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Patient's Medical History (patient + medical_history)

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Selected Abstracts

The relationship of stress and anxiety with chronic periodontitis

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2003
M.V. Vettore
Abstract Aim: This case,control study investigates the relationship of stress and anxiety with periodontal clinical characteristics. Method: Seventy-nine selected patients (mean age 46.8±8 years) were assigned to three groups in accordance with their levels of probing pocket depth (PPD): control group (PPD,3 mm, n=22), test group 1 (at least four sites with PPD ,4 mm and ,6 mm, n=27) and test group 2 (at least four sites with PPD >6 mm, n=30). An inclusion criterion of the study required that patients presented a plaque index (PI) with a value equal to or larger than 2 in at least 50% of dental surfaces. All subjects were submitted to stress and anxiety evaluations. Stress was measured by the Stress Symptom Inventory (SSI) and the Social Readjustment Rating Scale (SRRS), while the State,Trait Anxiety Inventory (STAI) was used to assess anxiety. Clinical measures such as PI, gingival index (GI), PPD and clinical attachment level (CAL) were collected. Patient's medical history and socioeconomic data were also recorded. Results: The mean clinical measures (PI, GI, PPD and CAL) obtained for the three groups, were: control group, 1.56±0.32, 0.68±0.49, 1.72±0.54 and 2.04±0.64 mm; group 1, 1.56±0.39, 1.13±0.58, 2.67±0.67 and 3.10±0.76 mm, group 2, 1.65±0.37, 1.54±0.46, 4.14±1.23 and 5.01±1.60 mm. The three groups did not differ with respect to percentage of clinical stress, scores of the SRRS, trait and state anxiety. Frequency of moderate CAL (4,6 mm) and moderate PPD (4,6 mm) were found to be significantly associated with higher trait anxiety scores after adjusting for socioeconomic data and cigarette consumption (p<0.05). Conclusions: Based on the obtained results, individuals with high levels of trait anxiety appeared to be more prone to periodontal disease. Zusammenfassung Die Beziehung von Stress und Angst bei chronischer Parodontitis Ziel: Diese Fall kontrollierte Studie untersuchte die Beziehung von Stress und Angst zu parodontal klinischen Charakteristika. Methoden: 79 ausgesuchte Patienten (mittleres Alter 46,8±8) wurden unter Berücksichtigung der Sondierungstiefen (PPD) in 3 Gruppen aufgeteilt: Kontrollgruppe (PPD,3 mm, n=22), Testgruppe 1 (mindestens 4 Flächen mit PPD,4 mm und 6 mm, n=27) und Testgruppe 2 (mindestens 4 Flächen mit PPD>6 mm, n=30). Ein Einschlusskriterium für die Studie erforderte, dass die Patienten einen Plaqueindex mit einem Wert gleich oder größer 2 an mindestens 50% der Zahnoberflächen hatten. Alle Personen wurden hinsichtlich Stress und Angst evaluiert. Stress wurde mit der Stress Symptom Aufnahme (SSI) und der sozialen Anpassungsrate Skala (SRRS) gemessen, während für die Erfassung der Angst der State Trait Anxiety Inventory (STAI) genutzt wurde. Die klinischen Messungen wie Plaque Index (PI), Gingivaindex (GI), PPD und klinisches Stützgewebeniveau (CAL) wurden aufgezeichnet. Die medizinische Anamnese der Patienten und die sozioökonomischen Daten wurden ebenso aufgezeichnet. Ergebnisse: Die mittleren klinischen Messungen (PI, GI, PPD und CAL) für die drei Gruppen waren: Kontrollgruppe 1,56±0,32, 0,68±0,49, 1,72±0,54 mm und 2,04± 0,64 mm; Gruppe 1 1,56±0,39, 1,13±0,58, 2,67±0,67 mm und 3,10±0,76 mm und Gruppe 2 1,65±0,37, 1,54±0,46, 4,14± 1,23 mm und 5,01±1,60 mm. Die drei Gruppen unterschieden sich nicht hinsichtlich der Prozentsätze für klinischen Stress, Werte des SRRS, Charakter- und Zustandsangst. Die Häufigkeit von moderatem CAL (4,6 mm) und moderaten PPD (4,6 mm) war signifikant verbunden mit höheren Charakterangst-Werten nach Adjustierung für sozio-ökonomische Daten und Zigarettenverbrauch (p<0,05). Zusammenfassung: Basierend auf den gewonnen Ergebnissen scheinen Individuen mit mehr Neigung zu parodontalen Erkrankungen höhere Werte von Charakterangst zu haben. Résumé Relation du stress et de l'anxiété avec la parodontite chronique Cette étude contrôle par cas a analysé la relation du stress et de l'anxiété avec les caractéristiques cliniques parodontales. Septante-neuf patients d'une moyenne d'âge de 46,8±8 ans ont été répartis en trois groupes suivant leur niveau de profondeur de poche au sondage (PPD) : groupe contrôle (PPD3 mm, n=22), groupe test 1 (au moins quatre sites avec PPD4 mm et 6 mm, n=27) et le groupe test 2 (au moins quatre sites avec PPD6 mm, n=30). Un critère d'inclusion dans cette étude exigeait que les patients montraient un indice de plaque d'une valeur égale ou supérieure à 2 sur au moins 50% des surfaces dentaires. Tous les sujets ont été soumis à des évaluations de stress et d'anxiété. Le stress a été mesuré par l'inventaire du symptôme de stress (SSI) et le niveau d'évaluation de réajustement social (SRRS), tandis que l'inventaire de l'état d'anxiété (STAI) était utilisé pour évaluer l'anxiété. Les mesures cliniques telles que l'indice de plaque (PlI), l'indice gingival (GI), PPD et le niveau d'attache clinique (CAL) ont été enregistrées. L'histoire médicale du patient et les données socio-économiques ont également été prises en considération. Les mesures cliniques moyennes (PlI, GI, PPD, CAL) obtenues pour les trois groupes étaient respectivement de : groupe contrôle 1,56±0,32, 0,68±0,49, 1,72± 0,54 mm et 2,04± 0,64 mm; groupe 1, 1,56± 0,39, 1,13±0,58, 2,67±0,67 mm et 3,10±0,76 mm et groupe 2, 1,65±0,37, 1,54±0,46, 4,14±1,23 mm et 5,01±1,60 mm. Les trois groupes ne différaient pas en ce qui concerne le pourcentage de stress clinique, des scores de SRRS, et le niveau d'anxiété. La fréquence de CAL modéré (4 à 6 mm) et de PPD modéré (4 à 6 mm) était constatée significativement en association avec les plus grands scores d'anxiété après l'ajustement pour les données socio-économiques et le tabagisme (p<0,05). Ces résultats indiquent que les individus avec de hauts niveaux d'anxiété semblent plus susceptibles à la maladie parodontale. [source]

Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2005
Linda Garand
Abstract Background While the deleterious psychosocial and mental health effects of dementia caregiving are firmly established, very little is known about the burdens or psychiatric outcomes of providing care to a spouse with less severe cognitive impairment, such as mild cognitive impairment (MCI). We characterized the nature and level of caregiver burden and psychiatric morbidity in spouses of persons diagnosed with MCI. Methods Interview assessments were completed on a cohort of 27 spouses of persons with a recent diagnosis of MCI. Patient medical records were reviewed to collect information regarding the MCI patient's medical history. Results Respondents endorsed elevated levels of both task-related responsibilities and subjective caregiver burden. Depression and anxiety symptom levels also showed some elevations. Measures of caregiver burden were significantly associated with depression and anxiety levels. In particular, even after controlling for demographic risk factors for distress, nursing task burden was correlated with elevated depressive symptoms, and greater lifestyle constraints were correlated with higher anxiety levels. Conclusions Although caregiver burden and psychiatric morbidity levels were lower than those typically observed in family dementia caregiving samples, our findings suggest that MCI caregivers have already begun to experience distress in association with elevated caregiving burden. These individuals may be ideal targets for selective preventive interventions to maximize their psychological well-being as caregiving burdens related to their spouses' cognitive impairment increase. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Blood cultures for febrile patients in the acute care setting: Too quick on the draw?

