Future Occurrence (future + occurrence)

Distribution by Scientific Domains

Selected Abstracts

Can haptoglobin be an indicator for the early diagnosis of neonatal jaundice?

Alpay Cakmak
Abstract Neonatal jaundice is the result of an imbalance between bilirubin production and elimination. Bilirubin conjugation in newborns is significantly impaired in the first few days; even a small increase in the rate of production can contribute to the development of hyperbilirubinemia. Hemolysis has a significant role in bilirubin increase in newborns. Intrauterine is tolerated by the maternal metabolism in life. When hemolysis takes place, a decrease is accepted in the haptoglobin and hemopoexin blood levels binding hemoglobin in the environment. Therefore, it may be considered that haptoglobin and hemopoexin from the early period umbilical cord (UC) blood in newborns may be an indicator in determining jaundice likely to develop in later stages. Babies were called to the control polyclinic in the third and fifthdays. Eighty-four babies with normal termbirth were included in the study. Gestational age of the mothers was 39.51.5 weeks in average. A significant negative correlation was found between the haptoglobin level from the UC taken during delivery and the bilirubin value in the fifth day (r=,0.345; P=0.001). The haptoglobin value from the blood of the UC can be used as a guiding indicator to demonstrate the future occurrence of jaundice in newborns. This way, the babies with high jaundice risk may be detected earlier and closer follow-up of these babies can be obtained. As a result, the haptoglobin level of the blood from the UC during delivery allows us to make an early prediction on whether neonatal jaundice will occur. J. Clin. Lab. Anal. 22:409,414, 2008. 2008 Wiley-Liss, Inc. [source]

Reconstructing and predicting the hepatitis C virus epidemic in Greece: increasing trends of cirrhosis and hepatocellular carcinoma despite the decline in incidence of HCV infection

V. Sypsa
Summary., In this study, a comprehensive methodology for modelling the hepatitis C virus (HCV) epidemic is proposed to predict the future disease burden and assess whether the recent decline in the incidence of HCV may affect the future occurrence of cirrhosis and hepatocellular carcinoma (HCC) cases. Using the prevalence of HCV, the distribution of chronic hepatitis C (CHC) patients within the various transmission groups and their infection-onset times, it was possible to reconstruct the incident infections per year in the past that progressed to CHC in Greece. The natural history of the disease was simulated in subcohorts of newly infected subjects using transition probabilities derived either empirically between fibrosis stages 0,4 or from literature review. Annual estimates of the incidence and prevalence of CHC by fibrosis stage, HCC and mortality in Greece were obtained up to 2030. HCV incidence peaked in the late 1980s at five new infections/10 000 person-years. Under the assumption of 20,100% decline in HCV incidence after 1990, the cumulative number of incident cirrhosis and HCC cases from 2002,2030 was projected to be lower by 9.6,48.2% and 5.9,29.5%, respectively, than that estimated under the assumption of no decline. However, the prevalent cirrhotic/HCC cases and HCV-related deaths are predicted to decline in the next 30 years only under the assumption of complete elimination of new HCV infections after 1990. Despite the progress in the reduction of HCV transmission, primary prevention does not seem adequate to reverse the rise in the incidence of cirrhosis and HCC. [source]

Identification and characterization of errors and incidents in a medical intensive care unit

J. Graf
Background:, To assess the frequency, type, consequences, and associations of errors and incidents in a medical intensive care unit (ICU). Methods:, Two-hundred and sixteen consecutive patients with predominantly cardiovascular and pulmonary disorders admitted between December 2002 and February 2003 were enrolled. Demographic data, SAPS II, and TISS-28 were obtained for all patients. Prior to patient enrolment all staff members (physicians, nurses, physiotherapists) were repeatedly encouraged to make use of the Incident Report Form (IRF) and detailed descriptions on how, why and when to use the IRF were provided. Results:, During the observation period of 64 days, 50 errors involving 32 patients (15%) were reported. Patients subjected to errors were more severely ill (SAPS II 42 25 vs. 32 18, P < 0.05), had a higher hospital mortality (38% vs. 9%), and a longer ICU stay (11 18 vs. 3 5 days, P < 0.05). Gender, age and TISS-28 were equally distributed. Each day of ICU stay increased the risk by 8% (odds ratio 1.078, 95% confidence interval 1.034,1.125, P < 0.001), and by 2.3% per SAPS II point (odds ratio 1.023, 95% confidence interval 1.006,1.040, P < 0.001). The majority of errors and incidents were judged as ,human failures' (73%), and 46 errors and incidents (92%) as ,avoidable'. Conclusions:, The identification and characterization of errors and incidents combined with contextual information is feasible and may provide sufficient background information for areas of quality improvement. Areas with a high frequency of errors and incidents need to undergo process evaluation to avoid future occurrence. [source]

