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Preventive Approach (preventive + approach)
Selected AbstractsAcute pulmonary failure during remission induction chemotherapy in adults with acute myeloid leukemia or high-risk myelodysplastic syndromeCANCER, Issue 1 2010Ali Al Ameri MD Abstract BACKGROUND: Acute pulmonary failure during remission induction therapy is a serious complication in patients with acute myeloid leukemia (AML). To the authors' knowledge, the course and prognosis of such patients is not well known. METHODS: A total of 1541 patients referred for remission induction chemotherapy of AML or high-risk myelodysplastic syndrome were retrospectively reviewed. RESULTS: A total of 120 (8%) patients developed acute pulmonary failure within 2 weeks of the initiation of chemotherapy; 87 of these patients (73%) died during remission induction, whereas 17 (14%) achieved a complete response. The median survival among the 120 patients with early acute pulmonary failure was 3 weeks. Predictive factors for the development of early acute pulmonary failure by multivariate analysis were: male sex (P = .00038), acute promyelocytic leukemia (P = .00003), poor performance status (P = .001), lung infiltrates at diagnosis (P = .000001), and increased creatinine (P = .000005). Patients who had 0 to 1, 2, 3, or 4 to 5 adverse factors were found to have estimated predictive incidences of acute pulmonary failure of 3%, 13%, 23%, and 34%, respectively. CONCLUSIONS: Preventive approaches at the start of induction therapy in patients at high risk of pulmonary failure may improve the outcome of these patients. Cancer 2010. © 2010 American Cancer Society. [source] Thiazolidinediones and the preservation of ,-cell function, cellular proliferation and apoptosisDIABETES OBESITY & METABOLISM, Issue 8 2008Michael Decker The thiazolidinediones (TZDs) or glitazones are pharmaceutical agents that have profound effects on energy expenditure and conservation. They also exert significant anti-inflammatory effects and influence cell proliferation and cell death. The drugs are primarily used in clinical practice in the treatment of patients with type 2 diabetes mellitus, a disorder of insulin resistance that occurs when the pancreatic ,-cells are unable to produce adequate amounts of insulin to maintain euglycaemia. Loss of pancreatic ,-cell function in type 2 diabetes is progressive and often precedes overt diabetes by 10 years or more, as was shown by the United Kingdom Prospective Diabetes Study. Any therapeutic or preventive approach that would limit or reverse loss of ,-cell function in diabetes would have profound effects on the morbidity associated with this widespread disease. Evidence suggesting a potential role of TZDs in preserving ,-cell function in type 2 diabetes as well as the ability of these agents to exert anti-inflammatory and proapoptotic anticancer effects, and their ability to promote cellular proliferation in various organs is reviewed. [source] Cardiovascular metabolic syndrome , an interplay of, obesity, inflammation, diabetes and coronary heart diseaseDIABETES OBESITY & METABOLISM, Issue 3 2007J. S. Rana Cardiovascular disease is currently one of the biggest causes of morbidity and mortality facing humanity. Such a paradigm shift of disease pattern over the last century has only worsened due to the alarming global prevalence of obesity and type 2 diabetes. In recent years there is increasing focus on inflammation as one of the key players in the patho-physiology of these disorders. In addition to these overt risk factors new research is unraveling the significance of a constellation of early metabolic abnormalities that include weight gain, insulin resistance, prehypertension and a specific pattern of dyslipidaemia. There exists a complex interrelationship of these various metabolic disorders and their effect on cardiovascular system. Simplified explanation can be that inflammation increases insulin resistance, which in turn leads to obesity while perpetuating diabetes, high blood pressure, prothrombotic state and dyslipidaemia. While inflammation and insulin resistance have direct adverse effects on cardiac muscle, these metabolic abnormalities as a whole cause causes cardiovascular complications; warranting a multi pronged therapeutic and preventive approach for the ,Cardiovascular Metabolic Syndrome' as an entity. [source] Prevalence of salivary Streptococcus mutans in mothers and in their preschool childrenINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2002I. Thorild Summary. Objectives. To establish the prevalence and possible relationship of oral Streptococcusmutans colonization in mother,child pairs. Design and setting. An analytical cross-sectional study was carried out at a well-baby evaluation clinic held at the Public Dental Clinic, Varberg, Sweden. Sample and methods. Two hundred preschool children, 100 of which were 18 months old and the remaining 100 were 3 years old, and their mothers attended the clinic. All mothers were interviewed and their children's medical history, oral hygiene routines and dietary habits established. All children were