research demonstrating that when followed to the letter, quarantine security or negligible pest risk would be achieved. Negligible pest risk is currently synonymous with probit 9, the level of security at which no more than 3.2 pests per 100,000 treated will survive. Probits are based on mortality; therefore, relatively high dosages will be required and in some instances could damage the commodity at the dosage necessary to kill the pest. If the purpose of quarantine treatment is to prevent perpetuation of the pest species into nonquarantined areas, the criterion should be based on the ability of the treated pests to reproduce. The criteria currently being discussed by APHIS and the Agricultural Research Service are presented. Two key criteria are a redefinition of negligible pest risk and the concept of a two-stage quarantine treatment schedule

Return of the psychedelics: Psilocybin for treatment resistant depression.

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Patra, Suravi

2016-12-01

Psilocybin, the clinically most researched classic psychedelic has recently been tested for its safety and efficacy in a clinical population of treatment resistant depression. The efficacy of psilocybin in clinical depression previously demonstrated in the elecrophysiologic and neuroimaging findings as also in neuropsychological assessments is further validated by the findings of this rigorously conducted randomized trial. Mechanism of action of psilocybin and efficacy in treatment resistant depression are discussed in this paper. Ethical issues of conducting clinical trials with psychedelics are also discussed with particular emphasis on their relative safety and absence of addiction potential. Implications of these issues for conduct of larger trials for establishing risk benefit ratio in treatment resistant depression are further suggested. Copyright © 2016 Elsevier B.V. All rights reserved.

Family-Related Opinions and Stressful Situations Associated with Psychological Distress in Women Undergoing Infertility Treatment

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Jiro Takaki

2014-09-01

Full Text Available The purpose of this study is to investigate how family-related opinions and stressful situations are related to psychological distress in women undergoing infertility treatment. The subjects in this cross-sectional study were recruited from female patients undergoing infertility treatment (n = 2540 at 70 infertility treatment institutions in Japan. Because of non-participation or missing data, the number of subjects included in the analysis was 635 (response rate, 25.0%. The family-related opinions and stressful situations were evaluated using the original questions. Psychological distress was assessed using a self-report measure, the Kessler Six-question Psychological Distress Scale (K6. The K6 scores of the following participants were significantly (p < 0.05 and independently high: those with more frequent miscarriage/stillbirth/abortions, those with repeated miscarriages as the cause of infertility, those with infertility of unknown causes, those living with no child, those having a low joint income with their partner, those with the opinion that “women should devote themselves to their household duties” those who had considered stopping treatment, those without the opinion that “married life without children is favorable” and those who had experienced stressful situations such as inadequate explanation by doctors, frustration of multiple failed attempts, differences of opinion with the partner, and lack of knowledge regarding when to stop treatment. Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment are outlined. The results of this study may contribute to the prevention of and care for psychological distress in female patients undergoing infertility treatment.

Cost Implications of Value-Based Pricing for Companion Diagnostic Tests in Precision Medicine.

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Zaric, Gregory S

2016-07-01

Many interpretations of personalized medicine, also referred to as precision medicine, include discussions of companion diagnostic tests that allow drugs to be targeted to those individuals who are most likely to benefit or that allow treatment to be designed in a way such that individuals who are unlikely to benefit do not receive treatment. Many authors have commented on the clinical and competitive implications of companion diagnostics, but there has been relatively little formal analysis of the cost implications of companion diagnostics, although cost reduction is often cited as a significant benefit of precision medicine. We investigate the potential impact on costs of precision medicine implemented through the use of companion diagnostics. We develop a framework in which the costs of companion diagnostic tests are determined by considerations of profit maximization and cost effectiveness. We analyze four scenarios that are defined by the incremental cost-effectiveness ratio of the new drug in the absence of a companion diagnostic test. We find that, in most scenarios, precision medicine strategies based on companion diagnostics should be expected to lead to increases in costs in the short term and that costs would fall only in a limited number of situations.

Initial assessment of a model relating intratumoral genetic heterogeneity to radiological morphology

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Noterdaeme, O; Kelly, M; Friend, P; Soonowalla, Z; Steers, G; Brady, M

2010-01-01

Tumour heterogeneity has major implications for tumour development and response to therapy. Tumour heterogeneity results from mutations in the genes responsible for mismatch repair or maintenance of chromosomal stability. Cells with different genetic properties may grow at different rates and exhibit different resistance to therapeutic interventions. To date, there exists no approach to non-invasively assess tumour heterogeneity. Here we present a biologically inspired model of tumour growth, which relates intratumoral genetic heterogeneity to gross morphology visible on radiological images. The model represents the development of a tumour as a set of expanding spheres, each sphere representing a distinct clonal centre, with the sprouting of new spheres corresponding to new clonal centres. Each clonal centre may possess different characteristics relating to genetic composition, growth rate and response to treatment. We present a clinical example for which the model accurately tracks tumour growth and shows the correspondence to genetic variation (as determined by array comparative genomic hybridisation). One clinical implication of our work is that the assessment of heterogeneous tumours using Response Evaluation Criteria In Solid Tumours (RECIST) or volume measurements may not accurately reflect tumour growth, stability or the response to treatment. We believe that this is the first model linking the macro-scale appearance of tumours to their genetic composition. We anticipate that our model will provide a more informative way to assess the response of heterogeneous tumours to treatment, which is of increasing importance with the development of novel targeted anti-cancer treatments. PMID:19690073

Retroperitoneal Sarcoma Involving Unilateral Double Ureter: Management, Treatment and Psychological Implications

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Vito Leanza

2014-05-01

Full Text Available The case of a 45-year-old woman who was admitted to our university hospital for polymenorrhea, weight gain and pain in the left iliac region is reported. An abdominal ultrasound revealed a 9.5 × 5.2-cm, hypoechoic and inhomogeneous mass located on the left side of the pelvis and behind the ovary. The patient underwent surgery. The pelvic mass was firmly anchored to the small intestine, colon, sigma and uterine fundus. After removing the adhesions, double ureters, which had been incorporated in the mass, were observed on the left side. Resection of the unilateral double ureters was necessary in order to remove the entire mass, and thereafter, a left salpingoophorectomy was performed. A histological examination showed a malignant retroperitoneal mass. Termino-terminal ureteral anastomosis with two double-J stents was carried out. Total hysterectomy with preservation of the right adenexum and regional lymphadenectomy was performed. The purpose of this case report is to discuss the physical and psychological implications related to the combination of two rare entities: leiomyosarcoma and a double ureter located within the mass. A literature review on the clinical management and psychological aspects from a female cancer patient's perspective undergoing surgery with the aforementioned disorders will be discussed.

Relational antecedents and social implications of the emotion of empathy: Evidence from three studies.

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Kim, Sanghag; Kochanska, Grazyna

2017-09-01

Despite emotion researchers' strong interest in empathy and its implications for prosocial functioning, surprisingly few studies have examined parent-child attachment as a context for early origins of empathy in young children. Consequently, empirical evidence on links among children's attachment, empathy, and prosociality is thin and inconsistent. We examined such links in 2 longitudinal studies of community families (Family Study, N = 101 mothers, fathers, and children, 14 to 80 months; Parent-Child Study, mothers and children, N = 108, 15 to 45 months) and a study of low-income, diverse mothers and toddlers (Play Study, N = 186, 30 months). Children's security was assessed in Strange Situation in infancy and rated by observers and mothers using Attachment Q-Set at toddler age. Children's empathy was observed in scripted probes that involved parental simulated distress. Children's prosociality was rated by parents (Family Study, Play Study). Security with mothers related to higher empathy. For mother- and father-child dyads, security moderated the path from empathy to prosociality. For insecure children, but not secure ones, variations in empathy related to prosociality. Insecure and unempathic children were particularly low in prosociality. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Treatment and prevention of cancer treatment related oral mucositis].

Science.gov (United States)

Ruiz-Esquide, Gonzalo; Nervi, Bruno; Vargas, Alex; Maíz, Alberto

2011-03-01

One of the most common and troublesome complications of modern intensive anticancer treatments is oral mucositis. The purpose of this review is to summarize current evidence and clinical guidelines regarding its prevention and therapy. The use of keratinocyte growth factor-1, supplementary glutamine and other recently developed treatment modalities are discussed. The injury of the oral mucosa caused by antineoplastic agents promotes the local expression of multiple pro-inflammatory and pro-apoptotic molecules and eventually leads to the development of ulcers. Such lesions predispose patients to several infectious and nutritional complications. Also, they lead to modification of treatment schedules, potentially affecting overall prognosis. Local cryotherapy with ice chips and phototherapy with low energy laser may be useful as preventive measures. Mouthwashes with allopurinol and phototherapy with low energy laser can be used as treatment. In radiotherapy, special radiation administration techniques should be used to minimize mucosal injury. Pain control should always be optimized, with the use of patient controlled analgesia and topical use of morphine. Supplemental glutamine should not be used outside of research protocols. Lastly, thorough attention should be paid to general care and hygiene measures.

Facilitating and inhibiting factors related to treatment adherence in women with polycystic ovary syndrome: A qualitative study

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Fatemeh Bazarganipour

2017-09-01

Full Text Available Background: Adherence issues in polycystic ovary syndrome (PCOS patients have not been examined thoroughly. Patients report prolonged periods of treatment and side effects of the drug as the most common reason for withdrawal from treatment. To improve the effective management of PCOS patients, it is fundamental to understand facilitating and inhibiting factors to treatment adherence. Objective: To explore facilitating/inhibiting factors related to treatment adherence among PCOS patients. Materials and Methods: This was a qualitative study with a purposive sample of women with confirmed diagnosis of PCOS. The data were collected via 20 in-depth semi-structured interviews with women aged between 21-34 yr. A qualitative content analysis was used to analyze the data. Results: Five themes were identified which described different types of facilitating/ inhibiting factors to treatment adherence. Inhibiting factors included financial issues, patient-related, disease-related, and health care provider-related factors; while social factors were found to be both facilitating and inhibiting. Conclusion: The findings suggest that successful adherence to PCOS treatment is highly dependent on patients recognizing and adapting to financial, social, and health care related inhibiting factors. It is also crucial for clinicians and policy makers to recognize these key inhibiting factors in order to improve treatment outcomes.

Impulse control disorders in Parkinson's disease: clinical characteristics and implications.

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Leeman, Robert F; Potenza, Marc N

2011-04-01

Impulse control disorders (ICDs), specifically those related to excessive gambling, eating, sex and shopping, have been observed in a subset of people with Parkinson's disease (PD). Although some initial case reports claimed that dopamine replacement therapies, particularly dopamine agonists, cause ICDs, more recent, larger and better controlled studies indicate a more complicated picture. While dopamine replacement therapy use is related to ICDs, other vulnerabilities, some related to PD and/or its treatment directly and others seemingly unrelated to PD, have also been associated with ICDs in PD. This suggests a complex etiology with multiple contributing factors. As ICDs occur in a sizable minority of PD patients and can be associated with significant distress and impairment, further investigation is needed to identify factors that can predict who may be more likely to develop ICDs. Clinical implications are discussed and topics for future research are offered.

Practice implications and recommendations for managing codeine misuse and dependence

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Bergin Michael

2015-12-01

Full Text Available Codeine, a weak opiate, requires increased pharmacovigilance relating to availability, heterogeneous nature of misuse, dependence and associated harm. A scoping review of literature on codeine was conducted using Arksey & O’Malley’s framework (1. Databases searched included PubMed, EBSCO Host, Science Direct, EMBASE, PsycINFO, Cochrane library and Medline from 1994 to 2014. Follow-up search strategies involved hand searching and searching of pharmaceutical, health, medical and drug related websites. Initial zscreening identified 3,105 articles with 475 meeting the inclusion criteria. Eight broad categories organised the literature, data charting and qualitative synthesis. This paper presents implications for practice and makes recommendations to address these issues. Themes identified relate to raising public and practitioner awareness, risk management, dispensing practices and monitoring and surveillance of codeine. Evidence to inform law enforcement, drug surveillance, public health initiatives, harm reduction approaches, pharmacy, clinical and treatment practices is warranted.

Increased Mindfulness Skills as Predictors of Reduced Trauma-Related Guilt in Treatment-Seeking Veterans.

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Held, Philip; Owens, Gina P; Monroe, J Richard; Chard, Kathleen M

2017-08-01

The present study examined the predictive role of increased self-reported mindfulness skills on reduced trauma-related guilt in a sample of veterans over the course of residential treatment for posttraumatic stress disorder (PTSD; N = 128). The residential treatment consisted of seven weeks of intensive cognitive processing therapy (CPT) for PTSD, as well as additional psychoeducational groups, including seven sessions on mindfulness skills. Increased mindfulness skills describing, acting with awareness, and accepting without judgment were significantly associated with reductions in trauma-related guilt over the course of treatment. Increases in the ability to act with awareness and accept without judgment were significantly associated with reductions in global guilt, R 2 = .26, guilt distress, R 2 = .23, guilt cognitions, R 2 = .23, and lack of justification, R 2 = .11. An increase in the ability to accept without judgment was the only self-reported mindfulness skill that was associated with reductions in hindsight bias, β = -.34 and wrongdoing, β = -.44. Increases in self-reported mindfulness skills explained 15.1 to 24.1% of the variance in reductions in trauma-related guilt, suggesting that mindfulness skills may play a key role in reducing the experience of trauma-related guilt during psychotherapy. Our results provide preliminary support for the use of mindfulness groups as an adjunct to traditional evidence-based treatments aimed at reducing trauma-related guilt, though this claim needs to be tested further using experimental designs. Copyright © 2017 International Society for Traumatic Stress Studies.

Implication of Emotional Labor, Cognitive Flexibility, and Relational Energy among Cabin Crew: A Review.

Science.gov (United States)

Baruah, Rithi; Reddy, K Jayasankara

2018-01-01

The primary aim of the civil aviation industry is to provide a secured and comfortable service to their customers and clients. This review concentrates on the cabin crew members, who are the frontline employees of the aviation industry and are salaried to smile. The objective of this review article is to analyze the variables of emotional labor, cognitive flexibility, and relational energy using the biopsychosocial model and identify organizational implications among cabin crew. Online databases such as EBSCOhost, JSTOR, Springerlink, and PubMed were used to gather articles for the review. The authors analyzed 17 articles from 2001 to 2016 and presented a comprehensive review. The review presented an integrative approach and suggested a hypothetical model that can prove to be a signitficant contribution to the avaition industry in particular and to research findings of aviation psychology.

Factors affecting ionizing radiation phytosanitary treatments, and implications for research and generic treatments

Science.gov (United States)

Phytosanitary irradiation (PI) treatments are promising measures to overcome quarantine barriers to trade and are currently used in several countries. Although PI has advantages compared with other treatments, one disadvantage bedevils research approval/application: organisms may remain alive afte...

Clinical implications of contemporary gender theory.

Science.gov (United States)

Kulish, Nancy

2010-04-01

The current intellectual scene in psychoanalysis is marked by vigorous theoretical controversies about gender. The ideas being debated have important implications for clinical work, which have not been thoroughly explicated or integrated into common practice. These implications include the following: gender can accrue idiosyncratic meanings; gender identity is considered fluid and rigidity of gender identity deemed problematic; gender-related conflicts are typically described as divergent; analysis of superego conflicts related to gender becomes particularly important; and, finally, gender-related biases are seen as inevitable and must be taken into account in the clinical situation. A detailed clinical example illustrates the application of these ideas. While the more dramatic cases related to gender have been more frequent subjects of study, conflicts about gender are everyday occurrences for our patients and deserve further attention.

Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review

Directory of Open Access Journals (Sweden)

Ethy Dorrepaal

2014-10-01

Full Text Available Introduction: Effective first-line treatments for posttraumatic stress disorder (PTSD are well established, but their generalizability to child abuse (CA-related Complex PTSD is largely unknown. Method: A quantitative review of the literature was performed, identifying seven studies, with treatments specifically targeting CA-related PTSD or Complex PTSD, which were meta-analyzed, including variables such as effect size, drop-out, recovery, and improvement rates. Results: Only six studies with one or more cognitive behavior therapy (CBT treatment conditions and one with a present centered therapy condition could be meta-analyzed. Results indicate that CA-related PTSD patients profit with large effect sizes and modest recovery and improvement rates. Treatments which include exposure showed greater effect sizes especially in completers’ analyses, although no differential results were found in recovery and improvement rates. However, results in the subgroup of CA-related Complex PTSD studies were least favorable. Within the Complex PTSD subgroup, no superior effect size was found for exposure, and affect management resulted in more favorable recovery and improvement rates and less drop-out, as compared to exposure, especially in intention-to-treat analyses. Conclusion: Limited evidence suggests that predominantly CBT treatments are effective, but do not suffice to achieve satisfactory end states, especially in Complex PTSD populations. Moreover, we propose that future research should focus on direct comparisons between types of treatment for Complex PTSD patients, thereby increasing generalizability of results.

Ablative dual-phase Erbium:YAG laser treatment of atrophy-related vaginal symptoms in post-menopausal breast cancer survivors omitting hormonal treatment.

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Mothes, A R; Runnebaum, M; Runnebaum, I B

2018-05-01

First evaluation of dual-phase vaginal Er:YAG laser to omit hormonal treatment for atrophy-related symptoms in post-menopausal breast cancer survivors following prolapse surgery. Patients with a history of breast cancer at the time of surgery for pelvic organ prolapse were offered non-hormonal vaginal Er:YAG laser treatment when complaining of atrophy-related genitourinary syndrome of menopause. A single 10-min course of dual-phase protocol of pulsed Er:YAG laser (2940 nm, fractional ablative and thermal mode, fluence according to tissue thickness). Follow-up included subjective satisfaction, vaginal pH, vaginal health index (VHI), and complications after 6 weeks. A total of 16 breast cancer survivors (age 71 years, SD 7) had been seeking treatment for pelvic floor symptoms related to vaginal atrophy at follow-up visits after prolapse surgery. All ablative vaginal Er:YAG laser outpatient procedures were successfully completed, all patients returned to daily activities without a need for analgetic medication. Evaluation was performed after 8.3 (SD 2.5) weeks. Pre-laser VHI scored 16 (SD 4.6) and post-laser VHI 20 (SD 3) with p = 0.01. Patients were satisfied in 94% (n = 15) regarding symptom relief. Breast cancer survivors with atrophy-related complaints after pelvic floor surgery may benefit from vaginal application of this innovative dual protocol of Er:YAG laser technology as a non-hormonal treatment approach.

Is cannabis treatment for anxiety, mood, and related disorders ready for prime time?

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Turna, Jasmine; Patterson, Beth; Van Ameringen, Michael

2017-11-01

Anxiety and related disorders are the most common mental conditions affecting the North American population. Despite their established efficacy, first-line antidepressant treatments are associated with significant side effects, leading many afflicted individuals to seek alternative treatments. Cannabis is commonly viewed as a natural alternative for a variety of medical and mental health conditions. Currently, anxiety ranks among the top five medical symptoms for which North Americans report using medical marijuana. However, upon careful review of the extant treatment literature, the anxiolytic effects of cannabis in clinical populations are surprisingly not well-documented. The effects of cannabis on anxiety and mood symptoms have been examined in healthy populations and in several small studies of synthetic cannabinoid agents but there are currently no studies which have examined the effects of the cannabis plant on anxiety and related disorders. In light of the rapidly shifting landscape regarding the legalization of cannabis for medical and recreational purposes, it is important to highlight the significant disconnect between the scientific literature, public opinion, and related policies. The aim of this article is to provide a comprehensive review of the current cannabis treatment literature, and to identify the potential for cannabis to be used as a therapeutic intervention for anxiety, mood, and related disorders. Searches of five electronic databases were conducted (PubMed, MEDLINE, Web of Science, PsychINFO, and Google Scholar), with the most recent in February 2017. The effects of cannabis on healthy populations and clinical psychiatric samples will be discussed, focusing primarily on anxiety and mood disorders. © 2017 Wiley Periodicals, Inc.

Stigma, social anxiety, and illness severity in bipolar disorder: Implications for treatment.

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Levy, Boaz; Tsoy, Elena; Brodt, Madeline; Petrosyan, Karen; Malloy, Mary

2015-02-01

Studies indicate that comorbid anxiety disorders predict a more severe course of illness in bipolar disorder (BD). The relatively high prevalence of social anxiety in BD points to the potential role that socio-cultural factors, such as stigma, play in exacerbating the progression of this disorder. Stigma creates social anxiety in affected individuals because it essentially forces them into a vulnerable social status that is marked by public disgrace. Although the etiology of debilitating social anxiety in BD may involve multiple factors, stigma deserves particular clinical attention because research in this area indicates that it is common and its internalization is associated with poor outcome. We conducted a literature review using search terms related to stigma, social anxiety, bipolar disorder, illness severity, and outcomes. The electronic databases searched included PsychINFO, PubMed, JSTOR, and EBSCOhost Academic Search Complete with limits set to include articles published in English. The literature indicates that internalized stigma often triggers the core psychological experiences of social anxiety and is highly correlated with clinical and functional outcome in BD. On a psychological level, internalized stigma and social anxiety can create distress that triggers symptoms of BD. From a biological perspective, stigma constitutes a chronic psychosocial stressor that may interact with the pathophysiology of BD in inflammatory ways. The connection between stigma and social anxiety, and their combined effects on people with BD, carries important implications for psychiatric care. To obtain an accurate clinical formulation, initial evaluations may seek to examine stigma-related experiences and determine their relationship to anxiety symptoms and psychosocial functioning. In addition, direct interventions for reducing the ill effects of stigma in BD deserve clinical attention, because they may carry the potential to enhance outcomes.

Inhibiting Interference - a grounded theory of health professionals' pattern of behaviour related to the relatives of older patients in fast-track treatment programmes

DEFF Research Database (Denmark)

Berthelsen, Connie Bøttcher; Lindhardt, Tove; Frederiksen, Kirsten

2014-01-01

AIM: To generate a grounded theory explaining health professionals' pattern of behaviour and experience related to the relatives of older patients in fast-track treatment programmes during total joint replacement. BACKGROUND: Health professionals uphold standardised care for patients, and effect...... on quality is seen when relatives support patients during total joint replacement. Since health professionals often have problematic relationships with relatives, knowledge is needed of the health professionals' pattern of behaviour in relation to relatives of older patients in fast-track treatment programme....... DESIGN: Grounded theory according to Glaser's methodology was used to generate substantive theory of health professionals' pattern of behaviour. METHODS: Data were collected from 2010 to 2011 by 44 health professionals in orthopaedic wards at two Danish hospitals. Data from nonparticipant observations...

Understanding motivation for substance use treatment: the role of social pressure during the transition to adulthood.

