Special needs children with speech and hearing difficulties: prevalence and unmet needs.

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Kenney, Mary Kay; Kogan, Michael D

2011-01-01

The purpose of this study was to establish prevalences and sociodemographic characteristics associated with parent-reported speech and hearing difficulties among children with special health care needs (CSHCN); determine unmet needs for therapy, hearing aids, and communication devices; and examine the association between unmet needs and resources such as health insurance, early intervention/special education, and a medical home. Data were analyzed for 300,910 children without special health care needs and 40,723 CSHCN from the 2005-2006 National Survey of Children with Special Health Care Needs. Prevalence, sociodemographic characteristics, and unmet needs for 7132 CSHCN with speech difficulties and 1982 CSHCN with hearing difficulties were assessed. Logistic regression was used to determine the associations between unmet needs for therapy or hearing/communication devices and resources for addressing needs for therapy, hearing, and communication aids. The parent-reported prevalence of speech difficulty among CSHCN in the general population was 2.9% and approximately 20% among all CSHCN, in contrast to the lower prevalence of hearing difficulty (0.7% and 5%, respectively). Relative unmet need was greatest for communication devices and least for hearing aids. The strongest association with reducing unmet needs was having a medical home, and the most significant aspect of medical home was having effective care coordination. Having a medical home is significantly associated with fewer unmet needs for therapy and hearing/communication devices among CSHCN with speech and hearing difficulties. Care coordination may constitute an important factor that allows the primary care provider to link with services that CSHCN with communication problems require. Published by Elsevier Inc.

Unmet service needs evaluated by case managers among disabled patients on hemodialysis in Japan

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Sugisawa H

2018-03-01

Full Text Available Hidehiro Sugisawa,1 Toshio Shinoda,2 Yumiko Shimizu,3 Tamaki Kumagai,4 Hiroaki Sugisaki,5 Seiji Ohira6,† 1Department of Gerontology, Graduate School of Gerontology, J. F. Oberlin University, Tokyo, 2Department of Medical Care Technology, Faculty of Medical and Health Science, Tsukuba International University, Tsuchiura, 3Department of Community Health Nursing, The Jikei University School of Nursing, Chofu, 4Department of Fundamental Nursing, Graduate School of Nursing, Osaka City University, Osaka, 5Hachioji Azumacho Clinic, Hachioji, Tokyo, 6Sapporo Kita Clinic, Sapporo, Hokkai-do, Japan †Professor Dr. Seiji Ohira passed away on September 5, 2017 Background: This study aimed to investigate the levels of unmet needs for home and ­community-based services (HCBS evaluated by case managers (CMs among disabled patients on hemodialysis (DPHD and to examine factors related to unmet needs. Unmet needs for HCBS were defined as situations in which patients do not use or underuse HCBS despite needing them. Candidates for the factors relating to unmet needs for HCBS included three dimensions: predisposing, enabling, and need factors.Methods: Self-administrated questionnaires were collected from 391 CMs of DPHD certified with long-term care insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. CMs were asked questions about their management of each individual case. HCBS included home help, visiting nursing, daycare, and short stay.Results: The prevalence of unmet needs for each HCBS ranged from 32% for home help to 48% for short stay. Barriers to service usage in the patients were associated with unmet needs for all four services. The patients with more severe cognitive malfunction were more likely to have unmet needs for visiting nursing and short stay. Heavier burden with caregiving was associated with more likelihood of unmet needs for home help and short stay

Health-related quality of life and unmet healthcare needs in Huntington's disease.

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van Walsem, Marleen R; Howe, Emilie I; Ruud, Gunvor A; Frich, Jan C; Andelic, Nada

2017-01-07

Huntington's disease (HD) is a rare neurodegenerative disorder with a prevalence of 6 per 100.000. Despite increasing research activity on HD, evidence on healthcare utilization, patients' needs for healthcare services and Health-Related Quality of Life (HRQoL) is still sparse. The present study describes HRQoL in a Norwegian cohort of HD patients, and assesses associations between unmet healthcare and social support service needs and HRQoL. In this cross-sectional population-based study, 84 patients with a clinical diagnosis of HD living in the South-East of Norway completed the HRQoL questionnaire EuroQol, EQ-5D-3L. Unmet needs for healthcare and social support services were assessed by the Needs and Provision Complexity Scale (NPCS). Furthermore, functional ability was determined using the Unified Huntington's Disease Rating Scale (UHDRS) Functional assessment scales. Socio-demographics (age, gender, marital status, occupation, residence, housing situation) and clinical characteristics (disease duration, total functional capacity, comorbidity) were also recorded. Descriptive statistics were used to describe the patients' HRQoL. Regression analyses were conducted in order to investigate the relationship between unmet healthcare needs and self-reported HRQoL. The patients were divided across five disease stages as follows: Stage I: n = 12 (14%), Stage II: n = 22 (27%), Stage III: n = 19 (23%), Stage IV: n = 14 (16%), and Stage V: n = 17 (20%). Overall HRQoL was lowest in patients with advanced disease (Stages IV and V), while patients in the middle phase (Stage III) showed the most varied health profile for the five EQ-5D-3L dimensions. The regression model including level of unmet needs, clinical characteristics and demographics (age and education) accounted for 42% of variance in HRQoL. A higher level of unmet needs was associated with lower HRQoL (β value - 0.228; p = 0.018) whereas a better total functional capacity corresponded to

Perceptions of unmet healthcare needs: what do Punjabi and Chinese-speaking immigrants think? A qualitative study.

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Marshall, Emily G; Wong, Sabrina T; Haggerty, Jeannie L; Levesque, Jean-Fréderic

2010-02-22

Unmet healthcare needs - the difference between healthcare services deemed necessary to deal with a particular health problem and the actual services received - is commonly measured by the question, "During the past 12 months, was there ever a time when you felt that you needed healthcare, but you didn't receive it?" In 2003, unmet needs were reported by 10% of immigrants in Canada, yet, little is known specifically about Chinese- or Punjabi-speaking immigrants' perceptions and reporting of unmet needs. Our study examined: 1) How are unmet healthcare needs conceptualized among Chinese- and Punjabi-speaking immigrants? 2) Are their primary healthcare experiences related to their unmet healthcare needs? Twelve focus groups (6 Chinese, 6 Punjabi; n = 78) were conducted in Chinese or Punjabi and socio-demographic and health data were collected. Thematic analysis of focus group data examined the perceptions of unmet needs and any relationship to primary healthcare experiences. Our analysis revealed two overarching themes: 1) defining an unmet healthcare need and 2) identifying an unmet need. Participants had unmet healthcare needs in relation to barriers to accessing care, their lack of health system literacy, and when the health system was less responsive than their expectations. Asking whether someone ever had a time when they needed healthcare but did not receive it can either underestimate or overestimate unmet need. Measuring unmet need using single items is likely insufficient since more detail in a revised set of questions could begin to clarify whether the reporting of an unmet need was based on an expectation or a clinical need. Who defines what an unmet healthcare need is depends on the context (insured versus uninsured health services, experience in two or more healthcare systems versus experience in one healthcare system) and who is defining it (provider, patient, insurer).

Financial hardship, unmet medical need, and health self-efficacy among African American men.

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Tucker-Seeley, Reginald D; Mitchell, Jamie A; Shires, Deirdre A; Modlin, Charles S

2015-06-01

Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet medical need due to cost potentially mediates this association. Cross-sectional analysis was conducted using data from a convenience sample of African American men who attended a 1-day annual community health fair in Northeast Ohio (N = 279). Modified Poisson regression models were estimated to obtain the relative risk of reporting low health self-efficacy. After adjusting for sociodemographic characteristics, those reporting financial hardship were 2.91 times, RR = 2.91 (confidence interval [1.24, 6.83]; p financial hardship and low health self-efficacy was no longer statistically significant. Our results suggest that the association between financial hardship and health self-efficacy can be explained by unmet medical need due to cost. Possible intervention efforts among African American men with low financial resources should consider expanding clinical and community-based health assessments to capture financial hardship and unmet medical need due to cost as potential contributors to low health self-efficacy. © 2014 Society for Public Health Education.

Prevalence and determinants of unmet need for family planning in Kishanganj district, Bihar, India

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Kanchan Lata

2012-01-01

Full Text Available Background: Unmet need is a valuable indicator for assessing the achievements of national family planning programs. The present study was undertaken with the objectives to determine the magnitude of unmet need for family planning among the married women of reproductive age group (15-49 years, to evaluate the various factors that influence the unmet need and to explore the common reasons for unmet need for family planning. Methods: A community based, cross-sectional study was conducted from February to April 2012 in Laucha village in Kishanganj, Bihar through multistage sampling. Married women aged 15-49 years, who were permanent residents of the village, were selected by complete enumeration (330 in total and interviewed through house to house survey with the help of a pre-designed, pre-tested and semi-structured questionnaire. Results: The total unmet need for family planning was 23.9%; 9.4% for spacing births and 14.5% for limiting births. The unmet need varied significantly with age (p < 0.05 and was highest in ≤ 19 years age group (33.7%. It was also significantly higher among illiterates, those with low monthly per capita income, among Muslims and among those having more than two living issues (p < 0.05. Husband’s disapproval (34.2%, lack of awareness (27.8% and fear of side effects (24.1% were common reasons behind the unmet need. Conclusion: the unmet need for family planning was quite high among the respondents and associated with various bio-social determinants that should be considered while planning for scaling-up the program.

Prevalence and determinants of unmet need for family planning in Kishanganj district, Bihar, India

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Kanchan Lata

2012-07-01

Full Text Available Background: Unmet need is a valuable indicator for assessing the achievements of national family planning programs. The present study was undertaken with the objectives to determine the magnitude of unmet need for family planning among the married women of reproductive age group (15-49 years, to evaluate the various factors that influence the unmet need and to explore the common reasons for unmet need for family planning. Methods: A community based, cross-sectional study was conducted from February to April 2012 in Laucha village in Kishanganj, Bihar through multistage sampling. Married women aged 15-49 years, who were permanent residents of the village, were selected by complete enumeration (330 in total and interviewed through house to house survey with the help of a pre-designed, pre-tested and semi-structured questionnaire. Results: The total unmet need for family planning was 23.9%; 9.4% for spacing births and 14.5% for limiting births. The unmet need varied significantly with age (p < 0.05 and was highest in ≤ 19 years age group (33.7%. It was also significantly higher among illiterates, those with low monthly per capita income, among Muslims and among those having more than two living issues (p < 0.05. Husband’s disapproval (34.2%, lack of awareness (27.8% and fear of side effects (24.1% were common reasons behind the unmet need. Conclusion: the unmet need for family planning was quite high among the respondents and associated with various bio-social determinants that should be considered while planning for scaling-up the program.

Unmet health care needs for persons with environmental sensitivity

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Gibson PR

2015-01-01

Full Text Available Pamela Reed Gibson, Shannon Kovach, Alexis LupferDepartment of Psychology, James Madison University, Harrisonburg, VA, USAAbstract: Studies of unmet health care needs have shown that women, people with poor health, and people with lower socioeconomic status are more likely to report having unmet health care needs. In this study, we examined the types of and reasons for unmet health care needs in 465 people with environmental sensitivities. A second area of inquiry involved negative reactions to general anesthesia. Results showed that the most common barriers to receiving care were the inability to find a provider who understands environmental sensitivities and a lack of accessibility due to chemical and electromagnetic exposures in health care environments. Lower income and poorer health (longer illness, a worsening or fluctuating course of illness, and a higher level of disability were significantly correlated with the total number of reported unmet health care needs. Some people with environmental sensitivities reported having negative reactions to anesthesia of long duration; most common were nausea and vomiting, fatigue, and reduced cognitive ability.Keywords: environmental sensitivity, chemical sensitivity, electrohypersensitivity, chemical hypersensitivity, chemical intolerance, contested illness

Prevalence and profiles of unmet healthcare need in Thailand

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Thammatacharee Noppakun

2012-10-01

Full Text Available Abstract Background In the light of the universal healthcare coverage that was achieved in Thailand in 2002, policy makers have raised concerns about whether there is still unmet need within the population. Our objectives were to assess the annual prevalence, characteristics and reasons for unmet healthcare need in the Thai population in 2010 and to compare our findings with relevant international literature. Methods A standard set of OECD unmet need questionnaires was used in a nationally-representative household survey conducted in 2010 by the National Statistical Office. The prevalence of unmet need among respondents with various socio-economic characteristics was estimated to determine an inequity in the unmet need and the reasons behind it. Results The annual prevalence of unmet need for outpatient and inpatient services in 2010 was 1.4% and 0.4%, respectively. Despite this low prevalence, there are inequities with relatively higher proportion of the unmet need among Universal Coverage Scheme members, and the poor and rural populations. There was less unmet need due to cost than there was due to geographical barriers. The prevalence of unmet need due to cost and geographical barriers among the richest and poorest quintiles were comparable to those of selected OECD countries. The geographical extension of healthcare infrastructure and of the distribution of health workers is a major contributing factor to the low prevalence of unmet need. Conclusions The low prevalence of unmet need for both outpatient and inpatient services is a result of the availability of well-functioning health services at the most peripheral level, and of the comprehensive benefit package offered free of charge by all health insurance schemes. This assessment prompts a need for regular monitoring of unmet need in nationally-representative household surveys.

Understanding unmet need: history, theory, and measurement.

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Bradley, Sarah E K; Casterline, John B

2014-06-01

During the past two decades, estimates of unmet need have become an influential measure for assessing population policies and programs. This article recounts the evolution of the concept of unmet need, describes how demographic survey data have been used to generate estimates of its prevalence, and tests the sensitivity of these estimates to various assumptions in the unmet need algorithm. The algorithm uses a complex set of assumptions to identify women: who are sexually active, who are infecund, whose most recent pregnancy was unwanted, who wish to postpone their next birth, and who are postpartum amenorrheic. The sensitivity tests suggest that defensible alternative criteria for identifying four out of five of these subgroups of women would increase the estimated prevalence of unmet need. The exception is identification of married women who are sexually active; more accurate measurement of this subgroup would reduce the estimated prevalence of unmet need in most settings. © 2013 The Population Council, Inc.

Determinants of the unmet need for family planning among women of Jaipur, Rajasthan

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Rajaat Vohra

2014-01-01

Full Text Available Background: More than 100 million women in less developed countries or about 17% of all married women would prefer to avoid pregnancy, but are not using any form of family planning. Despite the government′s many efforts, the unmet need for family planning in India is still 12.8%. The present study is aimed to assess prevalence of the unmet need for family planning, its determinants, and the reasons for the unmet need for family planning. Materials and Methods: A sample size of 500 was divided equally among the rural and urban areas. A simple random technique was used to select the first household for the survey. A predesigned and pretested questionnaire was used to record the information. Data was entered on Microsoft Access and analyzed using the statistical software SPSS version 11.5 for Windows Vista. The chi square test was used for finding the association and trends. Results: In the present study, 35% of the population had an unmet need, of which 58.28% belonged to rural area, while 41.71% belonged to the urban area. The significant determinants associated with the unmet need for family planning were religion, type of family, husband′s education and occupation, socioeconomic class, women′s age, women′s education and occupation, exposure to mass media, and healthcare facility where services were provided. Overall, lack of motivation and obstacles were the major reasons for the unmet need. Conclusion: Improved access to family planning services, better education, improved standard of living, and higher exposure to mass media can significantly decrease the unmet need of family planning.

Cancer survivors and their partners: the assessment of unmet supportive care needs

International Nuclear Information System (INIS)

Smith, K.; Pendlebury, S.; Butow, P.; Hobbs, K.; Wain, G.

2003-01-01

Our understanding of unmet supportive care needs of cancer survivors and their partners is limited. Most studies have focused on needs of patients undergoing treatment and on Quality of life or patient satisfaction. For the purpose of this research, cancer survivors are defined as persons who received a cancer diagnosis at least one year previously and are disease free. The aim of this study is to develop measures to assess unmet needs in survivors and their partners. After developing the questionnaire items it was piloted for validity in a wide sample of cancer patients from the radiation oncology department. 105 patients, all women, 101 with breast cancer and 40 partners participated. Psychological morbidity of depression and anxiety was recorded and was low. Quality of life for both survivors and partners was close to the US population mean. For patients top 4 unmet needs was 1. Anxiety about cancer returning (35%), current information (21%), understandable information (28%), ongoing case manager (25%). Unmet needs for partners were 1. Need to know all the doctors were communication (3.2%), need for local health services (2.8%), current information (2.1%) and help with managing concerns about the cancer returning (2.1%). 73% of partners reported at least one positive outcome from their partner's experience, significantly more than the survivors. In conclusion, interim analysis of the questionnaire reveals validity. Survivors report ongoing high levels of unmet needs 3-9 years after cancer diagnosis ( 30%). Less than 4% of partners report such unmet needs. There is significant correlation between needs of partners and survivors, many of which relate to issues of ongoing support and information delivery

Unmet needs of women with breast cancer during and after primary treatment: A prospective study in Denmark

DEFF Research Database (Denmark)

von Heymann-Horan, A.B; Dalton, Susanne Oksbjerg; Dziekanska, Angelika

2013-01-01

their diagnosis and throughout the disease trajectory. Material and methods. Consecutive women with newly diagnosed breast cancer, undergoing surgery at the Breast Surgery Clinic, Rigshospitalet, Denmark, between 2008 and 2009 (N = 261), completed questionnaires on their unmet needs, anxiety, physical functioning....... A total of 53% of women with breast cancer had unmet needs at some time between diagnosis and the end of primary treatment (eight months after diagnosis). A contextual understanding of unmet needs is necessary for planning cancer rehabilitation, as not only factors such as anxiety, physical functioning......Abstract Integrated plans will be required to ensure care and rehabilitation for the growing number of cancer survivors. Information is lacking, however, about the extent to which patients' rehabilitation needs are being met, and characteristics of patients who experience unmet needs after...

Unmet dental and orthodontic need of children with special healthcare needs in West Virginia.

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Wiener, R C; Wiener, M A

2012-01-01

Of children aged 0-17 years in the USA, an estimated 11 203 616 (15.1%; 95% CI: 14.8, 15.3) are Children with Special Health Care Needs (CSHCN). The state of West Virginia, the heart of Appalachia, has a land mass which is 97.65% rural with previously identified high overall dental need and oral health disparities. It is home to an estimated 70 609 CSHCN, or 18.5% (95% CI: 17.0, 19.9) of the state's children in 2009-2010. The purpose of this study was to determine the parent/guardian's perceived unmet dental care need of CSHCN in West Virginia. Data from the National Survey of Children with Special Health Care Needs was used to determine prevalence. A telephone survey of 59 941 parents/guardians of CSHCN (1149 from West Virginia) for the dental interview was conducted in 2009-2010. Nationwide, 26.7% (25.9, 27.5) of parents/guardians reported their CSHCN had dental care or orthodontia needs other than preventive care. In West Virginia, the perceived dental care or orthodontia needs other than preventive dental care need was 26.5% (22.2, 30.0). Unmet national dental care need other than preventive dental care was 5.4% (5.0, 5.9) and in West Virginia 5.0% (2.4, 7.5). CSHCN have significant unmet dental needs. Parents/guardians in West Virginia reported similar unmet need compared with national reporting. Policies to address the health care of CSHCN should include dental needs. The clinical implications are that CSHCN have a variety of needs, including orthodontia. The benefits of orthodontic referrals should be considered in treatment planning options for CSHCN.

Faktor yang Berhubungan dengan Terjadinya Unmet Need KB pada Pasangan Usia Subur (PUS di Kota Yogyakarta

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Susiana Sariyati

2015-11-01

Full Text Available The problem of population is important big issues and urgent, primarily related with aspects of the quality of population control, improving the quality of population and mobility of population, if its associated with the potential threat of explosion of population. The purpose of this study was to know factors associated with unmet need family planning among reproductive age couples in Yogyakarta. This study used descriptive method. The populations of this study were all of reproductive age couples in Yogyakarta. The sampling technique was done by probability proportional to size resulted on 779 respondents of reproductive age couples from 30 sub village in 30 village in Yogyakarta. The results of study showed that there was no significant relationship between respondent ages and unmet need, no significant relationship between wife education and unmet need, and no significant relationship between the number of children still live and unmet need.

UNMET NEEDS FOR HEALTH CARE SERVICES IN BULGARIA

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Elka Atanasova

2016-09-01

Full Text Available Background: In all European countries, an important policy objective is the equity of access to health care. The factors that affect access to health care can differ as the demand- and supply-side factors. Moreover, there are many tools to assess the extent of inequity in access to services. One simple tool is the assessing reports of unmet needs for health care. Purpose: The study has two objectives: to examine the evidence of self-reported unmet needs and to analyze the relationship between foregone medical care and both type of residence and socioeconomic status. Materials and Methods: We use data from the European Union Statistics on Income and Living Conditions. The access to health care is measured using the concept of unmet need for medical examination or treatment during the last 12 months. The relationship between foregone medical care and both type of residence and socioeconomic status is examined through the representative survey conducted in 2014. Results: The Eurostat results show that treatment costs are the most common reason for foregone medical care in Bulgaria. We observe a gradual decrease in the share of people who reported having unmet needs due to being too expensive. According to the 2014 survey, significant differences between urban and rural areas as well as among the income groups are identified. The results show the problems in access to health care services mainly in small towns and villages. Conclusion: Although major essential changes were made in the Bulgarian health care system, the equity problems remain an important challenge to policy-makers.

Habitual Sleep Duration, Unmet Sleep Need, and Excessive Daytime Sleepiness in Korean Adults.

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Hwangbo, Young; Kim, Won Joo; Chu, Min Kyung; Yun, Chang Ho; Yang, Kwang Ik

2016-04-01

Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults. The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous month. The question regarding sleep need was "How much sleep do you need to be at your best during the day?" Unmet sleep need was calculated as sleep need minus habitual sleep duration. Participants with a score of >10 on the Epworth Sleepiness Scale were considered to have EDS. The overall prevalence of EDS was 11.9%. Approximately one-third of the participants (31.9%) reported not getting at least 7 hours of sleep. An unmet sleep need of >0 hours was present in 30.2% of the participants. An adjusted multivariate logistic regression analysis revealed a significant excess risk of EDS in the groups with unmet sleep needs of ≥2 hours [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.27-2.54] and 0.01-2 hours (OR, 1.42; 95% CI, 1.02-1.98). However, habitual sleep duration was not significantly related to EDS. EDS was found to be associated with unmet sleep need but not with habitual sleep duration when both factors were examined together. We suggest that individual unmet sleep need is more important than habitual sleep duration in terms of the relation to EDS.

Do unmet needs differ geographically for children with special health care needs?

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Fulda, Kimberly G; Johnson, Katandria L; Hahn, Kristen; Lykens, Kristine

2013-04-01

The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.

Unmet health care needs for persons with environmental sensitivity

OpenAIRE

Gibson, Pamela Reed; Kovach, Shannon; Lupfer, Alexis

2015-01-01

Pamela Reed Gibson, Shannon Kovach, Alexis LupferDepartment of Psychology, James Madison University, Harrisonburg, VA, USAAbstract: Studies of unmet health care needs have shown that women, people with poor health, and people with lower socioeconomic status are more likely to report having unmet health care needs. In this study, we examined the types of and reasons for unmet health care needs in 465 people with environmental sensitivities. A second area of inquiry involved negative reactions ...

Unmet needs in the management of schizophrenia

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Torres-González F

2014-01-01

Full Text Available Francisco Torres-González,1,8 Inmaculada Ibanez-Casas,1,8 Sandra Saldivia,2,8 Dinarte Ballester,3,8 Pamela Grandón,4,8 Berta Moreno-Küstner,5,8 Miguel Xavier,6,8 Manuel Gómez-Beneyto7,8 1Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain; 2Department of Psychiatry and Mental Health, Faculty of Medicine, University of Concepcion, Chile; 3Sistema de Saúde Mãe de Deus, Escola Superior de Saúde, Universidade do Vale do Rio dos Sinos, Brazil; 4Department of Psychology, Faculty of Social Sciences, University of Concepcion, Chile; 5Andalusian Psychosocial Research Group and Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Malaga, Spain; 6Department of Mental Health, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal; 7Centro de Investigación Biomédica en Red de Salud Mental, University of Valencia, Spain; 8Maristán Network, University of Granada, Granada, Spain Abstract: Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to

Unmet Health Care Service Needs of Children With Disabilities in Penang, Malaysia.

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Tan, Seok Hong

2015-11-01

Information on unmet health care needs reveal problems that are related to unavailability and inaccessibility of services. The study objectives were to determine the prevalence, and the reasons for unmet service needs among children with disabilities in the state of Penang, Malaysia. Caregivers of children with disabilities aged 0 to 12 years registered with the Penang Social Welfare Department in 2012 answered a self-administered mailed questionnaire. A total of 305 questionnaires were available for analysis (response rate 37.9%). Services that were very much needed and yet highly unmet were dental services (49.6% needed, 59.9% unmet), dietary advice (30.9% needed, 63.3% unmet), speech therapy (56.9% needed, 56.8% unmet), psychology services (25.5% needed, 63.3% unmet), and communication aids (33.0% needed, 79.2% unmet). Access problems were mainly due to logistic issues and caregivers not knowing where to obtain services. Findings from this study can be used to inform strategies for service delivery and advocacy for children with disabilities in Penang, Malaysia. © 2015 APJPH.

Is Team-Based Primary Care Associated with Less Access Problems and Self-Reported Unmet Need in Canada?

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Zygmunt, Austin; Asada, Yukiko; Burge, Frederick

2017-10-01

As in many jurisdictions, the delivery of primary care in Canada is being transformed from solo practice to team-based care. In Canada, team-based primary care involves general practitioners working with nurses or other health care providers, and it is expected to improve equity in access to care. This study examined whether team-based care is associated with fewer access problems and less unmet need and whether socioeconomic gradients in access problems and unmet need are smaller in team-based care than in non-team-based care. Data came from the 2008 Canadian Survey of Experiences with Primary Health Care (sample size: 10,858). We measured primary care type as team-based or non-team-based and socioeconomic status by income and education. We created four access problem variables and four unmet need variables (overall and three specific components). For each, we ran separate logistic regression models to examine their associations with primary care type. We examined socioeconomic gradients in access problems and unmet need stratified by primary care type. Primary care type had no statistically significant, independent associations with access problems or unmet need. Among those with non-team-based care, a statistically significant education gradient for overall access problems existed, whereas among those with team-based care, no statistically significant socioeconomic gradients existed.

Trends in Unmet Need for Genetic Counseling Among Children With Special Health Care Needs, 2001-2010.

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Smith, Anna Jo; Oswald, Donald; Bodurtha, Joann

2015-01-01

Access to genetic counseling is increasingly important to guide families' and clinicians' decision making, yet there is limited research on accessibility and affordability of counseling for families with children with special health care needs (CSHCN). Our study's objectives were to measure changes in unmet need for genetic counseling for CSHCN from 2001 to 2010 and to characterize child, family, and health system factors associated with unmet need. We used parent-reported data from the 2001, 2005-2006, and 2009-2010 National Survey of Children With Special Health Care Needs. We used a logistic regression model to measure the impact of survey year, child (sex, age, severity of health condition), family (primary language, household income, insurance, financial problems related to cost of CSHCN's health care), and health system factors (region, genetic counselors per capita, having a usual source of care) on access to genetic counseling. Unmet need for genetic counseling increased significantly in 2009-2010 compared to 2001 (odds ratio 1.89; 95% confidence interval [CI] 1.44-2.47). Being older (adjusted odds ratio [aOR] 1.04; 95% CI 1.02-1.06), having severe health limitations (aOR 1.72; 95% CI 1.16-2.58), being uninsured (aOR 3.56; 95% CI 2.16-5.87), and having family financial problems due to health care costs (aOR 1.90; 95% CI 1.52-2.38) were significantly associated with greater unmet need for genetic counseling. Having a usual source of care was associated with decreased unmet need (aOR 0.55; 95% CI 0.37-0.83). Unmet need for genetic counseling has increased over the past 12 years. Uninsurance and financial problems related to health care costs were the largest drivers of unmet need over time. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Vaginal biological and sexual health--the unmet needs.

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Graziottin, A

2015-01-01

The vagina is a most neglected organ. It is usually clinically considered with a minimalistic view, as a 'connecting tube' for a number of physiologic functions: passage of menstrual blood, intercourse, natural conception and delivery. Unmet needs include, but are not limited to, respect of vaginal physiologic biofilms; diagnosis and care of the optimal tone of the levator ani, which surrounds and partly support it; care of its anatomic integrity at and after delivery and at pelvic/vaginal surgery; care of long-term consequences of pelvic radiotherapy; long-term care of the atrophic changes it will undergo after the menopause, unless appropriate, at least local, estrogen therapy is used; appreciation and respect of its erotic meaning, as a loving, receptive, 'bonding' organ for the couple. The vaginal erotic value is key as a non-visible powerful center of femininity and sexuality, deeply and secretly attractive in terms of taste, scent (together with the vulva), touch and proprioception. The most welcoming when lubrication, softness and vaginal orgasm award the woman and the partner with the best of pleasures. Prevention of sexual/vaginal abuse is a very neglected unmet need, as well. Who cares?

Unmet needs for comprehensive services in outpatient addiction treatment.

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Pringle, Janice L; Emptage, Nicholas P; Hubbard, Robert L

2006-04-01

Many addiction treatment patients suffer from health and psychosocial problems in addition to substance misuse at the time of their treatment entry. Outpatient treatment programs have attempted to address these problems by providing or facilitating access to comprehensive health and social services. Nevertheless, previous research have suggested high levels of unmet needs for these services in the addiction treatment population. Using data from a large study on community-based outpatient addiction treatment, this article provides additional information on levels of unmet service needs and the relationship between need and receipt of services during treatment. Our results suggest extremely high levels of unmet needs for a wide variety of health and psychosocial services. Specifically, the data suggest that unmet service needs may be far more prevalent than previous estimates and that addiction treatment populations in rural areas may be particularly disadvantaged.

Determinants of unmet need for family planning in rural Burkina Faso: a multilevel logistic regression analysis.

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Wulifan, Joseph K; Jahn, Albrecht; Hien, Hervé; Ilboudo, Patrick Christian; Meda, Nicolas; Robyn, Paul Jacob; Saidou Hamadou, T; Haidara, Ousmane; De Allegri, Manuela

2017-12-19

Unmet need for family planning has implications for women and their families, such as unsafe abortion, physical abuse, and poor maternal health. Contraceptive knowledge has increased across low-income settings, yet unmet need remains high with little information on the factors explaining it. This study assessed factors associated with unmet need among pregnant women in rural Burkina Faso. We collected data on pregnant women through a population-based survey conducted in 24 rural districts between October 2013 and March 2014. Multivariate multilevel logistic regression was used to assess the association between unmet need for family planning and a selection of relevant demand- and supply-side factors. Of the 1309 pregnant women covered in the survey, 239 (18.26%) reported experiencing unmet need for family planning. Pregnant women with more than three living children [OR = 1.80; 95% CI (1.11-2.91)], those with a child younger than 1 year [OR = 1.75; 95% CI (1.04-2.97)], pregnant women whose partners disapproves contraceptive use [OR = 1.51; 95% CI (1.03-2.21)] and women who desired fewer children compared to their partners preferred number of children [OR = 1.907; 95% CI (1.361-2.672)] were significantly more likely to experience unmet need for family planning, while health staff training in family planning logistics management (OR = 0.46; 95% CI (0.24-0.73)] was associated with a lower probability of experiencing unmet need for family planning. Findings suggest the need to strengthen family planning interventions in Burkina Faso to ensure greater uptake of contraceptive use and thus reduce unmet need for family planning.

Unmet/met need for contraception and self-reported abortion in Ghana.

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Amo-Adjei, Joshua; Darteh, Eugene K M

2017-10-01

Unmet need for contraception in several sub-Saharan African countries, including Ghana, remains high, with implications for unintended pregnancies and unsafe abortion, associated maternal morbidity and mortality. In this paper, we analysed for any associations between unmet/met need for contraception and the prevalence of abortion. The paper utilizes the 2014 Ghana Demographic Health Survey dataset. Applying descriptive statistics initially, and later, a binary logistic regression, we estimate two different models, taking into account, unmet/met need for contraception (Model 1) and a multivariable one comprising socioeconomic, spatial, cultural and demographic behaviour variables (Model 2) to test the associations between unmet/met need for contraception in Ghana. One-fourth (25%) of sampled women in 2014 had ever had an abortion. The bivariate results showed that women who reported "no unmet" considerably tended to report abortion more than the reference category - not married and no sex in the last 30days. The elevated odds among respondents who indicated "no unmet need" persisted even after controlling for all the relevant confounders. Relatedly, unlike women with an unmet need for spacing, women who desired to limit childbearing had a slightly higher tendency to report an abortion. The linkage between unmet need for contraception appears more complex, particularly when the connections are explored post-abortion. Thus, while an abortion episode is most likely due to unintended pregnancy, contraception may still not be used, after an abortion, probably because of failure, side effects or simply, a dislike for any method. Copyright © 2017 Elsevier B.V. All rights reserved.

Unmet needs in immigrant cancer survivors: a cross-sectional population-based study.

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Butow, P N; Bell, M L; Aldridge, L J; Sze, M; Eisenbruch, M; Jefford, M; Schofield, P; Girgis, A; King, M; Duggal, P S; McGrane, J; Goldstein, D

2013-09-01

Social suffering, language difficulties, and cultural factors may all make the cancer experience more difficult for immigrants. This study aimed to document unmet needs, and variables associated with these, in a population-based sample of first-generation immigrants and Anglo-Australians who had survived cancer. Participants were recruited via Australian cancer registries. Eligible cancer survivors had a new diagnosis 1-6 years earlier and were aged between 18 and 80 years at diagnosis. Eligible immigrant participants and parents were born in a country where Arabic, Chinese (Mandarin, Cantonese, and other dialects), or Greek is spoken, and they spoke one of these languages. A random sample of English-speaking Anglo-Australian-born controls was recruited. Five hundred ninety-six patients (277 immigrants) were recruited to the study (response rate, 26%). Compared to Anglo-Australians, the adjusted odds ratio of Chinese immigrants for at least one unmet information/support need was 5.1 (95% CI 3.1, 8.3) and for any unmet physical need was 3.1 (95% CI 1.9, 5.1). For Greek, these were 2.0 (95% CI 1.1, 4.0) and 2.7 (95% CI 1.4, 5.2). Arabic patients had elevated, but not statistically significant, odds ratios compared to Anglo-Australians. Written information and having a specialist, support services, and other health professionals who spoke their language were in the top ten unmet needs amongst immigrants. Immigrant cancer survivors, several years after initial diagnosis, are more likely to have an unmet need for information or for help with a physical problem than Anglo-Australians. They strongly desire information and support in their own language.

Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs.

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Ganz, Michael L; Tendulkar, Shalini A

2006-06-01

To estimate the prevalence and correlates of unmet needs for mental health care services for children with special health care needs and their families. We use the National Survey of Children With Special Health Care Needs to estimate the prevalence of unmet mental health care needs among children with special health care needs (1-17 years old) and their families. Using logistic-regression models, we also assess the independent impact of child and family factors on unmet needs. Substantial numbers of children with special health care needs and members of their families have unmet needs for mental health care services. Children with special health care needs who were poor, uninsured, and were without a usual source of care were statistically significantly more likely to report that their mental health care needs were unmet. More severely affected children and those with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Families of severely affected children or of children with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Our results indicate that children with special health care needs and their families are at risk for not receiving needed mental health care services. Furthermore, we find that children in families of lower socioeconomic status are disproportionately reporting higher rates of unmet needs. These data suggest that broader policies to identify and connect families with needed services are warranted but that child- and family-centered approaches alone will not meet the needs of these children and their families. Other interventions such as anti-poverty and insurance expansion efforts may be needed as well.

Sociodemographic disparities associated with perceived causes of unmet need for mental health care.

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Alang, Sirry M

2015-12-01

Mental disorders are among the leading causes of disability in the United States. In 2011, over 10 million adults felt that even though they needed treatment for mental health problems, they received insufficient or no mental health care and reported unmet need. This article assesses associations between sociodemographic characteristics and perceived causes of unmet needs for mental health care. A sample of 2,564 adults with unmet mental health need was obtained from the National Survey on Drug Use and Health. Outcome variables were 5 main reasons for unmet need: cost, stigma, minimization, low perceived treatment effectiveness, and structural barriers. Each cause of unmet need was regressed on sociodemographic, health, and service use characteristics. Women had higher odds of cost-related reasons for unmet need than men. Odds of stigma and structural barriers were greater among Blacks than Whites, and among rural than metropolitan residents. Compared with the uninsured, insured persons were less likely to report cost barriers. However, insured persons had higher odds of stigma and minimization of mental disorders. Insurance alone is unlikely to resolve the problem of unmet need. Understanding the social epidemiology of perceived unmet need will help identify populations at risk of not receiving mental health care or insufficient care. Focusing on specific programs and services that are designed to address the causes of perceived unmet need in particular populations is important. Future research should explore how intersecting social statuses affect the likelihood of perceived unmet need. (c) 2015 APA, all rights reserved).

Developing a European research network to address unmet needs in anxiety disorders.

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Baldwin, David S; Pallanti, Stefano; Zwanzger, Peter

2013-12-01

Anxiety disorders are common, typically have an early onset, run a chronic or relapsing course, cause substantial personal distress, impair social and occupational function, reduce quality of life, and impose a substantial economic burden: they are often comorbid with major depression, bipolar disorder, schizophrenia, substance misuse and physical illness, and are associated with increased risks of suicidal behaviour. As such, anxiety disorders should be regarded as a significant public health problem. However the causes of anxiety disorders remain largely unknown, which hinders accurate diagnosis, the prediction of prognosis, and the development of refined treatment approaches. In clinical practice, many patients with anxiety disorders do not present or are not recognised, the standard of care they receive is often sub-optimal, and the effectiveness of pharmacological and psychological treatment interventions in real-world clinical practice can be disappointing. The current substantial unmet public health, clinical and research needs in anxiety disorders could be addressed in part by developing independent collaborative European networks. Copyright © 2013 Elsevier Ltd. All rights reserved.

Unmet need for contraception and its association with unintended pregnancy in Bangladesh.

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Bishwajit, Ghose; Tang, Shangfeng; Yaya, Sanni; Feng, Zhanchun

2017-06-12

Unmet need for contraception and unintended pregnancy are important public health concerns both in developing and developed countries. Previous researches have attempted to study the factors that influence unintended pregnancy. However, the association between unmet need for contraception and unwanted pregnancy is not studied adequately. The aim of the present study was to measure the prevalence of unmet need for contraception and unwanted pregnancy, and to explore the association between these two in a nationally representative sample in Bangladesh. Data for the present study were collected from Bangladesh demographic and health survey conducted in 2011. Participants were 7338 mothers ageing between 13 and 49 years selected from both rural and urban residencies. Planning status of last pregnancy was the main outcome variable and unmet need for contraception was the explanatory variable of primary interest. Cross tabulation, chi-square tests and logistic regression (Generalised estimating equations) methods were used for data analysis. Mean age of the sample population was 25.6 years (SD 6.4). Prevalence of unmet need for contraception was 13.5%, and about 30% of the women described their last pregnancy as unintended. In the adjusted model, the odds of unintended pregnancy were about 16 fold among women who reported facing unmet need for contraception compared to those who did not (95% CI = 11.63-23.79). National rates of unintended pregnancy and of unmet need for contraception remain considerably high and warrant increased policy attention. Findings suggests that programs targeting to reduce unmet need for contraception could contribute to a lower rate of unintended pregnancy in Bangladesh. More in-depth and qualitative studies on the underlying sociocultural causes of unmet need can help develop context specific solutions to unintended pregnancies.

Measuring Nutrition-Related Unmet Needs in Recently Hospital-Discharged Homebound Older Adults.

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Vaudin, Anna; Song, Hee-Jung; Mehta, Mira; Sahyoun, Nadine

2018-01-01

Functional limitations in homebound older adults may cause difficulties with obtaining and preparing adequate healthy food. Services exist to help with these difficulties, however, not all individuals who could benefit receive them. This secondary analysis of observational data, obtained via questionnaires from homebound, recently hospital discharged older adults (n = 566), aimed to identify the prevalence and correlates of unmet need for such services, and to examine the disagreement between self-reported need for a service and functional limitation that could be addressed by that service. One-fifth of respondents reported unmet need for vision services and oral health services, and one-tenth reported unmet need for transportation services and physical therapy. There was a significant association between reported need and functional limitation (p < 0.001) for all services, except mental health and grocery delivery. However, for each service there were participants who under-reported need, compared with functional ability indicators. More research is required to determine the best methods for measuring these needs to ensure that nutritional vulnerability is detected and addressed in those returning from hospital.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women.

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Everett, Bethany G; Mollborn, Stefanie

2014-08-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen's health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen's model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women

Science.gov (United States)

Everett, Bethany G.; Mollborn, Stefanie

2013-01-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women. PMID:25382887

Service use and unmet service needs in grandparents raising grandchildren.

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Yancura, Loriena A

2013-01-01

Most in-depth studies of grandparents raising grandchildren use samples recruited from service providers, so little is known about those who do not use formal services. A sample of 200 grandparents registered with a public school district completed a survey on service use and unmet service needs. Of the 131 who did not use services, 82 reported unmet service needs, and 49 reported no needs. Those with unmet needs were younger, more likely to be Native Hawaiian, and less likely to receive public assistance. These findings indicate that some grandparents are falling through the cracks of the service provision network.

The influence of family violence and child marriage on unmet need for family planning in Jordan.

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Clark, Cari Jo; Spencer, Rachael A; Khalaf, Inaam A; Gilbert, Louisa; El-Bassel, Nabila; Silverman, Jay G; Raj, Anita

2017-04-01

Risk for unmet need for contraception is associated with men's perpetration of intimate partner violence (IPV) against women and may be influenced by violence perpetrated by other family members (family violence, FV). Women who married as minors may be most vulnerable to the potential compounding effect of IPV and FV on unmet need. Using nationally representative data from the 2012 Jordan Population and Family Health Survey we examined unmet need by exposure to IPV and FV by women's age at marriage (<18, 18+ years). Logistic regression was used to test whether IPV and FV were independently associated with unmet need, by age at marriage. Interaction terms (IPV×FV) were tested in both models. Stratification by FV was employed to clarify the interpretation of significant interactions. IPV increased the odds of unmet need by 87% [adjusted odds ratio (AOR) 1.87; 95% confidence interval (95% CI) 1.13-3.10] and 76% (AOR 1.76; 95% CI 1.30-2.38) among women who married prior to and after the age of 18 years, respectively. Women married as minors who experienced IPV and FV had a four-fold higher likelihood of having an unmet need (AOR 6.75; 95% CI 1.95-23.29) compared to those experiencing only IPV (AOR 1.49; 95% CI 0.84-2.38). No interaction between IPV and FV was detected for women married at or above majority. Laws that prohibit child marriage should be strengthened and health sector screening for violence experience could help identify women at risk of unmet need and improve women's reproductive agency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Muscle invasive bladder cancer: examining survivor burden and unmet needs.

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Mohamed, Nihal E; Chaoprang Herrera, Phapichaya; Hudson, Shawna; Revenson, Tracey A; Lee, Cheryl T; Quale, Diane Z; Zarcadoolas, Christina; Hall, Simon J; Diefenbach, Michael A

2014-01-01

Although improvements in perioperative care have decreased surgical morbidity after radical cystectomy for muscle invasive bladder cancer, treatment side effects still have a negative impact on patient quality of life. We examined unmet patient needs along the illness trajectory. A total of 30 patients (26.7% women) treated with cystectomy and urinary diversion for muscle invasive bladder cancer participated in the study. Patients were recruited from the Department of Urology at Mount Sinai and through advertisements on the Bladder Cancer Advocacy Network (BCAN) website between December 2011 and September 2012. Data were collected at individual interviews, which were audiotaped and transcribed. Transcribed data were quantitatively analyzed to explore key unmet needs. At diagnosis unmet informational needs were predominant, consisting of insufficient discussion of certain topics, including urinary diversion options and their side effects, self-care, the recovery process and medical insurance. Unmet psychological needs related to depression, and worries about changes in body image and sexual function were reported. Postoperative unmet needs revolved around medical needs (eg pain and bowel dysfunction) and instrumental needs (eg need of support for stomal appliances, catheters and incontinence). During survivorship (ie 6 to 72 months postoperatively) unmet needs centered around psychological support (ie depression, poor body image and sexual dysfunction) and instrumental support (eg difficulty adjusting to changes in daily living). Meeting patient needs is imperative to ensure adequate patient involvement in health care and enhance postoperative quality of life. An effective support provision plan should follow changes in patient needs. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Unmet need for contraception among married women in an urban area of Puducherry, India.

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Sulthana, Bahiya; Shewade, Hemant Deepak; Sunderamurthy, Bhuvaneswary; Manoharan, Keerthana; Subramanian, Manimozhi

2015-01-01

Unmet need for contraception remains a national problem. The study was conducted in an urban area of Puducherry, India, among the eligible couples to assess the unmet need for contraception and to determine the awareness and pattern of use of contraceptives along with the socio-demographic factors associated with the unmet needs for contraception. This cross-sectional study included eligible couples with married women in age group of 15-45 yr as the study population (n=267). Probability proportional to size sampling followed by systematic random sampling was used. A pre-tested questionnaire was administered to collect data from the respondents. Double data entry and validation of data was done. Unmet need for contraception was 27.3 per cent (95% CI: 22.3-33); unmet need for spacing and limiting was 4.9 and 22.5 per cent, respectively. Among those with unmet need (n=73), 50 per cent reported client related factors (lack of knowledge, shyness, etc.); and 37 per cent reported contraception related factors (availability, accessibility, affordability, side effects) as a cause for unmet need. Our study showed a high unmet need for contraception in the study area indicating towards a necessity to address user perspective to meet the contraception needs.

Unmet need for contraception among married women in an urban area of Puducherry, India

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Bahiya Sulthana

2015-01-01

Full Text Available Background & objectives: Unmet need for contraception remains a national problem. The study was conducted in an urban area of Puducherry, India, among the eligible couples to assess the unmet need for contraception and to determine the awareness and pattern of use of contraceptives along with the socio-demographic factors associated with the unmet needs for contraception. Methods: This cross-sectional study included eligible couples with married women in age group of 15-45 yr as the study population (n=267. Probability proportional to size sampling followed by systematic random sampling was used. A pre-tested questionnaire was administered to collect data from the respondents. Double data entry and validation of data was done. Results: Unmet need for contraception was 27.3 per cent (95% CI: 22.3-33; unmet need for spacing and limiting was 4.9 and 22.5 per cent, respectively. Among those with unmet need (n=73, 50 per cent reported client related factors (lack of knowledge, shyness, etc.; and 37 per cent reported contraception related factors (availability, accessibility, affordability, side effects as a cause for unmet need. Interpretation & conclusions: Our study showed a high unmet need for contraception in the study area indicating towards a necessity to address user perspective to meet the contraception needs.

Managing the unmet psychosocial and information needs of patients with cancer

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Kathleen Abrahamson

2010-11-01

Full Text Available Kathleen Abrahamson1, Morgan Durham1, Rebekah Fox21Department of Public Health, Western Kentucky University, Bowling Green, KY, USA; 2Department of Communication, Texas State University, San Marcos, TX, USAAbstract: In this article, we synthesize current literature regarding the unmet needs of cancer patients, with a specific focus on interventions that address psychosocial distress, social support, and information deficits. Research indicates many patients diagnosed with cancer express unmet needs in terms of emotional distress, decision-making support, and practical concerns such as childcare, transportation, and financial assistance. Four types of system-level barriers to the meeting of patient psychosocial and information-based needs emerge from the literature: underidentification of needs due to inadequate assessment, time constraints on cancer care providers, lack of adequate reimbursement for psychosocial and information services, and barriers related to communication of disease-related information. There is also evidence that unmet need, especially unmet information need, is related to the level of patient health literacy. Patient empowerment through the resolution of unmet needs increases patient participation in care, and is especially crucial in regards to understanding risks and benefits of treatment. There is evidence that some interventions are effective for some patients, and that even relatively simple interventions can reduce psychosocial and information-based needs. The challenge is therefore to discover which intervention will be effective for each individual patient, and to attain the skills and resources necessary to intervene appropriately.Keywords: cancer, unmet need, health literacy, intervention

Estimating demand and unmet need for allogeneic hematopoietic cell transplantation in the United States using geographic information systems.

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Besse, Kelsey L; Preussler, Jaime M; Murphy, Elizabeth A; Denzen, Ellen M; Lill, Michael C; Chell, Jeffrey W; Senneka, Mary K; Majhail, Navneet S; Williams, Eric P

2015-03-01

Allogeneic hematopoietic cell transplantation (HCT) is an increasingly used therapy for many patients with hematologic malignancies and other marrow failure or immune system disorders. The purpose of this study was to quantify and visualize both the demand and unmet need for HCT. HCT use for 2012 was described using the Center for International Blood and Marrow Transplant Research registry. Potential demand for HCT was calculated using 2012 SEER data and published literature for HCT-treatable conditions. Point locations of transplant centers were geocoded using geographic information system (GIS) software; Thiessen polygons were created to establish adult (age 20 to 74 years) and pediatric (age 0 to 19 years) market areas. Market-area population estimates were calculated using 2012 population estimates by age aggregated by census block. US market areas for HCTs were identified separately for transplant centers treating adult (n = 62) and pediatric patients (n = 52). Overall HCT demand among adults was 16,096, with an unmet need for HCTs of 10,276 patients. For pediatric patients, the total demand was 4,561, with an unmet need of 3,213 potential recipients. Evaluation of adult and pediatric market areas indicated that the largest unmet needs tended to be in areas with large populations. Market-area maps and statistics developed using GIS will help communicate the unmet need for HCT, inform policy, and assist transplant centers in planning for the anticipated growth in HCT use. Copyright © 2015 by American Society of Clinical Oncology.

Unmet needs in young adults with a parent with a chronic condition: a mixed-method investigation and measure development study.

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Nicholls, Wendy; Patterson, Pandora; McDonald, Fiona E J; Hulbert-Williams, Nicholas J

2017-03-01

Given the high number of young adults caring for a family member, and the potential for adverse psychosocial outcomes, there is a need for a screening tool, with clinical utility, to identify those most vulnerable to poor outcomes and to aid targeted interventions. (i) To determine whether current knowledge from cancer literature regarding young carers is generalisable to chronic conditions and, therefore, whether an existing screening tool could be adapted for this population. (ii) To develop a measure of unmet needs in this population and conduct initial psychometric analysis. This was mixed method; interviews in study one informed measure development in study two. Inclusion criteria were as follows: having a parent with a chronic condition and being aged 16-24 years. In study 1, an interpretative phenomenological analysis was conducted on interviews from seven young adults (age range 17-19 years). Study 2 explored factor structure, reliability and validity of the Offspring Chronic Illness Needs Inventory (OCINI). Participants were 73 females and 34 males (mean ages 18.22, SD = 1.16; 18.65, SD = 1.25). OCINI, Depression Anxiety and Stress Scale, and the Adult Carers Quality of Life Scale. Interviews communicated that the impact of their parent's condition went unacknowledged and resulted in psychosocial, support and informational needs. An exploratory principal axis analysis of the OCINI yielded five factors. Significant and positive correlations were found between unmet needs and stress, anxiety, and depression, and inversely with quality of life. The scale has applications in clinical settings where these young people, who are at risk of negative psychological outcomes, may be assessed and unmet needs targeted appropriately. © 2016 Nordic College of Caring Science.

International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)?: The unmet needs and the clinical grey zone in autoimmune disease management.

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Giacomelli, Roberto; Afeltra, Antonella; Alunno, Alessia; Baldini, Chiara; Bartoloni-Bocci, Elena; Berardicurti, Onorina; Carubbi, Francesco; Cauli, Alberto; Cervera, Ricard; Ciccia, Francesco; Cipriani, Paola; Conti, Fabrizio; De Vita, Salvatore; Di Benedetto, Paola; Doria, Andrea; Drosos, Alexandros A; Favalli, Ennio Giulio; Gandolfo, Saviana; Gatto, Mariele; Grembiale, Rosa Daniela; Liakouli, Vasiliki; Lories, Rik; Lubrano, Ennio; Lunardi, Claudio; Margiotta, Domenico Paolo Emanuele; Massaro, Laura; Meroni, Pierluigi; Minniti, Antonia; Navarini, Luca; Pendolino, Monica; Perosa, Federico; Pers, Jacques-Olivier; Prete, Marcella; Priori, Roberta; Puppo, Francesco; Quartuccio, Luca; Ruffatti, Amelia; Ruscitti, Piero; Russo, Barbara; Sarzi-Puttini, Piercarlo; Shoenfeld, Yehuda; Somarakis, George A; Spinelli, Francesca Romana; Tinazzi, Elisa; Triolo, Giovanni; Ursini, Francesco; Valentini, Gabriele; Valesini, Guido; Vettori, Serena; Vitali, Claudio; Tzioufas, Athanasios G

2017-09-01

Autoimmune diseases are a complex set of diseases characterized by immune system activation and, although many progresses have been done in the last 15years, several unmet needs in the management of these patients may be still identified. Recently, a panel of international Experts, divided in different working groups according to their clinical and scientific expertise, were asked to identify, debate and formulate a list of key unmet needs within the field of rheumatology, serving as a roadmap for research as well as support for clinicians. After a systematic review of the literature, the results and the discussions from each working group were summarised in different statements. Due to the differences among the diseases and their heterogeneity, a large number of statements was produced and voted by the Experts to reach a consensus in a plenary session. At all the steps of this process, including the initial discussions by the steering committee, the identification of the unmet needs, the expansion of the working group and finally the development of statements, a large agreement was attained. This work confirmed that several unmet needs may be identified and despite the development of new therapeutic strategies as well as a better understanding of the effects of existing therapies, many open questions still remain in this field, suggesting a research agenda for the future and specific clinical suggestions which may allow physicians to better manage those clinical conditions still lacking of scientific clarity. Copyright © 2017. Published by Elsevier B.V.

Unmet need and fertility decline: a comparative perspective on prospects in sub-Saharan Africa.

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Casterline, John B; El-Zeini, Laila O

2014-06-01

This study assesses how changes in unmet need for family planning have contributed to contemporary fertility declines, and the implications of this historical record for further fertility decline, especially in sub-Saharan Africa. We examine joint trends at the national level in fertility, unintended fertility, and unmet need. We bring unintended fertility into the analysis because the underlying rationale for reducing unmet need is to avert unintended pregnancies and births. The association over time between unmet need and fertility is investigated using survey data from 45 countries in Africa, Asia, and Latin America and the Caribbean from the mid-1970s to the present. The empirical analysis finds that reduction in unmet need, especially unmet need for limiting, is strongly associated with fertility decline in Latin America and the Caribbean and in Asia and North Africa. Fertility decline in sub-Saharan Africa is weakly associated with trends in unmet need (and satisfaction of demand). We propose that the stark regional difference is due to measurement problems and to the fundamentally different character of fertility decline in sub-Saharan Africa, itself reflective of basic differences in pretransition reproductive regimes. © 2013 The Population Council, Inc.

Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the Hierarchy Model of Needs in Dementia.

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Scholzel-Dorenbos, Carla J M; Meeuwsen, Els J; Olde Rikkert, Marcel G M

2010-01-01

To make an inventory of needs assessment instruments in dementia, to explore the interaction between unmet needs and health-related quality of life (HRQoL) and to relate these to the conceptual model of Maslow's Hierarchy of needs in order to design a dementia-specific model. Narrative review of literature on (measures of) needs of patients and caregivers and HRQoL determinants important in dementia. Relating these needs to individual goal setting instruments and Maslow's Hierarchy of needs model. The Camberwell Assessment of Needs for the Elderly (CANE) turns out to be a valid tool to assess needs of dementia patients, suitable for research and clinical use. The Carers' Needs Assessment for Dementia (CNA-D) is a valid instrument to assess needs of caregivers. Patients identified significantly fewer needs than (in)formal caregivers. The most important needs, that also determine large part of HRQoL, are need for information; support with regard to symptoms of dementia; social contact and company; and for health monitoring and safety. Goal attainment scaling in dementia is an important but not yet valid outcome measure, with only few data on feasibility in dementia patients. There are several instruments to assess needs of dementia patients and caregivers. Domains of unmet needs and HRQoL overlap. The Hierarchy Model of Needs in Dementia (HMND) offers a new theoretical framework to address the interplay between meeting of needs and improvement of HRQoL in dementia. By identifying unmet needs in dementia-research and focussing on unmet needs in dementia-care, much can be done to improve HRQoL.

Unmet Health Care Needs among Children Exposed to Parental Incarceration.

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Turney, Kristin

2017-05-01

Objectives The incarceration rate in the United States has increased rapidly since the mid-1970s and, accordingly, a large number of children are exposed to parental incarceration. Research finds that parental incarceration is associated with deleterious physical and mental health outcomes among children, but little is known about these children's health care access. Methods I used data from the 2011-2012 National Survey of Children's Health (N = 95,531), a population-based and nationally representative survey of non-institutionalized children ages 0-17 in the United States, to estimate the association between exposure to parental incarceration and children's unmet health care needs. Results In logistic regression models that adjust for an array of demographic and socioeconomic characteristics, children exposed to parental incarceration, compared to their counterparts, have 1.26 (95% CI 1.02-1.54) times the odds of having any unmet health care need. Analyses that disaggregate by type of unmet health care need (mental, dental, vision, mental health, or other) suggest this association is driven by a greater likelihood of unmet mental health care needs (OR 1.60; 95% CI 1.04-2.46). Conclusions Children exposed to parental incarceration, a vulnerable group especially at risk of physical and mental health problems, face challenges to health care access, especially mental health care access. Given that parental incarceration is concentrated among those children most in need of health care, parental incarceration may exacerbate existing inequalities in unmet health care needs.

Care coordination, medical complexity, and unmet need for prescription medications among children with special health care needs.

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Aboneh, Ephrem A; Chui, Michelle A

Children with special health care needs (CSHCN) have multiple unmet health care needs including that of prescription medications. The objectives of this study were twofold: 1) to quantify and compare unmet needs for prescription medications for subgroups of CSHCN without and with medical complexity (CMC)-those who have multiple, chronic, and complex medical conditions associated with severe functional limitations and high utilization of health care resources, and 2) to describe its association with receipt of effective care coordination services and level of medical complexity. A secondary data analysis of the 2009/2010 National Survey of CSHCN, a nationally representative telephone survey of parents of CSHCN, was conducted. Logistic regression models were constructed to determine associations between unmet need for prescription medications and medical complexity and care coordination for families of CSHCN, while controlling for demographic variables such as race, insurance, education level, and household income. Analyses accounted for the complex survey design and sampling weights. CMC represented about 3% of CSHCN. CMC parents reported significantly more unmet need for prescription medications and care coordination (4%, 68%), compared to Non-CMC parents (2%, 40%). Greater unmet need for prescription medications was associated with unmet care coordination (adjusted OR 3.81; 95% CI: 2.70-5.40) and greater medical complexity (adjusted OR 2.01; 95% CI: 1.00-4.03). Traditional care coordination is primarily facilitated by nurses and nurse practitioners with little formal training in medication management. However, pharmacists are rarely part of the CSHCN care coordination model. As care delivery models for these children evolve, and given the complexity of and numerous transitions of care for these patients, pharmacists can play an integral role to improve unmet needs for prescription medications. Copyright © 2016 Elsevier Inc. All rights reserved.

Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs.

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Hyshka, Elaine; Anderson, Jalene Tayler; Wild, T Cameron

2017-05-01

Research on perceived unmet need for care for mental health and substance use problems focuses on general populations to the detriment of hidden populations. This study describes prevalence and correlates of perceived unmet need for care in a community-based sample of street-involved people who use illicit drugs and identifies barriers to care. A sample of 320 street-involved people who use drugs participated in a structured, interviewer-assisted survey in Edmonton, Canada. The survey included the Perceived Need for Care Questionnaire, which assessed unmet need for care for mental health and substance use problems across seven service types. Logistic regression examined the associations between perceived unmet need, extent of socioeconomic marginalisation and problem severity. Barriers underlying unmet service needs were also examined. Most (82%) participants reported unmet need for one or more services during the past year. Odds of reporting one or more unmet needs were elevated amongst participants reporting substantial housing instability (adjusted odds ratio = 2.37; 95% confidence interval 1.19-4.28) and amongst participants meeting criteria for drug dependence (adjusted odds ratio = 1.22; 95% confidence interval 1.03-1.50), even after adjustment for sociodemographic covariates. Structural, rather than motivational barriers were the most commonly reported reasons underlying unmet service needs. Street-involved people who use drugs experience very high rates of perceived unmet need for care for mental health and substance use problems. General population studies on perceived unmet need are insufficient for understanding needs and barriers to care in hidden populations.[Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2017;36:295-304]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

The importance of measuring unmet healthcare needs.

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Gauld, Robin; Raymont, Antony; Bagshaw, Philip F; Nicholls, M Gary; Frampton, Christopher M

2014-10-17

Major restructuring of the health sector has been undertaken in many countries, including New Zealand and England, yet objective assessment of the outcomes has rarely been recorded. In the absence of comprehensive objective data, the success or otherwise of health reforms has been inferred from narrowly-focussed data or anecdotal accounts. A recent example relates to a buoyant King's Fund report on the quest for integrated health and social care in Canterbury, New Zealand which prompted an equally supportive editorial article in the British Medical Journal (BMJ) suggesting it may contain lessons for England's National Health Service. At the same time, a report published in the New Zealand Medical Journal expressed concerns at the level of unmet healthcare needs in Canterbury. Neither report provided objective information about changes over time in the level of unmet healthcare needs in Canterbury. We propose that the performance of healthcare systems should be measured regularly, objectively and comprehensively through documentation of unmet healthcare needs as perceived by representative segments of the population at formal interview. Thereby the success or otherwise of organisational changes to a health system and its adequacy as demographics of the population evolve, even in the absence of major restructuring of the health sector, can be better documented.

The association between perceived unmet medical need and mental health among the Republic of Korea Armed Forces.

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Kim, Tae Kyung; Lee, S G; Han, K-T; Choi, Y; Lee, S Y; Park, E-C

2017-06-01

We investigated the effect of unmet medical need on the mental health of Republic of Korea (ROK) Armed Forces personnel, as most of the service members work in remote areas and often experience such unmet needs. This study used secondary data from the 2014 Military Health Survey (MHS), conducted by the ROK School of Military Medicine and designed to collect military health determinants. Descriptive statistics showed the general characteristics of the study populations by variable. We specifically compared the population after stratifying participants by suicide ideation. An analysis of variance was also carried out to compare Kessler Psychological Distress Scale 10 Scores. Additionally, dependent spouses and children of both active-duty service members and retirees are included among those entitled to Military Health System healthcare. Among the 4967 military personnel, 681 (13.7%) individuals reported an experience of unmet medical need within the past 12 months and gave reasons of 'no time (5.15%)', 'long office wait (2.6%)', 'no money (0.22%)', 'long distance from base (1.19%)', 'illness but not very serious (1.65%)', 'mistrust in doctors (1.95%)' and 'pressure due to performance appraisal (0.95%)'. Regression analysis revealed that unmet medical need was significantly associated with negative mental health (β=1.753, pmental health effects. Our study indicates that unmet medical need is significantly associated with soldiers' mental health decline and suicide ideation, highlighting the importance of providing military personnel with timely, affordable and sufficient medical care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Care coordination and unmet specialty care among children with special health care needs.

