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Medical Disorders (medical + disorders)
Selected AbstractsSleep and Medical DisordersJOURNAL OF SLEEP RESEARCH, Issue 2006Article first published online: 7 AUG 200 [source] The mind-body connection in elderlyNURSING & HEALTH SCIENCES, Issue 1 2005Oksoo Kim rn Depression is an illness affecting mind and body. Depression in people aged 65 years and older is a major public health problem. Because many older people are unaware that they need treatment for depression, as depression in the elderly is insidious. The consequences of undiagnosed depression can be fatal, as depression is a leading cause of suicide among elders. Late-life depression is particularly tricky in that the relationship between depression, disability and illness is very difficult to disentangle. Specific symptoms and signs of depression may impair some functions and not others. Medical disorders accompanying geriatric depression can cause disability, independent of the depressive syndrome or in synergy with it. There is growing evidence that treating depression in patients with a chronic physical condition may improve their medical condition, reduce the degree of pain, increase activity and lessen disability, enhance their quality of life and increase their ability to follow their treatment plan. Health care providers, elderly and their family should be aware of geriatric depression. [source] Beliefs about medications: measurement and relationship to adherence in patients with severe mental disordersACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2009H. Jónsdóttir Objective:, To determine if the Beliefs about Medicines Questionnaire (BMQ) has satisfactory psychometric properties in patients with severe mental disorders and if their scores differ from those of patients with severe medical disorders. To investigate if the scores are related to medication adherence. Method:, Two hundred and eighty psychiatric patients completed the BMQ and reported how much of their medication they had taken the past week. Serum concentrations of medications were analyzed. BMQ scores were compared with those of patients with chronic medical disorders. Results:, Cronbach's alpha was satisfactory for all subscales. The psychiatric group scored lower on the necessity of taking medication than the medical group. Non-adherent patients felt medication to be less necessary and were more concerned about it than adherent patients. The necessity subscale predicted adherence fairly well. Conclusion:, The BMQ has satisfactory psychometric properties for use in patients with severe mental disorders. The constructs measured by the BMQ are related to adherence in these patients. [source] A comparison of risk factors for habitual violence in pre-trial subjectsACTA PSYCHIATRICA SCANDINAVICA, Issue 2002S. Z. Kaliski Objective: Pre-trial referrals to the Valkenberg Hospital forensic unit over a 6-month period were studied. Habitually violent offenders were compared with those with no history of violence. Methods:, Risk factors known to be associated with violent behaviour were elicited, i.e. demographics, behaviour during index offence (such as impulsivity, identity of victim, use of weapon, accomplices, intoxication, psychotic symptoms), psychiatric and family histories, history of suicide attempts, past child abuse, head injury, criminal record, psychiatric diagnosis and presence of medical disorders. EEG's, Barratt's Impulsivity, Zuckerman's Sensation Seeking and Mini-Mental Scales were administered. Behaviour in the ward during the 30 days was also appraised. Logistic regression models were used to determine relative risks. Results:, There were 155 subjects; 89.7% were male, 71.6% were single and 58.7% were unemployed. For 44.5% the index offence was violent, and 9.7% had committed sexual offences; 61.9% had histories of habitual violence. A psychotic disorder was diagnosed in 32.3% and a personality disorder in 48.4%. Habitually violent subjects were distin- guished by a history of issuing threats (OR=3.68; CI=3.19,4.16; P= 0.000), delusions of persecution (OR=3.43; CI=2.67,4.17; P=0.001), history of conduct disorder (OR=1.95; CI=1.70,2.19; P=0.006), alcohol/substance abuse (OR=2.08; CI=1.53,2.61; P=0.008) and violent index offence (OR=1.66; CI=1.54,2.61; P=0.035). Conclusion: This seems to confirm the relationship between threats, feeling threatened, psychosis, a history of antisocial behaviour and alcohol abuse. [source] Clinical dental examinations of 357 donkeys in the UK.EQUINE VETERINARY JOURNAL, Issue 4 2009Part 2: Epidemiological studies on the potential relationships between different dental disorders, between dental disease, systemic disorders Summary Reasons for performing study: Dental disease has been shown to be a risk factor for weight loss and colic in horses. No extensive clinical studies in donkeys have investigated the potential relationship between different dental disorders, or between dental disease and systemic disorders. Objectives: To determine possible associations between dental disease and body condition score, weight loss, the need for supplemental feeding and prevalence of colic in donkeys of all ages, and to gain a better understanding of the pathogenesis of dental disease by the determination of associations between different dental disorders. Methods: A prospective cross-sectional analysis of clinical dental examinations of 357 donkeys in The Donkey Sanctuary, Sidmouth was performed. Other epidemiological factors such as estimated age group, body condition