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Goodman, Ilana; Peterson-Badali, Michele; Henderson, Joanna

2011-06-01

Research has shown that social pressure is related to treatment motivation and plays an important role in treatment engagement in adults with problematic substance use. Despite the shifts in autonomy and decision-making in emerging adulthood, the factors affecting treatment motivation (e.g., readiness to comply with treatment) during this period have been largely ignored. In this cross sectional study, 134 youth (83 males and 51 females) presenting to an outpatient substance abuse program completed questionnaires regarding substance use history, mental health, social pressure to reduce use and enter treatment, and treatment motivation. Age was positively related to identification of internal reasons for seeking treatment and negatively related to external coercive social pressures as a motivator for treatment. Peer pressure accounted for significant variance in Identified (e.g., personal choice and commitment to the program) and Introjected (e.g., guilt about continued substance use) treatment motivation. Family pressure was related only to External treatment motivation when peer pressure was considered in the regression model. These results highlight the importance of emerging adult peers as motivators of youths' treatment seeking. Limitations, directions for future research and treatment implications are discussed. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Treatment of malaria and related symptoms using traditional herbal medicine in Ethiopia.

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Suleman, Sultan; Beyene Tufa, Takele; Kebebe, Dereje; Belew, Sileshi; Mekonnen, Yimer; Gashe, Fanta; Mussa, Seid; Wynendaele, Evelien; Duchateau, Luc; De Spiegeleer, Bart

2018-03-01

Medicinal plants have always been an integral part of different cultures in Ethiopia in the treatment of different illnesses including malaria and related symptoms. However, due to lack of proper documentation, urbanization, drought, acculturation and deforestation, there is an increased risk of losing this traditional knowledge. Hence, the use of the indigenous knowledge should be well documented and validated for potential future use. To gather and document information on medicinal plants which are used in the traditional treatment of malaria and related symptoms in Ethiopia. First, an ethnomedicinal survey of plants was conducted in 17 districts of Jimma zone, the Oromia national regional state of Ethiopia. Jimma zone is malarious and rich in natural flora. A total of 115 traditional healers were interviewed using a semi-structured questionnaire containing personal data of the respondents, and information on medicinal plants used to treat malaria and related symptoms. In addition, a literature search using Medline/PubMed, Google Scholar, ScienceDirect and HINARI was conducted on the indigenous use, in-vitro/in-vivo anti-malarial activity reports, and the chemical characterization of medicinal plants of Ethiopia used against malaria. From ethnomedicinal survey, a total of 28 species of plants used in the traditional treatment of malaria and related symptoms in Jimma Zone were collected, identified and documented. In addition, the literature search revealed that 124 medicinal plant species were reported to be traditionally used in the treatment of malaria in Ethiopia. From both ethnomedicinal survey and the literature search, Asteraceae and Fabaceae were the most represented families and Allium sativum L., Carica papaya L., Vernonia amygdalina Del., Lepidium sativum L. and Croton macrostachyus Del. were the most frequently reported plant species for their anti-malarial use. The dominant plant parts used in the preparation of remedies were leaves. About 54% of the

Endodontic treatment-related antibiotic prescribing patterns of South African oral health professionals.

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Lalloo, R; Solanki, G; Ramphoma, K; Myburgh, N G

2017-11-01

To assess the antibiotic prescribing patterns of South African dentists for patients undergoing endodontic treatment. This study used data from 2013 health insurance claims submitted by South African oral health professionals to determine the antibiotic prescribing patterns related to endodontic treatment. A logistic regression model was used to test the fully adjusted statistical significance of the association between the exploratory variables (gender, age group, event type, abscess treatment, chronic health) and the dependent variable (antibiotic prescription). Odds ratios with 95% confidence intervals (CI) are reported, and a 95% CI excluding 1 was considered statistically significant. Almost 10% of endodontic treatments were prescribed an antibiotic. There were no significant differences in prescribing patterns by gender, age and chronic health status. Prescriptions were more common at the preparatory stage (9.4%) of root canal treatment compared to the therapy (4.7%) and canal filling (2%) stages. Patients who received apical surgery (OR = 2.28; 95% CI 1.38-3.76) and treatment of an abscess (OR = 2.57; 95% 1.82-3.63) had a significantly increased odds of being prescribed an antibiotic. Almost three-quarters of prescriptions were for narrow spectrum antibiotics. The frequency of antibiotic prescribing by South African dental practitioners for patients undergoing endodontic treatment is relatively low and predominantly involved narrow spectrum antibiotics. It, however, remains important that antibiotics are only prescribed when clinically essential, such as when there are obvious systemic effects. These include fever above 37 degrees, malaise, lymphadenopathy, trismus, increase swelling, cellulitis, osteomyelitis and persistent infection. The wider dissemination and adherence to clear evidence-based prescribing guidelines for antibiotics in this clinical area are important. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

Science.gov (United States)

Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

2016-01-01

Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

Pharmacogenetic Predictors of Treatment-Related Toxicity Among Children With Acute Lymphoblastic Leukemia.

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Maxwell, Rochelle R; Cole, Peter D

2017-06-01

The aim of this review is to summarize the most recent and most robust pharmacogenetic predictors of treatment-related toxicity (TRT) in childhood acute lymphoblastic leukemia (ALL). Multiple studies have examined the toxicities of the primary chemotherapeutic agents used to treat childhood ALL in relation to host genetic factors. However, few results have been replicated independently, largely due to cohort differences in ancestry, chemotherapy treatment protocols, and definitions of toxicities. To date, there is only one widely accepted clinical guideline for dose modification based on gene status: thiopurine dosing based on TPMT genotype. Based on recent data, it is likely that this guideline will be modified to incorporate other gene variants, such as NUDT15. We highlight genetic variants that have been consistently associated with TRT across treatment groups, as well as those that best illustrate the underlying pathophysiology of TRT. In the coming decade, we expect that survivorship care will routinely specify screening recommendations based on genetics. Furthermore, clinical trials testing protective interventions may modify inclusion criteria based on genetically determined risk of specific TRTs.

Haematemesis related to orthodontic treatment with Nance palatal arch: a case report.

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Patini, Romeo; Alessandri Bonetti, Anna; Camodeca, Andrea; Staderini, Edoardo; Gallenzi, Patrizia

2018-03-07

Haematemesis is a worrying sign, generally related to acute upper gastrointestinal bleeding and potentially life-threatening condition. We present a case of a 15-year-old Caucasian girl who was belatedly diagnosed with oral bleeding because it was not related to the most common aetiologic factors. In fact, she was undergoing orthodontic treatment with a Nance palatal arch, an appliance used to reinforce anchorage during teeth movements. In her case haematemesis was a sign of inflammation and necrosis occurring in the palatal mucosa, under the acrylic button of palatal arch. The appliance was removed; antibiotic and Chlorhexidine 0.12% were recommended. After a 6-week follow-up, no pathological signs were present and the orthodontic treatment was resumed. Both physicians and dentists should be aware of the possible side effect of the Nance palatal arch use; this could help in achieving a diagnosis and providing a correct treatment. Orthodontists should avoid excessive compression over the palatal mucosa and check the appliance condition during every follow-up in order to avoid necrosis of the palatal mucosa.

Self-care practices and experiences of people living with HIV not receiving antiretroviral therapy in an urban community of Lusaka, Zambia: implications for HIV treatment programmes

Science.gov (United States)

2013-01-01

Background Despite the increasingly wider availability of antiretroviral therapy (ART), some people living with HIV (PLHIV) and eligible for treatment have opted to adopt self-care practices thereby risking early AIDS-related mortality. Methods A qualitative study was conducted in urban Zambia to gain insights into PLHIV self-care practices and experiences and explore the implications for successful delivery of ART care. Between March 2010 and September 2011, in-depth interviews were conducted with PLHIV who had dropped out of treatment (n=25) and those that had opted not to initiate medication (n=37). Data was entered into and managed using Atlas ti, and analysed inductively using latent content analysis. Results PHIV used therapeutic and physical health maintenance, psychological well-being and healthy lifestyle self-care practices to maintain physical health and mitigate HIV-related symptoms. Herbal remedies, faith healing and self-prescription of antibiotics and other conventional medicines to treat HIV-related ailments were used for therapeutic and physical health maintenance purposes. Psychological well-being self-care practices used were religiosity/spirituality and positive attitudes towards HIV infection. These practices were modulated by close social network relationships with other PLHIV, family members and peers, who acted as sources of emotional, material and financial support. Cessations of sexual relationships, adoption of safe sex to avoid re-infections and uptake of nutritional supplements were the commonly used risk reduction and healthy lifestyle practices respectively. Conclusions While these self-care practices may promote physical and psychosocial well-being and mitigate AIDS-related symptoms, at least in the short term, they however undermine PLHIV access to ART care thereby putting PLHIV at risk of early AIDS-related mortality. The use of scientifically unproven herbal remedies raises health and safety concerns; faith healing may create

Treatment of Diabetic Autonomic Neuropathy in Older Adults with Diabetes Mellitus.

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Scheinberg, Nataliya; Salbu, Rebecca L; Goswami, Gayotri; Cohen, Kenneth

2016-11-01

To review the epidemiology, pathophysiology, screening and diagnosis, and optimal treatment of diabetic autonomic neuropathy (DAN) and its implications in older adults. A search of PubMed using the Mesh terms "diabetes," "type 1," "insulin-dependent," "T1DM," and "diabetic autonomic neuropathy" was performed to find relevant primary literature. Additional search terms "epidemiology," "geriatric," and "risk" were employed. All English-language articles from 2005 to 2015 appearing in these searches were reviewed for relevance. Related articles suggested in the PubMed search and clinical guidelines from the American Diabetes Association and the American Association of Clinical Endocrinologists were reviewed. These uncovered further resources for risk stratification, pathophysiology, diagnosis, and treatment of DAN. DAN is highly prevalent in the diabetes population and increases the risk of morbidity and mortality in older adults, yet, often goes undiagnosed and untreated. Treatment of DAN is complex in the older adult because of poor tolerability of many pharmacologic treatment options; therefore, great care must be taken when selecting therapy as to avoid unwanted adverse effects. With increasing life-expectancy of patients with diabetes mellitus, awareness of DAN and its implications to older adults is needed in primary care. Consistent screening and appropriate treatment of DAN in older adults with diabetes mellitus is essential in helping to maintain functional status and avoid adverse events.

Health-related quality of life assessments in osteoarthritis during NSAID treatment.

Science.gov (United States)

de Bock, G H; Hermans, J; van Marwijk, H W; Kaptein, A A; Mulder, J D

1996-08-01

There is some evidence that nabumetone (1000 mg once daily) in comparison with piroxicam (20 mg once daily) in patients with OA in general practice is associated with a lower incidence and less severe occurrence of stomach pain but with more withdrawals due to lack of efficacy. The aim of this analysis was to investigate whether these differences are reflected in health-related quality of life assessments. Patients (n = 198) included in this study were selected in general practice according to a protocol. The patients were randomized and treated for a period of six weeks. Clinical assessments were performed by the general practitioner (CP) during treatment. The Sickness Impact Profile (SIP), the Activities of Daily Living (ADL), and a pain questionnaire were filled out by the patients before and after treatment. As measured with the SIP, the ADL and the pain questionnaire, there were no significant differences between nabumetone and piroxicam. The correlations between (changes in) patient assessments and (changes in) clinical assessments were low. The differences between the two drugs regarding withdrawals and adverse events were not reflected by patient health-related quality of life assessments. There was a low correlation between patient health-related quality of life assessment and clinical assessments. To get a complete picture of the efficacy and safety of a drug, patient health-related quality of life assessments should be a part of a clinical trial.

Fuzzy implicative hyper BCK-ideals of hyper BCK-algebras

OpenAIRE

Jun, Young Bae; Shim, Wook Hwan

2002-01-01

We consider the fuzzification of the notion of implicative hyper BCK-ideals, and then investigate several properties. Using the concept of level subsets, we give a characterization of a fuzzy implicative hyper BCK-ideal. We state a relation between a fuzzy hyper BCK-ideal and a fuzzy implicative hyper BCK-ideal. We establish a condition for a fuzzy hyper BCK-ideal to be a fuzzy implicative hyper BCK-ideal. Finally, we introduce the notion of hyper homomorphisms of hyper ...

Transfer pricing. Fiscal and accounting treatments

Directory of Open Access Journals (Sweden)

Carmen Elena ANTON

2015-12-01

Full Text Available This paper presents brief assertions on the issue of the transfer pricing and their fiscal and accounting treatment. The concept refers to the transactions between affiliated parties, namely aims at those transactions that are not exclusively governed by the rules of the free market, also considering other influence factors such as: the policy of the group of entities related to the minimization of the fiscal cost at the group level. The aimed goals are both fiscal and accounting and they see to the thoroughgoing study of the issues of the implications of practicing transfer pricing between the affiliated entities.

The Gender and Equity Implications of Land-Related Investments on Labour and Income-Generating Opportunities. A Case Study of Agricultural Investments in Lao PDR

NARCIS (Netherlands)

E. Daley (Elizabeth); M Osorio (Martha); C.M.Y. Park (Clara)

2013-01-01

markdownabstract__Abstract__ Concerns about the potential gender and equity implications of land-related investments on labour and income-generating opportunities and access, use and control of land come in the context of the current global policy interest in supporting agricultural investment

Assessment of suspended solids concentration in highway runoff and its treatment implication.

Science.gov (United States)

Hallberg, M; Renman, G

2006-09-01

It is understood that the major pollution from storm water is related to the content of particulate matter. One treatment practice is based on the first flush, i.e. detention of the initial part of the runoff that is considered to contain the highest concentrations of pollutants. This study has evaluated the concentration of total suspended solids in 30 consecutive runoff events during the winter season for an area of 6.7 hectares. A six-lane highway (E4) that has an annual average daily traffic load of 120,000 dominates the area and road de-icing salt (NaCl) and studded tires were in regular use during the studied period. The effluent standard for wastewater of 60 mg TSS per litre applied in EU was used to assess the treatment requirement of storm water. In only two of the events the event mean concentration was below 60 mg 1(-1). In four runoff events a partial event mean concentration below 60 mg 1(-1) was found, in 26 %, 12 %, 11 %, and 2 % respectively of the runoff volume. This would suggest that a capture of the initial part of the runoff for subsequent treatment is less applicable in this type of urban watershed.

Recent advances in understanding and treating COPD related to α1-antitrypsin deficiency.

Science.gov (United States)

Henao, Maria Paula; Craig, Timothy J

2016-12-01

Alpha-1-antitrypsin deficiency (AATD) is an orphan disease that predisposes individuals to COPD and liver disease. The following is a comprehensive review of AATD from epidemiology to treatment for physicians who treat COPD or asthma. Areas covered: In this comprehensive review of alpha-1-antitrypsin deficiency, we describe the historical perspective, genetics, epidemiology, clinical presentation and symptoms, screening and diagnosis, and treatments of the condition. Expert commentary: The two most important directions for advancing the understanding of AATD involve improving detection of the condition, especially in asymptomatic patients, and advancing knowledge of treatments directed specifically at AATD-related conditions. With regard to treatment for AATD-related conditions, research must continue to explore the implications and importance of augmentation therapy as well as consider new implementations that may prove more successful taking into consideration not only factors of pulmonary function and liver health, but also product availability and financial viability.

Improving alcohol and mental health treatment for lesbian, bisexual and queer women: Identity matters.

Science.gov (United States)

Pennay, Amy; McNair, Ruth; Hughes, Tonda L; Leonard, William; Brown, Rhonda; Lubman, Dan I

2018-02-01

Lesbian, bisexual and queer (LBQ) women experience substantial unmet alcohol and mental health treatment needs. This paper explores the way in which sexual identity shapes experience, and needs, in relation to alcohol and mental health treatment, and presents key messages for improving treatment. Twenty-five in-depth interviews were undertaken with same-sex attracted Australian women, aged 19-71. Interview transcripts were analysed thematically. Key messages offered by participants focused on language, disclosure and practitioner training. Variation in sexual identity did not alter treatment expectations or needs; however, we noted an important difference with respect to identity salience, with high LBQ identity salience linked with preference for disclosure and acknowledgement of sexual identity in treatment interactions, and low identity salience linked with a preference not to disclose and for sexual identity not to require acknowledgement in treatment. Treatment providers may find it useful to gather information about the centrality of sexual identity to LBQ women as a means of overcoming treatment barriers related to heteronormative conventions and discrimination, language and disclosure. Implications for public health: Treatment providers should adopt more inclusive language, seek information about identity salience and the importance of sexual identity to the current treatment, and regularly pursue LBQ-related professional development upskilling. © 2017 The Authors.

Health-related quality of life in patients with chronic hepatitis B during antiviral treatment and off-treatment

Directory of Open Access Journals (Sweden)

Xue X

2017-01-01

Full Text Available Xiulan Xue,1,* Shaohang Cai,1–3,* Hongjie Ou,1 Caixia Zheng,1 Xiaolu Wu1 1Department of Infectious Diseases, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, 2Department of Pathology, Sun Yat-sen University Cancer Center, 3State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, People’s Republic of China *These authors contributed equally to this work Introduction: Health-related quality of life (HRQoL has emerged as an important consideration in the care of patients with chronic hepatitis B (CHB. However, whether benefits from the improved HRQoL that occurs after antiviral treatment or drug discontinuation outweigh the risks of viral relapse is an unanswered question. The aim of this study was to evaluate the HRQoL among patients with CHB during antiviral treatment and withdrawal of treatment. Patients and methods: There were 102 patients who met the enrollment criteria with 54 patients in the treatment group and 48 patients in the discontinuation group. Sociodemographic information was collected. The 36-Item Short-Form Health Survey (SF-36, European Quality of Life-5 Dimensions, and Beck Depression Inventory (BDI were adopted to evaluate life quality and mental health. Results: In the treatment group, SF-36 showed that the physical functions were significantly increased. In the discontination group, the psychological functions showed improvement. A multivariate regression analysis indicated that baseline SF-36 score was a predictor for improvement in HRQoL (odds ratio =1.17, P=0.003 and baseline BDI score was a factor for remission of depression (odds ratio =0.75, P=0.005 after medical intervention. When the cutoff value of SF-36 score was set at 79.5, the sensitivity and specificity to predict improvement in HRQoL were 82.8% and 74.0%, respectively. When the cutoff value of BDI was found as 8.5, the sensitivity and specificity to predict

God, design, and naturalism: Implications of methodological naturalism in science for science-religion relation

Directory of Open Access Journals (Sweden)

Piotr Bylica

2015-03-01

Full Text Available The aim of this paper is to analyze the implications flowing from adopting methodological naturalism in science, with special emphasis on the relation between science and religion. Methodological naturalism, denying supernatural and teleological explanations, influences the content of scientific theories, and in practice leads to vision of science as compatible with ontological naturalism and in opposition to theism. Ontological naturalism in turn justifies the acceptance of methodological naturalism as the best method to know the reality. If we accept realistic interpretation of scientific theories, then methodological naturalism conflicts science with religion. Theistic evolution does not seem to be a proper way to reconcile Darwinism and methodological naturalism with theism. Many of such propositions are boiled down to deism. Although evolution can be interpreted theistically, it is not the way in which majority of modern scientists and respectable scientific institutions understand it.

Assessment of health implications related to processing and use of natural wool insulation products.

Science.gov (United States)

Mansour, E; Loxton, C; Elias, R M; Ormondroyd, G A

2014-12-01

This paper discusses possible health implications related to dust particles released during the manufacture of sheep's wool-based non-woven insulation material. Such insulation may replace traditional synthetic insulation products used in roofs, wall cavities, etc. A review of the literature concerning organic dusts in general and sheep's wool fiber summarizes dust exposure patterns, toxicological pathways and the hazards imposed by inhalation and explosion risk. This paper highlights a need for more research in order to refrain from overgeneralizing potential pulmonary and carcinogenic risks across the industries. Variables existing between industries such as the use of different wool types, processes, and additives are shown to have varying health effects. Within the final section of the paper, the health issues raised are compared with those that have been extensively documented for the rock and glass wool industries. Copyright © 2014 Elsevier Ltd. All rights reserved.

An evaluation of substance misuse treatment providers used by an employee assistance program.

Science.gov (United States)

Miller, N A

1992-05-01

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

Perceived Self-Control is Related to Mental Distress in Patients Entering Substance Use Disorder Treatment.

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Abel, Kristine Fiksdal; Skjærvø, Ingeborg; Ravndal, Edle; Clausen, Thomas; Bramness, Jørgen G

2018-01-05

Levels of mental distress are high in patients with substance use disorders (SUD) and investigation of correlates may broaden our understanding of this comorbidity. We investigated self-reported symptoms of mental distress among individuals entering either outpatient opioid maintenance treatment (OMT) or other inpatient SUD treatment and related factors, with a particular focus on perceived self-control. A cross-sectional study including substance users (n = 548; mean age 34 years; 27% women) entering treatment at 21 different treatment-centers across Norway, interviewed between December 2012 and April 2015. Symptoms of mental distress were assessed with Global Symptom Index (GSI) score. Adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) were estimated through multinomial logistic regression. More than half of the participants in both treatment groups reported mental distress (GSI) above clinical cut-off. The use of alcohol and exposure to violence were associated with increased likelihood of high GSI for both patient groups. Also, lower perceived self-control was related to high GSI in both treatment groups. Symptoms of mental distress were equally common among patients entering OMT and those entering other inpatient SUD treatment, even if the patients differed on a number of clinical characteristics. Use of alcohol and exposure to violence were associated with more mental distress in both groups. Perceived self-control also appeared to be important when explaining symptoms of mental distress among these SUD patients.

Immunoglobulin G4-Related Retroperitoneal Fibrosis Treated with Hochuekkito, a Kampo Medicine, following Steroid Treatment

Directory of Open Access Journals (Sweden)

Minoru Fukuchi

2014-05-01

Full Text Available We report a case of immunoglobulin G4 (IgG4-related retroperitoneal fibrosis (RF with complete remission and no relapses after therapy with steroids and Hochuekkito, a Kampo (i.e. traditional Japanese herbal medicine. A 62-year-old Japanese man was admitted to our hospital for treatment of a retroperitoneal mass detected by computed tomography. The mass had a maximum diameter of 11.0 cm; it involved the left ureter and was associated with left hydronephrosis. After inserting a ureteral stent, we performed a biopsy by laparotomy. Histopathology revealed IgG4-related RF. The lesion disappeared after 7 months of steroid therapy. We subsequently used Hochuekkito as an alternative maintenance treatment because of steroid-related complications. The patient has not relapsed in the 3 years since starting the medication. To the best of our knowledge, this is the first case of IgG4-related RF treated with Hochuekkito as a maintenance treatment.

Clinical features of pedophilia and implications for treatment.

