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Substantial Burden (substantial + burden)
Selected AbstractsEpidemiology of invasive and other pneumococcal disease in children in England and Wales 1996,1998ACTA PAEDIATRICA, Issue 2000E Miller The results of enhanced national surveillance of pneumococcal disease in children <15y of age in England and Wales are reported for the period 1996,1998. Of the 1985 cases of laboratory-confirmed invasive disease (annual incidence 6.6 per 100000 overall and 39.7 per 100000 in infants <1 y of age), 485 (24%) were meningitis (annual incidence of 1.6 per 100000 overall and 15.7 per 100000 in infants <1 y of age). Fifty-nine deaths in children with invasive disease were identified-3% of the total reports. Thirty-one different serogroups/types were identified, with organisms in the 7-valent conjugate vaccine responsible for 69% of the infections in children <5 y of age; this rose to 77% and 82%, respectively, for the 9-and 11-valent vaccines. Resistance to penicillin varied from 2.3% to 6.2% in different years, but erythromycin resistance remained constant at 17%. The vast majority of resistant isolates were in vaccine serotype/groups. Computerized hospital admission records for all children <15 y of age with a discharge diagnosis code indicating probable pneumococcal disease were also analysed for 1997. The annual incidence for cases with a code specifically mentioning S. pneumoniae was 9.9 per 100000 compared with 71.2 per 100000 for lobar pneumonia; the mean duration of stay for both was < 1 wk. The incidence of admission for pneumococcal meningitis (1.9 overall and 19.6 for infants < 1 y of age) was similar to that derived from laboratory reports and resulted in an average duration of stay of 2 wk. Conclusion: This surveillance has confirmed the substantial burden of morbidity attributable to pneumococcal disease in British children and the potential public health benefits that could be achieved by the use of pneumococcal conjugate vaccines. [source] Nuclear Cardiology in the Evaluation of Acute Chest Pain in the Emergency DepartmentECHOCARDIOGRAPHY, Issue 6 2000Brian G. Abbott M.D. Only a minority of patients presenting to the emergency department (ED) with acute chest pain will eventually be diagnosed with an acute coronary syndrome. The majority will have an electrocardiogram that is normal or nondiagnostic for acute myocardial ischemia or infarction. Typically, these patients are admitted to exclude myocardial infarction despite a very low incidence of coronary artery disease. However, missed myocardial infarctions in patients who are inadvertently sent home from the ED have significant adverse outcomes and associated legal consequences. This leads to a liberal policy to admit patients with chest pain, presenting a substantial burden in terms of cost and resources. Many centers have developed chest pain centers, using a wide range of diagnostic modalities to deal with this dilemma. We discuss the methods currently available to exclude myocardial ischemia and infarction in the ED, focusing on the use of myocardial perfusion imaging as both an adjunct and an alternative to routine testing. We review the available literature centering on the ED evaluation of acute chest pain and then propose an algorithm for the practical use of nuclear cardiology in this setting. [source] Emergency Department Patient Volume and Troponin Laboratory Turnaround TimeACADEMIC EMERGENCY MEDICINE, Issue 5 2010Ula Hwang MD Abstract Objectives:, Increases in emergency department (ED) visits may place a substantial burden on both the ED and hospital-based laboratories. Studies have identified laboratory turnaround time (TAT) as a barrier to patient process times and lengths of stay. Prolonged laboratory study results may also result in delayed recognition of critically ill patients and initiation of appropriate therapies. The objective of this study was to determine how ED patient volume itself is associated with laboratory TAT. Methods:, This was a retrospective cohort review of patients at five academic, tertiary care EDs in the United States. Data were collected on all adult patients seen in each ED with troponin laboratory testing during the months of January, April, July, and October 2007. Primary predictor variables were two ED patient volume measures at the time the troponin test was ordered: 1) number of all patients in the ED/number of beds (occupancy) and 2) number of admitted patients waiting for beds/beds (boarder occupancy). The outcome variable was troponin turnaround time (TTAT). Adjusted covariates included patient characteristics, triage severity, season (month of the laboratory test), and site. Multivariable adjusted quantile regression was carried out to assess the association of ED volume measures with TTAT. Results:, At total of 9,492 troponin tests were reviewed. Median TTAT for this cohort was 107 minutes (interquartile range [IQR] = 73,148 minutes). Median occupancy for this cohort was 1.05 patients (IQR = 0.78,1.38 patients) and median boarder occupancy was 0.21 (IQR = 0.11,0.32). Adjusted quantile regression demonstrated a significant association between increased ED patient volume and longer times to TTAT. For every 100% increase in census, or number of boarders over the number of ED beds, respectively, there was a 12 (95% confidence interval [CI] = 9 to 14) or 33 (95% CI = 24 to 42)-minute increase in TTAT. Conclusions:, Increased ED patient volume is associated with longer hospital laboratory processing times. Prolonged laboratory TAT may delay recognition of conditions in the acutely ill, potentially affecting