score, weight loss, medical history and supplemental feeding were also recorded, and multiple regression analyses were performed to determine possible associations. Results: Donkeys from older age groups were more likely to have dental disease, poor body condition score and suffered previous colic episodes. The presence of dental disease was also significantly associated with weight loss, colic, low body condition score and the need for supplemental feeding. The presence of diastemata, periodontal disease, wave mouth, smooth mouth and step mouth are frequently associated with the presence of other dental disorders. Conclusions: In addition to oral-related pain, dental disease can cause significant systemic disorders and so has increased welfare implications in donkeys. Some dental disorders promote the development of other types of dental abnormalities and thus increase the severity of dental disease in individual animals. Potential significance: Effective treatment of dental disorders slows down the progression of dental disease and decreases the risk of developing some medical disorders such as colic and weight loss that are associated with dental disease. [source] Antidepressant drug prescribing among elderly subjects: a population-based studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2005Mauro Percudani Abstract Background The patterns of antidepressant drug prescribing have rarely been studied in large and geographically defined populations of elderly subjects. In the present study we examined the prevalence and distribution of antidepressant prescribing in Lombardy, a northern Italy region with more than one and a half million elderly inhabitants. Methods We used the Regional Administrative Database of Lombardy. This database includes all prescriptions reimbursed by the National Health System in the population living in this region. All antidepressant prescriptions dispensed to subjects aged 65 years or above during 2001 were extracted and prevalence data calculated by dividing antidepressant users by the total number of male and female residents in each age group. Results During the 12 months surveyed 153,706 subjects were dispensed one or more prescriptions of antidepressants, yielding a prevalence of use of 9.49 subjects per 100 inhabitants (95% confidence interval 9.44, 9.53). Although the proportion of chronic users slightly decreased with age, more than 35% of those older that 85 years were moderate or chronic antidepressant users. General practitioners issued the majority of antidepressant prescriptions, and most antidepressant users were also dispensed agents for medical disorders. Conclusions The very high rates of antidepressant drug prescribing detected in late life suggest the need of characterising these subjects in terms of medical and psychiatric characteristics, needs and quality of life. It also suggests the need for pragmatic clinical trials, carried out in the general practice, with the aim of assessing whether antidepressants are effective in these conditions. Copyright © 2005 John Wiley & Sons, Ltd. [source] Medical comorbidity in late-life depressionINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2004Warren D. Taylor Abstract Objectives Medical comorbidity is common in elderly patients with depression, however the difference between depressed and non-depressed elderly populations is not well established. Additionally, differences between subgroups of depressed populations, including those with MRI-defined vascular depression and those with late-onset compared with early-onset depression are not well described. Methods We compared self-report of medical disorders between 370 depressed elders and 157 non-depressed control subjects. Subjects were additionally dichotomized based on presence or absence of subcortical MRI lesions and age of onset. Medical comorbidity was assessed by self report only, and depressed subjects were additionally assessed by the clinician-rated Cumulative Illness Rating Scale. Results When compared with the non-depressed group, depressed subjects were significantly more likely to report the presence of hypertension, heart disease, gastrointestinal ulcers, and ,hardening of the arteries'. Analyses of subjects with subcortical disease demonstrated they were significantly older, more likely to have depression, and more likely to report the presence of hypertension. Finally, the depressed cohort with late-onset depression (occurring after age 50 years) had more male subjects, exhibited greater CIRS scores, and greater prevalence of hypertension, but these did not reach a level of statistical significance after applying a Bonferroni correction. Conclusions Vascular comorbidities are common in depressed elders. The differences in the report of hypertension supports past work investigating a vascular contribution to late-life depression. Given the association between depression and poor medical outcomes of cardiac disease, this population deserves clinical scrutiny and further research. Copyright © 2004 John Wiley & Sons, Ltd. [source] Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and managementINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2003Kurt Kroenke MD Abstract Somatic symptoms are the leading cause of outpatient medical visits and also the predominant reason why patients with common mental disorders such as depression and anxiety initially present in primary care. At least 33% of somatic symptoms are medically unexplained, and these symptoms are chronic or recurrent in 20% to 25% of patients. Unexplained