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Cohen, Lisa J; Galynker, Igor I

2002-09-01

The authors discuss the diagnostic criteria for pedophilia and review the literature on its clinical features, including data on prevalence, gender, age of onset, number of victims, frequency and type of acts, violence, impulsivity, and insight. Findings concerning the characteristics of victims (e.g., sex, age, relationship to the pedophile) and research on pedophilic subtypes-exclusive versus nonexclusive; incestuous versus nonincestuous; heterosexual, homosexual, or bisexual-are reviewed. Studies have shown that pedophiles may share many psychiatric features beyond deviant sexual desire, including high rates of comorbid axis I disorders (affective disorders, substance use disorders, impulse control disorders, other paraphilias) as well as severe axis II psychopathology (especially antisocial and Cluster C personality disorders). The authors present several possible etiological models for pedophilia and conclude that further research is needed concerning the etiological role of a childhood history of sexual abuse as well as the underlying neurobiology of deviant sexual arousal and decreased erotic differentiation. Finally, findings concerning pharmacological and cognitive-behavioral treatments for pedophilia are briefly reviewed. Recidivism, drop-out, and noncompliance are significant problems in the treatment of pedophilia. The authors review predictors of treatment outcome and conclude that pedophilia is extremely difficult to treat and that effective treatment needs to be intensive, long-term, and comprehensive, possibly with lifetime follow-up.

An integrative review of sleep interventions and related clinical implications for obesity treatment in children.

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Fenton, Kathryn; Marvicsin, Donna; Danford, Cynthia A

2014-01-01

Evidence has shown correlations between obesity and sleep in children. The purpose of this review was to identify sleep interventions that could be utilized in primary care settings to prevent obesity in children. Three themes emerged: bedtime routines and environment; parental presence and graduated extinction; and health education. Effective strategies to improve sleep in children include consistent bedtime routine and self-soothing. Health care professionals can provide innovative and prevention-based sleep education for parents early in a child's development. Education, related to sleep, and appropriate sleep strategies may help prevent obesity and its long-term consequences. Copyright © 2014 Elsevier Inc. All rights reserved.

Novel Treatment of Staphylococcus aureus Device-Related Infections Using Fibrinolytic Agents.

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Hogan, S; O'Gara, J P; O'Neill, E

2018-02-01

Staphylococcal infections involving biofilms represent a significant challenge in the treatment of patients with device-related infections. Staphylococcus aureus biofilms have been shown to be SaeRS regulated and dependent on the coagulase-catalyzed conversion of fibrinogen into fibrin on surfaces coated with human plasma. Here we investigated the treatment of staphylococcal biofilm device-related infections by digesting the fibrin biofilm matrix with and without existing antimicrobials. The fibrinolytic agents plasmin, streptokinase, and nattokinase, and TrypLE, a recombinant trypsin-like protease, were used to digest and treat S. aureus biofilms grown in vitro using in vivo -like static biofilm assays with and without antimicrobials. Cytotoxicity, the potential to induce a cytokine response in whole human blood, and the risk of induction of tolerance to fibrinolytic agents were investigated. A rat model of intravascular catheter infection was established to investigate the efficacy of selected fibrinolytic agents in vivo Under biomimetic conditions, the fibrinolytic agents effectively dispersed established S. aureus biofilms and, in combination with common antistaphylococcal antimicrobials, effectively killed bacterial cells being released from the biofilm. These fibrinolytic agents were not cytotoxic and did not affect the host immune response. The rat model of infection successfully demonstrated the activity of the selected fibrinolytic agents alone and in combination with antimicrobials on established biofilms in vivo TrypLE and nattokinase most successfully removed adherent cells from plasma-coated surfaces and significantly improved the efficacy of existing antimicrobials against S. aureus biofilms in vitro and in vivo These biofilm dispersal agents represent a viable future treatment option for S. aureus device-related infections. Copyright © 2018 American Society for Microbiology.

Gendered Help at the Workplace: Implications for Organizational Power Relations.

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Chernyak-Hai, Lily; Waismel-Manor, Ronit

2018-01-01

One of the most thoroughly studied aspects of prosocial workplace behavior is organizational citizenship behavior (OCB). Yet, the definition of OCB seems to overlook the fact that help-giving acts may be of different types with different consequences for both giver and recipient. The present research explores workplace help-giving behavior by investigating the importance of gender as a factor that facilitates or inhibits specific types of help that empower and disempower independent coping: autonomy- and dependency-oriented help, respectively. A pilot and two following studies were conducted. The pilot study empirically assessed which acts would be clearly perceived by participants as representing both types of help. Then, using the descriptions of these acts, Study 1 examined which type of help would be perceived as most likely to be given by a male or female employee to a male or female colleague in a sample of 226 participants (78% women). Study 2 explored which type of help participants perceived as one they would rather receive from a male or female helper in a sample of 170 participants (65% women). Our findings indicate that male and female respondents who rated men giving help were more likely to expect them to give autonomy-oriented help, especially to women. There were no significant differences in dependency-oriented help. Further, women preferred to receive more autonomy-oriented help than men did, regardless of the help-giver's gender; no significant results were found for men. Implications for OCB and workplace power relations are discussed.

The association of subjective orthodontic treatment need with oral health-related quality of life.

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Kragt, Lea; Jaddoe, Vincent; Wolvius, Eppo; Ongkosuwito, Edwin

2017-08-01

The existing body of evidence reports an inconsistent association between subjective and objective orthodontic treatment need. The concept of oral health-related quality of life (OHRQoL) might help to explain the differences in subjective and objective orthodontic treatment need. Our aim was to investigate the association of subjective orthodontic treatment with OHRQoL in children. This cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort study. OHRQoL and subjective orthodontic treatment need were assessed by parental questionnaires. Questionnaire items were individually compared among children with no, borderline and definite subjective orthodontic need. The association between subjective orthodontic treatment need and OHRQoL was investigated in multivariate regression analysis with weighted least squares. Differences by sex and levels of objective orthodontic treatment need were evaluated. In total, 3774 children were included in the analysis. Children with borderline subjective orthodontic treatment need and those with definite subjective orthodontic treatment need had significantly poorer OHRQoL based on the fully adjusted model (adjusted regression coefficient (aβ)=-0.49, 95% CI: -0.75, -0.30; (aβ)=-1.58, 95% CI: -1.81, -1.58, respectively). The association between subjective orthodontic treatment need and OHRQoL was stronger in girls than in boys and stronger in children with objective orthodontic treatment need than in those with none. Oral health-related quality of life is poorer in children with subjective orthodontic treatment need. This has not been investigated before in such a large-population-based study and clearly offers an explanation for the lack of concurrence between objective and subjective orthodontic treatment need. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Evaluating the outcomes of the STEPPS programme in a UK community-based population; implications for the multidisciplinary treatment of borderline personality disorder.

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Hill, N; Geoghegan, M; Shawe-Taylor, M

2016-08-01

WHAT IS KNOWN ON THE SUBJECT?: Individuals with a diagnosis of Borderline Personality Disorder (BPD) now constitute a substantial portion of the caseload for community teams. Specialized treatments for BPD often consume a large portion of available psychology resources and also involve lengthy waiting lists. The STEPPS programme is a treatment approach which is growing in evidence, particularly in the US. However, further evidence for the effectiveness of this programme within the UK healthcare system is needed. The results of this study support the preliminary evidence for the effectiveness of STEPPS in a UK community-based population. A reduction in symptom severity was in evidence. Novel measures were used to build on previous evaluations of the STEPPS programme. These measures show a significant reduction in patients' affinity for unhelpful schemas, as well as an increase in patients' self-reported quality of life; an important perspective for a recovery focused approach to treatment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The STEPPS programme has shown its merit as an effective and more accessible treatment option for the community-based treatment of BPD, though some methodological limitations are noted. Furthermore, the results of this study demonstrate that STEPPS can be delivered effectively by teams of facilitators from different professional backgrounds who do not necessarily have extensive training in psychotherapeutic interventions. The result is a well-rounded and diverse skill set possessed by the team of facilitators, adding to the richness of the patient's recovery journey and leading to a more favourable spread of teams' resources. Aims & Background Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for individuals with a diagnosis of Borderline Personality Disorder (BPD) which has a growing evidence base, particularly in the US. Evidence is sparse for its use with UK populations, and this study seeks

The Role of Parathyroid Hormone-Related Protein (PTHrP in Osteoblast Response to Microgravity: Mechanistic Implications for Osteoporosis Development.

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Anne Camirand

Full Text Available Prolonged skeletal unloading through bedrest results in bone loss similar to that observed in elderly osteoporotic patients, but with an accelerated timeframe. This rapid effect on weight-bearing bones is also observed in astronauts who can lose up to 2% of their bone mass per month spent in Space. Despite the important implications for Spaceflight travelers and bedridden patients, the exact mechanisms involved in disuse osteoporosis have not been elucidated. Parathyroid hormone-related protein (PTHrP regulates many physiological processes including skeletal development, and has been proposed as a mechanosensor. To investigate the role of PTHrP in microgravity-induced bone loss, trabecular and calvarial osteoblasts (TOs and COs from Pthrp +/+ and -/- mice were subjected to actual Spaceflight for 6 days (Foton M3 satellite. Pthrp +/+, +/- and -/- osteoblasts were also exposed to simulated microgravity for periods varying from 6 days to 6 weeks. While COs displayed little change in viability in 0g, viability of all TOs rapidly decreased in inverse proportion to PTHrP expression levels. Furthermore, Pthrp+/+ TOs displayed a sharp viability decline after 2 weeks at 0g. Microarray analysis of Pthrp+/+ TOs after 6 days in simulated 0g revealed expression changes in genes encoding prolactins, apoptosis/survival molecules, bone metabolism and extra-cellular matrix composition proteins, chemokines, insulin-like growth factor family members and Wnt-related signalling molecules. 88% of 0g-induced expression changes in Pthrp+/+ cells overlapped those caused by Pthrp ablation in normal gravity, and pulsatile treatment with PTHrP1-36 not only reversed a large proportion of 0g-induced effects in Pthrp+/+ TOs but maintained viability over 6-week exposure to microgravity. Our results confirm PTHrP efficacy as an anabolic agent to prevent microgravity-induced cell death in TOs.

Topiramate in the treatment of substance related disorders: a critical review of the literature

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Shinn, Ann K.; Greenfield, Shelly F.

2013-01-01

Objective To critically review the literature on topiramate in the treatment of substance related disorders. Data Sources A PubMed search of human studies published in English through January 2009. Study Selection 26 articles were identified and reviewed; these studies examined topiramate in disorders related to alcohol, nicotine, cocaine, methamphetamine, opioids, ecstasy, and benzodiazepines. Data Extraction Study design, sample size, topiramate dose and duration, and study outcomes were reviewed. Data Synthesis There is compelling evidence for the efficacy of topiramate in the treatment of alcohol dependence. Two trials show trends for topiramate’s superiority over oral naltrexone in alcohol dependence, while one trial suggests topiramate is inferior to disulfiram. Despite suggestive animal models, evidence for topiramate in treating alcohol withdrawal in humans is slim. Studies of topiramate in nicotine dependence show mixed results. Human laboratory studies that used acute topiramate dosing show that topiramate actually enhances the pleasurable effects of both nicotine and methamphetamine. Evidence for topiramate in the treatment of cocaine dependence is promising, but limited by small sample size. The data on opioids, benzodiazepines, and ecstasy are sparse. Conclusion Topiramate is efficacious for the treatment of alcohol dependence, but side effects may limit widespread use. While topiramate’s unique pharmacodynamic profile offers a promising theoretical rationale for use across multiple substance related disorders, heterogeneity both across and within these disorders limits topiramate’s broad applicability in treating substance related disorders. Recommendations for future research include exploration of genetic variants for more targeted pharmacotherapies. PMID:20361908

Tobacco Denormalization as a Public Health Strategy: Implications for Sexual and Gender Minorities.

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Antin, Tamar M J; Lipperman-Kreda, Sharon; Hunt, Geoffrey

2015-12-01

Although the population-level success of tobacco denormalization is widely accepted, it remains unclear whether these strategies alleviate health inequities for sexual and gender minorities. The high risk of smoking among sexual and gender minorities together with research that documents a relationship between stigma-related processes and smoking prevalence for these groups raises questions about whether tobacco-related stigma intensifies the disadvantages associated with the stigmas of other social identities. We have not adequately considered how tobacco-related stigma overlaps with other social identity stigmas. Given concerns about the intensification of inequality, this type of inquiry has important implications for understanding both the effectiveness and limitations of tobacco denormalization strategies for sexual and gender minorities and identifying those tobacco prevention, treatment, and public health policies that work to ameliorate health inequities.

Genital herpes and its treatment in relation to preterm delivery.

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Li, De-Kun; Raebel, Marsha A; Cheetham, T Craig; Hansen, Craig; Avalos, Lyndsay; Chen, Hong; Davis, Robert

2014-12-01

To examine the risks of genital herpes and antiherpes treatment during pregnancy in relation to preterm delivery (PTD), we conducted a multicenter, member-based cohort study within 4 Kaiser Permanente regions: northern and southern California, Colorado, and Georgia. The study included 662,913 mother-newborn pairs from 1997 to 2010. Pregnant women were classified into 3 groups based on genital herpes diagnosis and treatment: genital herpes without treatment, genital herpes with antiherpes treatment, and no herpes diagnosis or treatment (unexposed controls). After controlling for potential confounders, we found that compared with being unexposed, having untreated genital herpes during first or second trimester was associated with more than double the risk of PTD (odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.80, 2.76). The association was stronger for PTD due to premature rupture of membrane (OR = 3.57, 95% CI: 2.53, 5.06) and for early PTD (≤35 weeks gestation) (OR = 2.87, 95% CI: 2.22, 3.71). In contrast, undergoing antiherpes treatment during pregnancy was associated with a lower risk of PTD compared with not being treated, and the PTD risk was similar to that observed in the unexposed controls (OR = 1.11, 95% CI: 0.89, 1.38). The present study revealed increased risk of PTD associated with genital herpes infection if left untreated and a potential benefit of antiherpes medications in mitigating the effect of genital herpes infection on the risk of PTD. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Close relatives find meaning to cope with cancer diagnosis and treatment of family members.

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Feyh, Janelle M; Levine, Ellen G; Clay, Karine

2012-12-01

Pediatric palliative care has recently become a priority in the health care field and is implemented at the time of diagnosis rather than days or weeks before the child's death. Social constructivism theory in which humans generate meaning from their experiences was utilized as a general framework to determine the impact of pediatric palliative care on close relatives. The purpose of this grounded theory study was to generate a substantive theory that explains how close relatives such as grandparents, aunts, and uncles of a child with cancer experience palliative care. The participants of the study included close relatives of children in palliative care. Semistructured interviews and journaling were used to collect data. Initial, focused, and axial coding procedures were used to manage the data and a content analysis of the textual data was performed. Findings from the data suggested a process of finding meaning which helps close relatives to let go of what they cannot control while holding on to what they can control. Social change implications of this study may include improving health care programming for close relatives utilizing supportive-expressive measures. This programming may promote mental health of the close relatives who will learn to deal with their adjustment difficulties and improve their coping skills.

A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team

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Munro, Calum; Thomson, Victoria; Corr, Jean; Randell, Louise; Davies, Jennie E.; Gittoes, Claire; Honeyman, Vicky; Freeman, Chris P.

2014-01-01

Aims and method A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described. Results Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced. Clinical implications There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission. PMID:25285220

Malocclusion severity in Asian men in relation to malocclusion type and orthodontic treatment need

NARCIS (Netherlands)

Soh, J; Sandham, John; Chin, Yeen

2005-01-01

The purpose of this study was to assess the severity of malocclusion in young Asian men in relation to types of malocclusion and orthodontic treatment need. Methods: Study models of 339 male army recruits (age, 17-22 years) with no history of orthodontic treatment were assessed. The peer assessment

The omni-relevance of surgery: how medical specialization shapes orthopedic surgeons' treatment recommendations.

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Hudak, Pamela L; Clark, Shannon J; Raymond, Geoffrey

2013-01-01

This article examines treatment recommendations in orthopedic surgery consultations and shows how surgery is treated as "omni-relevant" within this activity, providing a context within which the broad range of treatment recommendations proposed by surgeons is offered. Using conversation analysis to analyse audiotaped encounters between orthopedic surgeons and patients, we highlight how surgeons treat surgery as having a special, privileged status relative to other treatment options by (1) invoking surgery (whether or not it is actually being recommended) and (2) presenting surgery as the "last best resort" (in relation to which other treatment options are calibrated, described and considered). This privileged status surfaces in the design and delivery of recommendations as a clear asymmetry: Recommendations for surgery are proposed early, in relatively simple and unmitigated form. In contrast, recommendations not for surgery tend to be delayed and involve significantly more interactional work in their delivery. Possible implications of these findings, including how surgeons' structuring of recommendations may shape patient expectations (whether for surgery or some alternative), and potentially influence the distribution of orthopedic surgery procedures arising from these consultations, are considered.

Myasthenia Gravis and Its Aeromedical Implications.

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Jagathesan, Tania; O'Brien, Michael D

2017-01-01

Myasthenia gravis is an autoimmune condition where antibodies form against the acetylcholine receptors at the neuromuscular junction, eventually causing damage to the motor end plate. The clinical features include muscle fatigability as well as ocular, bulbar, and limb weakness, which can have implications on the role of a pilot or air traffic controller. This retrospective study reviewed the United Kingdom Civil Aviation Authority (UK CAA) experience of myasthenia gravis. A search of the United Kingdom Civil Aviation Authority medical records database from 1990 to 2016 identified 11 individuals with a diagnosis of myasthenia gravis. Data were extracted for the class of medical certificate, age at diagnosis, symptoms, acetylcholine receptor antibody status, treatment, the time from diagnosis to loss of medical certification, and the reasons for loss of certification. There were two Class 1 certificate holders (for professional flying) and six Class 2 certificate holders (for private pilot flying) and three air traffic controllers. The mean and median ages at diagnosis were 53 and 57 yr, respectively, with a range of 28-67 yr. The mean and median intervals from diagnosis to loss of certification were 22 and 11 mo, respectively, with a range of 0 to 108 mo. The aeromedical implications of myasthenia gravis, including complications, types of treatment, and functional impact, are considered. A policy for medical certification following a diagnosis of myasthenia gravis is proposed.Jagathesan T, O'Brien MD. Myasthenia gravis and its aeromedical implications. Aerosp Med Hum Perform. 2017; 88(1):30-33.

Attachment and object relations in patients with narcissistic personality disorder: implications for therapeutic process and outcome.

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Diamond, Diana; Meehan, Kevin B

2013-11-01

This article presents a therapeutic approach for patients with severe personality disorders, transference-focused psychotherapy (TFP), a manualized evidence-based treatment, which integrates contemporary object relations theory with attachment theory and research. Case material is presented from a narcissistic personality disorder (NPD) patient in TFP whose primary presenting problems were in the arena of sexuality and love relations, and whose attachment state of mind showed evidence of oscillation between dismissing and preoccupied mechanisms. Clinical process material is presented to illustrate the tactics and techniques of TFP and how they have been refined for treatment of individuals with NPD. The ways in which conflicts around sexuality and love relations were lived out in the transference is delineated with a focus on the interpretation of devalued and idealized representations of self and others, both of which are key components of the compensatory grandiose self that defensively protects the individual from an underlying sense of vulnerability and imperfection. © 2013 Wiley Periodicals, Inc.

Identifying and Describing the Impact of Cyclone, Storm and Flood Related Disasters on Treatment Management, Care and Exacerbations of Non-communicable Diseases and the Implications for Public Health.

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Ryan, Benjamin; Franklin, Richard C; Burkle, Frederick M; Aitken, Peter; Smith, Erin; Watt, Kerrianne; Leggat, Peter

2015-09-28

Over the last quarter of a century the frequency of natural disasters and the burden of non-communicable diseases (NCD) across the globe have been increasing. For individuals susceptible to, or chronically experiencing, NCDs this has become a significant risk. Disasters jeopardize access to essential treatment, care, equipment, water and food, which can result in an exacerbation of existing conditions or even preventable death. Consequently, there is a need to expand the public health focus of disaster management to include NCDs. To provide a platform for this to occur, this article presents the results from a systematic review that identifies and describes the impact of cyclone, flood and storm related disasters on those susceptible to, or experiencing, NCDs. The NCDs researched were: cardiovascular diseases; cancers; chronic respiratory diseases; and diabetes.   Four electronic publication databases were searched with a date limit of 31 December 2014. The data was analyzed through an aggregation of individual papers to create an overall data description. The data was then grouped by disease to describe the impact of a disaster on treatment management, exacerbation, and health care of people with NCDs. The PRISMA checklist was used to guide presentation of the research.   The review identified 48 relevant articles. All studies represented developed country data. Disasters interrupt treatment management and overall care for people with NCDs, which results in an increased risk of exacerbation of their illness or even death. The interruption may be caused by a range of factors, such as damaged transport routes, reduced health services, loss of power and evacuations. The health impact varied according to the NCD. For people with chronic respiratory diseases, a disaster increases the risk of acute exacerbation. Meanwhile, for people with cancer, cardiovascular diseases and diabetes there is an increased risk of their illness exacerbating, which can result in death

Threat Related Selective Attention Predicts Treatment Success in Childhood Anxiety Disorders

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Legerstee, Jeroen S.; Tulen, Joke H. M.; Kallen, Victor L.; Dieleman, Gwen C.; Treffers, Philip D. A.; Verhulst, Frank C.; Utens, Elisabeth M. W. J.

2009-01-01

Threat-related selective attention was found to predict the success of the treatment of childhood anxiety disorders through administering a pictorial dot-probe task to 131 children with anxiety disorders prior to cognitive behavioral therapy. The diagnostic status of the subjects was evaluated with a semistructured clinical interview at both pre-…

Invasive alien plants used in the treatment of HIV/AIDS-related ...

African Journals Online (AJOL)

Results: A total of 38 invasive alien plant species belonging to 23 families were recorded to be used in the treatment of HIV/AIDS related symptoms. The largest proportion of recorded invasive alien plants belonged to the family Asteraceae with 16%. Roots were the most frequently used parts constituting 35% followed ...

Oncology healthcare professionals' perspectives on the psychosocial support needs of cancer patients during oncology treatment.

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Aldaz, Bruno E; Treharne, Gareth J; Knight, Robert G; Conner, Tamlin S; Perez, David

2017-09-01

This study explored oncology healthcare professionals' perspectives on the psychosocial support needs of diverse cancer patients during oncology treatment. Six themes were identified using thematic analysis. Healthcare professionals highlighted the importance of their sensitivity, respect and emotional tact during appointments in order to effectively identify and meet the needs of oncology patients. Participants also emphasised the importance of building rapport that recognises patients as people. Patients' acceptance of treatment-related distress and uncertainty was described as required for uptake of available psychosocial supportive services. We offer some practical implications that may help improve cancer patients' experiences during oncology treatment.