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Boudreau, Alexy Arauz; Perrin, James M; Goodman, Elizabeth; Kurowski, Daniel; Cooley, W Carl; Kuhlthau, Karen

2014-06-01

Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families. Secondary data analysis of participants in the 2009–2010 National Survey of CSHCN who reported unmet specialty care needs and for whom care coordination and medical home status could be determined (n = 18 905). Logistic regression models explored the association of unmet need with care coordination and medical home status adjusting for household income. Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds of unmet specialty care need (without a medical home, odds ratio: 0.63, 95% confidence interval: 0.47–0.86; within a medical home, odds ratio: 0.22, 95% confidence interval: 0.16–0.29) with a greater reduction among those receiving care coordination within a medical home versus those receiving care coordination without a medical home. We did not find differences in the impact of care coordination by percentage of the federal poverty level. Care coordination is associated with family report of decreased unmet specialty care needs among CSHCN independent of household income. The effect of care coordination is greater when care is received in a medical home.

DETERMINANTS OF UNMET NEED FOR FAMILY PLANNING IN SLUMS OF LUCKNOW

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Mukesh

2015-06-01

Full Text Available INTRODUCTION: Understanding of family planning scenario among different societies and communities, which by and large reside in urban slum areas, might prove useful in increasing family planning acceptance by them and decreasing population growth. Unmet need is a valuable indicator for assessing the achievements of national family planning programs. OBJECTIVES: The present study was undertaken with the objectives to estimate unmet need for family planning among the married women of reproductive age group (15 - 49 years in urban slums of Lucknow and to determine the various factors that influence the unmet need. METHODS: A community based cross - sectional study was conducted in slums of Lucknow City from February 2014 to September 2014. A total 452 married women in reproductive age group were interviewed through house to house survey with the help of a pre - designed, pre - tested and semi - structured questionnaire. RESULTS: The total unmet need for family planning was 69.0%. Multivariate logistic regression revealed socioeconomic status upper lower and below (OR 2.7; 95% CI 1.5 - 5.1; p = 0.00; duration of marriage less than 1 year (OR 1.8; 95% CI 1.1 - 2.9; p = 0.01; less number of live issues (OR 1.6; 95% CI 1.1 - 2.5; p = 0.00; working status of women (OR 1.9; 95% CI 1.1 - 2.9; p = 0.03; social class i.e. OBC and SC/ST (OR 2.3; 95% CI 1.1 - 4.6; p = 0.02 were found to be independent predictors of unmet need of family planning. CONCLUSION: The present study revealed that unmet need for family planning was quite high among women belonging to social class i.e. OBC and SC/ST, with low socioeconomic status, duration of marriage less than one year less number of live issues and working status of the women.

Examining the unmet need in adults with severe asthma

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M. R. Partridge

2007-09-01

Full Text Available Asthma currently affects an estimated 300 million people worldwide and the number is expected to rise to 400 million by 2025. Asthma morbidity remains high and the economic burden is significant. Approximately 20% of patients have severe persistent asthma. As patients with severe asthma often have a variety of conditions that may coexist with or be mistaken for asthma, careful diagnosis and management are essential, and adhering to a protocol for investigations is helpful. For patients with severe persistent asthma, the Global Initiative for Asthma 2005 guidelines recommend the use of high-dose inhaled corticosteroids in combination with a long-acting beta2-agonist, with one or more additional controller medications if required (step 4 therapy. However, recent studies have shown that asthma remains inadequately controlled in many patients with severe asthma, despite treatment in accordance with guidelines. Patients with severe asthma have the highest healthcare utilisation and mortality, and there is clearly an unmet need for the effective and safe treatment of patients with severe persistent allergic asthma who remain symptomatic despite optimised standard treatment. The latest guidelines suggest that omalizumab may address this unmet need.

Unmet needs for cardiovascular care in Indonesia.

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Maharani, Asri; Tampubolon, Gindo

2014-01-01

In the past twenty years the heaviest burden of cardiovascular diseases has begun to shift from developed to developing countries. However, little is known about the real needs for cardiovascular care in these countries and how well those needs are being met. This study aims to investigate the prevalence and determinants of unmet needs for cardiovascular care based on objective assessment. Multilevel analysis is used to analyse the determinants of met needs and multilevel multiple imputation is applied to manage missing data. The 2008 Indonesian Family Life Survey (IFLS4) survey is the source of the household data used in this study, while district data is sourced from the Ministry of Health and Ministry of Finance. The data shows that nearly 70% of respondents with moderate to high cardiovascular risk failed to receive cardiovascular care. Higher income, possession of health insurance and residence in urban areas are significantly associated with met needs for cardiovascular care, while health facility density and physician density show no association with them. The prevalence of unmet needs for cardiovascular care is considerable in Indonesia. Inequality persists as a factor in meeting needs for cardiovascular care as the needs of people with higher incomes and those living in urban areas are more likely to be met. Alleviation of poverty, provision of health care insurance for the poor, and improvement in the quality of healthcare providers are recommended in order to meet this ever-increasing need.

Unmet needs for cardiovascular care in Indonesia.

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Asri Maharani

Full Text Available In the past twenty years the heaviest burden of cardiovascular diseases has begun to shift from developed to developing countries. However, little is known about the real needs for cardiovascular care in these countries and how well those needs are being met. This study aims to investigate the prevalence and determinants of unmet needs for cardiovascular care based on objective assessment.Multilevel analysis is used to analyse the determinants of met needs and multilevel multiple imputation is applied to manage missing data. The 2008 Indonesian Family Life Survey (IFLS4 survey is the source of the household data used in this study, while district data is sourced from the Ministry of Health and Ministry of Finance. The data shows that nearly 70% of respondents with moderate to high cardiovascular risk failed to receive cardiovascular care. Higher income, possession of health insurance and residence in urban areas are significantly associated with met needs for cardiovascular care, while health facility density and physician density show no association with them.The prevalence of unmet needs for cardiovascular care is considerable in Indonesia. Inequality persists as a factor in meeting needs for cardiovascular care as the needs of people with higher incomes and those living in urban areas are more likely to be met. Alleviation of poverty, provision of health care insurance for the poor, and improvement in the quality of healthcare providers are recommended in order to meet this ever-increasing need.

Family Caregiver Factors Associated with Unmet Needs for Care of Older Adults.

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Beach, Scott R; Schulz, Richard

2017-03-01

To examine caregiver factors associated with unmet needs for care of older adults. Population-based surveys of caregivers and older adult care recipients in the United States in 2011. 2011 National Health and Aging Trends Study and National Study of Caregiving. Family caregivers (n = 1,996) of community-dwelling older adults with disabilities (n = 1,366). Disabled care recipient reports of unmet needs for care in the past month with activities of daily living (ADLs; e.g., wet or soiled clothing), mobility (e.g., have to stay inside), or instrumental activities of daily living (IADLs; e.g., medication errors). Caregiver reported sociodemographic characteristics, caregiving intensity and tasks performed, health, and psychosocial effects. Of the care recipients, 44.3% reported at least one unmet need for care in the past month (38.2% ADL related, 14.6% IADL related). Younger caregivers, caregiving sons, caregivers not living with care recipients, and having supplemental paid caregivers were associated with more unmet needs. Caregivers with recipients reporting two or more unmet needs were more likely to spend more than 100 hours per month caregiving, help with skin care and wounds, report caregiving as emotionally and physically difficult, and report restricted participation in valued activities (all P family caregivers. Caregivers experiencing high levels of burden, stress, and negative physical and psychosocial impacts may provide substandard or poor care to older adults, which may be a risk factor for neglect. Clinicians caring for disabled older adults should assess their unmet needs and the capacity of caregivers to address them. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Associations between neighbourhood support and financial burden with unmet needs of head and neck cancer survivors.

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O'Brien, Katie M; Timmons, Aileen; Butow, Phyllis; Gooberman-Hill, Rachael; O'Sullivan, Eleanor; Balfe, Myles; Sharp, Linda

2017-02-01

To assess the unmet needs of head and neck cancer survivors and investigate associated factors. In particular, to explore whether social support (family/friends and neighbours) and financial burden are associated with unmet needs of head and neck cancer (HNC) survivors. This was a cross-sectional study of HNC survivors, with 583 respondents included in the analysis. Information was collected on unmet supportive care needs as measured by the Supportive Care Needs Survey (SCNS-SF34). Poisson regression with robust standard errors was used to examine factors associated with having one or more needs in each of the five domains (physical; psychological; sexuality; patient care and support; and health system and information). The mean age of respondents was 62.9years (standard deviation 11.3years) and one third of respondents were female. The top ten unmet needs was composed exclusively of items from the physical and psychological domains. Financial strain due to cancer and finding it difficult to obtain practical help from a neighbour were both associated with unmet needs in each of the five domains, in the adjusted analyses. Whilst in each domain, a minority of respondents have unmet needs, approximately half of respondents reported at least one unmet need, with the commonest unmet needs in the psychological domain. Providing services to people with these needs should be a priority for healthcare providers. We suggest that studies, which identify risk factors for unmet needs, could be used to develop screening tools or aid in the targeting of support. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predictors of unmet needs and psychological distress in adolescent and young adult siblings of people diagnosed with cancer.

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McDonald, F E J; Patterson, P; White, K J; Butow, P; Bell, M L

2015-03-01

Predictors of psychological distress and unmet needs amongst adolescents and young adults (AYAs) who have a brother or sister diagnosed with cancer were examined. There were 106 AYAs (12-24 years old) who completed questionnaires covering demographics, psychological distress (Kessler 10), unmet needs (Sibling Cancer Needs Instrument) and family relationships (Family Relationship Index; Adult Sibling Relationship Questionnaire; Sibling Perception Questionnaire (SPQ)). Three models were analysed (demographic variables, cancer-specific variables and family functioning variables) using multiple linear regression to determine the role of the variables in predicting psychological distress and unmet needs. Unmet needs were higher for AYA siblings when treatment was current or a relapse had occurred. Higher scores on the SPQ-Interpersonal subscale indicating a perceived decrease in the quality of relationships with parents and others were associated with higher levels of distress and unmet needs. The age and gender of the AYA sibling, whether it was their brother or sister who was diagnosed with cancer, the age difference between them, the number of parents living with the AYA sibling, parental birth country, time since diagnosis, Family Relationship Index, Adult Sibling Relationship Questionnaire and the SPQ-Communication subscale did not significantly impact outcome variables. These results highlight the variables that can assist in identifying AYA siblings of cancer patients who are at risk and have a greater need for psychosocial assistance. Variables that may be associated with increased distress and unmet needs are reported to assist with future research. The results are also useful in informing the development of targeted psychosocial support for AYA siblings of cancer patients. Copyright © 2014 John Wiley & Sons, Ltd.

Factors affecting unmet need for family planning in married women of reproductive age group in urban slums of Lucknow

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Anjali Pal

2014-03-01

Full Text Available Background: Unmet need for family planning signifies the gap between the reproductive intentions of couples and their actual contraceptive behaviour. The National Family Health Surveys carried out in India in 1992-93, 1998-99 and 2004-2005 have revealed that for a sizable proportion of the population in the reproductive age group, the need for contraceptive services are not met with despite the existence of a National Policy on family planning since 1983. This study was carried out to assess the extent of unmet need for family planning among married women of reproductive age group in urban slums of Lucknow and identify the various factors affecting it. Study design: Cross sectional Setting: four urban slums of Lucknow Participants: 414 married women in the age group of 15- 44 years Study variables: age, education, occupation, religion, parity Statistical analysis: chi- square test, logistic regression analysis, fisher’s exact test Results: the extent of unmet need among married women of reproductive age group was 53.1%. The unmet need was found to be significantly associated with age, number of living sons, discussion of family planning with husband, perception of husband’s view on family planning and husbands’ behaviour towards use of family planning method. Logistic regression analysis of unmet need showed that the lower age of the woman, lesser number of living sons and husband’s discouragement towards the use of FP method were correlated with the unmet need for Family Planning.

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

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Dickman, Ram; Maradey-Romero, Carla; Gingold-Belfer, Rachel; Fass, Ronnie

2015-01-01

Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the therapeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, maintenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett’s esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any future development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the aforementioned areas of unmet need. PMID:26130628

Medical Undergraduate Survey on Headache Education in Singapore: Knowledge, Perceptions, and Assessment of Unmet Needs.

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Ong, Jonathan Jia Yuan; Chan, Yee Cheun

2017-06-01

There have been no prior studies assessing the status of undergraduate headache training and education in Singapore. Unmet needs of undergraduate medical students in terms of knowledge-practice gaps pertaining to diagnosis and management of headache disorders are unknown. The possible underemphasis of this aspect of the curriculum as compared to other chronic conditions such as diabetes mellitus has also not been ascertained. The aim of this article is to assess the knowledge base and perceptions, thereby identifying the unmet needs of headache disorder education in undergraduate medical students. Students reported their perceived time that was devoted to the subject matter and this was recorded and reported. In order to provide a comparative indication on the level of prioritization, the total duration within the syllabus dedicated to headache education vs other chronic diseases (using diabetes mellitus as a surrogate) was sought. A comprehensive survey consisting of questions assessing the headache curriculum, knowledge, and perceptions was developed. The questionnaire was distributed to final year medical students attending a full-day Neurology review course in their last semester. Attendees were given the duration of the course to complete the questionnaire, and forms were collected at the end of the day. About 127 final year medical students completed our survey. More than half (55.1%) did not receive formal teaching on how to take a complete headache history. The majority (90.6%) have not attended a headache sub-specialty clinic. The mean total number of hours exposed to headache disorders was 5.69h (SD ± 5.19). The vast majority (96.1%) were unfamiliar with locally published clinical practice guidelines, and a significant proportion (74.0%) were unfamiliar with the third edition (beta) of the International Classification of Headache Disorders. Nearly half (47.2%) were unfamiliar with 'medication overuse headache' as a disease entity. Only one (0

Factors associated with unmet dental care needs in Canadian immigrants: an analysis of the longitudinal survey of immigrants to Canada.

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Calvasina, Paola; Muntaner, Carles; Quiñonez, Carlos

2014-12-03

Immigrants are often considered to have poorer oral health than native born-populations. One possible explanation for immigrants' poor oral health is lack of access to dental care. There is very little information on Canadian immigrants' access to dental care, and unmet dental care needs. This study examines predictors of unmet dental care needs among a sample of adult immigrants to Canada over a three-point-five-year post-migration period. A secondary data analysis was conducted on the Longitudinal Survey of Immigrants to Canada (LSIC). Sampling and bootstrap weights were applied to make the data nationally representative. Simple descriptive analyses were conducted to describe the demographic characteristics of the sample. Bivariate and multiple logistic regression analyses were applied to identify factors associated with immigrants' unmet dental care needs over a three-point-five-year period. Approximately 32% of immigrants reported unmet dental care needs. Immigrants lacking dental insurance (OR = 2.63; 95% CI: 2.05-3.37), and those with an average household income of $20,000 to $40,000 per year (OR = 1.62; 95% CI: 1.01-2.61), and lower than $20,000 (OR = 2.25; 95% CI: 1.31-3.86), were more likely to report unmet dental care needs than those earning more than $60,000 per year. In addition, South Asian (OR = 1.85; CI: 1.25-2.73) and Chinese (OR = 2.17; CI: 1.47-3.21) immigrants had significantly higher odds of reporting unmet dental care needs than Europeans. Lack of dental insurance, low income and ethnicity predicted unmet dental care needs over a three-point-five-year period in a sample of immigrants to Canada.

The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community.

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Chan, Kevin K S; Mak, Winnie W S

2014-11-01

For people with schizophrenia living in the community and receiving outpatient care, the issues of stigma and discrimination and dearth of recovery-oriented services remain barriers to recovery and community integration. The experience of self-stigma and unmet recovery needs can occur regardless of symptom status or disease process, reducing life satisfaction and disrupting overall well-being. The present study examined the mediating role of self-stigma and unmet needs in the relationship between psychiatric symptom severity and subjective quality of life. Structural equation modeling and mediation analyses were conducted based on a community sample of 400 mental health consumers with schizophrenia spectrum disorders in Hong Kong. The model of self-stigma and unmet needs as mediators between symptom severity and subjective quality of life had good fit to the data (GFI = .93, CFI = .93, NNFI = .92, RMSEA = .06, χ(2)/df ratio = 2.62). A higher level of symptom severity was significantly associated with increased self-stigma (R (2) = .24) and a greater number of unmet needs (R (2) = .53). Self-stigma and unmet needs were in turn negatively related to subjective quality of life (R (2) = .45). It is essential that service providers and administrators make greater efforts to eliminate or reduce self-stigma and unmet recovery needs, which are associated with the betterment of the overall quality of life and long-term recovery. Both incorporating empowerment and advocacy-based interventions into recovery-oriented services and providing community-based, person-centered services to people based on personally defined needs are important directions for future recovery-oriented efforts.

Challenges Addressing Unmet Need for Contraception: Voices of ...

African Journals Online (AJOL)

AJRH Managing Editor

Family Planning Service Providers in Rural Tanzania. Jitihada Baraka. 1 ... Keywords: Contraception, Unmet need for family planning, Provider perspectives, Tanzania, Quality of care. Résumé .... the Internal Review Board (IRB) of Columbia.

Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada.

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Jaworsky, Denise; Gadermann, Anne; Duhoux, Arnaud; Naismith, Trudy E; Norena, Monica; To, Matthew J; Hwang, Stephen W; Palepu, Anita

2016-08-01

This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.

MVO Automation Platform: Addressing Unmet Needs in Clinical Laboratories with Microcontrollers, 3D Printing, and Open-Source Hardware/Software.

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Iglehart, Brian

2018-05-01

Laboratory automation improves test reproducibility, which is vital to patient care in clinical laboratories. Many small and specialty laboratories are excluded from the benefits of automation due to low sample number, cost, space, and/or lack of automation expertise. The Minimum Viable Option (MVO) automation platform was developed to address these hurdles and fulfill an unmet need. Consumer 3D printing enabled rapid iterative prototyping to allow for a variety of instrumentation and assay setups and procedures. Three MVO versions have been produced. MVOv1.1 successfully performed part of a clinical assay, and results were comparable to those of commercial automation. Raspberry Pi 3 Model B (RPI3) single-board computers with Sense Hardware Attached on Top (HAT) and Raspberry Pi Camera Module V2 hardware were remotely accessed and evaluated for their suitability to qualify the latest MVOv1.2 platform. Sense HAT temperature, barometric pressure, and relative humidity sensors were stable in climate-controlled environments and are useful in identifying appropriate laboratory spaces for automation placement. The RPI3 with camera plus digital dial indicator logged axis travel experiments. RPI3 with camera and Sense HAT as a light source showed promise when used for photometric dispensing tests. Individual well standard curves were necessary for well-to-well light and path length compensations.

Clinical roundtable monograph: unmet needs in the treatment of chronic lymphocytic leukemia: integrating a targeted approach.

Science.gov (United States)

O'Brien, Susan M; Furman, Richard R; Byrd, John C; Smith, Ashbel

2014-01-01

Chronic lymphocytic leukemia (CLL) is the most frequently diagnosed hematologic malignancy in the United States. Although several features can be useful in the diagnosis of CLL, the most important is the immunophenotype.Two staging systems--the Binet system and the Rai classification--are used to assess risk. After diagnosis, the first major therapeutic decision is when to initiate therapy, as a watchful waiting approach is often appropriate for patients with asymptomatic disease. Once a patient has met the criteria for treatment, the choice of therapy is the next major decision. Younger patients (<65 years) often receive more aggressive treatment that typically consists of cytotoxic chemotherapy. There is a great unmet need concerning treatment of older patients with CLL, who often present with more comorbid conditions that can decrease their ability to tolerate particular regimens. The current standard of care for older patients with CLL is rituximab plus chlorambucil. The concept of targeted agents is currently an area of intense interest in CLL. The Bruton’s tyrosine kinase inhibitor ibrutinib is the targeted agent that is furthest along in clinical development. It is associated with an overall survival rate of 83%. Idelalisib targets the phosphatidyl inositol 3-kinase and is under evaluation in pivotal trials. Targeted agents offer much promise in terms of efficacy, toxicity, and oral availability. They will change the management of patients with CLL.

Unmet Dental Needs and Barriers to Dental Care among Children with Autism Spectrum Disorders

Science.gov (United States)

Lai, Bien; Milano, Michael; Roberts, Michael W.; Hooper, Stephen R.

2012-01-01

Mail-in pilot-tested questionnaires were sent to a stratified random sample of 1,500 families from the North Carolina Autism Registry. Multivariate logistic regression analysis was used to determine the significance of unmet dental needs and other predictors. Of 568 surveys returned (Response Rate = 38%), 555 were complete and usable. Sixty-five…

Addressing unmet needs in understanding asthma mechanisms: From the European Asthma Research and Innovation Partnership (EARIP) Work Package (WP)2 collaborators.

Science.gov (United States)

Edwards, Michael R; Saglani, Sejal; Schwarze, Jurgen; Skevaki, Chrysanthi; Smith, Jaclyn A; Ainsworth, Ben; Almond, Mark; Andreakos, Evangelos; Belvisi, Maria G; Chung, Kian Fan; Cookson, William; Cullinan, Paul; Hawrylowicz, Catherine; Lommatzsch, Marek; Jackson, David; Lutter, Rene; Marsland, Benjamin; Moffatt, Miriam; Thomas, Mike; Virchow, J Christian; Xanthou, Georgina; Edwards, Jessica; Walker, Samantha; Johnston, Sebastian L

2017-05-01

Asthma is a heterogeneous, complex disease with clinical phenotypes that incorporate persistent symptoms and acute exacerbations. It affects many millions of Europeans throughout their education and working lives and puts a heavy cost on European productivity. There is a wide spectrum of disease severity and control. Therapeutic advances have been slow despite greater understanding of basic mechanisms and the lack of satisfactory preventative and disease modifying management for asthma constitutes a significant unmet clinical need. Preventing, treating and ultimately curing asthma requires co-ordinated research and innovation across Europe. The European Asthma Research and Innovation Partnership (EARIP) is an FP7-funded programme which has taken a co-ordinated and integrated approach to analysing the future of asthma research and development. This report aims to identify the mechanistic areas in which investment is required to bring about significant improvements in asthma outcomes. Copyright ©ERS 2017.

Clinical roundtable monograph: Unmet needs in the management of chronic myelogenous leukemia.

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Jabbour, Elias J; Bixby, Dale; Akard, Luke P

2012-12-01

Approximately 5,000 cases of chronic myelogenous leukemia (CML) are diagnosed each year in the United States. The introduction of tyrosine kinase inhibitors (TKIs) has dramatically improved survival time for many CML patients. Current first-line treatment options include imatinib and the second-generation agents nilotinib and dasatinib. Second- and third-line agents include nilotinib, dasatinib, bosutinib, and the new agent ponatinib. Despite the effectiveness of TKIs, some patients develop resistance or intolerance to these agents. A number of mutations of the BCR-ABL gene have been identified and are associated with TKI resistance. Patients may benefit from switching to a second-line TKI, undergoing hematopoietic stem cell transplant, or receiving newly emerging agents. Although early response is associated with improved patient outcome, clinicians lack tests that can determine which patients will benefit from which therapies. To ensure adequate response, patients should be monitored by both polymerase chain reaction and cytogenetic analysis of the bone marrow. This roundtable monograph reviews key unmet needs in patients with CML related to disease management and treatment options.

The Northridge earthquake: community-based approaches to unmet recovery needs.

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Bolin, R; Stanford, L

1998-03-01

The 1994 Northridge, California earthquake has proven to be one of the most costly disasters in United States history. Federal and state assistance programmes received some 681,000 applications from victims for various forms of relief. In spite of the flow of US$11 billion in federal assistance into Los Angeles and Ventura counties, many victims have failed to obtain adequate relief. These unmet needs relate to the vulnerability of particular class and ethnic groups. In response to unmet needs, a number of non-governmental organisations (NGOs) have become involved in the recovery process. This paper, based on evidence collected from hundreds of in-depth interviews with the people involved, examines the activities of several community-based organisations (CBOs) and other NGOs as they have attempted to assist vulnerable people with unmet post-disaster needs. We discuss two small ethnically diverse communities in Ventura County, on the periphery of the Los Angeles metropolitan region. The earthquake and resultant disaster declaration provided an opportunity for local government and NGOs to acquire federal resources not normally available for economic development. At the same time the earthquake created political openings in which longer-term issues of community development could be addressed by various local stakeholders. A key issue in recovery has been the availability of affordable housing for those on low incomes, particularly Latinos, the elderly and farm workers. We discuss the successes and limitations of CBOs and NGOs as mechanisms for dealing with vulnerable populations, unmet needs and recovery issues in the two communities.

A dose-response relationship between long working hours and unmet need for access to hospital facilities.

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Soek, Hongdeok; Won, Jong-Uk; Lee, Tae Il; Kim, Yeong-Kwang; Lee, Wanhyung; Lee, June-Hee; Roh, Jaehoon; Yoon, Jin-Ha

2016-03-01

Lack of access to hospital facilities, indicating unmet healthcare need, plays an important role in health inequity in the workplace. We aimed to investigate the association between long working hours and unmet healthcare need. We used data from the Korea National Health and Nutrition Examination Surveys collected during 2007-2012, which included 8369 participants (4765 males, 3604 females) aged 20-54 years, who were paid workers. We used a logistic regression model with gender stratification to investigate the association between working hours and unmet healthcare need. Of the 8369 participants, 855 males (17.94%) and 981 females (27.22%) experienced unmet healthcare need. After adjusting for covariates, and compared to 30-39 working hours per week, the odds ratios (OR) of unmet healthcare need were 1.07 [(95% confidence interval (95% CI) 0.76-1.51], 1.46 (95% CI 1.03-2.07), and 1.57 (95% CI 1.11-2.23) in males, and 1.13 (95% CI 0.92-1.40), 1.30 (95% CI 0.99-1.69), and 1.60 (95% CI 1.21-2.10) in females, for 40-49, 50-59, and ≥ 60 work hours per week, respectively. There was a dose-response relationship between working hours per week and unmet healthcare need in both genders. Those who work long hours are more likely to have unmet healthcare needs, the cause of which seems to be lack of time.

Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care.

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Haley, Danielle F; Linton, Sabriya; Luo, Ruiyan; Hunter-Jones, Josalin; Adimora, Adaora A; Wingood, Gina M; Bonney, Loida; Ross, Zev; Cooper, Hannah L

2017-01-01

Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and trans- portation access to unmet need for medical care. We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and admin- istrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51-0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02-1.31). These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women

OpenAIRE

Everett, Bethany G.; Mollborn, Stefanie

2013-01-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexu...

Family planning unmet need and access among iTaukei women in New Zealand and Fiji.

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Cammock, Radilaite; Herbison, Peter; Lovell, Sarah; Priest, Patricia

2017-09-22

The aim of the study was to identify unmet need and family planning access among indigenous Fijian or iTaukei women living in New Zealand and Fiji. A cross-sectional survey was undertaken between 2012-2013 in five major cities in New Zealand: Auckland, Hamilton, Wellington, Christchurch and Dunedin; and in three suburbs in Fiji. Women who did not want any (more) children but were not using any form of contraception were defined as having an unmet need. Access experiences involving cost and health provider interactions were assessed. Unmet need in New Zealand was 26% and similar to the unmet need found in Fiji (25%). Cost and concern over not being seen by a female provider were the most problematic access factors for women. There is a need for better monitoring and targeting of family planning services among minority Pacific groups, as the unmet need found in New Zealand was three times the national estimate overall and similar to the rate found in Fiji. Cost remains a problem among women trying to access family planning services. Gendered traditional roles in sexual and reproductive health maybe an area from which more understanding into cultural sensitivities and challenges may be achieved.

Assessment of Unmet Need for Contraception among eligible couples in Urban Slums of Raipur city of Chhattisgarh state

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Nirmal Verma

2014-06-01

Full Text Available Background: India was the first country to launch National Family Planning Program in 1952. Even though various measures have been taken to encourage the usage of contraception but the achievement in this field was not to the extent expected due to various social and cultural factors. Objective: This study was planned to assess the prevalence and its determinants of unmet need for contraception among eligible couples in urban slums of Raipur city. Methodology: A cross sectional community based study was conducted using cluster sampling in urban slums of Raipur city from November 2011 to October 2012. During the study, 711 fecund married women, age group 15-49 years were included and predesigned and pretested proforma was used as a study tool. The obtained data were analyzed using appropriate statistical test. Results: Among all eligible married women 45 % were concentrated in the prime reproductive age 20-29 yrs. Majority of women were not educated. The total unmet need for family planning comes out to 32.9%. Age, Education, literacy, Occupation, Type of Family, No of living children, Birth Order , No of male child, No of female child , Husband literacy were the most significant predictor of unmet need. Conclusion: Percentage of unmet need is higher as compared to national data, so there is urgently need to ensure the same.

Merkel cell carcinoma: Epidemiology, prognosis, therapy and unmet medical needs.

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Schadendorf, Dirk; Lebbé, Céleste; Zur Hausen, Axel; Avril, Marie-Françoise; Hariharan, Subramanian; Bharmal, Murtuza; Becker, Jürgen C

2017-01-01

Merkel cell carcinoma (MCC) is a rare skin cancer that is associated with Merkel cell polyomavirus infection in most cases. Incidence rates of MCC have increased in past decades. Risk factors for MCC include ultraviolet light exposure, immunosuppression and advanced age. MCC is an aggressive malignancy with frequent recurrences and a high mortality rate, although patient outcomes are generally more favourable if the patient is referred for treatment at an early stage. Although advances have been made recently in the MCC field, large gaps remain with regard to definitive biomarkers and prognostic indicators. Although MCC is chemosensitive, responses in advanced stages are mostly of short duration, and the associated clinical benefit on overall survival is unclear. Recent nonrandomised phase 2 clinical trials with anti-PD-L1/PD-1 antibodies have demonstrated safety and efficacy; however, there are still no approved treatments for patients with metastatic MCC. Patients with advanced disease are encouraged to participate in clinical trials for treatment, indicating the largely unmet need for durable, safe treatment within this population. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need.

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Jens Detollenaere

Full Text Available Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013 and the Primary Healthcare Activity Monitor for Europe (2010. The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country's PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce as this can influence inequity in unmet need.

The Challenge of Controlling the COPD Epidemic Chronic Obstructive Pulmonary Disease: Unmet Needs.

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Polverino, Francesca; Celli, Bartolome

2018-05-17

Many unmet needs still remain in the assessment and treatment of patients with chronic obstructive pulmonary disease (COPD), particularly in relation to its under- and misdiagnosis, which lead to under- and mistreatment. This paucity of knowledge about the importance and presence of COPD, as well as its treatment, is seen with patients and carers as well as healthcare providers. This review considers the areas of key educational need, including the clinical characteristics of COPD, factors contributing to the disease, effective diagnosis, and clinical management of patients, and the implementation of treatment guidelines. As COPD remains the third most frequent cause of death in the world, we must continue to expand the scope and reach of our efforts to improve outcomes in this debilitating disease. Copyright © 2018. Published by Elsevier Inc.

Changing Patterns of Unmet Needs for Family Planning Among ...

African Journals Online (AJOL)

AJRH Managing Editor

This study employed secondary data analysis of the National HIV/AIDS and. Reproductive Health ... Keywords: Unmet Need, Family Planning, Women of Reproductive Age group. Résumé ... The World Health Organization in 2012 highlighted ...

Unmet Student Financial Need in the State of Washington: A Study of the "Need Gap."

Science.gov (United States)

Fenske, Robert; And Others

A study of unmet student financial need in Washington State was conducted by the Washington Council for Postsecondary Education. "Unmet need" is the difference between need and the total amount of aid received by the student through federal, state, and institutional financial aid programs, privately funded scholarships, and nonsubsidized…

Quality of life, unmet needs, and iatrogenic injuries in rehabilitation of patients with Ehlers-Danlos Syndrome hypermobility type/Joint Hypermobility Syndrome.

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Bovet, Claire; Carlson, Matthew; Taylor, Matthew

2016-08-01

Ehlers-Danlos Syndrome, hypermobility type (EDS-HT) and the joint hypermobility syndrome (JHS) are connective tissue disorders that form an overlapping clinical syndrome and are associated with frequent medical visits and substantial morbidity. EDS-HT/JHS-associated pain correlates with poor quality of life. While physical therapy is the recommended treatment for EDS-HT/JHS, little is known about therapy-related patient experiences and iatrogenic injuries. We studied 38 adult EDS-HT/JHS patients, eliciting health-related quality of life (HRQoL) from 28 patients through the RAND SF-36 questionnaire. We also explored physical therapy experiences through focus groups with 13 patients. Our patients displayed poor HRQoL, with 71% reporting worse health over the past year. SF-36 scores were significantly lower than the scores of the average American population (P < 0.001 for 8 of 10 categories assessed), but were comparable to EDS-HT/JHS populations in Belgium, the Netherlands, Sweden, and Italy. Focus groups identified factors associated with: negative past physical therapy experiences, iatrogenic joint injuries, positive treatment experiences, and unmet rehabilitation needs. This group of EDS-HT/JHS patients has significant decrements in HRQoL and many unmet treatment needs, as well as a risk for iatrogenic injuries. We identify several approaches to help meet patients' needs and improve joint rehabilitation in patients with EDS-HT/JHS. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Unmet care needs of the oldest old with late-life depression: A comparison of patient, caring relative and general practitioner perceptions - Results of the AgeMooDe study.

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Stein, Janine; Pabst, Alexander; Weyerer, Siegfried; Werle, Jochen; Maier, Wolfgang; Miebach, Lisa; Scherer, Martin; Stark, Anne; Kaduszkiewicz, Hanna; Wiese, Birgitt; Moor, Lilia; Bock, Jens-Oliver; König, Hans-Helmut; Riedel-Heller, Steffi G

2016-11-15

Research showed that the perception of unmet needs may differ between patients, caregivers and professionals. Lacking agreement with regard to unmet needs between raters involved may have a negative impact on treatment of late-life depression. As part of the multicenter German study "Late-life depression in primary care: needs, health care utilization and costs" (AgeMooDe), n=1188 primary care patients aged 75-98 with and without depression, relatives (n=366) and general practitioners (GPs, n=1152) were assessed using the German version of the Camberwell Assessment of Need for the Elderly (CANE) in order to identify patients' unmet needs from different perspectives. Kappa coefficients were computed to determine level of agreement between perspectives. Penalized likelihood logistic regression models were run in order to assess the association between depression severity and disagreement between perspectives with regard to unmet needs. The prevalence of unmet needs was higher in depressive patients. Kappa coefficients were on average higher for depressive patients ranging from poor to substantial. Severity of depression was significantly associated with disagreement regarding unmet needs between perspectives. The cross-sectional design of the study limits the results. Only a part of caring relatives was able to participate. Perceptions of unmet needs in the oldest old primary care patients suffering from depression strongly differ between raters. Severity of depression seems to exacerbate the discrepancy between involved perspectives. The negative impact that depression severity may have on the perception and assessment of unmet needs requires greater attention by GPs. Copyright © 2016 Elsevier B.V. All rights reserved.

Emerging organisational models of primary healthcare and unmet needs for care: insights from a population-based survey in Quebec province

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Levesque Jean-Frédéric

2012-07-01

Full Text Available Abstract Background Reform of primary healthcare (PHC organisations is underway in Canada. The capacity of various types of PHC organizations to respond to populations’ needs remains to be assessed. The main objective of this study was to evaluate the association of PHC affiliation with unmet needs for care. Methods Population-based survey of 9205 randomly selected adults in two regions of Quebec, Canada. Outcomes Self-reported unmet needs for care and identification of the usual source of PHC. Results Among eligible adults, 18 % reported unmet needs for care in the last six months. Reasons reported for unmet needs were: waiting times (59 % of cases; unavailability of usual doctor (42 %; impossibility to obtain an appointment (36 %; doctors not accepting new patients (31 %. Regression models showed that unmet needs were decreasing with age and was lower among males, the least educated, and unemployed or retired. Controlling for other factors, unmet needs were higher among the poor and those with worse health status. Having a family doctor was associated with fewer unmet needs. People reporting a usual source of care in the last two-years were more likely to report unmet need for care. There were no differences in unmet needs for care across types of PHC organisations when controlling for affiliation with a family physician. Conclusion Reform models of primary healthcare consistent with the medical home concept did not differ from other types of organisations in our study. Further research looking at primary healthcare reform models at other levels of implementation should be done.

Unmet social needs and teenage pregnancy in Ogbomosho, South-western Nigeria.

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Salami, Kabiru K; Ayegboyin, Matthew; Adedeji, Isaac A

2014-12-01

Consistent high teenage pregnancy rates in South-western Nigeria are characteristically underpinned by the unmet social needs of the teenagers. To elicit intergenerational views on the influence of unmet social needs on teenage pregnancy. Through a descriptive and cross-sectional design, a total of 174 respondents who were either pregnant teenagers, teenage mothers during the survey or had been pregnant as teenagers, were interviewed, using questionnaire supplemented with 12 key informant interviews. With the mean age of 16.5 years, and educational status range of between primary and below (25.8%) and tertiary (9.8%) levels, only 39.7% respondents were married, about half (47.7%) remained single while others were separated (12.6%). Less than half (44.9%) of the respondents were engaged in occupational activities. The unmet material and financial supports expected from parents (43.1%), the lack of free education from government up till secondary school level (51.2%), the lack of sex education and knowledge needs for signs of maturity (53.4%) and discouragement from friends not to have boyfriend (66.1%) prone teenagers to unplanned pregnancy. Promotion of sexual education and parental care is encouraged as strategy against unplanned pregnancy among teenagers.

Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs?

Science.gov (United States)

Bennett, Amanda C; Rankin, Kristin M; Rosenberg, Deborah

2012-12-01

This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs (CSHCN). Data were obtained from the 2007 National Survey of Children's Health, with analyses limited to non-Hispanic white and black CSHCN (n = 14,677). The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs. Overall, 43.0 % of white CSHCN and 60.4 % of black CSHCN did not have a medical home. Additionally, 8.8 % of white CSHCN and 15.3 % of black CSHCN had unmet healthcare needs. The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20 % as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN (OR(NIE) = 1.2, 95 % CI = 1.1, 1.3). The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN, blacks would still have 60 % higher odds of unmet healthcare needs than whites (OR(NDE) = 1.6, 95 % CI = 1.1, 2.4). The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home. Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs, but will not completely eliminate it.

Unmet need for family planning among married women of reproductive age group in urban Tamil Nadu

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Malini M Bhattathiry

2014-01-01

Full Text Available Context: Unmet need for family planning (FP, which refers to the condition in which there is the desire to avoid or post-pone child bearing, without the use of any means of contraception, has been a core concept in the field of international population for more than three decades. Objectives: The very objective of this study is to determine the prevalence of "unmet need for FP" and its socio-demographic determinants among married reproductive age group women in Chidambaram. Materials and Methods: The study was a community-based cross-sectional study of married women of the reproductive age group, between 15 and 49 years. The sample size required was 700. The cluster sampling method was adopted. Unmarried, separated, divorced and widows were excluded. Results: The prevalence of unmet need for FP was 39%, with spacing as 12% and limiting as 27%. The major reason for unmet need for FP among the married group was 18%, for low perceived risk of pregnancy, 9%, feared the side effects of contraception 5% lacked information on contraceptives, 4% had husbands who opposed it and 3% gave medical reasons. Higher education, late marriage, more than the desired family size, poor knowledge of FP, poor informed choice in FP and poor male participation were found to be associated with high unmet need for FP. Conclusion: Unmet need for younger women was spacing of births, whereas for older women, it was a limitation of births. Efforts should be made to identify the issues in a case by case approach. Male participation in reproductive issues should be addressed.

Unmet healthcare needs in homeless women with children in the Greater Paris area in France.

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Cécile Vuillermoz

Full Text Available Despite their poor health status, homeless women encounter many barriers to care. The objectives of our study were to estimate the prevalence of unmet healthcare needs in homeless women and to analyse associated relationships with the following factors: financial and spatial access to care, housing history, migration status, healthcare utilisation, victimization history, caring for children, social network and self-perceived health status.We used data from 656 homeless women interviewed during the ENFAMS representative survey of sheltered homeless families, conducted in the Paris region in 2013. Structural equation models (SEM were used to estimate the impact of various factors on homeless women's unmet healthcare needs.Among those interviewed, 25.1% (95%CI[21.3-29.0] had at least one unmet healthcare need over the previous year. Most had given up on visiting general practitioners and medical specialists. No association with factors related to financial access or to health insurance status was found. However, food insecurity, poor spatial health access and poor self-perceived health were associated with unmet healthcare needs. Self-perceived health appeared to be affected by victimization and depression.The lower prevalence of unmet healthcare needs in homeless women compared with women in stable housing situations suggests that homeless women have lower needs perceptions and/or lower expectations of the healthcare system. This hypothesis is supported by the results from SEM. Strategies to provide better access to care for this population should not only focus on financial interventions but also more broadly on spatial healthcare access, cultural norms, and perceptions of health. Reducing their unmet needs and improving their access to healthcare and prevention must include an improvement in their living, financial and housing conditions.

Envisioning how new technologies can fulfill customers’ unmet needs

NARCIS (Netherlands)

Chuang, Y.; Chen, Y.; Chen, L.; Chen, Y.-H.

2017-01-01

Intended Contribution to Knowledge: Undeniably, home is the most important environment for human beings. This study investigates customers’ unmet needs, develops design concepts with new IoT technologies, envisions the values for family members, and reveals its impact on human life and interpersonal

Asymptomatic bacteriuria. Clinical significance and management.

Science.gov (United States)

Raz, Raul

2003-10-01

The clinical significance and management of asymptomatic bacteriuria (ASB) differs according to different groups of patients. ASB requires antibiotic treatment in pregnant women, children aged 5-6 years and prior to invasive genitourinary procedures. However, there is a consensus that ASB in the elderly, healthy school girls and young women, diabetic women and patients with indwelling catheters or intermittent catheterization has no clinical significance and antibiotic prescription is not indicated.

The impact of family planning programs on unmet need and demand for contraception.

Science.gov (United States)

Bongaarts, John

2014-06-01

Much of the existing literature on the demographic impact of family planning programs focuses on their role in increasing contraceptive use, which, in turn, accelerates fertility decline. What is not clear, however, is whether this effect operates solely through a reduction in unmet need brought about by eliminating obstacles to use or whether and to what extent the programs also affect demand for contraception through messages concerning the benefits of family planning. This article aims to shed additional light on this issue by analyzing data drawn from recent Demographic and Health Surveys conducted in 63 developing countries. The first section reviews general levels and trends in unmet need, demand, and use over the course of the fertility transition. The second section presents different types of evidence of program effects, including results from a controlled experiment and from country case studies. The evidence indicates a program impact on both unmet need and demand. © 2013 The Population Council, Inc.

Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience.

Science.gov (United States)

Larsson, Markus; Ross, Michael W; Tumwine, Gilbert; Agardh, Anette

2016-01-01

Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited. To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality. In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex. Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7-5.7; OR 2.0, 95% CI: 1.3-3.0, respectively). Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1-4.8), exposure to sexual coercion (OR 2.6, 95% CI: 1.7-3.9), frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9-5.8), and number of sexual partners (OR 1.9, 95% CI: 1.04-3.3). The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1-8.5; AOR 2.8, 95% CI: 1.3-5.8) and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6-7.1; AOR 2.7, 95% CI: 1.4-5.4) persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking. These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of same-sex sexuality experienced students. Targeted interventions that integrate mental

Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience

Directory of Open Access Journals (Sweden)

Markus Larsson

2016-03-01

Full Text Available Background: Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited. Objective: To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality. Design: In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex. Results: Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7–5.7; OR 2.0, 95% CI: 1.3–3.0, respectively. Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1–4.8, exposure to sexual coercion (OR 2.6, 95% CI: 1.7–3.9, frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9–5.8, and number of sexual partners (OR 1.9, 95% CI: 1.04–3.3. The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1–8.5; AOR 2.8, 95% CI: 1.3–5.8 and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6–7.1; AOR 2.7, 95% CI: 1.4–5.4 persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking. Conclusions: These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of

Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional study.

Science.gov (United States)

Letamo, Gobopamang; Navaneetham, Kannan

2015-03-31

The objectives of this study are: (1) to estimate the prevalence of unmet need for family planning among married women using Botswana Family Health Survey 2007 data and (2) to identify risk factors for unmet need for family planning among married women. This study used secondary data from a cross-sectional survey that was conducted to provide a snapshot of health issues in Botswana. Nationally representative population survey data. 2601 married or in union women aged 15-49 years who participated in the 2007 Botswana Family Health Survey were included in the analysis. Unmet need for family planning, which was defined as the percentage of all fecund married women who are not using a method of contraception even though they do not want to get pregnant. Married women who had unmet need for family planning were 9.6% in 2007. Most of the unmet need was for limiting (6.7%) compared to spacing (2.9%). Unmet need for family planning was more likely to be among women whose partners disapproved of family planning, non-Christians, had one partner and had never discussed family planning with their partner. Women of low parity, aged 25-34 years, and greater exposure to mass media, were less likely to have experienced unmet need. The patterns and magnitude of covariates differed between unmet need for limiting and for spacing. The prevalence of unmet need for family planning was low in Botswana compared to other sub-Saharan African countries. The findings from this study reemphasise the importance of women's empowerment and men's involvement in women's sexual and reproductive healthcare needs and services. Different approaches are needed to satisfy the demand for family planning for spacing and limiting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Patterns of unmet needs in adolescent and young adult (AYA) cancer survivors: in their own words.

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Wong, Alex W K; Chang, Ting-Ting; Christopher, Katrina; Lau, Stephen C L; Beaupin, Lynda K; Love, Brad; Lipsey, Kim L; Feuerstein, Michael

2017-12-01

Categorization of the needs of AYA cancer survivors is primarily based on quantitative analyses of epidemiological and observational research. The present study classified the phenomenological experiences of AYA survivors based on their own language. A systematic approach for selecting qualitative studies of unmet needs in AYA cancer survivors was used. Following selection based on quality, survivor statements were entered verbatim and thematic analysis was conducted using NVivo qualitative research software. A total of 1993 AYA cancer survivors (post-treatment) were included in 58 studies (78% individual interviews). Mean age was 27.6 with an average of 8.6 years post-primary treatment. The organizational framework reported in this study was based on a heterogeneous group of cancer types. Thirteen themes including symptoms, function, reproductive health, emotional well-being, health management, health care system, social interaction, romantic relationships, cancer disclosure, normalcy, career development and employment, and school and fiscal concerns were identified. Forty-eight subthemes were also identified covering such areas as fertility, integrative health services, advice for cancer disclosure, family interaction, and insurance challenges. Direct analysis of text identified many common unmet needs similarly reported in the quantitative literature. The phenomenological data also provided a breakdown of unmet needs into subthemes or elements of unmet needs. This information can help form the basis for a personalized, valid, and reliable evaluation tool of the range of unmet needs in AYA survivors.

[Current clinical significance of anaerobic bacteremia].

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Jirsa, Roman; Marešová, Veronika; Brož, Zdeněk

2010-10-01

to estimate tje current clinical significance of anaerobic bacteremia in a group of Czech hospitals. this retrospective analysis comprised 8 444 anaerobic blood cultures in patients admitted to four Czech hospitals between 2004 and 2007. in 16 patients, blood cultures yielded significant anaerobic bacteria. Thus, anaerobic bacteremia accounted for less than 2 % of clinically significant bacteremia. Four patients (18 %) died but none of the deaths could be clearly attributable to anaerobic bacteria in the bloodstream. The most common comorbidities predisposing to anaerobic bacteremia and the most frequent sources of infection were similar to those reported by other authors. The majority of anaerobic bacteremia cases were due to gram-negative bacteria, followed by Clostridium perfringens and, surprisingly, Eubacterium spp. (particularly Eubacterium lentum). anaerobic bacteremia remains rare. The comparison of our data with those by other authors suggests that (despite the reported high mortality) the actual clinical significance of anaerobic bacteremia is rather controversial and that the anaerobic bacteremia might not correspond to more serious pathogenic role of the anaerobic bacteria as the source of infection.

Unmet information needs and limited health literacy in newly diagnosed breast cancer patients over the course of cancer treatment.

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Halbach, Sarah Maria; Ernstmann, Nicole; Kowalski, Christoph; Pfaff, Holger; Pförtner, Timo-Kolja; Wesselmann, Simone; Enders, Anna

2016-09-01

To investigate unmet information needs in newly diagnosed breast cancer patients over the course of cancer treatment and its association with health literacy. We present results from a prospective, multicenter cohort study (PIAT). Newly diagnosed breast cancer patients (N=1060) were surveyed directly after breast cancer surgery, 10 and 40 weeks later. Pooled linear regression modeling was employed analyzing changes in unmet information needs over time and its association with health literacy. Unmet information needs on side effects and medication and medical examination results and treatment options were high and increased during the first 10 weeks after breast cancer surgery. Considering health promotion and social issues, unmet information needs started high and decreased during post-treatment. Patients with limited health literacy had higher unmet information needs. Our results indicate a mismatch in information provision and breast cancer patients' information needs. Patients with limited health literacy may be at a distinct disadvantage in having their information needs met over the course of breast cancer treatment. Strategies are needed to reduce unmet information needs in breast cancer patients considering treatment-phase and health literacy and thereby enable them to better cope with their diseases. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Drug costs and benefits of medical treatments in high-unmet need solid tumours in the Nordic countries

DEFF Research Database (Denmark)

Osterlund, P; Sorbye, H; Pfeiffer, P.

2016-01-01

-unmet need solid tumour indications in Nordic countries (Sweden, Denmark, Finland, Norway and Sweden). Methods: For a selected number of cancer dugs, approved for metastatic cancer or non-curable treatment intention patients by the European Medicine Agency (EMA) after 2000, and indicated in high-unmet need...

Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004-2010.

Science.gov (United States)

Reeves, Aaron; McKee, Martin; Mackenbach, Johan; Whitehead, Margaret; Stuckler, David

2017-02-01

Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. We integrated panel data on 16 European countries for years 2004-2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI -0.55 to -1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI -1.19 to -2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=-1.21 percentage points, 95% CI -0.37 to -2.06). Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Unmet Supportive Care Needs among Breast Cancer Survivors of Community-Based Support Group in Kuching, Sarawak

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Emmanuel Joseph Fong

2016-01-01

Full Text Available Background. Recognizing the needs of cancer survivors is one of the important aspects in healthcare delivery. This study aimed to determine the prevalence of unmet supportive care needs and its associated factors among the breast cancer survivors of community-based support group in Kuching, Sarawak. Materials and Methods. This was a cross-sectional study using Supportive Care Needs Survey (SCNS-SF34. All the members of community-based breast cancer support groups in Kuching were invited. A total of 101 respondents were face-to-face interviewed after the consent was obtained. Data was entered and analyzed using SPSS version 20. Results. The respondents endorsed health system and information domain with the highest mean score (2.48; 95% CI: 2.32–2.64. Top 10 items with “moderate to high” level unmet needs had a prevalence of 14.9% to 34.7% of respondents indicating need. Significantly higher level of unmet needs was associated with survivors who were younger (less than 60 years old, had higher education attainment, were unemployed, had survival duration of up to 5 years, and were undergoing active treatment. Conclusion. Systematic delivery of health information which is targeted, culturally sensitive, and linguistically appropriate for addressing younger age, education level, employment status, length of survivorship, and treatment stage should be considered not only at hospital-based setting but also at the community-based support groups.

Assessing unmet anaesthesia need in Sierra Leone: a secondary ...

African Journals Online (AJOL)

Objectives: To determine the unmet anaesthesia need in a low resource region. Introduction: Surgery and anæsthesia services in low- and middle-income countries (LMICs) are under-equipped, under- staffed, and unable to meet current surgical need. There is little objective measure as to the true extent and nature of ...

Using Survey Data to Identify Opportunities to Reach Women with An Unmet Need for Family Planning: The Example of Madagascar.

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Meekers, Dominique; Ratovonanahary, Raseliarison; Andrianantoandro, Tokinirina; Randrianarisoa, Hiangotiana

2016-01-01

In several African countries fertility levels have stagnated or increased slightly. However, many women still report an unmet need for family planning. Therefore achieving further fertility declines requires programs that increase demand for family planning, but that also address the existing unmet need. One way to improve contraceptive access in a cost-effective manner might be to integrate family planning services into other existing health services. This paper analyzes secondary data from the 2012-2013 Millennium Development Goals (MDG) survey in Madagascar to estimate the number of women with an unmet need for family planning that might benefit from integrating family planning services into other health services. In Madagascar, one third of the demand for family planning is not met; an estimated 820,000 women have an unmet need for family planning. A substantial portion of these women can be reached by integrating family planning services into existing maternal and child health services. Health providers are uniquely positioned to help address method-related reasons for non-use of family planning, such as concerns about health problems and side-effects. Given the large unmet need for family planning, programs should not exclusively focus on increasing the demand for family planning, but also seek new ways to address the existing unmet need. Our study illustrates that simple analyses of existing health survey data can be an important tool for informing the design of programs to tackle this unmet need.

A binary logistic regression model with complex sampling design of unmet need for family planning among all women aged (15-49) in Ethiopia.

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Workie, Demeke Lakew; Zike, Dereje Tesfaye; Fenta, Haile Mekonnen; Mekonnen, Mulusew Admasu

2017-09-01

Unintended pregnancy related to unmet need is a worldwide problem that affects societies. The main objective of this study was to identify the prevalence and determinants of unmet need for family planning among women aged (15-49) in Ethiopia. The Performance Monitoring and Accountability2020/Ethiopia was conducted in April 2016 at round-4 from 7494 women with two-stage-stratified sampling. Bi-variable and multi-variable binary logistic regression model with complex sampling design was fitted. The prevalence of unmet-need for family planning was 16.2% in Ethiopia. Women between the age range of 15-24 years were 2.266 times more likely to have unmet need family planning compared to above 35 years. Women who were currently married were about 8 times more likely to have unmet need family planning compared to never married women. Women who had no under-five child were 0.125 times less likely to have unmet need family planning compared to those who had more than two-under-5. The key determinants of unmet need family planning in Ethiopia were residence, age, marital-status, education, household members, birth-events and number of under-5 children. Thus the Government of Ethiopia would take immediate steps to address the causes of high unmet need for family planning among women.

Targeting the unmet medical need: the Abbott Laboratories oncology approach.

Science.gov (United States)

Carlson, Dawn M; Steinberg, Joyce L; Gordon, Gary

2005-09-01

While significant advances in the treatment of cancer occured during the last half of the twentieth century, parallel decreases in overall cancer death rates were not observed. Cancer therapy remains an area of significant unmet medical need. Abbott's oncology research programs are focused on pioneering trageted, less toxic therapies, aimed at different aspects of tumor growth and development. Oncology drugs in development at Abbott target several mechanisms of cancer progression by interfering with multiple processes necessary for tumor growth: recruitment of a blood supply, cell proliferation, and the development of metastases. They include a selective endothelin A-receptor antagonist (atrasentan/Xinlay), 3 angiogenesis inhibitors (ABT 510, a thrombospondin mimetic: ABT-869, a multitargeted receptor tyrosine kinase inhibitor; and ABT 828, recombinant human plasminogen kringle 5), a cell proliferation inhibitor (ABT-751, an antimitotic agent), an apoptosis inducer (ABT 737, a Bcl-2 family inhibitor), and a poly(ADP-ribose)polymerase inhibitor.

Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana.

Science.gov (United States)

Staveteig, Sarah

2017-01-01

Despite a relatively strong family planning program and regionally modest levels of fertility, Ghana recorded one of the highest levels of unmet need for family planning on the African continent in 2008. Unmet need for family planning is a composite measure based on apparent contradictions between women's reproductive preferences and practices. Women who want to space or limit births but are not using contraception are considered to have an unmet need for family planning. The study sought to understand the reasons behind high levels of unmet need for family planning in Ghana. A mixed methods follow-up study was embedded within the stratified, two-stage cluster sample of the 2014 Ghana Demographic and Health Survey (GDHS). Women in 13 survey clusters who were identified as having unmet need, along with a reference group of current family planning users, were approached to be reinterviewed within an average of three weeks from their GDHS interview. Follow-up respondents were asked a combination of closed- and open-ended questions about fertility preferences and contraceptive use. Closed-ended responses were compared against the original survey; transcripts were thematically coded and analyzed using qualitative analysis software. Among fecund women identified by the 2014 GDHS as having unmet need, follow-up interviews revealed substantial underreporting of method use, particularly traditional methods. Complete postpartum abstinence was sometimes the intended method of family planning but was overlooked during questions about method use. Other respondents classified as having unmet need had ambivalent fertility preferences. In several cases, respondents expressed revised fertility preferences upon follow-up that would have made them ineligible for inclusion in the unmet need category. The reference group of family planning users also expressed unstable fertility preferences. Aversion to modern method use was generally more substantial than reported in the GDHS

Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana.

Directory of Open Access Journals (Sweden)

Sarah Staveteig

Full Text Available Despite a relatively strong family planning program and regionally modest levels of fertility, Ghana recorded one of the highest levels of unmet need for family planning on the African continent in 2008. Unmet need for family planning is a composite measure based on apparent contradictions between women's reproductive preferences and practices. Women who want to space or limit births but are not using contraception are considered to have an unmet need for family planning. The study sought to understand the reasons behind high levels of unmet need for family planning in Ghana.A mixed methods follow-up study was embedded within the stratified, two-stage cluster sample of the 2014 Ghana Demographic and Health Survey (GDHS. Women in 13 survey clusters who were identified as having unmet need, along with a reference group of current family planning users, were approached to be reinterviewed within an average of three weeks from their GDHS interview. Follow-up respondents were asked a combination of closed- and open-ended questions about fertility preferences and contraceptive use. Closed-ended responses were compared against the original survey; transcripts were thematically coded and analyzed using qualitative analysis software.Among fecund women identified by the 2014 GDHS as having unmet need, follow-up interviews revealed substantial underreporting of method use, particularly traditional methods. Complete postpartum abstinence was sometimes the intended method of family planning but was overlooked during questions about method use. Other respondents classified as having unmet need had ambivalent fertility preferences. In several cases, respondents expressed revised fertility preferences upon follow-up that would have made them ineligible for inclusion in the unmet need category. The reference group of family planning users also expressed unstable fertility preferences. Aversion to modern method use was generally more substantial than reported in

Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana

Science.gov (United States)

2017-01-01

Introduction Despite a relatively strong family planning program and regionally modest levels of fertility, Ghana recorded one of the highest levels of unmet need for family planning on the African continent in 2008. Unmet need for family planning is a composite measure based on apparent contradictions between women’s reproductive preferences and practices. Women who want to space or limit births but are not using contraception are considered to have an unmet need for family planning. The study sought to understand the reasons behind high levels of unmet need for family planning in Ghana. Methods A mixed methods follow-up study was embedded within the stratified, two-stage cluster sample of the 2014 Ghana Demographic and Health Survey (GDHS). Women in 13 survey clusters who were identified as having unmet need, along with a reference group of current family planning users, were approached to be reinterviewed within an average of three weeks from their GDHS interview. Follow-up respondents were asked a combination of closed- and open-ended questions about fertility preferences and contraceptive use. Closed-ended responses were compared against the original survey; transcripts were thematically coded and analyzed using qualitative analysis software. Results Among fecund women identified by the 2014 GDHS as having unmet need, follow-up interviews revealed substantial underreporting of method use, particularly traditional methods. Complete postpartum abstinence was sometimes the intended method of family planning but was overlooked during questions about method use. Other respondents classified as having unmet need had ambivalent fertility preferences. In several cases, respondents expressed revised fertility preferences upon follow-up that would have made them ineligible for inclusion in the unmet need category. The reference group of family planning users also expressed unstable fertility preferences. Aversion to modern method use was generally more substantial

Faktor-faktor yang Berhubungan Dengan Unmet Need KB Pasca-Salin IUD post-placenta di Kamar Rawat Pasca-bersalin RSUP DR. M. Djamil periode Januari-Maret 2013

Directory of Open Access Journals (Sweden)

Sari Handayani Utami

2013-09-01

women of fertile age couple who give birth per vaginam and selected by accidental sampling. This study had 88 respondents consists of 50 as not IUD Post-placenta acceptors and 38 respondents as IUD post-placenta acceptors. The data collected by using questionnaire through guided interview and analyzed through univariate and bivariate.The result of analysis showed that the factor had significant relation to unmet need of IUD post-placenta is knowledge (p value = 0,001, while another factors did not have significant relation are education level (p value = 0,222, economic level (p value=1,000, and family planning counselling (p value=0,583.Keywords:the relating factors, unmet need, post-partum contraception, IUDpost-placenta

Mucoadhesive oral films: The potential for unmet needs.

Science.gov (United States)

Silva, Branca M A; Borges, Ana Filipa; Silva, Cláudia; Coelho, Jorge F J; Simões, Sérgio

2015-10-15

Oral drug delivery is the most common route of drug administration. Nevertheless, there are some important limitations that reinforce the need for developing new drug delivery systems. Mucoadhesive oral films (MOF) are promising dosage forms that adhere to the oral mucosa and deliver the drug through it, which present several advantages. These include: bypassing the hepatic first pass effect, fast onset of action, ease of transportation and handling. The use of such dosage form is beneficial for drugs that have poor oral bioavailability and also for drugs that need to be rapidly absorbed. In spite of the known benefits, the number of marketed MOF is still quite small. This review explores the products under development and corresponding clinical trials in respect to their status, therapeutic indication, companies involved and technologies. In this way, it was possible to identify the preferred therapeutic indications, new research and market trends as well as future prospects of MOF. Moreover, it is reasonable to expect an increase in the number of products on the market due to their great potential to satisfy unmet medical needs. Copyright © 2015 Elsevier B.V. All rights reserved.

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments.

Science.gov (United States)

Kerätär, Raija; Taanila, Anja; Jokelainen, Jari; Soukainen, Jouko; Ala-Mursula, Leena

2016-12-01

Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. Paltamo, Finland. Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%). Based on data from theme interviews, patient records, supervisors' observations of work performance and clinical examinations, a physician concluded the individual's work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated. Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability. Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed. KEY POINTS Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce. Work disabilities are common among the unemployed. Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to

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

OpenAIRE

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 inclu...

Effect of Family Wealth and Attitudes toward Unmet Need for Family Planning Among Fertile Couples in Makassar, South Sulawesi, Indonesia

OpenAIRE

Rahmawati Azis; Muhammad Syafar; Andi Zulkifli; Arifin Seweng

2016-01-01

One of the problems generated by unmet need for family planning is the occurrence of unwanted pregnancies, that could impact on abortion. Unmet need for family planning affected by various factors, both from within and from outside the woman. This study aimed to analyze the influence of socio-demographic characteristics, knowledge and attitudes towards family planning unmet need in women of childbearing age couple in Makassar, South Sulawesi. This study is analytic observational research. Cro...

