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Significant Disability (significant + disability)
Selected AbstractsHeadache Progress in Canada Over the DecadesHEADACHE, Issue 5 2008Werner J. Becker MD As elsewhere in the world, migraine and other headache disorders have always produced very significant disability amongst Canadians. Over the last 50 years, progress has been made by health professionals to improve the care received by patients with headache, and to reduce the headache-related burden carried by patients and their families. Milestones in this progress have included programs for better education for the public, for neurologists, and for other physicians about migraine. Highlights in the Canadian battle against migraine and other headaches include those listed below: [source] Gender Differences in Treatment-Seeking Chronic Headache SufferersHEADACHE, Issue 7 2001Dawn A. Marcus MD Objective.,To identify gender differences within a group of patients seeking treatment for chronic headache. Previous studies of the general population have reported differences in headache symptoms, frequency, disability, and psychological distress, with women affected with more severe and disabling symptoms than men. This study evaluated these features in a population seeking treatment. Methods.,Two hundred fifty-eight consecutive patients with headache attending a university headache clinic were evaluated with questionnaires about headache symptoms and psychological distress. Comparisons between men and women were made for headache symptoms, severity, frequency, trigger factors, comorbid depression and anxiety, and response to treatment. Results.,There were no gender differences in headache symptoms, frequency, severity, and duration. Headache triggers were gender-specific, with men more likely to endorse exercise and women more likely to endorse stress and exposure to odors. Psychological comorbidity was similar among men and women seeking treatment, with a mean Beck Depression Inventory score of 10 and a mean Spielberger trait anxiety score of 39 for both men and women. Disability was greater in men, with 46% reporting restrictions in activities more than 3 days per week because of headache compared with 29% of women. In addition, men were more likely to contribute headache control to external figures than women. Conclusions.,Patients seeking treatment for chronic headache do not have the same gender-specific differences that have been reported in general population surveys. Men who seek treatment for headache are more likely to have significant disability, and are equally likely to have symptoms of depression and anxiety as women who seek treatment. Clinical and research investigations of headache triggers need to be gender-specific. [source] What happens after diagnosis?HEALTH EXPECTATIONS, Issue 2 2009Understanding the experiences of patients with newly-diagnosed bipolar disorder Abstract Bipolar disorder is chronic condition involving episodes of both depression and elevated mood, associated with significant disability and high relapse rates. Recent estimates suggest a lifetime prevalence of 5%. Little is known about the subjective experiences of patients after receiving a diagnosis of bipolar disorder, and the impact of these experiences on patients' willingness and ability to work with their health professionals to find the most effective combination of treatments and to set up self-management plans. Objective, This paper describes a qualitative study exploring the experiences and difficulties faced by patients after they have received a diagnosis of bipolar disorder, as expressed online to expert patients trained to provide informed support. Design, Qualitative study. Setting, Online communication within a public health service setting. Participants, Twenty-six participants with recently-diagnosed bipolar disorder communicated online with ,Informed Supporters', people who had been managing their bipolar disorder effectively for 2 years or more, as part of an online psycho-education programme. Results, Participants cited unwanted side-effects of medication, coping with unpleasant symptoms, positive and negative reactions to the diagnosis, identifying early warning signs and triggers of the illness, the loss of a sense of self, uncertainty about their future and stigma as issues of major importance after diagnosis. Conclusions, Personal concerns and difficulties following diagnosis can undermine effective treatment, thwart self-management efforts and interfere with effective functioning. Such data are important for clinicians to take into account when they work in partnership with their patients to fine-tune treatments and help them set up self-management plans. [source] Chronic Obstructive Pulmonary Disease Diagnosis and Management in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2010Nalaka S. Gooneratne MD Chronic obstructive pulmonary disease (COPD) in older adults is a complex disorder with several unique age-related aspects. Underlying changes in pulmonary lung function and poor sensitivity to bronchoconstriction and hypoxia with advancing age can place older adults at greater risk of mortality or other complications from COPD. The establishment of the Global Initiative for Obstructive Lung Disease criteria, which can be effectively applied to older adults, has more rigorously defined the diagnosis and management of COPD. An