Molecular Understanding of the Activation of CB1 and Blockade of TRPV1 Receptors: Implications for Novel Treatment Strategies in Osteoarthritis

Directory of Open Access Journals (Sweden)

Jakub Mlost

2018-01-01

Full Text Available Osteoarthritis (OA is a joint disease in which cartilage degenerates as a result of mechanical and biochemical changes. The main OA symptom is chronic pain involving both peripheral and central mechanisms of nociceptive processing. Our previous studies have implicated the benefits of dual- over single-acting compounds interacting with the endocannabinoid system (ECS in OA treatment. In the present study, we focused on the specific molecular alterations associated with pharmacological treatment. OA was induced in Wistar rats by intra-articular injection of 3 mg of monoiodoacetate (MIA. Single target compounds (URB597, an FAAH inhibitor, and SB366791, a TRPV1 antagonist and a dual-acting compound OMDM198 (FAAH inhibitor/TRPV1 antagonist were used in the present study. At day 21 post-MIA injection, rats were sacrificed 1 h after i.p. treatment, and changes in mRNA expression were evaluated in the lumbar spinal cord by RT-qPCR. Following MIA administration, we observed 2-4-fold increase in mRNA expression of targeted receptors (Cnr1, Cnr2, and Trpv1, endocannabinoid degradation enzymes (Faah, Ptgs2, and Alox12, and TRPV1 sensitizing kinases (Mapk3, Mapk14, Prkcg, and Prkaca. OMDM198 treatment reversed some of the MIA effects on the spinal cord towards intact levels (Alox12, Mapk14, and Prkcg. Apparent regulation of ECS and TRPV1 in response to pharmacological intervention is a strong justification for novel ECS-based multi-target drug treatment in OA.

Treatment-related decisional conflict in patients with depressive and anxious disorders

Directory of Open Access Journals (Sweden)

De las Cuevas C

2016-06-01

Full Text Available Carlos De las Cuevas,1 Ramsés Marrero,1 Casimiro Cabrera21Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain; 2Department of Psychiatry, Queen’s University, Kingston, ON, CanadaPurpose: To determine the level of treatment-related decisional conflict in patients with emotional disorders and to establish its relationship with sociodemographic and clinical variables.Methods: We conducted a cross-sectional survey on a convenience sample of 321 consecutive psychiatric outpatients with emotional disorders. All patients completed self-report questionnaires assessing sociodemographic and clinical variables, patients’ preference of participation in decision making, perceived decisional conflict about treatment, adherence to prescribed treatment, and satisfaction with the psychiatric care provided. Multiple correspondences analysis was used to investigate relationships of decisional conflict with the variables of interest.Results: Approximately, two-thirds of psychiatric outpatients self-reported decisional conflict regarding their treatment. Interestingly, the presence of decisional conflict did not influence significantly patients’ preferences of participation or their adherence to prescribed treatment. Patients without decisional conflict registered significantly higher satisfaction. Multiple correspondences analysis evidenced two clear profiles: patients without decisional conflict received the treatment they preferred, mainly psychotherapy or combined treatment, had been under psychiatric treatment for longer than 5 years, and self-reported high satisfaction with health care received; on the other hand, patients with decisional conflict did not receive the treatment they preferred, were treated with pharmacotherapy alone for a period of time between 1 and 5 years, and self-reported medium satisfaction with received health care.Conclusion: The high level of

The relation between mindfulness and fear of negative evaluation over the course of cognitive behavioral therapy for social anxiety disorder.

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Burton, Mark; Schmertz, Stefan K; Price, Matthew; Masuda, Akihiko; Anderson, Page L

2013-03-01

This study examined the relation between mindfulness and fear of negative evaluation over the course of nonmindfulness based cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). We expected that higher levels of mindfulness would be associated with a more positive response to treatment. This study is a secondary report from a randomized controlled trial in which participants (N = 65) diagnosed with SAD were randomly assigned to receive 8 weeks of 1 of 2 manualized treatments (exposure group therapy, n = 33; or virtual reality exposure therapy, n = 32) either immediately or following an 8 week waiting period. Fear of negative evaluation decreased following treatment and was negatively related to mindfulness throughout treatment and follow-up. Mindfulness did not moderate treatment outcome. These findings indicate that while mindfulness is related to fear, it is not a moderator of symptom reduction in nonmindfulness-based treatment. Implications for treatment and future research are discussed. 2012 Wiley Periodicals, Inc

Relative judgment theory and the mediation of facial recognition: Implications for theories of eyewitness identification.

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McAdoo, Ryan M; Gronlund, Scott D

2016-01-01

Many in the eyewitness identification community believe that sequential lineups are superior to simultaneous lineups because simultaneous lineups encourage inappropriate choosing due to promoting comparisons among choices (a relative judgment strategy), but sequential lineups reduce this propensity by inducing comparisons of lineup members directly to memory rather than to each other (an absolute judgment strategy). Different versions of the relative judgment theory have implicated both discrete-state and continuous mediation of eyewitness decisions. The theory has never been formally specified, but (Yonelinas, J Exp Psychol Learn Mem Cogn 20:1341-1354, 1994) dual-process models provide one possible specification, thereby allowing us to evaluate how eyewitness decisions are mediated. We utilized a ranking task (Kellen and Klauer, J Exp Psychol Learn Mem Cogn 40:1795-1804, 2014) and found evidence for continuous mediation when facial stimuli match from study to test (Experiment 1) and when they mismatch (Experiment 2). This evidence, which is contrary to a version of relative judgment theory that has gained a lot of traction in the legal community, compels reassessment of the role that guessing plays in eyewitness identification. Future research should continue to test formal explanations in order to advance theory, expedite the development of new procedures that can enhance the reliability of eyewitness evidence, and to facilitate the exploration of task factors and emergent strategies that might influence when recognition is continuously or discretely mediated.

Cholinergic connectivity: it’s implications for psychiatric disorders.

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Elizabeth eScarr

2013-05-01

Full Text Available Acetylcholine has been implicated in both the pathophysiology and treatment of a number of psychiatric disorders, with most of the data related to its role and therapeutic potential focussing on schizophrenia. However, there is little thought given to the consequences of the documented changes in the cholinergic system and how they may affect the functioning of the brain. This review looks at the cholinergic system and its interactions with the intrinsic neurotransmitters glutamate and gamma-amino butyric acid as well as those with the projection neurotransmitters most implicated in the pathophysiologies of psychiatric disorders; dopamine and serotonin. In addition, with the recent focus on the role of factors normally associated with inflammation in the pathophysiologies of psychiatric disorders, links between the cholinergic system and these factors will also be examined. These interfaces are put into context, primarily for schizophrenia, by looking at the changes in each of these systems in the disorder and exploring, theoretically, whether the changes are interconnected with those seen in the cholinergic system. Thus, this review will provide a comprehensive overview of the connectivity between the cholinergic system and some of the major areas of research into the pathophysiologies of psychiatric disorders, resulting in a critical appraisal of the potential outcomes of a dysregulated central cholinergic system.

Implication of using different carbon sources for denitrification in wastewater treatments.

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Cherchi, Carla; Onnis-Hayden, Annalisa; El-Shawabkeh, Ibrahim; Gu, April Z

2009-08-01

Application of external carbon sources for denitrification becomes necessary for wastewater treatment plants that have to meet very stringent effluent nitrogen limits (e.g., 3 to 5 mgTN/L). In this study, we evaluated and compared three carbon sources--MicroC (Environmental Operating Solutions, Bourne, Massachusetts), methanol, and acetate-in terms of their denitrification rates and kinetics, effect on overall nitrogen removal performance, and microbial community structure of carbon-specific denitrifying enrichments. Denitrification rates and kinetics were determined with both acclimated and non-acclimated biomass, obtained from laboratory-scale sequencing batch reactor systems or full-scale plants. The results demonstrate the feasibility of the use of MicroC for denitrification processes, with maximum denitrification rates (k(dmax)) of 6.4 mgN/gVSSh and an observed yield of 0.36 mgVSS/mgCOD. Comparable maximum nitrate uptake rates were found with methanol, while acetate showed a maximum denitrification rate nearly twice as high as the others. The maximum growth rates measured at 20 degrees C for MicroC and methanol were 3.7 and 1.2 day(-1), respectively. The implications resulting from the differences in the denitrification rates and kinetics of different carbon sources on the full-scale nitrogen removal performance, under various configurations and operational conditions, were assessed using Biowin (EnviroSim Associates, Ltd., Flamborough, Ontario, Canada) simulations for both pre- and post-denitrification systems. Examination of microbial population structures using Automated Ribosomal Intergenic Spacer Analysis (ARISA) throughout the study period showed dynamic temporal changes and distinct microbial community structures of different carbon-specific denitrifying cultures. The ability of a specific carbon-acclimated denitrifying population to instantly use other carbon source also was investigated, and the chemical-structure-associated behavior patterns observed

Silica nanoparticles capture atmospheric lead: implications in the treatment of environmental heavy metal pollution.

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Yang, Xifei; Shen, Zhiguo; Zhang, Bing; Yang, Jianping; Hong, Wen-Xu; Zhuang, Zhixiong; Liu, Jianjun

2013-01-01

Lead (Pb) contamination in the air is a severe global problem, most notably in China. Removal of Pb from polluted air remains a significant challenge. It is unclear what potential effects silica nanoparticles (SiNPs) exposure can have on atmospheric Pb. Here we first characterized the features of SiNPs by measuring the particle size, zeta potential and the specific surface area of SiO(2) particles using a Nicomp 380/ZLS submicron particle sizer, the Brunauer-Emmett-Teller (BET) method and transmission electronic microscopy (TEM). We measured the content of the metal Pb adsorbed by SiNPs exposed to two Pb polluted electric battery plants using inductively coupled plasma mass spectrometry (ICP-MS). It is found that SiNPs exposed to two Pb polluted electric battery plants absorb more atmospheric Pb compared to either blank control or micro-sized SiO(2) particles in a time-dependent manner. This is the first study demonstrating that SiNPs exposure can absorb atmospheric Pb in the polluted environment. These novel findings indicate that SiNPs have potential to serve as a significant adsorbent of Pb from industrial pollution, implicating a potentially novel application of SiNPs in the treatment of environmental heavy metal pollution. Copyright © 2012 Elsevier Ltd. All rights reserved.

Relational Issues Within Couples Coping With Parkinson's Disease: Implications and Ideas for Family-Focused Care.

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Martin, Summer C

2016-05-01

The ways in which Parkinson's disease (PD) impacts, and is experienced by, the couple (i.e., the individual with PD and his or her spouse or other romantic partner) have not been fully elucidated. Such research is strongly warranted because when one member of a couple is chronically ill, it can cause major distress for not only the patient but also for his or her partner and their relationship. Therefore, the goal of this study was to examine how PD affects a couple's relationship. Data from 44 individual, in-depth interviews (with 21 persons with PD and 23 partners) revealed several challenges that PD commonly invokes in the patient-partner relationship, though most participants reported that PD had not decreased their overall relational closeness. The findings have significant practical implications for family-focused care. © The Author(s) 2016.

The treatment of CIN: what are the risks?

LENUS (Irish Health Repository)

Prendiville, W

2012-02-01

The treatment of CIN: what are the risks?The treatment of squamous cervical intraepithelial neoplasia is to remove or destroy the transformation zone (TZ). It is likely that no method of treatment is superior to another if it is performed properly and the limited available evidence supports this view. The significant advantages of excision (simplicity, cost, outpatient procedure, histological examination of the entire TZ) mean that treatment thresholds may have lowered over the last decade. Long-term pregnancy-related morbidity associated with excision has been reported recently. The evidence would suggest that this increase equates to a genuine increase in serious adverse outcome for cone biopsy but not large loop excision of the transformation zone (LLETZ). The available data also point to an increase in both incomplete excision and premature labour associated with the excision of large endocervical TZs. The clinical implications arising from this are firstly that women with large type 2 and 3 TZs need appropriate counselling before treatment and that the threshold for treating young women with mild abnormalities needs review.

Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review

NARCIS (Netherlands)

Dorrepaal, Ethy; Thomaes, Kathleen; Hoogendoorn, Adriaan W.; Veltman, Dick J.; Draijer, Nel; van Balkom, Anton J. L. M.

2014-01-01

Effective first-line treatments for posttraumatic stress disorder (PTSD) are well established, but their generalizability to child abuse (CA)-related Complex PTSD is largely unknown. A quantitative review of the literature was performed, identifying seven studies, with treatments specifically

Chromium toxicity to nitrifying bacteria: implications to wastewater treatment

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Chromium, a heavy metal that enters wastewater treatment plants (WWTPs) through industrial discharges, can be toxic to microorganisms carrying out important processes within biological wastewater treatment systems. The effect of Cr(III) and Cr(VI) on ammonia dependent specific ox...

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS

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López, Mónica E.; Kaplan, Celia P.; Nápoles, Anna M.; Hwang, E. Shelly; Livaudais, Jennifer C.; Karliner, Leah S.

2013-01-01

Objective To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS. Methods Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women’s preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group. Results Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, pdecision-making (OR 0.4; CI 95%, 0.2-0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0-12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3-1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7-1.0), independent of ethnicity-language. Conclusion Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret. Practice Implications Use of professional interpreters may address communication-related disparities for these women. PMID:24207116

Treatment implications of posterior fossa ependymoma subgroups.

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Ramaswamy, Vijay; Taylor, Michael D

2016-11-15

Posterior fossa ependymoma comprises two distinct molecular entities, ependymoma_posterior fossa A (EPN_PFA) and ependymoma_posterior fossa B (EPN_PFB), with differentiable gene expression profiles. As yet, the response of the two entities to treatment is unclear. To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment, we studied a cohort of 820 patients with molecularly profiled, clinically annotated posterior fossa ependymomas. We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA, which was recently reported in the paper entitled "Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era: a retrospective multicohort analysis" in the Journal of Clinical Oncology. Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy, whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.

Cannabidiol regulation of learned fear: implications for treating anxiety-related disorders

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Regimantas Jurkus

2016-11-01

Full Text Available Anxiety and trauma-related disorders are psychiatric diseases with a lifetime prevalence of up to 25%. Phobias and post-traumatic stress disorder (PTSD are characterized by abnormal and persistent memories of fear-related contexts and cues. The effects of psychological treatments such as exposure therapy are often only temporary and medications can be ineffective and have adverse side effects. Growing evidence from human and animal studies indicates that cannabidiol, the main non-psychotomimetic phytocannabinoid present in Cannabis sativa, alleviates anxiety in paradigms assessing innate fear. More recently, the effects of cannabidiol on learned fear have been investigated in preclinical studies with translational relevance for phobias and PTSD. Here we review the findings from these studies, with an emphasis on cannabidiol regulation of contextual fear. The evidence indicates that cannabidiol reduces learned fear in different ways: (1 cannabidiol decreases fear expression acutely, (2 cannabidiol disrupts memory reconsolidation, leading to sustained fear attenuation upon memory retrieval, and (3 cannabidiol enhances extinction, the psychological process by which exposure therapy inhibits learned fear. We also present novel data on cannabidiol regulation of learned fear related to explicit cues, which indicates that auditory fear expression is also reduced acutely by cannabidiol. We conclude by outlining future directions for research to elucidate the neural circuit, psychological, cellular, and molecular mechanisms underlying the regulation of fear memory processing by cannabidiol. This line of investigation may lead to the development of cannabidiol as a novel therapeutic approach for treating anxiety and trauma-related disorders such as phobias and PTSD in the future.

Beyond symptom management: Family relations, unmet needs of persons living with severe mental illnesses, and potential implications for social work in South Africa.

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Tomita, Andrew; Burns, Jonathan K; King, Howard; Baumgartner, Joy Noel; Davis, Glen P; Mtshemla, Sisanda; Nene, Siphumelele; Susser, Ezra

2016-01-01

This study examined the quality of family relationships and its associations with the severity of unmet needs of individuals admitted to a tertiary psychiatric hospital in South Africa. The quality of family relations and perceived unmet needs were assessed using the Lehman Quality of Life Interview and Camberwell Assessment of Needs, respectively. The results show that higher total unmet needs were associated with lower quality of family relations. The main areas of serious unmet needs included accessing government benefits and information, and establishing social relations. The results have implications for hospital-based social workers beyond managing psychiatric symptoms in South Africa.

The family in Romania: cultural and economic context and implications for treatment.

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Mihai, Adriana; Butiu, Otilia

2012-04-01

The study of family structures, functioning, roles and values is fundamental in family therapist's activities for better understanding the psychological, cultural and social specificity of different clients and interventions. In this paper we describe the Romanian family and the family therapies which are available in Romania. We illustrate basic needs using demographic data and research available from Romania. The nuclear family remains dominant instead of other alternatives, the age of marriage is earlier than in western European countries and celibate and consensual living are exceptions or only for the transitional period before marriage. The role of marriage and childbirth within the marital setting is still important. The model of a single child appears increasingly common due to an improvement in financial resources and better living conditions. Relations with family of origin remain close. The difficulties for children with parents working in different countries raise problems and have implications for the extended family, educators and psychotherapists as well as mental health service providers. Family therapists should keep in mind the structure, function, role and values of the Romanian family for better understanding the issues and resources and use these accordingly in therapy. Policy-makers should be aware of the difficulties concerning availability and access to this therapeutic approach.

Treatment-Related Predictive and Prognostic Factors in Trimodality Approach in Stage IIIA/N2 Non-Small Cell Lung Cancer.

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Jeremić, Branislav; Casas, Francesc; Dubinsky, Pavol; Gomez-Caamano, Antonio; Čihorić, Nikola; Videtic, Gregory; Igrutinovic, Ivan

2018-01-01

While there are no established pretreatment predictive and prognostic factors in patients with stage IIIA/pN2 non-small cell lung cancer (NSCLC) indicating a benefit to surgery as a part of trimodality approach, little is known about treatment-related predictive and prognostic factors in this setting. A literature search was conducted to identify possible treatment-related predictive and prognostic factors for patients for whom trimodality approach was reported on. Overall survival was the primary endpoint of this study. Of 30 identified studies, there were two phase II studies, 5 "prospective" studies, and 23 retrospective studies. No study was found which specifically looked at treatment-related predictive factors of improved outcomes in trimodality treatment. Of potential treatment-related prognostic factors, the least frequently analyzed factors among 30 available studies were overall pathologic stage after preoperative treatment and UICC downstaging. Evaluation of treatment response before surgery and by pathologic tumor stage after induction therapy were analyzed in slightly more than 40% of studies and found not to influence survival. More frequently studied factors-resection status, degree of tumor regression, and pathologic nodal stage after induction therapy as well as the most frequently studied factor, the treatment (in almost 75% studies)-showed no discernible impact on survival, due to conflicting results. Currently, it is impossible to identify any treatment-related predictive or prognostic factors for selecting surgery in the treatment of patients with stage IIIA/pN2 NSCLC.

Triggers of Substance Abuse Slip and Relapse During Outpatient Treatment in Methadone/Buprenorphine Maintenance Therapy Clinics: A Predictive Model with Emphasis on Treatment-Related Factors

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Saeid Komasi

2017-07-01

Full Text Available Background Most addicts relapse in the first year of treatment especially in the first 3 - 6 months, which is the most vulnerable period. Objectives The present study aimed to assess the predictors of substance abuse slip and relapse among addicts in the first 6 months of treatment with an emphasis on treatment related factors. Methods The data of this cross-sectional study collected through assessment of 148 patients who were referred to the Methadone/Buprenorphine maintenance therapy clinics of Kermanshah city during April to September of 2015. Demographic, history, treatment checklist, comorbidity index, and medical records were used for collecting data. Data was analyzed through chi-square, t-test, and Binary logistic regression analysis. Results The mean age of total participants was 42.4 ± 11.3 years and 98% of them were male. 27% and 35.1% of the patients, respectively, had a slip and relapse during the first 6 months of treatment. After adjustment for all demographic data, it was indicated that self-employment (P = 0.037, more treatment costs (P = 0.049, previous treatment history (P = 0.027, not satisfied dose of medication (P = 0.012, and lack of medical therapy history under physicians supervision (P = 0.046 can increase the possibility of a slip significantly. Conclusions Despite the fact that prevention of re-abuse and relapse of disease includes multi-factorial approach, it seems that the treatment-related factors are as the most major factors in relapse and slip during the first 6 months of treatment. Health practitioners’ special attention to treatment related factors in addiction, especially previous treatment history as the most important predictor of relapse, are probably effective in the control and decrease of a slip and relapse.

NATURAL COURSE OF PATIENTS DISCONTINUING TREATMENT FOR AGE-RELATED MACULAR DEGENERATION AND FACTORS ASSOCIATED WITH VISUAL PROGNOSIS.

Science.gov (United States)

Kim, Jae Hui; Chang, Young Suk; Kim, Jong Woo

2017-12-01

To evaluate the 24-month natural course of visual changes in patients discontinuing treatment despite persistent or recurrent fluid and factors predictive of visual prognosis. This retrospective, observational study included 35 patients (35 eyes) who initially received anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD), but discontinued treatment despite persistent or recurrent fluid. The best-corrected visual acuity (BCVA) at treatment discontinuation was determined and compared with the 24-month BCVA, which was then compared between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes. Baseline characteristics predictive of visual outcome and the degree of visual change were also analyzed. The mean number of anti-vascular endothelial growth factor injections before treatment discontinuation was 4.0 ± 1.6. The mean logarithm of minimal angle of resolution of BCVA at treatment discontinuation and that at 24 months were 1.02 ± 0.20 (Snellen equivalents = 20/209) and 1.60 ± 0.56 (20/796), respectively (P age-related macular degeneration subtypes (P = 0.803). The type of fluid (intraretinal fluid vs. no intraretinal fluid) was predictive of 24-month BCVA (P = 0.004) and the degree of changes in BCVA (P = 0.043). Marked deterioration in visual acuity was noted in patients discontinuing treatment, regardless of neovascular age-related macular degeneration subtypes. The presence of intraretinal fluid was associated with worse visual prognosis, suggesting that patients with intraretinal fluid should be strongly warned about their poor prognosis before they decide to discontinue treatment.

Potential role of anticonvulsants in the treatment of obsessive-compulsive and related disorders.

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Wang, Hee Ryung; Woo, Young Sup; Bahk, Won-Myong

2014-10-01

We reviewed the extant literature to evaluate the current evidence regarding the efficacy and safety of anticonvulsants in the treatment of obsessive-compulsive and related disorders. Relevant literature was accessed using the Cochrane database, embase and PubMed on 29 October 2013. Prospective studies examining the efficacy of anticonvulsants in obsessive-compulsive and related disorders were included. Case reports, case series, and retrospective studies were excluded. A total of 10 studies were included in this review. The studies of obsessive-compulsive disorder, except for two negative studies, showed favorable efficacy results of anticonvulsants. In one study on body dysmorphic disorder, levetiracetam showed favorable efficacy. In two lamotrigine studies for pathologic skin-picking, the efficacy findings were inconsistent. In one trichotillomania study, topiramate had reduced hair-pulling symptoms. Despite limited evidence, our review suggests that anticonvulsants have a potential role in the treatment of obsessive-compulsive and related disorders. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Predicting treatment related imaging changes (TRICs) after radiosurgery for brain metastases using treatment dose and conformality metrics.