Disparities in unmet dental need and dental care received by pregnant women in Maryland.

Science.gov (United States)

Singhal, Astha; Chattopadhyay, Amit; Garcia, A Isabel; Adams, Amy B; Cheng, Diana

2014-09-01

To examine prenatal dental care needs, utilization and oral health counseling among Maryland women who delivered a live infant during 2001-2003 and identify the factors associated with having a dental visit and having an unmet dental need during pregnancy. Pregnancy Risk Assessment Monitoring System is an ongoing population based surveillance system that collects information of women's attitudes and experiences before, during, and shortly after pregnancy. Logistic regression was used to model dental visits and unmet dental need using predictor variables for Maryland 2001-2003 births. Less than half of all women reported having a dental visit and receiving oral health advice during pregnancy. Twenty-five percent of women reported a need for dental care, of which 33 % did not receive dental care despite their perceived need. Multivariate modeling revealed that racial minorities, women who were not married and those with annual income dental visit. Women who were not married, had low annual income, were older than 40 years of age, had an unintended pregnancy and received prenatal care later than desired were most likely to have an unmet dental need during pregnancy. Despite reported needs and existing recommendations to include oral health as a component of prenatal care, less than half of pregnant women have a dental visit during their pregnancy. One-third of women with a dental problem did not have a dental visit highlighting the unmet need for dental care during pregnancy.

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

OpenAIRE

Ker?t?r, Raija; Taanila, Anja; Jokelainen, Jari; Soukainen, Jouko; Ala-Mursula, Leena

2016-01-01

Objective Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. Design Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. Setting Paltamo, Finland. Participants Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n?=?230, 81%). Main outcome measures Based on data from theme int...

Children--The Effect of Rural Residence on Dental Unmet Need for Children with Special Health Care Needs

Science.gov (United States)

Skinner, Asheley Cockrell; Slifkin, Rebecca T.; Mayer, Michelle L.

2006-01-01

Background: Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet…

Impact of caregivers' unmet needs for supportive care on quality of terminal cancer care delivered and caregiver's workforce performance.

Science.gov (United States)

Park, Sang Min; Kim, Young Jin; Kim, Samyong; Choi, Jong Soo; Lim, Ho-Yeong; Choi, Youn Seon; Hong, Young Seon; Kim, Si-Young; Heo, Dae Seog; Kang, Ki Moon; Jeong, Hyun Sik; Lee, Chang Geol; Moon, Do Ho; Choi, Jin-Young; Kong, In Sik; Yun, Young Ho

2010-06-01

Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood. We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL). Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P < 0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care. Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged.

Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004–2010

Science.gov (United States)

Reeves, Aaron; McKee, Martin; Mackenbach, Johan; Whitehead, Margaret; Stuckler, David

2017-01-01

Background Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. Methods We integrated panel data on 16 European countries for years 2004–2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. Results We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI −0.55 to −1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI −1.19 to −2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=−1.21 percentage points, 95% CI −0.37 to −2.06). Conclusions Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments. PMID:27965315

Unmet need of contraceptives among eligible couples of urban slum dwellers in Dhaka

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Shamsun Nahar

2009-01-01

Full Text Available This cross-sectional study was conducted on married women residing in urban slums of Kamrangirchar in Dhaka to determine the magnitude of unmet need for family planning. A total of 265 married women of reproductive age who were fecund and living with husband were the sample of the study. The mean age of the respondents was 26.8±6.7 years. A little above 14% of the women were in the age group of 15–19 years. Almost equal proportion of respondents and their husbands were found to be illiterate. Nearly one-tenth of the respondents have not had ever experienced pregnancy, while 23% experienced pregnancy once, 18.1% twice and 33.6% three-four times, 17% more than four times. Among the respondents, 51.3% were currently using a contraceptive method. Around 5% were pregnant, which was intended. Another 3% wanted to conceive. The rest 41.1% wanted to use a contraceptive but certain barriers did not allow them to use the same suggesting that their family planning need was unmet. This need included limiting (21.5% and spacing (19.6%. Lactational amenorrhea, no specific reasons, side effect of past contraceptive use, lack of support from husband or other family members, lack of proper knowledge of contraceptive and difficulties in obtaining contraceptive supplies were the cited reasons. Unmet need of contraceptive is high despite an extensive family planning programme in Bangladesh. Mean age at marriage is still below the legal age and gender discrimination plays a vital role in this unmet need. Ibrahim Med. Coll. J. 2009; 3(1: 24-28

Levels, trends and correlates of unmet need for family planning among postpartum women in Indonesia: 2007-2015.

Science.gov (United States)

Wilopo, Siswanto Agus; Setyawan, Althaf; Pinandari, Anggriyani Wahyu; Prihyugiarto, Titut; Juliaan, Flourisa; Magnani, Robert J

2017-11-28

Although Indonesia has relatively high contraceptive prevalence, postpartum family planning (PP-FP) has not been a particular point of emphasis. This article reports the results of analyses undertaken in order to (1) better understand levels and trends in unmet need for family planning among postpartum women, (2) assess the extent to which unmet need is concentrated among particular population sub-groups, and (3) assess the policy priority that PP-FP should have in relation to other interventions. The analyses were based on data from the 2007 and 2012 Indonesia Demographic and Health Surveys (IDHS) and the 2015 PMA2020 survey. Postpartum contraceptive use and unmet need were analyzed for fecund women who had given birth in the 3-5 years of preceding the respective surveys who were in the extended postpartum period at the time of the respective surveys. Factors associated with contraceptive use and unmet were assessed via multivariable logistic regressions using merged data from all three surveys. A wide range of biologic, demographic, socio-economic, geographic and programmatic factors were considered. Contraceptive use during the extended postpartum period is high in Indonesia, with more than 74% of post-partum women reporting currently using a family planning method in the 2015 PMA2020 survey. This is up from 68% in 2007 and 70% in 2012. Total unmet need was 28% in 2007, falling slightly to 23% in 2012 and 24% in 2015. However, the timing of contraceptive initiation is less than optimal. By six months postpartum, only 50% of mothers had begun contraceptive use. Unmet need was highest among older women, women with 4+ children, with limited knowledge of contraceptive methods, making fewer ANC visits, from poor families and residents of islands other than Java and Bali. Unmet need for family planning among postpartum women in Indonesia is low in comparison with other low- and middle-income countries. However, because of limited durations of exclusive breastfeeding

Differences in behavioral health disorders and unmet treatment needs between medical marijuana users and recreational marijuana users: Results from a national adult sample.

Science.gov (United States)

Park, Ji-Yeun; Wu, Li-Tzy

2017-11-01

Available data suggest that medical marijuana users may have more mental health problems than recreational marijuana users. There is limited information about differences in behavioral health disorders and unmet treatment needs between medical and recreational marijuana users. We compared past-year prevalence of behavioral health disorders and unmet treatment needs across three marijuana subgroups (recreational use only, medical use only, and both). Sex-stratified logistic regression was performed to determine their associations with marijuana use status. We analyzed data from adults (≥18 years) who used marijuana in the past year (N=15,440) from 2013 to 2014 National Surveys on Drug Use and Health. Among 15,440 past-year marijuana users, 90.2% used recreational marijuana only, 6.2% used medical marijuana only, and 3.6% used both. Both users had the highest prevalence of behavioral health disorders and unmet treatment needs overall, with no significant sex differences. In the sex-specific logistic regression analysis, medical only users and both users showed somewhat different patterns of associations (reference group=recreational only users). Medical only users had decreased odds of alcohol or drug use disorders, and unmet need for alcohol or drug treatment among males and females. Additionally, female medical only users had decreased odds of opioid use disorder. Both users had increased odds of major depressive episode, hallucinogen use disorder, and unmet need for mental health services among males, and cocaine use disorder among females. Different approaches tailored to individuals' sex and motives for marijuana use is needed for the prevention and treatment of behavioral health problems. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical significance of neonatal menstruation.

Science.gov (United States)

Brosens, Ivo; Benagiano, Giuseppe

2016-01-01

Past studies have clearly shown the existence of a spectrum of endometrial progesterone responses in neonatal endometrium, varying from proliferation to full decidualization with menstrual-like shedding. The bleedings represent, similar to what occurs in adult menstruation, a progesterone withdrawal bleeding. Today, the bleeding is completely neglected and considered an uneventful episode of no clinical significance. Yet clinical studies have linked the risk of bleeding to a series of events indicating fetal distress. The potential link between the progesterone response and major adolescent disorders requires to be investigated by prospective studies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

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Larsson, Laura S; Kuster, Emilie

2013-01-01

The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

Do ambivalent women have an unmet need for family planning? A longitudinal study from Bali, Indonesia.

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Withers, Mellissa H; Tavrow, Paula; Adinata, N Ardika

2011-01-01

Fertility intentions often can predict contraceptive demand and fertility outcomes. Little is known about women reporting ambivalent fertility intentions, who are usually classified as having an unmet need for contraception. This study's objectives were to determine 1) which fertility intention group ambivalent women more closely resemble and 2) whether ambivalent women seem to have an unmet contraceptive need. We analyzed longitudinal data from 1,018 married Balinese women aged 15 to 45, of whom 33% desired more children, 52% wanted no more, and 14% were ambivalent. Ambivalent women were compared with those with definitive intentions using bivariate analyses. Regression analysis was used to determine the predictors of birth avoidance. Although ambivalent women were significantly older, and had less education and more children than women who wanted more children, ambivalent women were more similar in their contraceptive use to those who wanted more children than those who wanted no more. However, in terms of birth outcomes, ambivalent women resembled more the women who intended to avoid childbearing: After 4 years, 33% of ambivalent women had another birth compared with 29% of women who wanted no more and 57% of women who desired more children. Contraceptive use at baseline did not predict ambivalent women's fertility outcomes, unlike the other groups. Despite their relatively low rates of contraceptive use at baseline, ambivalent women generally avoided giving birth during the study period. This suggests that ambivalent women may not have a high unmet need for family planning. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

A STUDY TO ASSESS THE FACTORS DETERMINING THE UNMET NEED FOR CONTRACEPTIVE USAGE IN AN URBAN AREA RAJAPUR

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Mohammad Waseem Faraz

2015-08-01

Full Text Available INTRODUCTI ON: Family planning is a “way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes, and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country”. 1 The concept of unmet need for contraception has been central to international family planning programs and research for more than forty years, but it has perhaps never been more salient to research and practice than it is now. Over the past decade, the rising rates of contraceptive use have reduced the unmet need for family planning in most countries. However the unmet need remains persistently high or is increasing in developing countries like India, indicating that greater efforts are needed to understand and address the causes of unm et need. OBJECTIVES: 1 To assess the Unmet need for family planning among married women of reproductive age group (15 – 44 years. 2 To identify certain socio - demographic factors associated with unmet need for family planning. 3 To determine the reasons for non - usage of contraceptive use. MATERIALS AND METHODS: A cross - sectional study was carried out in the Urban health training Centre of Department of Community Medicine. The study population included 924 married women aged 15 - 44 years. The data was collected u sing pre te st ed profor m a and was analyzed using percentages and Chi - Square test. RESULTS : The unmet need for family planning was 28.9% in the study population. The overall unmet need is low at the beginning of reproductive age, but it increased and reached a peak in the mid - twenties & then declined. The literacy status among women with unmet needs is plays a vital role. Want of child in future was quoted as the main reason for non - use of contraceptives. CONCLUSION: Despite a fair knowledge about the family planning methods, various socio - cultural and problems

Unmet Need for Therapy Among Children with Autism Spectrum Disorder: Results from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs.

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Benevides, Teal W; Carretta, Henry J; Lane, Shelly J

2016-04-01

We examined population-based trends in unmet need for therapy service in children with autism spectrum disorder (ASD) compared to other children with special health care needs (CSHCN), and identified factors associated with unmet need for therapy. A pooled cross-sectional comparison of the 2005-2006 and 2009-2010 waves of the National Survey for Children with Special Health Care Needs (NS-CSHCN) was used. Weighted bivariate analyses were used to compare children ages 3-17 years with ASD (n = 5113) to other CSHCN (n = 71,294) on unmet need for therapy services. Survey weighted multivariate models were used to examine child, family, and contextual characteristics associated with unmet need. A greater percentage of children with ASD across both surveys were reported to need therapy than other children with CSHCN. Among children with a reported need, children with ASD were 1.4 times more likely to report an unmet need for therapy compared to other CSHCN (OR 1.42, 95 % CI 1.18-1.71). Variables significantly associated with unmet need for therapy services included not receiving a well-child visit in the past year (OR 5.81, CI 3.83-8.81), surveyed in 2009 (OR 1.42, CI 1.18-1.71), child being female (OR 1.27, CI 1.05-1.53), uninsured (OR 1.72, CI 1.15-2.56), and having greater functional limitation (OR 2.44, CI 1.80-3.34). Children with ASD require supportive services such as occupational, physical, and speech therapy but are less likely to receive such services than other CSHCN. Receiving a well-child visit in the past year was strongly associated with receipt of needed therapy services.

Comparison of problems and unmet needs of patients with advanced cancer in a European country and an asian country

NARCIS (Netherlands)

Effendy, C.; Vissers, K.; Osse, B.H.; Tejawinata, S.; Vernooij-Dassen, M.J.F.J.; Engels, Y.M.

2015-01-01

BACKGROUND: Patients with advanced cancer experience problems and unmet needs. However, we assume that patients with advanced cancer will have more problems and unmet needs in a country with a lower economic status than in an economically stronger country. We studied whether patients with advanced

Clinical significance of anismus in encopresis.

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Catto-Smith, A G; Nolan, T M; Coffey, C M

1998-09-01

Treatments designed to relieve paradoxical contraction of the anal sphincters during defecation (anismus) have had limited success in children with encopresis. This has raised doubts as to the clinical relevance of this diagnosis in childhood as anorectal dysfunction. Our aim was to determine whether, in patients who had treatment-resistant encopresis, the presence of electromyographic anismus was associated with increased faecal retention. Sixty-eight children with soiling (mean age 8.7+/-2.06 years) were assessed by clinical examination, abdominal radiography and then with anorectal manometry. Patients with electromyographic anismus (n=32; 47%) had significantly increased radiographic rectal faecal retention and were significantly less likely to be able to defecate water-filled balloons. There were no significant differences in response to prior therapy, history of primary encopresis, behavioural adjustment or in sociodemographic data. Our results suggest that electromyographic anismus is associated with obstructed defecation and faecal retention.

The thresholds for statistical and clinical significance

DEFF Research Database (Denmark)

Jakobsen, Janus Christian; Gluud, Christian; Winkel, Per

2014-01-01

BACKGROUND: Thresholds for statistical significance are insufficiently demonstrated by 95% confidence intervals or P-values when assessing results from randomised clinical trials. First, a P-value only shows the probability of getting a result assuming that the null hypothesis is true and does...... not reflect the probability of getting a result assuming an alternative hypothesis to the null hypothesis is true. Second, a confidence interval or a P-value showing significance may be caused by multiplicity. Third, statistical significance does not necessarily result in clinical significance. Therefore...... of the probability that a given trial result is compatible with a 'null' effect (corresponding to the P-value) divided by the probability that the trial result is compatible with the intervention effect hypothesised in the sample size calculation; (3) adjust the confidence intervals and the statistical significance...

Borderline personality disorder and unmet needs.

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Grambal, Ales; Prasko, Jan; Ociskova, Marie; Slepecky, Milos; Kotianova, Antonia; Sedlackova, Zuzana; Zatkova, Marta; Kasalova, Petra; Kamaradova, Dana

2017-08-01

Borderline personality disorder (BPD) is a disabling psychiatric condition with a chronic and challenging course. BPD is reflected as a disorder of self-regulation" and is associated with both psychological vulnerabilities and social relations that fail to support basic emotional needs. The objective of the paper is to provide the up-to-date data on the unmet needs of BPD patients and their families. A computerized search of the literature printed between January 1990 and May 2017 was conducted in PubMed, and additional papers were extracted using keywords "borderline personality disorder,"needs," "pharmacotherapy," "psychotherapy," "CBT," and "family" in various combinations. According to the eligibility criteria, 57 articles were chosen. Secondary articles from the reference lists of primarily identified papers have been selected for the eligibility and added to the first list (N=151). The results were divided into three categories: the needs connected with (1) the symptom control; (2) the treatment; (3) the quality of life. The needs connected with symptoms were described issues such as emotional needs, social interactions, self-harm, parasuicide, suicidality, comorbidity, mentalization, identity disturbance, moreover, barriers to treatment. The needs connected with the treatment described are focused on needs for early diagnosis, early intervention, holding environment, therapeutic relation, assertive community treatment, destigmatization, hospitalization, and primary care. The needs connected with the quality of life involve family needs, physical health, spiritual needs, advocacy needs, and needs for the separation-individuation. The part focused on implications for the treatment presented several treatment approaches, focusing mostly on the their basics and efficacy. Observing the patients' needs may be essential to the treatment of the individuals suffering from BPD. However, many needs remain unmet in the areas linked to medical, personal, and social

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

Science.gov (United States)

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.

Macroeconomic costs of the unmet burden of surgical disease in Sierra Leone: a retrospective economic analysis.

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Grimes, Caris E; Quaife, Matthew; Kamara, Thaim B; Lavy, Christopher B D; Leather, Andy J M; Bolkan, Håkon A

2018-03-14

The Lancet Commission on Global Surgery estimated that low/middle-income countries will lose an estimated cumulative loss of US$12.3 trillion from gross domestic product (GDP) due to the unmet burden of surgical disease. However, no country-specific data currently exist. We aimed to estimate the costs to the Sierra Leone economy from death and disability which may have been averted by surgical care. We used estimates of total, met and unmet need from two main sources-a cluster randomised, cross-sectional, countrywide survey and a retrospective, nationwide study on surgery in Sierra Leone. We calculated estimated disability-adjusted life years from morbidity and mortality for the estimated unmet burden and modelled the likely economic impact using three different methods-gross national income per capita, lifetime earnings foregone and value of a statistical life. In 2012, estimated, discounted lifetime losses to the Sierra Leone economy from the unmet burden of surgical disease was between US$1.1 and US$3.8 billion, depending on the economic method used. These lifetime losses equate to between 23% and 100% of the annual GDP for Sierra Leone. 80% of economic losses were due to mortality. The incremental losses averted by scale up of surgical provision to the Lancet Commission target of 80% were calculated to be between US$360 million and US$2.9 billion. There is a large economic loss from the unmet need for surgical care in Sierra Leone. There is an immediate need for massive investment to counteract ongoing economic losses. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia.

Science.gov (United States)

Fekadu, Abebaw; Hanlon, Charlotte; Gebre-Eyesus, Emebet; Agedew, Melkamu; Solomon, Haddis; Teferra, Solomon; Gebre-Eyesus, Tsehaysina; Baheretibeb, Yonas; Medhin, Girmay; Shibre, Teshome; Workneh, Abraham; Tegegn, Teketel; Ketema, Alehegn; Timms, Philip; Thornicroft, Graham; Prince, Martin

2014-08-20

The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia. A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule. We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness. Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.

Traumatic brain injury: unmet support needs of caregivers and families in Florida.

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Christina Dillahunt-Aspillaga

Full Text Available Sustaining a Traumatic Brain Injury results in familial strain due to the significant impact the injury has upon the role and function of individuals and their families at home and in the community. Using the Stress Process Model of Caregiving, a caregiver needs assessment survey was developed and conducted to better understand the needs of individuals with a Traumatic Brain Injury and their caregivers. Survey results indicate that caregivers experience many challenges including unmet needs in areas of relational supports such as maintaining relationships, long-term emotional and financial support for themselves and the survivor, and the need for a patient or caregiver advocate. Implications for future practice are presented.

Challenges Addressing Unmet Need for Contraception: Voices of Family Planning Service Providers in Rural Tanzania.

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Baraka, Jitihada; Rusibamayila, Asinath; Kalolella, Admirabilis; Baynes, Colin

2015-12-01

Provider perspectives have been overlooked in efforts to address the challenges of unmet need for family planning (FP). This qualitative study was undertaken in Tanzania, using 22 key informant interviews and 4 focus group discussions. The research documents perceptions of healthcare managers and providers in a rural district on the barriers to meeting latent demand for contraception. Social-ecological theory is used to interpret the findings, illustrating how service capability is determined by the social, structural and organizational environment. Providers' efforts to address unmet need for FP services are constrained by unstable reproductive preferences, low educational attainment, and misconceptions about contraceptive side effects. Societal and organizational factors--such as gender dynamics, economic conditions, religious and cultural norms, and supply chain bottlenecks, respectively--also contribute to an adverse environment for meeting needs for care. Challenges that healthcare providers face interact and produce an effect which hinders efforts to address unmet need. Interventions to address this are not sufficient unless the supply of services is combined with systems strengthening and social engagement strategies in a way that reflects the multi-layered, social institutional problems.

Clinical significance of the fabella

International Nuclear Information System (INIS)

Dodevski, A.; Lazarova-Tosovska, D.; Zhivadinovik, J.; Lazareska, M.

2012-01-01

Full text: Introduction: There is variable number of sesamoid bones in the human body; one of them is fabella, located in the tendon of the gastrocnemius muscle. Aim of this study was to investigate the frequency of occurrence of fabella in the Macedonian population and to discuss about clinical importance of this bone. Materials and methods: We retrospectively examined radiographs of 53 patients who had knee exams undertaken for a variety of clinical reasons, performed as a part of their medical treatment. Over a time span of six months, 53 patients (38 males and 15 females, age range 19-60 years, mean age of 36.7±12.3 years) were examined. Results: In seven (13.2%) patients of 53 analyzed reports, fabella was found in the lateral tendon of gastrocnemius muscle. We did not find a significant gender or side difference in the appearance of fabella. Conclusion: Although anatomic studies emphasized a lack of significance of the fabella, this bone has been associated with a spectrum of pathology affecting the knee as fabellar syndrome, perineal nerve injury and fracture. We should think of this sesamoid bone while performing diagnostic and surgical procedures

Geospatial Analysis of Unmet Surgical Need in Uganda: An Analysis of SOSAS Survey Data.

Science.gov (United States)

Farber, S Harrison; Vissoci, Joao Ricardo Nickenig; Tran, Tu M; Fuller, Anthony T; Butler, Elissa K; Andrade, Luciano; Staton, Catherine; Makumbi, Fredrick; Luboga, Samuel; Muhumuza, Christine; Namanya, Didacus B; Chipman, Jeffrey G; Galukande, Moses; Haglund, Michael M

2017-02-01

Globally, a staggering five billion people lack access to adequate surgical care. Sub-Saharan Africa represents one of the regions of greatest need. We sought to understand how geographic factors related to unmet surgical need (USN) in Uganda. We performed a geographic information system analysis of a nationwide survey on surgical conditions performed in 105 enumeration areas (EAs) representing the national population. At the district level, we determined the spatial autocorrelation of the following study variables: prevalence of USN, hub distance (distance from EA to the nearest surgical center), area of coverage (geographic catchment area of each center), tertiary facility transport time (average respondent-reported travel time), and care availability (rate of hospital beds by population and by district). We then used local indicators of spatial association (LISA) and spatial regression to identify any significant clustering of these study variables among the districts. The survey enumerated 4248 individuals. The prevalence of USN varied from 2.0-45 %. The USN prevalence was highest in the Northern and Western Regions. Moran's I bivariate analysis indicated a positive correlation between USN and hub distance (p = 0.03), area of coverage (p = 0.02), and facility transport time (p = 0.03). These associations were consistent nationally. The LISA analysis showed a high degree of clustering among sets of districts in the Northern Sub-Region. This study demonstrates a statistically significant association between USN and the geographic variables examined. We have identified the Northern Sub-Region as the highest priority areas for financial investment to reduce this unmet surgical disease burden.

Unmet Support Service Needs and Health-Related Quality of Life among Adolescents and Young Adults with Cancer: The AYA HOPE Study

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Ashley Wilder Smith

2013-04-01

Full Text Available Introduction: Cancer for adolescents and young adults (AYA differs from younger and older patients; AYA face medical challenges while navigating social and developmental transitions. Research suggests that these patients are under- or inadequately served by current support services, which may affect health-related quality of life (HRQOL.Methods: We examined unmet service needs and HRQOL in the National Cancer Institute’s Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE study, a population-based cohort (n=484, age 15-39, diagnosed with cancer 6-14 months prior, in 2007-2009. Unmet service needs were psychosocial, physical, spiritual, and financial services where respondents endorsed that they needed, but did not receive, a listed service. Linear regression models tested associations between any or specific unmet service needs and HRQOL, adjusting for demographic, medical and health insurance variables.Results: Over one-third of respondents reported at least one unmet service need. The most common were financial (16%, mental health (15%, and support group (14% services. Adjusted models showed that having any unmet service need was associated with worse overall HRQOL, fatigue, physical, emotional, social, and school/work functioning, and mental health (p’s<0.0001. Specific unmet services were related to particular outcomes (e.g., needing pain management was associated with worse overall HRQOL, physical and social functioning (p’s<0.001. Needing mental health services had the strongest associations with worse HRQOL outcomes; needing physical/occupational therapy was most consistently associated with poorer functioning across domains.Discussion: Unmet service needs in AYAs recently diagnosed with cancer are associated with worse HRQOL. Research should examine developmentally appropriate, relevant practices to improve access to services demonstrated to adversely impact HRQOL, particularly physical therapy and mental

Clinical significance of dental root canal microflora.

Science.gov (United States)

Gomes, B P; Lilley, J D; Drucker, D B

1996-01-01

Previous work by this group has shown that a significant association exists between pain and the presence of either Prevotella or Peptostreptococcus spp. in dental root canals. The aim of this study was to examine a more extensive series of canals microbiologically, to determine whether any other particular endodontic symptoms or clinical signs showed specific associations with individual bacterial species. Seventy root canals were examined microbiologically and clinical data collected to investigate in detail such associations. Of the canals studied, 37 were associated with pain, 49 with tenderness to percussion, 23 with swelling, six with purulent exudate and 57 presented with wet root canals. Anaerobes were isolated from 70.3% of painful canals and from 29.7% of pain-free canals. Significant associations were found between (a) pain and either Prevotella spp. or peptostreptococci, both with P spp. (P Eubacterium spp. (P spp. or Pstr. micros, both with P spp. (each P Eubacterium, Peptostreptococcus, Prevotella or Propionibacterium (each P < 0.05). It was concluded that several different endodontic clinical signs and symptoms are significantly associated with specific bacterial species.

Association of family-centered care with improved anticipatory guidance delivery and reduced unmet needs in child health care.

Science.gov (United States)

Kuo, Dennis Z; Frick, Kevin D; Minkovitz, Cynthia S

2011-11-01

Little is known about the association of family-centered care (FCC) with the quality of pediatric primary care. The objectives were to assess (1) associations between family-centered care (FCC), receipt of anticipatory guidance, and unmet need for health care; and (2) whether these associations vary for children with special health care needs (CSHCN). The study, a secondary data analysis of the 2004 Medical Expenditure Panel Survey, used a nationally representative sample of family members of children 0-17 years. We measured receipt of FCC in the last 12 months with a composite score average>3.5 on a 4 point Likert scale from 4 Consumer Assessment of Healthcare Providers and Systems questions. Outcome measures were six anticipatory guidance and six unmet health care service needs items. FCC was reported by 69.6% of family members. One-fifth (22.1%) were CSHCN. Thirty percent of parents reported≥4 of 6 anticipatory guidance topics discussed and 32.5% reported≥1 unmet need. FCC was positively associated with anticipatory guidance for all children (OR=1.45; 95% CI 1.19, 1.76), but no relation was found for CSHCN in stratified analyses (OR=1.01; 95% CI .75, 1.37). FCC was associated with reduced unmet needs (OR=.38; 95% CI .31, .46), with consistent findings for both non-CSHCN and CSHCN subgroups. Family-centered care is associated with greater receipt of anticipatory guidance and reduced unmet needs. The association between FCC and anticipatory guidance did not persist for CSHCN, suggesting the need for enhanced understanding of appropriate anticipatory guidance for this population.

Perceived Unmet Rehabilitation Needs 1 Year After Stroke: An Observational Study From the Swedish Stroke Register.

Science.gov (United States)

Ullberg, Teresa; Zia, Elisabet; Petersson, Jesper; Norrving, Bo

2016-02-01

Met care demands are key aspects in poststroke quality of care. This study aimed to identify baseline predictors and 12-month factors that were associated with perceived unmet rehabilitation needs 1 year poststroke. Data on patients who were independent in activities of daily living, hospitalized for acute stroke during 2008 to 2010, and followed up 1 year poststroke through a postal questionnaire were obtained from the Swedish stroke register. Patients reporting fulfilled rehabilitation needs were compared with those with unmet needs (Chi square test). The study included 37 383 patients, 46% female. At 12 months, 8019 (21.5%) patients reported unmet rehabilitation needs. Compared with those with met rehabilitation needs, patients reporting unmet rehabilitation needs were older (75.4 versus 72.4 years; Prehabilitation needs at 12 months in an age-adjusted model were severe stroke (odds ratio [OR]=3.04; confidence interval [CI]: 2.39-3.87), prior stroke (OR=1.63; CI: 1.53-1.75), female sex (OR=1.14; CI: 1.07-1.20), diabetes mellitus (OR=1.24; CI: 1.15-1.32), stroke other than ischemic (OR=1.26; CI: 1.20-1.32), and atrial fibrillation (OR=1.19; CI: 1.12-1.27). Unfulfilled rehabilitation needs 1 year poststroke are common and associated with high age, dependency, pain, and depression. Long-term follow-up systems should, therefore, be comprehensive and address multiple domains of poststroke problems, rather than having a single-domain focus. © 2016 American Heart Association, Inc.

Use, non-use and perceived unmet needs of assistive technology among Swedish people in the third age.

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Löfqvist, Charlotte; Slaug, Björn; Ekström, Henrik; Kylberg, Marianne; Haak, Maria

2016-01-01

To describe the most prominent use of or perceived unmet need of assistive technology (AT) and to compare the characteristics of users, non-users and those expressing perceived unmet need with respect to overall health, independence in everyday life, environmental barriers and socio-demographic features. The study is based on data collected in the "Home and Health in the Third Age Project". In all, 371 individuals participated and data were collected during home visits in southern Sweden by interviewers trained specifically for this project. The data collection comprised well-proven self-report scales and observational formats on the home environment and health indicators as well as questions about basic demographics and socio-structural data. The proportion of users constituted almost half of the total sample. The most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need concerned AT for communication, in total 8%. Those cohabiting were to a higher extent users of AT for furnishing/adaptation, compared to those who lived alone. A higher perceived unmet need was seen among those who lived alone compared with cohabiting people. These findings are of importance for future planning and development of policy to improve health services for the new generation of elderly. Implications for Rehabilitation In order to support the ageing process, the need for assistive technology has to be monitored in the third age. Assistive technology for furnishings and adaptation are frequently used by individuals in their third age and are important to support ageing in the home. Not only do health aspects impact the use of assistive technology, but gender, living conditions and social situation also matter - older men especially need to be monitored thoroughly according to their perceived unmet needs as well as do older persons living alone.

Determinants of unmet need for family planning among currently married women in Dangila town administration, Awi Zone, Amhara regional state; a cross sectional study.

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Genet, Ewnetu; Abeje, Gedefaw; Ejigu, Tadese

2015-05-13

Unmet need for family planning is a major problem of developing countries. Evidences about unmet need for family planning and associated factors are not enough in Dangila town. Therefore, this study was done to assess the magnitude and determinants of unmet need for family planning among currently married women in Dangila town. Community based cross sectional study design was used to collect data from a total of 551 currently married women from February to March 2014. Data were collected using pretested structured interviewer administered questionnaire after written consent was obtained from respondents. Collected data were edited, coded, and entered to SPSS version 16.0. Bivariate and multivariable logistic regression analyses were done to identify determinants of unmet need for family planning. This study revealed that 17.4 % of married women had unmet need for family planning. In this study, women who were housewife/farmers were about 7 [OR = 6.81 (1.91-24.29)] times more likely to have unmet need compared to employed women. Women who were not counseled about family planning by health workers [OR = 6.76 (3.17-14.42)], women whose partner had non-supportive attitude for family planning use [OR = 3.34 (1.26-8.90)] and rural women [OR = 17.65 (4.35-71.67)] were also more likely to have unmet need for family planning. About 33 %, 32 %, 23.5 % and 11.8 % of women mentioned less perceived risk of pregnancy due to breast feeding, fear of side effects, partner opposition and religious prohibition respectively as reasons for not using contraceptives at the time of interview. The level of unmet need for family planning in the study area is still high compared to the target set (10 %) in the national family planning guide plan of Ethiopia to be achieved by the end of 2015. Therefore, it is important to strengthen counseling and partner involvement in Dangila town to reduce unmet need for family planning.

Expert Nordic perspectives on the potential of novel inhalers to overcome unmet needs in the management of obstructive lung disease

DEFF Research Database (Denmark)

Løkke, Anders; Ahlbeck, Lars; Bjermer, Leif

2015-01-01

fails to achieve adequate lung deposition and therapeutic effect. In this report, the potential of novel inhaler devices to overcome unmet needs in the management of obstructive lung disease is considered by a panel of Nordic experts. The panel concludes that innovative inhalers can contribute to good......The effective self-management of obstructive lung disease is dependent upon the patient achieving good inhaler technique. However, many current inhalers are complicated to use, which may lead to handling difficulties. These difficulties can cause clinically relevant errors, whereby pharmacotherapy...... disease management and better use of healthcare resources....

Use of Mental Health Care and Unmet Needs for Health Care Among Lesbian and Bisexual Chinese-, Korean-, and Vietnamese-American Women.

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Hahm, Hyeouk Chris; Lee, Jieha; Chiao, Christine; Valentine, Anne; Lê Cook, Benjamin

2016-12-01

This study examined associations between sexual orientation of Asian-American women and receipt of mental health care and unmet need for health care. Computer-assisted self-interviews were conducted with 701 unmarried Chinese-, Korean-, and Vietnamese-American women ages 18 to 35. Multivariate regression models examined whether lesbian and bisexual participants differed from exclusively heterosexual participants in use of mental health care and unmet need for health care. After the analyses controlled for mental health status and other covariates, lesbian and bisexual women were more likely than exclusively heterosexual women to have received any past-year mental health services and reported a greater unmet need for health care. Sexual-minority women were no more likely to have received minimally adequate care. Given the high rates of mental health problems among Asian-American sexual-minority women, efforts are needed to identify and overcome barriers to receipt of adequate mental health care and minimize unmet health care needs.

A Systematic Review of Unmet Information and Psychosocial Support Needs of Adults Diagnosed with Thyroid Cancer.

Science.gov (United States)

Hyun, Yong Gyu; Alhashemi, Ahmad; Fazelzad, Rouhi; Goldberg, Alyse S; Goldstein, David P; Sawka, Anna M

2016-09-01

Patient education and psychosocial support to patients are important elements of comprehensive cancer care, but the needs of thyroid cancer survivors are not well understood. The published English-language quantitative literature on (i) unmet medical information and (ii) psychosocial support needs of thyroid cancer survivors was systematically reviewed. A librarian information specialist searched seven electronic databases and a hand search was conducted. Two reviewers independently screened citations from the electronic search and reviewed relevant full-text papers. There was consensus between reviewers on the included papers, and duplicate independent abstraction was performed. The results were summarized descriptively. A total of 1984 unique electronic citations were screened, and 51 full-text studies were reviewed (three from the hand search). Seven cross-sectional, single-arm, survey studies were included, containing data from 6215 thyroid cancer survivor respondents. The respective study sizes ranged from 57 to 2398 subjects. All of the studies had some methodological limitations. Unmet information needs were variable relating to the disease, diagnostic tests, treatments, and co-ordination of medical care. There were relatively high unmet information needs related to aftercare (especially long-term effects of the disease or its treatment and its management) and psychosocial concerns (including practical and financial matters). Psychosocial support needs were incompletely met. Patient information on complementary and alternative medicine was very limited. In conclusion, thyroid cancer survivors perceive many unmet information needs, and these needs extend to aftercare. Psychosocial information and supportive care needs may be insufficiently met in this population. More work is needed to improve knowledge translation and psychosocial support for thyroid cancer survivors.

County-level poverty is equally associated with unmet health care needs in rural and urban settings.

Science.gov (United States)

Peterson, Lars E; Litaker, David G

2010-01-01

Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Compare the association between regional poverty with self-reported unmet need, a marker of health care access, by rural/urban setting. Multilevel, cross-sectional analysis of a state-representative sample of 39,953 adults stratified by rural/urban status, linked at the county level to data describing contextual characteristics. Weighted random intercept models examined the independent association of regional poverty with unmet needs, controlling for a range of contextual and individual-level characteristics. The unadjusted association between regional poverty levels and unmet needs was similar in both rural (OR = 1.06 [95% CI, 1.04-1.08]) and urban (OR = 1.03 [1.02-1.05]) settings. Adjusting for other contextual characteristics increased the size of the association in both rural (OR = 1.11 [1.04-1.19]) and urban (OR = 1.11 [1.05-1.18]) settings. Further adjustment for individual characteristics had little additional effect in rural (OR = 1.10 [1.00-1.20]) or urban (OR = 1.11 [1.01-1.22]) settings. To better meet the health care needs of all Americans, health care systems in areas with high regional poverty should acknowledge the relationship between poverty and unmet health care needs. Investments, or other interventions, that reduce regional poverty may be useful strategies for improving health through better access to health care. © 2010 National Rural Health Association.

Unmet need for modern contraceptives and associated factors among women in the extended postpartum period in Dessie town, Ethiopia.

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Tegegn, Masresha; Arefaynie, Mastewal; Tiruye, Tenaw Yimer

2017-01-01

The contraceptive use of women in the extended postpartum period is usually different from other times in a woman's life cycle due to the additional roles and presence of emotional changes. However, there is lack of evidence regarding women contraceptive need during this period and the extent they met their need. Therefore, the objective of this study was to assess unmet need for modern contraceptives and associated factors among women during the extended postpartum period in Dessie Town, North east Ethiopia in December 2014. A community-based cross-sectional study was conducted among women who gave birth one year before the study period. Systematic random sampling technique was employed to recruit a total of 383 study participants. For data collection, a structured and pretested standard questionnaire was used. Descriptive statistics were done to characterize the study population using different variables. Bivariate and multiple logistic regression models were fitted to control confounding factors. Odds ratios with 95% confidence intervals were computed to identify factors associated with unmet need. This study revealed that 44% of the extended post-partum women had unmet need of modern contraceptives of which 57% unmet need for spacing and 43% for limiting. Education of women (being illiterate) (AOR (adjusted odds ratio) =3.37, 95% CI (confidence interval) 1.22-7.57), antenatal care service (no) (AOR = 2.41, 95% CI 1.11-5.79), Post-natal care service (no) (AOR = 3.63, CI 2.13-6.19) and knowledge of lactational amenorrhea method (AOR = 7.84 95% CI 4.10-15.02) were the factors positively associated with unmet need modern contraceptives in the extended postpartum period. The unmet need for modern contraception is high in the study area. There is need to improve the quality of maternal health service, girls education, information on postpartum risk of pregnancy on the recommended postpartum contraceptives to enable mothers make informed choices of

Clinical Significance: a Therapeutic Approach Topsychological Assessment in Treatment Planning

Directory of Open Access Journals (Sweden)

Afolabi Olusegun Emmanuel

2015-06-01

Full Text Available Psychological assessment has long been reported as a key component of clinical psychology. This paper examines the complexities surrounding the clinical significance of therapeutic approach to treatment planning. To achieve this objective, the paper searched and used the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to analysed, 1 a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2 explained the conceptual meaning of clinical significant change in therapeutic assessment, 3 answered some of the questions regarding practicability and the clinical significance of therapeutic approach to treatment plans, particularly during or before treatment, 4 linked therapeutic assessment to change in clients’ clinical impression, functioning and therapeutic needs 5 analysed the empirically documenting clinically significant change in therapeutic assessment. Finally, the study suggested that though therapeutic assessment is not sufficient for the systematic study of psychotherapy outcome and process, it is still consistent with both the layman and professional expectations regarding treatment outcome and also provides a precise method for classifying clients as ‘changed’ or ‘unchanged’ on the basis of clinical significance criteria.

Challenges and opportunities in clinical translation of biomedical optical spectroscopy and imaging

Science.gov (United States)

Wilson, Brian C.; Jermyn, Michael; Leblond, Frederic

2018-03-01

Medical devices face many hurdles before they enter routine clinical practice to address unmet clinical needs. This is also the case for biomedical optical spectroscopy and imaging systems that are used here to illustrate the opportunities and challenges involved. Following initial concept, stages in clinical translation include instrument development, preclinical testing, clinical prototyping, clinical trials, prototype-to-product conversion, regulatory approval, commercialization, and finally clinical adoption and dissemination, all in the face of potentially competing technologies. Optical technologies face additional challenges from their being extremely diverse, often targeting entirely different diseases and having orders-of-magnitude differences in resolution and tissue penetration. However, these technologies can potentially address a wide variety of unmet clinical needs since they provide rich intrinsic biochemical and structural information, have high sensitivity and specificity for disease detection and localization, and are practical, safe (minimally invasive, nonionizing), and relatively affordable.

pancreatic steatosis: diagnosis and clinical significance

Directory of Open Access Journals (Sweden)

Murat Daðdeviren

2017-03-01

Full Text Available Pancreatic steatosis (PS, with increased use of abdominal imaging in recent years generally appears as incidental. But it is a condition that is often overlooked. The reason for this is not yet fully demonstrated the clinical significance of PS while. However, in recent years, there are some studies conducted on the relationship with ps and other disease such as diabetes, metabolic syndrome, acute and chronic pancreatitis and pancreatic cancer. In this review, the etiology, diagnosis, treatment and clinical characteristics of ps were evaluated in the light of recent literature and current approaches. [J Contemp Med 2017; 7(1.000: 107-112

Assessing clinical significance of treatment outcomes using the DASS-21.

Science.gov (United States)

Ronk, Fiona R; Korman, James R; Hooke, Geoffrey R; Page, Andrew C

2013-12-01

Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change. (c) 2013 APA, all rights reserved.

Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany

Directory of Open Access Journals (Sweden)

Jens Hoebel

2017-09-01

Full Text Available Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived from the Robert Koch Institute’s cross-sectional German Health Update study. The sample was restricted to participants aged 50–85 years (n = 11,811. Socioeconomic status (SES was measured based on education, (former occupation, and income. Odds ratios and prevalence differences were estimated using logistic regression and linear probability models, respectively. Our results show that self-reported health problems were more prevalent among men and women with lower SES. The extent of SES-related health inequalities decreased at older ages, predominantly among men. Although the prevalence of perceived unmet needs for healthcare was low overall, low SES was associated with higher perceptions of unmet needs in both sexes and for several kinds of health services. In conclusion, socioeconomic inequalities in health exist in a late working age and early retirement but may narrow at older ages, particularly among men. Socially disadvantaged elderly people perceive greater barriers to accessing healthcare services than those who are better off.

Comprehensive care and pregnancy: The unmet care needs of pregnant women with a history of rape

Science.gov (United States)

Munro, Michelle L.; Rietz, Melissa Foster

2013-01-01

This paper proposes a framework for assessing the unmet needs of rape survivors during pregnancy based on the Sexual Assault Nurse Examiner (SANE) practice level theory and an empirical exploration of rape survivors’ health status in pregnancy via a secondary analysis. Our findings indicate that there may be unmet needs in pregnancy related to all five post-assault comprehensive care components: (1) physical care, (2) pregnancy prevention, (3) sexually transmitted infection screening, (4) psychological care, and (5) legal care. Rape history and its current impact on the survivor predicted somatic disorders, substance use, unwanted pregnancy, infections, posttraumatic stress disorder, and recent abuse. PMID:23215990

The relationship between unmet needs and distress amongst young people with cancer.

Science.gov (United States)

Dyson, Gavin J; Thompson, Kate; Palmer, Susan; Thomas, David M; Schofield, Penelope

2012-01-01

Most psychosocial research in cancer has been restricted to paediatric or older adult populations. This study aimed to explore psychological distress and unmet needs in adolescents and young adults (AYA) with cancer and identify predictors of distress among demographic and illness characteristics and supportive care needs. Fifty-three patients between 16 and 30 years completed a cross-sectional survey, administered shortly after presentation to an AYA oncology service and within 4 months of diagnosis. Measures included the Beck Depression Inventory-Fast Screen (BDI-FS), State-Trait Anxiety Inventory-State Form (STAI-S) and the Supportive Care Needs Survey. Level of distress-related sypmtomatology in this population was based on previous work, whereby a cut-off score of 4 or greater was used for the BDI-FS, and one standard deviation above the sample population mean was used for the STAI-S. Prevalence of distress (25%) was lower than that found previously in AYA with cancer. Physical and daily living needs were the most frequently unmet needs overall, followed by psychological needs, health system and information needs and care and support needs. Lastly, being pre-treatment predicted increased depression and state anxiety, while having treatment post-surgery predicted reduced state anxiety. After controlling for treatment status, however, the main predictors of depression and state anxiety were physical and daily living needs and health system and information needs, respectively. Lower levels of distress and unmet psychological needs were related to the few participants (17%) in this study who were pre-treatment, when distress was most likely. However, physical needs and information needs, which are almost inevitable throughout treatment and beyond, were more important predictors of distress. Further exploration must consider the psychosocial difficulties underlying this association and the needs of AYA at transitions between critical periods in their cancer journey

Prevalence and factors associated with unmet need for family planning among the currently married reproductive age women in Shire-Enda- Slassie, Northern West of Tigray, Ethiopia 2015: a community based cross-sectional study.

Science.gov (United States)

Gebre, Gelawdiwos; Birhan, Nigussie; Gebreslasie, Kahsay

2016-01-01

Unmet family planning is one of the common causes for low contraceptive prevalence rate in developing countries including Ethiopia. Thus, this study designed to assess the prevalence and associated factors of unmet need in Shire Endaslassie town, Northern west of Tigray, Ethiopia. A community based cross sectional study design was employed. Multistage sampling technique was employed and data were collected using a semi-structured questionnaire by interviewer administered technique. Questionnaires were reviewed and checked for completeness, accuracy and consistency. Reviewed data were entered to Epi info 7 and analyzed by SPSS version 20 statistical software. Variables with P-value of less than 0.2 in bivariate analyses were entered for multivariate analysis and AOR at 95% CI with p-value of less than 0.05 were considered as significant variables. The overall unmet need for family planning in the study area was 109(21.4%). 74(14.5%) for spacing and 35(6.9%) for limiting. Age group of 35-39 and >=40 (AOR= 2.7,95%CI:1.1,6.5), (AOR = 2.65, 95%CI:1.10, 6.40) respectively, decided numbers of desired children more than five (AOR = O.48, 95%CI: 0.28, 0.80), discussions of client with heath care providers (AOR = 6.32, 95%CI: 2.56, 15.58), previous use of modern family planning (AOR = 2.29, 95%CI, 1.20, 4.34) were significantly associated with unmet need for family planning. Unmet need for family planning in the study area was high, so continuous discussion on modern family planning with community health workers and encouraging of women to decide desired numbers of children of less than five in general are better to be strengthened.

Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders.

Science.gov (United States)

Colman, Elien; Symoens, Sara; Bracke, Piet

2012-11-22

The high mental health care consumption rates of divorced singles may constitute a heavy burden on the public health care system. This raises the question of whether their higher health care use stems from a greater need, or whether there are other factors contributing to these high consumption rates. We examine both health care use and subjective unmet need (perceiving a need for care without seeking it) because of social or emotional problems of the divorced singles, the repartnered divorcees, and the married. Moreover, we investigate how health care use and subjective unmet need relate to each other. We conduct several gender specific logistic regressions employing data from the Divorce in Flanders Survey (N men = 2884; N women = 3317). Results show that the divorced singles have more contact with professional health care providers (general practitioners, psychiatrists, and psychologists) because of social or emotional problems, and more often perceive unmet needs. The higher health care use rates and greater subjective unmet needs can largely be attributed to higher levels of depressive symptoms. Surprisingly, we find that non-frequent health care users more often perceive a subjective unmet need than frequent health care users and those who have not contacted any health care provider. The single divorced consult health care providers more often because of social or emotional problems and they also perceive unmet needs more often.

Sonographic ally Detected Architectural Distortion: Clinical Significance

Energy Technology Data Exchange (ETDEWEB)

Kim, Shin Kee; Seo, Bo Kyoung; Yi, Ann; Cha, Sang Hoon; Kim, Baek Hyun; Cho, Kyu Ran; Kim, Young Sik; Son, Gil Soo; Kim, Young Soo; Kim, Hee Young [Korea University Ansan Hospital, Ansan (Korea, Republic of)

2008-12-15

Architectural distortion is a suspicious abnormality for the diagnosis of breast cancer. The aim of this study was to investigate the clinical significance of sonographic ally detected architectural distortion. From January 2006 to June 2008, 20 patients were identified who had sonographic ally detected architectural distortions without a history of trauma or surgery and abnormal mammographic findings related to an architectural distortion. All of the lesions were pathologically verified. We evaluated the clinical and pathological findings and then assessed the clinical significance of the sonographic ally detected architectural distortions. Based on the clinical findings, one (5%) of the 20 patients had a palpable lump and the remaining 19 patients had no symptoms. No patient had a family history of breast cancer. Based on the pathological findings, three (15%) patients had malignancies. The malignant lesions included invasive ductal carcinomas (n = 2) and ductal carcinoma in situ (n = 1). Four (20%) patients had high-risk lesions: atypical ductal hyperplasia (n = 3) and lobular carcinoma in situ (n = 1). The remaining 13 (65%) patients had benign lesions, however, seven (35%) out of 13 patients had mild-risk lesions (three intraductal papillomas, three moderate or florid epithelial hyperplasia and one sclerosing adenosis). Of the sonographic ally detected architectural distortions, 35% were breast cancers or high-risk lesions and 35% were mild-risk lesions. Thus, a biopsy might be needed for an architectural distortion without an associated mass as depicted on breast ultrasound, even though the mammographic findings are normal

Sonographic ally Detected Architectural Distortion: Clinical Significance

International Nuclear Information System (INIS)

Kim, Shin Kee; Seo, Bo Kyoung; Yi, Ann; Cha, Sang Hoon; Kim, Baek Hyun; Cho, Kyu Ran; Kim, Young Sik; Son, Gil Soo; Kim, Young Soo; Kim, Hee Young

2008-01-01

Architectural distortion is a suspicious abnormality for the diagnosis of breast cancer. The aim of this study was to investigate the clinical significance of sonographic ally detected architectural distortion. From January 2006 to June 2008, 20 patients were identified who had sonographic ally detected architectural distortions without a history of trauma or surgery and abnormal mammographic findings related to an architectural distortion. All of the lesions were pathologically verified. We evaluated the clinical and pathological findings and then assessed the clinical significance of the sonographic ally detected architectural distortions. Based on the clinical findings, one (5%) of the 20 patients had a palpable lump and the remaining 19 patients had no symptoms. No patient had a family history of breast cancer. Based on the pathological findings, three (15%) patients had malignancies. The malignant lesions included invasive ductal carcinomas (n = 2) and ductal carcinoma in situ (n = 1). Four (20%) patients had high-risk lesions: atypical ductal hyperplasia (n = 3) and lobular carcinoma in situ (n = 1). The remaining 13 (65%) patients had benign lesions, however, seven (35%) out of 13 patients had mild-risk lesions (three intraductal papillomas, three moderate or florid epithelial hyperplasia and one sclerosing adenosis). Of the sonographic ally detected architectural distortions, 35% were breast cancers or high-risk lesions and 35% were mild-risk lesions. Thus, a biopsy might be needed for an architectural distortion without an associated mass as depicted on breast ultrasound, even though the mammographic findings are normal

Desire for more children, contraceptive use and unmet need for family planning in a remote area of Bali, Indonesia.

Science.gov (United States)

Withers, Mellissa; Kano, Megumi; Pinatih, Gde Ngurah Indraguna

2010-07-01

Exploring fertility preferences in relation to contraceptive use can increase the understanding of future reproductive behaviour and unmet family planning needs. This knowledge can help assist women in meeting their reproductive goals. The influences on the desire for more children and current contraceptive use were examined among 1528 married women of reproductive age in an isolated community in Bali, Indonesia, using multivariate logistic regression analysis. Women who were younger, had fewer living children, had given birth in the past year and had regular access to health services were more likely to desire children. Being older, having fewer living children, not having regular access to health services, having given birth in the past year and having the desire for more children were associated with a lower likelihood of using contraception. Women with regular access to health care are more likely to desire more children, probably because they are confident in their ability to have successful birth outcomes. However, specialized clinics or family planning outreach workers may be required to reduce barriers to service utilization among some groups. The findings of this study identify key target populations for family planning, including older women and postpartum women--groups that may not perceive themselves to be at risk for unintended pregnancy. Meeting unmet need for family planning among these groups could help women meet their fertility goals, as well as reduce maternal morbidity and mortality.

Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women.

Science.gov (United States)

Jeong, Yoo Mi; Veldhuis, Cindy B; Aranda, Frances; Hughes, Tonda L

2016-12-01

To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual). Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority women's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity. Cross-sectional analysis of existing data. Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment. Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment. Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment. Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed. © 2016 John Wiley & Sons Ltd.

Applying Technology to Unmet Needs. Technology and the American Economy, Appendix, Volume V.

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National Commission on Technology, Automation and Economic Progress, Washington, DC.

Twelve studies dealing with the problems of applying technology to unmet human and community needs are presented. "Urban Planning and Metropolitan Development--The Role of Technology," examines the possibilities of the computer and other modern planning tools. "Technology, Automation, and Economic Progress in Housing and Urban Development"…

Unmet needs among men with human immunodeficiency virus in community mental health care: a cross-sectional study.

Science.gov (United States)

Durbin, Anna; Sirotich, Frank; Antoniou, Tony; Roesslein, Kay; Durbin, Janet; Lunsky, Yona

2016-07-01

While community-based mental health services play an important role in caring for persons with HIV (human immunodeficiency virus) and co-existing mental health disorders, the extent to which their support needs are addressed in this setting is unknown. Accordingly, we examined if HIV infection was associated with unmet support needs among men living with and without HIV receiving community mental health care. This cross-sectional study examined 215 men (135 living with HIV and 80 without HIV) receiving case management services in urban Ontario. Using the Camberwell Assessment of Need, we ascertained the prevalence of support needs in 13 domains grouped into three clusters: Basic needs (accommodation, food, benefits, and money management); self-care/functional needs (daytime activities, self-care, and looking after the home); and health/safety needs (physical, psychological distress, psychotic symptoms, safety to self, and safety to others). We used generalized estimating equations with a logit link to examine the association between HIV and unmet need in each domain. Compared to HIV-negative men, men with HIV were more likely to have mood and concurrent disorders, and intellectual and developmental disabilities. Following multivariable analyses, men with HIV had greater unmet needs related to food (odds ratio + 95% confidence interval: 9.36 (4.03, 21.75), p health and safety domains]. Despite living in a setting with universal health insurance, men with HIV receiving community mental health support had greater unmet need in basic and health domains than HIV-negative men receiving such support. Further research is required to develop and evaluate interventions to best support community-dwelling persons with HIV and mental health disorders.

Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders

Directory of Open Access Journals (Sweden)

Colman Elien

2012-11-01

Full Text Available Abstract Background The high mental health care consumption rates of divorced singles may constitute a heavy burden on the public health care system. This raises the question of whether their higher health care use stems from a greater need, or whether there are other factors contributing to these high consumption rates. We examine both health care use and subjective unmet need (perceiving a need for care without seeking it because of social or emotional problems of the divorced singles, the repartnered divorcees, and the married. Moreover, we investigate how health care use and subjective unmet need relate to each other. Methods We conduct several gender specific logistic regressions employing data from the Divorce in Flanders Survey (N men = 2884; N women = 3317. Results Results show that the divorced singles have more contact with professional health care providers (general practitioners, psychiatrists, and psychologists because of social or emotional problems, and more often perceive unmet needs. The higher health care use rates and greater subjective unmet needs can largely be attributed to higher levels of depressive symptoms. Surprisingly, we find that non-frequent health care users more often perceive a subjective unmet need than frequent health care users and those who have not contacted any health care provider. Conclusion The single divorced consult health care providers more often because of social or emotional problems and they also perceive unmet needs more often.

Factors associated with unmet dental care needs in Canadian immigrants: an analysis of the longitudinal survey of immigrants to Canada

OpenAIRE

Calvasina, Paola; Muntaner, Carles; Quiñonez, Carlos

2014-01-01

Background Immigrants are often considered to have poorer oral health than native born-populations. One possible explanation for immigrants’ poor oral health is lack of access to dental care. There is very little information on Canadian immigrants’ access to dental care, and unmet dental care needs. This study examines predictors of unmet dental care needs among a sample of adult immigrants to Canada over a three-point-five-year post-migration period. Methods A secondary data analysis was con...

Unmet Needs of Families of School-Aged Children with an Autism Spectrum Disorder

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Brown, Hilary K.; Ouellette-Kuntz, Helene; Hunter, Duncan; Kelley, Elizabeth; Cobigo, Virginie

2012-01-01

Background: To aid decision making regarding the allocation of limited resources, information is needed on the perceived unmet needs of parents of school-aged children with an autism spectrum disorder. Materials and Methods: A cross-sectional survey was conducted of 101 Canadian families of school-aged children with an autism spectrum disorder.…

Identifying Adult Dengue Patients at Low Risk for Clinically Significant Bleeding.

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Joshua G X Wong

Full Text Available Clinically significant bleeding is important for subsequent optimal case management in dengue patients, but most studies have focused on dengue severity as an outcome. Our study objective was to identify differences in admission parameters between patients who developed clinically significant bleeding and those that did not. We sought to develop a model for discriminating between these patients.We conducted a retrospective study of 4,383 adults aged >18 years who were hospitalized with dengue infection at Tan Tock Seng Hospital, Singapore from 2005 to 2008. Patients were divided into those with clinically significant bleeding (n = 188, and those without (n = 4,195. Demographic, clinical, and laboratory variables on admission were compared between groups to determine factors associated with clinically significant bleeding during hospitalization.On admission, female gender (p38°C (p38°C (aOR 1.81; 95% CI: 1.27-2.61, nausea/vomiting (aOR 1.39; 95% CI: 0.94-2.12, ANC (aOR 1.3; 95% CI: 1.15-1.46, ALC (aOR 0.4; 95% CI: 0.25-0.64, hematocrit percentage (aOR 0.96; 95% CI: 0.92-1.002 and platelet count (aOR 0.993; 95% CI: 0.988-0.998. At the cutoff of -3.919, the model achieved an AUC of 0.758 (sensitivity:0.87, specificity: 0.38, PPV: 0.06, NPV: 0.98.Clinical risk factors associated with clinically significant bleeding were identified. This model may be useful to complement clinical judgement in triaging adult dengue patients given the dynamic nature of acute dengue, particularly in pre-identifying those less likely to develop clinically significant bleeding.

Measuring unmet obstetric need at district level: how an epidemiological tool can affect health service organization and delivery.

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Guindo, Gabriel; Dubourg, Dominique; Marchal, Bruno; Blaise, Pierre; De Brouwere, Vincent

2004-10-01

A national retrospective survey on the unmet need for major obstetric surgery using the Unmet Obstetric Need Approach was carried out in Mali in 1999. In Koutiala, the district health team decided to carry on the monitoring of the met need for several years in order to assess their progress over time. The first prospective study, for 1999, estimated that more than 100 women in need of obstetric care never reached the hospital and probably died as a consequence. This surprising result shocked the district health team and the resulting increased awareness of service deficits triggered operational measures to tackle the problem. The Unmet Obstetric Need study in Koutiala district was implemented without financial support and only limited external technical back-up. The appropriation of the study by the district team for solving local problems of access to obstetric care may have contributed to the success of the experience. Used as a health service management tool, the study and its results started a dialogue between the hospital staff and both health centre staff and community representatives. This had not only the effect of triggering consideration of coverage, but also of quality of obstetric care. Copyright 2004 Oxford University Press

Irritable bowel syndrome: the burden and unmet needs in Europe.

LENUS (Irish Health Repository)

Quigley, E M M

2012-02-03

Irritable bowel syndrome affects approximately 10-15% of the European population, although prevalence rates vary depending on the classification used and the country surveyed. This may be due to differences in patterns of medical care and diagnosis of the condition. Up to 70% of individuals with irritable bowel syndrome may not have been formally diagnosed. The disorder affects 1.5-3 times as many women as men and poses a significant economic burden in Europe, estimated at euro 700-euro 1600 per person per year. It also reduces quality of life and is associated with psychological distress, disturbed work and sleep, and sexual dysfunction. It is a chronic disorder, which affects many individuals for more than 10 years. Most patients are managed in primary care, although some are referred to gastroenterologists and other specialists. Patients with irritable bowel syndrome undergo more abdomino-pelvic surgery than the general population. We propose that a positive diagnosis of the condition may avoid the delay in diagnosis many patients experience. We conclude that, in Europe, there are significant unmet needs including lack of familiarity with irritable bowel syndrome, difficulties in diagnosis and lack of effective treatments for the multiple symptoms of the disorder. The development of pan-European guidelines for irritable bowel syndrome will benefit patients with this condition in Europe.

Health and Health Care From the Perspective of Intimate Partner Violence Adult Female Victims in Shelters: Impact of IPV, Unmet Needs, Barriers, Experiences, and Preferences.

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Wadsworth, Pamela; Kothari, Catherine; Lubwama, Grace; Brown, Cathy L; Frank Benton, Jennifer

Intimate partner violence (IPV) predicts poor health for victims and their children, but little is known about the perspective of victims. This study reports the perspectives of adult female IPV victims about the impact of IPV on their health and barriers of health care access for themselves and their children. The majority rated their health as good to excellent (69%). However, 83.5% indicated that IPV negatively affected their health; 53.5% had unmet health care needs. Mental health care was the most common unmet need for women; children's unmet needs were immunizations and preventive care. Transportation difficulties posed the biggest barrier to health care access.

How to emerge from the conservatism in clinical research methodology?

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Kotecki, Nuria; Penel, Nicolas; Awada, Ahmad

2017-09-01

Despite recent changes in clinical research methodology, many challenges remain in drug development methodology. Advances in molecular biology and cancer treatments have changed the clinical research landscape. Thus, we moved from empirical clinical oncology to molecular and immunological therapeutic approaches. Along with this move, adapted dose-limiting toxicities definitions, endpoints, and dose escalation methods have been proposed. Moreover, the classical frontier between phase I, phase II, and phase III has become unclear in particular for immunological approaches. So, investigators are facing major challenges in drug development methodology. We propose to individualize clinical research using innovative approaches to significantly improve patient outcomes and targeting what is considered unmet need. Integrating high level of translational research and performing well designed biomarker studies with great potential for clinical practice are of utmost importance. This could be performed within new models of clinical research networks and by building a strong collaboration between academic, cooperative groups, on-site investigators, and pharma.