important component of this approach is the use of spirometry for disease staging, a procedure that can be performed in most older adults. The management of COPD includes smoking cessation, influenza and pneumococcal vaccinations, and the use of short- and long-acting bronchodilators. Unlike with asthma, corticosteroid inhalers represent a third-line option for COPD. Combination therapy is frequently required. When using various inhaler designs, it is important to note that older adults, especially those with more-severe disease, may have inadequate inspiratory force for some dry-powder inhalers, although many older adults find the dry-powder inhalers easier to use than metered-dose inhalers. Other important treatment options include pulmonary rehabilitation, oxygen therapy, noninvasive positive airway pressure, and depression and osteopenia screening. Clinicians caring for older adults with an acute COPD exacerbation should also guard against prognostic pessimism. Although COPD is associated with significant disability, there is a growing range of treatment options to assist patients. [source] Call for a national plan for rare diseasesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2010Adam Jaffe Abstract Australia requires a national plan, similar to plans developed internationally, to address the impacts of rare diseases on individuals, the community and health services. Rare diseases often present in childhood, many are chronic, some life threatening and others associated with significant disability. However, diagnosis is often delayed, because of lack of knowledge and experience of health professionals and uncertainty about where to refer. Specialised health services are frequently lacking and specific therapies are often not available, partly because of lack of research funding directed towards rare diseases. A national plan would facilitate a coordinated response to service development, carer support, and health professional and community education, and would promote research and advocacy for affected children and their families. [source] One-year neurodevelopmental outcome after moderate newborn hypoxic ischaemic encephalopathyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2004G Carli Objectives: To define the 1-year neurodevelopmental outcome for survivors of moderate (Sarnat stage 2) neonatal hypoxic-ischaemic encephalopathy (HIE) to facilitate appropriate parental counselling. Methods: Hospital-based retrospective review of admissions to a tertiary newborn intensive care unit between 1988 and 2000. All babies admitted for seizures were reviewed and those in whom the probable diagnosis was moderate HIE were identified from chart review. Perinatal variables, number of anticonvulsants, duration of hospital stay and 1-year neurodevelopmental outcome was recorded in survivors. Results: Fifty-three babies who survived probable moderate HIE were identified. Forty-two of these were seen at 1 year of age. Of these, 22 (52%) had normal development and neurological examination and four (9.5%) had mild developmental delay with normal neurological examination. Thirteen babies (31%) had cerebral palsy, 11 of whom also had developmental delay. Two infants (5%) who had been severely impaired at 6 months died before 1 year of age. Overall, 36% of survivors of the neonatal period had significant disability and or had died by 1 year of age. Duration of anticonvulsant treatment and length of hospital stay were significantly related to adverse outcome. Conclusions: These data suggest morbidity rates after moderate HIE in the upper end of the range previously described in the literature. Systematic longer-term follow up of this high-risk group of infants is needed. [source] The nonmotor symptoms of Parkinson's disease,An overview,MOVEMENT DISORDERS, Issue S1 2010FRACP, Shen-Yang Lim MBBS Abstract Nonmotor symptoms (NMS) are very common in Parkinson's disease (PD) and may result in significant disability. The increased focus on these important clinical features represents a major advance in the care of PD patients. In this article, we provide an overview of recent developments in the field. © 2010 Movement Disorder Society [source] Profile of Cognitive Impairment in Parkinson's DiseaseBRAIN PATHOLOGY, Issue 3 2010G. Stennis Watson Abstract Cognitive impairment (CI) is a common nonmotor complication of Parkinson's disease (PD), and is associated with significant disability for patients and burden for caregivers. Similar to motor symptoms, the characteristics of CI in PD can be quite variable, both in terms of what cognitive domains are impaired, and the timing of onset and rate of progression. This review will examine the profile of cognitive domain impairments observed in PD, with a focus on early CI (without dementia). We will also discuss possible relationships between specific cognitive domain impairments in PD and pathological processes such as Lewy-related pathology and Alzheimer's disease. It is our hypothesis that the specific characteristics of CI observed in individual PD patients provide clues to the underlying pathological processes, and that understanding the biological basis of this clinical phenomenon will assist in directing disease-specific treatments. Given the high lifetime risk for CI in PD, it is imperative that we improve our understanding and treatments for this common and disabling problem in PD. [source] | ||||||||||