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Taylor, B Frazier; Knisely, Jonathan P; Qian, Jack M; Yu, James B; Chiang, Veronica L

2016-01-01

Treatment-related imaging changes (TRICs) after stereotactic radiosurgery (SRS) involves the benign transient enlargement of radiographic lesions after treatment. Identifying the radiation dose volumes and conformality metrics associated with TRICs for different post-treatment periods would be helpful and improve clinical decision making. 367 metastases in 113 patients were treated using Gamma Knife SRS between 1/1/2007-12/31/2009. Each metastasis was measured at each imaging follow-up to detect TRICs (defined as ≥ 20% increase in volume). Fluctuations in small volume lesions (less than 108 mm 3 ) were ignored given widely variable conformity indices (CI) for small volumes. The Karolinska Adverse Radiation Effect (KARE) factor, Paddick's CI, Shaw's CI, tumor volume (TV), 10 Gy (V10) and 12 Gy (V12) volumes, and prescription isodose volume (PIV) were calculated. From 0-6 months, all measures correlated with the incidence of TRICs (p<.001), except KARE, which was inversely correlated. During the 6-12 month period all measures except KARE were still correlated. Beyond 12 months, no correlation was found between any of the measures and the development of TRICs. All metrics except KARE were associated with TRICs from 0-12 months only. Additional patient and treatment factors may become dominant at greater times after SRS.

Comorbidity of Personality Disorders and Depression: Implications for Treatment.

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Shea, M. Tracie; And Others

1992-01-01

Reviews studies of impact of comorbidity of personality disorders and depression on response to various forms of treatment. Notes that findings support belief that personality disorders are associated with poorer response to treatment for depression. Also notes that limited data available suggest that depression may be positive prognostic…

Immunological Factors in the Pathogenesis and Treatment of Age-Related Macular Degeneration

NARCIS (Netherlands)

Kijlstra, A.; Heij, La E.C.; Hendrikse, F.

2005-01-01

Recent findings indicate that immunological factors are involved not only in the pathogenesis of age-related macular degeneration (AMD), but also in its treatment. Earlier data showing the presence of inflammatory cells in affected areas of AMD retinas support this statement. Although a possible

Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD

Directory of Open Access Journals (Sweden)

Luis Fernando Hernández-Zimbrón

2018-01-01

Full Text Available Age-related macular degeneration (AMD is a well-characterized and extensively studied disease. It is currently considered the leading cause of visual disability among patients over 60 years. The hallmark of early AMD is the formation of drusen, pigmentary changes at the macula, and mild to moderate vision loss. There are two forms of AMD: the “dry” and the “wet” form that is less frequent but is responsible for 90% of acute blindness due to AMD. Risk factors have been associated with AMD progression, and they are taking relevance to understand how AMD develops: (1 advanced age and the exposition to environmental factors inducing high levels of oxidative stress damaging the macula and (2 this damage, which causes inflammation inducing a vicious cycle, altogether causing central vision loss. There is neither a cure nor treatment to prevent AMD. However, there are some treatments available for the wet form of AMD. This article will review some molecular and cellular mechanisms associated with the onset of AMD focusing on feasible treatments for each related factor in the development of this pathology such as vascular endothelial growth factor, oxidative stress, failure of the clearance of proteins and organelles, and glial cell dysfunction in AMD.

Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD.

Science.gov (United States)

Hernández-Zimbrón, Luis Fernando; Zamora-Alvarado, Ruben; Ochoa-De la Paz, Lenin; Velez-Montoya, Raul; Zenteno, Edgar; Gulias-Cañizo, Rosario; Quiroz-Mercado, Hugo; Gonzalez-Salinas, Roberto

2018-01-01

Age-related macular degeneration (AMD) is a well-characterized and extensively studied disease. It is currently considered the leading cause of visual disability among patients over 60 years. The hallmark of early AMD is the formation of drusen, pigmentary changes at the macula, and mild to moderate vision loss. There are two forms of AMD: the "dry" and the "wet" form that is less frequent but is responsible for 90% of acute blindness due to AMD. Risk factors have been associated with AMD progression, and they are taking relevance to understand how AMD develops: (1) advanced age and the exposition to environmental factors inducing high levels of oxidative stress damaging the macula and (2) this damage, which causes inflammation inducing a vicious cycle, altogether causing central vision loss. There is neither a cure nor treatment to prevent AMD. However, there are some treatments available for the wet form of AMD. This article will review some molecular and cellular mechanisms associated with the onset of AMD focusing on feasible treatments for each related factor in the development of this pathology such as vascular endothelial growth factor, oxidative stress, failure of the clearance of proteins and organelles, and glial cell dysfunction in AMD.

Genital warts: Canadians' perception, health-related behaviors, and treatment preferences.

Science.gov (United States)

Steben, Marc; LaBelle, Deborah

2012-10-01

The study aimed to gauge the perceptions of Canadians toward genital warts, related health behaviors, and treatment preferences. An online survey supported by an unrestricted grant from Graceway Canada was conducted in February 2011 by Leger Marketing. It included 9 demographic questions and 17 questions relating to genital wart perception (2 multiple-choice, 15 four-point rating from strongly agree to strongly disagree). The survey was completed by 1520 Canadian adults aged 18 to older than 75 years, of whom 52% (786/1520) were female. Fifty-two percent of respondents stated that they would monitor an unrecognized spot on their genitals, and only seek medical assistance if it did not go away. Only 43% (652/1520) said that they would stop having sex until the spots were gone. Although only 10% (158/1520) of respondents stated that they would not inform their partner, this was much higher among men (14%, 103/734) than women (7%, 55/786), with p ≤ .01. Concerns of being judged by friends/family were high (44%, 669/1520), especially among younger (18-34 y) Canadians (60%), with p ≤ .05. Regarding prevention, 32% (493/1520) of respondents believed that monogamy would protect against genital warts and 25% (373/1520) believed they are not at risk if they use a condom. Treatment preference was in favor of a cream rather than an "invasive" treatment (58%, 886/1520), particularly among younger (67%, 283/425, p ≤ .05) and male respondents (63%, 464/734, p ≤ .01). Sixty percent (921/1520) would worry that genital warts could not be resolved; and 44% (668/1520), that they would recur. Among Canadians, genital warts were associated with a fair degree of social stigma and potential negative impact on their psyche, especially for younger Canadians.

Treatment of addiction and addiction-related behavior

Energy Technology Data Exchange (ETDEWEB)

Dewey, Stephen L. (Manorville, NY); Brodie, Jonathan D. (Cos Cob, CT); Ashby, Jr., Charles R. (Miller Place, NY)

2003-01-01

The present invention provides a highly efficient method for treating substance addiction and for changing addiction-related behavior of a mammal suffering from substance addiction. The method includes administering to a mammal an effective amount of gamma vinylGABA or a pharmaceutically acceptable salt thereof. The present invention also provides a method of treatment of cocaine, morphine, heroin, nicotine, amphetamine, methamphetamine, or ethanol addiction by treating a mammal with an effective amount of gamma vinylGABA or a pharmaceutically acceptable salt thereof. In one embodiment, the method of the present invention includes administering to the mammal an effective amount of a composition which increases central nervous system GABA levels wherein the effective amount is sufficient to diminish, inhibit or eliminate behavior associated with craving or use of drugs of abuse. The composition includes GVG, gabapentin, valproic acid, progabide, gamma-hydroxybutyric acid, fengabine, cetylGABA, topiramate or tiagabine or a pharmaceutically acceptable salt thereof, or an enantiomer or a racemic mixture thereof.

A review of omeprazole use in the treatment of acid-related disorders in children.

Science.gov (United States)

Zimmermann, A E; Walters, J K; Katona, B G; Souney, P E; Levine, D

2001-05-01

Acid peptic disease is a common problem, with a similar prevalence of gastroesophageal reflux disease (GERD) in adults and children. The presentation of GERD in infants and children varies from crying, irritability, or sleep disturbance to feeding difficulties, vomiting, or rumination. Helicobacter pylori (HP)-related diseases and gastric and duodenal ulcers are much more common in adults than in children, who are more likely to have gastritis or duodenitis. However, because HP infection is most likely acquired in childhood, treatment of children with endoscopically documented active HP disease may minimize the potential risk for peptic ulcer or gastric cancer in adulthood, although this is yet to be proved. Omeprazole has been shown to be effective in the treatment of acid-related diseases. This paper reviews the literature on the use and administration of omeprazole for the treatment of GERD, peptic ulcer disease, HP infection, and other acid-related conditions in children. Studies were identified through searches of MEDLINE and Science Citation Index for the period 1986 to November 2000, and from the reference lists of identified articles. The search terms used included omeprazole, proton pump inhibitor (PPI), children, pediatrics, routes of administration, GERD, HP infection, esophagitis, and administration. In addition, the manufacturer of omeprazole was asked for relevant unpublished information. Marketed and extemporaneous formulations of omeprazole have been administered to children aged 2 months to 18 years for the treatment of erosive esophagitis, gastric ulcer, duodenal ulcer, HP infection, and related conditions at dosages of 5 to 80 mg/d (0.2-3.5 mg/kg/d) for periods ranging from 14 days to 36 months with a low incidence of adverse effects. The initial dose most consistently reported to heal esophagitis and provide relief of symptoms of GERD appears to be 1 mg/kg per day. In uncontrolled clinical trials and case reports to date, omeprazole has been

Tactile event-related potentials in amyotrophic lateral sclerosis (ALS): Implications for brain-computer interface.

Science.gov (United States)

Silvoni, S; Konicar, L; Prats-Sedano, M A; Garcia-Cossio, E; Genna, C; Volpato, C; Cavinato, M; Paggiaro, A; Veser, S; De Massari, D; Birbaumer, N

2016-01-01

We investigated neurophysiological brain responses elicited by a tactile event-related potential paradigm in a sample of ALS patients. Underlying cognitive processes and neurophysiological signatures for brain-computer interface (BCI) are addressed. We stimulated the palm of the hand in a group of fourteen ALS patients and a control group of ten healthy participants and recorded electroencephalographic signals in eyes-closed condition. Target and non-target brain responses were analyzed and classified offline. Classification errors served as the basis for neurophysiological brain response sub-grouping. A combined behavioral and quantitative neurophysiological analysis of sub-grouped data showed neither significant between-group differences, nor significant correlations between classification performance and the ALS patients' clinical state. Taking sequential effects of stimuli presentation into account, analyses revealed mean classification errors of 19.4% and 24.3% in healthy participants and ALS patients respectively. Neurophysiological correlates of tactile stimuli presentation are not altered by ALS. Tactile event-related potentials can be used to monitor attention level and task performance in ALS and may constitute a viable basis for future BCIs. Implications for brain-computer interface implementation of the proposed method for patients in critical conditions, such as the late stage of ALS and the (completely) locked-in state, are discussed. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Topiramate in the treatment of substance-related disorders: a critical review of the literature.

Science.gov (United States)

Shinn, Ann K; Greenfield, Shelly F

2010-05-01

To critically review the literature on topiramate in the treatment of substance-related disorders. A PubMed search of human studies published in English through January 2009 was conducted using the following search terms: topiramate and substance abuse, topiramate and substance dependence, topiramate and withdrawal, topiramate and alcohol, topiramate and nicotine, topiramate and cocaine, topiramate and opiates, and topiramate and benzodiazepines. 26 articles were identified and reviewed; these studies examined topiramate in disorders related to alcohol, nicotine, cocaine, methamphetamine, opioids, Ecstasy, and benzodiazepines. Study design, sample size, topiramate dose and duration, and study outcomes were reviewed. There is compelling evidence for the efficacy of topiramate in the treatment of alcohol dependence. Two trials show trends for topiramate's superiority over oral naltrexone in alcohol dependence, while 1 trial suggests topiramate is inferior to disulfiram. Despite suggestive animal models, evidence for topiramate in treating alcohol withdrawal in humans is slim. Studies of topiramate in nicotine dependence show mixed results. Human laboratory studies that used acute topiramate dosing show that topiramate actually enhances the pleasurable effects of both nicotine and methamphetamine. Evidence for topiramate in the treatment of cocaine dependence is promising, but limited by small sample size. The data on opioids, benzodiazepines, and Ecstasy are sparse. Topiramate is efficacious for the treatment of alcohol dependence, but side effects may limit widespread use. While topiramate's unique pharmacodynamic profile offers a promising theoretical rationale for use across multiple substance-related disorders, heterogeneity both across and within these disorders limits topiramate's broad applicability in treating substance-related disorders. Recommendations for future research include exploration of genetic variants for more targeted pharmacotherapies. �

Essential elements of Internet infidelity treatment.

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Hertlein, Katherine M; Piercy, Fred P

2012-06-01

As the worldwide usage of the Internet tops 1.6 billion people, problems related to its use such as online Infidelity are becoming widespread issues for couples and, consequently, for their therapists. The purpose of this qualitative study was to understand how practicing therapists treat Internet infidelity through exploring the basic themes used in Internet infidelity treatment. We conducted in-depth interviews of 15 therapists with experience in treating Internet infidelity. Our findings indicate that therapists go through a variety of steps in treatment, including: (a) develop physical boundaries, (b) develop psychological boundaries, (c) manage accountability, trust, and feelings, (d) increase client awareness around etiology of the Internet relationship, (e) assessment of the couple's context and readiness for change, (f) assess the presence of unique circumstances, and (g) work toward forgiveness. Implications and future research are discussed. © 2012 American Association for Marriage and Family Therapy.

The embodied and relational nature of the mind: implications for clinical interventions in aging individuals and populations.

Science.gov (United States)

Rejeski, W Jack; Gauvin, Lise

2013-01-01

Considerable research over the past decade has garnered support for the notion that the mind is both embodied and relational. Jointly, these terms imply that the brain, physical attributes of the self, and features of our interpersonal relationships and of the environments in which we live jointly regulate energy and information flow; they codetermine how we think, feel, and behave both individually and collectively. In addition to direct experience, evidence supports the view that stimuli embedded within past memories trigger multimodal simulations throughout the body and brain to literally recreate lived experience. In this paper, we review empirical support for the concept of an embodied and relational mind and then reflect on the implications of this perspective for clinical interventions in aging individuals and populations. Data suggest that environmental influences literally "get under the skin" with aging; that musculoskeletal and visceral sensations become more prominent in activities of the mind due to aging biological systems and chronic disease. We argue that conceiving the mind as embodied and relational will grow scientific inquiry in aging, transform how we think about the self-system and well-being, and lead us to rethink health promotion interventions aimed at aging individuals and populations.

Revenge Pornography: Mental Health Implications and Related Legislation.

Science.gov (United States)

Kamal, Mudasir; Newman, William J

2016-09-01

Revenge pornography, also known as nonconsensual pornography, is a subtype of cyberharassment/cyberstalking, and a serious problem facing society in the Internet age. Revenge pornography can result in lifelong mental health consequences for victims, damaged relationships, and social isolation. Recently, a growing number of states have recognized the importance of this phenomenon and have enacted legislation that criminalizes it. The technology industry has also taken steps to assist victims of revenge pornography by creating web forms to request removal of links leading to the explicit content. The Cyber Civil Rights Initiative (CCRI) has been instrumental in promoting public awareness of this often overlooked problem and in providing services for victims. Although important steps have been made, greater recognition of the gravity of this problem and the mental health implications of revenge pornography is needed to expand legislation criminalizing such acts. A federal criminal law, in particular, is much overdue. Mental health professionals must understand the dimensions of revenge pornography to be able to identify and address the consequences in both forensic and clinical settings. © 2016 American Academy of Psychiatry and the Law.

Young Adults' Attitudes and Perceptions of Obesity and Weight Management: Implications for Treatment Development.

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Lanoye, Autumn; Gorin, Amy A; LaRose, Jessica Gokee

2016-03-01

Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight-related constructs. The aim of this review is to explore young adults' attitudes toward obesity and weight management, with particular attention to those factors that may play a role in the development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults' perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group.

Young Adults’ Attitudes and Perceptions of Obesity and Weight Management: Implications for Treatment Development

Science.gov (United States)

Lanoye, Autumn; Gorin, Amy A.; LaRose, Jessica Gokee

2017-01-01

Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight related constructs. The aim of this review is to explore young adults’ attitudes toward obesity and weight management, with particular attention to those factors that may play a role in development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults’ perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group. PMID:26923688

Effectiveness of a social relations intervention program for aggressive and nonaggressive, rejected children.

Science.gov (United States)

Lochman, J E; Coie, J D; Underwood, M K; Terry, R

1993-12-01

A sample of 52 Black aggressive, rejected and nonaggressive, rejected children were randomly assigned to receive a social relations intervention or to be in a nonintervention control group. The school-based intervention for fourth-grade children focused on positive social skill training and cognitive-behavioral strategies to promote deliberate, nonimpulsive problem solving. At both the post-treatment and the 1-year follow-up assessments, the social relations intervention was found to be effective only with the aggressive, rejected children. Implications for the importance of assessing subtypes of rejected children are discussed.

The treatment of terms relating to Islam and the Arab World in ...

African Journals Online (AJOL)

This article investigates the treatment of vocabulary items relating to Islam and the Arab world in three major English dictionaries: Longman Dictionary of Contemporary English, New Oxford Dictionary of English, and Merriam-Webster's Collegiate Dictionary. The three dictionaries are compared with regard to their inclusion ...

Clinical Implications of Hedgehog Pathway Signaling in Prostate Cancer

Directory of Open Access Journals (Sweden)

Daniel L. Suzman

2015-09-01

Full Text Available Activity in the Hedgehog pathway, which regulates GLI-mediated transcription, is important in organogenesis and stem cell regulation in self-renewing organs, but is pathologically elevated in many human malignancies. Mutations leading to constitutive activation of the pathway have been implicated in medulloblastoma and basal cell carcinoma, and inhibition of the pathway has demonstrated clinical responses leading to the approval of the Smoothened inhibitor, vismodegib, for the treatment of advanced basal cell carcinoma. Aberrant Hedgehog pathway signaling has also been noted in prostate cancer with evidence suggesting that it may render prostate epithelial cells tumorigenic, drive the epithelial-to-mesenchymal transition, and contribute towards the development of castration-resistance through autocrine and paracrine signaling within the tumor microenvironment and cross-talk with the androgen pathway. In addition, there are emerging clinical data suggesting that inhibition of the Hedgehog pathway may be effective in the treatment of recurrent and metastatic prostate cancer. Here we will review these data and highlight areas of active clinical research as they relate to Hedgehog pathway inhibition in prostate cancer.

Prevention and treatment of radiotherapy-induced oral mucositis: a literature review; Prevencao e tratamento da mucosite oral induzida por radioterapia: revisao de literatura

Energy Technology Data Exchange (ETDEWEB)

Albuquerque, Ieda Lessa de Souza [Instituto Nacional de Cancer (INCa), Rio de Janeiro, RJ (Brazil). Hospital do Cancer I. Servico de Enfermagem]. E-mail: iedalessa@yahoo.com.br; Camargo, Teresa Caldas [Instituto Nacional de Cancer (INCa), Rio de Janeiro, RJ (Brazil). Hospital do Cancer III. Servico de Enfermagem]. E-mail: tcamargo@inca.gov.br

2007-04-15

The prevention and treatment of radiotherapy-induced oral mucositis have still not been fully defined. The current study thus involved a literature search aimed at identifying preventive and therapeutic measures in relation to oral mucositis in patients submitted to radiotherapy, analyzing the level of evidence in the selected studies, identifying which indications for prevention and treatment in the literature pertain to the field of nursing, and critically analyzing the results and their implications for nursing care. This was a systematic literature survey without a meta analysis, consulting the following databases: BIREME, Medline, CancerLit, Scirus, CAPES, Free medical journal, High wire press, SCIELO, and Medscape, from 2000 to 2005. According to observations, nursing care was capable of improving patient's quality of life, promoting education of patients, implementing and supervising oral care programs, and providing guidance on hygiene, prevention, and treatment of oral mucositis, including pain management. However, no Brazilian nursing publications were found on the subject. Research and publications focusing on nursing experience in the prevention and treatment of radiotherapy-related oral mucositis and the implications for patients and nurses are important to provide evidence-based nursing guidelines. (author)

Minireview: the health implications of water treatment with ozone.

Science.gov (United States)

Carmichael, N G; Winder, C; Borges, S H; Backhouse, B L; Lewis, P D

1982-01-11

Ozone is a highly efficient disinfectant which may have significant advantages in water treatment compared to chlorine. It has, however, been shown that mutagenic and possibly carcinogenic byproducts may be produced under certain conditions of ozonation. Light chlorination following ozonization may meet the highest standards of disinfection. In addition the destruction of much of the organic matter by prior ozone treatment may well result in less harmful chlorinated and brominated products in the finished water. In many cases ozone treatment alone may suffice. It would be desirable to test with long term in vivo experiments which of the alternatives produces the best combination of microbiologically clean and pleasant water with minimum mutagenic and carcinogenic effect.

Radiation safety implications of 131I treatment in a patient with Grave's disease undergoing home hemodialysis.

Science.gov (United States)

Simpson, J B; Godwin, G A

2006-12-01

The radiation safety implications following the administration of 131I for the treatment of Grave's disease to a patient undergoing home-based renal dialysis was investigated. External dose-rate measurements from the patient revealed a peak value at around day 2, post administration. The effective half-life was determined as 6.5 d. From day 3, the clearance of 131I was observed to be fairly constant and equated to 2.7% per day or 5.4% per dialysis session. From this the biological half-life was determined as 15 d. Radiation monitoring of the dialysis unit, disposables, and bed linen found no detectable contamination. For the purpose of useful protection, at a distance of 1 m from the patient, the average dose rate over the effective treatment duration was determined to be 8 microSv h(-1) and at 2 m distance, 2.6 microSv h(-1). Thus, in order to keep below a level of dose constraint of 3 mSv the total allowable time spent at 1 m would be 375 h or 15 h per day. To comply with a 1-mSv constraint, the average daily exposure allowable at 1 m would be 5 h per day. Neither of these time limits would be difficult to achieve for the majority of situations with fairly modest behavioral constraints. Initial discharge concentration rates into the waste water system are estimated at 200 MBq m(-3) and therefore might need to be considered depending upon the regulatory environment.

Treatment dropout in drug-addicted women: are eating disorders implicated?

Science.gov (United States)

Bonfà, F; Cabrini, S; Avanzi, M; Bettinardi, O; Spotti, R; Uber, E

2008-06-01

A high prevalence of eating disorders among drug-addicted female patients has been noted, and it could be associated to psychopathological underlying factors. Our aim was to assess eating disorder traits in women approaching a residential program for drug addiction. We hypothesized that these traits would correlate to more general psychopathological factors, and would influence treatment relapse. A sample of 204 substance dependent women attending a residential treatment was screened for psychopathological indices, and follow-up data were obtained at the end of the treatment. Clients had a high risk for eating disorders (15%), and lifetime prevalence was even higher (20%). Disordered eating was associated to psychopathological distress, in particular harm avoidance resulted significantly lower (p=0.005), evoking higher unresponsiveness to danger. Drug addiction treatment outcome is associated to completion of defined programs, and eating disorder was a key covariable in determining treatment relapse or success (p=0.03). Clinicians should be aware of this potential co-morbidity, and concurrent treatments should be attempted, in order to prevent symptomatic shifting.