CIRM Alpha Stem Cell Clinics: Collaboratively Addressing Regenerative Medicine Challenges.

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Jamieson, Catriona H M; Millan, Maria T; Creasey, Abla A; Lomax, Geoff; Donohoe, Mary E; Walters, Mark C; Abedi, Mehrdad; Bota, Daniela A; Zaia, John A; Adams, John S

2018-06-01

The California Institute for Regenerative Medicine (CIRM) Alpha Stem Cell Clinic (ASCC) Network was launched in 2015 to address a compelling unmet medical need for rigorous, FDA-regulated, stem cell-related clinical trials for patients with challenging, incurable diseases. Here, we describe our multi-center experiences addressing current and future challenges. Copyright © 2018 Elsevier Inc. All rights reserved.

Self-perceived met and unmet care needs of frail older adults in primary care

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Hoogendijk, Emiel O; Muntinga, Maaike E; van Leeuwen, Karen M; van der Horst, Henriëtte E; Deeg, Dorly J H; Frijters, Dinnus H M; Hermsen, Lotte A H; Jansen, Aaltje P D; Nijpels, Giel; van Hout, Hein P J

2013-01-01

In order to provide adequate care for frail older adults in primary care it is essential to have insight into their care needs. Our aim was to describe the met and unmet care needs as perceived by frail older adults using a multi-dimensional needs assessment, and to explore their associations with

Unmet medical needs in systemic lupus erythematosus

Science.gov (United States)

2012-01-01

Systemic lupus erythematosus (SLE) is an autoimmune disease of diverse manifestations, with onset usually in young women in the third to fourth decade of life. The chronic nature of this relapsing remitting disease leads to organ damage accrual over time. Mortality and morbidity are increased in patients with SLE compared with the general population. Therapeutic advances over the last few decades have led to significant improvements in patient outcomes. Five-year survival has improved to over 90% from a low of 50% in the 1950s. However, multiple aspects of the management of SLE patients are still far from optimal. Early diagnosis remains a challenge; diagnostic delays leading to delay in definitive treatment are common. Monitoring treatment remains problematic due to the paucity of sensitive biomarkers. Current treatment regimens rely heavily on corticosteroids, even though corticosteroids are well known to cause organ damage. Treatment of refractory disease manifestations such as nephritis, recalcitrant cutaneous lesions and neurological involvement require new approaches with greater efficacy. Cognitive dysfunction is common in SLE patients, but early recognition and adequate treatment are yet to be established. Premature accelerated atherosclerosis remains a leading cause of morbidity and mortality. Fatigue is one of the most disabling symptoms, and contributes to the poor quality of life in patients with SLE. Ongoing research in SLE faces many challenges, including enrollment of homogeneous patient populations, use of reliable outcome measures and a standard control arm. The current review will highlight some of the outstanding unmet challenges in the management of this complex disease. PMID:23281889

Assessing met and unmet needs in the oldest-old and psychometric properties of the German version of the Camberwell assessment of need for the elderly (CANE)--a pilot study.

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Stein, Janine; Luppa, Melanie; König, Hans-Helmut; Riedel-Heller, Steffi G

2014-02-01

The current demographic and social developments in our society will lead to a significant increase in treatment and healthcare needs in the future, particularly in the elderly population. The Camberwell Assessment of Need for the Elderly (CANE) was developed in the United Kingdom to measure physical-, psychological-, and environment-related treatment as well as healthcare needs of older people in order to identify their unmet needs. So far, the German version of the CANE has not been established in health services research. Major reasons for this are a lack of publications of CANE's German version and the missing validation of the instrument. The aims of the present study were to evaluate the currently available German version of the CANE in a sample of older primary care patients. Descriptive statistics and inference-statistical analyses were calculated. Patients reported unmet needs mostly in CANE's following sections: mobility/falls, physical health, continence, company, and intimate relationships. Agreement level between patients' and relatives' ratings in CANE was moderate to low. Evidence for the construct validity of CANE was found in terms of significant associations between CANE and other instruments or scores. The study results provide an important basis for studies aiming at the assessment of met and unmet needs in the elderly population. Using the German version of the CANE may substantially contribute to an effective and good-quality health and social care as well as an appropriate allocation of healthcare resources in the elderly population.

What do multiple sclerosis patients and their caregivers perceive as unmet needs?

OpenAIRE

Lorefice, Lorena; Mura, Gioia; Coni, Giulia; Fenu, Giuseppe; Sardu, Claudia; Frau, Jessica; Coghe, Giancarlo; Melis, Marta; Marrosu, Maria Giovanna; Cocco, Eleonora

2013-01-01

Background Multiple sclerosis (MS) has a major impact on the physical, psychological and social life of patients and their families. The aim of this study was to evaluate the different perceptions of patients and caregivers about management of MS, particularly about the same items, to gather information to ameliorate the care of patients. Methods We evaluated what MS patients and caregivers perceive as unmet needs and compared patients? opinions with caregivers? opinions using a multidimensio...

What Do the Parents of Children Who Have Chronic Pain Expect from Their First Visit to a Pediatric Chronic Pain Clinic?

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Kathy Reid

2010-01-01

Full Text Available BACKGROUND: Chronic pain in childhood is increasingly recognized as a significant clinical problem. Best-practice management of pediatric chronic pain in a multidisciplinary pain clinic involves a variety of treatment modalities. It is important that parents of children treated in these settings understand the different treatment options available for their children. By involving parents more effectively, care providers may more efficiently address unmet treatment needs and improve tailoring of treatment programs aimed at increasing function, reducing pain-related disability and improving quality of life.

Poverty in the midst of plenty: unmet needs and distribution of health care resources in South Korea.

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Jongho Heo

Full Text Available BACKGROUND: The unmet needs for health care have been used as an alternative measurement to monitor equity in health services. We sought to examine contextual influences on unmet needs for health care whereas precedent studies have been focused on individual characteristics on them. METHODS AND FINDINGS: The current study conducted multilevel logistic regression analysis to assess the effects of individual- and contextual-level predictors in meeting individual health care needs in South Korea. We sampled 7,200 individuals over the age of 19 in the Fourth Korea National Health and Nutrition Examination Survey in 2009. Included in the regression model were individual predictors such as demographic variables, socio-economic status, and self-rated health; the density of beds and physicians in public and private sectors within different regions were used as contextual-level predictors. This study showed the inverse association between unmet needs and regional resources in private sectors after controlling for the effects of individual-level predictors. CONCLUSION: Our findings suggest that increasing regional resources in private sectors might produce inefficiency in the health care system and inequity in access to health services, particularly where the competition in private health care sectors was highly stimulated under the fee-for-service reimbursement scheme. Policies for the reallocation of health care resources and for reduction of individual health care costs are needed in Korea.

Hospital Readmission among Older Adults Who Return Home with Unmet Need for ADL Disability

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DePalma, Glen; Xu, Huiping; Covinsky, Kenneth E.; Craig, Bruce A.; Stallard, Eric; Thomas, Joseph, III.; Sands, Laura P.

2013-01-01

Purpose: This study determined whether returning to the community from a recent hospitalization with unmet activities of daily living (ADL) need was associated with probability of readmission. Methods: A total of 584 respondents to the 1994, 1999, and/or 2004 National Long-Term Care Surveys (NLTCS) who were hospitalized within 90 days prior to the…

A Model for Clinical Informatics Education for Residents: Addressing an Unmet Need.

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Mai, Mark V; Luo, Brooke T; Orenstein, Evan W; Luberti, Anthony A

2018-04-01

Opportunities for education in clinical informatics exist throughout the spectrum of formal education extending from high school to postgraduate training. However, physicians in residency represent an underdeveloped source of potential informaticians. Despite the rapid growth of accredited fellowship programs since clinical informatics became a board-eligible subspecialty in 2011, few resident physicians are aware of their role at the intersection of clinical medicine and health information technology or associated opportunities. In an effort to educate and engage residents in clinical informatics, Children's Hospital of Philadelphia has developed a three-pronged model: (1) an elective rotation with hands-on project experience; (2) a longitudinal experience that offers increased exposure and mentorship; and (3) a resident founded and led working group in clinical informatics. We describe resident participation in these initiatives and lessons learned, as well as resident perceptions of how these components have positively influenced informatics knowledge and career choices. Since inception of this model, five residents have pursued the clinical informatics fellowship. This educational model supports resident involvement in hospital-wide informatics efforts with tangible projects and promotes wider engagement through educational opportunities commensurate with the resident's level of interest. Schattauer GmbH Stuttgart.

Methodological approaches and magnitude of the clinical unmet need associated with amotivation in mood disorders.

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Calabrese, Joseph R; Fava, Maurizio; Garibaldi, George; Grunze, Heinz; Krystal, Andrew D; Laughren, Thomas; Macfadden, Wayne; Marin, Robert; Nierenberg, Andrew A; Tohen, Mauricio

2014-10-01

There is growing research interest in studying motivational deficits in different neuropsychiatric disorders because these symptoms appear to be more common than originally reported and negatively impact long-term functional outcomes. However, there is considerable ambiguity in the terminology used to describe motivational deficits in the scientific literature. For the purposes of this manuscript, the term "amotivation" will be utilised in the context of mood disorders, since this is considered a more inclusive/appropriate term for this patient population. Other challenges impacting the study of amotivation in mood disorders, include: appropriate patient population selection; managing or controlling for potential confounding factors; the lack of gold-standard diagnostic criteria and assessment scales; and determination of the most appropriate study duration. This paper summarises the search for a consensus by a group of experts in the optimal approach to studying amotivation in mood disorders. The consensus of this group is that amotivation in mood disorders is a legitimate therapeutic target, given the magnitude of the associated unmet needs, and that proof-of-concept studies should be conducted in order to facilitate subsequent larger investigations. The focus of this manuscript is to consider the study of amotivation, as a residual symptom of major depressive disorder (MDD) or bipolar depression (BD), following adequate treatment with a typical antidepressant or mood stabiliser/antipsychotic, respectively. There is a paucity of data studying amotivation in mood disorders. This manuscript provides general guidance on the most appropriate study design(s) and methodology to assess potential therapeutic options for the management of residual amotivation in mood disorders. Copyright © 2014 Elsevier B.V. All rights reserved.

Quantifying the Clinical Significance of Cannabis Withdrawal

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Allsop, David J.; Copeland, Jan; Norberg, Melissa M.; Fu, Shanlin; Molnar, Anna; Lewis, John; Budney, Alan J.

2012-01-01

Background and Aims Questions over the clinical significance of cannabis withdrawal have hindered its inclusion as a discrete cannabis induced psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). This study aims to quantify functional impairment to normal daily activities from cannabis withdrawal, and looks at the factors predicting functional impairment. In addition the study tests the influence of functional impairment from cannabis withdrawal on cannabis use during and after an abstinence attempt. Methods and Results A volunteer sample of 49 non-treatment seeking cannabis users who met DSM-IV criteria for dependence provided daily withdrawal-related functional impairment scores during a one-week baseline phase and two weeks of monitored abstinence from cannabis with a one month follow up. Functional impairment from withdrawal symptoms was strongly associated with symptom severity (p = 0.0001). Participants with more severe cannabis dependence before the abstinence attempt reported greater functional impairment from cannabis withdrawal (p = 0.03). Relapse to cannabis use during the abstinence period was associated with greater functional impairment from a subset of withdrawal symptoms in high dependence users. Higher levels of functional impairment during the abstinence attempt predicted higher levels of cannabis use at one month follow up (p = 0.001). Conclusions Cannabis withdrawal is clinically significant because it is associated with functional impairment to normal daily activities, as well as relapse to cannabis use. Sample size in the relapse group was small and the use of a non-treatment seeking population requires findings to be replicated in clinical samples. Tailoring treatments to target withdrawal symptoms contributing to functional impairment during a quit attempt may improve treatment outcomes. PMID:23049760

Quantifying the clinical significance of cannabis withdrawal.

Directory of Open Access Journals (Sweden)

David J Allsop

Full Text Available Questions over the clinical significance of cannabis withdrawal have hindered its inclusion as a discrete cannabis induced psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV. This study aims to quantify functional impairment to normal daily activities from cannabis withdrawal, and looks at the factors predicting functional impairment. In addition the study tests the influence of functional impairment from cannabis withdrawal on cannabis use during and after an abstinence attempt.A volunteer sample of 49 non-treatment seeking cannabis users who met DSM-IV criteria for dependence provided daily withdrawal-related functional impairment scores during a one-week baseline phase and two weeks of monitored abstinence from cannabis with a one month follow up. Functional impairment from withdrawal symptoms was strongly associated with symptom severity (p=0.0001. Participants with more severe cannabis dependence before the abstinence attempt reported greater functional impairment from cannabis withdrawal (p=0.03. Relapse to cannabis use during the abstinence period was associated with greater functional impairment from a subset of withdrawal symptoms in high dependence users. Higher levels of functional impairment during the abstinence attempt predicted higher levels of cannabis use at one month follow up (p=0.001.Cannabis withdrawal is clinically significant because it is associated with functional impairment to normal daily activities, as well as relapse to cannabis use. Sample size in the relapse group was small and the use of a non-treatment seeking population requires findings to be replicated in clinical samples. Tailoring treatments to target withdrawal symptoms contributing to functional impairment during a quit attempt may improve treatment outcomes.

Breast cancer patients treated with chemotherapy reports more unmet supportive care needs in the early treatment phase, than patients treated only with radiotherapy

DEFF Research Database (Denmark)

Jensen-Johansen, Mikael Birkelund; Meldgaard, Anette; Henriksen, Jette

2016-01-01

of a large battery of selfadministered questionnaires, the women filled out at home, the Supportive Care Needs Survey (SCNS-SF34) together with demographic items (socioeconomic status, working hours, marital status etc.). The SCNS-SF34 includes 5 different domains of needs: Psychological-, Health system...... Aims: The purpose was to identify unmet supportive care needs in the early treatment phase of women treated for breast cancer and to investigate differences in needs between groups treated with chemo-therapy and radiationtherapy. If it is possible to identify early unmet needs, it may be possible...... to predict levels of unmet needs in the post-treatment phase and target an early rehabilitation to specific groups and with specific interventions. Population: Over a six-month period, 123 Danish women treated with mastectomy or lumpectomy, were assessed for eligibility in the midst of their primary...

Seniors’ unmet mobility needs – how important is a driving licence?

DEFF Research Database (Denmark)

Haustein, Sonja; Siren, Anu Kristiina

2014-01-01

Previous studies have come to different conclusions regarding how important a driving licence is for seniors to fulfil their mobility needs. We investigated this question based on three groups of Danish seniors: persons who were licensed as drivers (‘‘drivers’’); persons who have never been...... it became insignificant for unmet shopping needs. The effect of never having had a licence was hardly affected by the inclusion of control variables. The results emphasise the importance of a driving licence in fulfilling seniors’ mobility needs. Contrary to our hypotheses, more experience with, and better...

Stigma, explanatory models and unmet needs of caregivers of children with developmental disorders in a low-income African country: a cross-sectional facility-based survey.

Science.gov (United States)

Tilahun, Dejene; Hanlon, Charlotte; Fekadu, Abebaw; Tekola, Bethlehem; Baheretibeb, Yonas; Hoekstra, Rosa A

2016-04-27

Understanding the perspectives of caregivers of children with developmental disorders living in low-income countries is important to inform intervention programmes. The purpose of this study was to examine the stigma experiences, explanatory models, unmet needs, preferred interventions and coping mechanisms of caregivers of children with developmental disorders in Ethiopia. Participants comprised caregivers (n = 102) of children with developmental disorders attending two child mental health clinics in Addis Ababa. The majority (66.7%; n = 68) had a diagnosis of intellectual disability (ID); 34 children (33.3%) had autism spectrum disorder (ASD) as their primary diagnosis. All caregivers were administered a structured questionnaire via a face-to-face interview, which included an adaptation of the Family Interview Schedule, closed questions about socio-demographic characteristics, explanatory models of illness, type of interventions used or desired and coping strategies, and an open ended question regarding the family's unmet needs. Most caregivers reported experience of stigma: 43.1% worried about being treated differently, 45.1% felt ashamed about their child's condition and 26.7% made an effort to keep their child's condition secret. Stigma did not depend on the type of developmental disorder, the child's age or gender, or on the age or level of education of the caregiver (all p > 0.05). Reported stigma was significantly higher in caregivers who had sought traditional help (p child's condition (p = .02) and in caregivers of Orthodox Christian faith (p = .03). Caregivers gave a mixture of biomedical explanations (e.g. head injury (30.4%) or birth complications (25.5%)) and supernatural explanations (e.g. spirit possession (40.2%) or sinful act (27.5%)) for their child's condition. The biggest reported unmet need was educational provision for their child (74.5%), followed by treatment by a health professional (47.1%), financial support (30.4%) and expert help to

Confidence intervals for effect sizes: compliance and clinical significance in the Journal of Consulting and clinical Psychology.

Science.gov (United States)

Odgaard, Eric C; Fowler, Robert L

2010-06-01

In 2005, the Journal of Consulting and Clinical Psychology (JCCP) became the first American Psychological Association (APA) journal to require statistical measures of clinical significance, plus effect sizes (ESs) and associated confidence intervals (CIs), for primary outcomes (La Greca, 2005). As this represents the single largest editorial effort to improve statistical reporting practices in any APA journal in at least a decade, in this article we investigate the efficacy of that change. All intervention studies published in JCCP in 2003, 2004, 2007, and 2008 were reviewed. Each article was coded for method of clinical significance, type of ES, and type of associated CI, broken down by statistical test (F, t, chi-square, r/R(2), and multivariate modeling). By 2008, clinical significance compliance was 75% (up from 31%), with 94% of studies reporting some measure of ES (reporting improved for individual statistical tests ranging from eta(2) = .05 to .17, with reasonable CIs). Reporting of CIs for ESs also improved, although only to 40%. Also, the vast majority of reported CIs used approximations, which become progressively less accurate for smaller sample sizes and larger ESs (cf. Algina & Kessleman, 2003). Changes are near asymptote for ESs and clinical significance, but CIs lag behind. As CIs for ESs are required for primary outcomes, we show how to compute CIs for the vast majority of ESs reported in JCCP, with an example of how to use CIs for ESs as a method to assess clinical significance.

Otolaryngology Needs in a Free Clinic Providing Indigent Care.

Science.gov (United States)

Hu, Amanda; Sibert, Thomas; Zhao, Wei; Zarro, Vincent

2016-06-01

To determine the otolaryngology needs in a free clinic providing care to medically indigent patients, as perceived by the patients and health care providers. Cross-sectional survey. A survey was administered to patients and health care providers of a free clinic from September 2014 through January 2015 in an urban, inner-city location. One hundred and thirty-seven patients (35.8% male, age 50.8 ± 13.0 years) completed the survey. Mean household income was $29,838 ± $10,425; 32.1% spoke English; 54.7% were employed; 10.2% had health insurance; and 37.2% had seen a primary care provider outside of the free clinic. The top three otolaryngology symptoms among patients were sleep apnea/snoring (39.4%), heartburn/reflux (30.7%), and dizziness (29.9%). Eleven health care providers (45% male, age 50.5 ± 15.3 years, 63.6% physician, 36% nurse) completed the survey. Providers perceived the following otolaryngology complaints as the most prevalent, in descending order: cough, nasal congestion, reflux/heartburn, sore throat, and ear infection/otalgia. Providers felt that sleep apnea and hearing loss were the less common otolaryngology complaints, whereas surveyed patients indicated these symptoms with high frequency. The most requested diagnostic tool among patients and providers was chest X-rays. There are unmet otolaryngology needs in a free clinic. Medically indigent patients have significant barriers to accessing health care. Patient and provider perceptions of top otolaryngology complaints differed, but both identified access to chest X-rays as a major unmet need. Knowledge of patient perceptions may help providers elicit the breadth of otolaryngology complaints. 4. Laryngoscope, 126:1321-1326, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Association between unmet needs and quality of life in hospitalised cancer patients no longer receiving anti-cancer treatment.

Science.gov (United States)

Bužgová, R; Hajnová, E; Sikorová, L; Jarošová, D

2014-09-01

Assessing the quality of life and unmet needs of cancer patients is an integral part of palliative care. This cross-sectional study sought to determine whether there is an association between quality of life and unmet needs, anxiety and depression in cancer patients who are no longer receiving anti-cancer treatment. The sample consisted of 93 patients from the oncology department at the University Hospital in Ostrava for whom further cancer treatment had been terminated as ineffective in halting the progression of their cancer. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Patient Needs Assessment in Palliative Care (PNAP) questionnaire, and the Hospital Anxiety and Depression Scale (HADS) were used to collect data. The overall quality of life score was quite low at 46. Most unmet needs were defined in terms of physical, psychological or spiritual needs. Correlations were found between impaired quality of life and lower Karnofsky scores (r = 0.50); increased physical (r = 0.52), psychological (r = 0.44) and spiritual (r = 0.36) needs; and higher levels of anxiety (r = -0.30) and depression (r = -0.68). Effective management of patients' physical (pain, fatigue and depression), psychological and spiritual needs may improve their quality of life. © 2014 John Wiley & Sons Ltd.

Identification of clinically significant drug-drug interactions in cardiac ...

African Journals Online (AJOL)

Purpose: To identify clinically significant potential drug-drug interactions in cardiac intensive care units of two tertiary care ... hypertension, hyperlipidemia, diabetes or other diseases .... May result in digoxin toxicity (nausea, vomiting, cardiac.

The prevalence and clinical significance of maxillary sinus mucous retention cysts in a general clinic population.

Science.gov (United States)

Rhodus, N L

1990-02-01

Previous studies have documented the occurrence and potential clinical significance of MSMR cysts. Studies also have alluded to a relationship between the MSMR cyst and certain signs or symptoms of disease. We determined the prevalence of MSMR cysts in a general clinic population and identified some important correlations with clinical signs and symptoms.

Unmet Needs of Family Planning Among Women: A Cross-Sectional Study in a Rural Area of Kanchipuram District, Tamil Nadu, South India.

Science.gov (United States)

Vishnu Prasad, R; Venkatachalam, J; Singh, Zile

2016-10-01

Global contraceptive usage was 63.3 % in 2010 which was 9 % more than that in 1990. NFHS-III 2005-2006 revealed that the contraceptive prevalence rate was 56 % while in the past decade it was 48 %. In India, female sterilization is the most commonly preferred method of contraception accounting for 76 %, while in Tamil Nadu it was 90 %. Thus, this study aims at measuring the prevalence of unmet needs of family planning and its determinants in a rural area of Kancheepuram district, Tamil Nadu. The study was carried out as a community-based cross-sectional study in Chunambed panchayat, a rural area in Kanchipuram District, Tamil Nadu, India, among 505 women of age group 15-49 years. Cluster random sampling was done to select the households to include in the study. In every household, all the available and eligible women were explained about the study and recruited after obtaining informed consent. Chi-square test was applied for finding the difference in proportion, and p value <0.05 was considered statistically significant. The prevalence of unmet need for family planning in our study population was nearly 31 %; it was even more for younger age groups and for the women whose family size was less. 51.7 % of the participants were currently using a contraceptive measure and very few of their partners used contraception. Government health facilities were the major source of contraceptive service and majority of our participants were well aware about the various contraceptive methods. Unmet needs of family planning were high in our study population, and the knowledge about the contraceptive use and family planning was found to be fairly adequate.

Assessing the clinical significance of tumor markers in common neoplasms.

Science.gov (United States)

Beketic-Oreskovic, Lidija; Maric, Petra; Ozretic, Petar; Oreskovic, Darko; Ajdukovic, Mia; Levanat, Sonja

2012-06-01

The term tumor markers include a spectrum of molecules and substances with widely divergent characteristics whose presence in the significant amount can be related to the malignant disease. An ideal tumor marker should have high specificity and sensitivity, which would allow its use in early diagnosis and prognosis of malignant disease, as well as in prediction of therapeutic response and follow-up of the patients. Numerous biochemical entities have emerged as potentially valuable tumor markers so far, but only few markers showed to be of considerable clinical reliability and have been accepted into standard clinical practice. Recent development of genomics and proteomics has enabled the examination of many new potential tumor markers. Scientific studies on discovery, development, and application of tumor markers have been proceeding quite rapidly providing great opportunities for improving the management of cancer patients. This review is focusing on the clinical usefulness of various tumor markers already in clinical practice as well as certain potential markers, giving a brief description of their prognostic and predictive significance in most common malignancies.

Clinically significant anti M antibodies--a report of two cases.

Science.gov (United States)

Kaur, Gagandeep; Basu, Sabita; Kaur, Paramjit; Kaur, Ravneet

2012-12-01

Most anti-M antibodies are not active at 37°C and are thus of no clinical significance. Occasionally these antibodies have a wide thermal range and can lead to hemolytic transfusion reactions or hemolytic disease of the new born. We describe two cases of anti-M antibodies, both of which were clinically significant. The first case was detected due to crossmatch incompatibility and the second presented as a blood group discrepancy. When the antibody is active at 37°C, M antigen negative red cell units should be issued. Copyright © 2012 Elsevier Ltd. All rights reserved.

Self-reported health problems, health care utilisation and unmet health care needs of elderly men and women in an urban municipality and a rural area of Bhaktapur District of Nepal.

Science.gov (United States)

Kshetri, Dan B B; Smith, William C S

2011-06-01

The study aimed to identify the felt common health problems, utilisation of health services and unmet needs of urban and rural elderly people of Bhaktapur district, Nepal. It was a cross sectional population study of people aged 60 years or more where 204 respondents were interviewed in 2009. The common felt problems were pain and swelling of joints (65.7%), indigestion (63.7%), excessive tiredness (38.2%) and hypertension (35.8%). Pain and swelling of joints (72.5%) and back pain (40.4%) were higher in rural elderly population whereas indigestion (67.6%) and hypertension (37.85%) were higher in urban population. Pain and swelling of joints (66.7%) and indigestion (69.6%) were higher in males, and hypertension (50.0%), back pain (38.2%) and chronic bronchitis/asthma (39.2%) were higher in females. The unmet needs varied between different health problems. In general women had more unmet needs than men, where 80 unmet needs were identified for the 102 men compared with 105 for the 102 women, and these unmet needs increased dramatically with age. This approach yields new insights into the health care needs of the elderly and will be helpful to health care planners.

Coronary Stents: The Impact of Technological Advances on Clinical Outcomes.

Science.gov (United States)

Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G

2016-02-01

Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

Unmet need and demand for family planning among married women of Abha, Aseer Region in Saudi Arabia

Directory of Open Access Journals (Sweden)

Shamsun Nahar Khalil

2018-03-01

Conclusion: Around one third of the women in the present study have an unmet need for family planning and demand for Contraception for this population has been found to be high. All these findings point out the need of action in this regards.

A global study of the unmet need for glycemic control and predictor factors among patients with type 2 diabetes mellitus who have achieved optimal fasting plasma glucose control on basal insulin.

Science.gov (United States)

Raccah, Denis; Chou, Engels; Colagiuri, Stephen; Gaàl, Zsolt; Lavalle, Fernando; Mkrtumyan, Ashot; Nikonova, Elena; Tentolouris, Nikolaos; Vidal, Josep; Davies, Melanie

2017-03-01

This study used data from different sources to identify the extent of the unmet need for postprandial glycemic control in patients with type 2 diabetes mellitus (T2DM) after the initiation of basal insulin therapy in Europe, Asia Pacific, the United States, and Latin America. Different levels of evidence were used as available for each country/region, with data extracted from seven randomized controlled trials (RCTs), three clinical trial registries (CTRs), and three electronic medical record (EMR) databases. Glycemic status was categorized as "well controlled" (glycated hemoglobin [HbA 1c ] at target [130/140 mg/dL, depending on country-specific recommendations]), or "uncontrolled" (both FPG and HbA 1c above target). Predictor factors were identified from the RCT data set using logistic regression analysis. RCT data showed that 16.9% to 28.0%, 42.7% to 54.4%, and 16.9% to 38.1% of patients with T2DM had well-controlled glycemia, residual hyperglycemia, and uncontrolled hyperglycemia, respectively. In CTRs, respective ranges were 21.8% to 33.6%, 31.5% to 35.6%, and 30.7% to 46.8%, and in EMR databases were 4.4% to 21.0%, 23.9% to 31.8%, and 53.6% to 63.8%. Significant predictor factors of residual hyperglycemia identified from RCT data included high baseline HbA 1c (all countries/regions except Brazil), high baseline FPG (United Kingdom/Japan), longer duration of diabetes (Brazil), and female sex (Europe/Latin America). Irrespective of intrinsic differences between data sources, 24% to 54% of patients with T2DM globally had residual hyperglycemia with HbA 1c not at target, despite achieving FPG control, indicating a significant unmet need for postprandial glycemic control. © 2016 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.

Determinants of low family planning use and high unmet need in Butajira District, South Central Ethiopia

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Mekonnen Wubegzier

2011-12-01

Full Text Available Abstract Background The rapid population growth does not match with available resource in Ethiopia. Though household level family planning delivery has been put in place, the impact of such programs in densely populated rural areas was not studied. The study aims at measuring contraception and unmet need and identifying its determinants among married women. Methods A total of 5746 married women are interviewed from October to December 2009 in the Butajira Demographic Surveillance Area. Contraceptive prevalence rate and unmet need with their 95% confidence interval is measured among married women in the Butajira district. The association of background characteristics and family planning use is ascertained using crude and adjusted Odds ratio in logistic regression model. Results Current contraceptive prevalence rate among married women is 25.4% (95% CI: 24.2, 26.5. Unmet need of contraception is 52.4% of which 74.8% was attributed to spacing and the rest for limiting. Reasons for the high unmet need include commodities' insecurity, religion, and complaints related to providers, methods, diet and work load. Contraception is 2.3 (95% CI: 1.7, 3.2 times higher in urbanites compared to rural highlanders. Married women who attained primary and secondary plus level of education have about 1.3 (95% CI: 1.1, 1.6 and 2 (95% CI: 1.4, 2.9 times more risk to contraception; those with no child death are 1.3 (95% CI: 1.1, 1.5 times more likely to use contraceptives compared to counterparts. Besides, the odds of contraception is 1.3 (95% CI: 1.1, 1.6 and 1.5 (1.1, 2.0 times more likely among women whose partners completed primary and secondary plus level of education. Women discussing about contraception with partners were 2.2 (95% CI: 1.8, 2.7 times more likely to use family planning. Nevertheless, contraception was about 2.6 (95% CI: 2.1, 3.2 more likely among married women whose partners supported the use of family planning. Conclusions The local government

Clinical significance of anaplasia in childhood rhabdomyosarcoma

International Nuclear Information System (INIS)

Sidhom, I.; El Nadi, E.; Taha, H.; Elkinaai, N.; Zaghloul, M.S.; Younes, A.; Labib, R.; Sabry, M.

2015-01-01

Background: The presence of anaplastic features has been known to correlate with poor clinical outcome in various pediatric malignancies, including Wilms tumor and medulloblastoma but not in rhabdomyosarcoma. Aim: Aim was to study the frequency of anaplasia at presentation in childhood rhabdomyosarcoma and its relationship to clinical and pathological characteristics as well as to outcome. Patients and Methods: Anaplasia was retrospectively assessed in 105 consecutive pediatric rhabdomyosarcoma patients who were registered at the Children’s Cancer Hospital in Egypt (CCHE) during the period from July 2007 till the end of May 2010. Results: Anaplasia was diagnosed in 18 patients (17.1%), focal in 10 (9.5%) and diffuse in 8 (7.6%). The distribution of anaplasia was found to be more common in older patients having age P 10 years. Also it was more likely to occur in the high risk group and in tumors with unfavorable histology (alveolar subtype), and stage IV. The 3-year failure free survival rates for patients with and without anaplasia were 27.8 ± 10.6% and 53.4 ± 5.8%, respectively (p = 0.014) and the 3-year overall survival rates were 35.3 ± 11.6% and 61 ± 6%, respectively (p = 0.019). Conclusions: The frequency of anaplasia in pediatric patients with rhabdomyosarcoma in our study was 17.1%. The presence of anaplasia had statistically significant worse clinical outcome

Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis

Science.gov (United States)

Keefer, Laurie; Taft, Tiffany H; Kiebles, Jennifer L; Martinovich, Zoran; Barrett, Terrence A; Palsson, Olafur S

2013-01-01

Summary Background Psychotherapy is not routinely recommended for in ulcerative colitis (UC). Gut-directed hypnotherapy (HYP) has been linked to improved function in the gastrointestinal tract and may operate through immune-mediated pathways in chronic diseases. Aims To determine the feasibility and acceptability of hypnotherapy and estimate the impact of hypnotherapy on clinical remission status over a 1 year period in patients with an historical flare rate of 1.3 times per year. Methods 54 patients were randomized at a single site to 7 sessions of gut-directed hypnotherapy (N = 26) or attention control (CON; N = 29) and followed for 1 year. The primary outcome was the proportion of participants in each condition that had remained clinically asymptomatic (clinical remission) through 52 weeks post-treatment. Results One-way ANOVA comparing hypnotherapy and control subjects on number of days to clinical relapse favored the hypnotherapy condition [F = 4.8 (1, 48), p = .03] by 78 days. Chi square analysis comparing the groups on proportion maintaining remission at 1 year was also significant [X2(1) = 3.9, p = .04], with 68% of hypnotherapy and 40% of control patients maintaining remission for 1 year. There were no significant differences between groups over time in quality of life, medication adherence, perceived stress or psychological factors. Conclusions This is the first prospective study that has demonstrated a significant effect of a psychological intervention on prolonging clinical remission in patients with quiescent UC. Clinical Trial # NCT00798642 PMID:23957526

Habitual Sleep Duration, Unmet Sleep Need, and Excessive Daytime Sleepiness in Korean Adults

OpenAIRE

Hwangbo, Young; Kim, Won-Joo; Chu, Min Kyung; Yun, Chang-Ho; Yang, Kwang Ik

2016-01-01

Background and Purpose Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults. Methods The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous...

78 FR 3005 - Creating an Alternative Approval Pathway for Certain Drugs Intended to Address Unmet Medical Need...

Science.gov (United States)

2013-01-15

... approaches that can facilitate development of treatment for unmet needs. Traditional drug development... considerations need to be taken into account before and after marketing and how should they be addressed? 6..., subject to certain limitations, to videotape, film, or otherwise record FDA's public administrative...

Participation in cancer rehabilitation and unmet needs: a population-based cohort study

DEFF Research Database (Denmark)

Holm, L.V.; Hansen, D.G.; Johansen, C.

2012-01-01

sex, age, and diagnosis, and the outcome variables for rehabilitation. RESULTS: A total of 3,439 patients participated, yielding an overall response rate of 70%. One third of the cancer patients reported a need for physical rehabilitation and one third for psychological rehabilitation. Half...... of the patients participated in at least one activity. Unmet needs were most often reported in psychological, sexual, and financial areas. Women expressed more needs, participated more often in rehabilitation activities, and had, to a higher extent, their emotional needs fulfilled. Breast cancer patients...

Beliefs about unmet interpersonal needs mediate the relation between conflictual family relations and borderline personality features in young adult females.

Science.gov (United States)

Kalpakci, Allison; Venta, Amanda; Sharp, Carla

2014-01-01

Central to most theories of borderline personality disorder (BPD) is the notion that the family environment interacts with genetically-based vulnerabilities to influence the development of BPD, with particular attention given to risk conferred by conflictual familial relations. However, the extent to which family conflict may relate to the development of BPD via related interpersonal beliefs is currently unknown. This study sought to test the hypothesis that the concurrent relation between conflictual family relations and borderline features in female college students is explained by beliefs associated with real or perceived unmet interpersonal needs (captured by Joiner's [2005] Interpersonal Psychological Theory, specifically thwarted belongingness and perceived burdensomeness). The sample included 267 female undergraduates ages 18-25 years (M = 20.86; SD = 1.80). Level of borderline personality features, unmet interpersonal needs, and family conflict were assessed. Bivariate analyses revealed significant relations between both thwarted belongingness and perceived burdensomeness, conflictual family relations, and borderline features. Multivariate analyses revealed that thwarted belongingness and perceived burdensomeness both mediated the relation between family conflict and borderline personality features, thus supporting a multiple mediation model. This cross-sectional study is a preliminary step towards confirming the broad theoretical hypothesis that conflictual family relations relate to beliefs about thwarted belongingness and perceived burdensomeness, which, in turn, relate to borderline personality pathology. Limitations and areas of future research are discussed.

What is the best care for community-dwelling dependent adults? Sources of care and perception of unmet needs in Spain

Directory of Open Access Journals (Sweden)

Rogero-García, Jesús

2014-08-01

Full Text Available The objectives of this study in the Spanish context are: (1 to identify what source of care (informal, private or public care achieves the lowest perception of unmet needs amongst dependent adults and (2 to identify which factors are associated with a greater perception of unmet needs within each source of care. This research is based on a sample of 4,766 dependent adults who completed the 2008 Survey on Disability, Personal Autonomy and Dependency Situations (EDAD. Dependent adults who received only paid care were less likely to perceive unmet needs compared to those who received other types of care. Dependents who received public care were more likely to perceive unmet needs. Perception of unmet needs is related to the characteristics of the dependent adults, the primary carers and the caregiving context. The results suggest that policy design must not assume that dependent people prefer family care to other types of care and demonstrate that public care is perceived as unsatisfactory.Los objetivos de este trabajo son: (1 identificar el proveedor de cuidado (informal, privado o público que consigue una menor percepción de necesidades no cubiertas entre los adultos dependientes en España, (2 identificar qué factores se relacionan con una mayor percepción de necesidades no cubiertas en cada situación, atendiendo al proveedor de cuidado. Se analizó una muestra de 4.766 adultos dependientes de la Encuesta sobre Discapacidades, Autonomía personal y situaciones de Dependencia (EDAD 2008. Los adultos dependientes que recibieron únicamente cuidado privado tuvieron menos probabilidades de percibir sus necesidades no cubiertas, en comparación con quienes recibieron cualquier otro tipo de cuidado. Quienes recibieron cuidado solo de servicios sociales tuvieron más probabilidades de percibir sus necesidades como no cubiertas. La percepción de necesidades no cubiertas está relacionada con las características de la persona dependiente, del

Unmet need for contraception among sex workers in Madagascar☆,☆☆

Science.gov (United States)

Khan, Maria R.; Turner, Abigail Norris; Pettifor, Audrey; Van Damme, Kathleen; Rabenja, Ny Lovaniaina; Ravelomanana, Noro; Swezey, Teresa; Williams, D’Nyce; Jamieson, Denise; Behets, Frieda

2018-01-01

Background The study was conducted to investigate past and future pregnancy preferences and contraceptive need among Malagasy sex workers. Study Design We analyzed data on pregnancy and contraceptive use collected during the baseline visit of a randomized, prospective formative trial which assessed diaphragm and microbicide acceptability among sex workers. To be eligible, women could not be pregnant or planning pregnancy for the next 2 months. Results Women (N=192) from four cities (Antananarivo, Antsiranana, Mahajanga and Toamasina) reported a median of 10 sex acts per week. Fifty-two percent reported a prior unwanted pregnancy, 45% at least one induced abortion and 86% that preventing future pregnancy was moderately to very important. During the last sex act, 24% used a hormonal method, 36% used a male condom, 2% used a traditional method and 38% used no method. Nearly 30% of participants reported that pregnancy prevention was moderately or very important but used no contraception at last sex; these women were categorized as having “unmet need” for contraception. In multivariable binomial regression analyses, factors associated with unmet need included low knowledge of contraceptive effectiveness [age- and site-adjusted prevalence ratio (PR): 2.1; 95% confidence interval (CI): 1.4–3.0] and low self-efficacy to negotiate condom use (age- and site-adjusted PR: 2.0; 95% CI: 1.4–3.0). Conclusions Among these women, prior unwanted pregnancy and induced abortion were common and preventing future pregnancy was important, yet gaps in contraceptive use were substantial. Contraceptive knowledge and self-efficacy should be improved to promote contraceptive use by sex workers. PMID:19185677

Unmet belongingness needs but not high belongingness needs alone predict adverse well-being; A response surface modeling approach

NARCIS (Netherlands)

Verhagen, M.; Lodder, G.M.A.; Baumeister, R.F.

2018-01-01

Objective: Previous work has linked high levels of belongingness needs to low well-being, suggesting that high desire for social connection causes problems. Against that view, we hypothesized that problems stem especially from unmet belongingness needs. To examine this, discrepancies between

Monoscopic versus stereoscopic photography in screening for clinically significant macular edema.

Science.gov (United States)

Welty, Christopher J; Agarwal, Anita; Merin, Lawrence M; Chomsky, Amy

2006-01-01

The purpose of the study was to determine whether monoscopic photography could serve as an accurate tool when used to screen for clinically significant macular edema. In a masked randomized fashion, two readers evaluated monoscopic and stereoscopic retinal photographs of 100 eyes. The photographs were evaluated first individually for probable clinically significant macular edema based on the Early Treatment Diabetic Retinopathy Study criteria and then as stereoscopic pairs. Graders were evaluated for sensitivity and specificity individually and in combination. Individually, reader one had a sensitivity of 0.93 and a specificity of 0.77, and reader two had a sensitivity of 0.88 and a specificity of 0.94. In combination, the readers had a sensitivity of 0.91 and a specificity of 0.86. They correlated on 0.76 of the stereoscopic readings and 0.92 of the monoscopic readings. These results indicate that the use of monoscopic retinal photography may be an accurate screening tool for clinically significant macular edema.

Clinical significance of anaplasia in childhood rhabdomyosarcoma.

Science.gov (United States)

Sidhom, Iman; El Nadi, Enas; Taha, Hala; Elkinaai, Naglaa; Zaghloul, Mohamed S; Younes, Alaa; Labib, Rania; Sabry, Mohamed

2015-06-01

The presence of anaplastic features has been known to correlate with poor clinical outcome in various pediatric malignancies, including Wilms tumor and medulloblastoma but not in rhabdomyosarcoma. Aim was to study the frequency of anaplasia at presentation in childhood rhabdomyosarcoma and its relationship to clinical and pathological characteristics as well as to outcome. Anaplasia was retrospectively assessed in 105 consecutive pediatric rhabdomyosarcoma patients who were registered at the Children's Cancer Hospital in Egypt (CCHE) during the period from July 2007 till the end of May 2010. Anaplasia was diagnosed in 18 patients (17.1%), focal in 10 (9.5%) and diffuse in 8 (7.6%). The distribution of anaplasia was found to be more common in older patients having age⩾10 years. Also it was more likely to occur in the high risk group and in tumors with unfavorable histology (alveolar subtype), and stage IV. The 3-year failure free survival rates for patients with and without anaplasia were 27.8±10.6% and 53.4±5.8%, respectively (p=0.014) and the 3-year overall survival rates were 35.3±11.6% and 61±6%, respectively (p=0.019). The frequency of anaplasia in pediatric patients with rhabdomyosarcoma in our study was 17.1%. The presence of anaplasia had statistically significant worse clinical outcome. Copyright © 2015 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

Prevalence and clinical significance of cathepsin G antibodies in systemic sclerosis

Directory of Open Access Journals (Sweden)

M. Favaro

2011-09-01

Full Text Available Objectives: To evaluate the prevalence and clinical significance of cathepsin G antibodies in patients affected with systemic sclerosis (SSc, scleroderma. Methods: 115 patients affected by SSc, 55 (47,8% with diffuse scleroderma (dSSc and 60 (52,2% with limited scleroderma (lSSc, were tested for cathepsin G antibodies by ELISA method. Moreover these sera were evaluated by indirect immunofluorescence (IIF on ethanol and formalin fixed human neutrophils. Results: By means of the ELISA method 16 (13,9% patients were found to be sera positive for anti-cathepsin G, 2 (12.5% of which showed a perinuclear fluorescence pattern (P-ANCA and 4 (25% an atypical ANCA staining, while 10 (62,5% were negative on IIF. The IIF on scleroderma sera revealed 5 (4,3% P-ANCA and 18 (15,7% atypical ANCA patterns. The anti-cathepsin G antibodies significantly prevailed in scleroderma sera (p=0.02 when their frequency was compared with that of healthy controls; while they were not significantly associated to any clinical or serological features of SSc patients. Conclusions: The anti-cathepsin G antibodies were significantly frequent in scleroderma sera; however, no clinical correlations were found. Thus, the significance of their presence in SSc still needs to be clarified.

Oral Health Equity and Unmet Dental Care Needs in a Population-Based Sample: Findings From the Survey of the Health of Wisconsin

Science.gov (United States)

Wisk, Lauren E.; Walsh, Matthew; McWilliams, Christine; Eggers, Shoshannah; Olson, Melissa

2015-01-01

Objectives. We used objective oral health screening and survey data to explore individual-, psychosocial-, and community-level predictors of oral health status in a statewide population of adults. Methods. We examined oral health status in a sample of 1453 adult Wisconsin residents who participated in the Survey of the Health of Wisconsin Oral Health Screening project, conducted with the Wisconsin Department of Health Services during 2010. Results. We found significant disparities in oral health status across all individual-, psychosocial-, and community-level predictors. More than 15% of participants had untreated cavities, and 20% did not receive needed oral health care. Individuals who self-reported unmet need for dental care were 4 times as likely to have untreated cavities as were those who did not report such a need, after controlling for sociodemographic and behavioral factors. Conclusions. Our results suggested that costs were a primary predictor of access to care and poor oral health status. The results underscored the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers (e.g., the costs associated with unmet dental care) and promoting preventive health behaviors (e.g., teeth brushing). PMID:25905843

Clinical Significance and Characteristic Clinical Differences of Cytolytic Vaginosis in Recurrent Vulvovaginitis.

Science.gov (United States)

Yang, Shuhua; Zhang, Yuexiang; Liu, Ying; Wang, Jianhong; Chen, Shuqin; Li, Shuxia

2017-01-01

The study aimed to evaluate whether cytolytic vaginosis (CV) has important clinical implications for recurrent vulvovaginitis and to identify clinical differences between CV and vulvovaginal candidosis (VVC). Medical histories, physical examinations and laboratory findings were used to diagnose and assess the prevalence rates of various vulvovaginal infections among 536 women with recurrent vulvovaginitis. Chi-square and Fisher exact tests were used to compare age, menstrual cycle phase at episode onset, symptoms/signs of infection and discharge characteristics between CV and VVC with single infection. Among the 484 women with a single-infection recurrent vulvovaginitis, the prevalence of CV (n = 143; 26.7%) was second only to VVC (n = 196; 36.6%). CV symptoms occurred predominantly during the ovulatory and luteal phases. Meanwhile, VVC episodes were not concentrated premenstrually, but rather occurred throughout the menstrual cycle. Significant differences were found in the vaginal pH, discharge characteristics and frequency of inflammatory symptoms between the 2 groups. CV is clinically important, because it is a common cause of recurrent vulvovaginitis. To distinguish CV from VVC, gynecologists should consider the patient's medical history, physical and laboratory findings, vaginal pH and vaginal discharge characteristics. © 2016 S. Karger AG, Basel.

Clinical Significance of CK19 Negative Breast Cancer

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Fujisue, Mamiko, E-mail: nishimura.reiki@cityhosp-kumamoto.jp; Nishimura, Reiki; Okumura, Yasuhiro [Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Kumamoto City, Kumamoto 862-8505 (Japan); Tashima, Rumiko [Department of Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Kumamoto City, Kumamoto 862-8505 (Japan); Nishiyama, Yasuyuki; Osako, Tomofumi [Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Kumamoto City, Kumamoto 862-8505 (Japan); Toyozumi, Yasuo; Arima, Nobuyuki [Department of Pathology, Kumamoto City Hospital, 1-1-60 Kotoh, Kumamoto City, Kumamoto 862-8505 (Japan)

2012-12-21

Analysis of sentinel lymph nodes (SLNs) by means of One-Step Nucleic Acid Amplification (OSNA) is gaining widespread use as a quick and accurate method. This assay detects the expression level of cytokeratin 19 (CK19) which is present in some but not all breast tumors. In this study, the clinical significance of negative CK19 was investigated in 219 cases of primary breast cancer. In 179 patients with clinically negative nodes, OSNA and imprint smear cytology of SLN were performed simultaneously. The OSNA revealed a node-positive rate of 24.6%. Negative CK19 correlated significantly with negative ER/PgR and higher Ki-67 values, and marginally with higher nuclear grade and p53 overexpression. The triple negative subtype showed lower CK19 expression. OSNA revealed that one of the negative CK19 cases was actually a false negative but this was corrected with the use of the imprint smear cytology. In conclusion, CK19 negativity reflected the aggressiveness of primary breast cancer. OSNA assay used to analyze SLN was useful, but there is a possibility that it will mistakenly detect false negatives in CK19 negative tumors. Therefore, in tumors with negative CK19, the imprint smear cytology may be more useful in cases with macrometastasis.

Clinical Significance of CK19 Negative Breast Cancer

Directory of Open Access Journals (Sweden)

Nobuyuki Arima

2012-12-01

Full Text Available Analysis of sentinel lymph nodes (SLNs by means of One-Step Nucleic Acid Amplification (OSNA is gaining widespread use as a quick and accurate method. This assay detects the expression level of cytokeratin 19 (CK19 which is present in some but not all breast tumors. In this study, the clinical significance of negative CK19 was investigated in 219 cases of primary breast cancer. In 179 patients with clinically negative nodes, OSNA and imprint smear cytology of SLN were performed simultaneously. The OSNA revealed a node-positive rate of 24.6%. Negative CK19 correlated significantly with negative ER/PgR and higher Ki-67 values, and marginally with higher nuclear grade and p53 overexpression. The triple negative subtype showed lower CK19 expression. OSNA revealed that one of the negative CK19 cases was actually a false negative but this was corrected with the use of the imprint smear cytology. In conclusion, CK19 negativity reflected the aggressiveness of primary breast cancer. OSNA assay used to analyze SLN was useful, but there is a possibility that it will mistakenly detect false negatives in CK19 negative tumors. Therefore, in tumors with negative CK19, the imprint smear cytology may be more useful in cases with macrometastasis.

Clinical Significance of CK19 Negative Breast Cancer

International Nuclear Information System (INIS)

Fujisue, Mamiko; Nishimura, Reiki; Okumura, Yasuhiro; Tashima, Rumiko; Nishiyama, Yasuyuki; Osako, Tomofumi; Toyozumi, Yasuo; Arima, Nobuyuki

2012-01-01

Analysis of sentinel lymph nodes (SLNs) by means of One-Step Nucleic Acid Amplification (OSNA) is gaining widespread use as a quick and accurate method. This assay detects the expression level of cytokeratin 19 (CK19) which is present in some but not all breast tumors. In this study, the clinical significance of negative CK19 was investigated in 219 cases of primary breast cancer. In 179 patients with clinically negative nodes, OSNA and imprint smear cytology of SLN were performed simultaneously. The OSNA revealed a node-positive rate of 24.6%. Negative CK19 correlated significantly with negative ER/PgR and higher Ki-67 values, and marginally with higher nuclear grade and p53 overexpression. The triple negative subtype showed lower CK19 expression. OSNA revealed that one of the negative CK19 cases was actually a false negative but this was corrected with the use of the imprint smear cytology. In conclusion, CK19 negativity reflected the aggressiveness of primary breast cancer. OSNA assay used to analyze SLN was useful, but there is a possibility that it will mistakenly detect false negatives in CK19 negative tumors. Therefore, in tumors with negative CK19, the imprint smear cytology may be more useful in cases with macrometastasis

The influence of unmet supportive care needs on anxiety and depression during cancer treatment and beyond: a longitudinal study of survivors of haematological cancers.

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Oberoi, Devesh; White, Victoria M; Seymour, John F; Miles Prince, H; Harrison, Simon; Jefford, Michael; Winship, Ingrid; Hill, David; Bolton, Damien; Kay, Anne; Millar, Jeremy; Doo, Nicole Wong; Giles, Graham

2017-11-01

This paper aims to examine the cross-sectional and longitudinal associations between patient-reported unmet needs and anxiety and depression for survivors of diffuse large B cell lymphoma (DLBCL) and multiple myeloma (MM). In a longitudinal study design, self-reported data were collected through telephone interviews at two time points approximately 7 (T1) and 15 (T2) months post-diagnosis. The sample was recruited through the population-based Victorian Cancer Registry. At T1 and T2, the study outcomes, anxiety and depression, were assessed using the Hospital Anxiety and Depression Scale (HADS) and unmet needs were measured using the Supportive Care Needs Survey (SCNS-SF34). Questions related to social/family problems, relationship problems and financial problems were also asked. A three-step multivariable hierarchical logistic regression analysis examined the relative role of T1 anxiety and depression, T1 and T2 unmet needs and other psychosocial factors with T2 anxiety and depression. Both cross-sectional and longitudinal associations were observed between unmet needs and psychological distress. T2 anxiety was associated with T1 anxiety (OR 4.75, 95% CI 1.86-11.09), T2 psychological needs (OR 1.68, 95% CI 1.34-2.11) and with T1 social problems (OR 2.33, 95% CI 1.03-5.05) in multivariate analysis. T2 depression was associated with both T1 (OR 1.28, 95% CI 1.06-1.57) and T2 psychological needs (OR 1.35, 95% CI 1.06-1.70), T2 physical needs (OR 1.89, 95% CI 1.27-2.81) and T1 depression (OR 4.52, 95% CI 1.88-10.86). Unmet needs that manifest following diagnosis and treatment may persist into early survivorship and contribute to psychological distress. Addressing these needs during treatment may diminish the risk of current and future anxiety and depression.

Prevalence and clinical significance of extravascular incidental findings in patients undergoing CT cervico-cerebral angiography

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Crockett, Matthew Thomas; Murphy, Blathnaid; Smith, Jennifer; Kavanagh, Eoin Carl

2015-01-01

Highlights: • CT cervico-cerebral angiography (CTCCA) is a commonly performed study for assessment of vascular pathologies of head and neck. • This study assessed the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA. • This study demonstrated the presence of clinically significant incidental findings in 14% of patients undergoing CTCCA with 8% of these findings deemed to be highly significant. 19% of patients with highly clinically significant findings did not receive appropriate follow up. • A standardised method of reporting incidental findings, such as that used in this paper is suggested to aid radiologists and referring physicians in recording and communicating these findings. - Abstract: Introduction: CT cervico-cerebral angiography (CTCCA) is now the first line diagnostic imaging modality for the majority of vascular pathologies of the head and neck with diagnostic value comparable to or better than traditional angiographic techniques. The aim of this study was to assess the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA. Materials and methods: A retrospective review of the CTCCA reports of 302 consecutive patients from 2009 to 2013 was undertaken. Extravascular incidental findings were classified, according to an adaptation of the CT colonography data and reporting system (CRADS), as EV1–EV4. EV1 = no incidental findings, EV2 = clinically insignificant incidental finding, EV3 = incidental finding of intermediate clinical significance, EV4 = highly clinically significant finding. Follow up of the electronic medical records of patients with EV3 or EV4 findings was undertaken to determine subsequent management. Results: Potentially clinically significant findings were demonstrated in 14.2% of patients with 8.6% of patients having a highly clinically significant finding. 4 incidental findings were confirmed to be malignant lesions and 5

Confidence Intervals for Effect Sizes: Compliance and Clinical Significance in the "Journal of Consulting and Clinical Psychology"

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Odgaard, Eric C.; Fowler, Robert L.

2010-01-01

Objective: In 2005, the "Journal of Consulting and Clinical Psychology" ("JCCP") became the first American Psychological Association (APA) journal to require statistical measures of clinical significance, plus effect sizes (ESs) and associated confidence intervals (CIs), for primary outcomes (La Greca, 2005). As this represents the single largest…

Computational Approach to Annotating Variants of Unknown Significance in Clinical Next Generation Sequencing.

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Schulz, Wade L; Tormey, Christopher A; Torres, Richard

2015-01-01

Next generation sequencing (NGS) has become a common technology in the clinical laboratory, particularly for the analysis of malignant neoplasms. However, most mutations identified by NGS are variants of unknown clinical significance (VOUS). Although the approach to define these variants differs by institution, software algorithms that predict variant effect on protein function may be used. However, these algorithms commonly generate conflicting results, potentially adding uncertainty to interpretation. In this review, we examine several computational tools used to predict whether a variant has clinical significance. In addition to describing the role of these tools in clinical diagnostics, we assess their efficacy in analyzing known pathogenic and benign variants in hematologic malignancies. Copyright© by the American Society for Clinical Pathology (ASCP).

Allergy in Hong Kong: an unmet need in service provision and training.

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Chan, Y T; Ho, H K; Lai, Christopher K W; Lau, C S; Lau, Y L; Lee, T H; Leung, T F; Wong, Gary W K; Wu, Y Y

2015-02-01

Many children in Hong Kong have allergic diseases and epidemiological data support a rising trend. Only a minority of children will grow out of their allergic diseases, so the heavy clinical burden will persist into adulthood. In an otherwise high-quality health care landscape in Hong Kong, allergy services and training are a seriously unmet need. There is one allergy specialist for 1.5 million people, which is low not only compared with international figures, but also compared with most other specialties in Hong Kong. The ratio of paediatric and adult allergists per person is around 1:460 000 and 1:2.8 million, respectively, so there is a severe lack of adult allergists, while the paediatric allergists only spend a fraction of their time working with allergy. There are no allergists and no dedicated allergy services in adult medicine in public hospitals. Laboratory support for allergy and immunology is not comprehensive and there is only one laboratory in the public sector supervised by accredited immunologists. These findings clearly have profound implications for the profession and the community of Hong Kong and should be remedied without delay. Key recommendations are proposed that could help bridge the gaps, including the creation of two new pilot allergy centres in a hub-and-spoke model in the public sector. This could require recruitment of specialists from overseas to develop the process if there are no accredited allergy specialists in Hong Kong who could fulfil this role.

Breast cancer patients receiving postoperative radiotherapy: Distress, depressive symptoms and unmet needs of psychosocial support

International Nuclear Information System (INIS)

Luutonen, Sinikka; Vahlberg, Tero; Eloranta, Sini; Hyvaeri, Heidi; Salminen, Eeva

2011-01-01

Background and purpose: The diagnosis and treatment of breast cancer can cause considerable psychological consequences, which may remain unrecognized and untreated. In this study, the prevalence of depressive symptoms and distress, and unmet needs for psychosocial support were assessed among breast cancer patients receiving postoperative radiotherapy. Material and methods: Out of 389 consecutive patients, 276 responded and comprised the final study group. Depressive symptoms were assessed with the Beck Depression Inventory. Distress was measured with the Distress Thermometer. Hospital records of the patients were examined for additional information. Results: Nearly one third of patients (32.1%) displayed depressive symptoms, and more than a quarter of patients (28.4%) experienced distress. Younger age (p = 0.001) and negative hormone receptor status (p = 0.008) were independent factors associated with distress. One quarter of the patients expressed an unmet need for psychosocial support, which was independently associated with depressive symptoms and/or distress (p = 0.001) and younger age (p = 0.006). Conclusions: During radiotherapy for breast cancer, the staff should have awareness of the higher risk of depression and distress in their patients and should consider screening tools to recognise distress and depressive symptoms. Special attention should be paid to younger patients.

Public pensions and unmet medical need among older people: Cross-national analysis of 16 European countries, 2004-2010

NARCIS (Netherlands)

A. Reeves (Aaron); M. McKee (Martin); J.P. Mackenbach (Johan); M. Whitehead (Margaret); D. Stuckler (David)

2016-01-01

textabstractBackground Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge,

Great expectations - and what comes of it: The effects of unmet expectations on work motivation and outcomes among newcomers

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Taris, T.W.; Feij, J.A.; Capel, S.

2006-01-01

Purpose - Examines how the socialization of new employees affects their future work performance, studying the impact of unmet expectations on their later motivation for learning, effort and turnover. Design/methodology/approach - Uses data from the Work Socialization of Youth study, which studied

Great expectations and what comes of it: the effects of unmet expectations on work motivation and outcomes among newcomers

NARCIS (Netherlands)

Taris, T.W.; Feij, J.A.; Capel, S.

2006-01-01

The present research focused on newcomers' socialization process in a three-wave study among 1477 newcomers from seven Western (mainly European) countries. Based on previous research, we expected that unmet expectations regarding selected intrinsic work aspects would have adverse effects on work

Challenges, coping strategies, and unmet needs of families with a child with autism spectrum disorder in Goa, India.

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Divan, Gauri; Vajaratkar, Vivek; Desai, Miraj U; Strik-Lievers, Luisa; Patel, Vikram

2012-06-01

Autism Spectrum Disorders (ASD) are increasingly recognized in developing countries like India. However, little is known about the experiences of parents raising a child with ASD. This study aimed to describe the experiences of families in Goa, India with a view to understanding the unmet needs of families raising a child with ASD. Twenty in-depth interviews and nine focus group discussions were carried out with families of children with ASD and key community stakeholders such as special educators, teachers, and parents of typically developing children. This qualitative data was triangulated to explore the experiences, life impact, and unmet needs of raising a child with ASD. Key findings suggest that raising a child with ASD puts a tremendous strain on families due to competing commitments, often leading to initial social withdrawal with later reintegration into social networks. Second, the impact is multidimensional, involving the personal sphere but also extending into the wider community with negative experiences of discrimination. Third, parents actively respond to these challenges through a range of approaches with help from existing and new social support networks and health care providers. Fourth, professionals from the health, education, and religious sectors have a low awareness of the unique needs of families living with ASD which leads to a considerable economic and emotional burden on families. Finally, as a consequence of these experiences, several unmet needs can be identified, notably for supporting increasingly isolated families and the limited access to multidisciplinary evidence-based services for ASD. Autism Res 2012, 5: 190-200. © 2012 International Society for Autism Research, Wiley Periodicals, Inc. © 2012 International Society for Autism Research, Wiley Periodicals, Inc.

The initial development of an instrument to assess the psychosocial needs and unmet needs of young people who have a parent with cancer: piloting the offspring cancer needs instrument (OCNI).

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Patterson, Pandora; Pearce, Angela; Slawitschka, Emma

2011-08-01

This study aimed to identify the psychosocial needs of young people (12-24 years) who have a parent with cancer and to assess whether these needs are being met. This paper also presented the initial steps in the development of a need-based measure-the Offspring Cancer Needs Instrument (OCNI). Study 1 used qualitative methods to identify the needs of the target population, including a focus group (n = 6), telephone interviews (n = 8) and staff survey (n = 26). In study 2, a quantitative survey design was employed where 116 young people completed the 67-item OCNI and either the total difficulties score of the Strengths and Difficulties Questionnaire (SDQ-TD; 12-17-year-old) or Depression, Anxiety, Stress Scale-21 (DASS-21) (18-24-year-old). Tests of reliability (Cronbach's alpha) were used to assess the properties of each domain, where a level of 0.70 was deemed satisfactory as per scale guidelines. Construct validity was assessed by testing the proposed relationship between unmet needs and functioning where a coefficient of 0.03 was deemed satisfactory. The qualitative data yielded eight need domains (information, peer support, feelings, carer support, family, school/work environment, access to support and respite and recreation), which were subsequently used to inform the item content of the OCNI. The survey data revealed that 90% of young people endorsed 10 or more needs, and nearly a quarter indicated >50 needs. It was also found that these needs often go unmet: 87% of the participants had at least one unmet need, 43% reported >10 and just under a quarter had >20 unmet needs. The two highest reported unmet needs related to understanding from friends and assistance with concentrating and staying on task. The OCNI exhibited face and content validity and acceptable reliability for most of the domains. Cronbach's alpha ranged from 0.64 (access to support) to 0.92 (information). Preliminary construct validity was assessed through the hypothesised positive

Significance of mammographic signs in clinically occult disease

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Waal, J.C. de; Steil, B.; Baltzer, J.; Vaillant, W.; Zander, J.