or multiple somatic symptoms are strongly associated with coexisting depressive and anxiety disorders. Other predictors of psychiatric co-morbidity include recent stress, lower self-rated health and higher somatic symptom severity, as well as high healthcare utilization, difficult patient encounters as perceived by the physician, and chronic medical disorders. Antidepressants and cognitive-behavioural therapy are both effective for treatment of somatic symptoms, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache. A stepped care approach is described, which consists of three phases that may be useful in the care of patients with somatic symptoms. Copyright © 2003 Whurr Publishers Ltd. [source] Rationale for medical director acceptance or rejection of allogeneic plateletpheresis donors with underlying medical disordersJOURNAL OF CLINICAL APHERESIS, Issue 3 2002Ronald G. Strauss Abstract A survey was completed by 25 medical directors at different institutions performing plateletpheresis. The practices of these 25 physicians were analyzed regarding the acceptance/rejection of plateletpheresis donors with a history of cardiac disease/surgery, seizures/epilepsy, cancer, or autoimmune diseases. Although available medical literature documents little risk of these disorders either to donors (i.e., donation reactions) or to transfusion recipients (i.e., disease transmission), up to 24% of medical directors outright reject some of these potential donors while others accept patients/donors with these illnesses, providing they meet certain medical/health criteria. Acceptance/rejection of individuals with medical disorders has relevance for the availability of the blood supply and blood product shortages because several million Americans, diagnosed with these illnesses, represent a sizable pool of potential blood and platelet donors. J. Clin. Apheresis 17:111,117, 2002. © 2002 Wiley-Liss, Inc. [source] Alpha2 macroglobulin elevation without an acute phase response in depressed adults with Down's syndrome: implications,JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2000J. A. Tsiouris Abstract Studies of immune function during depression in persons without intellectual disability (ID) have revealed elevated levels of ,2 macroglobulin (,2M) and an acute phase protein (APP) response. Clinical observation suggests that people with Down's syndrome (DS) may have associated genetic abnormalities in their immune systems. The APP response and ,2M changes in depressed versus non-depressed adults with DS was the subject of the present study. The serum pan-proteinase inhibitor ,2M, and the AP proteins c-reactive protein (CRP), ,1 antitrypsin (,1AT), ceruloplasmin (Cp), ,2 Macroglobulin (,2M), transthyretin (Trans), serum amyloid protein (SAP), and albumin (Alb) were measured in 38 adults with DS, 19 of whom were diagnosed with and 19 without depression using a sandwich enzyme-linked immunosorbent assay (ELISA). The DSM-IV criteria were used for diagnoses. Medical and neurological examinations excluded medical disorders associated with APP response. Only ,2M and CRP were significantly different in the depressed versus non-depressed groups. The ,2M was higher, a response similar to one observed in depressed people without ID, but the CRP was lower in the depressed group, especially in those subjects not on psychotropic medications, contrary to the expected APP response to depression. The results suggest that ,2M elevation in depressed adults with DS is independent of the APP response. An alternative explanation for its elevation is proposed linking the core symptom of depression with the mammalian dormancy/hibernation process. Further studies are needed to confirm that ,2M elevation is specific to depression and that it might provide a helpful marker for the diagnosis of depression in people with ID. [source] Common Health Hazards in French Pilgrims During the Hajj of 2007: A Prospective Cohort StudyJOURNAL OF TRAVEL MEDICINE, Issue 6 2009Philippe Gautret MD Background. The majority of published studies on Hajj-related diseases were based on hospitalized patient cohorts. Methods. A total of 545 Hajj pilgrims from Marseille were enrolled in a prospective epidemiological study to evaluate the incidence of common health hazards. They were administered a questionnaire before traveling addressing demographic factors and health status indicators and a post-travel questionnaire about travel-associated diseases. Results. Respondents had a median age of 61 years and originated mainly from North Africa (81%). A significant proportion of individuals had chronic medical disorders such as walking disability (26%), diabetes mellitus (21%), and hypertension (21%). A total of 462 pilgrims were administered a questionnaire on returning home. A proportion of 59% of travelers presented at least one health problem during the pilgrimage and 44% of the cohort attended a doctor during travel; 3% were hospitalized. Cough was the main complaint among travelers (attack rate of 51%), followed by headache, heat stress, and fever. Few travelers suffered diarrhea and vomiting. Cardiovascular diseases, neurological disorders, trauma, skin and gastrointestinal problems were not frequently observed in our survey, suggesting that their prevalence among the causes of admission to Saudi hospitals reflects a bias of selection. Cough episodes were significantly more frequent in individuals >55 years. We also evidenced that women were more likely to present underlying chronic cardiovascular disorder and diabetes compared to men and