Alternative methods of ophthalmic treatment in Russia.

Science.gov (United States)

Vader, L

1994-04-01

Russian ophthalmic nurses and physicians are using alternative methods of treatment to supplement traditional eye care. As acupuncture and iridology become more popular in the United States, ophthalmic nurses need to be more knowledgeable about these treatments and the implications for patients.

Trauma-Related Pain, Reexperiencing Symptoms, and Treatment of Posttraumatic Stress Disorder: A Longitudinal Study of Veterans.

Science.gov (United States)

Bartoszek, Gregory; Hannan, Susan M; Kamm, Janina; Pamp, Barbara; Maieritsch, Kelly P

2017-06-01

Research has demonstrated a strong positive association between posttraumatic stress disorder (PTSD) symptoms and physical pain. However, few studies have explored the impact of pain problems on the symptoms and treatment of PTSD, and results remain inconsistent. This longitudinal study examined whether trauma-related and trauma-unrelated pain differentially and uniquely predicted reexperiencing symptoms. We also examined whether levels of reexperiencing symptoms mediated the relationship between pain intensity and posttreatment symptoms of avoidance, numbing, and hyperarousal (ANH). Analyses were conducted using archival data from 99 treatment-seeking veterans who reported the etiology and intensity of their pain and severity of PTSD symptoms pre- and posttreatment. Among veterans with trauma-related pain, pain intensity (a) uniquely corresponded to greater posttreatment reexperiencing symptoms (b = 1.09), and (b) was indirectly predictive of ANH symptoms via the reexperiencing symptoms (b = 1.93). However, veterans with trauma-unrelated pain evidenced no associations between pain intensity and reexperiencing (b = 0.04) or ANH symptoms (b = 0.06). We thus found that trauma-related pain was indirectly related to poor PTSD treatment outcomes via reexperiencing symptoms. These findings offer additional insight into factors that may influence PTSD treatment outcomes for pain-suffering trauma survivors. Copyright © 2017 International Society for Traumatic Stress Studies.

Trauma cognitions are related to symptoms up to 10 years after cognitive behavioral treatment for posttraumatic stress disorder.

Science.gov (United States)

Scher, Christine D; Suvak, Michael K; Resick, Patricia A

2017-11-01

This study examined (a) relationships between trauma-related cognitions and posttraumatic stress disorder (PTSD) symptoms from pretreatment through a long-term period after cognitive-behavioral therapy (CBT) for PTSD and (b) whether these relationships were impacted by treatment type. Participants were 171 women randomized into treatment for PTSD after rape. Measures of self-reported trauma-related cognitions and interviewer-assessed PTSD symptoms (i.e., Posttraumatic Maladaptive Beliefs Scale, Trauma-Related Guilt Inventory, and Clinician-Administered PTSD Scale) were obtained at pretreatment, posttreatment, and 3-month, 9-month, and 5-10 year follow-ups. Multilevel regression analyses were used to examine relationships between trauma-related cognitions and PTSD symptoms throughout the study period and whether these relationships differed as a function of treatment type (i.e., Cognitive Processing Therapy or Prolonged Exposure). Initial multilevel regression analyses that examined mean within-participant associations suggested that beliefs regarding Reliability and Trustworthiness of Others, Self-Worth and Judgment, Threat of Harm, and Guilt were related to PTSD symptoms throughout follow-up. Growth curve modeling suggested that patterns of belief change throughout follow-up were similar to those previously observed in PTSD symptoms over the same time period. Finally, multilevel mediation analyses that incorporated time further suggested that change in beliefs was related to change in symptoms throughout follow-up. With 1 minor exception, relationships between beliefs and symptoms were not moderated by treatment type. These data suggest that trauma-related cognitions are a potential mechanism for long-term maintenance of treatment gains after CBT for PTSD. Moreover, these cognitions may be a common, rather than specific, treatment maintenance mechanism. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Relations of husbands and wives dysphoria to marital conflict resolution strategies.

Science.gov (United States)

Du Rocher Schudlich, Tina D; Papp, Lauren M; Cummings, E Mark

2004-03-01

This study investigated relations between spouses' dysphoria and constructive and destructive emotions and tactics displayed by husbands and wives throughout marital conflicts. Behavioral observations were made of 267 couples' interactions during marital conflict resolution tasks. Husbands' and wives' dysphoria levels were related to particular negative marital conflict expressions and the absence of positive strategies, even after taking into account couples' marital satisfaction and their partners' levels of dysphoria. Moreover, in comparison with wives' dysphoria, husbands' dysphoria was associated with more pervasive impairments in couples" conflict strategies evident in multiple contexts of conflict resolution, including discussion of relatively minor sources of disagreement. Implications for the treatment of depressed or maritally discordant couples are discussed.

Eating disorders in children: is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment?

Science.gov (United States)

Kennedy, Grace A; Wick, Madeline R; Keel, Pamela K

2018-01-01

Avoidant-restrictive food intake disorder (ARFID) is a current diagnosis in the "Feeding and Eating Disorders" section of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) and captures a heterogeneous presentation of eating disturbances. In recent years, ARFID has been studied primarily within the context of eating disorders despite having historical roots as a feeding disorder. The following review examines ARFID's similarities with and differences from feeding disorders and eating disorders, focusing on research published within the last three years. Implications of this differentiation for treatment are discussed.

Prefrontal cortex and drug abuse vulnerability: translation to prevention and treatment interventions.

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Perry, Jennifer L; Joseph, Jane E; Jiang, Yang; Zimmerman, Rick S; Kelly, Thomas H; Darna, Mahesh; Huettl, Peter; Dwoskin, Linda P; Bardo, Michael T

2011-01-01

Vulnerability to drug abuse is related to both reward seeking and impulsivity, two constructs thought to have a biological basis in the prefrontal cortex (PFC). This review addresses similarities and differences in neuroanatomy, neurochemistry and behavior associated with PFC function in rodents and humans. Emphasis is placed on monoamine and amino acid neurotransmitter systems located in anatomically distinct subregions: medial prefrontal cortex (mPFC); lateral prefrontal cortex (lPFC); anterior cingulate cortex (ACC); and orbitofrontal cortex (OFC). While there are complex interconnections and overlapping functions among these regions, each is thought to be involved in various functions related to health-related risk behaviors and drug abuse vulnerability. Among the various functions implicated, evidence suggests that mPFC is involved in reward processing, attention and drug reinstatement; lPFC is involved in decision-making, behavioral inhibition and attentional gating; ACC is involved in attention, emotional processing and self-monitoring; and OFC is involved in behavioral inhibition, signaling of expected outcomes and reward/punishment sensitivity. Individual differences (e.g., age and sex) influence functioning of these regions, which, in turn, impacts drug abuse vulnerability. Implications for the development of drug abuse prevention and treatment strategies aimed at engaging PFC inhibitory processes that may reduce risk-related behaviors are discussed, including the design of effective public service announcements, cognitive exercises, physical activity, direct current stimulation, feedback control training and pharmacotherapies. A major challenge in drug abuse prevention and treatment rests with improving intervention strategies aimed at strengthening PFC inhibitory systems among at-risk individuals. Copyright © 2010 Elsevier B.V. All rights reserved.

Potential psychological & neural mechanisms in binge eating disorder: Implications for treatment.

Science.gov (United States)

Kober, Hedy; Boswell, Rebecca G

2018-03-01

Binge Eating Disorder (BED) is a newly-established eating disorder diagnosis in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although systematic research on BED is in its infancy and many studies feature small samples, several observations emerge. First, we review diagnostic, developmental, and socio-demographic features of BED. Next, although BED and obesity are linked and frequently co-occur, we review data suggesting that BED is a distinct phenotype. Importantly, we take a mechanism-focused approach and propose four psychological processes with neurobiological bases that may uniquely differentiate BED from obesity: emotion reactivity, food-cue reactivity, food craving, and cognitive control. Further, we propose that interactions between impairments in cognitive control and increased emotional reactivity, food-cue reactivity, and craving may underlie emotion dysregulation and promote binge eating. Consistently, neuroimaging studies point towards neural alterations in the response to rewards and to food specifically, and suggest preliminary links between impaired cognitive-control-related neural activity and binge eating. However, additional systematic work is required in this area. We conclude with a detailed review of treatment approaches to BED; specifically, we suggest that psychological and pharmacological treatments that target core mechanisms - including cognitive control and emotion/craving dysregulation - may be particularly effective. Copyright © 2018 Elsevier Ltd. All rights reserved.

Implicative Algebras

African Journals Online (AJOL)

Tadesse

In this paper we introduce the concept of implicative algebras which is an equivalent definition of lattice implication algebra of Xu (1993) and further we prove that it is a regular Autometrized. Algebra. Further we remark that the binary operation → on lattice implicative algebra can never be associative. Key words: Implicative ...

Cannabis abstinence during treatment and one-year follow-up: relationship to neural activity in men.

Science.gov (United States)

Kober, Hedy; DeVito, Elise E; DeLeone, Cameron M; Carroll, Kathleen M; Potenza, Marc N

2014-09-01

Cannabis is among the most frequently abused substances in the United States. Cognitive control is a contributory factor in the maintenance of substance-use disorders and may relate to treatment response. Therefore, we assessed whether cognitive-control-related neural activity before treatment differs between treatment-seeking cannabis-dependent and healthy individuals and relates to cannabis-abstinence measures during treatment and 1-year follow-up. Cannabis-dependent males (N=20) completed a functional magnetic resonance imaging (fMRI) cognitive-control (Stroop) task before a 12-week randomized controlled trial of cognitive-behavioral therapy and/or contingency management. A healthy-comparison group (N=20) also completed the fMRI task. Cannabis use was assessed by urine toxicology and self-report during treatment, and by self-report across a 1-year follow-up period (N=18). The cannabis-dependent group displayed diminished Stroop-related neural activity relative to the healthy-comparison group in multiple regions, including those strongly implicated in cognitive-control and addiction-related processes (eg, dorsolateral prefrontal cortex and ventral striatum). The groups did not differ significantly in response times (cannabis-dependent, N=12; healthy-comparison, N=14). Within the cannabis-dependent group, greater Stroop-related activity in regions including the dorsal anterior cingulate cortex was associated with less cannabis use during treatment. Greater activity in regions including the ventral striatum was associated with less cannabis use during 1-year posttreatment follow-up. These data suggest that lower cognitive-control-related neural activity in classic 'control' regions (eg, dorsolateral prefrontal cortex and dorsal anterior cingulate) and classic 'salience/reward/learning' regions (eg, ventral striatum) differentiates cannabis-dependent individuals from healthy individuals and relates to less abstinence within-treatment and during long-term follow

Predicting treatment noncompliance among criminal justice-mandated clients: a theoretical and empirical exploration.

Science.gov (United States)

Sung, Hung-En; Belenko, Steven; Feng, Li; Tabachnick, Carrie

2004-01-01

Compliance with therapeutic regimens constitutes an important but infrequently studied precursor of treatment engagement and is a necessary condition of successful treatment. This study builds on recent treatment process research and provides a theory-driven analysis of treatment compliance. Five hypotheses are formulated to predict treatment noncompliance among criminal justice-mandated clients. These hypotheses tap different determinants of treatment progress, including physical prime, supportive social network, conventional social involvement, treatment motivation, and risk-taking propensity. Data from 150 addicted felons participating in a diversion program are analyzed to test the hypotheses. Predictors related to these hypotheses correctly identify 58% of the fully compliant clients and 55-88% of the noncompliant clients. Most hypotheses are at least partially corroborated and a few strong correlates emerge across analyses. Clients in their physical prime, those with poorer social support, and those lacking internal desires for change were found especially likely to violate treatment program rules. Clinical implications are discussed.

Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis susceptible patients. Part I: Clinical outcome. A randomized clinical trial.

Science.gov (United States)

Zasčiurinskienė, Eglė; Basevičienė, Nomeda; Lindsten, Rune; Slotte, Christer; Jansson, Henrik; Bjerklin, Krister

2018-02-01

To compare two treatment strategies regarding the effect of orthodontic treatment on periodontal status in patients with plaque-induced periodontitis. This was a randomized clinical trial. Fifty periodontal patients were randomly assigned to the test or control groups according to periodontal treatment timing. All patients received supra- and subgingival debridement following baseline examination. Control group patients received cause-related periodontal treatment before the start of orthodontic treatment and which was performed simultaneous to orthodontic treatment for the test group patients. No difference between the test and control groups was found regarding change of clinical attachment level (CAL) after periodontal-orthodontic treatment. Fewer sites with initial pocket depth (PD) of 4-6 mm healed after periodontal-orthodontic treatment in the test group (20.5%, IQR = 11.9%) in comparison with controls (30.4%, IQR = 27.1%) (p = .03). Anterior teeth [OR 2.5] and teeth in male patients [OR 1.6] had a greater chance for PD improvement ≥2 mm. Total periodontal-orthodontic treatment duration was significantly longer for the control group (p Orthodontic treatment, simultaneously to the periodontal treatment, could be used in the routine treatment of patients with plaque-induced periodontitis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review.

Directory of Open Access Journals (Sweden)

Janine T Hidding

Full Text Available BACKGROUND: Breast cancer is the most common type of cancer in women in the developed world. As a result of breast cancer treatment, many patients suffer from serious complaints in their arm and shoulder, leading to limitations in activities of daily living and participation. In this systematic literature review we present an overview of the adverse effects of the integrated breast cancer treatment related to impairment in functions and structures in the upper extremity and upper body and limitations in daily activities. Patients at highest risk were defined. METHODS AND FINDINGS: We conducted a systematic literature search using the databases of PubMed, Embase, CINAHL and Cochrane from 2000 to October 2012, according to the PRISMA guidelines. Included were studies with patients with stage I-III breast cancer, treated with surgery and additional treatments (radiotherapy, chemotherapy and hormonal therapy. The following health outcomes were extracted: reduced joint mobility, reduced muscle strength, pain, lymphedema and limitations in daily activities. Outcomes were divided in within the first 12 months and >12 months post-operatively. Patients treated with ALND are at the highest risk of developing impairments of the arm and shoulder. Reduced ROM and muscle strength, pain, lymphedema and decreased degree of activities in daily living were reported most frequently in relation to ALND. Lumpectomy was related to a decline in the level of activities of daily living. Radiotherapy and hormonal therapy were the main risk factors for pain. CONCLUSIONS: Patients treated with ALND require special attention to detect and consequently address impairments in the arm and shoulder. Patients with pain should be monitored carefully, because pain limits the degree of daily activities. Future research has to describe a complete overview of the medical treatment and analyze outcome in relation to the treatment. Utilization of uniform validated measurement

Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review.

Science.gov (United States)

Hidding, Janine T; Beurskens, Carien H G; van der Wees, Philip J; van Laarhoven, Hanneke W M; Nijhuis-van der Sanden, Maria W G

2014-01-01

Breast cancer is the most common type of cancer in women in the developed world. As a result of breast cancer treatment, many patients suffer from serious complaints in their arm and shoulder, leading to limitations in activities of daily living and participation. In this systematic literature review we present an overview of the adverse effects of the integrated breast cancer treatment related to impairment in functions and structures in the upper extremity and upper body and limitations in daily activities. Patients at highest risk were defined. We conducted a systematic literature search using the databases of PubMed, Embase, CINAHL and Cochrane from 2000 to October 2012, according to the PRISMA guidelines. Included were studies with patients with stage I-III breast cancer, treated with surgery and additional treatments (radiotherapy, chemotherapy and hormonal therapy). The following health outcomes were extracted: reduced joint mobility, reduced muscle strength, pain, lymphedema and limitations in daily activities. Outcomes were divided in within the first 12 months and >12 months post-operatively. Patients treated with ALND are at the highest risk of developing impairments of the arm and shoulder. Reduced ROM and muscle strength, pain, lymphedema and decreased degree of activities in daily living were reported most frequently in relation to ALND. Lumpectomy was related to a decline in the level of activities of daily living. Radiotherapy and hormonal therapy were the main risk factors for pain. Patients treated with ALND require special attention to detect and consequently address impairments in the arm and shoulder. Patients with pain should be monitored carefully, because pain limits the degree of daily activities. Future research has to describe a complete overview of the medical treatment and analyze outcome in relation to the treatment. Utilization of uniform validated measurement instruments has to be encouraged.

Epidemiology and treatment of relative anemia in children with sickle cell disease in sub-Saharan Africa.

Science.gov (United States)

Bello-Manga, Halima; DeBaun, Michael R; Kassim, Adetola A

2016-11-01

Sickle cell disease (SCD) is the most common inherited hemoglobinopathy in the world, with the majority of cases in sub-Saharan Africa. Concomitant nutritional deficiencies, infections or exposure to environmental toxins exacerbate chronic anemia in children with SCD. The resulting relative anemia is associated with increased risk of strokes, poor cognitive function and impaired growth. It may also attenuate optimal response to hydroxyurea therapy, the only effective and practical treatment option for SCD in sub-Saharan Africa. This review will focus on the epidemiology, clinical sequelae, and treatment of relative anemia in children with SCD living in low and middle-income countries in sub-Saharan Africa. Areas covered: The causes and treatment of relative anemia in children with SCD in sub-Saharan Africa. The MEDLINE database was searched using medical subject headings (MeSH) and keywords for articles regarding relative anemia in children with SCD in sub-Saharan Africa. Expert commentary: Anemia due to nutritional deficiencies and infectious diseases such as helminthiasis and malaria are prevalent in sub-Saharan Africa. Their co-existence in children with SCD increases morbidity and mortality. Therefore, preventing, diagnosing and treating the underlying cause of this relative anemia will improve SCD-related outcomes in children in sub-Saharan Africa.

Cognitive Factors in Fibromyalgia: The Role of Self-Concept and Identity Related Conflicts

Science.gov (United States)

Compañ, Victoria; Feixas, Guillem; Varlotta-Domínguez, Nicolás; Torres-Viñals, Mercedes; Aguilar-Alonso, Ángel; Dada, Gloria; Ángel Saúl, Luís

2010-01-01

Fibromyalgia is a syndrome characterized by the presence of diffuse and chronic musculoskeletal pain of unknown etiology. Clinical diagnosis and the merely palliative treatments considerably affect the patient's experience and the chronic course of the disease. Therefore, several authors have emphasized the need to explore issues related to self in these patients. The repertory grid technique (RGT), derived from personal construct theory, is a method designed to assess the patient's construction of self and others. A group of women with fibromyalgia (n = 30) and a control group (n = 30) were assessed using RGT. Women with fibromyalgia also completed the Fibromyalgia Impact Questionnaire and a visualanalogue scale for pain, and painful tender points were explored. Results suggest that these women had a higher present self–ideal self discrepancy and a lower perceived adequacy of others, and it was more likely to find implicative dilemmas among them compared to controls. These dilemmas are a type of cognitive conflict in which the symptom is construed as “enmeshed” with positive characteristics of the self. Finally, implications of these results for the psychological treatment of fibromyalgia are suggested to give a more central role to self-identity issues and to the related cognitive conflicts. PMID:22629110

Phase-based treatment versus immediate trauma-focused treatment in patients with childhood trauma-related posttraumatic stress disorder : study protocol for a randomized controlled trial

NARCIS (Netherlands)

van Vliet, Noortje I.; Huntjens, Rafaele J. C.; van Dijk, Maarten K.; de Jongh, Ad

2018-01-01

Background: The treatment of posttraumatic stress disorder (PTSD) related to a history of sexual and/or physical abuse in childhood is the subject of international debate, with some favouring a phase-based approach as their preferred treatment, while others argue for immediate trauma-focused

Phase-based treatment versus immediate trauma-focused treatment in patients with childhood trauma-related posttraumatic stress disorder : study protocol for a randomized controlled trial

NARCIS (Netherlands)

van Vliet, Noortje I; Huntjens, Rafaele J C; van Dijk, Maarten K; de Jongh, Ad

2018-01-01

BACKGROUND: The treatment of posttraumatic stress disorder (PTSD) related to a history of sexual and/or physical abuse in childhood is the subject of international debate, with some favouring a phase-based approach as their preferred treatment, while others argue for immediate trauma-focused

The Parameters Related to Polycystic Ovarian Syndrome in Epileptic Patients Under Valproate Treatment

Directory of Open Access Journals (Sweden)

Nilgün CENGIZ

2005-09-01

Full Text Available OBJECTIVE: To investigate the parameters related to polycystic ovarian syndrome (PCOS in epileptic patients under valproate (VPA treatment. Design: Cross-sectional clinical study. Setting: Ondokuz Mayis University Teaching Hospital. Patients: 16 patients using VPA for epileptic disorders. Intervensions: Reproductive history, measurement of height and weight, hormone analyses, pelvic ultrasonography. Main outcome measures: Menstrual regularity, body mass index (BMI, early follicular phase serum total testosterone level and LH/FSH ratio, fasting insulin level, polycystic ovaries (PCO’s at ultrasonography. RESULTS: Thirteen patients used VPA for generalized tonic-clonic seizures (81.2% and 3 patients for focal seizures (18.8%. Mean duration of treatment was 4.9±2.9 (2-13 years. 37.5% of the patients had irregular menses in the pattern of oligomenorrhea. Mean BMI was 22.4±3.0 (17.4-27.3 kg/m2 in the group. Only 2 patients had an LH/FSH ratio of ≥ 2 (12.5%, and hyperandrogenemia was detected at a ratio of 37.5%. Insulin levels of all the patients were within the normal range. PCO’s were observed at ultrasonography at a ratio of 62.5%. Seven out of our 16 patients were diagnosed as PCOS (43.8%. Correlation analyses didn’t reveal any significant relation between the BMI, LH/FSH ratios, total testosteron and insulin levels of the patients (p>0,05. CONCLUSIONS: The relationship of epilepsy – VPA treatment – and PCOS is a controversial issue. PCOS is diagnosed at quite a high ratio in our patient group, which mostly consisted of the ones with generalized tonic-clonic seizures. Besides the epileptic disorder itself, this high ratio appears to be related to the VPA treatment as well

Quantum histories and their implications

International Nuclear Information System (INIS)

Kent, A.

2000-01-01

Classical mechanics and standard Copenhagen quantum mechanics respect subspace implications. For example, if a particle is confined in a particular region R of space, then in these theories we can deduce that it is confined in regions containing R. However, subspace implications are generally violated by versions of quantum theory that assign probabilities to histories, such as the consistent histories approach. I define here a new criterion, ordered consistency, which refines the criterion of consistency and has the property that inferences made by ordered consistent sets do not violate subspace relations. This raises the question: do the operators defining our observations form an ordered consistent history? If so, ordered consistency defines a version of quantum theory with greater predictive power than the consistent histories formalism. If not, and our observations are defined by a non-ordered consistent quantum history, then subspace implications are not generally valid. (orig.)