1987-10-01

The significance of various radiographic signs in 183 patients with clinically occult breast disease is described. 30.6% hat a carcinoma of the breast or a carcinoma in situ. The radiological features have varying predictive values and there is variation in the incidence of lymph node metastases. It is considered useful to classify the radiological appearances under the headings of round foci, star-shaped opacities, diffuse opacities, opacities with calcification and groups of micro-calcification. Despite the early diagnosis, 24% of patients already had lymph node metastases.

Integrative approach to pre-operative determination of clinically significant prostate cancer

Directory of Open Access Journals (Sweden)

Shatylko T.V.

2015-09-01

Full Text Available Aim: improvement of early diagnostics of prostate cancer by developing a technique, which makes possible to predict its clinical significance in outpatient setting before initiation of invasive procedures. Material and Methods. Clinical data of 398 patients who underwent transrectal prostate biopsy in 2012-2014 in SSMU S. R. Mirotvortsev Clinical Hospital, was used to build an artificial neural network, while its output allowed to determine whether the tumour corresponds to Epstein criteria and which D'Amico risk group it belongs to. Internal validation was performed on 80 patients, who underwent prostate biopsy in September 2014 — December 2014. Sensitivity, specificity, positive and negative predictive value of artificial neural network were calculated. Results. Accuracy of predicting adenocarcinoma presence in biopsy specimen was 93,75%; accuracy of predicting whether the cancer meets active surveillance criteria was 90%. Accuracy of predicting T stage (T1c, T2a, T2b, T2cwas 57,1%. Prediction of D'Amico risk group was accurate in 70% of cases; for low-risk cancer accuracy was 81,2%. Conclusion. Artificial neural networks may be responsible for prostate cancer risk stratification and determination of its clinical significance prior to biopsy.

Expression and clinical significance of Pax6 gene in retinoblastoma

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Hai-Dong Huang

2013-07-01

Full Text Available AIM: To discuss the expression and clinical significance of Pax6 gene in retinoblastoma(Rb. METHODS: Totally 15 cases of fresh Rb organizations were selected as observation group and 15 normal retinal organizations as control group. Western-Blot and reverse transcriptase polymerase chain reaction(RT-PCRmethods were used to detect Pax6 protein and Pax6 mRNA expressions of the normal retina organizations and Rb organizations. At the same time, Western Blot method was used to detect the Pax6 gene downstream MATH5 and BRN3b differentiation gene protein level expression. After the comparison between two groups, the expression and clinical significance of Pax6 gene in Rb were discussed. RESULTS: In the observation group, average value of mRNA expression of Pax6 gene was 0.99±0.03; average value of Pax6 gene protein expression was 2.07±0.15; average value of BRN3b protein expression was 0.195±0.016; average value of MATH5 protein expression was 0.190±0.031. They were significantly higher than the control group, and the differences were statistically significant(PCONCLUSION: Abnormal expression of Pax6 gene is likely to accelerate the occurrence of Rb.

Prognostic significance of clinical seizures after cardiac arrest and target temperature management

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Lybeck, Anna; Friberg, Hans; Aneman, Anders

2017-01-01

AIM: Clinical seizures are common after cardiac arrest and predictive of a poor neurological outcome. Seizures may be myoclonic, tonic-clonic or a combination of seizure types. This study reports the incidence and prognostic significance of clinical seizures in the target temperature management (...

Clinically significant change in stroke volume in pulmonary hypertension.

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van Wolferen, Serge A; van de Veerdonk, Marielle C; Mauritz, Gert-Jan; Jacobs, Wouter; Marcus, J Tim; Marques, Koen M J; Bronzwaer, Jean G F; Heymans, Martijn W; Boonstra, Anco; Postmus, Pieter E; Westerhof, Nico; Vonk Noordegraaf, Anton

2011-05-01

Stroke volume is probably the best hemodynamic parameter because it reflects therapeutic changes and contains prognostic information in pulmonary hypertension (PH). Stroke volume directly reflects right ventricular function in response to its load, without the correction of compensatory increased heart rate as is the case for cardiac output. For this reason, stroke volume, which can be measured noninvasively, is an important hemodynamic parameter to monitor during treatment. However, the extent of change in stroke volume that constitutes a clinically significant change is unknown. The aim of this study was to determine the minimal important difference (MID) in stroke volume in PH. One hundred eleven patients were evaluated at baseline and after 1 year of follow-up with a 6-min walk test (6MWT) and cardiac MRI. Using the anchor-based method with 6MWT as the anchor, and the distribution-based method, the MID of stroke volume change could be determined. After 1 year of treatment, there was, on average, a significant increase in stroke volume and 6MWT. The change in stroke volume was related to the change in 6MWT. Using the anchor-based method, an MID of 10 mL in stroke volume was calculated. The distribution-based method resulted in an MID of 8 to 12 mL. Both methods showed that a 10-mL change in stroke volume during follow-up should be considered as clinically relevant. This value can be used to interpret changes in stroke volume during clinical follow-up in PH.

Comparison of 5 health care professionals’ratings of the clinical significance of drug related problems

DEFF Research Database (Denmark)

Villesen, Christine; Hojsted, Jette; Kjeldsen, Lene Juel

2014-01-01

to a mutual agreement on the level of clinical significance. However, to what degree does the panel agree?Purpose To compare the agreement between different health care professionals who have evaluated the clinical significance of DRPs.Materials and methods DRPs were identified in 30 comprehensive medicines...... reviews conducted by a clinical pharmacist. Two hospital pharmacists, a general practitioner and two specialists in pain management from hospital care (the Panel) evaluated each DRP considering the potential clinical outcome for the patient. The DRPs were rated either nil, low, minor, moderate or highly...... clinically significant. Agreement was analysed using Kappa statistics. A Kappa value of 0.8 to 1.0 indicated nearly perfect agreement between ratings of the Panel members.Results The Panel rated 45 percent of the total 162 DRPs as of moderate clinical significance. However, the overall kappa score was 0...

Evidence of clinical utility: an unmet need in molecular diagnostics for patients with cancer.

Science.gov (United States)

Parkinson, David R; McCormack, Robert T; Keating, Susan M; Gutman, Steven I; Hamilton, Stanley R; Mansfield, Elizabeth A; Piper, Margaret A; Deverka, Patricia; Frueh, Felix W; Jessup, J Milburn; McShane, Lisa M; Tunis, Sean R; Sigman, Caroline C; Kelloff, Gary J

2014-03-15

This article defines and describes best practices for the academic and business community to generate evidence of clinical utility for cancer molecular diagnostic assays. Beyond analytical and clinical validation, successful demonstration of clinical utility involves developing sufficient evidence to demonstrate that a diagnostic test results in an improvement in patient outcomes. This discussion is complementary to theoretical frameworks described in previously published guidance and literature reports by the U.S. Food and Drug Administration, Centers for Disease Control and Prevention, Institute of Medicine, and Center for Medical Technology Policy, among others. These reports are comprehensive and specifically clarify appropriate clinical use, adoption, and payer reimbursement for assay manufacturers, as well as Clinical Laboratory Improvement Amendments-certified laboratories, including those that develop assays (laboratory developed tests). Practical criteria and steps for establishing clinical utility are crucial to subsequent decisions for reimbursement without which high-performing molecular diagnostics will have limited availability to patients with cancer and fail to translate scientific advances into high-quality and cost-effective cancer care. See all articles in this CCR Focus section, "The Precision Medicine Conundrum: Approaches to Companion Diagnostic Co-development." ©2014 AACR.

Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome.

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Schlegl, Sandra; Diedrich, Alice; Neumayr, Christina; Fumi, Markus; Naab, Silke; Voderholzer, Ulrich

2016-05-01

This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2). Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

[Clinical Significance of HBV Detection in NHL Patients].

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Zhang, Tian-Ling; Zhang, Juan; Lv, Cheng-Xiu; Hu, Tian-Yu; Li, Qing

2018-04-01

To analyze the relation of HBV infection with clinical characteristics and prognosis in NHL patients, so as to explore the significance of HBV detection. Sixty-eight NHL patients from December 2013 to December 2016 were enrolled in NHL group and 136 patients with other malignancies were chosen in control group, the detectable rate of HBV was compared between 2 groups. The correlation of HBV infection with sex, age, stage, cell origin, expression of P53 and BCL-2 in NHL patients was analyzed. The prognosis-related factors in NHL patients were also analyzed. The infection rate of HBV in NHL group was 51.47%(35/68), that in control group was 15.44% (21/136), and the difference was statistically significant(χ 2 =27.768,PHBV infection correlated with cell origins and expression of BCL-2 in NHL patients(PHBV infection (P>0.05), while the prognosis was significantly related with stage, expression of P53 and BCL-2(PHBV infection correlates with BCL-2 expression level of NHL patients, and shows influence on the prognosis of patients.

Measuring household consumption and waste in unmetered, intermittent piped water systems

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Kumpel, Emily; Woelfle-Erskine, Cleo; Ray, Isha; Nelson, Kara L.

2017-01-01

Measurements of household water consumption are extremely difficult in intermittent water supply (IWS) regimes in low- and middle-income countries, where water is delivered for short durations, taps are shared, metering is limited, and household storage infrastructure varies widely. Nonetheless, consumption estimates are necessary for utilities to improve water delivery. We estimated household water use in Hubli-Dharwad, India, with a mixed-methods approach combining (limited) metered data, storage container inventories, and structured observations. We developed a typology of household water access according to infrastructure conditions based on the presence of an overhead storage tank and a shared tap. For households with overhead tanks, container measurements and metered data produced statistically similar consumption volumes; for households without overhead tanks, stored volumes underestimated consumption because of significant water use directly from the tap during delivery periods. Households that shared taps consumed much less water than those that did not. We used our water use calculations to estimate waste at the household level and in the distribution system. Very few households used 135 L/person/d, the Government of India design standard for urban systems. Most wasted little water even when unmetered, however, unaccounted-for water in the neighborhood distribution systems was around 50%. Thus, conservation efforts should target loss reduction in the network rather than at households.

Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy.

Science.gov (United States)

Ohtsuka, Takao; Mori, Yasuhisa; Ishigami, Kousei; Fujimoto, Takaaki; Miyasaka, Yoshihiro; Nakata, Kohei; Ohuchida, Kenoki; Nagai, Eishi; Oda, Yoshinao; Shimizu, Shuji; Nakamura, Masafumi

2017-08-01

Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas. Circumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups. Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical significance of Phosphatidyl Inositol Synthase overexpression in oral cancer

International Nuclear Information System (INIS)

Kaur, Jatinder; Sawhney, Meenakshi; DattaGupta, Siddartha; Shukla, Nootan K; Srivastava, Anurag; Ralhan, Ranju

2010-01-01

We reported increased levels of Phosphatidyl Inositol synthase (PI synthase), (enzyme that catalyses phosphatidyl inositol (PI) synthesis-implicated in intracellular signaling and regulation of cell growth) in smokeless tobacco (ST) exposed oral cell cultures by differential display. This study determined the clinical significance of PI synthase overexpression in oral squamous cell carcinoma (OSCC) and premalignant lesions (leukoplakia), and identified the downstream signaling proteins in PI synthase pathway that are perturbed by smokeless tobacco (ST) exposure. Tissue microarray (TMA) Immunohistochemistry, Western blotting, Confocal laser scan microscopy, RT-PCR were performed to define the expression of PI synthase in clinical samples and in oral cell culture systems. Significant increase in PI synthase immunoreactivity was observed in premalignant lesions and OSCCs as compared to oral normal tissues (p = 0.000). Further, PI synthase expression was significantly associated with de-differentiation of OSCCs, (p = 0.005) and tobacco consumption (p = 0.03, OR = 9.0). Exposure of oral cell systems to smokeless tobacco (ST) in vitro confirmed increase in PI synthase, Phosphatidylinositol 3-kinase (PI3K) and cyclin D1 levels. Collectively, increased PI synthase expression was found to be an early event in oral cancer and a target for smokeless tobacco

Universal or Commodified Healthcare? Linking Out-of-Pocket Payments to Income-Related Inequalities in Unmet Health Needs in Europe

DEFF Research Database (Denmark)

Kaminska, Monika Ewa; Wulfgramm, Melike

2018-01-01

This study investigates the outcomes out-of-pocket payments (OOPP) produce in terms of income-related disparities in unmet health needs (UHN) due to inability to pay and highlights the commodifying effect of OOPP in European healthcare systems. It merges micro data from the European Union...

Clinical significance of gamma camera renography in chronic renal insufficiency

International Nuclear Information System (INIS)

Dudczak, R.; Frischauf, H.; Kletter, K.

1980-01-01

Gamma camera renography allows, together with renal imaging, an evaluation of individual renal function. For these examinations, I 123 orthoiodohippurate is preferred and most widely used. The results on patients with chronic renal insufficiency, including urologic and posttransplantation patients, are reported. Whereas the method is of clinical significance in evaluating posttransplantation complications and in assessing individual kidney function preoperatively in urology, as well as in monitoring therapeutic effects in the early period of renal disease, it is of limited diagnostic value in chronic renal insufficiency. In this latter regard, clinical and laboratory examinations are of primary importance. (author)

Is statistical significance clinically important?--A guide to judge the clinical relevance of study findings

NARCIS (Netherlands)

Sierevelt, Inger N.; van Oldenrijk, Jakob; Poolman, Rudolf W.

2007-01-01

In this paper we describe several issues that influence the reporting of statistical significance in relation to clinical importance, since misinterpretation of p values is a common issue in orthopaedic literature. Orthopaedic research is tormented by the risks of false-positive (type I error) and

Subclassification of autoimmune pancreatitis: a histologic classification with clinical significance.

Science.gov (United States)

Deshpande, Vikram; Gupta, Rajib; Sainani, Nisha; Sahani, Dushyant V; Virk, Renu; Ferrone, Cristina; Khosroshahi, Arezou; Stone, John H; Lauwers, Gregory Y

2011-01-01

Autoimmune pancreatitis (AIP) is a chronic inflammatory disease of the pancreas. Examination of pancreatic resection specimens from patients with AIP has shown that there are 2 subclasses of this disease. However, there is no widely accepted pathologic classification scheme and the clinical significance of such a classification remains to be established. In this study, we revisited the subclassification of AIP and examine whether this provides clinically and prognostically meaningful information. We evaluated 29 pancreatic resection specimens from patients with AIP. Demographic, clinical, and imaging data were recorded, as was evidence of extrapancreatic manifestations. In addition to a detailed and semiquantitative histologic evaluation, immunohistochemistry for IgG4 was performed on pancreatic and extrapancreatic tissues. We also evaluated 48 consecutive cases of chronic pancreatitis, not otherwise specified. The resected specimens could readily be subclassified into 2 subtypes: type 1 (n=11) and type 2 (n=18). In comparison with patients with type 2 disease, patients with type 1 disease were significantly more likely to be males (P=0.09), older (P=0.02), and present with jaundice (P=0.01), and less likely to be associated with abdominal pain (P=0.04). On imaging, the pancreatic tail cut-off sign was exclusively seen in patients with type 2 disease (4 of 10 cases). Hypercellular inflamed interlobular stroma was unique to type 1 pattern (91%), whereas significant ductal injury in the form of microabscesses and ductal ulceration was almost exclusively seen in type 2 pattern (78%). Eight of 10 patients with a type 1 pattern had evidence of a systemic disease. Three patients with type 2 disease had recurrent episodes of pancreatitis after their pancreatic resection. In comparison with the cohort of chronic pancreatitis, not otherwise specified, type 2 AIP cases were less likely to be associated with a history of alcohol abuse, and showed significantly more foci of

Yoga & Cancer Interventions: A Review of the Clinical Significance of Patient Reported Outcomes for Cancer Survivors

Directory of Open Access Journals (Sweden)

S. Nicole Culos-Reed

2012-01-01

Full Text Available Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

Dual cusped protostylid: Case report and clinical significance

Directory of Open Access Journals (Sweden)

Preeti Bhattacharya

2016-01-01

Full Text Available Protostylids are superstructures on maxillary or mandibular molars, which have rarely been reported in literature, and the significance of their presence has also been underestimated. The dental practitioners may easily misdiagnose a tooth, with such conical tubercles as malformed tooth. Interestingly, this is neither a malformation nor an anomaly but rather an important morphological trait of an individual. Once in a while, one may come across such a distinct morphological trait without being able to diagnose. To the authors' best knowledge, only one similar case has been reported previously, and the second such case internationally. Bearing all such facts in mind, the authors attempt to educate the readers towards the existence of such a trait so that it can be identified and studied in larger numbers. Hence, it is the authors' endeavor to report an unusual case of dual cusped maxillary protostylid along with its clinical significance.

Assessing Clinical Significance: Does it Matter which Method we Use?

Science.gov (United States)

Atkins, David C.; Bedics, Jamie D.; Mcglinchey, Joseph B.; Beauchaine, Theodore P.

2005-01-01

Measures of clinical significance are frequently used to evaluate client change during therapy. Several alternatives to the original method devised by N. S. Jacobson, W. C. Follette, & D. Revenstorf (1984) have been proposed, each purporting to increase accuracy. However, researchers have had little systematic guidance in choosing among…

Intensive inpatient treatment for bulimia nervosa: Statistical and clinical significance of symptom changes.

Science.gov (United States)

Diedrich, Alice; Schlegl, Sandra; Greetfeld, Martin; Fumi, Markus; Voderholzer, Ulrich

2018-03-01

This study examines the statistical and clinical significance of symptom changes during an intensive inpatient treatment program with a strong psychotherapeutic focus for individuals with severe bulimia nervosa. 295 consecutively admitted bulimic patients were administered the Structured Interview for Anorexic and Bulimic Syndromes-Self-Rating (SIAB-S), the Eating Disorder Inventory-2 (EDI-2), the Brief Symptom Inventory (BSI), and the Beck Depression Inventory-II (BDI-II) at treatment intake and discharge. Results indicated statistically significant symptom reductions with large effect sizes regarding severity of binge eating and compensatory behavior (SIAB-S), overall eating disorder symptom severity (EDI-2), overall psychopathology (BSI), and depressive symptom severity (BDI-II) even when controlling for antidepressant medication. The majority of patients showed either reliable (EDI-2: 33.7%, BSI: 34.8%, BDI-II: 18.1%) or even clinically significant symptom changes (EDI-2: 43.2%, BSI: 33.9%, BDI-II: 56.9%). Patients with clinically significant improvement were less distressed at intake and less likely to suffer from a comorbid borderline personality disorder when compared with those who did not improve to a clinically significant extent. Findings indicate that intensive psychotherapeutic inpatient treatment may be effective in about 75% of severely affected bulimic patients. For the remaining non-responding patients, inpatient treatment might be improved through an even stronger focus on the reduction of comorbid borderline personality traits.

Body Dysmorphic Disorder and Other Clinically Significant Body Image Concerns in Adolescent Psychiatric Inpatients: Prevalence and Clinical Characteristics

Science.gov (United States)

Dyl, Jennifer; Kittler, Jennifer; Phillips, Katharine A.; Hunt, Jeffrey I.

2006-01-01

Background: This study assessed prevalence and clinical correlates of body dysmorphic disorder (BDD), eating disorders (ED), and other clinically significant body image concerns in 208 consecutively admitted adolescent inpatients. It was hypothesized that adolescents with BDD would have higher levels of depression, anxiety, and suicidality.…

PA26 Unmet needs and stress among caregivers of bedridden stroke patients in north kerala - a community based study.

Science.gov (United States)

Usha, K

2015-04-01

In developing countries informal care by an unpaid relative is the most prevalent form of long-term care. Being bedridden consumes the victim and the caregiver physically, psychologically, socially and financially. In developing countries, strengthening support for family caregivers is essential to sustain long term health care system. Therefore unmet needs and burdens of family caregivers, including inadequate training, respite, and access to support programs should be studied and addressed. To study unmet needs of caregivers of stroke patients in the home settings. To study physical, psychological and social stress of these caregivers. Descriptive Study setting: Four rural panchayats, where home based care is given to bed ridden patients by the palliative team of our medical college. Sampling design: Convenience sampling study population: Care givers of bedridden stroke patients tool: A semi structured questionnaire Forty caregivers participated in the study. Their mean age was 51 years. Most were wives (15, 37.5%) and daughters (14, 35%). All belonged to low socioeconomic class. Unmet needs were lack of recreation (67%), inadequate sleep (67%), total responsibility (65%), illnesses (53%) and insufficient money (67%). Severe to moderate physical, psychological and social stress was seen in 90%, 87.5% and 70% of caregivers respectively. Services to be aimed primarily at informal caregivers may be designed to increase the level of knowledge and emotional support of caregivers, provide respite, or provide financial benefits as social schemes. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Accurate coding in sepsis: clinical significance and financial implications.

Science.gov (United States)

Chin, Y T; Scattergood, N; Thornber, M; Thomas, S

2016-09-01

Sepsis is a major healthcare problem and leading cause of death worldwide. UK hospital mortality statistics and payments for patient episodes of care are calculated on clinical coding data. The accuracy of these data depends on the quality of coding. This study aimed to investigate whether patients with significant bacteraemia are coded for sepsis and to estimate the financial costs of miscoding. Of 54 patients over a one-month period with a significant bacteraemia, only 19% had been coded for sepsis. This is likely to lead to falsely high calculated hospital mortality. Furthermore, this resulted in an underpayment of £21,000 for one month alone. Copyright © 2016 The Healthcare Infection Society. All rights reserved.

Causes of childhood visual impairment and unmet low-vision care in blind school students in Ghana.

Science.gov (United States)

Ntim-Amponsah, C T; Amoaku, W M K

2008-10-01

The purpose of this study was to determine the causes of childhood visual impairment and blindness in students of a school for blind children, to determine how many students had some residual vision, and to evaluate any unmet low-vision care. A survey of students in the blind school was conducted in two parts in May-June and then October 2003. The sample consisted of 201 students who became blind before the age of 16. Information was obtained from student interviews, doctors' referral notes and ophthalmic examination of all students who consented. Students with residual vision had low-vision assessments. These investigations were supplemented with active participation of the investigators in Parent-Teacher Association meetings and focus group discussions with parents. One hundred and ninety-nine students consented and were recruited, whereas two declined. Ninety-six became visually impaired within their first year of life and 33 by the age of 5 years. Pathology of the cornea and then the lens were the commonest causes of blindness. One hundred and eight students were totally blind, whereas 87 (43.7%) had some residual vision and formed the target for the second part of the study. Fifty-one out of 77 of this target group who turned up for low-vision examination had useful residual vision by the World Health Organisation (WHO) low-vision examination chart. Spectacle magnifiers aided two students to read normal print at N5 and N8, respectively. Different visual aids would help enhance the residual vision in some of the others. Emotional trauma was apparent in parents and teachers. Children who became blind later in life remained in shock for a longer time and adapted less well to their visual impairment. Visual impairment in the population is not uncommon. Some causes are preventable. There is a significant unmet need for low-vision care, particularly amongst children in Ghana, and perhaps many countries in the West Africa subregion. It is hoped that the findings from

Frequency and clinical significance of transient hyperechoic renal medulla in neonates

International Nuclear Information System (INIS)

Cho, Sung Shick; Kim, Jung Hoon; Hong, Hyun Sook; Shin, Ji Hoon; Hwang, Jung Hwa; Goo, Dong Erk; Kwon, Kui Hyang; Choi, Deuk Lin

2001-01-01

To evaluate the clinical significance of transient hyperechogenicity of the renal medulla in neonates by comparing the clinical features, urinalysis and follow-up ultrasonographic examination of the control group. One hundred ten neonates were divided into 2 groups, hyperechoic and normal renal medulla groups, and all of them underwent abdominal ultrasound with a 7.5 MHz linear transducer (Sonoace 8800MT, Medicine, Korea) from November 1999 to January 2000. Whether there was any difference in clinical features including birth weight, body surface area, gestational age, sex, date of examination and mode of delivery between two groups was evaluated. In addition, any difference in their urinary osmolarity, albumin, uric acid and calcium in 41 neonates who underwent urinalysis was evaluated. In ten neonates with hyperechoic renal medulla underwent follow-up study, the follow-up ultrasonographic findings were compared with the initial study. In 67 of 110 (61%) neonates, ultrasonography demonstrated hyperechoic renal medulla. There was no difference in clinical features between the hyperechoic renal medullary group and normal group. In 41 neonates, there was no significant difference in urinalysis between two groups. (Osmolarity=146.46 ± 68.4 mOsml/KgH 2 O in the hyperechoic renal medullary group vs. 149.8 ± 77.7 mOsml/KgH 2 O in the normal group; albumin=13.9 ± 10.2 mg/ml vs. 17.6 ± 13.6 mg/dl; uric acid=50.0 ± 23.3 mg/dl vs. 44.9 ± 34.1 mg/dl; calcium=1.38 ± 3.0 mg/ dl vs. 0.44 ± 0.07 mg/dl.) Ten neonates who underwent follow-up ultrasonography within 20 days after the initial study showed the normal medullary echogenicity. There were no significant difference between the hyperechoic renal medullary group and the normal echogenic group in their clinical features and urinalysis. Therefore, the hyperechoic renal medullar in neonate is considered as an usual and transient finding which disappears on follow-up study.

EAACI Food Allergy and Anaphylaxis Guidelines. Protecting consumers with food allergies: understanding food consumption, meeting regulations and identifying unmet needs

NARCIS (Netherlands)

Muraro, A.; Hoffmann-Sommergruber, K.; Holzhauser, T.; Poulsen, L. K.; Gowland, M. H.; Akdis, C. A.; Mills, E. N. C.; Papadopoulos, N.; Roberts, G.; Schnadt, S.; van Ree, R.; Sheikh, A.; Vieths, S.

2014-01-01

Individuals suffering from IgE-mediated food allergy usually have to practise life-long food allergen avoidance. This document aims to provide an overview of recent evidence-based recommendations for allergen risk assessment and management in the food industry and discusses unmet needs and

The clinical significance of detection of serum Pre-S1 antigen

International Nuclear Information System (INIS)

Jiang Xuehua; Huang Zhuqing; Han Yi; Gong Shoujun

2003-01-01

To study the clinical significance of detection of serum Pre-S 1 Ag, the serum Pre-S 1 Ag, HBV-marks and HBV-DNA were detected in 338 patients with hepatitis B. The positive rate and the relationship between them were analyzed and compared. In 338 patients, the positive rate of serum Pre-S 1 Ag, HBeAg, HBV-DNA was 63.02%, 48.52%, 68.05% respectively, and the co-positive rate of Pre-S 1 Ag with HBV-DNA, HBeAg was 78.56%, 81.17% respectively. There was a significant correlation between Pre-S 1 Ag, HBeAg and HBV-DNA (P 1 Ag could well reflect the reproductive status of hepatitis B virus, and so it could be used as the clinical marker of the reproductive status of hepatitis B virus

Fracture liaison services for osteoporosis in the Asia-Pacific region: current unmet needs and systematic literature review.

Science.gov (United States)

Chang, Y -F; Huang, C -F; Hwang, J -S; Kuo, J -F; Lin, K -M; Huang, H -C; Bagga, S; Kumar, A; Chen, F -P; Wu, C -H

2018-04-01

The analysis aimed to identify the treatment gaps in current fracture liaison services (FLS) and to provide recommendations for best practice establishment of future FLS across the Asia-Pacific region. The findings emphasize the unmet need for the implementation of new programs and provide recommendations for the refinement of existing ones. The study's objectives were to evaluate fracture liaison service (FLS) programs in the Asia-Pacific region and provide recommendations for establishment of future FLS programs. A systematic literature review (SLR) of Medline, PubMed, EMBASE, and Cochrane Library (2000-2017 inclusive) was performed using the following keywords: osteoporosis, fractures, liaison, and service. Inclusion criteria included the following: patients ≥ 50 years with osteoporosis-related fractures; randomized controlled trials or observational studies with control groups (prospective or retrospective), pre-post, cross-sectional and economic evaluation studies. Success of direct or indirect interventions was assessed based on patients' understanding of risk, bone mineral density assessment, calcium intake, osteoporosis treatment, re-fracture rates, adherence, and mortality, in addition to cost-effectiveness. Overall, 5663 unique citations were identified and the SLR identified 159 publications, reporting 37 studies in Asia-Pacific. These studies revealed the unmet need for public health education, adequate funding, and staff resourcing, along with greater cooperation between departments and physicians. These actions can help to overcome therapeutic inertia with sufficient follow-up to ensure adherence to recommendations and compliance with treatment. The findings also emphasize the importance of primary care physicians continuing to prescribe treatment and ensure service remains convenient. These findings highlight the limited evidence supporting FLS across the Asia-Pacific region, emphasizing the unmet need for new programs and/or refinement of

Identifying and predicting subgroups of information needs among cancer patients: an initial study using latent class analysis.

Science.gov (United States)

Neumann, Melanie; Wirtz, Markus; Ernstmann, Nicole; Ommen, Oliver; Längler, Alfred; Edelhäuser, Friedrich; Scheffer, Christian; Tauschel, Diethard; Pfaff, Holger

2011-08-01

Understanding how the information needs of cancer patients (CaPts) vary is important because met information needs affect health outcomes and CaPts' satisfaction. The goals of the study were to identify subgroups of CaPts based on self-reported cancer- and treatment-related information needs and to determine whether subgroups could be predicted on the basis of selected sociodemographic, clinical and clinician-patient relationship variables. Three hundred twenty-three CaPts participated in a survey using the "Cancer Patients Information Needs" scale, which is a new tool for measuring cancer-related information needs. The number of information need subgroups and need profiles within each subgroup was identified using latent class analysis (LCA). Multinomial logistic regression was applied to predict class membership. LCA identified a model of five subgroups exhibiting differences in type and extent of CaPts' unmet information needs: a subgroup with "no unmet needs" (31.4% of the sample), two subgroups with "high level of psychosocial unmet information needs" (27.0% and 12.0%), a subgroup with "high level of purely medical unmet information needs" (16.0%) and a subgroup with "high level of medical and psychosocial unmet information needs" (13.6%). An assessment of sociodemographic and clinical characteristics revealed that younger CaPts and CaPts' requiring psychological support seem to belong to subgroups with a higher level of unmet information needs. However, the most significant predictor for the subgroups with unmet information needs is a good clinician-patient relationship, i.e. subjective perception of high level of trust in and caring attention from nurses together with high degree of physician empathy seems to be predictive for inclusion in the subgroup with no unmet information needs. The results of our study can be used by oncology nurses and physicians to increase their awareness of the complexity and heterogeneity of information needs among CaPts and of

Significance and clinical value of the transitional zone volume (TZV ...

African Journals Online (AJOL)

M. El Ghoneimy

2017-01-12

Jan 12, 2017 ... Objective: The aim of this work was to evaluate the significance and clinical value of the TZI, which has been a point of ... Conclusion: Estimating the transition zone volume during TRUS is a reasonable way to obtain the required ... Besides the IPSS score, a complete medical and surgical history was also.

Do mobile family planning clinics facilitate vasectomy use in Nepal?

Science.gov (United States)

Padmadas, Sabu S; Amoako Johnson, Fiifi; Leone, Tiziana; Dahal, Govinda P

2014-06-01

Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy. A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages. The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21-2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters. Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning. Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition. Copyright © 2014 Elsevier Inc. All rights reserved.

Clinical significance of inadequate endometrial biopsies prior to hysterectomy.

Science.gov (United States)

Turney, Emily H; Farghaly, Hanan; Eskew, Ashley M; Parker, Lynn P; Milam, Michael R

2012-01-01

To evaluate preoperative clinical risk factors associated with significant uterine histopathologic abnormalities in final hysterectomy specimens in patients with inadequate preoperative endometrial biopsies. This is an institutional review board-approved, retrospective cohort analysis of 469 consecutive patients who underwent preoperative endometrial biopsies with subsequent hysterectomy from January 1, 2005, to December 31, 2009, at the University of Louisville Medical Center. We analyzed risk factors for inadequate biopsy and for final diagnosis of endometrial pathology (defined as endometrial hyperplasia or uterine cancer). Of the 469 preoperative endometrial biopsies reviewed, 26.2% (123/469) were inadequate (IBx) and 73.8% (346/469) were adequate and benign. IBx on endometrial biopsies was associated with a greater risk of having significant uterine histopathologic abnormalities on final hysterectomy specimens (6.5% vs. 2.3%, RR 2.8 [95% CI 1.1-7.3], p = 0.04). Although inadequate endometrial biopsies are a common finding, they can be associated with significant uterine histopathologic abnormalities on final hysterectomy specimens.

Can models of self-management support be adapted across cancer types? A comparison of unmet self-management needs for patients with breast or colorectal cancer.

Science.gov (United States)

Mansfield, Elise; Mackenzie, Lisa; Carey, Mariko; Peek, Kerry; Shepherd, Jan; Evans, Tiffany-Jane

2018-03-01

There is an increased focus on supporting patients with cancer to actively participate in their healthcare, an approach commonly termed 'self-management'. Comparing unmet self-management needs across cancer types may reveal opportunities to adapt effective self-management support strategies from one cancer type to another. Given that breast and colorectal cancers are prevalent, and have high survival rates, we compared these patients' recent need for help with self-management. Data on multiple aspects of self-management were collected from 717 patients with breast cancer and 336 patients with colorectal cancer attending one of 13 Australian medical oncology treatment centres. There was no significant difference between the proportion of patients with breast or colorectal cancer who reported a need for help with at least one aspect of self-management. Patients with breast cancer were significantly more likely to report needing help with exercising more, while patients with colorectal cancer were more likely to report needing help with reducing alcohol consumption. When controlling for treatment centre, patients who were younger, experiencing distress or had not received chemotherapy were more likely to report needing help with at least one aspect of self-management. A substantial minority of patients reported an unmet need for self-management support. This indicates that high-quality intervention research is needed to identify effective self-management support strategies, as well as implementation trials to identify approaches to translating these strategies into practice. Future research should continue to explore whether self-management support strategies could be adapted across cancer types.

Report of the Inaugural Meeting of the TFOS i(2) = initiating innovation Series: Targeting the Unmet Need for Dry Eye Treatment.

Science.gov (United States)

Chao, Wendy; Belmonte, Carlos; Benitez Del Castillo, José M; Bron, Anthony J; Dua, Harminder S; Nichols, Kelly K; Novack, Gary D; Schrader, Stefan; Willcox, Mark D; Wolffsohn, James S; Sullivan, David A

2016-04-01

On March 21, 2015, a meeting was held in London, United Kingdom, to address the progress in targeting the unmet need for dry eye disease (DED) treatment. The meeting, which launched the i(2) = initiating innovation series, was sponsored by the Tear Film & Ocular Surface Society (TFOS; www.TearFilm.org) and supported by Dompé. The TFOS i(2) meeting was designed to review advances in the understanding of DED since publication of the 2007 TFOS International Dry Eye WorkShop (DEWS) report, and to help launch the highly anticipated sequel, DEWS II. The meeting was structured to discuss the scope of the DED problem, to review the clinical challenges of DED, and to consider the treatment challenges of DED. This article provides a synopsis of the presentations of this TFOS i(2) meeting. Copyright © 2016 Elsevier Inc. All rights reserved.

Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya

DEFF Research Database (Denmark)

Echoka, Elizabeth; Dubourg, Dominique; Makokha, Anselimo

2014-01-01

BackgroundDeveloping countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept...... was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located.MethodsA facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died...... in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were...

Gene variants of unknown clinical significance in Lynch syndrome. An introduction for clinicians

NARCIS (Netherlands)

Sijmons, Rolf H.; Greenblatt, Marc S.; Genuardi, Maurizio

Clinicians referring patients for genetic testing for Lynch syndrome will sooner or later receive results for DNA Mismatch Repair (MMR) genes reporting DNA changes that are unclear from a clinical point of view. These changes are referred to as variants of unknown, or unclear, clinical significance

Clinical significance of nerve root enhancement in contrast-enhanced MR imaging of the postoperative lumbar spine

International Nuclear Information System (INIS)

Lee, Yeon Soo; Lee, Eun Ja; Kang, Si Won; Choi, Eun Seok; Song, Chang June; Kim, Jong Chul

2001-01-01

To determine the significance of nerve root contrast enhancement in patients with residual or recurrent symptomatic postoperative lumbar spine. Eighty-eight patients with 116 postoperative lumbar disc lesions causing radiating back pain underwent enhanced MR imaging. Intradural nerve root enhancement was quantified by pixel measurement, and affected nerve roots were compared before and after contrast administration. Extradural nerve root enhancement was assessed visually, and nerve root enhancement and clinical symptoms were correlated. Associated lesions such as recurrent disc herniation, scar tissue, nerve root thickening and nerve root displacement were also evaluated. Of 26 cases (22.4%) involving intradural nerve root enhancement, 22 (84.6%) showed significant clinical symptoms (p=0.002). and of 59 (50.9%) demonstrating extradural enhancement, clinical symptoms showed significant correlation in 47 (79.7%) (p=0.001). Nerve root enhancement, including eleven cases where this was both intra-and extradural, showed highly significant association with clinical symptoms in 74 of the 116 cases (63.8%) (p=0.000). Among 33 cases (28.4%) of recurrent disc herniation, nerve root enhancement was observed in 28 (84.8%) and in 24 of these 28 (85.7%), significant correlation with clinical symptoms was observed (p=0.000). Where epidural fibrosis was present, correlation between nerve root enhancement and clinical symptoms was not significant (p>0.05). Nerve root thickening and displaced nerve root were, however, significantly associated with symptoms (87.2% and 88.6%, respectively). In patients with postoperative lumbar spine, the association between nerve root enhancement revealed by MRI and clinical symptoms was highly significant

The case for investing in family planning in the Pacific: costs and benefits of reducing unmet need for contraception in Vanuatu and the Solomon Islands

Science.gov (United States)

2013-01-01

Background Unmet need for family planning in the Pacific is among the highest in the world. Better understanding of required investments and associated benefits of increased access to family planning in the Pacific may assist prioritisation and funding. Methods We modelled the costs and associated health, demographic and economic impacts of reducing unmet need for family planning between 2010–2025 in Vanuatu and the Solomon Islands. Baseline data were obtained from census reports, Demographic and Health Surveys, and UN agency reports. Using a demographic modelling program we compared a scenario of “no change in unmet need” with two distinct scenarios: 1) all family planning needs met by 2020; and, 2) all needs met by 2050. Results Meeting family planning needs by 2020 would increase prevalence of modern contraception in 2025 from 36.8 to 65.5% in Vanuatu and 28.5 to 37.6% in the Solomon Islands. Between 2010–2025 the average annual number of unintended pregnancies would decline by 68% in Vanuatu and 50% in the Solomon Islands, and high-risk births would fall by more than 20%, averting 2,573 maternal and infant deaths. Total fertility rates would fall from 4.1 to 2.2 in Vanuatu and 3.5 in the Solomon Islands, contributing to slowed population growth and lower dependency ratios. The direct cost of reducing unmet need by 2020 was estimated to be $5.19 million for Vanuatu and $3.36 million for the Solomon Islands between 2010–2025. Preventing unintended pregnancies would save $112 million in health and education expenditure. Conclusions In small island developing states such as Vanuatu and the Solomon Islands, increasing investment in family planning would contribute to improved maternal and infant outcomes and substantial public sector savings. PMID:23758783

Clinical significance of the corpus callosum in cerebral palsy

International Nuclear Information System (INIS)

Lee, Eun Ja; Kim, Ji Chang; Kim, Jong Chul; And Others

2000-01-01

To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. Fifty-two children (30 boys and 22 girls aged between six and 96 (median, 19) months) in whom cerebral palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebral palsy were classified as hemiplegia (n=14), spastic diplegia (n=22), or spastic quadriplegia (n=16), and according to the severity of motor palsy, the condition was also classified as mild (n=26), moderate (n=13), or severe (n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p less than 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p less than 0.05). There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury

Clinical significance of the corpus callosum in cerebral palsy

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Lee, Eun Ja; Kim, Ji Chang [The Catholic University of Korea, Seoul (Korea, Republic of); Kim, Jong Chul [School of Medicine, Chungnam National University, Taejon (Korea, Republic of); And Others

2000-10-01

To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. Fifty-two children (30 boys and 22 girls aged between six and 96 (median, 19) months) in whom cerebral palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebral palsy were classified as hemiplegia (n=14), spastic diplegia (n=22), or spastic quadriplegia (n=16), and according to the severity of motor palsy, the condition was also classified as mild (n=26), moderate (n=13), or severe (n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p less than 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p less than 0.05). There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury.

Clinical Significance of A Waves in Acute Inflammatory Demyelinating Polyradiculoneuropathy.

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Lakshminarasimhan, Sindhuja; Venkatraman, Chandramouleeswaran; Vellaichamy, Kannan; Ranganathan, Lakshminarasimhan

2018-05-25

A wave is a late response recognized during recording of F waves. Though they might be seen in healthy subjects, their presence assumes significance in a patient presenting with polyradiculoneuropathy. In this prospective study, 75 patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) were enrolled. They were divided into two groups based on the presence or absence of A waves. Clinical features, electrophysiological parameters and extent of clinical recovery in short-term follow-up were analyzed. A waves were present in 49 out of 75 patients (65%). Most common pattern observed was multiple A waves. Prevalence of A waves was more in lower limb nerves than upper limb nerves. Occurrence of A waves correlated with the presence of conduction block. Patients with A waves had higher Hughes grade (P = 0.003) and lower Medical Research Council sum score at 6 weeks of follow-up (P = 0.04) as compared to patients without A waves. A waves are common in acute inflammatory demyelinating polyradiculoneuropathy form of Guillain Barre syndrome and are considered as a marker of demyelination. Long-term follow-up studies are required to ascertain their significance in prognostication and assessing recovery.

Clinical significance of pretreatment FDG PET/CT IN MOBG-avid pediatric neuroblastoma

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Kang, Seo Young; Kim, Yong Il; Cheon, Gi Jeong; Kang, Keon Wook; Chung, June Key; Lee, Dong Soo; Kang, Hyoung Jin; Shin, Hee Young [Seoul National University Hospital, Seoul (Korea, Republic of); Kim, E. Edmund [Seoul National University, Seoul (Korea, Republic of); Rahim, Muhammad Kashif [Nishtar Medical College and Hospital, Multan (Pakistan)

2017-06-15

{sup 18}F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is well known to have clinical significance in the initial staging and response evaluation of the many kinds of neoplasms. However, its role in the pediatric neuroblastoma is not clearly defined. In the present study, the clinical significance of FDG-PET/computed tomography (CT) in 123I- or 131I-metaiodobenzylguanidine (MIBG)-avid pediatric neuroblastoma was investigated. Twenty patients with neuroblastoma who undertook pretreatment FDG PET/CT at our institute between 2008 and 2015 and showed MIBG avidity were retrospectively enrolled in the present study. Clinical information—including histopathology, and serum markers—and several PET parameters—including SUVmax of the primary lesion (Psuv), target-to-background ratio (TBR), metabolic tumor volume (MTV), and coefficient of variation (CV)—were analyzed. The prognostic effect of PET parameters was evaluated in terms of progression-free survival (PFS). Total 20 patients (4.5 ± 3.5 years) were divided as two groups by disease progression. Six patients (30.0 %) experienced disease progression and one patient (5.0 %) died during follow-up period. There were not statistically significant in age, stage, MYCN status, primary tumor size, serum lactate dehydrogenase (LDH), neuron-specific enolase (NSE), and ferritin level between two groups with progression or no progression. However, Psuv (p = 0.017), TBR (p = 0.09), MTV (p = 0.02), and CV (p = 0.036) showed significant differences between two groups. In univariate analysis, PFS was significantly associated with Psuv (p = 0.021) and TBR (p = 0.023). FDG-PET parameters were significantly related with progression of neuroblastoma. FDG-PET/CT may have the potential as a valuable modality for evaluating prognosis in the patients with MIBG-avid pediatric neuroblastoma.

Beyond Stroke Prevention in Atrial Fibrillation: Exploring Further Unmet Needs with Rivaroxaban.

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Gibson, C M; Hankey, G J; Nafee, T; Welsh, R C

2018-03-22

With improved life expectancy and the aging population, the global burden of atrial fibrillation (AF) continues to increase, and with AF comes an estimated fivefold increased risk of ischaemic stroke. Prophylactic anticoagulant therapy is more effective in reducing the risk of ischaemic stroke in AF patients than acetylsalicylic acid or dual-antiplatelet therapy combining ASA with clopidogrel. Non-vitamin K antagonist oral anticoagulants are the standard of care for stroke prevention in patients with non-valvular AF. The optimal anticoagulant strategy to prevent thromboembolism in AF patients who are undergoing percutaneous coronary intervention and stenting, those who have undergone successful transcatheter aortic valve replacement and those with embolic stroke of undetermined source are areas of ongoing research. This article provides an update on three randomized controlled trials of rivaroxaban, a direct, oral factor Xa inhibitor, that are complete or are ongoing, in these unmet areas of stroke prevention: oPen-label, randomized, controlled, multicentre study explorIng twO treatmeNt stratEgiEs of Rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in patients with Atrial Fibrillation who undergo Percutaneous Coronary Intervention (PIONEER AF-PCI) trial; the New Approach riVaroxaban Inhibition of factor Xa in a Global trial vs Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE ESUS) trial and the Global study comparing a rivAroxaban-based antithrombotic strategy to an antipLatelet-based strategy after transcatheter aortIc vaLve rEplacement to Optimize clinical outcomes (GALILEO) trial. The data from these studies are anticipated to help address continuing challenges for a range of patients at risk of stroke. Schattauer.

Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

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Kelly, Peter James

2010-01-01

The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

Clinical, Radiologic, and Legal Significance of "Extensor Response" in Posttraumatic Coma.

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Firsching, Raimund; Woischneck, Dieter; Langejürgen, Alexander; Parreidt, Andreas; Bondar, Imre; Skalej, Martin; Röhl, Friedrich; Voellger, Benjamin

2015-11-01

The timely detection of neurologic deterioration can be critical for the survival of a neurosurgical patient following head injury. Because little reliable evidence is available on the prognostic value of the clinical sign "extensor response" in comatose posttraumatic patients, we investigated the correlation of this clinical sign with outcome and with early radiologic findings from magnetic resonance imaging (MRI). This retrospective analysis of prospectively obtained data included 157 patients who had remained in a coma for a minimum of 24 hours after traumatic brain injury. All patients received a 1.5-T MRI within 10 days (median: 2 days) of the injury. The correlations between clinical findings 12 and 24 hours after the injury-in particular, extensor response and pupillary function, MRI findings, and outcome after 1 year-were investigated. Statistical analysis included contingency tables, Fisher exact test, odds ratios (ORs) with confidence intervals (CIs), and weighted κ values. There were 48 patients with extensor response within the first 24 hours after the injury. Patients with extensor response (World Federation of Neurosurgical Societies coma grade III) statistically were significantly more likely to harbor MRI lesions in the brainstem when compared with patients in a coma who had no further deficiencies (coma grade I; p = 0.0004 by Fisher exact test, OR 10.8 with 95% CI, 2.7-42.5) and patients with unilateral loss of pupil function (coma grade II; p = 0.0187, OR 2.8 with 95% CI, 1.2-6.5). The correlation of brainstem lesions as found by MRI and outcome according to the Glasgow Outcome Scale after 1 year was also highly significant (p ≤ 0.016). The correlation of extensor response and loss of pupil function with an unfavorable outcome and with brainstem lesions revealed by MRI is highly significant. Their sudden onset may be associated with the sudden onset of brainstem dysfunction and should therefore be regarded as one of the most

Asymptomatic proteinuria. Clinical significance.

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Papper, S

1977-09-01

Patients with asymptomatic proteinuria have varied reasons for the proteinuria and travel diverse courses. In the individual with normal renal function and no systemic cause, ie, idiopathic asymptomatic proteinuria, the outlook is generally favorable. Microscopic hematuria probably raises some degree of question about prognosis. The kidney shows normal glomeruli, subtle changes, or an identifiable lesion. The initial approach includes a clinical and laboratory search for systemic disease, repeated urinalyses, quantitative measurements of proteinuria, determination of creatinine clearance, protein electrophoresis where indicated, and intravenous pyelography. The need for regularly scheduled follow-up evaluation is emphasized. Although the initial approach need not include renal biopsy, a decline in creatinine clearance, an increase in proteinuria, or both are indications for biopsy and consideration of drug therapy.

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study.

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Machiyama, Kazuyo; Casterline, John B; Mumah, Joyce N; Huda, Fauzia Akhter; Obare, Francis; Odwe, George; Kabiru, Caroline W; Yeasmin, Sharifa; Cleland, John

2017-02-09

Unmet need for family planning points to the gap between women's reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women's self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women's perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys. A multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods. Policy and programmes intended to reduce

Clinical significance of combined measurement of serum sex hormones in secondary amenorrhea

International Nuclear Information System (INIS)

Chen Boxun; Chen Yue; Gan Xilun

2004-01-01

Objective: To study the clinical significance of changes of levels of serum sex hormones in the diagnosis of the types of secondary amenorrhea. Methods: Serum sex hormones levels were measured with chemiluminescence in 100 patients with secondary amenorrhea and 42 controls. The serum hormones determined were: estradiol (E 2 )-, progesterone (PROG), follicle stimulating hormone (FSH)-, luteinizing hormone (LH), prolactin (PRL), testosterone (TSTO). Results: Patients with secondary amenorrhea had significantly higher levels of serum FSH, LH and PRL ( P 2 (P<0.05) than those in the controls. Serum levels of PROG and TSTO were about the same in the patients and controls. Conclusion: Determination of serum hormones levels with chemiluminescence is clinically useful for diagnosis of the types of secondary amenorrhea. (authors)

Spontaneous pneumomediastinum on CT : related condition and its clinical significance

International Nuclear Information System (INIS)

Kim, Sung Hyun; Im, Jung Gi; Seo, Joon Beom; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung

1998-01-01

The purpose of this paper is to tabulate underlying disease and to assess the clinical significance of CT-diagnosed spontaneous pneumomediastinum. We retrospectively reviewed CT scans and medical records of 11 consecutive patients with spontaneous pneumomediastinum, and analyzed their clinical history and course, and in five cases, pulmonary function. CT scans of 126 patients with idiopathic pulmonary fibrosis (IPE) collected while the 11 consecutive patients were being treated were analyzed for the prevalence of pneumomediastinum. We analyzed CT findings with respect to the amount and distribution of air in the mediastinum, and the presence of absence of air outside the mediastinum. Spontaneous pneumomediastinum might be associated with idiopathic pulmonary fibrosis and might be a poor prognostic factor in patients with IPE or BOOP. (author). 18 refs., 2 figs

Spontaneous pneumomediastinum on CT : related condition and its clinical significance

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Kim, Sung Hyun; Im, Jung Gi; Seo, Joon Beom; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung [Seoul National Univ. (Korea, Republic of). Coll. of Medicine

1998-03-01

The purpose of this paper is to tabulate underlying disease and to assess the clinical significance of CT-diagnosed spontaneous pneumomediastinum. We retrospectively reviewed CT scans and medical records of 11 consecutive patients with spontaneous pneumomediastinum, and analyzed their clinical history and course, and in five cases, pulmonary function. CT scans of 126 patients with idiopathic pulmonary fibrosis (IPE) collected while the 11 consecutive patients were being treated were analyzed for the prevalence of pneumomediastinum. We analyzed CT findings with respect to the amount and distribution of air in the mediastinum, and the presence of absence of air outside the mediastinum. Spontaneous pneumomediastinum might be associated with idiopathic pulmonary fibrosis and might be a poor prognostic factor in patients with IPE or BOOP. (author). 18 refs., 2 figs.

How Many Dystonias? Clinical Evidence.

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Albanese, Alberto

2017-01-01

Literary reports on dystonia date back to post-Medieval times. Medical reports are instead more recent. We review here the early descriptions and the historical establishment of a consensus on the clinical phenomenology and the diagnostic features of dystonia syndromes. Lumping and splitting exercises have characterized this area of knowledge, and it remains largely unclear how many dystonia types we are to count. This review describes the history leading to recognize that focal dystonia syndromes are a coherent clinical set encompassing cranial dystonia (including blepharospasm), oromandibular dystonia, spasmodic torticollis, truncal dystonia, writer's cramp, and other occupational dystonias. Papers describing features of dystonia and diagnostic criteria are critically analyzed and put into historical perspective. Issues and inconsistencies in this lumping effort are discussed, and the currently unmet needs are critically reviewed.

Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy

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Simon Roh

2016-04-01

Full Text Available Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Methods: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5–7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. Results: A total of 395 esophagectomies were performed (mean age, 62.2 years. The indications for the esophagectomy were as follows: malignancy (n=320, high-grade dysplasia (n=14, perforation (n=27, benign stricture (n=7, achalasia (n=16, and other (n=11. A variety of techniques were used including transhiatal (n=351, McKeown (n=35, and Ivor Lewis (n=9 esophagectomies. Operative mortality was 2.8% (n=11. Three hundred and sixty-eight patients (93% underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%. Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Conclusion: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

The unmet need for philanthropic funding of early career cardiovascular investigators.

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Ahmad, Tariq; Becker, Richard C

2014-05-01

Philanthropic donations have funded scientific investigations of cardiovascular disease for much of human history, and the patrons who enabled them are indirectly responsible for major breakthroughs in the field. Today, however, the lion's share of funding for cardiovascular research in Western countries comes from the government, professional agencies, and industry. Rapid budget cuts at these traditional sources of financial support are having a devastating impact on the cardiovascular research infrastructure by slashing funding for investigators. A particularly unfortunate consequence is the discouraging effect this is having on early career investigators, who are the life-blood of future breakthroughs in the field, leading to the potential loss of an entire generation of researchers. Here, we summarize the challenges faced by emerging cardiovascular investigators, make a case for the unmet need for appropriately targeted philanthropic support for cardiovascular research, and provide a roadmap for solving the funding shortfall for these investigators.

Clinical significance of abnormal nonosseous soft tissue uptake of bone tracer

International Nuclear Information System (INIS)

Zhu Bao; Shang Yukun; Li Jiannan; Bai Jing; Cai Liang

2006-01-01

Objective: To evaluate the clinical significance of abnormal soft tissue uptake of bone tracer. Methods: Thirty patients with abnormal soft tissue uptake of bone tracer on 99 Tc m -methylene diphosphonic acid (MDP) skeletal imaging were analyzed. Radioactivity of soft tissue accumulated equal to or greater than the ribs were considered as abnormal. The result was compared with pathology, MRI, CT, X-ray, ultrasound, findings for evaluating its clinical significance. Results: In 7 patients with diffuse liver uptake of 99 Tc m -MDP, 6 were massive and 1 nodular liver cancer. In 2 patients with local liver uptake, one was metastatic and the other primary liver cancer. In 5 local lung uptake cases 4 were primary lung cancer and one metastatic. In 5 cases with colonic uptake 1 was schistosomiasis while the other 4 unexplainable. Subcutaneous tissue uptake was observed in 4 patients, symmetrical uptake in 2 patients with metastatic calcification microfoci in multiple myeloma, unsymmetrical uptake in 2 patients with hemangioma and abscess. Pleural uptake in 3 patients all was metastatic cancer. Abdominal uptake in 3 patients was omentum, paravertebral soft tissue metastasis and unknown cause. Breast uptake in one patient was due to breast cancer. Conclusions: There are many causes resulting in abnormal nonosseous soft tissue uptake of 99 Tc m -MDP. The final diagnosis should correlate with clinical data and other examinations. (authors)

Amotivation in Schizophrenia: Integrated Assessment With Behavioral, Clinical, and Imaging Measures

OpenAIRE

Wolf, Daniel H.; Satterthwaite, Theodore D.; Kantrowitz, Jacob J.; Katchmar, Natalie; Vandekar, Lillie; Elliott, Mark A.; Ruparel, Kosha

2014-01-01

Motivational deficits play a central role in disability caused by schizophrenia and constitute a major unmet therapeutic need. Negative symptoms have previously been linked to hypofunction in ventral striatum (VS), a core component of brain motivation circuitry. However, it remains unclear to what extent this relationship holds for specific negative symptoms such as amotivation, and this question has not been addressed with integrated behavioral, clinical, and imaging measures. Here, 41 indiv...

[Expression and clinical significance of 5hmC in bladder urothelial carcinoma].

Science.gov (United States)

Li, Jie; Xu, Yuqiao; Zhang, Zhiwen; Zhang, Ming; Zhang, Zhekai; Zhang, Feng; Li, Qing

2016-02-01

To investigate the expression of 5-hydroxymethylcytosine (5hmC) in bladder urothelial carcinoma (UC) and its clinical significance. The expression of 5hmC in 21 cases of UC tissues and pericarcinous urinary tract epithelium was detected by immunohistochemical staining. Then the expression of 5hmC in the surgical resection of UC tissues in 92 cases was also surveyed. Non parametric U Mann-Whitney test was used to analyze the correlation between 5hmC expression and clinical data. Single factor survival analysis was performed by Kaplan-Meier test. The expression of 5hmC in normal urinary tract epithelium and UC tissues was significantly different, but there was no significant difference in the expression of 5hmC between low and high grades of UC tissues as well as between different TNM grades. Kaplan-Meier single factor survival analysis showed that there was no significant correlation between the 5hmC expression level and the survival rate or the recurrence-free survival of UC patients. The expression level of 5hmC in UC tissues is significantly lower than that in pericarcinous urinary tract epithelium. There is no correlation between the 5hmC expression and the progression, prognosis and recurrence of UC.

Clinical significance of determination of serum C-peptide levels

International Nuclear Information System (INIS)

Wang Guohong; Xu Ruiji; Zhang Zhongshu; Wang Xiaoji

2006-01-01

Objective: To study the clinical meanings of changes of serum C-peptide levels and insulin/C-peptide ratio. Methods: Serum insulin and C-peptide levels were determined with RIA in 171 patients with DM-2 of all ages (31-50, n= 50, 51-60, n=60, over 60, n=61) and 50 patients with renal insufficiency. The insulin/C-peptide ratio were calculated. Results: The serum C-peptide and insulin levels in patients with renal insufficiency were significantly higher than those in diabetics of all age groups and the insulin/C-peptide ratio were significantly lower than those in diabetics (P 0.05), but the serum C-peptide levels increased as the age of patients increased with decrease of insulin/C-peptide ratio (P<0.01). Conclusion: Abnormal changes of C-peptide levels and insulin/C-peptide ratio in diabetics (the age-factor corrected) might reflect renal dysfunction. (authors)

Expression and clinical significance of MMP-2, MVD, MEK-2 in endometriosis

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Wei Zhang

2016-03-01

Full Text Available Objective: To investigate the expression and clinical significance of MMP-2, MVD, MEK-2in the endometriosis. Methods: A total of 42 endometrial endometriosis patients with surgery were selected in our hospital obstetrics and gynecology from September 1, 2008 to December 18, 2014. Endometriosis were removed during surgery and served as ectopic group. A total of 42 examples of the above-described patients with endometriosis eutopic were taken out as the eutopic group. Another 34 patients with uterine fibroids were selected in our hospital obstetrics and gynecology during the same period. Normal endometrium were taken as the normal endometrium group. Clinical expression of MMP-2, MVD, MEK-2 of three groups were analyzed. Results: MVD in ectopic endometrium group were significantly higher than those in eutopic and normal endometrium (P<0.05. MEK-2 expression in normal endometrial tissue mainly was negative and weakly positive. The expression was positive in ectopic endometrium and eutopic. The expression of ectopic endometrium MEK-2and MMP-2 were the highest, followed by the reign of endometrium, and the expression of normal endometrium were the lowest. Conclusions: MMP-2, MVD, MEK-2 in ectopic endometrium show high expression, detection of MMP-2, MVD, MEK-2-clinical expression in endometriosis can help in pathogenesis, clinical diagnosis and treatment.

Occult pneumomediastinum in blunt chest trauma: clinical significance.

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Rezende-Neto, J B; Hoffmann, J; Al Mahroos, M; Tien, H; Hsee, L C; Spencer Netto, F; Speers, V; Rizoli, S B

2010-01-01

Thoracic injuries are potentially responsible for 25% of all trauma deaths. Chest X-ray is commonly used to screen patients with chest injury. However, the use of computed tomography (CT) scan for primary screening is increasing, particularly for blunt trauma. CT scans are more sensitive than chest X-ray in detecting intra-thoracic abnormalities such as pneumothoraces and pneumomediastinums. Pneumomediastinum detected by chest X-ray or "overt pneumomediastinum", raises the concern of possible aerodigestive tract injuries. In contrast, there is scarce information on the clinical significance of pneumomediastinum diagnosed by CT scan only or "occult pneumomediastinum". Therefore we investigated the clinical consequences of occult pneumomediastinum in our blunt trauma population. A 2-year retrospective chart review of all blunt chest trauma patients with initial chest CT scan admitted to a level I trauma centre. Data extracted from the medical records include; demographics, occult, overt, or no pneumomediastinum, the presence of intra-thoracic aerodigestive tract injuries (trachea, bronchus, and/or esophagus), mechanism and severity of injury, endotracheal intubation, chest thoracostomy, operations and radiological reports by an attending radiologist. All patients with intra-thoracic aerodigestive tract injuries from 1994 to 2004 were also investigated. Of 897 patients who met the inclusion criteria 839 (93.5%) had no pneumomediastinum. Five patients (0.6%) had overt pneumomediastinum and 53 patients (5.9%) had occult pneumomediastinum. Patients with occult pneumomediastinum had significantly higher ISS and AIS chest (pchest thoracostomy tube was more common (ppneumothorax. None of the patients with occult pneumomediastinum had aerodigestive tract injuries (95%CI 0-0.06). Follow up CT scan of patients with occult pneumomediastinum showed complete resolution in all cases, in average 3 h after the initial exam. Occult pneumomediastinum occurred in approximately 6% of

Attributing variance in supportive care needs during cancer: culture-service, and individual differences, before clinical factors.