that they more frequently suffered from cough episodes associated with fever during the Hajj. Conclusions. Health risks associated with the Hajj in our experience are much more related to crowding conditions than to travel. Our work suggests that the studies performed in Saudi specialized units probably overestimate the part of certain diseases within the spectrum of Hajj-associated diseases. Our results also suggest that old female Hajjes should be considered as a high-risk population and that preventive measures should be reinforced before departing for Saudi Arabia. [source] Epidural Catheter Analgesia in Dogs and Cats: Technique and Review of 182 Cases (1991,1999)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2001Bernie D. Hansen DVM, DACVECC Abstract Objective: To characterize the indications and techniques for catheterization of the epidural space to treat pain in dogs and cats in a veterinary teaching hospital intensive care unit, and describe the analgesic regimens used in those patients. To provide a detailed description of the technique of epidural catheterization in companion animals. Design: Retrospective case series and clinical practice review. Setting: The Veterinary Teaching Hospital at the North Carolina State University College of Veterinary Medicine. Animals: Records from 160 dogs and 22 cats that had epidural catheters placed were identified. Interventions: Epidural catheterization for the purpose of providing analgesia for a variety of surgical and medical disorders was performed on both awake and anesthetized patients. Measurements and main results: The most frequently used analgesic agents were preservative-free morphine and bupivacaine. 2The range of duration of catheter dwell time was 1.3,332 hours, with a mean duration of 50 hours and a median of 39 hours. Suspicion of catheter malpositioning prompted radiographic imaging of the catheter in 44 patients, and malpositioning was confirmed in 6 of those. Catheter tip positioning was recorded in 46 patients. The tip was located at L3-L6 in 16, and T5-L3 in 30. Twenty-seven of those 30 patients were catheterized to treat pain associated with thoracotomy, forelimb amputation, pancreatitis, or peritonitis. Fifty-one (28%) patients received no analgesics beyond those provided by the epidural catheter. Conclusions: Epidural administration of analgesia appeared to provide significant pain relief and was adequate as a sole analgesic treatment in some patients. Serious complications in these critically ill animals appeared to be uncommon. (J Vet Emerg Crit Care 2001; 11(2): 95,103) [source] Prevalence and Incidence of Serum Magnesium Abnormalities in Hospitalized CatsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2002Jeffrey Toll Total serum magnesium concentration ([Mg2+]s) was prospectively determined for 57 cats admitted to the intensive care unit (ICU) of the Cornell University Hospital for Animals. Data were collected and analyzed to determine the following: prevalence and incidence of [Mg2+]s abnormalities, medical disorders associated with altered [Mg2+]s, association of altered [Mg2+]s with other electrolyte abnormalities, length of hospitalization for cats with abnormalities of [Mg2+]s versus those with normal [Mg2+]s, and survival of cats with abnormal [Mg2+]s versus those with normal [Mg2+]s. The point prevalence of magnesium abnormalities was 26%, the period prevalence was 46%, and the cumulative incidence was 23%. Hypermagnesemia was associated with abnormalities of serum potassium (P= .04) and phosphate (P= .01) concentrations. Abnormalities of [Mg2+]s were not associated with abnormal serum concentrations of Na+, Ca2+, or Cl - . On admission, hypomagnesemia was detected in cats with gastrointestinal, endocrine, and other disorders; hypermagnesemia was detected only in cats with renal disease, obstructive uropathy, or neoplastic disease. The median hospital stay for cats that developed abnormal [Mg2+]s after admission was longer than for cats that remained nor-momagnesemic (5 versus 4 days, respectively; P= .03). Despite the longer hospital stay, the survival of these cats was lower than that of normomagnesemic cats (54 versus 77%; P= .05). When all cats were considered, the survival of cats with abnormal [Mg2+]s also was decreased compared with normomagnesemic cats (62 versus 81%; P= .05). We conclude that abnormalities of [Mg2+]s may affect morbidity and mortality of affected cats. [source] Clinical significance of RLSMOVEMENT DISORDERS, Issue S18 2007Wayne A. Hening MD Abstract While the restless legs syndrome (RLS) may have been known in antiquity, it has only recently come to medical attention. Individuals with RLS fall along a spectrum from mild, infrequent symptoms to those with severe daily life-impairing discomforts and sleep disruption. These problems can cause impaired mood, daytime fatigue, cognitive difficulties, and inability to participate in a variety of quiet activities. This leads to a general reduction in quality of life similar to other significant psychiatric and medical disorders. Recent studies suggest that RLS may be a risk factor for developing both psychiatric disorders (such as major depression and anxiety) and somatic diseases (such as hypertension and cardiovascular disease). In dialysis patients, RLS has been found to be a risk factor for mortality. Therefore, those with RLS who have clinically significant symptoms suffer increased morbidity and are at risk for impaired long-term medical outcomes. © 2007 Movement Disorder Society [source] | ||||||||||||||||||||||