clinician decision-making and the initiation of timely treatment. Use of laboratory TAT as a patient throughput measure and the study of factors associated with its prolonging should be further investigated. ACADEMIC EMERGENCY MEDICINE 2010; 17:501,507 © 2010 by the Society for Academic Emergency Medicine [source] Clinical outcome of moderate haemophilia compared with severe and mild haemophiliaHAEMOPHILIA, Issue 1 2009I. E. M. DEN UIJL Summary., Information on outcome and treatment of patients with moderate haemophilia is scarce. In this study, we compared self-reported burden of disease in moderate haemophilia to severe and mild haemophilia. A nationwide questionnaire on bleeding pattern, treatment, impairment and quality of life was sent to 1567 Dutch patients with haemophilia. Out of 1066 respondents (response rate: 68%), 16% had moderate, 44% severe and 39% mild haemophilia. Median age was 36 years. Although overall outcome in moderate haemophilia was in between severe and mild haemophilia, moderate haemophilia patients did report a substantial burden of disease. The majority of patients with moderate haemophilia (73%) reported bleeds in the previous year; and a considerable proportion of moderate patients reported joint impairment (43%), chronic pain (15%), needed orthopaedic aids (24%) or were unemployed because of disability (27%). Within the group of moderate haemophilia patients, a large variation in bleeding pattern and outcome was observed. A quarter of patients with moderate haemophilia reported a more severe phenotype and intermittent use of prophylaxis. These patients reported frequent bleeding, with a median of eight bleeds per year, including two joint bleeds, and 68% reported joint impairment. In conclusion: Although outcome in moderate haemophilia is generally in between severe and mild haemophilia, moderate haemophilia patients reported a substantial burden of disease, and for more than 25% of patients with moderate haemophilia long term prophylaxis was implemented because of frequent bleeds. [source] The burden of influenza in East and South-East Asia: a review of the English language literatureINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 3 2008James M. Simmerman Abstract, While human infections with avian influenza A (H5NI) viruses in Asia have prompted concerns about an influenza pandemic, the burden of human influenza in East and Southeast Asia has received far less attention. We conducted a review of English language articles on influenza in 18 countries in East and Southeast Asia published from 1980 to 2006 that were indexed on PubMed. Articles that described human influenza-associated illnesses among outpatients or hospitalized patients, influenza-associated deaths, or influenza-associated socioeconomic costs were reviewed. We found 35 articles from 9 countries that met criteria for inclusion in the review. The quality of articles varied substantially. Significant heterogeneity was noted in case definitions, sampling schemes and laboratory methods. Early studies relied on cell culture, had difficulties with specimen collection and handling, and reported a low burden of disease. The recent addition of PCR testing has greatly improved the proportion of respiratory illnesses diagnosed with influenza. These more recent studies reported that 11,26% of outpatient febrile illness and 6-14% of hospitalized pneumonia cases had laboratory-confirmed influenza infection. The influenza disease burden literature from East and Southeast Asia is limited but expanding. Recent studies using improved laboratory testing methods and indirect statistical approaches report a substantial burden of disease, similar to that of Europe and North America. Current increased international focus on influenza, coupled with unprecedented funding for surveillance and research, provide a unique opportunity to more comprehensively describe the burden of human influenza in the region. [source] Impact of salvage therapy for biochemical recurrence on health-related quality of life following radical prostatectomyINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2007Shunichi Namiki Objective: To determine the impact of salvage therapy for prostate-specific antigen (PSA) recurrence on the health-related quality of life (HRQOL) of patients after radical retropubic prostatectomy (RP). Methods: Between January 2000 and December 2003, a total of 249 patients who underwent RP were available for 2-year follow up. Of the respondents, 203 men did not show evidence of recurrence (group A), and 46 men received salvage hormonal therapy and/or radiotherapy after RP because of a rise in PSA (group B). The general and prostate-target HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form and University of California, Los Angeles Prostate Cancer Index, respectively. Patients completed the HRQOL instruments by mail at baseline and at 24 months after RP. Results: All of the patients completed both questionnaires. At baseline no significant differences were found between the two groups in any of the HRQOL domains. There were significant improvements in mental health and social function for the patients without biochemical recurrence postoperatively. Repeated measure anova revealed significantly different patterns of alteration in several general HRQOL domains among the treatment groups. The urinary and bowel domains were equivalent between the two treatment groups at baseline and 24 months after RP. The patients treated with salvage hormonal therapy tended to show delayed recovery of sexual function. Conclusion: Using a self-administered questionnaire, biochemical