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Fielding, Richard; Lam, Wendy Wing Tak; Shun, Shiow Ching; Okuyama, Toru; Lai, Yeur Hur; Wada, Makoto; Akechi, Tatsuo; Li, Wylie Wai Yee

2013-01-01

Studies using the Supportive Care Needs Survey (SCNS) report high levels of unmet supportive care needs (SCNs) in psychological and less-so physical & daily living domains, interpreted as reflecting disease/treatment-coping deficits. However, service and culture differences may account for unmet SCNs variability. We explored if service and culture differences better account for observed SCNs patterns. Hong Kong (n = 180), Taiwanese (n = 263) and Japanese (n = 109) CRC patients' top 10 ranked SCNS-34 items were contrasted. Mean SCNS-34 domain scores were compared by sample and treatment status, then adjusted for sample composition, disease stage and treatment status using multivariate hierarchical regression. All samples were assessed at comparable time-points. SCNs were most prevalent among Japanese and least among Taiwanese patients. Japanese patients emphasized Psychological (domain mean = 40.73) and Health systems and information (HSI) (38.61) SCN domains, whereas Taiwanese and Hong Kong patients emphasized HSI (27.41; 32.92) and Patient care & support (PCS) (19.70; 18.38) SCN domains. Mean Psychological domain scores differed: Hong Kong = 9.72, Taiwan = 17.84 and Japan = 40.73 (pcultural influences, age and occupation differences, and less so clinical factors, differentially account for significant variation in published studies of SCNs.

Multiparametric MRI in the detection of clinically significant prostate cancer

Energy Technology Data Exchange (ETDEWEB)

Futterer, Jurgen J. [Dept. of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen (Netherlands)

2017-08-01

Prostate cancer is the most common cancer among men aged 50 years and older in developed countries and the third leading cause of cancer-related death in men. Multiparametric prostate MR imaging is currently the most accurate imaging modality to detect, localize, and stage prostate cancer. The role of multi-parametric MR imaging in the detection of clinically significant prostate cancer are discussed. In addition, insights are provided in imaging techniques, protocol, and interpretation.

Occult pneumothoraces in Chinese patients with significant blunt chest trauma: radiological classification and proposed clinical significance.

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Lee, Ryan K L; Graham, Colin A; Yeung, Janice H H; Ahuja, Anil T; Rainer, Timothy H

2012-12-01

An occult pneumothorax (OP) is a pneumothorax not seen on a supine chest X-ray (CXR) but detected on abdominal or thoracic computed tomography (CT) scanning. With the increasing use of CT in the management of significantly injured trauma patients, more OPs are being detected. The aim of this study was to classify OPs diagnosed on thoracic CT (TCT) and correlate them with their clinical significance. Retrospective analysis of prospectively collected trauma registry data. Total 36 (N=36) consecutive significantly injured trauma patients admitted through the emergency department (ED) who sustained blunt chest trauma and underwent TCT between 1 January 2007 and 31 December 2008 were included. OP was defined as the identification (by a consultant radiologist) of a pneumothorax on TCT that had not been detected on supine CXR. OPs were classified by laterality (unilateral/bilateral) and location (apical, basal, non apical/basal). The size of pneumothoraces, severity of injury [including number of associated thoracic injuries and injury severity score (ISS)], length of hospital stay and mortality were compared between groups. The need for tube thoracostomy and clinical outcome were also analysed. Patients with bilateral OPs (N=8) had significantly more associated thoracic injuries (median: 2 vs. 1, p=0.01), higher ISS (median: 35 vs. 23, p=0.02) and longer hospital stay (median: 20 days vs. 11 days, p=0.01) than those with a unilateral OP (N=28). Basal OPs (N=7) were significantly larger than apical (N=10) and non-apical/basal Ops (N=11). Basal OPs were associated with significantly more associated thoracic injuries (median: 2 vs. 1, p=0.01), higher ISS (median: 35 vs. 25, p=0.04) and longer hospital stays (median: 23 days vs. 17 days, p=0.02) than apical Ops, which had higher ISS (median: 35 vs. 25, p=0.04) and longer hospital stays (median: 23 days vs. 15 days, p=0.02) than non-apical/basal OPs. Non-apical/basal OPs were associated with more related injuries (median: 2

Thyroid Incidentalomas on 18F-FDG PET/CT: Clinical Significance and Controversies

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William Makis

2017-10-01

Full Text Available Objective: The purpose of the current study is to examine the incidence and clinical significance of unexpected focal uptake of 18F-fluorodeoxyglucose (18F-FDG on positron emission tomography/computed tomography (PET/CT in the thyroid gland of oncology patients, the maximum standardized uptake value (SUVmax of benign and malignant thyroid incidentalomas in these patients, and review the literature. Methods: Seven thousand two hundred fifty-two 18F-FDG PET/CT studies performed over four years, were retrospectively reviewed. Studies with incidental focal 18F-FDG uptake in the thyroid gland were further analyzed. Results: Incidental focal thyroid 18F-FDG uptake was identified in 157 of 7252 patients (2.2%. Sufficient follow-up data (≥12 months were available in 128 patients, of whom 57 (45% had a biopsy performed and 71 had clinical follow-up. Malignancy was diagnosed in 14 of 128 patients (10.9%. There was a statistically significant difference between the median SUVmax of benign thyroid incidentalomas (SUVmax 4.8 vs malignant (SUVmax 6.3, but the wide range of overlap between the two groups yielded no clinically useful SUVmax threshold value to determine malignancy. Conclusion: 18F-FDG positive focal thyroid incidentalomas occurred in 2.2% of oncologic PET/CT scans, and were malignant in 10.9% of 128 patients. This is the lowest reported malignancy rate in a North American study to date, and significantly lower than the average malignancy rate (35% reported in the literature. Invasive biopsy of all 18F-FDG positive thyroid incidentalomas, as recommended by some studies, is unwarranted and further research to determine optimal management is needed. There was no clinically useful SUVmax cut-off value to determine malignancy and PET/CT may not be a useful imaging modality to follow these patients conservatively.

What do multiple sclerosis patients and their caregivers perceive as unmet needs?

Science.gov (United States)

Lorefice, Lorena; Mura, Gioia; Coni, Giulia; Fenu, Giuseppe; Sardu, Claudia; Frau, Jessica; Coghe, Giancarlo; Melis, Marta; Marrosu, Maria Giovanna; Cocco, Eleonora

2013-11-15

Multiple sclerosis (MS) has a major impact on the physical, psychological and social life of patients and their families. The aim of this study was to evaluate the different perceptions of patients and caregivers about management of MS, particularly about the same items, to gather information to ameliorate the care of patients. We evaluated what MS patients and caregivers perceive as unmet needs and compared patients' opinions with caregivers' opinions using a multidimensional questionnaire. The questionnaire was specifically designed for the study, taking into account different aspects of the global care perceived by patients and care givers, such as information about MS, medical treatment and rehabilitation, patients' relationships with medical staff and their psychological and social life. We administered the questionnaire to 497 patients and 206 caregivers. Results showed that the majority of participants were satisfied with medical staff but expressed a desire that staff be more forthcoming with information about MS. As for medical treatment concerns, more patients found there to be useful a multidisciplinary approach than caregivers did. Both required psychological support for patients but patients felt a greater need for it at the time of diagnosis, whereas caregivers felt it was required post-diagnosis. Both reported significant strains on patient relationships at work but no effect on other social interactions. A better understanding of MS patient needs, starting from the point of view of patients and caregivers, could have a great impact on quality of life and on management of the disease.

Anaerobic bacteraemia in patients admitted to Auckland City Hospital: its clinical significance.

Science.gov (United States)

Muttaiyah, Sharmini; Paviour, Sue; Buckwell, Leanne; Roberts, Sally A

2007-11-09

To determine the clinical significance and outcomes for patients with anaerobic bacteraemia at our institution over a 2-year period. The isolates were identified from the laboratory database and patient information obtained from clinical records. Anaerobes were isolated from 140 blood culture sets taken from 114 patients. For 59 patients, the isolates were considered to be contaminants. Of note, all Propionibacterium spp. were considered contaminants. For the patients with true bacteraemias, the most likely source of infection was intra-abdominal, 26 (50%), mucositis associated with neutropaenia contributed to by cytotoxic therapy, 11 (19%), skin and soft tissue, 4 (8%), pelvic, 5 (9%) and oropharyngeal, 4 (8%). Thirty-five patients were on appropriate therapy prior to the availability culture results. Five patients died but only one death was directly attributable to anaerobic bacteraemia. At our institution, anaerobes accounted for 2.3% of all positive blood cultures. Excluding Propionibacterium spp., most isolates were considered clinically significant. The most common source for the bacteraemia was intra-abdominal infection, followed by mucositis in neutropaenic patients. Empiric antimicrobial therapy provided appropriate cover for two-thirds of the patients. One death was directly attributable to anaerobic bacteraemia.

Detection of Clinically Significant Retinopathy of Prematurity Using Wide-angle Digital Retinal Photography

Science.gov (United States)

Chiang, Michael F.; Melia, Michele; Buffenn, Angela N.; Lambert, Scott R.; Recchia, Franco M.; Simpson, Jennifer L.; Yang, Michael B.

2013-01-01

Objective To evaluate the accuracy of detecting clinically significant retinopathy of prematurity (ROP) using wide-angle digital retinal photography. Methods Literature searches of PubMed and the Cochrane Library databases were conducted last on December 7, 2010, and yielded 414 unique citations. The authors assessed these 414 citations and marked 82 that potentially met the inclusion criteria. These 82 studies were reviewed in full text; 28 studies met inclusion criteria. The authors extracted from these studies information about study design, interventions, outcomes, and study quality. After data abstraction, 18 were excluded for study deficiencies or because they were superseded by a more recent publication. The methodologist reviewed the remaining 10 studies and assigned ratings of evidence quality; 7 studies were rated level I evidence and 3 studies were rated level III evidence. Results There is level I evidence from ≥5 studies demonstrating that digital retinal photography has high accuracy for detection of clinically significant ROP. Level III studies have reported high accuracy, without any detectable complications, from real-world operational programs intended to detect clinically significant ROP through remote site interpretation of wide-angle retinal photographs. Conclusions Wide-angle digital retinal photography has the potential to complement standard ROP care. It may provide advantages through objective documentation of clinical examination findings, improved recognition of disease progression by comparing previous photographs, and the creation of image libraries for education and research. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. PMID:22541632

The clinical significance of quality of life assessments in oncology: a summary for clinicians

NARCIS (Netherlands)

Sloan, Jeff A.; Frost, Marlene H.; Berzon, Rick; Dueck, Amylou; Guyatt, Gordon; Moinpour, Carol; Sprangers, Mirjam; Ferrans, Carol; Cella, David

2006-01-01

BACKGROUND: A series of six manuscripts with an introduction appeared in the Mayo Clinic Proceedings, based upon the collective effort of 30 individuals with an interest and expertise in assessing the clinical significance of quality of life (QOL) assessments. The series of manuscripts described the

Clinically significant discrepancies between sleep problems assessed by standard clinical tools and actigraphy

Directory of Open Access Journals (Sweden)

Kjersti Marie Blytt

2017-10-01

Full Text Available Abstract Background Sleep disturbances are widespread among nursing home (NH patients and associated with numerous negative consequences. Identifying and treating them should therefore be of high clinical priority. No prior studies have investigated the degree to which sleep disturbances as detected by actigraphy and by the sleep-related items in the Cornell Scale for Depression in Dementia (CSDD and the Neuropsychiatric Inventory – Nursing Home version (NPI-NH provide comparable results. Such knowledge is highly needed, since both questionnaires are used in clinical settings and studies use the NPI-NH sleep item to measure sleep disturbances. For this reason, insight into their relative (disadvantages is valuable. Method Cross-sectional study of 83 NH patients. Sleep was objectively measured with actigraphy for 7 days, and rated by NH staff with the sleep items in the CSDD and the NPI-NH, and results were compared. McNemar's tests were conducted to investigate whether there were significant differences between the pairs of relevant measures. Cohen's Kappa tests were used to investigate the degree of agreement between the pairs of relevant actigraphy, NPI-NH and CSDD measures. Sensitivity and specificity analyses were conducted for each of the pairs, and receiver operating characteristics (ROC curves were designed as a plot of the true positive rate against the false positive rate for the diagnostic test. Results Proxy-raters reported sleep disturbances in 20.5% of patients assessed with NPI-NH and 18.1% (difficulty falling asleep, 43.4% (multiple awakenings and 3.6% (early morning awakenings of patients had sleep disturbances assessed with CSDD. Our results showed significant differences (p<0.001 between actigraphy measures and proxy-rated sleep by the NPI-NH and CSDD. Sensitivity and specificity analyses supported these results. Conclusions Compared to actigraphy, proxy-raters clearly underreported NH patients' sleep disturbances as assessed

Rationing of hip and knee referrals in the public hospital: the true unmet need.

Science.gov (United States)

Inglis, Tom; Armour, Paul; Inglis, Grahame; Hooper, Gary

2017-03-24

The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA). Between 1 August 2015 and 31 March 2016 data was collected from all elective hip and knee referrals that underwent triage for a FSA. The number of outpatient appointments available according to the government four-month waiting time is set by the CDHB. Patients were triaged by two consultant surgeons on the basis of their referral letter and radiological imaging into one of five categories: accepted for FSA, insufficient information, no capacity, low priority or direct entry to waiting list (if already seen by a specialist). Those not accepted for an FSA were returned to general practitioner (GP) care. During the study period there were 1,733 referrals (838 hip related referrals and 895 knee related referrals) to the orthopaedic department with a request for FSA. All patients had failed conservative management. Of these referrals 43% of hip and 54% of knee related referrals could not be offered an FSA and were returned, following triage, to general practitioner care unseen. Only 8% and 9% respectively were declined for insufficient information in the referral letter or lack of need. This study details the implementation of a triage system for elective hip and knee referrals to the CDHB and with accurate data we have been able to determine the large number of patients unable to access a specialist opinion. These patients represent the unmet need within our community and highlights the degree of rationing taking place within the public hospital.

PRAME Gene Expression in Acute Leukemia and Its Clinical Significance

International Nuclear Information System (INIS)

Ding, Kai; Wang, Xiao-ming; Fu, Rong; Ruan, Er-bao; Liu, Hui; Shao, Zong-hong

2012-01-01

To investigate the expression of the preferentially expressed antigen of melanoma (PRAME) gene in acute leukemia and its clinical significance. The level of expressed PRAME mRNA in bone marrow mononuclear cells from 34 patients with acute leukemia (AL) and in 12 bone marrow samples from healthy volunteers was measured via RT-PCR. Correlation analyses between PRAME gene expression and the clinical characteristics (gender, age, white blood count, immunophenotype of leukemia, percentage of blast cells, and karyotype) of the patients were performed. The PRAME gene was expressed in 38.2% of all 34 patients, in 40.7% of the patients with acute myelogenous leukemia (AML, n=27), and in 28.6% of the patients with acute lymphoblastic leukemia (ALL, n=7), but was not expressed in the healthy volunteers. The difference in the expression levels between AML and ALL patients was statistically significant. The rate of gene expression was 80% in M 3 , 33.3% in M 2 , and 28.6% in M 5 . Gene expression was also found to be correlated with CD15 and CD33 expression and abnormal karyotype, but not with age, gender, white blood count or percentage of blast cells. The PRAME gene is highly expressed in acute leukemia and could be a useful marker to monitor minimal residual disease. This gene is also a candidate target for the immunotherapy of acute leukemia

Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the Hierarchy Model of Needs in Dementia.

NARCIS (Netherlands)

Scholzel-Dorenbos, C.J.M.; Meeuwsen, E.J.; Olde Rikkert, M.G.M.

2010-01-01

OBJECTIVES: To make an inventory of needs assessment instruments in dementia, to explore the interaction between unmet needs and health-related quality of life (HRQoL) and to relate these to the conceptual model of Maslow's Hierarchy of needs in order to design a dementia-specific model. METHODS:

Novel perspectives on diagnosis and clinical significance of the post-thrombotic syndrome in children.

Science.gov (United States)

Jones, Sophie; Newall, Fiona; Monagle, Paul

2016-10-01

Given the increase in venous thromboembolic events (VTE) in children, the incidence, diagnosis and management of post thrombotic syndrome (PTS) in children is of increasing interest. Current challenges facing clinicians caring for children with VTE is the limited evidence of the long-term outcomes for this cohort; specifically the significance and potential functional impairment associated with PTS. This paper reviews the current evidence to elucidate the risk factors for PTS in children, methods for diagnosis and management of PTS in children (aged less than 18 years). Medline, Cinahl and PsycINFO database searches were undertaken using key search terms. Priority areas in need of further research are highlighted. Expert commentary: The two paediatric PTS assessment tools currently in use have been acknowledged to overcall the incidence of mild PTS in children. A PTS tool's ability to distinguish between clinically significant PTS and mild PTS is crucial. Variation in how PTS has been reported in children across the literature suggests that the real incidence of moderate and /or clinically significant PTS in children is unknown. Furthermore, evidence is lacking about the functional impairment experienced by children with clinically significant PTS and what this means for their long-term health.

Psychometric evaluation of the Sibling Cancer Needs Instrument (SCNI): an instrument to assess the psychosocial unmet needs of young people who are siblings of cancer patients.

Science.gov (United States)

Patterson, P; McDonald, F E J; Butow, P; White, K J; Costa, D S J; Millar, B; Bell, M L; Wakefield, C E; Cohn, R J

2014-03-01

The current study sought to establish the psychometric properties of the revised Sibling Cancer Needs Instrument (SCNI) when completed by young people who have a brother or sister with cancer. The participants were 106 young people aged between 12 and 24 who had a living brother or sister diagnosed with any type or stage of cancer in the last 5 years. They were recruited from multiple settings. The initial step in determining the dimensional structure of the questionnaire was exploratory factor analysis and further assessment followed using Rasch analysis. Construct validity and test-retest reliability (n = 17) were also assessed. The final SCNI has 45 items and seven domains: information; practical assistance; "time out" and recreation; feelings; support (friends and other young people); understanding from my family; and sibling relationship. There was a reasonable spread of responses across the scale for every item. Rasch analysis results suggested that overall, respondents used the scale consistently. Support for construct validity was provided by the correlations between psychological distress and the SCNI domains. The internal consistency was good to excellent; Cronbach's alphas ranged from 0.78 to 0.94. The test-retest reliability of the overall measure is 0.88. The SCNI is the first measure of psychosocial unmet needs which has been developed for young people who have a brother or sister with cancer. The sound psychometric properties allow the instrument to be used with confidence. The measure will provide a substantial clinical benefit in highlighting the unmet needs of this population to assist with the prioritisation of targeted supportive care services and evaluating the impact of interventions targeted at siblings.

Clinical significance of anaplasia in childhood rhabdomyosarcoma

OpenAIRE

Sidhom, Iman; El Nadi, Enas; Taha, Hala; Elkinaai, Naglaa; Zaghloul, Mohamed S.; Younes, Alaa; Labib, Rania; Sabry, Mohamed

2015-01-01

Background: The presence of anaplastic features has been known to correlate with poor clinical outcome in various pediatric malignancies, including Wilms tumor and medulloblastoma but not in rhabdomyosarcoma. Aim: Aim was to study the frequency of anaplasia at presentation in childhood rhabdomyosarcoma and its relationship to clinical and pathological characteristics as well as to outcome. Patients and Methods: Anaplasia was retrospectively assessed in 105 consecutive pediatric rhabdomy...

Brief Group Psychoeducation for Bulimia Nervosa: Assessing the Clinical Significance of Change.

Science.gov (United States)

Davis, Ron; And Others

1990-01-01

Brief intervention designed to promote symptom management was completed by 41 women with bulimia nervosa. Findings revealed diversity of outcomes that individuals reported following participation in intervention. Found differential reporting of clinically significant change in favor of specific eating psychopathology relative to personality…

Developing advanced clinical practice skills in gastrointestinal consequences of cancer treatment.

Science.gov (United States)

Gee, Caroline; Andreyev, Jervoise; Muls, Ann

2018-03-08

This article explores the transition from a clinical nurse specialist (CNS) towards developing advanced clinical practice skills within a gastrointestinal consequences of cancer clinic. It presents data on the first 50 patients assessed by the CNS from a prospective service evaluation, demonstrating how this informed the nurse's future learning. There is high demand for advanced clinical practice skills to address unmet health needs and improve the quality, efficiency, and sustainability of healthcare services. However, a literature review found no literature on developing advanced clinical practice skills in this setting. Emerging themes from the service evaluation focused on barriers and enablers, ongoing support, organisational commitment and working in a multidisciplinary team. Blended learning provided both structured and opportunistic learning, embedding both formal and tacit knowledge, as roles require increasing flexibility. Clinical supervision and reflective practice were key in maintaining professional and peer support.

Transforming User Needs into Functional Requirements for an Antibiotic Clinical Decision Support System

Science.gov (United States)

Bright, T.J.

2013-01-01

Summary Background Many informatics studies use content analysis to generate functional requirements for system development. Explication of this translational process from qualitative data to functional requirements can strengthen the understanding and scientific rigor when applying content analysis in informatics studies. Objective To describe a user-centered approach transforming emergent themes derived from focus group data into functional requirements for informatics solutions and to illustrate these methods to the development of an antibiotic clinical decision support system (CDS). Methods The approach consisted of five steps: 1) identify unmet therapeutic planning information needs via Focus Group Study-I, 2) develop a coding framework of therapeutic planning themes to refine the domain scope to antibiotic therapeutic planning, 3) identify functional requirements of an antibiotic CDS system via Focus Group Study-II, 4) discover informatics solutions and functional requirements from coded data, and 5) determine the types of information needed to support the antibiotic CDS system and link with the identified informatics solutions and functional requirements. Results The coding framework for Focus Group Study-I revealed unmet therapeutic planning needs. Twelve subthemes emerged and were clustered into four themes; analysis indicated a need for an antibiotic CDS intervention. Focus Group Study-II included five types of information needs. Comments from the Barrier/Challenge to information access and Function/Feature themes produced three informatics solutions and 13 functional requirements of an antibiotic CDS system. Comments from the Patient, Institution, and Domain themes generated required data elements for each informatics solution. Conclusion This study presents one example explicating content analysis of focus group data and the analysis process to functional requirements from narrative data. Illustration of this 5-step method was used to develop an

Clinical significance and taxonomy of Actinobacillus hominis

DEFF Research Database (Denmark)

Friis-Møller, Alice; Christensen, J J; Fussing, V

2001-01-01

Clinical findings in 36 immunosuppressed patients with lower respiratory tract infection or bacteremia with Actinobacillus hominis are described. Animal contact was only recorded for three patients; nine patients died despite appropriate antimicrobial treatment. Although infections with this micr......Clinical findings in 36 immunosuppressed patients with lower respiratory tract infection or bacteremia with Actinobacillus hominis are described. Animal contact was only recorded for three patients; nine patients died despite appropriate antimicrobial treatment. Although infections...

Prostate atypia: does repeat biopsy detect clinically significant prostate cancer?

Science.gov (United States)

Dorin, Ryan P; Wiener, Scott; Harris, Cory D; Wagner, Joseph R

2015-05-01

While the treatment pathway in response to benign or malignant prostate biopsies is well established, there is uncertainty regarding the risk of subsequently diagnosing prostate cancer when an initial diagnosis of prostate atypia is made. As such, we investigated the likelihood of a repeat biopsy diagnosing prostate cancer (PCa) in patients in which an initial biopsy diagnosed prostate atypia. We reviewed our prospectively maintained prostate biopsy database to identify patients who underwent a repeat prostate biopsy within one year of atypia (atypical small acinar proliferation; ASAP) diagnosis between November 1987 and March 2011. Patients with a history of PCa were excluded. Chart review identified patients who underwent radical prostatectomy (RP), radiotherapy (RT), or active surveillance (AS). For some analyses, patients were divided into two subgroups based on their date of service. Ten thousand seven hundred and twenty patients underwent 13,595 biopsies during November 1987-March 2011. Five hundred and sixty seven patients (5.3%) had ASAP on initial biopsy, and 287 (50.1%) of these patients underwent a repeat biopsy within one year. Of these, 122 (42.5%) were negative, 44 (15.3%) had atypia, 19 (6.6%) had prostatic intraepithelial neoplasia, and 102 (35.6%) contained PCa. Using modified Epstein's criteria, 27/53 (51%) patients with PCa on repeat biopsy were determined to have clinically significant tumors. 37 (36.3%) proceeded to RP, 25 (24.5%) underwent RT, and 40 (39.2%) received no immediate treatment. In patients who underwent surgery, Gleason grade on final pathology was upgraded in 11 (35.5%), and downgraded 1 (3.2%) patient. ASAP on initial biopsy was associated with a significant risk of PCa on repeat biopsy in patients who subsequently underwent definitive local therapy. Patients with ASAP should be counseled on the probability of harboring both clinically significant and insignificant prostate cancer. © 2015 Wiley Periodicals, Inc.

Clinical significance of MUC13 in pancreatic ductal adenocarcinoma.

Science.gov (United States)

Khan, Sheema; Zafar, Nadeem; Khan, Shabia S; Setua, Saini; Behrman, Stephen W; Stiles, Zachary E; Yallapu, Murali M; Sahay, Peeyush; Ghimire, Hemendra; Ise, Tomoko; Nagata, Satoshi; Wang, Lei; Wan, Jim Y; Pradhan, Prabhakar; Jaggi, Meena; Chauhan, Subhash C

2018-01-15

Poor prognosis of pancreatic cancer (PanCa) is associated with lack of an effective early diagnostic biomarker. This study elucidates significance of MUC13, as a diagnostic/prognostic marker of PanCa. MUC13 was assessed in tissues using our in-house generated anti-MUC13 mouse monoclonal antibody and analyzed for clinical correlation by immunohistochemistry, immunoblotting, RT-PCR, computational and submicron scale mass-density fluctuation analyses, ROC and Kaplan Meir curve analyses. MUC13 expression was detected in 100% pancreatic intraepithelial neoplasia (PanIN) lesions (Mean composite score: MCS = 5.8; AUC >0.8, P 0.8; P artificial intelligence based algorithm analyses also elucidated association of MUC13 with greater morphological disorder (P < 0.001) and nuclear MUC13 as strong predictor for cancer aggressiveness and poor patient survival. This study provides significant information regarding MUC13 expression/subcellular localization in PanCa samples and supporting the use anti-MUC13 MAb for the development of PanCa diagnostic/prognostic test. Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

The significance of reduced respiratory chain enzyme activities: clinical, biochemical and radiological associations.

Science.gov (United States)

Mordekar, S R; Guthrie, P; Bonham, J R; Olpin, S E; Hargreaves, I; Baxter, P S

2006-03-01

Mitochondrial diseases are an important group of neurometabolic disorders in children with varied clinical presentations and diagnosis that can be difficult to confirm. To report the significance of reduced respiratory chain enzyme (RCE) activity in muscle biopsy samples from children. Retrospective odds ratio was used to compare clinical and biochemical features, DNA studies, neuroimaging, and muscle biopsies in 18 children with and 48 without reduced RCE activity. Children with reduced RCE activity were significantly more likely to have consanguineous parents, to present with acute encephalopathy and lactic acidaemia and/or within the first year of life; to have an axonal neuropathy, CSF lactate >4 mmol/l; and/or to have signal change in the basal ganglia. There were positive associations with a maternal family history of possible mitochondrial cytopathy; a presentation with failure to thrive and lactic acidaemia, ragged red fibres, reduced fibroblast fatty acid oxidation and with an abnormal allopurinol loading test. There was no association with ophthalmic abnormalities, deafness, epilepsy or myopathy. The association of these clinical, biochemical and radiological features with reduced RCE activity suggests a possible causative link.

Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy

International Nuclear Information System (INIS)

Cihoric, Nikola; Crowe, Susanne; Eychmüller, Steffen; Aebersold, Daniel M; Ghadjar, Pirus

2012-01-01

This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method. Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37–93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5–45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 (n = 39), 1 (n = 12), 2 (n = 6), 3 (n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed. Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients

Modulating soluble mediators to restore joint homeostasis

NARCIS (Netherlands)

Tsuchida, A.I.

2013-01-01

Regenerative therapy meets a previously unmet medical need in current clinical care. Autologous chondrocye implantation results in significantly better clinical outcome than microfracture in patients with defects > 4 cm2 at two years follow-up. This information is of great value for the

Small airway function changes and its clinical significance of asthma patients in different clinical phases

Directory of Open Access Journals (Sweden)

Yan-Hui Zhou

2016-11-01

Full Text Available Objective: To observe the small airways function changes of asthmatic patients in different clinical phases and to discuss its clinical significance. Methods: A total of 127 patients diagnosed as asthma were selected randomly and pulmonary function (PF of them was determined by conventional method. Then they were divided into A, B and C group based on PF results. All 34 patients in A group suffered from acute asthma attack for the first time. All 93 patients in B group had been diagnosed as asthma but in remission phase. C Group was regarded as Control group with 20 healthy volunteers. Then FEV1, FEF50%, FEF75% levels of patients in each group were analyzed, and ΔFEV1, ΔFEF75% and ΔFEF50% levels of patients in each group were compared after bronchial dilation test. Results: It was found that most patients in group A and B had abnormal small airways function, and their small airways function was significantly different compared with that of group C (P<0.01. In addition, except for group C, ΔFEF75%,ΔFEF50% levels in A and B group were improved more significantly than ΔFEV1 levels (P<0.01. Conclusions: Asthma patients in acute phase all have abnormal small airways function. Most asthma patients in remission phase also have abnormal small airways function. After bronchial dilation test, whether patients in acute phase or in remission phase, major and small airways function of them are improved, but improvement of small airways function is weaker than that of major airways. This indicates that asthma respiratory tract symptoms in different phases exists all the time and so therapeutic process is needed to perform step by step.

A Two-Week Psychosocial Intervention Reduces Future Aggression and Incarceration in Clinically Aggressive Juvenile Offenders.

Science.gov (United States)

Kendall, Ashley D; Emerson, Erin M; Hartmann, William E; Zinbarg, Richard E; Donenberg, Geri R

2017-12-01

There is a largely unmet need for evidence-based interventions that reduce future aggression and incarceration in clinically aggressive juvenile offenders serving probation. We addressed this gap using a group randomized controlled trial. Offenders both with and without clinical aggression were included, enabling comparison of intervention effects. Juveniles 13 to 17 years old (N = 310, mean = 16 years, 90% African-American, 66% male) on probation were assigned to a 2-week intervention targeting psychosocial factors implicated in risky behavior (e.g., learning strategies to manage "hot" emotions that prompt risk taking) or to an equally intensive health promotion control. Participants completed aggression measures at baseline, 6-, and 12-month follow-up and reported on incarceration at 12 months. Spline regression tested symptom change. Among clinically aggressive offenders (n = 71), the intervention arm showed significantly greater reductions in aggression over the first 6 months compared with controls. Juveniles from the intervention no longer met clinical criteria, on average, but clinically significant symptoms persisted in the control group. By 12 months, participants from the intervention appeared to maintain treatment gains, but their symptom levels no longer differed significantly from those in the control. However, the intervention group was nearly 4 times less likely than controls to report incarceration. Intervention effects were significantly stronger for offenders with clinical than with nonclinical (n = 239) baseline aggression. A 2-week intervention expedited improvements in aggression and reduced incarceration in clinically aggressive juvenile offenders. The findings underscore the importance of directing intervention resources to the most aggressive youth. Clinical trial registration information-PHAT Life: Preventing HIV/AIDS Among Teens in Juvenile Justice (PHAT Life); http://clinicaltrials.gov/; NCT02647710. Copyright © 2017 American

Photocoagulation treatment for clinically significant radiation macular oedema

Energy Technology Data Exchange (ETDEWEB)

Kinyoun, J.L.; Zamber, R.W.; Lawrence, B.S.; Barlow, W.E.; Arnold, A.M. [Washington Univ., Seattle, WA (United States)

1995-02-01

Macular oedema is a leading cause of vision loss in patients with radiation retinopathy. In an effort to find an effective treatment for this vision threatening complication, 12 eyes (eight patients) were treated with photocoagulation for clinically significant radiation macular oedema (CSRMO) defined as central macular thickening, exudates threatening the macular centre, or one disc area of thickening in the macula. Median visual acuity improved from 20/100 pre-operatively to 20/90 at the initial post-operative examination (mean follow up 5 months) and to 20/75 at the final post-operative examination (mean follow up 39 months). At the final post-operative examination, visual acuity had improved in eight (67%) eyes and six (50%) eyes had complete resolution of the CSRMO; two (17%) other eyes had improved anatomically in that fewer CSRMO criteria were present. These results suggest that macular photocoagulation is effective in decreasing macular oedema and improving vision in eyes with CSRMO. (author).

Photocoagulation treatment for clinically significant radiation macular oedema

International Nuclear Information System (INIS)

Kinyoun, J.L.; Zamber, R.W.; Lawrence, B.S.; Barlow, W.E.; Arnold, A.M.

1995-01-01

Macular oedema is a leading cause of vision loss in patients with radiation retinopathy. In an effort to find an effective treatment for this vision threatening complication, 12 eyes (eight patients) were treated with photocoagulation for clinically significant radiation macular oedema (CSRMO) defined as central macular thickening, exudates threatening the macular centre, or one disc area of thickening in the macula. Median visual acuity improved from 20/100 pre-operatively to 20/90 at the initial post-operative examination (mean follow up 5 months) and to 20/75 at the final post-operative examination (mean follow up 39 months). At the final post-operative examination, visual acuity had improved in eight (67%) eyes and six (50%) eyes had complete resolution of the CSRMO; two (17%) other eyes had improved anatomically in that fewer CSRMO criteria were present. These results suggest that macular photocoagulation is effective in decreasing macular oedema and improving vision in eyes with CSRMO. (author)

Clinical significance of isometric bite force versus electrical activity in temporal and masseter muscles

DEFF Research Database (Denmark)

Bakke, Merete; Michler, L; Han, K

1989-01-01

significant with respect to unilateral, but not to bilateral force measurements. Only in the masseter muscle was strength of dynamic contractions during chewing significantly correlated to bite force. With the present method it was demonstrated that unilateral bite force is a simple clinical indicator...

Amotivation in schizophrenia: integrated assessment with behavioral, clinical, and imaging measures.

Science.gov (United States)

Wolf, Daniel H; Satterthwaite, Theodore D; Kantrowitz, Jacob J; Katchmar, Natalie; Vandekar, Lillie; Elliott, Mark A; Ruparel, Kosha

2014-11-01

Motivational deficits play a central role in disability caused by schizophrenia and constitute a major unmet therapeutic need. Negative symptoms have previously been linked to hypofunction in ventral striatum (VS), a core component of brain motivation circuitry. However, it remains unclear to what extent this relationship holds for specific negative symptoms such as amotivation, and this question has not been addressed with integrated behavioral, clinical, and imaging measures. Here, 41 individuals with schizophrenia and 37 controls performed a brief, computerized progressive ratio task (PRT) that quantifies effort exerted in pursuit of monetary reward. Clinical amotivation was assessed using the recently validated Clinical Assessment Interview for Negative Symptoms (CAINS). VS function was probed during functional magnetic resonance imaging using a monetary guessing paradigm. We found that individuals with schizophrenia had diminished motivation as measured by the PRT, which significantly and selectively related to clinical amotivation as measured by the CAINS. Critically, lower PRT motivation in schizophrenia was also dimensionally related to VS hypofunction. Our results demonstrate robust dimensional associations between behavioral amotivation, clinical amotivation, and VS hypofunction in schizophrenia. Integrating behavioral measures such as the PRT will facilitate translational efforts to identify biomarkers of amotivation and to assess response to novel therapeutic interventions. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Electrochemical sensors for identifying pyocyanin production in clinical Pseudomonas aeruginosa isolates.

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Sismaet, Hunter J; Pinto, Ameet J; Goluch, Edgar D

2017-11-15

In clinical practice, delays in obtaining culture results impact patient care and the ability to tailor antibiotic therapy. Despite the advancement of rapid molecular diagnostics, the use of plate cultures inoculated from swab samples continues to be the standard practice in clinical care. Because the inoculation culture process can take between 24 and 48h before a positive identification test can be run, there is an unmet need to develop rapid throughput methods for bacterial identification. Previous work has shown that pyocyanin can be used as a rapid, redox-active biomarker for identifying Pseudomonas aeruginosa in clinical infections. However, further validation is needed to confirm pyocyanin production occurs in all clinical strains of P. aeruginosa. Here, we validate this electrochemical detection strategy using clinical isolates obtained from patients with hospital-acquired infections or with cystic fibrosis. Square-wave voltammetric scans of 94 different clinical P. aeruginosa isolates were taken to measure the concentration of pyocyanin. The results showed that all isolates produced measureable concentrations of pyocyanin with production rates correlated with patient symptoms and comorbidity. Further bioinformatics analysis confirmed that 1649 genetically sequenced strains (99.9%) of P. aeruginosa possess the two genes (PhzM and PhzS) necessary to produce pyocyanin, supporting the specificity of this biomarker. Confirming the production of pyocyanin by all clinically-relevant strains of P. aeruginosa is a significant step towards validating this strategy for rapid, point-of-care diagnostics. Copyright © 2017 Elsevier B.V. All rights reserved.

[The changes in vestibular function in patients with diabetes mellitus and its clinical significance].

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Li, Juan; Zhang, Tianyu; Shen, Jianzhong; Gong, Jingrong; Wang, Hongli; Zhang, Jimin; Pang, Yufeng

2008-01-01

To study the changes of vestibular function in patients with diabetes mellitus and its clinical significance. Electronystagmography (ENG) was used to examine 76 patients with diabetes mellitus and 60 healthy adults subjects. After clinical detection of vestibular function including spontaneous nystagmus, positional test, head shaking nystagmus, neck torsion test, caloric test, and sensory organization tests which consist of gaze, saccade and smooth pursuit test, the results of these two groups were recorded for qualitative and quantitative statistical analysis. The rate of vestibular dysfunction in patients with diabetes mellitus were 68.4%. and that of the controls were 8.3%. There was significant difference between these two groups (chi2 = 15.472, P Vertigo or dizziness occurred in patients with diabetes mellitus might be related to vestibular dysfunction. ENG test could be used as one of the objective clinical examinations in patients with diabetes mellitus.

Clinical significance of conventional rib series in patients with minor thoracic trauma

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Hoffstetter, P.; Dornia, C. [Asklepios Medical Center, Bad Abbach (Germany). Radiology; University Medical Center Regensburg (Germany). Radiology; Wagner, M.; Niessen, C.; Dendl, L.M.; Stroszczynski, C.; Schreyer, A.G. [University Medical Center Regensburg (Germany). Radiology; Al Suwaidi, M.H. [Asklepios Medical Center, Bad Abbach (Germany). Rheumatology/Clinical Immmunology

2014-09-15

Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4% men, 38.6% women, median age: 51 years, range: 13-92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5%) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5%) patients. Considering the 157 patients with fractured ribs, 73 (46.8%) had a single fracture, 38 (24.4%) and two fractures and 45 (28.8%) had more than two fractures. When assessing the 405 CRs, we detected 69 (17%) fractures while the corresponding RS of the same patients revealed 87 (21.5%) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1% received medical therapy, while 64.5% of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosing rib fractures, the results from RS seem to have no significant influence on further clinical management and therapeutic measures. Minor thoracic trauma should be evaluated

Clinical significance of conventional rib series in patients with minor thoracic trauma

International Nuclear Information System (INIS)

Hoffstetter, P.; Dornia, C.; University Medical Center Regensburg; Wagner, M.; Niessen, C.; Dendl, L.M.; Stroszczynski, C.; Schreyer, A.G.; Al Suwaidi, M.H.

2014-01-01

Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4% men, 38.6% women, median age: 51 years, range: 13-92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5%) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5%) patients. Considering the 157 patients with fractured ribs, 73 (46.8%) had a single fracture, 38 (24.4%) and two fractures and 45 (28.8%) had more than two fractures. When assessing the 405 CRs, we detected 69 (17%) fractures while the corresponding RS of the same patients revealed 87 (21.5%) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1% received medical therapy, while 64.5% of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosing rib fractures, the results from RS seem to have no significant influence on further clinical management and therapeutic measures. Minor thoracic trauma should be evaluated

Studies on clinical significances of intracranial meningiomas in computerized tomography

International Nuclear Information System (INIS)

Kasamo, Shizuya

1986-01-01

Meningioma has been widely assumed to be a representative benign tumor among the primary intracranial tumors. However, many problems still remain in the clinical management of meningioma. The author had studied the clinical significance of meningiomas from the 104 cases he had experienced. CT was performed in 101 cases of them. In this paper, CT findings of meningioma were initially analyzed with reference to correlations of symptomatological and histopathological features. The mechanism of occurrence of the peritumoral low density (PTL) found on CT was discussed under an identification of cerebral edema. Secondly, the endocrinological environment was studied since certain hormonal changes might influence the growth and spread of the tumor. Estrogen receptor (ER) and progesterone receptor (PgR) in the tumor tissue were studied and discussed as to their clinical evaluation. Thirdly, fine structures in 12 cases of meningiomas were studied by transmission electron microscopy (TEM). And the correlation between the TEM findings and clinical and endocrinological findings were discussed. From these results, the author drew the following conclusions; 1) There was no correlation between the tumor and the hormonal environment, but there is a suggestive evidence that meningioma might be hormone-dependent. 2) The factors of occurrence of PTL were tumor size, location of tumor and histological subtype. And from the findings of TEM, one of the mechanisms of occurrence of PTL might be due to secretion of an edema factor from tumor tissue. 3) Close correlation between tumor size and period from onset to admission was found, and when the tumor size (xmm) was measured on CT, the time of occurrence of tumor (y months ago) could be roughly calculated from the following equation; y = 1.9x - 13.3 (r = 0.683, p < 0.01). (J.P.N.)

Reliability and Clinical Significance of Mobility and Balance Assessments in Multiple Sclerosis

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Learmonth, Yvonne C.; Paul, Lorna; McFadyen, Angus K.; Mattison, Paul; Miller, Linda

2012-01-01

The aim of the study was to establish the test-retest reliability, clinical significance and precision of four mobility and balance measures--the Timed 25-Foot Walk, Six-minute Walk, Timed Up and Go and the Berg Balance Scale--in individuals moderately affected by multiple sclerosis. Twenty four participants with multiple sclerosis (Extended…

Current drug and molecular therapies for the treatment of atrophic age-related macular degeneration: phase I to phase III clinical development.

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Li, Huiling; Chintalapudi, Sumana R; Jablonski, Monica M

2017-10-01

Age-related macular degeneration (AMD) is the leading cause of vision loss among the elderly. Atrophic AMD, including early, intermediate and geographic atrophy (GA), accounts for ~90% of all cases. It is a multifactorial degeneration characterized by chronic inflammation, oxidative stress and aging components. Although no FDA-approved treatment yet exists for the late stage of atrophic AMD, multiple pathological mechanisms are partially known and several promising therapies are in various stages of development. Areas covered: Underlying mechanisms that define atrophic AMD will help provide novel therapeutic targets that will address this largely unmet clinical need. The purpose of this paper is to review current promising drugs that are being evaluated in clinical trials. Because no pharmacological treatments are currently available for late stage of atrophic AMD, any new therapy would have extensive market potential. Expert opinion: The number of AMD patients is predicted to increase to ~30 million worldwide by 2020. In response to this enormous unmet clinical need, new promising therapies are being developed and evaluated in clinical trials. We propose that the assessment of novel interventions will also need to consider the genotypes of participants, as the benefit may be determined by polymorphisms in an individual's genetic background.

Interim analysis: A rational approach of decision making in clinical trial.

Science.gov (United States)

Kumar, Amal; Chakraborty, Bhaswat S

2016-01-01

Interim analysis of especially sizeable trials keeps the decision process free of conflict of interest while considering cost, resources, and meaningfulness of the project. Whenever necessary, such interim analysis can also call for potential termination or appropriate modification in sample size, study design, and even an early declaration of success. Given the extraordinary size and complexity today, this rational approach helps to analyze and predict the outcomes of a clinical trial that incorporate what is learned during the course of a study or a clinical development program. Such approach can also fill the gap by directing the resources toward relevant and optimized clinical trials between unmet medical needs and interventions being tested currently rather than fulfilling only business and profit goals.

Interim analysis: A rational approach of decision making in clinical trial

Directory of Open Access Journals (Sweden)

Amal Kumar

2016-01-01

Full Text Available Interim analysis of especially sizeable trials keeps the decision process free of conflict of interest while considering cost, resources, and meaningfulness of the project. Whenever necessary, such interim analysis can also call for potential termination or appropriate modification in sample size, study design, and even an early declaration of success. Given the extraordinary size and complexity today, this rational approach helps to analyze and predict the outcomes of a clinical trial that incorporate what is learned during the course of a study or a clinical development program. Such approach can also fill the gap by directing the resources toward relevant and optimized clinical trials between unmet medical needs and interventions being tested currently rather than fulfilling only business and profit goals.

Pricing Unmetered Irrigation Water under Asymmetric Information and Full Cost Recovery

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Alban Lika

2016-12-01

Full Text Available The objective of this study is to define an efficient pricing scheme for irrigation water in conditions of unmetered water use. The study is based on a principal-agent model and identifies a menu of contracts, defined as a set of payments and share of irrigated area, able to provide incentives for an efficient use of the resource by maximizing social welfare. The model is applied in the case study of the Çukas region (Albania where irrigation water is not metered. The results demonstrate that using a menu of contracts makes it possible to define a second best solution that may improve the overall social welfare derived from irrigation water use compared with the existing pricing structure, though, in the specific case study, the improvement is small. Furthermore, the results also suggest that irrigation water pricing policy needs to take into account different farm types, and that appropriate contract-type pricing schemes have a potential role in providing incentives to farmers to make irrigation choices to the social optimum.

International nursing students and what impacts their clinical learning: literature review.

Science.gov (United States)

Edgecombe, Kay; Jennings, Michele; Bowden, Margaret

2013-02-01

This paper reviews the sparse literature about international nursing students' clinical learning experiences, and also draws on the literature about international higher education students' learning experiences across disciplines as well as nursing students' experiences when undertaking international clinical placements. The paper aims to identify factors that may impact international nursing students' clinical learning with a view to initiating further research into these students' attributes and how to work with these to enhance the students' clinical learning. Issues commonly cited as affecting international students are socialisation, communication, culture, relationships, and unmet expectations and aspirations. International student attributes tend to be included by implication rather than as part of the literature's focus. The review concludes that recognition and valuing of international nursing students' attributes in academic and clinical contexts are needed to facilitate effective strategies to support their clinical practice in new environments. Copyright © 2012. Published by Elsevier Ltd.

Clinical and prognostic significance of plasma fibrinogen in lung cancer

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Chen YS

2014-01-01

Full Text Available Objectives: Hyperfibrinogenemia is a common problem associated with various carcinomas. The recent studies have shown that high plasma fibrinogen concentration is associated with invasion, growth and metastases of cancer. Furthermore, the recent studies focus on the prognostic significance of fibrinogen in the patients with advanced NSCLC (stage IIIB -IV. However, the prognostic significance of the plasma fibrinogen levels in early stage NSCLC patients (stage I -IIIA still remains unclear. In addition, it remains unclear whether or not chemotherapy-induced changes in fibrinogen level relate to the prognosis. The aims of this study were to 1 further explore the relationship between the plasma fibrinogen concentration and the stage and metastases of lung cancer 2 evaluate the prognostic significance of the basal plasma fibrinogen level in patients with lung cancer 3 explore the prognostic value of the change in fibrinogen levels between pre and post-chemotherapy. Methods: In this retrospective study, the data from 370 patients with lung cancer were enrolled into this study. The plasma fibrinogen levels were compared with the clinical and prognostic significance of lung cancer. The association between the plasma fibrinogen level and clinical-prognostic characteristics were analyzed using SPSS 17.0 software. Results: 1 The median pre-treatment plasma fibrinogen levels were 4.20g/L. Pre-treatment plasma fibrinogen levels correlated significantly with gender (p = 0.013. A higher plasma fibrinogen concentration was associated with squamous cell carcinoma versus adenocarcinoma (4.83±1.50 g/L versus 4.15±1.30 g/L; P<0.001, there was a significant association between plasma fibrinogen level and metastases of lung cancer, pointing a higher plasma fibrinogen level in lymph nodes or distant organ metastases (p < 0.001. 2 Patients with low plasma fibrinogen concentration demonstrates higher overall survival compared with those with high plasma fibrinogen

Dog and cat respiratory capilariasis - clinical, parasitological and epidemiological significance

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Ilić Tamara

2015-01-01

Full Text Available Respiratory capillariasis is a disease of domestic and wild carnivores as well as of people, caused by nematode Eucoleus aerophilus syn. Capillaria aerophila, which lives as a parasite in mucosa of trachea, bronchi and bronchioles, rarely in nasal and frontal sinuses of the host. This parasite has either direct or indirect development cycle which includes optional transition hosts - earthworms. Clinical picture is manifested in the form of a very severe respiratory disease, which is accompanied by an increased bronchovesicular sound, sneezing, gasping and chronic dry cough. Despite the fact that this nematode is widespread in all the parts of the world, that it causes a disease followed by a severe clinical picture and has a zoonotic potential as well, it has been insufficiently investigated and moreover from clinical and parasitological aspect it has not been given enough attention so far. The reason for this is the fact that C. aerophila had been considered to be a strain of very low level of pathogenicity causing only sporadic respiratory infections in dogs and cats. The interest of scientific community for this parasitosis increased the moment when its causative agent spread outside the endemic areas. From the standpoint of monitoring and health protection of both carnivores and peorle, knowledge of basic epizootiological and epidemiological characteristics of these nematodes is of crucial importance, having in mind that its prevalence has significantly increased in dogs and cats in the last ten years, both in Europe and worldwide.

[Expression of IMP3 in osteosarcoma and its clinical significance].

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Li, Kang-hua; Huang, Yue-ping; Zhang, Jun; Li, Guo-jun; Li, Si-hong

2009-05-01

To analyze the expressional variability of IMP3 between osteosarcoma and osteochondroma and explore its clinical significance. Paraffin sections from 68 patients with osteosarcoma and 20 patients with osteochondroma were examined for the expression of IMP3 by SP immunohistochemistry. The negative, weak positive, moderate positive and strong positive expression rates of IMP3 in 68 patients with osteosarcoma were 4.41% (3/68), 22.06% (15/68), 22.74% (19/68), 45.59% (31/68), respectively, which were significantly higher than those in 20 cases of osteochondroma tissues (P<0.01). The positive expression of IMP3 in osteosarcoma was negative correlation with the 3-year survival rate of osteosarcoma patients after the operation (P<0.01). The results suggest that IMP3 plays important roles in the tumorigenesis, progress and prognosis of osteosarcoma, and the expression of IMP3 may be an important feature of osteosarcoma.

Do glycine-extended hormone precursors have clinical significance?

DEFF Research Database (Denmark)

Rehfeld, Jens Frederik

2014-01-01

Half of the known peptide hormones are C-terminally amidated. Subsequent biogenesis studies have shown that the immediate precursor is a glycine-extended peptide. The clinical interest in glycine-extended hormones began in 1994, when it was suggested that glycine-extended gastrin stimulated cancer...... and clinical effects of glycine-extended precursors for most other amidated hormones than gastrin and cholecystokinin (CCK). The idea of glycine-extended peptides as independent messengers was interesting. But clinical science has to move ahead from ideas that cannot be supported at key points after decades...

From unmet clinical need to entrepreneurship: taking your informatics solution to market.

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Bowles, Kathryn H; Heil, Eric

2014-01-01

This paper will describe the process for taking a decision support solution to market as a start-up business. The nurse inventor and Co-Founder of RightCare Solutions, Inc. will share the steps from answering a clinical question, to registering an invention, creating a business plan and company, obtaining venture funding, and launching a commercial product. We will share positives about the experience such as how to get start-up funds, gaining national exposure and access to an excellent team, disseminating your work broadly, further enhancing the product, and obtaining equity, and financial rewards. We will discuss cons such as losing control, dilution of ownership, and conflict of interest. This paper will encourage nurse informaticians to think differently and learn about the steps in the process from an experienced team.

Change and clinical significance of serum PG in patients with chronic gastritis

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Wei-Hua Huan

2017-06-01

Full Text Available Objective: To observe the change and clinical significance of serum PG in patients with chronic atrophic gastritis (CAG. Methods: ELISA was used to detect the peripheral blood PG level in patients confirmed with CAG, gastric polyps, and gastric cancer who were admitted in our hospital from January, 2015 to January, 2016. The normal individuals who came for physical examinations were served as the control group. The peripheral blood PG level in patients with various gastric diseases was observed. Results: The serum PG Ⅰ expression and PG I/PG Ⅱ in the gastritis group were significantly lower than those in the gastric polyps group and control group, but were significantly higher than those in the gastric cancer group; while PG Ⅱ expression was significantly higher than that in the gastric polyps group and control group, but was significantly lower than those in the gastric cancer group. PG Ⅰ expression and PG I/ PG Ⅱ in the gastric polyps group were significantly higher than those in the gastritis group and gastric cancer group, while PG Ⅱ expression was significantly lower than that in the gastritis group and gastric cancer group. PG Ⅰ expression and PG I/ PG Ⅱ in the gastric cancer group were significantly lower than those in the other three groups, while PG Ⅱ expression was significantly higher than that in the other three groups. The serum PG Ⅰ expression in patients with positive HP infection in the gastritis group and gastric cancer group was significantly higher than that in patients with negative HP infection, but the comparison of PG I/ PG Ⅱ was not statistically significant. The serum PG Ⅰ expression and PG I/ PG Ⅱ in patients with negative and positive HP infection in the gastritis group were significantly higher than those in patients with negative and positive HP infection in the gastric cancer group; while PG Ⅱ expression was significantly was significantly lower than that in the gastric cancer group

Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension

DEFF Research Database (Denmark)

Jansen, Christian; Bogs, Christopher; Verlinden, Wim

2017-01-01

BACKGROUND & AIMS: Clinically significant portal hypertension (CSPH) is associated with severe complications and decompensation of cirrhosis. Liver stiffness measured either by transient elastography (TE) or Shear-wave elastography (SWE) and spleen stiffness by TE might be helpful in the diagnosis...... correlate with portal pressure and can both be used as a non-invasive method to investigate CSPH. Even though external validation is still missing, these algorithms to rule-out and rule-in CSPH using sequential SWE of liver and spleen might change the clinical practice....

[Aortic elastic properties and its clinical significance in intracranial aneurysms].

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Pu, Zhao-xia; You, Xiang-dong; Weng, Wen-chao; Wang, Jian-an; Shi, Jian

2011-09-01

To investigate the aortic elastic properties and its clinical significance in intracranial aneurysms (IAs). One hundred and seven IAs patients (57 with hypertension) and 108 healthy subjects were recruited. The internal aortic diameters in systole and diastole were measured by the M-mode echocardiography, the aortic elasticity indexes were calculated and compared. The aortic distensibility (DIS) was lower and the aortic stiffness index (SI) was higher in IAs patients than those in controls (both P IAs patients with hypertension (IAs-HP) than those in IAs with no hypertension (P IAs patients and hypertension is closely related to the severity of aortic elasticity.

Unmet need for modern contraceptives and associated factors among women in the extended postpartum period in Dessie town, Ethiopia

OpenAIRE

Tegegn, Masresha; Arefaynie, Mastewal; Tiruye, Tenaw Yimer

2017-01-01

Background The contraceptive use of women in the extended postpartum period is usually different from other times in a woman’s life cycle due to the additional roles and presence of emotional changes. However, there is lack of evidence regarding women contraceptive need during this period and the extent they met their need. Therefore, the objective of this study was to assess unmet need for modern contraceptives and associated factors among women during the extended postpartum period in Dessi...

Clinical significance of posteroanterior and its cephalometry in adults with facial asymmetry

International Nuclear Information System (INIS)

Sun Xinhua; Feng Qinghui; Jiao Jian

2004-01-01

Objective: To study the clinical significance of posteroanterior (PA) radiographs and cephalometries for diagnosis of facial asymmetry of adults. Methods: PA radiographs in 16 cases of facial asymmetry patients (experiment group, 8 males and 8 females) and 16 normal adults with facial symmetry (control group, 8 males and 8 females) were taken and analyzed. The data was analyzed with Student T test. Results: There were significant differences of DifManM-Y, DifMaxM-Y, DifGo-Y, Me-Y and LI-Y between experiment group and control group by PA radiographs and cephalometries (P<0.01, P<0.05). Conclusion: PA radiographs and cephalometries have a specific significance of diagnosis for facial asymmetry in adults

Exploring patient experiences with prescription medicines to identify unmet patient needs: implications for research and practice.

Science.gov (United States)

Kucukarslan, Suzan N; Lewis, Nancy J W; Shimp, Leslie A; Gaither, Caroline A; Lane, Daniel C; Baumer, Andrea L

2012-01-01

Pharmacy services are offered to patients, and often, they decline participation. Research is needed to better understand patients' unmet needs when taking prescribed medications. To identify and characterize patients' unmet needs related to using prescribed medication for chronic conditions. Focus groups of patients using prescription medication for chronic conditions discussed their experiences with medications, starting from initial diagnosis to ongoing management. Sessions involved 40 patients from 1 Midwestern U.S. state. Major themes were identified using content analysis. Three major themes emerged. First, patients seek information to understand their health condition and treatment rationale. Patients form an illness perception (its consequence, controllability, cause, and duration) that dictates their actions. Second, patients desire to be involved in treatment decisions, and they often feel that decisions are made for them without their understanding of the risk-to-benefit trade-off. Third, patients monitor the impact of treatment decisions to determine if anticipated outcomes are achieved. The results were consistent with Dowell's therapeutic alliance model (TAM) and Leventhal's common sense model (CSM). The TAM can be used to model the consultative services between pharmacists and patients. The impact of the new services (or interventions) can be evaluated using the CSM. Patients expressed a strong desire to be involved in their treatment decisions. The effectiveness of medication therapy management services may be enhanced if pharmacists build on patients' desire to be involved in their treatment decisions and assist them to understand the role of medications and their risks and expected outcomes within the context of the patients' perceptions of illness and desired coping strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

UNMET NEED OF SEX EDUCATION AMONG ADOLESCENTS IN URBAN SLUM AREA: AN INTERVENTIONAL STUDY

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Tamboli Kshitij S, Avachat Subhada S, Tamboli Suchit S

2015-07-01

Full Text Available Context: Adolescents comprise one-fifth of India’s total population. There is widespread ignorance associated with unprotected sex, contraceptives, among young people. As majority adolescents in slum areas have illiterate and ignorant family backgrounds; they are misguided by the myths. Hence providing sex education for them is the need of the hour. Aims: 1 To assess the knowledge and awareness of adolescents in an urban slum area regarding some aspects of reproductive health. 2 To assess the need of sex education among them. 3 To study the impact of sex education on their knowledge Material and Methods: An interventional study was done on 132 adolescents of urban slum area, selected by simple random sampling. Informed consent was obtained from the participants. Data was collected with the help of structured questionnaire prepared by literature search. Response of adolescents was recorded through questionnaires. A sensitization workshop was organized as intervention. The same questionnaire was given to them and the effect of intervention was assessed. Statistical analysis of data was done using percentage, proportion and appropriate tests of significance. Result and Conclusions: Only 31.06% adolescents had discussed the topic of reproductive health with some or other person and out of them friends were the major sources (39.2% of information. Only 38.63% knew the hazards of teenage pregnancy which significantly rose to 89.4% after intervention workshop. The study concludes that the slum adolescents profoundly lack adequate knowledge of sexuality related matters. Even before intervention workshop, unmet need of reproductive health education was 59.1% and 93.93% was the felt need in the post test.

Clinical significance of determination serum sex hormones levels in patients with secondary amenorrhea

International Nuclear Information System (INIS)

Jiang Hua

2007-01-01

Objective: To explore the clinical significance of changes of serum sex hormones levels in patients with secondary amenorrhea. Methods: Serum levels of E 2 , FSH, LH, PRL and P were detected with RIA in 33 patients with secondary amenorrhea and 30 controls. Results: In the patients, the serum E 2 levels were significantly lower and FSH, LH, PRL and P levels were significantly higher than those in controls (P 2 , FSH, LH, PRL and P levels is of help for assessment of severity of secondary amenorrhea as well as outcome prediction. (authors)

Results from an online survey of patient and caregiver perspectives on unmet needs in the treatment of bipolar disorder.

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Masand, Prakash S; Tracy, Natasha

2014-01-01

To look at the manner in which patients and caregivers perceive the treatment of bipolar disorder compared with the evidence base for bipolar treatment. Between April 2013 and March 2014, 469 respondents took a 14-question online survey on demographics, medications taken, and perspectives on bipolar treatment and medications. Participants were recruited through social media outlets (Facebook and Twitter accounts) of Global Medical Education (New York, New York) and the blog Bipolar Burble, which has a primary audience of people with bipolar disorder. There were no exclusion criteria to participation, and both patients and health care professionals were encouraged to participate. Most respondents were taking ≥ 3 medications, and the greatest unmet need in treatment was for bipolar depression. In general, respondent perspectives on the effectiveness of individual medication treatments did not align with the available literature. Weight gain was the greatest side effect concern for both antipsychotics and mood stabilizers. Our survey demonstrates that there are still many unmet needs in the treatment of bipolar disorder. There is also a mismatch between the evidence base for treatments in bipolar disorder and patient perception of the relative efficacy of different medications. In order to achieve better outcomes, there is a need to provide patients and clinicians greater quality education with regard to the best evidence-based treatments for bipolar disorder.

CT classification and clinical significance of rupture globe

International Nuclear Information System (INIS)

Diao Jinzhong; Zhang Guixiang

1998-01-01

Purpose: To discuss CT appearances of the rupture globe, and CT classifications and their clinical significance. Materials and methods: Forty-nine rupture globes were verified; 79% patents were scanned within 24 hours. Axial plane scanning were done with 3 mm slice and 256 x 256 matrix. Bone and soft tissue conditions were adjusted to analyse the bone and globe structures. Results: CT showed that globe circle rupture in one point of 32%, two points of 20%, and multiple points of 28%. Thickening of globe circle was as follows: 5 mm in 10 globes, 6 mm in 24, and 7 mm in 9.20% injured globes were enlarged and 32% were contracted. 14 anterior chambers deepened more than 4 mm. 83% rupture globes also had intraglobe hemorrhage and 48% foreign bodies. 28% injured globes had exophthalmus, and 75% had injured parasinuses or orbits, or brain trauma. Conclusion: The authors classified the rupture globe into three types. Type III showed unrepaired that should ablate the injured globes, whereas type I and II had to repair and to debride

Clinical significance of quantitative analysis of facial nerve enhancement on MRI in Bell's palsy.

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Song, Mee Hyun; Kim, Jinna; Jeon, Ju Hyun; Cho, Chang Il; Yoo, Eun Hye; Lee, Won-Sang; Lee, Ho-Ki

2008-11-01

Quantitative analysis of the facial nerve on the lesion side as well as the normal side, which allowed for more accurate measurement of facial nerve enhancement in patients with facial palsy, showed statistically significant correlation with the initial severity of facial nerve inflammation, although little prognostic significance was shown. This study investigated the clinical significance of quantitative measurement of facial nerve enhancement in patients with Bell's palsy by analyzing the enhancement pattern and correlating MRI findings with initial severity of facial palsy and clinical outcome. Facial nerve enhancement was measured quantitatively by using the region of interest on pre- and postcontrast T1-weighted images in 44 patients diagnosed with Bell's palsy. The signal intensity increase on the lesion side was first compared with that of the contralateral side and then correlated with the initial degree of facial palsy and prognosis. The lesion side showed significantly higher signal intensity increase compared with the normal side in all of the segments except for the mastoid segment. Signal intensity increase at the internal auditory canal and labyrinthine segments showed correlation with the initial degree of facial palsy but no significant difference was found between different prognostic groups.