Do Assault-Related Variables Predict Response to Cognitive Behavioral Treatment for PTSD?

Science.gov (United States)

Hembree, Elizabeth A.; Street, Gordon P.; Riggs, David S.; Foa, Edna B.

2004-01-01

This study examined the hypothesis that variables such as history of prior trauma, assault severity, and type of assault, previously found to be associated with natural recovery, would also predict treatment outcome. Trauma-related variables were examined as predictors of posttreatment posttraumatic stress disorder (PTSD) severity in a sample of…

[Tamsulosin, oxybutynin or their combination in the treatment of ureteral stent-related symptoms].

Science.gov (United States)

Maldonado-Alcaraz, Efraín; Moreno-Palacios, Jorge; López-Sámano, Virgilio A; Landa-Salas, Jason D; Torres-Mercado, León O; García-Cruz, Carlos

2017-01-01

The aim of this paper is to compare the efficacy of tamsulosin, oxybutynin or their combination for the treatment of symptoms related to double J stent (DJS). Randomized clinical non-blinded trial with three arms (tamsulosin, oxybutynin or combination) to assess the improvement of ureteral related symptoms with DJS with the questionnaire of Ureteral Stent Symptom Questionnaire (USSQ) and the adverse effects of treatment. Evaluations were made at 7 and 21 days after the placement of DJS. The maneuvers were compared using Chi squared test, Kruskall-Wallis, ANOVA and Wilcoxon considering a statistically significant p ≤ 0.05. 170 patients with CJJ were evaluated. A perprotocol analysis was performed in 142 patients, 53 received tamsulosin (37.4%), 42 oxybutynin (29.6%) and 47 the combination of both (33%). At 7 and 21 days the improvement was similar in all three arms. Men with tamsulosin and women with oxybutynin had less general symptoms. Tamsulosin, oxybutynin or its combination similarly improve ureteral stent related symptoms and this improvement becomes more noticeable over time. Men are less symptomatic with tamsulosin and women with oxybutynin.

Acquired apraxia of speech: features, accounts, and treatment.

Science.gov (United States)

Peach, Richard K

2004-01-01

The features of apraxia of speech (AOS) are presented with regard to both traditional and contemporary descriptions of the disorder. Models of speech processing, including the neurological bases for apraxia of speech, are discussed. Recent findings concerning subcortical contributions to apraxia of speech and the role of the insula are presented. The key features to differentially diagnose AOS from related speech syndromes are identified. Treatment implications derived from motor accounts of AOS are presented along with a summary of current approaches designed to treat the various subcomponents of the disorder. Finally, guidelines are provided for treating the AOS patient with coexisting aphasia.

Risk of bleeding related to antithrombotic treatment in cardiovascular disease

DEFF Research Database (Denmark)

Sørensen, Rikke; Olesen, Jonas B; Charlot, Mette

2012-01-01

Antithrombotic therapy is a cornerstone of treatment in patients with cardiovascular disease with bleeding being the most feared complication. This review describes the risk of bleeding related to different combinations of antithrombotic drugs used for cardiovascular disease: acute coronary...... syndrome (ACS), atrial fibrillation (AF), cerebrovascular (CVD) and peripheral arterial disease (PAD). Different risk assessment schemes and bleeding definitions are compared. The HAS-BLED risk score is recommended in patients with AF and in ACS patients with AF. In patients with ACS with or without...

Mental health treatment-related stigma and professional help seeking among student veterans.

Science.gov (United States)

Currier, Joseph M; McDermott, Ryon C; McCormick, Wesley H

2017-11-01

Record numbers of military veterans are enrolling at colleges/universities across the United States. Although a substantive subset might suffer from mental health problems, the majority of these students might not be amenable to utilizing services. The purpose of this study was to examine the role of treatment-related stigma in intentions to seek professional help among undergraduate student veterans at a university on the U.S. Gulf Coast. Focusing on 251 veterans and a gender-matched comparison group of 251 nonveterans, student veterans endorsed higher probabilities of seeking care from physicians (d = .77) and psychologists or other professionals (d = .67). In addition, nonveteran students had greater self-stigma about seeking help (d = -.27) but veterans had more negative beliefs about treatment efficacy (d = 1.07). When compared with veterans who did not exceed clinical thresholds, those with a probable need for treatment had more stigma (ds = .63). Multivariate analyses also revealed an inverse main effect of self-stigma on intentions to seek help from both professional categories. However, military experience differentially moderated associations between treatment-related beliefs and intentions to seek mental health services. Finally, exploratory analyses identified that student veterans were most likely to engage in therapy/counseling at a Veterans Affairs Medical Center or Clinic, Vet Center, or other noninstitutionally sponsored settings in the community (e.g., private practices, faith-based organizations). Looking ahead, these findings will inform research and the provision of services for addressing the mental health needs of this substantive subpopulation of college students in the United States. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Changes in Tracheostomy- and Intubation-Related Tracheal Stenosis: Implications for Surgery.

Science.gov (United States)

Kim, Samuel S; Khalpey, Zain; Hsu, Charles; Little, Alex G

2017-09-01

This study sought to identify the changing characteristic patterns and locations of stenosis after tracheostomy or intubation and to assess the risk factors associated with perioperative complication and restenosis after primary resection and reconstruction. A retrospective review was performed (January /2012 to March 2015) on patients treated at the University of Arizona Medical Center (Tucson, Arizona) who had symptomatic tracheal stenosis secondary to prolonged intubation or tracheostomy. Data on demographics, surgical approach, and outcome were obtained. Analysis was performed using the χ 2 test, Kaplan-Meier estimate of survival, Cox proportional hazards survival analysis, and univariate and multivariate logistic regression. Forty-eight patients were referred for surgical resection, and 36 patients underwent primary resection and reconstruction; 72% of patients had previous endobronchial treatments for stenosis. Fourteen patients had postintubation tracheal stenosis, and 22 had tracheostomy-related stenosis (16 percutaneous, 6 open tracheostomy). Among all patients, 52.8% had stenosis proximal to or involving the cricoid; 72.7% of patients with tracheostomy-related stenosis had stenosis at or proximal to the cricoid, whereas only 21.4% of the patients with intubation-related stenosis had a similar location. Nineteen patients underwent laryngotracheal resection, and 17 patients had tracheal resection. The mean length of resection was 3.6 cm. A body mass index greater than 35 was associated with increased perioperative complications (p = 0.012). In multivariate analysis, patients younger than 30 years of age at operation had an increased relative risk of recurrence. Recent advances in percutaneous tracheostomy have increased the numbers of patients presenting with proximal tracheal stenosis, thus necessitating more complex subglottic resection and reconstruction. The anastomotic and overall complication rate remains low despite these more complex operations

The Influence of Treatment Motivation on Outcomes of Social Skills Training for Juvenile Delinquents.

Science.gov (United States)

van der Stouwe, Trudy; Asscher, Jessica J; Hoeve, Machteld; van der Laan, Peter H; Stams, Geert Jan J M

2018-01-01

This study examined the influence of treatment motivation on posttreatment effectiveness of an outpatient, individual social skills training for juvenile delinquents imposed as a penal sanction. Propensity score matching was used to match a control group of juveniles receiving treatment as usual ( n = 108 of total N = 354) to a treatment group of juveniles receiving Tools4U, a social skills training with a parental component ( N = 115). Treatment motivation was examined as a moderator and predictor of treatment effects on impulsivity, social perspective-taking, social problem-solving, lack of critical reasoning, developmental task-related skills, and parenting skills. Treatment effects were mostly consistent across juveniles with different levels of treatment motivation. Only one moderating effect was found on active tackling (i.e., actively addressing problems), and predictive effects were found on seeking social support, cognitive empathy, hostile intent attribution, and self-centeredness. Implications for further research are discussed.

The Influence of Treatment Motivation on Outcomes of Social Skills Training for Juvenile Delinquents

Science.gov (United States)

van der Stouwe, Trudy; Asscher, Jessica J.; Hoeve, Machteld; van der Laan, Peter H.; Stams, Geert Jan J. M.

2016-01-01

This study examined the influence of treatment motivation on posttreatment effectiveness of an outpatient, individual social skills training for juvenile delinquents imposed as a penal sanction. Propensity score matching was used to match a control group of juveniles receiving treatment as usual (n = 108 of total N = 354) to a treatment group of juveniles receiving Tools4U, a social skills training with a parental component (N = 115). Treatment motivation was examined as a moderator and predictor of treatment effects on impulsivity, social perspective-taking, social problem-solving, lack of critical reasoning, developmental task-related skills, and parenting skills. Treatment effects were mostly consistent across juveniles with different levels of treatment motivation. Only one moderating effect was found on active tackling (i.e., actively addressing problems), and predictive effects were found on seeking social support, cognitive empathy, hostile intent attribution, and self-centeredness. Implications for further research are discussed. PMID:27225504

Oral health-related concerns, behavior, and communication with health care providers of patients with breast cancer: impact of different treatments.

Science.gov (United States)

Taichman, L Susan; Van Poznak, Catherine H; Inglehart, Marita R

2018-01-01

The objectives are to compare responses of breast cancer (BCa) treatment groups (chemotherapy, tamoxifen, and aromatase inhibitors (AIs) to each other and a control regarding (a) subjective oral health, (b) oral health-related behaviors, (c) oral health-related concerns, and (d) communication with health care providers. Survey data were collected from 140 postmenopausal BCa patients and 41 healthy postmenopausal control respondents. BCa patients reported on average more frequent mouth sores/mucositis (5-point scale with 1 = never: 1.63 vs. 1.14; p oral health than patients on tamoxifen/AI (93% vs. 55%/56%; p oral health-related effects of cancer treatment than by dentists. Oncologists/nurses were more likely to communicate about oral health-related treatment effects with patients undergoing chemotherapy than patients on tamoxifen or AIs. Few BCa patients perceived dentists as knowledgeable about cancer treatment-related oral concerns and trusted them less than oncologists. BCa treatments impact oral health. Low percentages of BCa patients had received specific information about impacts of BCa treatments on oral health from their dentists. © 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.

Distress Tolerance among Students Referred for Treatment Following Violation of\\ud Campus Cannabis Use Policy: Relations to Use, Problems, and Motivation

OpenAIRE

Buckner, Julia D.; Jeffries, Emily R.; Terlecki, Meredith A.; Ecker, Anthony H.

2015-01-01

Students referred to treatment after violating campus drug policies represent a high-risk\\ud group. Identification of factors related to these students’ cannabis use could inform prevention\\ud and treatment efforts. Distress tolerance (DT) is negatively related to substance-related\\ud behaviors and may be related to high-risk cannabis use vulnerability factors that can impact\\ud treatment outcome. Thus, the current study tested whether DT was related to cannabis use\\ud frequency, cannabis-rel...

Masticatory performance and oral health-related quality of life before and after complete denture treatment.

Science.gov (United States)

Yamamoto, Saori; Shiga, Hiroshi

2018-03-13

To clarify the relationship between masticatory performance and oral health-related quality of life (OHRQoL) before and after complete denture treatment. Thirty patients wearing complete dentures were asked to chew a gummy jelly on their habitual chewing side, and the amount of glucose extraction during chewing was measured as the parameter of masticatory performance. Subjects were asked to answer the Oral Health Impact Profile (OHIP-J49) questionnaire, which consists of 49 questions related to oral problems. The total score of 49 question items along with individual domain scores within the seven domains (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability and handicap) were calculated and used as the parameters of OHRQoL. These records were obtained before treatment and 3 months after treatment. Each parameter of masticatory performance and OHRQoL was compared before treatment and after treatment. The relationship between masticatory performance and OHRQoL was investigated, and a stepwise multiple linear regression analysis was performed. Both masticatory performance and OHRQoL were significantly improved after treatment. Furthermore, masticatory performance was significantly correlated with some parameters of OHRQoL. The stepwise multiple linear regression analysis showed functional limitation and pain as important factors affecting masticatory performance before treatment and functional limitation as important factors affecting masticatory performance after treatment. These results suggested that masticatory performance and OHRQoL are significantly improved after treatment and that there is a close relationship between the two. Moreover, functional limitation was found to be the most important factor affecting masticatory performance. Copyright © 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

The Military Coup and its Implications for the Thai Economy

DEFF Research Database (Denmark)

Schmidt, Johannes Dragsbæk

The paper analyses the regional and international implications of the Thai military coup in September 2006. Focus is furthermore  attached to the economic consequences and the geo-political and geo-economic aspects related to the coup.......The paper analyses the regional and international implications of the Thai military coup in September 2006. Focus is furthermore  attached to the economic consequences and the geo-political and geo-economic aspects related to the coup....

Treatment implications of high-resolution manometry findings: options for patients with esophageal dysmotility.

Science.gov (United States)

Bolkhir, Ahmed; Gyawali, C Prakash

2014-03-01

High-resolution manometry (HRM) has significantly impacted diagnosis and management of achalasia in particular, and has improved characterization of other motor disorders. Achalasia, the most profound esophageal motor disorder, is characterized by esophageal outflow obstruction from abnormal relaxation of the lower esophageal sphincter (LES) during swallowing, and presents with transit symptoms (dysphagia, regurgitation). Esophageal body motor disorders include both inhibitory nerve dysfunction associated with hypermotility or spasm, and hypomotility disorders with poor contraction. The implications of hypermotility disorders are both perceptive and obstructive. On the other hand, hypomotility disorders have reflux implications because of abnormal barrier function at the LES, and abnormal bolus clearance. Esophageal outflow obstruction in achalasia responds favorably to disruption of the LES, and outcome may be predicted by HRM subtyping of achalasia. Identification of dominant (perceptive vs. obstructive) mechanisms of symptom generation help direct therapy of hypermotility disorders, while hypomotility disorders typically require management of concurrent reflux disease.

Decline in adolescent treatment admissions for methamphetamine ...

African Journals Online (AJOL)

Background and objectives. The purpose of this report is to describe the changing trends in adolescent treatment admissions for methamphetamine in Cape Town, and to discuss possible implications. Method. Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug ...

Hostile attribution biases for relationally provocative situations and event-related potentials.

Science.gov (United States)

Godleski, Stephanie A; Ostrov, Jamie M; Houston, Rebecca J; Schlienz, Nicolas J

2010-04-01

This exploratory study investigates how hostile attribution biases for relationally provocative situations may be related to neurocognitive processing using the P300 event-related potential. Participants were 112 (45 women) emerging adults enrolled in a large, public university in upstate New York. Participants completed self-report measures on relational aggression and hostile attribution biases and performed an auditory perseveration task to elicit the P300. It was found that hostile attribution biases for relational provocation situations was associated with a larger P300 amplitude above and beyond the role of hostile attribution biases for instrumental situations, relational aggression, and gender. Larger P300 amplitude is interpreted to reflect greater allocation of cognitive resources or enhanced "attending" to salient stimuli. Implications for methodological approaches to studying aggression and hostile attribution biases and for theory are discussed, as well as implications for the fields of developmental psychology and psychopathology. Copyright 2010 Elsevier B.V. All rights reserved.

IMPLICATION OF THE FIXED COMBINATIONS IN THE HYPERTENSION TREATMENT

Directory of Open Access Journals (Sweden)

Z. D. Kobalava

2010-01-01

Full Text Available The role of fixed combinations in the hypertension (HT treatment is discussed. Theoretical and practical aspects of combination therapy, principles of rational combination therapy are present. Current guidelines on the use of fixed dose combinations, including start antihypertensive therapy are analyzed. Classification of combinations, advantages and limitations of some of them implementation are also presented. Significance of beta-blocker bisoprolol and thiazide diuretic hydrochlorothiazide fixed combination (Lodoz is shown in HT treatment.

Alcohol abuse and related disorders treatment of alcohol dependence

Directory of Open Access Journals (Sweden)

Yu. P. Sivolap

2014-01-01

Full Text Available Alcohol abuse and alcoholism are the leading causes of worse health and increased mortality rates. Excessive alcohol consumption is the third leading cause of the global burden of diseases and a leading factor for lower lifespan and higher mortality. Alcohol abuse decreases working capacity and efficiency and requires the increased cost of the treatment of alcohol-induced disorders, which entails serious economic losses. The unfavorable medical and social consequences of excessive alcohol use determine the importance of effective treatment for alcoholism. The goals of rational pharmacotherapy of alcohol dependence are to enhance GABA neurotransmission, to suppress glutamate neurotransmission, to act on serotonin neurotransmission, to correct water-electrolyte balance, and to compensate for thiamine deficiency. Alcoholism treatment consists of two steps: 1 the prevention and treatment of alcohol withdrawal syndrome and its complications (withdrawal convulsions and delirium alcoholicum; 2 antirecurrent (maintenance therapy. Benzodiazepines are the drugs of choice in alleviating alcohol withdrawal and preventing its convulsive attacks and delirium alcoholicum. Diazepam and chlordiazepoxide are most commonly used for this purpose; the safer drugs oxazepam and lorazepam are given to the elderly and patients with severe liver lesions. Anticonvulsants having normothymic properties, such as carbamazepine, valproic acid, topiramate, and lamotrigine, are a definite alternative to benzodiazepines. The traditional Russian clinical practice (clearance detoxification has not a scientific base or significant impact on alcohol withdrawal-related states in addicts. Relapse prevention and maintenance therapy for alcohol dependence are performed using disulfiram, acamprosate, and naltrexone; since 2013 the European Union member countries have been using, besides these agents, nalmefene that is being registered in Russia. Memantine and a number of other

Implications of surgical intervention in the treatment of neuroblastomas. 20-year experience of a single institution

International Nuclear Information System (INIS)

Tajiri, Tatsuro; Souzaki, Ryota; Kinoshita, Yoshiaki; Koga, Yuhki; Suminoe, Aiko; Hara, Toshiro; Taguchi, Tomoaki

2012-01-01

The implications of surgical intervention for neuroblastomas were assessed in one institution. We analyzed the clinical characteristics and extension of resection in 123 pediatric patients with neuroblastoma diagnosed between 1985 and 2004. The 5-year survival rate of the 82 patients under 12 months of age, 59 of whom were treated with complete resection of the primary tumor, was 97%. The 5-year survival rate of the 41 patients over 12 months of age did not differ significantly according to whether complete (n=19) or incomplete resection (n=22) was performed (46 vs. 38%, respectively). No local recurrence was observed in ten patients over 12 months of age with stage 4 disease who underwent complete resection of the primary tumor; however, four of these ten patients died of metastatic recurrence. Considering that the majority of infantile neuroblastomas in this study had favorable biology, complete resection might be unnecessary for patients under 12 years of age. For advanced neuroblastomas in patients over 12 months of age, the main treatment for metastasis is systemic chemotherapy, although extirpation of the primary tumor without extensive surgery might prevent local recurrence when combined with radiation therapy. (author)

Tocilizumab treatment for refractory uveitis-related cystoid macular edema.

Science.gov (United States)

Adán, Alfredo; Mesquida, Marina; Llorenç, Victor; Espinosa, Gerard; Molins, Blanca; Hernández, Maria V; Pelegrín, Laura

2013-11-01

This retrospective study investigated the efficacy of tocilizumab (TCZ), a fully humanized antibody that binds both to soluble and membrane bound IL-6 receptors, for the treatment of uveitis-related cystoid macular edema (CME) refractory to immunomodulatory therapy. Five refractory patients with uveitis-related CME who received TCZ between January and August 2012 were included. All patients received 8 mg/kg TCZ at 4-week intervals. Data regarding patient demographics, use of immunosuppressive drugs, biologic agents or intravitreal therapies prior to TCZ infusions were collected. Main outcome measure was central foveal thickness (CFT) measured by optical coherence tomography at 6 months. Secondary outcome measures were degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria) and visual acuity (logarithm of the minimum angle of resolution [log-MAR]) at month 6. Adverse events (AEs) related to TCZ therapy were also assessed. Eight eyes from five patients (all females) were included. Mean age was 49.4 years (range, 30-68). Mean follow-up was 8.4 months (range, 6-12). Before TCZ, all patients received and failed conventional immunosuppressive therapy and had received at least another biologic agent. Uveitis diagnoses were Birdshot chorioretinopathy (n = 3), juvenile idiopathic arthritis (JIA)-associated uveitis (n = 1), and idiopathic panuveitis (n = 1). Mean evolution of CME was 13.4 years (range, 2-30). Mean baseline CFT (95% confidence interval) was 602 ± 236 μm at baseline, 386 ± 113 μm at month 1 (p = 0.006), 323 ± 103 μm at month 3 (p = 0.026), and 294.5 ± 94.5 μm at month 6 (p = 0.014). Median best-corrected visual acuity (BCVA) improved from 0.66 ± 0.57 at baseline to 0.47 ± 0.62 at month 6 (p = 0.035). After 6 months, an improvement of ≥ 2 lines of BCVA was observed in 50% of eyes (p = 0.028) remained stable in 25% and worsened in none of the patients. Sustained uveitis remission was

Health-Related Quality of Life of Rural Clients Seeking Telepsychology Services

Directory of Open Access Journals (Sweden)

Kevin R. Tarlow

2014-01-01

Full Text Available Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n=94 had low health-related quality of life (HRQOL, often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n=40 was associated with an improvement in mental health-related quality of life (d = 0.70,  P<.001. These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.

Changes in children′s oral health related quality of life following dental treatment under general anesthesia

Directory of Open Access Journals (Sweden)

Seyed Ebrahim Jabarifar

2009-01-01

Full Text Available Background: Children′s oral health related quality of life (OHRQoL evaluates the impacts of oral daily activities of children and family on quality of life. Oral health related quality of life as outcome can be used to evaluate the dental health services. This study aimed to assess the extent to which den-tal treatment under general anesthesia affects quality of life of children and their families. Methods: One hundred parents of 3-10 year-old children who needed dental treatment under general anesthesia completed a parent-children perception questionnaire (P-CPQ and family impact scale (FIS before, and 4 weeks after dental treatment under general anesthesia. The questionnaire had statements related to oral health, functional limitation, emotional state and well being social well-being and family issues. Data were analyzed using SPSS version 11.5. Results: The mean scores and standard deviations of oral health quality of life of the children before and after dental treatment were 43.3 ± 7.14 and 39.24 ± 5.47 respectively. The mean scores of FIS before and after dental treatment were 8.00 ± 3.21 and 3.66 ± 2.62, respectively. The effect size of mean differences in P-CPQ and FIS scores were 1.84 ± 1.64 and 1.35 ± 4.34, respectively. Conclusion: Provision of dental treatment under general anesthesia for uncooperative, young chil-dren with extensive dental problems had significant effects on quality of life of both children and their families.

Antipsychotic treatment in schizophrenia: the role of computerized neuropsychological assessment.