recurrence following RP was found to impose a substantial burden in patients with localized prostate cancer. [source] Pediatric Heart Transplantation: Current Clinical ReviewJOURNAL OF CARDIAC SURGERY, Issue 1 2008D.Sc., F.I.C.S., M.B.A., M.P.H., M.Sc., Yanto Sandy Tjang M.D. Its incidence and prevalence is increasing and imposes substantial burden on the health care system. Despite much progress in development of many new drugs and innovations in palliative surgical strategy, nontransplant cardiac surgical procedures and the use of mechanical assist devices, pediatric heart transplantation remains the best treatment option for patients with end-stage heart failure. So far, more than 6000 pediatric heart transplantations have been performed worldwide. This article reviews some clinical aspects of pediatric heart transplantation, including the history, indications and contraindications, donor evaluation and recipient management, surgical techniques, risk factors of mortality, and survival of pediatric heart transplantation. The short- and long-term outcomes of pediatric heart transplantation are encouraging. However, the lack of donor hearts still hampers its clinical application. [source] Resilience factors in families living with people with mental illnessesJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 7 2009Liezl Jonker In South Africa, a substantial burden is placed on families living with people with mental illnesses. The aim of this study was to identify resilience factors in families living in an underprivileged area, caring for people with mental illnesses. Data was obtained from family representatives (N=34) using semistructured interviews and a set of seven self-report, quantitative questionnaires during the course of a once-off interview. The results of the qualitative analysis show that the most commonly cited resilience factors are religion and spirituality, and personal characteristics of individual family members. Both these factors were cited by 67.6% of the participants. The results of the Spearman correlations showed that the factor that displayed the strongest relationship with family adaptation was the quality of communication in the family unit. © 2009 Wiley Periodicals, Inc. [source] Burden of Medical Illness in Drug- and Alcohol-dependent Persons Without Primary CareTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 1 2004Israel De Alba M.D., M.P.H. Little is known about the frequency, severity, and risk factors for disease in drug- and alcohol-dependent persons without primary medical care. Our aims are to assess the burden of medical illness, identify patient and substance dependence characteristics associated with worse physical health, and compare measures of illness burden in this population. This was accomplished through a cross-sectional study among alcohol-, heroin- or cocaine-dependent persons without primary medical care who were admitted to an urban inpatient detoxification unit. The mean age of these patients was 35.7 (SD 7.8) years; 76% were male and 46% were Black. Forty-five percent reported being diagnosed with a chronic illness, and 80% had prior medical hospitalizations. The mean age-adjusted SF-36 Physical Component Summary (PCS) score was lower than the general U.S. population norm (44.1 vs 50.1; p < 0.001). In multivariable analysis, female gender (adjusted mean change in PCS score: ,3.71 points, p = .002), problem use of hallucinogens (,3.51, p = 0.013), heroin (,2.94, p = 0.008), other opiates (,3.20, p = .045), living alone (,3.15, p = .023), having medical insurance (,2.26, p = 0.014) and older age (,.22 points per year, p = 0.001) were associated with worse health. From these data, it seems that alcohol- and drug-dependent persons without primary medical care have a substantial burden of medical illness compared to age- and gender-matched U.S. population controls. While the optimal measure of medical illness burden in this population is unclear, a variety of health measures document this medical illness burden in addicted persons. [source] Diarrheal illness in a cohort of children 0,2 years of age in rural Bangladesh: I. Incidence and risk factorsACTA PAEDIATRICA, Issue 4 2006Preeti Pathela Abstract Aim: To describe clinical characteristics and age- and season-specific incidences of diarrheal episodes, and to evaluate risk factors associated with the occurrence of diarrheal disease. Methods: A total of 252 infants from rural Bangladesh were followed through household surveillance for 2 y from birth during the years 1993,1996. Demographic and household determinants were linked to the probability of illness using logistic regression models. Results: The overall incidence of diarrhea was 4.25 episodes per child per year. Peak rates of overall, acute, and persistent diarrhea occurred in the 6,11-mo and 12,17-mo age groups. Diarrheal rates peaked during the spring and summer. Among host-related characteristics, having a sibling in the household and having had prior diarrhea were significant risk factors for diarrhea. Among environmental characteristics, spring season remained a highly statistically significant risk factor for diarrhea. Conclusion: Diarrheal disease continues to be a substantial burden in young children in rural Bangladesh. Most diarrheal episodes are of short duration, and should primarily be treated with oral rehydration therapy to prevent diarrhea-related mortality. Improved knowledge of oral rehydration therapy, feeding during episodes to prevent further malnutrition, prolonged breastfeeding, and the keeping of livestock in corralled areas of the home are advocated. [source] | ||||||||||