Unmet needs for analyzing biological big data: A survey of 704 NSF principal investigators.

Science.gov (United States)

Barone, Lindsay; Williams, Jason; Micklos, David

2017-10-01

In a 2016 survey of 704 National Science Foundation (NSF) Biological Sciences Directorate principal investigators (BIO PIs), nearly 90% indicated they are currently or will soon be analyzing large data sets. BIO PIs considered a range of computational needs important to their work, including high performance computing (HPC), bioinformatics support, multistep workflows, updated analysis software, and the ability to store, share, and publish data. Previous studies in the United States and Canada emphasized infrastructure needs. However, BIO PIs said the most pressing unmet needs are training in data integration, data management, and scaling analyses for HPC-acknowledging that data science skills will be required to build a deeper understanding of life. This portends a growing data knowledge gap in biology and challenges institutions and funding agencies to redouble their support for computational training in biology.

Clinical significance of serum thymosin α1 assay in tumor patients

International Nuclear Information System (INIS)

Wang Jiamin; Lv Ming'en; Zhao Xiaojuan; Gao Weiqiang; Bai Xia; Wang Zhaoyue

2003-01-01

Objective: To investigate the clinical significance of thymosin α1(Tα1) measurement in evaluating clinical status of patients with solid malignant tumors. Methods: Tα1 levels in serum of 50 normal adults, 20 patients with benign tumors and 63 patients with malignant tumors were measured by enzyme linked immunosorbent assay (ELISA). The association of Tα1 level with tumor invasion, metastasis and its alteration after different treatment in patients with malignant tumors were also studied. Results: The serum Tα1 level was 0.69±0.35 μg/L in normal adults, 0.96±0.37 μg/L in patients with benign tumors and 1.46±0.90 μg/L in patients with malignant tumors. In comparison it was both increased between patients with benign and malignant tumors and the normal adults (P<0.01 and P<0.001). And its increasing extent in malignant tumors was much greater than that in benign tumors (P<0.05). The serum Tα1 level in patients with malignant tumors was correlated with tumor invasion, metastasis and different treatment intervention. Conclusions: Our findings suggest that the serum Tα1 level be increased in tumor patients, and that it may be used as a new tumor marker in clinic

Unmet Needs and Unused Capacities: Time Banking as a Solution

Directory of Open Access Journals (Sweden)

Neva Goodwin

2018-02-01

Full Text Available In market economies many human activities have little or no money value; these include, especially, the kinds of caring labor that are supplied, mostly by women, mostly in homes and communities. Nevertheless, there is, as ever, a great need for such activities. At the same time, wealthy societies are producing ever more people who suffer from feeling that they have little or nothing of value to offer to the world. Retired people, in their growing numbers, are the most obvious examples, but teenagers and other youth, who in other societies can contribute significantly to the well-being of a family or a community, are seldom seen as assets in modern economies. Market-dominated societies have had difficulty expressing the value of work that is not organized for profit. Such work is undertaken in the public purpose economy, consisting of governments and their agencies as well as non-profit organizations. Much of this kind of work is also undertaken in the core economy, where households and communities carry on their internal activities of resource management, production, distribution, and consumption. The core economy and the public purpose economy, together with the market economy, are a trio that are differentiated by their goals; by what kind of demand they respond to; by how they define and reward work; and by what kind of currency they use. TimeBanking is an innovation in currency that turns out to affect all of these areas by getting us out of the binary box that classifies all contributions in just two ways: work (defined in market terms, or volunteering (defined as uncompensated labor. Responding effectively to different values and goals than those recognized in the market, TimeBanking has been shown able to respond to a wide variety of unmet needs by creating relationships where everyone can get some of their needs met, and everyone is valued for what they can offer.  

The clinical significance of axillary sentinel lymph node biopsy in different clinical stages breast cancer patients after neoadjuvant chemotherapy

Institute of Scientific and Technical Information of China (English)

Juan Xu; Xinhong Wu; Yaojun Feng; Feng Yuan; Wei Fan

2013-01-01

Objective:We aimed to study the success and false negative rate of sentinel lymph node biopsy (SLNB) in dif-ferent clinical stages breast cancer patients being carried out with neoadjuvant chemotherapy (NAC), and the clinical signifi-cance of SLNB, we conducting this trial. Methods:One hunderd and thirty-seven cases were enrol ed in this clinical research from March 2003 to March 2007. Al of the patients’ sentinel lymph nodes were detected with 99mTc-Dx and methylene blue. There were 61 patients with stage T1-2N0M0 carried SLNB without NAC (group A), 76 cases were carried out NAC 3-4 cycles before SLNB, including 39 T2-4N0-1M0 cases (group B) and 27 T2-4N2-3M0 cases (group C). The success and false negative rate of SLNB were analysed with chi-square test. Results:In group A, the successful and false negative rate of SLNB were 92.31%(36/39), 8.57%(3/35), and in group B and C were 92.31%(36/39), 8.57%(3/35) and 74.07%(20/27), 18.52%(5/27), respectively. The successful rate of group C decreased and false negative rate increased significantly compared with group A and B (P0.05). Conclusion:The SLNB can accurately predict lymph node status of axil ary lymph node in N0-1 stage patients with NAC, but in N2-3 stage patients the success rate decreased and false rate increased negative significantly.

Clinical Significance of Histological Features of Thrombi in Patients with Myocardial Infarction

Energy Technology Data Exchange (ETDEWEB)

Sebben, Juliana Canedo; Cambruzzi, Eduardo; Avena, Luisa Martins; Gazeta, Cristina do Amaral; Gottschall, Carlos Antonio Mascia; Quadros, Alexandre Schaan de, E-mail: quadros.pesquisa@gmail.com [Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS (Brazil)

2013-12-15

Percutaneous Coronary Intervention (PCI) is the most common strategy for the treatment of Acute ST segment elevation Myocardial Infarction (STEMI), and thromboaspiration has been increasingly utilized for removal of occlusive thrombi. To analyze the influence of histopathological features of coronary thrombi in clinical outcomes of patients with STEMI, and the association of these variables with clinical, angiographic, and laboratory features and medications used in hospitalization. Prospective cohort study. All patients were monitored during hospitalization and thirty days after the event. Aspirated thrombi were preserved in formalin and subsequently stained with hematoxylin-eosin and embedded in paraffin. Thrombi were classified as recent and old. The primary outcome was the occurrence of major cardiovascular events within thirty days. During the study period, 1,149 patients were evaluated with STEMI, and 331 patients underwent thrombi aspiration, leaving 199 patients available for analysis. It was identified recent thrombi in 116 patients (58%) and old thrombi in 83 patients (42%). Recent thrombi have greater infiltration of red blood cells than old thrombi (p = 0.02), but there were no statistically significant differences between other clinical, angiographic, laboratory, and histopathological features and medications in both group of patients. The rates of clinical outcomes were similar in both groups. Recent thrombi were identified in 58% of patients with STEMI and it was observed an association with infiltration of red blood cells. There was no association between histopathological features of thrombi and clinical variables and cardiovascular outcomes.

Unmet demand for training among mature age Australians: Prevalence, differentials and perceived causes.

Science.gov (United States)

Adair, Tim; Lourey, Emma; Taylor, Philip

2016-03-01

To explore the prevalence of unmet demand for training by mature age Australians and to identify the main barriers to accessing training. A total of 3007 Australians aged 45-74 years were surveyed using Computer Assisted Telephone Interviewing. The sample frame was randomly selected and stratified based on the capital city and the rest of the state, and data were weighted to be nationally representative. Over one-third (37%) of respondents who had worked in the past five years reported wanting to attend some form of training but were unable to; these were most likely women and those aged 45-54 year. Commonly cited reasons for not being able to attend training included not being able to fit it in with work commitments, affordability and employer reluctance. Reduction of these barriers to workplace training can improve mature age people's ability to remain engaged in the workforce. © 2015 AJA Inc.

Clinical significance of pneumatosis intestinalis - correlation of MDCT-findings with treatment and outcome

Energy Technology Data Exchange (ETDEWEB)

Treyaud, Marc-Olivier; Duran, Rafael; Knebel, Jean-Francois; Meuli, Reto A.; Schmidt, Sabine [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Zins, Marc [Fondation Hopital St Joseph, Department of Radiology, Paris (France)

2017-01-15

To evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome. Two radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome. The most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p < 0.001). Elevated white blood count significantly correlated with ischemia (p = 0.03). In emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia. (orig.)

Assessing clinical significance in measuring oncology patient quality of life: Introduction to the symposium, content overview, and definition of terms

NARCIS (Netherlands)

Sloan, Jeff A.; Cella, David; Frost, Marlene; Guyatt, Gordon H.; Sprangers, Mirjam; Symonds, Tara

2002-01-01

The Clinical Significance Consensus Meeting Group of the Symposium on the Clinical Significance of Quality-of-Life Measures in Cancer Patients produced 6 articles regarding the clinical significance of quality of life (QOL) assessments in oncology. The 6 articles deal with the methods used to date:

Sonographic Evaluation of Clinically Significant Perigraft Hematomas in Kidney Transplant Recipients.

Science.gov (United States)

Fananapazir, Ghaneh; Rao, Rajiv; Corwin, Michael T; Naderi, Sima; Santhanakrishnan, Chandrasekar; Troppmann, Christoph

2015-10-01

The purpose of this study was to assess the sensitivity of ultrasound in evaluating peritransplant hematomas that require surgical evacuation in recipients of kidney transplants. Thirty-four patients who underwent 37 hematoma evacuations underwent ultrasound examinations in the 24 hours before surgical evacuation. The operative reports were evaluated for presence and size of collection, presence of active bleeding at operation, and composition of the hematoma. The clinical findings leading to the ultrasound examination were recorded. Ultrasound examinations were evaluated in consensus by two board-certified and fellowship-trained abdominal radiologists for the presence, size, and echogenicity of the collection; subjective perfusion visualized with color and power Doppler ultrasound; velocities of the renal arteries; and arcuate artery resistive indexes. Ten of the 37 imaged hematomas (27%) had either no or small (hematomas. Our results suggest that gray-scale sonography alone appears to have limited sensitivity in detecting clinically significant peritransplant hematomas and that its use may result in overall underestimates of hematomas.

Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life.

Science.gov (United States)

Galvão, Daniel A; Newton, Robert U; Gardiner, Robert A; Girgis, Afaf; Lepore, Stephen J; Stiller, Anna; Occhipinti, Stefano; Chambers, Suzanne K

2015-06-18

The purpose of this study was to determine prevalence of Australian prostate cancer survivors meeting contemporary exercise-oncology guidelines and identify associations with distress, unmet supportive care needs, and quality of life. A population-based cohort of 463 prostate cancer survivors who were on 10.8 months post-curative therapy was assessed for compliance with current exercise guidelines for cancer survivors, motivational readiness for physical activity, psychological distress, unmet supportive care needs, and quality of life. Only 57 men (12.3%) reported sufficient exercise levels (150 min of moderate intensity or 75 min of strenuous exercise per week and twice weekly resistance exercise), 186 (40.2%) were insufficiently active, and 220 (47.5%) were inactive. Among inactive men, 99 (45.0%) were in the contemplation or preparation stage of motivation readiness. Inactive men had higher global distress (p = 0.01) and Brief Symptom Inventory-Anxiety (p Australian prostate cancer survivors met contemporary exercise-oncology recommendations despite increasing recognition of exercise to improve patient outcomes. Strategies are urgently required to increase prostate cancer survivors' participation in aerobic and resistance exercise training.Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients

International Nuclear Information System (INIS)

Breen, Micheal; Lee, Edward Y.; Zurakowski, David

2015-01-01

The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children. The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children. This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms ''nodule,'' ''nodular'' or ''mass'' in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student's t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules. Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these

Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients

Energy Technology Data Exchange (ETDEWEB)

Breen, Micheal; Lee, Edward Y. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Zurakowski, David [Boston Children' s Hospital and Harvard Medical School, Departments of Anesthesiology and Surgery, Boston, MA (United States)

2015-11-15

The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children. The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children. This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms ''nodule,'' ''nodular'' or ''mass'' in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student's t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules. Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these

Prevention of epilepsy: Should we be avoiding clinical trials?

Science.gov (United States)

Klein, Pavel; Tyrlikova, Ivana

2017-07-01

Epilepsy prevention is one of the great unmet needs in epilepsy. Approximately 15% of all epilepsy is caused by an acute acquired CNS insult such as traumatic brain injury (TBI), stroke or encephalitis. There is a latent period between the insult and epilepsy onset that presents an opportunity to intervene with preventive treatment that is unique in neurology. Yet no phase 3 epilepsy prevention studies, and only 2 phase 2 studies have been initiated in the last 16years. Current prevailing opinion is that the research community is not ready for clinical preventive epilepsy studies, and that animal models should first be refined and biomarkers of epileptogenesis and of epilepsy discovered before clinical studies are embarked upon. We review data to suggest that there is basis to do epilepsy prevention studies now with the current knowledge and available drugs, and that those studies are feasible with currently available tools. We suggest that a different approach is needed from the past in order to maximize chances of success, minimize the cost, and set up platform for future preventive treatment development. That approach should include close coordination of preclinical and clinical development programs in a combined PTE prevention strategy, consideration of polytherapy, and simultaneous, combined clinical development of preventive treatment and of biomarker discovery. We argue that the currently favored approach of eschewing clinical studies until biomarkers are available will delay the discovery of epilepsy prevention treatment by at least 10 years and significantly increase the cost of such discovery. Copyright © 2017 Elsevier Inc. All rights reserved.

Distinguishing between statistical significance and practical/clinical meaningfulness using statistical inference.

Science.gov (United States)

Wilkinson, Michael

2014-03-01

Decisions about support for predictions of theories in light of data are made using statistical inference. The dominant approach in sport and exercise science is the Neyman-Pearson (N-P) significance-testing approach. When applied correctly it provides a reliable procedure for making dichotomous decisions for accepting or rejecting zero-effect null hypotheses with known and controlled long-run error rates. Type I and type II error rates must be specified in advance and the latter controlled by conducting an a priori sample size calculation. The N-P approach does not provide the probability of hypotheses or indicate the strength of support for hypotheses in light of data, yet many scientists believe it does. Outcomes of analyses allow conclusions only about the existence of non-zero effects, and provide no information about the likely size of true effects or their practical/clinical value. Bayesian inference can show how much support data provide for different hypotheses, and how personal convictions should be altered in light of data, but the approach is complicated by formulating probability distributions about prior subjective estimates of population effects. A pragmatic solution is magnitude-based inference, which allows scientists to estimate the true magnitude of population effects and how likely they are to exceed an effect magnitude of practical/clinical importance, thereby integrating elements of subjective Bayesian-style thinking. While this approach is gaining acceptance, progress might be hastened if scientists appreciate the shortcomings of traditional N-P null hypothesis significance testing.

Prediction of Unmet Primary Care Needs for the Medically Vulnerable Post-Disaster: An Interrupted Time-Series Analysis of Health System Responses

Directory of Open Access Journals (Sweden)

Amy B. Martin

2012-09-01

Full Text Available Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.

External Beam Radiotherapy for Clinically Localized Hormone-Refractory Prostate Cancer: Clinical Significance of Nadir Prostate-Specific Antigen Value Within 12 Months

International Nuclear Information System (INIS)

Ogawa, Kazuhiko; Nakamura, Katsumasa; Sasaki, Tomonari; Onishi, Hiroshi; Koizumi, Masahiko; Shioyama, Yoshiyuki; Araya, Masayuki; Mukumoto, Nobutaka M.S.; Mitsumori, Michihide; Teshima, Teruki

2009-01-01

Purpose: To analyze retrospectively the results of external beam radiotherapy for clinically localized hormone-refractory prostate cancer and investigate the clinical significance of nadir prostate-specific antigen (PSA) value within 12 months (nPSA12) as an early estimate of clinical outcomes after radiotherapy. Methods and Materials: Eighty-four patients with localized hormone-refractory prostate cancer treated with external beam radiotherapy were retrospectively reviewed. The total radiation doses ranged from 30 to 76 Gy (median, 66 Gy), and the median follow-up period for all 84 patients was 26.9 months (range, 2.7-77.3 months). Results: The 3-year actuarial overall survival, progression-free survival (PFS), and local control rates in all 84 patients after radiotherapy were 67%, 61%, and 93%, respectively. Although distant metastases and/or regional lymph node metastases developed in 34 patients (40%) after radiotherapy, local progression was observed in only 5 patients (6%). Of all 84 patients, the median nPSA12 in patients with clinical failure and in patients without clinical failure was 3.1 ng/mL and 0.5 ng/mL, respectively. When dividing patients according to low (<0.5 ng/mL) and high (≥0.5 ng/mL) nPSA12 levels, the 3-year PFS rate in patients with low nPSA12 and in those with high nPSA12 was 96% and 44%, respectively (p < 0.0001). In univariate analysis, nPSA12 and pretreatment PSA value had a significant impact on PFS, and in multivariate analysis nPSA12 alone was an independent prognostic factor for PFS after radiotherapy. Conclusions: External beam radiotherapy had an excellent local control rate for clinically localized hormone-refractory prostate cancer, and nPSA12 was predictive of clinical outcomes after radiotherapy.

Candiduria: A review of clinical significance and management

International Nuclear Information System (INIS)

Bukhary, Z.A.

2008-01-01

Candiduria is a common nosocomial infection afflicting the urinary tract. This review is aimed at providing an updated summary of the problem in hospitalized adult patients. A review of English Medline literature published between January 1970 until June 2007 was performed. Reviews, clinical trials and case-controlled studies in adult patients were included. Risk factors for candiduria included urinary indwelling catheters, use of antibiotics, elderly age, underlying genitourinary tract abnormality, previous surgery and presence of diabetes mellitus. Presence of candiduria may represent only colonization and there are no consistent diagnostic criteria to define significant infection. Candiduria may not be associated with candidemia and most cases are asymptomatic. Asymptomatic canididuria is usually benign, and does not require local or systemic antifungal therapy. Physicians need to confirm the infection by a second sterile urine sample, adopt non-pharmacologic interventions and modify risk factors. Mortality rate can be high particularly in debilitated patients and awareness to validate candiduria is necessary to stratify treatment according to patient status. Appropriate use of antifungal drugs, when indicated, should not replace correction of the underlying risk factors. Treatment of symptomatic candiduria is less controversial and easier. (author)

[Expression and clinical significance of CD147 in parathyroid carcinoma].

Science.gov (United States)

Du, X M; Wang, L L; Chang, H; Meng, W; Zhang, J Y; Shen, B

2016-06-08

To study the expression and clinical significance of CD147 in the patients of parathyroid carcinoma. Fourteen cases of parathyroid carcinoma encountered during the period from 2012 to 2015 were enrolled. Thirty three cases of parathyroid adenoma encountered during the same period were enrolled. The expression of CD147 in parathyroid carcinoma and parathyroid adenoma was studied by means of immunohistochemistry (EnVision method). CD147 positive color was brown and yellow, and positive position was located mainly in the cytomembrane, and a small amount of cytoplasm was appeared. Among 14 cases of parathyroid carcinoma, 11 cases of CD147 positive score was 3+ , 3 cases of CD147 positive score was 2+ ; Among 33 cases of parathyroid adenoma , 8 cases of CD147 positive score was 2+ , 15 cases of it was 1+ , 10 cases of it was negative. CD147 was highly expressed in parathyroid carcinoma tissues, and the expression of CD147 was significantly different from the expression of parathyroid adenoma(PCD147 immunohistochemical staining can help to diagnose parathyroid carcinoma.

Unmet needs for analyzing biological big data: A survey of 704 NSF principal investigators.

Directory of Open Access Journals (Sweden)

Lindsay Barone

2017-10-01

Full Text Available In a 2016 survey of 704 National Science Foundation (NSF Biological Sciences Directorate principal investigators (BIO PIs, nearly 90% indicated they are currently or will soon be analyzing large data sets. BIO PIs considered a range of computational needs important to their work, including high performance computing (HPC, bioinformatics support, multistep workflows, updated analysis software, and the ability to store, share, and publish data. Previous studies in the United States and Canada emphasized infrastructure needs. However, BIO PIs said the most pressing unmet needs are training in data integration, data management, and scaling analyses for HPC-acknowledging that data science skills will be required to build a deeper understanding of life. This portends a growing data knowledge gap in biology and challenges institutions and funding agencies to redouble their support for computational training in biology.

Clinical Significance of Immuno phenotypic Markers in Pediatric T-cell Acute Lymphoblastic Leukemia

International Nuclear Information System (INIS)

SIDHOM, I.; SHAABAN, Kh.; SOLIMAN, S.; HAMDY, N.; YASSIN, D.; SALEM, Sh.; HASSANEIN, H.; MANSOUR, M.T.; EZZAT, S.; EL-ANWAR, W.

2008-01-01

Background: Cell-marker profiling has led to conflicting conclusions about its prognostic significance in T-ALL. Aim: To investigate the prevalence of the expression of CD34, CD10 and myeloid associated antigens (CD13/ CD33) in childhood T-ALL and to relate their presence to initial clinical and biologic features and early response to therapy. Patients and Methods: This study included 67 consecutive patients with newly diagnosed T-ALL recruited from the Children's Cancer Hospital in Egypt during the time period from July 2007 to June 2008. Immuno phenotypic markers and minimal residual disease (MRD) were studied by five-color flow cytometry. Results: The frequency of CD34 was 34.9%, CD10 33.3%, while CD13/CD33 was 18.8%. No significant association was encountered between CD34, CD10 or myeloid antigen positivity and the presenting clinical features as age, sex, TLC and CNS leukemia. Only CD10+ expression had significant association with initial CNS involvement (p=0.039). CD34 and CD13/CD33 expression was significantly associated with T-cell maturation stages (p<0.05). No relationship was observed for age, TLC, gender, NCI risk or CNS involvement with early response to therapy illustrated by BM as well as MRD day 15 and day 42. CD34+, CD13/CD33+ and early T-cell stage had high MRD levels on day 15 that was statistically highly significant (p<0.01), but CD10+ had statistically significant lower MRD level on day 15 (p=0.049). However, only CD34 retained its significance at an MRD cut-off level of 0.01%. Conclusion: CD34, CD10, CD13/CD33 expression, as well as T-cell maturation stages, may have prognostic significance in pediatric T-ALL as they have a significant impact on early clearance of leukemic cells detected by MRD day 15.

A randomized controlled trial of a community-based dementia care coordination intervention: effects of MIND at Home on caregiver outcomes.

Science.gov (United States)

Tanner, Jeremy A; Black, Betty S; Johnston, Deirdre; Hess, Edward; Leoutsakos, Jeannie-Marie; Gitlin, Laura N; Rabins, Peter V; Lyketsos, Constantine G; Samus, Quincy M

2015-04-01

To assess whether MIND at Home, a community-based, multicomponent, care coordination intervention, reduces unmet caregiving needs and burden in informal caregivers of persons with memory disorders. An 18-month randomized controlled trial of 289 community-living care recipient (CR)-caregiver (informal caregivers, i.e., unpaid individuals who regularly assisted the CR) dyads from 28 postal code areas of Baltimore, Maryland was conducted. All dyads and the CR's primary care physician received the written needs assessment results and intervention recommendations. Intervention dyads then received an 18-month care coordination intervention delivered by nonclinical community workers to address unmet care needs through individualized care planning, referral and linkage to dementia services, provision of caregiver dementia education and skill-building strategies, and care progress monitoring by an interdisciplinary team. Primary outcome was total percent of unmet caregiver needs at 18 months. Secondary outcomes included objective and subjective caregiver burden measures, quality of life (QOL), and depression. Total percent of unmet caregiver needs declined in both groups from baseline to 18 months, with no statistically significant between-group difference. No significant group differences occurred in most caregiver burden measures, depression, or QOL. There was a potentially clinically relevant reduction in self-reported number of hours caregivers spent with the CR for MIND participants compared with control subjects. No statistically significant impacts on caregiver outcomes were found after multiple comparison adjustments. However, MIND at Home appeared to have had a modest and clinically meaningful impact on informal caregiver time spent with CRs. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

[Expression and clinical significance of KIAA1199 in primary hepatocellular carcinoma].

Science.gov (United States)

Gu, C J; Ni, Q C; Ni, K; Zhang, S; Qian, H X

2018-05-29

Objective: To investigate the expression and clinical significance of KIAA1199 in primary hepatocellular carcinoma. Methods: A total of 136 cases of primary hepatocellular carcinoma tissues and paired adjacent tissues were collected. Immunohistochemistry and Western blot were used to detect the expression of KIAA1199 in primary hepatocellular carcinoma tissues and paired adjacent tissues. The relationship between KIAA1199 and clinicopathological parameter of primary hepatocellular carcinoma was analyzed. Results: The positive rate of KIAA1199 in primary hepatocellular carcinoma was 82.3% (112/136), which was higher than that in paired para-cancerous tissues (14.7%, 20/136). High expression of KIAA1199 was significantly correlated with age, cirrhosis history, tumor size, tumor number, degree of differentiation, TNM staging and microvenous invasion (MVI) ( P 0.05). The Kaplan-Meier survival curves indicated that high KIAA1199 expression was associated with poor survival ( P hepatocellular carcinoma, which is significantly correlated with the clinicopathological features and prognosis, high expression of KIAA1199 increased the risk of death in patients with primary hepatocellular carcinoma.

LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People.

Science.gov (United States)

Steele, Leah S; Daley, Andrea; Curling, Deone; Gibson, Margaret F; Green, Datejie C; Williams, Charmaine C; Ross, Lori E

2017-02-01

Previous studies have found that transgender, lesbian, and bisexual people report poorer mental health relative to heterosexuals. However, available research provides little information about mental health service access among the highest need groups within these communities: bisexual women and transgender people. This study compared past year unmet need for mental health care and untreated depression between four groups: heterosexual cisgender (i.e., not transgender) women, cisgender lesbians, cisgender bisexual women, and transgender people. This was a cross-sectional Internet survey. We used targeted sampling to recruit 704 sexual and gender minority people and heterosexual cisgendered adult women across Ontario, Canada. To ensure adequate representation of vulnerable groups, we oversampled racialized and low socioeconomic status (SES) women. Trans participants were 2.4 times (95% confidence intervals [CI] = 1.6-3.8, p mental healthcare as cisgender heterosexual women. Trans participants were also 1.6 times (95% CI = 1.0-27, p = 0.04) more likely to report untreated depression. These differences were not seen after adjustment for social context factors such as discrimination and social support. We conclude that there are higher rates of unmet need and untreated depression in trans and bisexual participants that are partly explained by differences in social factors, including experiences of discrimination, lower levels of social support, and systemic exclusion from healthcare. Our findings suggest that the mental health system in Ontario is not currently meeting the needs of many sexual and gender minority people.

Expression and clinical significance of fibroblast growth factor 1 in gastric adenocarcinoma

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Liu NQ

2015-03-01

Full Text Available Naiqing Liu,1,2,* Jingyu Zhang,2,* Shuxiang Sun,2 Liguang Yang,2 Zhongjin Zhou,2 Qinli Sun,2 Jun Niu11Department of General Surgery, Qilu Hospital Affiliated to Shandong University, Jinan, People’s Republic of China; 2Department of General Surgery, Yishui Central Hospital, Linyi, People’s Republic of China*These authors contributed equally to this workBackground: The clinical significance of fibroblast growth factor 1 (FGF1 has been revealed in several cancers, including ovarian cancer, breast cancer, and bladder cancer. However, the clinical significance of FGF1 in gastric adenocarcinoma has not been explored.Patients and methods: In our experiments, we systematically evaluated FGF1 expression in 178 cases of gastric adenocarcinoma with immunohistochemistry, and subsequently analyzed the correlation between FGF1 expression and clinicopathologic features. Moreover, FGF1 expression in tumor tissue and corresponding adjacent tissue was detected and compared by real-time polymerase chain reaction. The Kaplan–Meier method and the Cox-regression model were used with univariate and multivariate analysis, respectively, to evaluate the prognostic value of FGF1 in gastric adenocarcinoma.Results: Higher FGF1 expression rate is 56.7% (101/178 in gastric adenocarcinoma. FGF1 expression in gastric adenocarcinoma was significantly higher than adjacent tissue (P<0.0001. Expression of FGF1 is significantly associated with lymph node invasion (P<0.001, distant metastasis (P=0.013, and differentiation (P=0.015. Moreover, FGF1 overexpression was closely related to unfavorable overall survival rate (P=0.021, and can be identified to be an independent unfavorable prognostic factor (P=0.004.Conclusion: FGF1 is an independent prognostic factor, indicating that FGF1 could be a potential molecular drug target in gastric adenocarcinoma.Keywords: fibroblast growth factor 1, gastric adenocarcinoma, prognosis, biomarker, lymph node, gene fusion

Study to determine the clinical significance of HEmolysis During Orbital AtheRectomy (CLEAR study).

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Staniloae, Cezar S; Korabathina, Ravikiran; Lane, Thomas A; Dattilo, Raymond; Church, Kevin J; Mody, Kanika P; Mayeda, Guy S

2011-02-01

To evaluate the incidence of clinically evident hemolysis associated with orbital atherectomy used to treat severe peripheral artery disease. The observational CLEAR study enrolled 31 subjects (16 men; mean age 71 ± 10 years, range 44-92) with claudication (58.1%) or critical limb ischemia (38.7%) who underwent orbital atherectomy with the Diamondback 360 system at 4 US centers. The 42 lesions in 31 limbs were located in the superficial femoral (n = 19, 45.2%), popliteal (n = 8, 19.0%), and tibial arteries (n = 15, 35.8%). The majority of lesions (34, 81.0%) were de novo; moderate or severe calcification was identified in 90.5% of cases. Lesion and procedural parameters were analyzed at a core laboratory. Blood samples were collected during and post procedure and analyzed for markers of hemolysis. The primary endpoint was the occurrence of clinically significant hemolysis. The secondary endpoints included the occurrence of any clinical symptoms/signs potentially related to hemolysis. Statistical analysis was performed to identify predictors for hemolysis. Laboratory evidence of hemolysis was seen in 11 (35.5%) subjects. No one met the clinical event criteria, and so the primary endpoint of the study was not reached. The secondary endpoints were hypertensive crisis (1, 3.2%) and transient hemoglobinuria (3, 9.7%). Lower glomerular filtration rates, calcified plaque, long atherectomy runs, and solid crown selection were independent predictors of hemolysis. There was no clinically significant hemolysis after orbital atherectomy. The results of this study will enable users to predict conditions that predispose to high levels of red cell hemolysis following orbital atherectomy and to take appropriate measures to limit its occurrence.

Clinical significance of methicillin-resistant Staphylococcus aureus colonization on hospital admission: one-year infection risk.

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Jessica P Ridgway

Full Text Available BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA nasal colonization among inpatients is a well-established risk factor for MRSA infection during the same hospitalization, but the long-term risk of MRSA infection is uncertain. We performed a retrospective cohort study to determine the one-year risk of MRSA infection among inpatients with MRSA-positive nasal polymerase chain reaction (PCR tests confirmed by positive nasal culture (Group 1, patients with positive nasal PCR but negative nasal culture (Group 2, and patients with negative nasal PCR (Group 3. METHODOLOGY/PRINCIPAL FINDINGS: Subjects were adults admitted to a four-hospital system between November 1, 2006 and March 31, 2011, comprising 195,255 admissions. Patients underwent nasal swab for MRSA PCR upon admission; if positive, nasal culture for MRSA was performed; if recovered, MRSA was tested for Panton-Valentine Leukocidin (PVL. Outcomes included MRSA-positive clinical culture and skin and soft tissue infection (SSTI. Group 1 patients had a one-year risk of MRSA-positive clinical culture of 8.0% compared with 3.0% for Group 2 patients, and 0.6% for Group 3 patients (p<0.001. In a multivariable model, the hazard ratios for future MRSA-positive clinical culture were 6.52 (95% CI, 5.57 to 7.64 for Group 1 and 3.40 (95% CI, 2.70 to 4.27 for Group 2, compared with Group 3 (p<0.0001. History of MRSA and concurrent MRSA-positive clinical culture were significant risk factors for future MRSA-positive clinical culture. Group 1 patients colonized with PVL-positive MRSA had a one-year risk of MRSA-positive clinical culture of 10.1%, and a one-year risk of MRSA-positive clinical culture or SSTI diagnosis of 21.7%, compared with risks of 7.1% and 12.5%, respectively, for patients colonized with PVL-negative MRSA (p = 0.04, p = 0.005, respectively. CONCLUSIONS/SIGNIFICANCE: MRSA nasal colonization is a significant risk factor for future MRSA infection; more so if detected by

Clinical significance of autoantibodies in autoimmune hepatitis.

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Liberal, Rodrigo; Mieli-Vergani, Giorgina; Vergani, Diego

2013-10-01

The accurate diagnosis and classification of autoimmune hepatitis (AIH) rely upon the detection of characteristic autoantibodies. Positivity for anti-nuclear (ANA) and/or anti-smooth muscle (SMA) autoantibodies defines AIH type 1 (AIH-1), whereas anti-liver kidney microsomal type 1 (anti-LKM1) and/or anti-liver cytosol type 1 (anti-LC1) define AIH type 2 (AIH-2). ANA and SMA, and less commonly anti-LKM1, have also been detected in de-novo autoimmune hepatitis developing after liver transplantation, a condition that may affect patients transplanted for non-autoimmune liver disease. The diagnostic autoantibodies associated with AIH-1 are also detected in the paediatric AIH/sclerosing cholangitis overlap syndrome, referred to as autoimmune sclerosing cholangitis (ASC). ASC, like adult primary sclerosing cholangitis, is often associated with atypical perinuclear anti-neutrophil cytoplasmic autoantibodies (p-ANCA), although p-ANCA are also detected in other autoimmune liver diseases. These associations highlight the necessity for simple and prompt diagnostic autoantibody testing, and the requirement for the accurate interpretation of the results of the tests in the clinical context. Fine-mapping of antigenic autoantibody targets has facilitated the development of rapid molecular assays that have the potential to revolutionise the field if properly standardised and when used in combination with classical immunofluorescence. Despite their diagnostic significance, the pathogenic role of the various autoantibodies and the mechanisms by which they can potentially inflict damage onto the liver cell remain a topic for further research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Clinical significance of sleep bruxism on several occlusal and functional parameters.

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Ommerborn, Michelle A; Giraki, Maria; Schneider, Christine; Fuck, Lars Michael; Zimmer, Stefan; Franz, Matthias; Raab, Wolfgang Hans-michael; Schaefer, Ralf

2010-10-01

The aim of this study was to evaluate the association between various functional and occlusal parameters and sleep bruxism. Thirty-nine (39) sleep bruxism patients and 30 controls participated in this investigation. The assessment of sleep bruxism was performed using the Bruxcore Bruxism-Monitoring Device (BBMD) combined with a new computer-based analyzing method. Sixteen functional and/or occlusal parameters were recorded. With a mean slide of 0.95 mm in the sleep bruxism group and a mean slide of 0.42 mm in the control group (Mann Whitney U test; p<0.003), results solely demonstrated a significant group difference regarding the length of a slide from centric occlusion to maximum intercuspation. The results suggest that the slightly pronounced slide could be of clinical importance in the development of increased wear facets in patients with current sleep bruxism activity. Following further evaluation including polysomnographic recordings, the BBMD combined with this new analyzing technique seems to be a clinically feasible instrument that allows the practitioner to quantify abrasion over a short period.

The clinical significance of brain microbleeds in patients with Alzheimer′s disease: Preliminary study

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Jae-Hyeok Heo

2016-01-01

Full Text Available Background: Microbleeds (MBs are observed frequently in Alzheimer′s disease (AD and suggested to play a crucial role in the pathophysiology, but their clinical significance remains unclear. Materials and Methods: The study recruited 100 patients with AD who were diagnosed at the memory clinic in Seoul Medical Center in 2014. For each patient, baseline characteristics, neuropsychological tests, cerebrovascular risk factors, medial temporal lobe atrophy (MTLA, and severity of small vessel disease (SVD according to the existence of MBs were evaluated. Results: The prevalence of MBs in patients with AD was 33%. The percentage of male gender, the severity of SVD and MTLA were significantly increased in MB(+ group. The MB(+ group showed more severe MTLA and SVD than MB(− group. Conclusions: These results suggested that MBs might reflect the burden of amyloid and ischemic vascular pathology.

Expression of transcription factor Pokemon in non-small cell lung cancer and its clinical significance.

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Zhao, Zhi-hong; Wang, Sheng-fa; Yu, Liang; Wang, Ju; Chang, Hao; Yan, Wei-li; Fu, Kai; Zhang, Jian

2008-03-05

Transcription factor Pokemon, a central regulation gene of the important tumor suppressor ARF gene, exerted its activity by acting upstream of many tumor-suppressing genes and proto-oncogenes. Its expression in non-small cell lung cancer (NSCLC) and its clinical significance remains unclear. The aim of this study was to investigate the expression of Pokemon in NSCLC and to explore its correlation with the clinical pathological characteristics and its influence on patients' prognosis. Fifty-five cases of NSCLC were involved in this study. The expression of Pokemon in the tumor tissue, the corresponding tumor adjacent tissue and the surrounding tissue was detected via reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, with the aim of investigating the correlation between the expression of Pokemon in tumor tissue of NSCLC and its clinical pathological characteristics. Moreover, a prognostic analysis was carried out based upon the immunohistochemical (IHC) detection of the expression of Pokemon gene in archival tumor specimens (5 years ago) of 62 cases of NSCLC. Statistical significance of the expression of Pokemon mRNA and protein was determined in the tumor tissue, the tumor adjacent tissue and the surrounding tissue (PPokemon was determined not to be associated with the patients' sex, age, smoking condition, tumor differentiation degree, histology and lymph node metastasis condition. However, its relationship with TNM staging was established (PPokemon expression was significantly higher than that of those with positive Pokemon expression (P=0.004), therefore, the expression of Pokemon is believed to be an independent factor affecting prognosis (P=0.034). Pokemon was over-expressed in NSCLC tissue and the expression of Pokemon might be of clinical significance in non-small cell lung cancer prognostic evaluation.

Prevalence, characterization and clinical significance of Klebsiella pneumoniae carbapenemase (KPC producing Klebsiella pneumoniae

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: Sarita Nayak, Suman Singh, Soeb Jankhwala, Riddhi Pradhan

2014-11-01

Full Text Available Klebsiella peumoniae, a capsulated gram negative bacillus is responsible for causing life threatening infections in humans. Carbapenems are the drug of choice for serious infection caused by multidrug resistant Klebsiella pneumoniae. The emergence of carbapenem resistance has made it extremely difficult to treat such infections resulting in significant morbidity and mortality. Aims: To study the prevalence of carbapenem resistance using ertapenem as a marker and to detect Klebsiella pneumoniae Carbapenemase (KPC producing Klebsiella pneumoniae as a mechanism of resistance. Material and Methods: The study included 102 patients from which Klebsiella pneumoniae isolated. Identification and antibiotic susceptibility testing of Klebsiella pneumoniae was performed on miniAPI (Analytical Profile Index, Semiautomated bacterial identification system according to Clinical and Laboratory Standards Institute (CLSI guidelines of 2011. The modified Hodge test was performed for detection of Carbapenemase production. Patient’s clinical and demographic details along with risk factors and co-morbid conditions, type of response to antimicrobial therapy and mortality were collected. Results: The prevalence of carbapenem resistance was found to be 30.41% with 16.6% KPC producing Klebsiella pneumoniae. The co-morbid conditions like immunocompromised state (p =0.042, prior antibiotics therapy (p=0.047, previous hospitalization (p =0.021, intensive care unit stay (p=0.047 and use of indwelling devices (p =0.013 were found to be significantly associated with carbapenem resistance. Adverse clinical outcomes (death or worsening among patients infected with ertapenem resistant patients was found to be statistically significant than ertapenem sensitive strains (p =0.008. Conclusions: A high degree of carbapenem resistance in present study is alarming and poses therapeutic dilemmas for clinicians. Initiating timely and appropriate infection control measures along with a

The prevalence and clinical significance of intestinal parasites in HIV-infected patients in Denmark

DEFF Research Database (Denmark)

Stensvold, Christen Rune; Nielsen, Susanne Dam; Badsberg, Jens Henrik

2011-01-01

To investigate the prevalence and clinical significance of intestinal parasites in human immunodeficiency virus (HIV)-infected patients, faecal specimens from 96 HIV-infected patients were submitted to microbiological analyses, including microscopy and polymerase chain reaction for protozoa and e...

Clinical significance of serum neuropeptide Y levels changes in chronic obstructive pulmonary diseases

International Nuclear Information System (INIS)

Jin Yuanhong; Pan Jiongwei; Cao Zhuo; Ji Naijun

2004-01-01

Objective: To study the clinical significance of serum neuropeptide Y level changes in patients with chronic obstructive pulmonary diseases (COPD). Methods: The serum neuropeptide Y levels were determined by radioimmunoassay in 40 patients with chronic obstructive pulmonary diseases (COPD) and 30 patients without COPD. Results: Mean serum neuropeptide Y level in patients with COPD was significantly higher than that in patients without COPD (130.36 ± 20.58 pg/ml vs 86.62 ± 13.02 pg/ml; t=10.201, p<0.01). Moreover, the levels in patients of the different stages (I, II, III) of COPD were significantly different from one another (F=20.334, p<0.01). Conclusion: the serum neuropeptide Y levels increased significantly in patients with COPD and were correlated to the different disease stages

Effect of postmortem sampling technique on the clinical significance of autopsy blood cultures.

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Hove, M; Pencil, S D

1998-02-01

Our objective was to investigate the value of postmortem autopsy blood cultures performed with an iodine-subclavian technique relative to the classical method of atrial heat searing and antemortem blood cultures. The study consisted of a prospective autopsy series with each case serving as its own control relative to subsequent testing, and a retrospective survey of patients coming to autopsy who had both autopsy blood cultures and premortem blood cultures. A busy academic autopsy service (600 cases per year) at University of Texas Medical Branch Hospitals, Galveston, Texas, served as the setting for this work. The incidence of non-clinically relevant (false-positive) culture results were compared using different methods for collecting blood samples in a prospective series of 38 adult autopsy specimens. One hundred eleven adult autopsy specimens in which both postmortem and antemortem blood cultures were obtained were studied retrospectively. For both studies, positive culture results were scored as either clinically relevant or false positives based on analysis of the autopsy findings and the clinical summary. The rate of false-positive culture results obtained by an iodine-subclavian technique from blood drawn soon after death were statistically significantly lower (13%) than using the classical method of obtaining blood through the atrium after heat searing at the time of the autopsy (34%) in the same set of autopsy subjects. When autopsy results were compared with subjects' antemortem blood culture results, there was no significant difference in the rate of non-clinically relevant culture results in a paired retrospective series of antemortem blood cultures and postmortem blood cultures using the iodine-subclavian postmortem method (11.7% v 13.5%). The results indicate that autopsy blood cultures obtained using the iodine-subclavian technique have reliability equivalent to that of antemortem blood cultures.

Antenatal Sonographic Diagnosis and Clinical Significance of Placenta Previa Accreta after Cesarean Section.

Science.gov (United States)

Liu, Zhen-Zhen; Wei, Yao; Wang, Ruo-Jiao; Xu, Wen; Shi, Zhi-Min; Dai, Qing

2017-10-30

Objective To investigate the clinical and antenatal sonographic characteristics of placenta previa accreta after cesarean section. Methods The data of 21 inpatients diagnosed as placenta previa accreta after cesarean section in PUMC Hospital from 2006 to 2016 were retrospectively reviewed. The clinical and ultrasound features were recorded and compared among three placental accreta groups,including placenta accrete group(n=5),increta group(n=12),and percreta group(n=4). The relationship between the placental thickness at the uterine anterior lower segment level and the blood loss of the following cesarean section was tested. Results Of 21 patients,placenta previa was diagnosed by ultrasound in 20 cases(95.2%) and placenta previa accreta was diagnosed in 9 cases(42.9%). Antenatal ultrasound findings included following signs:loss of "clear zone"(15/18,83.3%),myometrial thinning(12/18,66.7%),abnormal placental lacunae(12/19,63.2%),bladder wall interruption(2/18,11.1%),and uterovesical hypervascularity(4/9,44.4%). Myometrial thinning(J-T=64.000,P=0.036),abnormal placental lacunae(J-T=74.500,P=0.032) and the placental thickness at the uterine anterior lower segment level(U=83.000,P=0.010) showed significant difference among different placenta accreta groups. Placental thickness at the uterine anterior lower segment level showed linear correlation with the blood loss of the following cesarean section(r=0.669,P=0.002). The blood loss of the following cesarean section showed significant difference among different placenta accreta groups(U=118.500,P=0.000). Conclusions The clinical and sonographic manifestations of placenta previa accreta after cesarean section show a spectrum of demographic characteristics. The measurement of thickness of placenta at the anterior lower segment may help the evaluation of the clinical prognosis of this special pathology.

Medical condition and care of undocumented migrants in ambulatory clinics in Tel Aviv, Israel: assessing unmet needs.

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Mor, Zohar; Raveh, Yuval; Lurie, Ido; Leventhal, Alex; Gamzu, Roni; Davidovitch, Nadav; Benari, Orel; Grotto, Itamar

2017-07-14

Approximately 150,000 undocumented migrants (UM) who are medically uninsured reside in Israel, including ~50,000 originating from the horn of Africa (MHA). Free medical-care is provided by two walk-in clinics in Tel-Aviv. This study aims to compare the medical complaints of UM from different origins, define their community health needs and assess gaps between medical needs and available services. This cross-sectional study included a random sample of 610 UM aged 18-64 years, who were treated in these community clinics between 2008 and 2011. The study compared UM who had complex medical conditions which necessitated referral to more equipped medical settings with UM having mild/simple medical conditions, who were treated at the clinics. MHA were younger, unemployed and more commonly males compared with UM originating from other countries. MHA also had longer referral-delays and visited the clinics less frequently. UM with complex medical conditions were more commonly females, had chronic diseases and demonstrated longer referral-delays than those who had mild/simple medical conditions. The latter more commonly presented with complained of respiratory, muscular and skeletal discomfort. In multivariate analysis, the variables which predicted complex medical conditions included female gender, chronic illnes and self-referral to the clinics. The ambulatory clinics were capable of responding to mild/simple medical conditions. Yet, the health needs of women and migrants suffering from complex medical conditions and chronic diseases necessitated referrals to secondary/tertiary medical settings, while jeopardizing the continuity of care. The health gaps can be addressed by a more holistic social approach, which includes integration of UM in universal health insurance.

The clinical significance of neutrophilic pleocytosis in cerebrospinal fluid in patients with viral central nervous system infections

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Siraya Jaijakul

2017-06-01

Conclusions: The results of a study exploring the association between CSF neutrophilic pleocytosis and clinical and prognostic significance are presented here. This study suggests that CSF neutrophilic pleocytosis is not associated with higher adverse clinical outcomes.

The clinical significance of perivalvular pannus in prosthetic mitral valves: Can cardiac CT be helpful?

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Chang, Suyon; Suh, Young Joo; Han, Kyunghwa; Kim, Jin Young; Kim, Young Jin; Chang, Byung-Chul; Choi, Byoung Wook

2017-12-15

The clinical significance of pannus in the prosthetic mitral valve (MV) is not well documented. To investigate the clinical significance of pannus on cardiac computed tomography (CT) in patients with a prosthetic MV. A total of 130 patients with previous MV replacement who underwent cardiac CT were retrospectively included in this study. The presence of pannus, paravalvular leak (PVL) around the prosthetic MV and limitation of motion (LOM) of the MV were analyzed using CT. Between patients with MV pannus and those without pannus, CT, echocardiographic, and redo-surgery findings were compared. The diagnostic performance of CT and transesophageal echocardiography (TEE) for the detection of MV pannus was also compared, using surgical findings as a standard reference. MV pannus was observed on cardiac CT in 32.3% of the study population. Patients with MV pannus detected on CT more commonly had LOM (28.2% vs. 15.2%) and less frequently had PVL of the prosthetic MV (16.7% vs. 25%) than patients without MV pannus (P>0.05). Prosthetic valve obstruction (PVO) due prosthetic MV pannus requiring redo-surgery was present in only five patients (11.9%). Cardiac CT detected MV pannus with sensitivity of 65.2% and specificity of 80.9% and showed better diagnostic performance than TEE (Ppannus can frequently be seen on cardiac CT. However, its clinical significance should be assessed with careful consideration, because PVO due to MV pannus is relatively uncommon, and pannus can be seen in patients without any clinical problems. Copyright © 2017 Elsevier B.V. All rights reserved.

BRCA1 and BRCA2 genetic testing—pitfalls and recommendations for managing variants of uncertain clinical significance

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Eccles, D. M.; Mitchell, G.; Monteiro, A. N. A.; Schmutzler, R.; Couch, F. J.; Spurdle, A. B.; Gómez-García, E. B.

2015-01-01

BackgroundIncreasing use of BRCA1/2 testing for tailoring cancer treatment and extension of testing to tumour tissue for somatic mutation is moving BRCA1/2 mutation screening from a primarily prevention arena delivered by specialist genetic services into mainstream oncology practice. A considerable number of gene tests will identify rare variants where clinical significance cannot be inferred from sequence information alone. The proportion of Variants of Uncertain clinical Significance (VUS) ...

The clinical significance of lung hypoexpansion in acute childhood asthma

International Nuclear Information System (INIS)

Spottswood, Stephanie E.; Allison, Kelley Z.; Narla, Lakshmana D.; Lowry, Patricia A.; Lopatina, Olga A.; Sethi, Narinder N.; Nettleman, Mary D.

2004-01-01

Many children experiencing acute asthmatic episodes have chest radiographs, which may show lung hyperinflation, hypoinflation, or normal inflation. Lung hypoinflation may be a sign of respiratory fatigue and poor prognosis. To compare the clinical course in children with asthma according to the degree of lung inflation on chest radiographs. We conducted a retrospective study during a 24-month period (from July 1999 to July 2001) of children aged 0-17 years, who presented to a pediatric emergency department or outpatient clinic with an asthma exacerbation. Chest radiographs obtained at presentation were reviewed independently by three pediatric radiologists who were blinded to the admission status of the patient. The correlation between hypoinflation and hospital admission was assessed in three age groups: 0-2 years, 3-5 years, and 6-17 years. Hypoinflation on chest radiographs was significantly correlated with hospital admission for children aged 6-17 years (odds ratio 16.00, 95% confidence interval 1.89-135.43). The inter-reader agreement for interpretation of these radiographs was strong, with a kappa score of 0.76. Hypoinflation was not correlated with admission in younger children. Lung hypoinflation is associated with a greater likelihood of hospital admission in children aged 6 years or older. Therefore, hypoinflation was a poor prognostic sign and may warrant more aggressive therapy. (orig.)

The clinical significance of lung hypoexpansion in acute childhood asthma

Energy Technology Data Exchange (ETDEWEB)

Spottswood, Stephanie E. [Department of Radiology, Medical College of Virginia, Virginia Commonwealth University Health System, Box 980615, 23298-0615, Richmond, VA (United States); Department of Radiology, The Children' s Hospital of the King' s Daughters, 601 Children' s Lane, Norfolk, VA 23507 (United States); Allison, Kelley Z.; Narla, Lakshmana D.; Lowry, Patricia A. [Department of Radiology, Medical College of Virginia, Virginia Commonwealth University Health System, Box 980615, 23298-0615, Richmond, VA (United States); Lopatina, Olga A.; Sethi, Narinder N. [School of Medicine, Medical College of Virginia, Virginia Commonwealth University Health System, Richmond, VA (United States); Nettleman, Mary D. [Department of Internal Medicine, B-427 Clinical Center, Michigan State University, East Lansing, MI 48824 (United States)

2004-04-01

Many children experiencing acute asthmatic episodes have chest radiographs, which may show lung hyperinflation, hypoinflation, or normal inflation. Lung hypoinflation may be a sign of respiratory fatigue and poor prognosis. To compare the clinical course in children with asthma according to the degree of lung inflation on chest radiographs. We conducted a retrospective study during a 24-month period (from July 1999 to July 2001) of children aged 0-17 years, who presented to a pediatric emergency department or outpatient clinic with an asthma exacerbation. Chest radiographs obtained at presentation were reviewed independently by three pediatric radiologists who were blinded to the admission status of the patient. The correlation between hypoinflation and hospital admission was assessed in three age groups: 0-2 years, 3-5 years, and 6-17 years. Hypoinflation on chest radiographs was significantly correlated with hospital admission for children aged 6-17 years (odds ratio 16.00, 95% confidence interval 1.89-135.43). The inter-reader agreement for interpretation of these radiographs was strong, with a kappa score of 0.76. Hypoinflation was not correlated with admission in younger children. Lung hypoinflation is associated with a greater likelihood of hospital admission in children aged 6 years or older. Therefore, hypoinflation was a poor prognostic sign and may warrant more aggressive therapy. (orig.)

Clinical significance of bone age estimation

International Nuclear Information System (INIS)

Heinrich, U.E.

1986-01-01

Skeletal development is an important maturity indicator during childhood. In clinical practice determination of skeletal age is helpful for the diagnosis of disorders of growth and development. Most hormones have specific effects on skeletal maturation. Thus, different disease states (growth disorders, disorders of pubertal development, chornic disorders of the bowels, kidneys, heart etc.) are characterized by retardation or acceleration of skeletal maturation. Therapeutic effects as well as side effects of hormones can be monitored by skeletal age determination. Typical disharmonic patterns in the appearance of bone centres of hand and wrist have been found in certain disorders of development. (orig.) [de

Tissue engineered constructs: perspectives on clinical translation.

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Lu, Lichun; Arbit, Harvey M; Herrick, James L; Segovis, Suzanne Glass; Maran, Avudaiappan; Yaszemski, Michael J

2015-03-01

In this article, a "bedside to bench and back" approach for developing tissue engineered medical products (TEMPs) for clinical applications is reviewed. The driving force behind this approach is unmet clinical needs. Preclinical research, both in vitro and in vivo using small and large animal models, will help find solutions to key research questions. In clinical research, ethical issues regarding the use of cells and tissues, their sources, donor consent, as well as clinical trials are important considerations. Regulatory issues, at both institutional and government levels, must be addressed prior to the translation of TEMPs to clinical practice. TEMPs are regulated as drugs, biologics, devices, or combination products by the U.S. Food and Drug Administration (FDA). Depending on the mode of regulation, applications for TEMP introduction must be filed with the FDA to demonstrate safety and effectiveness in premarket clinical studies, followed by 510(k) premarket clearance or premarket approval (for medical devices), biologics license application approval (for biologics), or new drug application approval (for drugs). A case study on nerve cuffs is presented to illustrate the regulatory process. Finally, perspectives on commercialization such as finding a company partner and funding issues, as well as physician culture change, are presented.

Clinical significance of lymph node metastasis in gastric cancer

Science.gov (United States)

Deng, Jing-Yu; Liang, Han

2014-01-01

Gastric cancer, one of the most common malignancies in the world, frequently reveals lymph node, peritoneum, and liver metastases. Most of gastric cancer patients present with lymph node metastasis when they were initially diagnosed or underwent surgical resection, which results in poor prognosis. Both the depth of tumor invasion and lymph node involvement are considered as the most important prognostic predictors of gastric cancer. Although extended lymphadenectomy was not considered a survival benefit procedure and was reported to be associated with high mortality and morbidity in two randomized controlled European trials, it showed significant superiority in terms of lower locoregional recurrence and disease related deaths compared to limited lymphadenectomy in a 15-year follow-up study. Almost all clinical investigators have reached a consensus that the predictive efficiency of the number of metastatic lymph nodes is far better than the extent of lymph node metastasis for the prognosis of gastric cancer worldwide, but other nodal metastatic classifications of gastric cancer have been proposed as alternatives to the number of metastatic lymph nodes for improving the predictive efficiency for patient prognosis. It is still controversial over whether the ratio between metastatic and examined lymph nodes is superior to the number of metastatic lymph nodes in prognostic evaluation of gastric cancer. Besides, the negative lymph node count has been increasingly recognized to be an important factor significantly associated with prognosis of gastric cancer. PMID:24744586

Clinical significance of atypical squamous cells of undetermined significance in detecting preinvasive cervical lesions in post- menopausal Turkish women.

Science.gov (United States)

Tokmak, Aytekin; Guzel, Ali Irfan; Ozgu, Emre; Oz, Murat; Akbay, Serap; Erkaya, Salim; Gungor, Tayfun

2014-01-01

To evaluate the clinical significance of atypical squamous cells of undetermined significance (ASCUS) in PAP test in post-menopausal women and compare with reproductive age women. A total of 367 patients who referred to our gynecologic oncology clinic were included to the study between September 2012 and August 2013. Data for 164 post-menopausal (group 1) and 203 pre-menopausal (group 2) women with ASCUS cytology were evaluated retrospectively. Immediate colposcopy and endocervical curettage was performed for both groups and conization for all women with a result suggestive of CIN2-3. Histopathological results and demographic features of patients were compared between the two groups. Mean age of the patients was 54.6±6.5 years in group 1 and 38±6.6 years in group 2. Some 14 (8.5%) of post- menopausal women and 36 (17.7%) of pre-menopausal women were current smokers (p=011). Totals of 38 (23.2%) post-menopausal and 64 (31.5%) pre-menopausal women were assessed for HPV-DNA. High risk HPV was detected in 7 (4.3%) and 21 (10.3%), respectively (p=0.029). Final histopathological results recorded were normal cervix, low grade cervical intra-epithelial neoplasia (CIN 1), and high grade cervical intra-epithelial neoplasia (CIN2-3). In group 1 results were 84.8%, 12.2% and 1.8%, respectively, and in group 2 were 71.9%, 23.2% and 4.9%. There were no cases of micro invasive or invasive cervical carcinoma in either group. Two cases were detected as endometrial carcinoma in the menopausal group (1.2%). In current study we found that preinvasive lesions were statistically significantly higher in pre-menopausal women than post- menopausal women with ASCUS. Cervicitis was more common in menopausal women. Therefore, we think that in case of ASCUS in a post-menopausal woman there is no need for radical management.

Clinical significance of measurements of serum IL-6 levels in patients with cardiovascular and cerebrovascular diseases

International Nuclear Information System (INIS)

Wu Cuihua; Luo Nanping; Zhang Daojie; Wei Hong

2004-01-01

Objective: To explore the clinical significance of changes of serum IL-6 levels in patients with cardiovascular and cerebrovascular diseases. Methods: Serum IL-6 levels were determined with RIA in 35 patients with coronary heart disease, 20 patients with essential hypertension, 28 patients with cerebral infarction and 30 controls. Results: Serum IL-6 levels in patients with coronary heart disease and cerebral infarction were significantly higher than those in the controls (P 0.05). Conclusion: Serum IL-6 levels changes could reflect the severity of the inflammatory process and would be helpful in clinical assessment. (authors)

Transgender Veterans' Satisfaction With Care and Unmet Health Needs.

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Lehavot, Keren; Katon, Jodie G; Simpson, Tracy L; Shipherd, Jillian C

2017-09-01

Transgender individuals are overrepresented among Veterans. However, little is known regarding their satisfaction with Veterans Administration (VA) care and unmet health needs. This study examined transgender Veterans' satisfaction with VA medical and mental health care, prevalence of delaying care, and correlates of these outcomes. We used data from transgender Veterans collected in 2014 through an online, national survey. In total, 298 transgender Veterans living in the United States. We assessed patient satisfaction with VA medical and mental health care and self-reported delays in seeking medical and mental health care in the past year. Potential correlates associated with these 4 outcomes included demographic, health, and health care variables. Over half of the sample used VA (56%) since their military discharge. Among transgender Veterans who had used VA, 79% were satisfied with medical care and 69% with mental health care. Lower income was associated with dissatisfaction with VA medical care, and being a transgender man was associated with dissatisfaction with VA mental health care. A substantial proportion reported delays in seeking medical (46%) or mental (38%) health care in the past year (not specific to VA). Screening positive for depression and/or posttraumatic stress disorder was associated with delays in seeking both types of care. Although the majority of transgender Veterans are satisfied with VA health care, certain subgroups are less likely to be satisfied with care. Further, many report delaying accessing care, particularly those with depression and/or posttraumatic stress disorder symptoms. Adapting health care settings to better engage these vulnerable Veterans may be necessary.

Clinical significance of determination of serum BGP levels in patients with Graves' disease

International Nuclear Information System (INIS)

Tu Liping; Zhang Chunyan; Wang Linglong; Yu Yuefang; Zhu Weijie; Cai Ao

2006-01-01

Objective: To study the clinical significance of changes of serum BGP levels in patients with Graves' disease. Methods: Serum BOP levels as well as T 3 , T 4 , FT 3 , FT 4 , TSH, TGA, TMA levels were determined with RIA in 158 patients with Graves' disease and 145 controls. Results: The serum BGP levels in patients with Graves' disease were significantly higher than those in controls (P 3 , T 4 , FT 3 , FT 4 levels, but not with TSH, TGA, TMA. Conclusion: Serum BGP levels is a useful marker for monitoring bone metabolism in patients with Graves' disease. (authors)

Clinical significance of white matter hyperintensities in MRI in senile dementia of the Alzheimer type

International Nuclear Information System (INIS)

Takita, Masashi

1996-01-01

To elucidate clinical significance of white matter hyperintensities (WMH) in MRI, fifty patients with senile dementia of the Alzheimer type (SDAT) and twenty normal controls were studied. Twenty nine patients with SDAT (58.0%) had periventricular hyperintensities (PVH) and twenty three patients with SDAT (46.0%) had deep white matter hyperintensities (DWMH). Eight controls (40.0%) had PVH and ten controls (50.0%) had DWMH. There were no significant differences in frequency of WMH between patients with SDAT and normal controls. Past history of hypertension was more frequent in patients with PVH or DWMH than in patients without them. Serum cholesterol level was higher in patients with DWMH than in patients without them. However there were no significant differences in the other clinical features between patients with WMH and patients without them. The results of present study suggest that DWMH in patients with SDAT is associated with cerebrovascular risk factors such as hypertension and hyperlipidemia. (author)

Repurposing Clinical Molecule Ebselen to Combat Drug Resistant Pathogens.