Science.gov (United States)

Kertzman, Semion; Reznik, Ilya; Grinspan, Haim; Weizman, Abraham; Kotler, Moshe

2008-01-01

The present study analyzes the role of neurocognitive assessment instruments in the detection of the contribution of antipsychotic treatment to cognitive functioning. Recently, a panel of experts suggested six main domains (working memory; attention/vigilance; verbal/visual learning and memory; reasoning and problem solving; speed of processing) implicated in schizophrenia-related cognitive deficits, which serve as a theoretical base for creation of real-time computerized neurocognitive batteries. The high sensitivity of computerized neuropsychological testing is based on their ability to adopt the reaction time (RT) paradigm for the assessment of brain function in a real-time regime. This testing is highly relevant for the monitoring of the cognitive effects of antipsychotics. Computerized assessment assists in the identification of state- and trait-related cognitive impairments. The optimal real-time computerized neurocognitive battery should composite balance between broad and narrow coverage of cognitive domains relevant to the beneficial effects of antipsychotics and will enable better planning of treatment and rehabilitation programs.

Neoadjuvant twice daily chemoradiotherapy for esophageal cancer: Treatment-related mortality and long-term outcomes

Directory of Open Access Journals (Sweden)

Stuart E. Samuels, MD, PhD

2017-07-01

Conclusion: Neoadjuvant twice-daily chemoradiation for esophageal cancer is a safe and effective alternative to daily fractionation with low treatment-related mortality and long-term outcomes similar to standard fractionation courses.

Morbidity related to axillary irradiation in the treatment of breast cancer

Energy Technology Data Exchange (ETDEWEB)

Bentzen, S.M.; Dische, S. [Mount Vernon Centre for Cancer Treatment, Northwood (United Kingdom). The Marie Curie Research Wing

2000-07-01

Some of the most debilitating morbidity after surgery and radiotherapy for breast cancer is related to treatment of the axilla. This includes persistent arm lymphoedema, impaired shoulder mobility and brachial plexopathy. Considerable research efforts have been carried out on the radiation pathogenesis and the clinical radiobiology of these clinical endpoints, which has enabled their severity and incidence to be minimized. It is clear that the radiation dose-response relationships for these late endpoints are very steep. In other words, even small changes in the exact dose fractionation and physical dose distribution can cause major changes in toxicity. In particular, in many treatment schedules dose fractions larger than 2 Gy have been used without a sufficient reduction in total dose to avoid increased late effects. This is important, as much of the available literature reports side effects after suboptimal dose-fractionation schedules of side effects guaranteed and the locoregional lymphanot representative of what can be achieved using modern radiotherapy. An interesting parallelism to the problems encountered in reviewing historical experience is found in the British breast litigation, the current status of which is presented in this article. Furthermore, morbidity after radiotherapy is strongly influenced by concomitant surgery and/or chemotherapy, and this should be allowed for when designing the overall treatment. Apart from other therapeutic modalities, it has been suggested that other exogenous factors have an influence on the risk of radiotherapy-related morbidity. However, patients' age and, in the case of lymphoedema, also obesity are the only factors that have been established with some certainty. Routine adjustment of radiotherapy dose in these cases is not recommended. Two current developments may strengthen the role of radiotherapy in the treatment of breast cancer. Sentinel node biopsy may allow nodal staging without major surgical excision of

The role of forest stand density in controlling soil erosion: implications to sediment-related disasters in Japan.

Science.gov (United States)

Razafindrabe, Bam H N; He, Bin; Inoue, Shoji; Ezaki, Tsugio; Shaw, Rajib

2010-01-01

The role of forest stand density in controlling soil erosion was investigated in Ehime Prefecture, Japan. The main objective was to compare soil erosion under different forest conditions including forest type, species composition, and stand density as influenced by thinning operations. Relative yield index (Ry) was used as an indicator of stand density to reflect the degree of management operations in the watershed. Eleven treatments were established based on the above forest conditions. Soil loss was collected in each of the 11 treatments after each rainfall event for a period of 1 year. The paper presents summary data on soil loss as affected by forest conditions and rainfall patterns. Findings showed that an appropriate forest management operation, which can be insured by stand density control, is needed to reduce soil loss. The present study plays an important role in clarifying technical processes related to soil erosion, while it helps linking these elements to current Japanese forestry issues and bringing new inputs to reducing sediment-related disasters in Japan.

Dual-release hydrocortisone treatment: glycometabolic profile and health-related quality of life

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L M Mongioì

2018-01-01

Full Text Available Objective: Adrenal insufficiency (AI is a chronic condition associated with increased mortality and morbidity. The treatment of AI in the last years has been object of important changes due to the development of a dual-release preparation of hydrocortisone. It differs from previous therapeutic strategy as it contemplates a once-daily tablet that allows more closely mimicking the physiological circadian cortisol rhythm. The aim of the study was to evaluate the effects of dual-release hydrocortisone treatment on the glycometabolic profile and health-related quality of life of patients with AI. Design and Methods: In this clinical open trial, we enrolled ten patients with primary AI (41 ± 2.67 years and nine patients with AI secondary to hypopituitarism (53.2 ± 17.7 years. We evaluated the glycometabolic profile before and 3, 6, 9 and 12 months after dual-release hydrocortisone administration. We also evaluated health-related quality of life, estimated by the AddiQol questionnaire. The mean dose administered of dual-release hydrocortisone was 28.33 ± 6.68 mg/day. Results: One female hypopituitary patient dropped out from the study. After 12 months of treatment, the mean dosage administered of dual-release hydrocortisone was significantly lower (P < 0.05 and all patients reported improved quality of life and well-being. The glycometabolic profile improved and the glycosylated hemoglobin decreased significantly in patients with primary AI (6.25 ± 0.2 vs 5.35 ± 0.17, P < 0.05. In contrast, hypopituitary patients had worse glycometabolic profile and a trend toward hypertriglyceridemia. Conclusions: Dual-release hydrocortisone treatment improved the quality of life of patients with AI, and it allowed a decrease of cortisol dosage administered in the absence of side effects. The glycometabolic profile worsened in hypopituitary patients.

Understanding Autoimmune Mechanisms in Multiple Sclerosis Using Gene Expression Microarrays: Treatment Effect and Cytokine-related Pathways

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A. Achiron

2004-01-01

Full Text Available Multiple sclerosis (MS is a central nervous system disease in which activated autoreactive T-cells invade the blood brain barrier and initiate an inflammatory response that leads to myelin destruction and axonal loss. The etiology of MS, as well as the mechanisms associated with its unexpected onset, the unpredictable clinical course spanning decades, and the different rates of progression leading to disability over time, remains an enigma. We have applied gene expression microarrays technology in peripheral blood mononuclear cells (PBMC to better understand MS pathogenesis and better target treatment approaches. A signature of 535 genes were found to distinguish immunomodulatory treatment effects between 13 treated and 13 untreated MS patients. In addition, the expression pattern of 1109 gene transcripts that were previously reported to significantly differentiate between MS patients and healthy subjects were further analyzed to study the effect of cytokine-related pathways on disease pathogenesis. When relative gene expression for 26 MS patients was compared to 18 healthy controls, 30 genes related to various cytokine-associated pathways were identified. These genes belong to a variety of families such as interleukins, small inducible cytokine subfamily and tumor necrosis factor ligand and receptor. Further analysis disclosed seven cytokine-associated genes within the immunomodulatory treatment signature, and two cytokine-associated genes SCYA4 (small inducible cytokine A4 and FCAR (Fc fragment of IgA, CD89 that were common to both the MS gene expression signature and the immunomodulatory treatment gene expression signature. Our results indicate that cytokine-associated genes are involved in various pathogenic pathways in MS and also related to immunomodulatory treatment effects.

Higher risk sexual behaviour is associated with unawareness of HIV-positivity and lack of viral suppression - implications for Treatment as Prevention.

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Huerga, Helena; Venables, Emilie; Ben-Farhat, Jihane; van Cutsem, Gilles; Ellman, Tom; Kenyon, Chris

2017-11-23

Efficacy of Treatment as Prevention Strategy depends on a variety of factors including individuals' likelihood to test and initiate treatment, viral load and sexual behaviour. We tested the hypothesis that people with higher risk sexual behaviour are less likely to know their HIV-positive status and be virologically suppressed. A cross-sectional population-based survey of individuals aged 15-59 years old was conducted in 2013 in KwaZulu-Natal, South Africa. A two-stage cluster probability sampling was used. After adjustment for age and sex, lack of awareness of HIV-positivity was strongly associated with having more than one sexual partner in the preceding year (aOR: 2.1, 95%CI: 1.5-3.1). Inconsistent condom use was more common in individuals with more than one sexual partner (aOR: 16.6, 95%CI: 7.6-36.7) and those unaware (aOR: 3.7, 95%CI: 2.6-5.4). Among people aware of their HIV-positivity, higher risk sexual behaviour was associated with lack of viral suppression (aOR: 2.2, 95%CI: 1.1-4.5). Risky sexual behaviour seems associated with factors linked to poor health-seeking behaviour which may have negative implications for HIV testing and Treatment as Prevention. Innovative strategies, driven by improved epidemiological and anthropological understanding, are needed to enable comprehensive approaches to HIV prevention.

Study on Spheroidization and Related Heat Treatments of Medium Carbon Alloy Steels

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Harisha S. R.

2018-01-01

Full Text Available The importance of medium carbon steels as engineering materials is reflected by the fact that out of the vast majority of engineering grade ferrous alloys available and used in the market today, a large proportion of them are from the family of medium carbon steels. Typically medium carbon steels have a carbon range of 0.25 to 0.65% by weight, and a manganese content ranging from 0.060 to 1.65% by weight. Medium carbon steels are more resistive to cutting, welding and forming as compared to low carbon steels. From the last two decades a number of research scholars reported the use of verity of heat treatments to tailor the properties of medium carbon steels. Spheroidizing is the novel industrial heat treatment employed to improve formability and machinability of medium/high carbon low alloy steels. This exclusive study covers procedure, the effects and possible outcomes of various heat treatments on medium carbon steels. In the present work, other related heat treatments like annealing and special treatments for property alterations which serve as pretreatments for spheroidizing are also reviewed. Medium carbon steels with property alterations by various heat treatment processes are finding increased responsiveness in transportation, aerospace, space, underwater along with other variegated fields. Improved tribological and mechanical properties consisting of impact resistance, stiffness, abrasion and strength are the main reasons for the increased attention of these steels in various industries. In the present scenario for the consolidation of important aspects of various heat treatments and effects on mechanical properties of medium carbons steel, a review of different research papers has been attempted. This review may be used as a guide to provide practical data for heat treatment industry, especially as a tool to enhance workability and tool life.

A systematic review on the neural effects of music on emotion regulation: implications for music therapy practice.

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Moore, Kimberly Sena

2013-01-01

Emotion regulation (ER) is an internal process through which a person maintains a comfortable state of arousal by modulating one or more aspects of emotion. The neural correlates underlying ER suggest an interplay between cognitive control areas and areas involved in emotional reactivity. Although some studies have suggested that music may be a useful tool in ER, few studies have examined the links between music perception/production and the neural mechanisms that underlie ER and resulting implications for clinical music therapy treatment. Objectives of this systematic review were to explore and synthesize what is known about how music and music experiences impact neural structures implicated in ER, and to consider clinical implications of these findings for structuring music stimuli to facilitate ER. A comprehensive electronic database search resulted in 50 studies that met predetermined inclusion and exclusion criteria. Pertinent data related to the objective were extracted and study outcomes were analyzed and compared for trends and common findings. Results indicated there are certain music characteristics and experiences that produce desired and undesired neural activation patterns implicated in ER. Desired activation patterns occurred when listening to preferred and familiar music, when singing, and (in musicians) when improvising; undesired activation patterns arose when introducing complexity, dissonance, and unexpected musical events. Furthermore, the connection between music-influenced changes in attention and its link to ER was explored. Implications for music therapy practice are discussed and preliminary guidelines for how to use music to facilitate ER are shared.

Treatment Related Thoughts Based on Health Belief Model and Medication Nonadherence in Patients who Prescribed Anxiolytics and Antidepressants

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Meltem Meric

2010-10-01

Full Text Available AIM: The purpose of this study was to evaluate the relationship between treatment adherence and treatment related thoughts based on health belief model in patients who currently take medication due to depression and anxiety disorder. METHOD: The present study was performed at the Psychiatry Department of a teaching hospital. The sample of the study consisted from 112 individuals who take medications due to depression and anxiety disorder. Personal information form and an inquiry form including treatment related thoughts based on health belief model were used to collect data. Chi- Square and Percentages were used for statistical analysis. RESULTS: Of the patients, 58.9% were diagnosed as depression and 41.1% anxiety disorder. 60.7% stated that they had a non-adherence experience in the past. Of these non-adherent patients, 29.5% stopped to take the medication with the idea “I can do it without medication” and 14.3% stopped the medication because of the side effects. Gender, age, marital status and education level were not related to the non-adherence. Only two treatment related thoughts based on health belief concepts were significantly related to the non adherence experience. These thoughts were “If I do not take the medications properly the problems may be permanent” and “If I do not take the medications properly my illness may get worse”. Most of the patients marked “agree” options of the items under the perceived severity, self-efficacy, benefits, susceptibility and health motivation subheads. CONCLUSION: The results of this study showed that the thoughts and perceptions based on health belief concepts helps to identify and express the thoughts related to treatment adherence. These concepts can be used to describe and classify the thoughts about the treatments of patients. However, prospective and qualitative studies may be useful to clarify the influence of the health beliefs on treatment adherence. [TAF Prev Med Bull 2010; 9

Magnetic resonance imaging in the evaluation of treatment-related central nervous system damage

International Nuclear Information System (INIS)

Packer, R.J.; Zimmerman, R.A.; Bilaniuk, L.T.

1986-01-01

Neurologic and neuropsychologic treatment related sequelae are increasingly encountered in children with cancer, but conventional means of neurologic investigation are insensitive to the presence and extent of damage. Magnetic resonance imaging (MRI) has shown brain damage not demonstrable by other means of investigation. For this reason, 11 children with cancer and with nontumor-related neurologic dysfunction were studied on a 1.5 Tesla MRI unit. All had concurrent computed tomography (CT). MRI abnormalities were seen in all (100%) patients. In 10 of 11 patients, abnormalities were of greater extent on MRI than on CT. White matter changes were frequently seen on MRI without corresponding CT abnormality. Those patients with the most severe forms of neurologic compromise had the most extensive changes on MRI. Focal neurologic findings correlated well with regions of focal signal change. Milder forms of neurologic compromise occurred in patients with definite, but less extensive, periventricular and/or subcortical change on MRI. MRI is more sensitive than CT in demonstrating treatment-related neurologic damage in children with cancer, and the type of change seen on MRI seems to correlate well with the type and severity of neurologic dysfunction present

[Urgent surgical treatment of gastric volvulus related to upside-down stomach syndrome].

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Hána, L; Kasalický, M; Koblihová, E; Suchánek, Š; Horažďovský, P; Ryska, M

2015-12-01

Upside-down stomach syndrome is a rare type of a large paraoesophageal hiatal hernia, which requires an immediate surgical treatment in case of incarceration. The authors present a case report of a 53-year-old male patient with gastric volvulus related to the upside-down stomach syndrome. Surgical treatment was complicated by an injury to distal oesophagus, which was successfully treated using a self-expandable metallic stent among other methods. Despite the complicated postoperative course with a necessity of reoperation, insertion of an oesophageal stent, thoracotomy for a mediastinal abscess and secondary healing of the laparotomy, the patient was discharged in a good condition with healed oesophageal perforation and laparotomy after 52 days.

The association between interpersonal problems and treatment outcome in the eating disorders: A systematic review.

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Jones, Allan; Lindekilde, Nanna; Lübeck, Marlene; Clausen, Loa

2015-01-01

To review systematically the eating disorder literature in order to examine the association between pre-treatment interpersonal problems and treatment outcome in people diagnosed with an eating disorder. Six relevant databases were searched for studies in which interpersonal problems prior to treatment were examined in relation to treatment outcome in patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS). Thirteen studies were identified (containing 764 AN, 707 BN and 48 EDNOS). The majority of studies indicated that interpersonal problems at the start of therapy were associated with a detrimental treatment outcome. Individuals with a binge/purge-type of eating disorder may be particularly vulnerable to interpersonal issues and these issues may lead to poorer treatment recovery by reducing the individual's ability to engage in the treatment process on a functional level. The clinical and research implications are discussed.

[TREATMENT OF ATTENTION DEFICIT AND HYPERACTIVITY DISORDER (ADHD): NURSING IMPLICATIONS].

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Luna Delgado, Laura; Moriones Jiménez, Olalla

2014-09-01

This review aims to know the role of the nurse in ADHD treatment, identifying the most appropriate therapeutic options between nursing interventions and pharmacological treatment. In ADHD, the role of the nurse is to respond family needs about the effectiveness of medication, behavior modification treatment and other alternatives. There are family interventions of psychoeducation that assist the child in the recovery process. Through the education for health, the nurse should promote the combination of behavioral therapy and pharmacological as the only one able to improve child's quality of life. Nurses have a privileged role due to its experience in education for health; this contributes to being a competent agent that provides families essential information about the disease treatment. Spanish schools are lacking a figure that represent health as a relevant subject in the vital process, hence the need of the school nurse.

Room for improvement in the treatment of hip fractures in Denmark

DEFF Research Database (Denmark)

Egerod, Ingrid; Rud, Kirsten; Specht, Kirsten

2010-01-01

INTRODUCTION: Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records. MATERIAL......, nutritional screening, ambulation characteristics, training in activities of daily living, and rehabilitation planning were consistently inadequate. Length of stay was 7-11 days. CONCLUSION: Although the principles for fast-track surgery have been adapted to some extent at all departments in Denmark...... with an annual treatment of at least 50 patients with hip fractures, no single department has implemented the whole package. Hospital stay has been reduced since the introduction of fast-track regimes, and improvements were seen in many of the quality indicators. Implications for future practice include better...

Overstory removal and residue treatments affect soil surface, air, and soil temperature: implications for seedling survival

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Roger D. Hungerford; Ronald E. Babbitt

1987-01-01

Potentially lethal ground surface temperatures were measured at three locations in the Northern Rocky Mountains but occurred more frequently under treatments with greater overstory removal. Observed maximum and minimum temperatures of exposed surfaces are directly related to the thermal properties of the surface materials. Survival of planted seedlings was consistent...

Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes

DEFF Research Database (Denmark)

Hölmich, P; Uhrskou, P; Ulnits, L

1999-01-01

Groin pain is common among athletes. A major cause of long-standing problems is adductor-related groin pain. The purpose of this randomised clinical trial was to compare an active training programme (AT) with a physiotherapy treatment without active training (PT) in the treatment of adductor-rela...

Intranasal bevacizumab in the treatment of HHT -related epistaxis: a systematic review.

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Stokes, P; Rimmer, J

2018-03-01

Hereditary haemorrhagic telangiectasia (HHT) remains a difficult disease for the ENT specialist to manage. Affected patients often report recurrent epistaxis as the most debilitating symptom. The pathogenesis of the disease is due to genetic mutations affecting angiogenesis. For this reason, the anti-angiogenic therapy bevacizumab has gained popularity in the local treatment of epistaxis in patients with HHT. A systematic review of the efficacy of bevacizumab in local treatment of epistaxis in patients with HHT based on epistaxis duration, frequency, severity and impact on quality of life. A systematic search was performed using the PubMed, MEDLINE and EMBASE databases. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured the efficacy of intranasal bevacizumab treatment of epistaxis in patients with HHT were included for qualitative analysis. Thirteen studies (four randomised controlled trials, three prospective studies, three retrospective studies, one case series and two case reports) with a total of 357 patients were included. Local administration (either by submucosal injection or topically) did not have a significant impact on epistaxis duration, frequency, severity or quality of life compared to placebo or other local treatments. The available evidence suggests that intranasal bevacizumab treatment does not have a significant effect on epistaxis in patients with HHT. There are several limitations that require further investigation to confidently rule out local bevacizumab as an effective therapy in HHT related epistaxis.

Patient satisfaction with inpatient psychiatric treatment and its relation to treatment outcome in unipolar depression and schizophrenia.

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Köhler, Stephan; Unger, Theresa; Hoffmann, Sabine; Steinacher, Bruno; Fydrich, Thomas

2015-06-01

Patient satisfaction with psychiatric treatment has emerged as an important factor with respect to the quality of health care. Patient satisfaction using the Zurich Satisfaction Questionnaire (ZUF-8) as well as symptom severity (measured with the Hamilton Depression Scale [HRSD], Brief Psychiatric Rating Scale and Clinical Global Impression Scale) was assessed at admission and discharge of inpatient treatment in patients with a major depressive episode (MDD, N = 217) and schizophrenia (N = 75). Differences between the two diagnostic groups (using T-tests) and correlations of patient satisfaction with different social and treatment variables were calculated (Pearson product-moment correlation). The mean score of patient satisfaction was 26.8 points (ZUF-8; range 8-32 points), without differences between MDD and schizophrenia (t = 0.45, p = 0.78). Patients with MDD and personality disorder showed lower satisfaction than patients with MDD without personality disorder (t = 2.31, p = 0.03). Patient satisfaction correlated negatively with severity of depressive symptoms at discharge (HRSD: r = - 0.38; p patient satisfaction in both groups (depression: r = - 0.28, p = 0.02; schizophrenia: r = - 0.24; p = 0.03). Patient satisfaction was high without differences between MDD and schizophrenia. Severity of disease and comorbidites in MDD and number of prescribed drugs in both groups were related with reduced patient satisfaction.

Evolving Knowledge in Pharmacologic Treatments of Age-Related Macular Degeneration.

Science.gov (United States)

Soubrane Daguet, Gisèle; Risard-Gasiorowski, Sarah; Massamba, Nathalie

2016-01-01

Modern retinal drug therapy is a result of the recent challenges and breakthroughs in chemistry, physics, genetics, cell biology and biotechnologies. Specific pharmaceutical and pharmacokinetic characteristics of a drug are of major importance and contribute to its ability to penetrate targeted ocular tissues in order to result in effective therapeutic concentrations. In addition, the drugs should maintain a prolonged time of activity and be safe with minimal local and systemic toxicity. The transporter vehicle or drug delivery system is crucial in order to enhance ocular tissue penetration and establish controlled drug release. Administration methods should be local, thereby reducing systemic side effects, and, ideally, treatment should be noninvasive. Within the group of so-called classic therapies, the use of pharmacologic treatments has become widespread for most severe retinal diseases. Thereby, ocular therapy of diseases like exudative age-related macular degeneration has improved markedly. Moreover, new metabolic pathways have been identified, new molecules have emerged, new synthesis technologies have been discovered, and new formulae conceived. These developments have opened new avenues for limiting disease progression. © 2016 S. Karger AG, Basel.

Bone Health and Impact of Tenofovir Treatment in Men with Hepatitis-B Related Chronic Liver Disease.