Lifetime prognosis of schizophrenia: extended observation (more than 40 years) of 129 patients with typical schizophrenia

Abstract Background:, The excess mortality among patients with schizophrenia has been documented by epidemiological studies. These studies have shown that suicide accounts for most of this mortality. In contrast, the natural deaths of patients with schizophrenia have been commonly related to cardiovascular disease in these studies. Methods:, In this study, the clinical features of 129 patients with typical schizophrenia were examined in order to study the lifetime prognosis of patients with schizophrenia in Japan. These patients had their first visit to Kawagoe Dojinkai Hospital in 1963 and had been continuously observed for over 40 years. Results:, As at January 2003, the status of these 129 patients was categorized as follows: 27 patients were inpatients (mean age was 72.9 years), 20 patients were outpatients (mean age was 68.8 years), 2 patients were outpatients of another hospital, 20 patients had been admitted into nursing homes, 53 patients had passed away and 7 patients were missing. Clinical features were recorded for 44 (23 male patients with a mean age of 68.6 years and 21 female patients with a mean age of 64.2 years) out of the 53 patients who had passed away. The causes of death consisted of malignancy (13 cases), pneumonia (eight cases), heart failure (five cases), cerebral infarction (three cases), diabetes mellitus (three cases), cardiac infarction (two cases), ileus (two cases), asphyxia (one case), liver cirrhosis (one case), gastric ulcer (one case), heat stroke (one case), homicide (one case) and suicide (three cases). Two patients were discovered to have passed away alone at home. Conclusion:, The mean age of death was found to be lower than the life expectancy. However, only three patients committed suicide. These findings suggest that patients with schizophrenia may possess some biological vulnerability. Further study is needed to evaluate the effects of long-term antipsychotic medication. Clinically, medical checks for malignancy and care services for elderly patients are needed. Furthermore, in order to prevent future occurrences of patients dying alone in their own home, a social support system should be established. [source]

Community-based Participatory Research: Development of an Emergency Department,based Youth Violence Intervention Using Concept Mapping

Carolyn E. Snider MD, FRCPC
ACADEMIC EMERGENCY MEDICINE 2010; 17:1,9 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Emergency departments (EDs) see a high number of youths injured by violence. In Ontario, the most common cause of injury for youths visiting EDs is assault. Secondary prevention strategies using the teachable moment (i.e., events that can lead individuals to make positive changes in their lives) are ideal for use by clinicians. An opportunity exists to take advantage of the teachable moment in the ED in an effort to prevent future occurrences of injury in at-risk youths. However, little is known about perceptions of youths, parents, and community organizations about such interventions in EDs. The aims of this study were to engage youths, parents, and frontline community workers in conceptualizing a hospital-based violence prevention intervention and to identify outcomes relevant to the community. Methods:, Concept mapping is an innovative, mixed-method research approach. It combines structured qualitative processes such as brainstorming and group sorting, with various statistical analyses such as multidimensional scaling and hierarchical clustering, to develop a conceptual framework, and allows for an objective presentation of qualitative data. Concept mapping involves multiple structured steps: 1) brainstorming, 2) sorting, 3) rating, and 4) interpretation. For this study, the first three steps occurred online, and the fourth step occurred during a community meeting. Results:, Over 90 participants were involved, including youths, parents, and community youth workers. A two-dimensional point map was created and clusters formed to create a visual display of participant ideas on an ED-based youth violence prevention intervention. Issues related to youth violence prevention that were rated of highest importance and most realistic for hospital involvement included mentorship, the development of youth support groups in the hospital, training doctors and nurses to ask questions about the violent event, and treating youth with respect. Small-group discussions on the various clusters developed job descriptions, a list of essential services, and suggestions on ways to create a more youth-friendly environment in the hospital. A large-group discussion revealed outcomes that participants felt should be measured to determine the success of an intervention program. Conclusions:, This study has been the springboard for the development of an ED-based youth violence intervention that is supported by the community and affected youth. Using information generated by youth that is grounded in their experience through participatory research methods is feasible for the development of successful and meaningful youth violence prevention interventions. [source]