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Thangamani, Shankar; Younis, Waleed; Seleem, Mohamed N

2015-01-01

Without a doubt, our current antimicrobials are losing the battle in the fight against newly-emerged multidrug-resistant pathogens. There is a pressing, unmet need for novel antimicrobials and novel approaches to develop them; however, it is becoming increasingly difficult and costly to develop new antimicrobials. One strategy to reduce the time and cost associated with antimicrobial innovation is drug repurposing, which is to find new applications outside the scope of the original medical indication of the drug. Ebselen, an organoselenium clinical molecule, possesses potent antimicrobial activity against clinical multidrug-resistant Gram-positive pathogens, including Staphylococcus, Streptococcus, and Enterococcus, but not against Gram-negative pathogens. Moreover, the activity of ebselen against Gram-positive pathogens exceeded those activities determined for vancomycin and linezolid, drugs of choice for treatment of Enterococcus and Staphylococcus infections. The minimum inhibitory concentrations of ebselen at which 90% of clinical isolates of Enterococcus and Staphylococcus were inhibited (MIC90) were found to be 0.5 and 0.25 mg/L, respectively. Ebselen showed significant clearance of intracellular methicillin-resistant S. aureus (MRSA) in comparison to vancomycin and linezolid. We demonstrated that ebselen inhibits the bacterial translation process without affecting mitochondrial biogenesis. Additionally, ebselen was found to exhibit excellent activity in vivo in a Caenorhabditis elegans MRSA-infected whole animal model. Finally, ebselen showed synergistic activities with conventional antimicrobials against MRSA. Taken together, our results demonstrate that ebselen, with its potent antimicrobial activity and safety profiles, can be potentially used to treat multidrug resistant Gram-positive bacterial infections alone or in combination with other antibiotics and should be further clinically evaluated.

Psychogeriatrics and Psychogeriatric Services in Nigeria | Baiyewu ...

African Journals Online (AJOL)

Psychogeriatrics services began in Nigeria in the 1960's with the work of Adeoye Lambo. Today, some limited progress has been made in services and a little more in research. A number of geriatric psychiatric clinics are available in some tertiary hospitals in the country, but there are significant unmet needs in clinical care.

Variability in anatomical features of human clavicle: Its forensic anthropological and clinical significance

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Jagmahender Singh Sehrawat

2016-06-01

Full Text Available Bones can reflect the basic framework of human body and may provide valuable information about the biological identity of the deceased. They, often, survive the morphological alterations, taphonomic destructions, decay/mutilation and decomposition insults. In-depth knowledge of variations in clavicular shape, size and its dimensions is very important from both clinical (fixation of clavicular fractures using external or inter-medullary devices, designing orthopedic fixation devices as well as forensic anthropological perspectives. Human clavicle is the most frequently fractured bone of human skeleton, possessing high degree of variability in its anatomical, biomechanical and morphological features. Extended period of skeletal growth (up to third decade in clavicle imparts it an additional advantage for forensic identification purposes. In present study, five categories of clavicular features like lengths, diameters, angles, indices and robustness were examined to explore the suitability of collarbone for forensic and clinical purposes. For this purpose, 263 pairs of adult clavicles (195 Males and 68 Females were collected from autopsied cadavers and were studied for 13 anatomical features. Gender and occupational affiliations of cadavers were found to have significant influences on anatomical dimensions of their clavicles. Product index, weight and circumference of collarbone were found the best univariate variables, discriminating sex of more than 80% individuals. The best multivariate Function-I (DF: -17.315 + 0.054 CL-L+0.196 CC-R+0.184 DM-L could identify sex and occupation of 89.4% (89.2% Male and 89.7% Female and 65.4% individuals, respectively. All clavicular variables were found bilaterally asymmetric; left clavicles being significantly longer in length, lighter in weight, smooth in texture and less curved than the right side bones. Among non-metric traits, sub-clavian groove, nutrient foramina and ‘type’ of clavicle exhibited

Clinical significance of high-sensitivity C- reactive protein in systemic sclerosis

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T. A. Nevskaya

2007-01-01

Full Text Available Objective. To determine diagnostic and prognostic significance of high-sensitivity Creactive protein (hsCRP in systemic sclerosis (SS, to define relationship of this factor with activity of the disease and cardiovascular pathology, to assess role of pro-inflammatory cytokines in induction of acute phase proteins synthesis in SS.Material and methods. Serum levels of hsCRP, interleukin (IL 6, IL 1β, IL1ra, IL 10, sIL2r were evaluated by enzyme immunoassay (EIA in 40 pts with SS and 24 subjects of control group. Relationship with clinical features of the disease, endothelial dysfunction, capillaries structure changes, sub-clinical atherosclerosis, total coronary risk and some traditional cardiovascular risk factors was analyzed. Instrumental assessment included nailfold capillaroscopy, sonographic duplex examination of carotids , brachial arte ry sonographic examination. HsCRP prognostic significance was assessed in 51 pts with SS.Results. Elevated levels of hsCRP were found in 32% of SS pts and correlated with activity and severity of the disease, HAQ and SHAQ. Direct correlation of hsCRP with skin fibrosis distribution, interstitial lung disease, arthritis, laboratory indices of SS activity (ESR, sIL2r and Scl-70 was revealed. HsCRP concentration in SS did not depend on character and intensity of cardiovascular pathology, subclinical atherosclerosis, endothelial dysfunction and proinflammatory cytokines production.Conclusion. HsCRP in SS reflects intensity of immuno-inflammatory process, correlates with T-cell activation markers and can be used as index of the disease activity, severity of skin and lung fibrosis.

Transforming user needs into functional requirements for an antibiotic clinical decision support system: explicating content analysis for system design.

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Bright, T J

2013-01-01

Many informatics studies use content analysis to generate functional requirements for system development. Explication of this translational process from qualitative data to functional requirements can strengthen the understanding and scientific rigor when applying content analysis in informatics studies. To describe a user-centered approach transforming emergent themes derived from focus group data into functional requirements for informatics solutions and to illustrate these methods to the development of an antibiotic clinical decision support system (CDS). THE APPROACH CONSISTED OF FIVE STEPS: 1) identify unmet therapeutic planning information needs via Focus Group Study-I, 2) develop a coding framework of therapeutic planning themes to refine the domain scope to antibiotic therapeutic planning, 3) identify functional requirements of an antibiotic CDS system via Focus Group Study-II, 4) discover informatics solutions and functional requirements from coded data, and 5) determine the types of information needed to support the antibiotic CDS system and link with the identified informatics solutions and functional requirements. The coding framework for Focus Group Study-I revealed unmet therapeutic planning needs. Twelve subthemes emerged and were clustered into four themes; analysis indicated a need for an antibiotic CDS intervention. Focus Group Study-II included five types of information needs. Comments from the Barrier/Challenge to information access and Function/Feature themes produced three informatics solutions and 13 functional requirements of an antibiotic CDS system. Comments from the Patient, Institution, and Domain themes generated required data elements for each informatics solution. This study presents one example explicating content analysis of focus group data and the analysis process to functional requirements from narrative data. Illustration of this 5-step method was used to develop an antibiotic CDS system, resolving unmet antibiotic prescribing

Family perception of unmet support needs following a diagnosis of congenital coronary anomaly in children: Results of a survey.

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Agrawal, Hitesh; Wright, Oriana K; Carberry, Kathleen E; Sexson Tejtel, S Kristen; Mery, Carlos M; Molossi, Silvana

2017-12-01

Long-term outcome data on patients with anomalous aortic origin of coronary arteries (AAOCA) is sparse and they are often managed in a nonuniform manner. There is subjective perception of anxiety and unmet needs in these patients and families. An online survey of 13 questions was sent to 74 families of patients with AAOCA between May and October 2015. Descriptive statistics were performed. A total of 31 (47%) families responded. Of these, 27 expressed the need to interact with other patients/families with AAOCA. The majority were interested in either face-to-face meetings (77%) or online support groups (71%). Regarding content of the meeting, 74% were interested in brief talks by medical personnel/families, 58% suggested informal interactions with families, 55% proposed a structured discussion with a moderator and 39% mentioned fun activities/games. Regarding participants in these meetings, 90% would like to include healthcare providers, 61% suggested including family friends, 58% wished to include psychologists and 16% mentioned including social workers. The families currently use various social media including Facebook (87%), YouTube (39%), Google+ (36%), and LinkedIn (32%). For future online resources, 77% of families would like a Facebook site, an informative website (58%), a blog (52%), or an open forum (29%). The majority of the families (77%) were interested in attending a dedicated AAOCA meeting. There appears to be an unmet need for family support in those affected by AAOCA, a substantial life changing diagnosis for patients and families. Further research is needed to assess quality of life in this population. © 2017 Wiley Periodicals, Inc.

Trends in Canadian Respiratory Clinical Trials from 2001 to 2011

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Claire Elizabeth Tacon

2014-01-01

Full Text Available Clinical research bridges patients’ unmet medical need with innovative medicines, increases knowledge acquisition by clinicians, and creates solutions to improve the sustainability and quality of the Canadian health care system and economy. The Canadian Institutes of Health Research and the Canadian Lung Association have recently raised concerns over declining research activities within the Canadian respiratory community. While there are currently >3000 ongoing clinical trials in Canada, the number of trials investigating common respiratory diseases is unknown. The objective of the present study was to monitor the trends in industry- and non-industry-sponsored respiratory clinical trials in Canada from 2001 to 2011. Trialtrove 2012 (Citeline, an Informa UK business, a database containing summarized clinical trial information regarding pharmaceutical products, was searched using common chronic respiratory disease terms: “allergic rhinitis”, “asthma”, “chronic obstructive pulmonary disease (COPD”, “cystic fibrosis”, “respiratory infections”, “pulmonary fibrosis” and “smoking cessation”. Over the past 10 years, the number of respiratory clinical trials conducted in Canada has increased (4.49 per year; P=0.004. From 2001 to 2011, the majority of trials were performed in asthma, followed closely by respiratory infections and COPD. Over the past decade, the number of trials investigating COPD and respiratory infections increased (P<0.05, while asthma trials showed a declining trend since 2007. Of the clinical trials performed during this 10-year period, the majority were in phase III, with a significant increase in the number of phase II trials (2.49 per year; P=0.008. However, certain trends observed are concerning and warrant further monitoring in the coming years.

Environmental pollution and DNA methylation: carcinogenesis, clinical significance, and practical applications.

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Cao, Yi

2015-09-01

Environmental pollution is one of the main causes of human cancer. Exposures to environmental carcinogens result in genetic and epigenetic alterations which induce cell transformation. Epigenetic changes caused by environmental pollution play important roles in the development and progression of environmental pollution-related cancers. Studies on DNA methylation are among the earliest and most conducted epigenetic research linked to cancer. In this review, the roles of DNA methylation in carcinogenesis and their significance in clinical medicine were summarized, and the effects of environmental pollutants, particularly air pollutants, on DNA methylation were introduced. Furthermore, prospective applications of DNA methylation to environmental pollution detection and cancer prevention were discussed.

Levels and clinical significance of serum IGF-II in patients with five kinds of malignant tumors

International Nuclear Information System (INIS)

Qi Falian; Xu Jun; Du Xiumin; Ke Bingkun; Yang Daoli

2002-01-01

Objective: To study the levels and clinical significance of serum IGF-II in patients with malignant tumor. Methods: Levels of serum IGF-II were detected in patients with gastric cancer, lung cancer, liver cancer, ovarian carcinoma and endometrial carcinoma by radioimmunoassay, levels in patients with hepatic cirrhosis, uterine myoma and normal controls were also determined for comparison. Results: The levels of serum IGF-II in patients with gastric cancer, lung cancer and liver cancer were significantly higher than those in normal controls (p 0.05). Conclusion: The determination of serum IGF-II has no clinical significance in patients with endometrial carcinoma, ovarian carcinoma and uterine myoma but it could be useful to judge the severity and evaluate the prognosis in patients with gastric cancer, lung cancer, liver cancer and cirrhosis

Acrophialophora, a Poorly Known Fungus with Clinical Significance

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Sandoval-Denis, Marcelo; Sutton, Deanna A.; Wiederhold, Nathan P.; Guarro, Josep

2015-01-01

Acrophialophora fusispora is an emerging opportunistic fungus capable of causing human infections. The taxonomy of the genus is not yet resolved and, in order to facilitate identification of clinical specimens, we have studied a set of clinical and environmental Acrophialophora isolates by morphological and molecular analyses. This set included the available type strains of Acrophialophora species and similar fungi, some of which were considered by various authors to be synonyms of A. fusispora. Sequence analysis of the large subunit (LSU) and internal transcribed spacer (ITS) regions of the nuclear ribosomal DNA and a fragment of the β-tubulin (Tub) gene revealed that Acrophialophora belongs in the family Chaetomiaceae and comprises three different species, i.e., A. fusispora, Acrophialophora levis, and Acrophialophora seudatica; the latter was previously included in the genus Ampullifera. The most prevalent species among clinical isolates was A. levis (72.7%), followed by A. fusispora (27.3%), both of which were isolated mostly from respiratory specimens (72.7%), as well as subcutaneous and corneal tissue samples. In general, of the eight antifungal drugs tested, voriconazole had the greatest in vitro activity, while all other agents showed poor in vitro activity against these fungi. PMID:25716450

Childhood-compared to adolescent-onset bipolar disorder has more statistically significant clinical correlates.

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Holtzman, Jessica N; Miller, Shefali; Hooshmand, Farnaz; Wang, Po W; Chang, Kiki D; Hill, Shelley J; Rasgon, Natalie L; Ketter, Terence A

2015-07-01

The strengths and limitations of considering childhood-and adolescent-onset bipolar disorder (BD) separately versus together remain to be established. We assessed this issue. BD patients referred to the Stanford Bipolar Disorder Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD Affective Disorders Evaluation. Patients with childhood- and adolescent-onset were compared to those with adult-onset for 7 unfavorable bipolar illness characteristics with replicated associations with early-onset patients. Among 502 BD outpatients, those with childhood- (adolescent- (13-18 years, N=218) onset had significantly higher rates for 4/7 unfavorable illness characteristics, including lifetime comorbid anxiety disorder, at least ten lifetime mood episodes, lifetime alcohol use disorder, and prior suicide attempt, than those with adult-onset (>18 years, N=174). Childhood- but not adolescent-onset BD patients also had significantly higher rates of first-degree relative with mood disorder, lifetime substance use disorder, and rapid cycling in the prior year. Patients with pooled childhood/adolescent - compared to adult-onset had significantly higher rates for 5/7 of these unfavorable illness characteristics, while patients with childhood- compared to adolescent-onset had significantly higher rates for 4/7 of these unfavorable illness characteristics. Caucasian, insured, suburban, low substance abuse, American specialty clinic-referred sample limits generalizability. Onset age is based on retrospective recall. Childhood- compared to adolescent-onset BD was more robustly related to unfavorable bipolar illness characteristics, so pooling these groups attenuated such relationships. Further study is warranted to determine the extent to which adolescent-onset BD represents an intermediate phenotype between childhood- and adult-onset BD. Copyright © 2015 Elsevier B.V. All rights reserved.

Expression of tumor necrosis factor receptor-associated protein 1 and its clinical significance in kidney cancer.

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Si, Tong; Yang, Guosheng; Qiu, Xiaofu; Luo, Youhua; Liu, Baichuan; Wang, Bingwei

2015-01-01

To investigate the expression and clinical significance of TRAP1 (tumor necrosis factor receptor-associated protein 1) in kidney cancer. TRAP1 expression was detected in kidney cancer and normal kidney tissues by qRT-PCR and immunohistochemistry (IHC), respectively. Then, the correlation of TRAP1 expression with clinicopathological characters and patients' prognosis was evaluated in kidney cancer. IHC results revealed that the high-expression rates of TRAP1 in kidney cancer tissues and normal kidney tissues were 51.3% (41/80), 23.3% (7/30), and the difference was statistically significant (P=0.01). Also, TRAP1 mRNA level in kidney cancer was found to be significantly greater compared with those in normal kidney by qRT-PCR. In addition, TRAP1 expression in kidney cancer significantly correlated with lymph node metastasis and clinical stage (Pkidney cancer and correlates with patients prognosis, which may be served as a potential marker for the diagnosis and treatment of kidney cancer.

Clinically significant fatigue: prevalence and associated factors in an international sample of adults with multiple sclerosis recruited via the internet.

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Tracey J Weiland

Full Text Available Fatigue contributes a significant burden of disease for people with multiple sclerosis (PwMS. Modifiable lifestyle factors have been recognized as having a role in a range of morbidity outcomes in PwMS. There is significant potential to prevent and treat fatigue in PwMS by addressing modifiable risk factors.To explore the associations between clinically significant fatigue and demographic factors, clinical factors (health-related quality of life, disability and relapse rate and modifiable lifestyle, disease-modifying drugs (DMD and supplement use in a large international sample of PwMS.PwMS were recruited to the study via Web 2.0 platforms and completed a comprehensive survey measuring demographic, lifestyle and clinical characteristics, including health-related quality of life, disability, and relapse rate.Of 2469 participants with confirmed MS, 2138 (86.6% completed a validated measure of clinically significant fatigue, the Fatigue Severity Scale. Participants were predominantly female from English speaking countries, with relatively high levels of education, and due to recruitment methods may have been highly pro-active about engaging in lifestyle management and self-help. Approximately two thirds of our sample (1402/2138; 65.6% (95% CI 63.7-67.7 screened positive for clinically significant fatigue. Bivariate associations were present between clinically significant fatigue and several demographic, clinical, lifestyle, and medication variables. After controlling for level of disability and a range of stable socio-demographic variables, we found increased odds of fatigue associated with obesity, DMD use, poor diet, and reduced odds of fatigue with exercise, fish consumption, moderate alcohol use, and supplementation with vitamin D and flaxseed oil.This study supports strong and significant associations between clinically significant fatigue and modifiable lifestyle factors. Longitudinal follow-up of this sample may help clarify the contribution

A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs.

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Flores, Glenn; Lin, Hua; Walker, Candy; Lee, Michael; Portillo, Alberto; Henry, Monica; Fierro, Marco; Massey, Kenneth

2016-03-22

Minority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children's uninsurance on health, access to care, unmet needs, and family financial burden. For this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden. The mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child's health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child's health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden. Half of parents

Relationship between health-related quality of life, perceived family support and unmet health needs in adult patients with multimorbidity attending primary care in Portugal: a multicentre cross-sectional study.

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Prazeres, Filipe; Santiago, Luiz

2016-11-11

Multimorbidity has a high prevalence in the primary care context and it is frequently associated with worse health-related quality of life (HRQoL). Few studies evaluated the variables that could have a potential effect on HRQoL of primary care patients with multimorbidity. The purpose of this study, the first of its kind ever undertaken in Portugal, is to analyse the relationship between multimorbidity, health-related quality of life, perceived family support and unmet health needs in adult patients attending primary care. Multicentre, cross-sectional survey conducted among primary care patients with multimorbidity. It included 521 participants (64.1 % females) who met the inclusion criteria. HRQoL was evaluated using the Portuguese Short Form-12 Health Status Questionnaire. The Portuguese Family APGAR was used to measure the perceived family support. A patients' unmet health needs questionnaire was used. The unmet needs for medical, surgical and dental care; prescription medications; mental healthcare or counselling; and eyeglasses or other technical aid was assessed. Descriptive and multivariate analyses were performed. The sample had an overall average of 4.5 chronic health problems. Increased multimorbidity levels were linked to worse health-related quality of life, particularly the physical health. Some variables were confirmed as playing a role on health-related quality of life. Male patients with high monthly incomes and highly functional families had better physical and mental health. High levels of education and the presence of asthma were also associated with better physical health. Contrariwise, elderly patients with high levels of multimorbidity and with osteoarthritis had lower physical health. The majority of the patients did not have unmet health needs. When health needs were stated they were mostly for generalist medical care, dental care, and eyeglasses/other technical aid. Financial insufficiency was the primary reason for not fulfilling their

Retention Esophagitis as a Significant Clinical Predictor of Progression to Esophageal Cancer in Achalasia

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Haewon Kim

2018-03-01

Full Text Available Background/Aims Chronic liquid and/or food stasis caused by retention esophagitis (RE in achalasia is a notable endoscopic finding because of the presence of a thickened or whitish esophageal mucosa and histologically altered squamous hyperplasia. We aimed to identify the clinical features of RE associated with achalasia and to clarify the clinical definition of RE in achalasia as a precancerous lesion identified by analyzing biomarker expressions. Methods From 2006 to 2015, we retrospectively reviewed 37 patients with achalasia without previous treatment. Among them, 21 patients had diagnostic findings of RE (RE+ and 16 patients had no diagnostic findings of RE (RE–. Immunohistochemical staining of p53, p16, and Ki-67 was performed on the endoscopic biopsy tissues from the patients with achalasia and 10 control patients with non-obstructive dysphagia. Results The symptom duration and transit delay were significantly longer in the RE+ group than in the RE– group. We found particularly high p53 positivity rates in the RE+ group (p<0.001. The rate of p16 expression was also significantly higher in the RE+ group than in the other two groups (p=0.003. Conclusions A high p53 expression rate was more frequently found in the RE+ group than in the other two groups. RE could be a meaningful clinical feature of achalasia for predicting esophageal carcinogenesis.

Needs in nursing homes and their relation with cognitive and functional decline, behavioral and psychological symptoms

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Ana Rita Ferreira

2016-04-01

Full Text Available Unmet needs are becoming acknowledged as better predictors of the worst prognostic outcomes than common measures of functional or cognitive decline. Their accurate assessment is a pivotal component of effective care delivery, particularly in institutionalized care where little is known about the needs of its residents, many of whom suffer from dementia and show complex needs. The aims of this study were to describe the needs of an institutionalized sample and to analyze its relationship with demographic and clinical characteristics. A cross-sectional study was conducted with a sample from three nursing homes. All residents were assessed with a comprehensive protocol that included Mini Mental State Examination (MMSE, Geriatric Depression Scale (GDS15, Neuropsychiatric Inventory (NPI and Adults and Older Adults Functional Inventory (IAFAI. To identify needs, the Camberwell Assessment of Need for the Elderly (CANE was used. The final sample included 175 residents with a mean age of 80.6(sd=10.1. From these, 58.7% presented cognitive deficit (MMSE and 45.2% depressive symptoms (GDS. Statistically significant negative correlations were found between MMSE score and met(rs=-0.425, unmet(rs=-0.369 and global needs(rs=-0.565. Data also showed significant correlations between depressive symptoms and unmet(rs=0.683 and global needs(rs=0.407 and between behavioral and psychological symptoms (BPSD and unmet (rs=0.181 and global needs (rs=0.254. Finally, significant correlations between functional impairment and met(rs=0.642, unmet(rs=0.505 and global needs(rs=0.796 were also found. These results suggest that in this sample, more unmet needs are associated with the worst outcomes measured. This is consistent with previous findings and seems to demonstrate that the needs of those institutionalized elderly remain under-diagnosed and untreated.

Theileriosis in six dogs in South Africa and its potential clinical significance

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Chantal T. Rosa

2014-08-01

Full Text Available Theileriosis is a tick-borne disease caused by a piroplasma of the genus Theileria that can causeanaemia and thrombocytopenia. Its clinical importance for dogs’ remains poorly understood,as only some develop clinical signs. In this study, physical and laboratory findings, treatment and outcomes of six client-owned diseased dogs presented at the Onderstepoort Veterinary Academic Hospital are described retrospectively. In the dogs, Theileria species (n = 4and Theileria equi (n = 2 were detected by a polymerase chain reaction (PCR-reverse blothybridisation assay in blood samples, whilst PCR for Babesia, Anaplasma and Ehrlichia were negative. The most common physical findings were pale mucous membranes (five out of six dogs, bleeding tendencies (five out of six dogs and lethargy (three out of six dogs. All dogs were thrombocytopenic [median 59.5 x 109/L (range 13–199] and five out of six dogs were anaemic [median haematocrit 18% (range 5–32]. Bone marrow core biopsies performed in two dogs showed myelofibrosis. Theileriosis was treated with imidocarb dipropionate and the suspected secondary immune-mediated haematological disorders with prednisolone and azathioprine. Five dogs achieved clinical cure and post-treatment PCR performed in three out of five dogs confirmed absence of circulating parasitaemia. An immune-mediated response to Theileria species is thought to result in anaemia and/or thrombocytopenia in diseased dogs with theileriosis. A bleeding tendency, most likely secondary to thrombocytopenia and/or thrombocytopathy, was the most significant clinical finding in these cases. The link between thrombocytopenia, anaemia and myelofibrosis in theileriosis requires further investigation and theileriosis should be considered a differential diagnosis for dogs presenting with anaemia and/or thrombocytopenia in endemic tick-borne disease areas.

Three-dimensional (3D) culture in sarcoma research and the clinical significance.

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Gao, Songtao; Shen, Jacson; Hornicek, Francis; Duan, Zhenfeng

2017-08-03

Sarcomas are rare malignant tumors that arise from transformed cells of mesenchymal origin. Despite the progress in diagnosis and treatment, sarcomas have a high mortality rate due to local recurrence, metastasis, and the development of drug resistance to chemotherapy. New models for sarcoma research are required to further understand the disease and to develop new therapies. In vitro sarcoma modeling is challenging because of significant genetic heterogeneities, diverse pathological, and overlapping clinical characteristics. Studies on the mechanisms of recurrence, metastasis, and drug resistance in sarcoma have resulted in the generation of novel three-dimensional (3D) culture models for sarcoma research. 3D culture models aim to recapitulate the tumor microenvironment that plays a critical role in the pathogenesis of sarcoma using biomaterial scaffolds of natural biological materials and artificial polymers. An ideal 3D culture model can properly mimic not only the microenvironment, oncogenesis, and maintenance of sarcoma cell growth, but also imitate the interactions between cells and to the extracellular matrix. More recently, 3D cell culture has been used to research the biological behavior and mechanism of chemotherapy and radiotherapy resistance in different sarcoma models. Ultimately, findings using 3D models that more accurately reflect human sarcoma biology are likely to translate into improved clinical outcomes. In this review, we discuss the most recent advances of 3D culture technologies in sarcoma research and emerging clinical applications.

Clinical significance of C-reactive protein for assessment and outcomes of severe acute pancreatitis

Directory of Open Access Journals (Sweden)

REN Linan

2015-05-01

Full Text Available ObjectiveTo study the change in serum CRP level in patients with severe acute pancreatitis (SAP, and to explore its clinical significance in predicting outcomes and assessing the severity of SAP. MethodsA retrospective analysis was performed on 52 SAP patients with complete case data and admitted to General Hospital of Shenyang Military Area Command from September 2013 to September 2014. Blood drawing was performed and serum CRP concentration was determined on admission and at 24, 48, 72, 96, 120, and 144 hours after admission. The pattern of its dynamic change was observed. ResultsSerum CRP level in SAP patients significantly increased, and had a positive correlation with clinical outcomes. Forty-two cases (80.77% gradually recovered with aggressive treatment and the serum CRP levels were also slowly reduced (P＜0.05. The serum CRP levels in four death cases (7.7% had no significant decrease and was maintained at a high level (P＜0.05. Six patients (11.53% had aggravated conditions and recovered after aggressive treatment; meanwhile, the serum CRP levels first increased and then decreased (P＜0.05. ConclusionFor SAP patients, serum CRP level fluctuates as their conditions change and can be considered as an important reference index for evaluating the severity and judging the outcomes of SAP.

Development and Clinical Evaluation of an mHealth Application for Stress Management

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Brent D. Winslow

2016-07-01

Full Text Available A large number of individuals experience mental health disorders, with cognitive behavioral therapy (CBT emerging as a standard practice for reduction in psychiatric symptoms including stress, anger, anxiety and depression. However, CBT is associated with significant patient dropout, and lacks the means to provide objective data regarding a patient’s experience and symptoms between sessions. Emerging wearables and mobile health (mHealth applications represent an approach that may provide objective data to the patient and provider between CBT sessions. Here we describe the development of a classifier of real-time physiological stress in a healthy population (n=35, and apply it in a controlled clinical evaluation for armed forces veterans undergoing CBT for stress and anger management (n=16. Using cardiovascular and electrodermal inputs from a wearable device, the classifier was able to detect physiological stress in a non-clinical sample with an accuracy greater than 90%. In a small clinical sample, patients who used the classifier and an associated mHealth application were less likely to discontinue therapy (p=0.016, d=1.34 and significantly improved on measures of stress (p=0.032, d=1.61, anxiety (p=0.050, d=1.26, and anger (p=0.046, d=1.41 compared to controls undergoing CBT alone. Given the large number of individuals that experience mental health disorders, and the unmet need for treatment, especially in developing nations, such mHealth approaches have the potential to provide or augment treatment at low cost in the absence of in-person care.

Clinical application and evaluation of the diagnostic significance of NMR-tomography

International Nuclear Information System (INIS)

Bielke, G.; Higer, P.

1987-01-01

Aim of the project was the clinical application and evaluation of the diagnostic significance of NMR-tomography. About 3 000 patients have been examined especially with diseases of the brain. In 75% of all cases pathological findings could be detected. A subgroup of these patients was used for comprehensive studies with regard to tissue characterization based on the calculation of relaxation time parameters. With methods of image processing and classification techniques we tried to get a clear correlation between combined NMR-parameters and human tissue types. The results show that this procedure is able to improve the detectibility and the association to finding groups and tumorgradings in certain cases. (orig./ECB) With 134 refs., 17 tabs., 86 figs [de

[Nutritional risk screening and its clinical significance in 706 children hospitalized in the surgical department].

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Peng, Lu-Ting; Li, Rong; Zhao, Wei-Hua; Chen, Yin-Hua; Li, Xiao-Mei; Chen, Meng-Ying; Cao, Jia; Li, Xiao-Nan

2013-10-01

To investigate nutritional risk and its relationship with clinical outcome in children hospitalized in the surgical department, and to provide a scientific basis for clinical nutrition management. Nutritional risk screening was performed on 706 children hospitalized in the surgical department using the Screening Tool for Risk on Nutritional Status and Growth. The data on nutritional support during hospitalization, incidence of infectious complications, length of hospital stay, post operative length of hospital stay and total hospital expenses were recorded. Of the 706 cases, 11.5% had high nutritional risk, 46.0% had moderate nutritional risk, and 42.5% had low nutritional risk. Congenital hypertrophic pyloric stenosis, intestinal obstruction and congenital heart disease were the three most common types of high nutritional risk. The incidence of high nutritional risk was significantly higher in infants than in other age groups (Pnutritional risk received parenteral nutrition. Children with high nutritional risk were significantly more likely to have weight loss than children with low nutritional risk (Pnutritional risk had significantly increased incidence of infectious complications, length of hospital stay, post operative length of hospital stay and total hospital expenses compared with those with moderate or low nutritional risk (Pnutritional risk is seen in children hospitalized in the surgical department. Nutritional risk score is correlated with clinical outcome. Nutritional support for these children is not yet properly provided. Nutritional risk screening and standard nutritional support should be widely applied among hospitalized children.

Clinical significance of hypoalbuminemia in outcome of patients with scrub typhus

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Kwon Keun-Sang

2010-07-01

Full Text Available Abstract Background This study was designed to investigate the clinical significance of hypoalbuminemia as a marker of severity and mortality in patients with Scrub typhus. Methods The patients with scrub typhus were divided into two groups based on the serum albumin levels; Group I (serum albumin Results Of the total 246 patients who underwent the study, 84 patients (34.1% were categorized as Group I and 162 patients were (65.9% as Group II. Group I showed significantly higher incidence of confusion (24.6% vs. 5.3%, p p = 0.002, pleural effusion (22.8% vs. 11.1%, p = 0.03, arrhythmia (12.3% vs. 2.6%, p = 0.008 and non-oliguric acute renal failure (40.4% vs. 11.1%, p p p = 0.012, and higher hospital cost compared to Group II. Conclusions This study showed hypoalbuminemia in scrub typhus was closely related to the frequency of various complication, longer hospital stay, consequently the higher medical cost, necessitating more efficient management of patients, including medical resources.

Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance

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Knutson Gary A

2005-07-01

Full Text Available Abstract Background Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional "short leg" including anatomic-functional relationships, and provides an outline for clinical decision-making. Methods Online database – Medline, CINAHL and MANTIS – and library searches for the time frame of 1970–2005 were done using the term "leg-length inequality". Results and Discussion Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1. The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches ~ 20 mm (~3/4". Conclusion Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.

Measurement and Clinical Significance of Biomarkers of Oxidative Stress in Humans

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Ilaria Marrocco

2017-01-01

Full Text Available Oxidative stress is the result of the imbalance between reactive oxygen species (ROS formation and enzymatic and nonenzymatic antioxidants. Biomarkers of oxidative stress are relevant in the evaluation of the disease status and of the health-enhancing effects of antioxidants. We aim to discuss the major methodological bias of methods used for the evaluation of oxidative stress in humans. There is a lack of consensus concerning the validation, standardization, and reproducibility of methods for the measurement of the following: (1 ROS in leukocytes and platelets by flow cytometry, (2 markers based on ROS-induced modifications of lipids, DNA, and proteins, (3 enzymatic players of redox status, and (4 total antioxidant capacity of human body fluids. It has been suggested that the bias of each method could be overcome by using indexes of oxidative stress that include more than one marker. However, the choice of the markers considered in the global index should be dictated by the aim of the study and its design, as well as by the clinical relevance in the selected subjects. In conclusion, the clinical significance of biomarkers of oxidative stress in humans must come from a critical analysis of the markers that should give an overall index of redox status in particular conditions.

BRCA1 and BRCA2 genetic testing—pitfalls and recommendations for managing variants of uncertain clinical significance

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Eccles, D. M.; Mitchell, G.; Monteiro, A. N. A.; Schmutzler, R.; Couch, F. J.; Spurdle, A. B.; Gómez-García, E. B.

2015-01-01

Background Increasing use of BRCA1/2 testing for tailoring cancer treatment and extension of testing to tumour tissue for somatic mutation is moving BRCA1/2 mutation screening from a primarily prevention arena delivered by specialist genetic services into mainstream oncology practice. A considerable number of gene tests will identify rare variants where clinical significance cannot be inferred from sequence information alone. The proportion of variants of uncertain clinical significance (VUS) is likely to grow with lower thresholds for testing and laboratory providers with less experience of BRCA. Most VUS will not be associated with a high risk of cancer but a misinterpreted VUS has the potential to lead to mismanagement of both the patient and their relatives. Design Members of the Clinical Working Group of ENIGMA (Evidence-based Network for the Interpretation of Germline Mutant Alleles) global consortium (www.enigmaconsortium.org) observed wide variation in practices in reporting, disclosure and clinical management of patients with a VUS. Examples from current clinical practice are presented and discussed to illustrate potential pitfalls, explore factors contributing to misinterpretation, and propose approaches to improving clarity. Results and conclusion Clinicians, patients and their relatives would all benefit from an improved level of genetic literacy. Genetic laboratories working with clinical geneticists need to agree on a clinically clear and uniform format for reporting BRCA test results to non-geneticists. An international consortium of experts, collecting and integrating all available lines of evidence and classifying variants according to an internationally recognized system, will facilitate reclassification of variants for clinical use. PMID:26153499

Melatonin: a chemical photoperiodic signal with clinical significance in humans.

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Pang, S F; Pang, C S; Poon, A M; Lee, P P; Liu, Z M; Shiu, S Y

1998-03-01

Secretion of pineal melatonin exhibits a diumal rhythm and a seasonal rhythm in humans. Night-time melatonin is high at 3-5 year-old and decreases with age. Many drugs and pathological conditions also change melatonin levels in the circulation. Melatonin has a mild sedative effect and has been used effectively in synchronizing the sleep-wake cycle of patients with sleep disorders. Immunoenhancing, anti-cancer, anti-aging and anti-oxidant effects of melatonin have been proposed. Recent studies suggest that melatonin receptors are present in central and peripheral tissues. The importance of melatonin receptors on the nervous, reproductive, immune and renal functions is implicated. Studies on the molecular biology, physiology and pathology of melatonin receptors in different tissues are progressing rapidly. The physiological and pathological changes in melatonin secretion, multifarious melatonin actions, and diverse melatonin receptors reported suggest that melatonin is a photoperiodic signal with clinical significance in humans.

Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods

DEFF Research Database (Denmark)

Jakobsen, Janus Christian; Wetterslev, Jorn; Winkel, Per

2014-01-01

BACKGROUND: Thresholds for statistical significance when assessing meta-analysis results are being insufficiently demonstrated by traditional 95% confidence intervals and P-values. Assessment of intervention effects in systematic reviews with meta-analysis deserves greater rigour. METHODS......: Methodologies for assessing statistical and clinical significance of intervention effects in systematic reviews were considered. Balancing simplicity and comprehensiveness, an operational procedure was developed, based mainly on The Cochrane Collaboration methodology and the Grading of Recommendations...... Assessment, Development, and Evaluation (GRADE) guidelines. RESULTS: We propose an eight-step procedure for better validation of meta-analytic results in systematic reviews (1) Obtain the 95% confidence intervals and the P-values from both fixed-effect and random-effects meta-analyses and report the most...

Psychological distress, quality of life, symptoms and unmet needs of colorectal cancer survivors near the end of treatment.

Science.gov (United States)

Russell, Lahiru; Gough, Karla; Drosdowsky, Allison; Schofield, Penelope; Aranda, Sanchia; Butow, Phyllis N; Westwood, Jennifer A; Krishnasamy, Mei; Young, Jane M; Phipps-Nelson, Jo; King, Dorothy; Jefford, Michael

2015-09-01

This study investigated psychological morbidity, quality of life (QoL), colorectal cancer (CRC)-specific symptoms and supportive care needs in a CRC population at the end of treatment (EOT). CRC survivors (n = 152) completed a post-treatment baseline questionnaire as part of a multisite supportive care randomised controlled trial (SurvivorCare). CRC survivors had completed treatment with curative intent within 0 to 6 months. Measures are as follows: Brief Symptom Inventory 18 (BSI-18) (psychological morbidity), EORTC QLQ-C30 and QLQ-CR29 (QoL and CRC-specific symptoms and problems) and Cancer Survivors' Unmet Needs (CaSUN) measure with a simplified response format (unmet needs). Linear regression models were used to compare participants' QoL with a general population sample. Correlation analysis examined associations between psychological morbidity, QoL and CRC-specific symptoms and problems. Average participant age was 64 years, and 51% were male. The majority (68%) had stage 3 disease. In comparison to population norms, CRC survivors had lower depression and anxiety scores (47.4 and 45.6, respectively) but higher somatisation, and lower role, cognitive and social functioning (p < 0.001). CRC survivors had higher fatigue, nausea/vomiting, appetite loss, diarrhoea and financial problems (all p < 0.001), as well as pain (p = 0.002) and constipation (p = 0.019). CRC-specific psychological scores were positively correlated with all three BSI domain scores, and pain and fatigue symptom scores on the QLQ-C30 while negatively correlated with all five functional scales of the QLQ-C30. CRC survivors reported good mental health at EOT. Role and social functioning were impaired compared to population norms, possibly related to physical symptoms. Findings may help guide consultations with patients and inform the design of more tailored supportive care interventions. ACTRN12610000207011.

Measuring domestic water use: a systematic review of methodologies that measure unmetered water use in low-income settings.

Science.gov (United States)

Tamason, Charlotte C; Bessias, Sophia; Villada, Adriana; Tulsiani, Suhella M; Ensink, Jeroen H J; Gurley, Emily S; Mackie Jensen, Peter Kjaer

2016-11-01

To present a systematic review of methods for measuring domestic water use in settings where water meters cannot be used. We systematically searched EMBASE, PubMed, Water Intelligence Online, Water Engineering and Development Center, IEEExplore, Scielo, and Science Direct databases for articles that reported methodologies for measuring water use at the household level where water metering infrastructure was absent or incomplete. A narrative review explored similarities and differences between the included studies and provide recommendations for future research in water use. A total of 21 studies were included in the review. Methods ranged from single-day to 14-consecutive-day visits, and water use recall ranged from 12 h to 7 days. Data were collected using questionnaires, observations or both. Many studies only collected information on water that was carried into the household, and some failed to mention whether water was used outside the home. Water use in the selected studies was found to range from two to 113 l per capita per day. No standardised methods for measuring unmetered water use were found, which brings into question the validity and comparability of studies that have measured unmetered water use. In future studies, it will be essential to define all components that make up water use and determine how they will be measured. A pre-study that involves observations and direct measurements during water collection periods (these will have to be determined through questioning) should be used to determine optimal methods for obtaining water use information in a survey. Day-to-day and seasonal variation should be included. A study that investigates water use recall is warranted to further develop standardised methods to measure water use; in the meantime, water use recall should be limited to 24 h or fewer. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Unmet needs of people with severe multiple sclerosis and their carers: qualitative findings for a home-based intervention.

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Claudia Borreani

Full Text Available Few data on services for people with severe multiple sclerosis (MS are available. The Palliative Network for Severely Affected Adults with MS in Italy (PeNSAMI developed a home palliative care program for MS patients and carers, preceded by a literature review and qualitative study (here reported.To identify unmet needs of people with severe MS living at home by qualitative research involving key stakeholders, and theorize broad areas of intervention to meet those needs.Data were collected from: at least 10 personal interviews with adults with severe MS (primary/secondary progressive, EDSS≥8.0; three focus group meetings (FGs of carers of people with severe MS; and two FGs of health professionals (HPs. Grounded theory guided the analysis of interview and FG transcripts, from which the areas of intervention were theorized.Between October 2012 and May 2013, 22 MS patients, 30 carers and 18 HPs participated. Forty-eight needs themes were identified, grouped into 14 categories and four domains. Seven, highly interdependent intervention areas were theorized. Patients had difficulties expressing needs; experiences of burden and loneliness were prominent, chiefly in dysfunctional, less affluent families, and among parent carers. Needs differed across Italy with requirements for information and access to services highest in the South. All participants voiced a strong need for qualified personnel and care coordination in day-to-day home care. Personal hygiene emerged as crucial, as did the need for a supportive network and preservation of patient/carer roles within family and community.Unmet needs transcended medical issues and embraced organizational and psychosocial themes, as well as health policies. The high interdependence of the seven intervention areas theorized is in line with the multifaceted approach of palliative care. At variance with typical palliative contexts, coping with disability rather than end-of-life was a major concern of patients

Clinical significance of FLG gene mutations in children with atopic dermatitis

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E. E. Varlamov

2015-01-01

Full Text Available Skin barrier dysfunction due to deficiency of the skin protein filaggrin is one of the factors involved in the pathogenesis of atopic dermatitis. Objective: to determine the clinical significance of 2282 del CAGT, R501X, R2447X, and S3247X mutations in the FLG gene in children with atopic dermatitis. The investigation included 58 children with atopic dermatitis. A molecular genetic analysis of the four mutations in the FLG gene was done in all the children. In the patients with FLG gene mutations, there was a tendency towards a higher frequency of sensitization to house dust allergens, significantly more often sensitization to cat epidermal allergen, and significantly higher levels of specific IgE to the cat epidermis. Conclusion. Mutations in the FLG gene encoding the protein filaggrin raise the risk for sensitization to domestic and epidermal allergens and, in case of already existing sensitization to the cat epidermis, the patients are found with a high degree of probability to have the high concentration of specific IgE to this allergen. The above fact justifies the need to place special emphasis on measures to eliminate house dust allergens, and cat epidermis allergen in particular, and to personalize approaches to therapy and prevention of atopic dermatitis in children. 

BRCA1 and BRCA2 genetic testing-pitfalls and recommendations for managing variants of uncertain clinical significance.

Science.gov (United States)

Eccles, D M; Mitchell, G; Monteiro, A N A; Schmutzler, R; Couch, F J; Spurdle, A B; Gómez-García, E B

2015-10-01

Increasing use of BRCA1/2 testing for tailoring cancer treatment and extension of testing to tumour tissue for somatic mutation is moving BRCA1/2 mutation screening from a primarily prevention arena delivered by specialist genetic services into mainstream oncology practice. A considerable number of gene tests will identify rare variants where clinical significance cannot be inferred from sequence information alone. The proportion of variants of uncertain clinical significance (VUS) is likely to grow with lower thresholds for testing and laboratory providers with less experience of BRCA. Most VUS will not be associated with a high risk of cancer but a misinterpreted VUS has the potential to lead to mismanagement of both the patient and their relatives. Members of the Clinical Working Group of ENIGMA (Evidence-based Network for the Interpretation of Germline Mutant Alleles) global consortium (www.enigmaconsortium.org) observed wide variation in practices in reporting, disclosure and clinical management of patients with a VUS. Examples from current clinical practice are presented and discussed to illustrate potential pitfalls, explore factors contributing to misinterpretation, and propose approaches to improving clarity. Clinicians, patients and their relatives would all benefit from an improved level of genetic literacy. Genetic laboratories working with clinical geneticists need to agree on a clinically clear and uniform format for reporting BRCA test results to non-geneticists. An international consortium of experts, collecting and integrating all available lines of evidence and classifying variants according to an internationally recognized system, will facilitate reclassification of variants for clinical use. © The Author 2015. 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.

[The pathogenetic and clinical significance of disorders in hemostatic homeostasis in diabetics].

Science.gov (United States)

Lapchyns'ka, I I; Bielits'ka, H O; Kovalenko, S O

1997-01-01

DM patients who do not present with clinical manifestations of nephropathy exhibited significant reduction of urine fibrinolytic activity which is regarded as suggesting a preclinical stage of renal lesion in DM as well as hyperaggregation of platelets, enhanced activity of coagulative link of hemostasis and changes of different directions in the system of fibrinolysis. Among coagulologic methods, of most informative value is the turbidimetric method. In DM and low tolerability to glucosa, there is an increased incidence of gastroduodenal abnormalities, ulcer disease included, which fact warrants a gastroenterologic evaluation to be done in this patient population prior to prescribing anticoagulants.

CLASSIFICATION OF TEMPOROMANDIBULAR-JOINT OSTEOARTHROSIS AND INTERNAL DERANGEMENT .1. DIAGNOSTIC-SIGNIFICANCE OF CLINICAL AND RADIOGRAPHIC SYMPTOMS AND SIGNS

NARCIS (Netherlands)

STEGENGA, B; DEBONT, LGM; VANDERKUIJL, B; BOERING, G

In the clinical setting, diagnosis primarily depends on the history and present status of the patient, and on the examiner's expertise in physical examination and interpretation of conventional radiographs. In order to evaluate the diagnostic significance of clinical and radiographic variables, the

Repurposing Clinical Molecule Ebselen to Combat Drug Resistant Pathogens.

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Shankar Thangamani

Full Text Available Without a doubt, our current antimicrobials are losing the battle in the fight against newly-emerged multidrug-resistant pathogens. There is a pressing, unmet need for novel antimicrobials and novel approaches to develop them; however, it is becoming increasingly difficult and costly to develop new antimicrobials. One strategy to reduce the time and cost associated with antimicrobial innovation is drug repurposing, which is to find new applications outside the scope of the original medical indication of the drug. Ebselen, an organoselenium clinical molecule, possesses potent antimicrobial activity against clinical multidrug-resistant Gram-positive pathogens, including Staphylococcus, Streptococcus, and Enterococcus, but not against Gram-negative pathogens. Moreover, the activity of ebselen against Gram-positive pathogens exceeded those activities determined for vancomycin and linezolid, drugs of choice for treatment of Enterococcus and Staphylococcus infections. The minimum inhibitory concentrations of ebselen at which 90% of clinical isolates of Enterococcus and Staphylococcus were inhibited (MIC90 were found to be 0.5 and 0.25 mg/L, respectively. Ebselen showed significant clearance of intracellular methicillin-resistant S. aureus (MRSA in comparison to vancomycin and linezolid. We demonstrated that ebselen inhibits the bacterial translation process without affecting mitochondrial biogenesis. Additionally, ebselen was found to exhibit excellent activity in vivo in a Caenorhabditis elegans MRSA-infected whole animal model. Finally, ebselen showed synergistic activities with conventional antimicrobials against MRSA. Taken together, our results demonstrate that ebselen, with its potent antimicrobial activity and safety profiles, can be potentially used to treat multidrug resistant Gram-positive bacterial infections alone or in combination with other antibiotics and should be further clinically evaluated.

Information needs of adolescent and young adult cancer patients and their parent-carers.

Science.gov (United States)

McCarthy, Maria C; McNeil, Robyn; Drew, Sarah; Orme, Lisa; Sawyer, Susan M

2018-05-01

This study aimed to explore health-related information needs of adolescent and young adults (AYAs) and their parent-carers and to examine demographic and clinical variables associated with unmet information needs, including patient activation. In a national cross-sectional study, 196 Australian AYAs diagnosed with cancer between 15 and 25 years and within 24 months of diagnosis and 204 parent-carers reported on total and unmet needs for cancer and health-related information. Fifty-one percent of AYAs were male, 81% had completed treatment and 86% were treated in adult hospitals. AYAs and parents reported high levels of total need for information. The mean number of unmet needs was 5.63 and 6.82 for AYAs and parents, respectively. AYAs reported the highest unmet needs in relation to their cancer (e.g. late effects and cancer recurrence, and having children in the future). The highest unmet parent information needs were related to medical information about their child as well as information on financial issues for their children and themselves. Unmet information need was associated with psychological distress (posttraumatic stress symptoms) for AYAs and parents. Patient activation was negatively associated with unmet information needs for AYAs. Demographic and treatment variables were not significantly associated with information needs. These findings indicate the importance of information needs for AYAs and their carers. The association between patient activation and information needs suggests that promoting young people's engagement with healthcare is a key opportunity within AYA care. Parent information needs and associated emotional distress additionally highlight the importance of family-centered care.

Expression and clinical significance of ATM and PUMA gene in patients with colorectal cancer.

Science.gov (United States)

Xiong, Hui; Zhang, Jiangnan

2017-12-01

The expression of ataxia-telangiectasia mutated (ATM) and p53 upregulated modulator of apoptosis (PUMA) genes in patients with colorectal cancer were investigated, to explore the correlation between the expression of ATM and PUMA and tumor development, to evaluate the clinical significance of ATM and PUMA in the treatment of colorectal cancer. Quantitative real-time PCR was used to detect the expression of ATM and PUMA in tumor tissue and adjacent healthy tissue of 67 patients with colorectal cancer and in normal colorectal tissue of 33 patients with colorectal polyps at mRNA level. The expression level of ATM mRNA in colorectal cancer tissues was significantly higher than that in normal mucosa tissues and adjacent non-cancerous tissue (P≤0.05), while no significant differences in expression level of ATM mRNA were found between normal mucosa tissues and adjacent noncancerous tissue (P=0.07). There was a negative correlation between the expression of ATM mRNA and the degree of differentiation of colorectal cancer (r= -0.312, P=0.013), while expression level of ATM mRNA was not significantly correlated with the age, sex, tumor invasion, lymph node metastasis or clinical stage (P>0.05). Expression levels of PUMA mRNA in colorectal cancer tissues, adjacent noncancerous tissue and normal tissues were 0.68±0.07, 0.88±0.04 and 1.76±0.06, respectively. Expression level of PUMA mRNA in colorectal cancer tissues and adjacent noncancerous tissue was significantly lower than that in normal colorectal tissues (PATM mRNA is expressed abnormally in colorectal cancer tissues. Expression of PUMA gene in colorectal carcinoma is downregulated, and is negatively correlated with the occurrence of cancer.

An initiative to improve the management of clinically significant test results in a large health care network.

Science.gov (United States)

Roy, Christopher L; Rothschild, Jeffrey M; Dighe, Anand S; Schiff, Gordon D; Graydon-Baker, Erin; Lenoci-Edwards, Jennifer; Dwyer, Cheryl; Khorasani, Ramin; Gandhi, Tejal K

2013-11-01

The failure of providers to communicate and follow up clinically significant test results (CSTR) is an important threat to patient safety. The Massachusetts Coalition for the Prevention of Medical Errors has endorsed the creation of systems to ensure that results can be received and acknowledged. In 2008 a task force was convened that represented clinicians, laboratories, radiology, patient safety, risk management, and information systems in a large health care network with the goals of providing recommendations and a road map for improvement in the management of CSTR and of implementing this improvement plan during the sub-force sequent five years. In drafting its charter, the task broadened the scope from "critical" results to "clinically significant" ones; clinically significant was defined as any result that requires further clinical action to avoid morbidity or mortality, regardless of the urgency of that action. The task force recommended four key areas for improvement--(1) standardization of policies and definitions, (2) robust identification of the patient's care team, (3) enhanced results management/tracking systems, and (4) centralized quality reporting and metrics. The task force faced many challenges in implementing these recommendations, including disagreements on definitions of CSTR and on who should have responsibility for CSTR, changes to established work flows, limitations of resources and of existing information systems, and definition of metrics. This large-scale effort to improve the communication and follow-up of CSTR in a health care network continues with ongoing work to address implementation challenges, refine policies, prepare for a new clinical information system platform, and identify new ways to measure the extent of this important safety problem.

Role of MLH1 methylation in esophageal cancer carcinogenesis and its clinical significance.

Science.gov (United States)

Li, Jinyun; Ye, Dong; Wang, Lei; Peng, Yingying; Li, Qun; Deng, Hongxia; Zhou, Chongchang

2018-01-01

The mutL homolog-1 ( MLH1 ) is a DNA mismatch repair gene and has been reported to be frequently methylated in numerous cancers. However, the association between MLH1 methylation and esophageal cancer (EC), as well as its clinical significance, remains unclear. Hence, we conducted a systematic meta-analysis based on 19 articles (including 1384 ECs, 345 premalignant lesions, and 1244 healthy controls). Our analysis revealed that the frequency of MLH1 methylation was significantly elevated during EC carcinogenesis. In addition, we observed that MLH1 promoter methylation was associated with age (odds ratio [OR]=1.79; 95% CI =1.20-2.66), advanced tumor grade (OR=3.7; 95% CI =2.37-5.77), lymph node metastasis (OR=2.65; 95% CI =1.81-3.88), distant metastasis (OR=7.60; 95% CI =1.23-47.19), advanced clinical stage (OR=4.46; 95% CI =2.88-6.91), and poor prognosis in EC patients (hazard ratio =1.64, 95% CI =1.00-2.69). The pooled sensitivity, specificity, and area under the curve of MLH1 methylation in EC patients versus healthy individuals were 0.15, 0.99, and 0.77, respectively. Our findings indicate that MLH1 methylation is involved in the carcinogenesis, progression, and metastasis of EC. Moreover, methylated MLH1 could be a potential diagnostic and prognostic biomarker for EC.

Necrotizing pneumonia: CT findings and its clinical significance

International Nuclear Information System (INIS)

Park, Hong Suk; Im, Jung Gi; Ryoo, Jae Wook; Yeon, Kyung Mo; Han, Man Chung

1995-01-01

To analyze CT and follow-up chest radiographic findings in patients with necrotizing pneumonia and to evaluate clinical significance of the extent of necrosis. We reviewed medical records and retrospectively analysed CT scans and follow-up chest radiographs of 22 patients with necrotizing pneumonia, confirmed by biopsy (n = 7) and culture (n = 15). Inclusion criteria for necrotizing pneumonia was necrotic low attenuation, with or without cavitation on postcontrast enhanced CT scan. The study group included 15 men and seven women, aged 11-66 years (average: 47 years). The pathogens of necrotizing pneumonia were Klebsiella spp (n = 7), Enterobacter spp (n = 5), Actinomyces spp (n = 4), Pseudomonas spp (n = 4), Nocardia spp (n = 4), and others (n = 5). Average duration of pneumonia was 4.1 months. On CT scan, pneumonic consolidations were well-marginated in 14 patients and there were cavities on initial CT scan in 16 cases. Margins of the necrotic portion on CT scan were well-demarcated in majority of the patients (16/22). Low attenuation areas on initial CT scan resulted in cavitation, fibrosis and volume loss as shown on follow-up chest radiographs. The larger the necrotic areas on CT, the more the volume loss was. CT findings of necrotizing pneumonia were well-marginated air-space consolidation with low attenuation area, with or without cavity. The extent of necrotic area was closely related with the degree of fibrotic change later on. CT is important tool for diagnosis and prediction of parenchymal damage in necrotizing pneumonia

The clinical significance of fatty acid binding proteins

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Barbara Choromańska

2011-11-01

Full Text Available Excessive levels of free fatty acids are toxic to cells. The human body has evolved a defense mechanism in the form of small cytoplasmic proteins called fatty acid binding proteins (FABPs that bind long-chain fatty acids (LCFA, and then refer them to appropriate intracellular disposal sites (oxidation in mitochondria and peroxisomes or storage in the endoplasmic reticulum. So far, nine types of these proteins have been described, and their name refers to the place in which they were first identified or where they can be found in the greatest concentration. The most important FABPs were isolated from the liver (L-FABP, heart (H-FABP, intestine (I-FABP, brain (B-FABP, epidermis (E-FABP and adipocytes (A-FABP. Determination of H-FABP is used in the diagnosis of myocardial infarction, and L-FABP in kidney lesions of different etiologies. It is postulated that FABPs play an important role in the pathogenesis of metabolic diseases. Elevated levels of A-FABP have been found in the pericardial fat tissue and were associated with cardiac dysfunction in obese people. A rise in A-FABP has been observed in patients with type II diabetes. I-FABP is known as a marker of cell damage in the small intestine. Increased concentration of B-FABP has been associated with human brain tumors such as glioblastoma and astrocytoma, as well as with neurodegenerative diseases (Alzheimer’s, Parkinson’s and other disorders of cognitive function. The aim of this work was to present current data on the clinical significance of fatty acid binding proteins.

Mentorship Programs in Radiation Oncology Residency Training Programs: A Critical Unmet Need

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Dhami, Gurleen; Gao, Wendy; Gensheimer, Michael F. [Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); Trister, Andrew D. [Sage Bionetworks, Seattle, Washington (United States); Kane, Gabrielle [Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); Zeng, Jing, E-mail: jzeng13@uw.edu [Department of Radiation Oncology, University of Washington, Seattle, Washington (United States)

2016-01-01

Purpose: To conduct a nationwide survey to evaluate the current status of resident mentorship in radiation oncology. Methods and Materials: An anonymous electronic questionnaire was sent to all residents and recent graduates at US Accreditation Council for Graduate Medical Education–accredited radiation oncology residency programs, identified in the member directory of the Association of Residents in Radiation Oncology. Factors predictive of having a mentor and satisfaction with the mentorship experience were identified using univariate and multivariate analyses. Results: The survey response rate was 25%, with 85% of respondents reporting that mentorship plays a critical role in residency training, whereas only 53% had a current mentor. Larger programs (≥10 faculty, P=.004; and ≥10 residents, P<.001) were more likely to offer a formal mentorship program, which makes it more likely for residents to have an active mentor (88% vs 44%). Residents in a formal mentoring program reported being more satisfied with the overall mentorship experience (univariate odds ratio 8.77, P<.001; multivariate odds ratio 5, P<.001). On multivariate analysis, women were less likely to be satisfied with the mentorship experience. Conclusions: This is the first survey focusing on the status of residency mentorship in radiation oncology. Our survey highlights the unmet need for mentorship in residency programs.

Clinical significance of DVM and its prevalence in pre-gestational diabetes cases versus normal pregnancies

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Farideh Akhlaghi

2015-06-01

Full Text Available Pre-gestational diabetes mellitus affects less than 1% of all pregnancies and is a significant cause of fetal morbidity and mortality. It is hypothesized that impaired placental function, in the form of abnormal placental weight and/or abnormal placental histology, may be responsible for this event in such pregnancies. Delayed villous maturation of placental villi, which is one of the findings associated with pre-gestational diabetes increases the rate of perinatal mortality. There is limited literature regarding the delayed maturation of placental villous. This review included trials (randomized and non-randomized, cohort and case-control studies registered in Medline/PubMed database, from January 2001 to September 2012 that evaluated the clinical significance of delayed villous maturation and its prevalence in pre-gestational diabetic cases compared to normal pregnancies.It emphasizes that further studies with focus on possible clinical or ultrasound markers of placental delayed villous maturation, especially in a high risk-group such as women with pre-gestational diabetes mellitus are highly recommended.

Clinical Significance of Reticulocyte Hemoglobin Content in the Diagnosis of Iron Deficiency Anemia

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Mustafa Karagülle

2013-06-01

Full Text Available OBJECTIVE: The aim of this study was to evaluate the clinical significance of reticulocyte hemoglobin content (CHr in the diagnosis of iron deficiency anemia (IDA and to compare it with other conventional iron parameters. METHODS: A total of 32 female patients with IDA (serum hemoglobin 120 g/L and serum ferritin <20 ng/mL were enrolled. RESULTS: CHr was 24.95±3.92 pg in female patients with IDA and 29.93±2.96 pg in female patients with iron deficiency. CHr showed a significant positive correlation with hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, serum iron, and transferrin saturation and a significant negative correlation with transferrin and total iron-binding capacity. The cut-off value of CHr for detecting IDA was 29 pg. CONCLUSION: Our data demonstrate that CHr is a useful parameter that can be confidently used in the diagnosis of IDA, and a CHr cut-off value of 29 pg predicts IDA.

Clinical significance of the radioimmunological determination of C-peptide

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Dudczak, R.; Waldhaeusl, W.

1979-01-01

The aim of this study was to investigate the relationship of metabolic control to insulinogenic reserve in insulin-dependent diabetics. Thus, the secretory reserve of the pancreatic beta cell was estimated in insulin-dependent diabetics by measuring changes in peripheral serum immunoreactive C-peptide (IRCP) concentrations in response to intravenous arginine (n = 19; 0.5 g/kg,t = 30 min) or glibenclamide-glucose (n = 6; 2 mg HB 419 - 0.33 g/kg intravenously). In the majority of ''stable'' diabetics a small secretory reserve of the beta cell was demonstrated, but both the absolute and relative increase in IRCP was reduced after intravenous arginine or glibenclamide-glucose in comparison with normal controls. In ''unstable'' diabetics a decreased basal concentration of IRCP, significantly smaller than that seen in ''stable'' diabetics (p < 0.01), was accompanied by a complete lack of IRCP release on intravenous arginine administration. Thus, we conclude that the radioimmunological determination of IRCP is of clinical interest in assessing the residual secretory capacity of the beta cell in insulin-dependent diabetics. In revealing a lack of insulin this diagnostic tool seems to detect a group of potentially ''unstable'' diabetics in need of strict observation, which would minimize the risks of bad metabolic control. (author)

Clinical significance of the radioimmunological determination of C-peptide

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Dudczak, R; Waldhaeusl, W [Vienna Univ. (Austria). 1. Medizinische Klinik

1979-10-12

The aim of this study was to investigate the relationship of metabolic control to insulinogenic reserve in insulin-dependent diabetics. Thus, the secretory reserve of the pancreatic beta cell was estimated in insulin-dependent diabetics by measuring changes in peripheral serum immunoreactive C-peptide (IRCP) concentrations in response to intravenous arginine (n = 19; 0.5 g/kg,t = 30 min) or glibenclamide-glucose (n = 6; 2 mg HB 419 - 0.33 g/kg intravenously). In the majority of stable diabetics a small secretory reserve of the beta cell was demonstrated, but both the absolute and relative increase in IRCP was reduced after intravenous arginine or glibenclamide-glucose in comparison with normal controls. In unstable diabetics a decreased basal concentration of IRCP, significantly smaller than that seen in stable diabetics (p < 0.01), was accompanied by a complete lack of IRCP release on intravenous arginine administration. Thus, we conclude that the radioimmunological determination of IRCP is of clinical interest in assessing the residual secretory capacity of the beta cell in insulin-dependent diabetics. In revealing a lack of insulin this diagnostic tool seems to detect a group of potentially unstable diabetics in need of strict observation, which would minimize the risks of bad metabolic control.