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2008
ACNP-BC, Barbara K. Chesnutt MSN
Abstract Purpose: To review the fever literature and determine how 38.3°C was deemed the optimal fever threshold that predicts bacteremia. Data sources: PubMed, MEDLINE, Cochrane database, and the Cumulative Index to Nursing and Allied Health. Conclusions: A temperature of 38.3°C has come to be the threshold value that typically triggers diagnostic fever evaluation for bacteremia in hospitalized patients. Studies that define predictors of bacteremia provide conflicting results, and most bacteremia predictor models have not been externally validated. Therefore, current fever guidelines are based on consensus opinion rather than large clinical trials identifying a specific threshold with high sensitivity and a high negative predictive value. Implications for practice: The use of a single temperature threshold of 38.3°C for the prediction of bacteremia is not sufficient in all patients. Additional factors should be considered, including patient population, supporting clinical signs and symptoms, and the patient's medical history. [source]

Osteonecrosis of the Mandible or Maxilla Associated with the use of New Generation Bisphosphonates

THE LARYNGOSCOPE, Issue 1 2006
Matthew C. Farrugia DO
Objective: The use of bisphosphonates is well established for the treatment of patients with metastatic bone disease, osteoporosis, and Paget's disease. Osteonecrosis of the mandible or maxilla associated with the use of bisphosphonates is a newly described entity never before discussed in the otolaryngology literature. In this paper, we review a series of patients diagnosed with osteonecrosis, all treated with new generation bisphosphonates. Our objective is to inform and educate others, particularly otolaryngologists/head and neck surgeons, about this drug induced entity, a condition that should be recognized early to avoid potential devastating consequences. Study Design: Retrospective chart review of a series of patients from a tertiary referral center. Methods: Pathology reports of specimens submitted from either the mandible or maxilla were reviewed from the previous 12 months. Any patient diagnosed with osteonecrosis without evidence of metastatic disease at that site was included; those with a previous history of radiation therapy were excluded. Each patient's medical history and profile were reviewed. Results: Twenty-three patients were identified with osteonecrosis of the mandible or maxilla. All of these were associated with the use of new generation bisphosphonates: zolendronate (Zometa, Novartis), pamidronate (Aredia, Novartis), and alendronate (Fosamax, Merck). Eighteen patients with known bone metastases had been treated with the intravenous form, whereas five patients with either osteoporosis or Paget's disease were using oral therapy. Patients typically presented with a nonhealing lesion, often times the result of previous dental intervention. Although the majority of these patients were treated with conservative surgical debridement, we present a case requiring a near total maxillectomy. Conclusions: Drug induced osteonecrosis of the mandible or maxilla has been recently recognized as a sequelae of treatment with the new generation of bisphosphonates. Most patients can be treated with conservative surgical debridement and cessation of bisphosphonate therapy, whereas a few may require radical surgical intervention. Other recommendations include regimented prophylactic care with an assessment of dental status before the administration of bisphosphonates, avoidance of dental procedures, and close monitoring of oral hygiene. [source]

Diagnostic clues to megaloblastic anaemia without macrocytosis

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 3 2007
C. W. J. CHAN
Summary Masking of the macrocytic expression of megaloblastic anaemia (MA) by coexisting thalassaemia, iron deficiency and chronic illness has been widely reported. We described the haematological and clinical features of 20 Chinese patients with MA presenting with mean corpuscular volume (MCV) ,99 fl, and analysed the steps leading to the final diagnosis of MA with concomitant thalassaemia trait (n = 11), thalassaemia trait and iron deficiency (n = 3), iron deficiency (n = 4) and chronic illness (n = 2). We also compared the haematological characteristics of this group of patients with a group of normocytic anaemic patients without vitamin B12/folate deficiency, and identified certain laboratory information useful for differentiating the two groups. Statistically significant parameters included the mean values of haemoglobin, MCV, red cell distribution width (RDW), reticulocyte index, platelet count and serum bilirubin. All provided clues to maturation disorders within the marrow. A decision flowchart for the diagnosis of MA without macrocytosis was proposed. In the studied population, by using the parameters of haemoglobin <10 g/dl, MCV 80,99 fl, RDW , 16% and reticulocyte index , 2% as indicators, there was a 58% chance that a patient had MA without macrocytosis if he/she had all the four indicators, and a 2.2% chance of having it if he/she did not have these indicators. We emphasized the importance of including peripheral blood smear examination in the diagnostic procedures for such patients, as well as the importance of paying attention to patients' medical history, racial background and previous MCV value. [source]