clinically examined. The presence and level of S. mutans was estimated in the mother,child pairs with the aid of the Strip mutans chair-side test. Results. Nearly 50% of mothers exhibited high levels of salivary S. mutans, prevalence among the 18-month- and 3-year-olds was 30% and 42%, respectively. A statistically significant (P < 0·01) mother,child relationship was found; a greater presence in mothers led to a higher number of children found harbouring the bacteria. Logistic regression analysis found that high maternal S. mutans levels (P < 0·001), daily sweet intake (P < 0·01) and sugary drinks in feeding bottles (P < 0·05) were significant factors for S. mutans colonization in children. Absence of daily toothbrushing and use of feeding bottles at night failed to fit into the model. Caries prevalence (initial and manifest decayed surfaces) was significantly related to S. mutans colonization (P < 0·01). Conclusion. The results support the concept of vertical transmission (mother,child), emphasizing the importance of the dietary component, and justifying a primary preventive approach with targeted action directed at mothers with high levels of S. mutans colonization. [source] Burns to persons suffering from diabetes: a systemic preventive approachJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2009MScN (edu), Ma'en Zaid Abu-Qamar Dnurs Aims. To report the findings of an investigation of patients with diabetes and burns, with emphasis on implications for practice: primary and secondary preventions. Background. Diabetes and burns are complex conditions with multi-system involvements, which worsen outcomes for patients, and their management. This research investigated outcomes for patients and diabetes management. Methods. Data on outcomes were obtained from records of patients hospitalised for foot burns in an Australian hospital from 1999,2004. A questionnaire survey design was employed to obtain information on how clinicians in burns units manage diabetes. SPSS was used to analyse data obtained from both resources. Comments written in the questionnaire were analysed using relational analysis. Results. Of the 64 patients, 12 were with diabetes and 52 were without diabetes. Those with diabetes were more likely to sustain contact foot burns (58·3% Diabetes Mellitus vs. 13·5% non Diabetes Mellitus ,2 = 11·487, p = 0·002). The duration of hospitalisation was statistically significantly longer among patients with diabetes compared with those without diabetes (U = 169, p = 0·014); although the two groups were not statistically significant different in terms of severity of burns and received treatment. Of the 29 clinical leaders, 21 (72%) indicated that they regularly provided care to patients with diabetes. Most respondents (n = 15; 58%) reported that new plans need to be initiated to accommodate the combined insult of diabetes and burns. Diabetes centres were located in all participating sites; but not always involved in the process of care. Conclusion. The co-existence of diabetes and burns worsens outcomes for patients, and complicates management plans. Optimal management can be achieved via a multidisciplinary approach starting with glycaemic control, and continued to aggressive management of diabetes and burns. Relevance to clinical practice. Preventive measures should start with tight glycaemic control, identification and avoidance of sources of trauma, early detection and treatment, and continue to aggressive inpatient management of patients with both diabetes and a burn injury. [source] The recognition and management of early psychosis: a preventive approachACTA NEUROPSYCHIATRICA, Issue 3 2009Kirsteen Moss No abstract is available for this article. [source] Risk factors for incident mild cognitive impairment , results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2010T. Luck Luck T, Riedel-Heller SG, Luppa M, Wiese B, Wollny A, Wagner M, Bickel H, Weyerer S, Pentzek M, Haller F, Moesch E, Werle J, Eisele M, Maier W, van den Bussche H, Kaduszkiewicz H for the AgeCoDe Study Group. Risk factors for incident mild cognitive impairment , results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Objectives:, To provide age- and gender-specific incidence rates of MCI among elderly general practitioner (GP) patients (75+ years) and to identify risk factors for incident MCI. Method:, Data were derived from the longitudinal German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Incidence was calculated according to the ,person-years-at-risk' method. Risk factors were analysed using multivariate logistic regression models. Results:, During the 3-year follow-up period, 350 (15.0%) of the 2331 patients whose data were included in the calculation of incidence developed MCI [person-years (PY) = 6198.20]. The overall incidence of MCI was 56.5 (95% confidence interval = 50.7,62.7) per 1000 PY. Older age, vascular diseases, the apoE ,4 allele and subjective memory complaints were identified as significant risk factors for future MCI. Conclusion:, Mild cognitive impairment is frequent in older GP patients. Subjective memory complaints predict incident MCI. Especially vascular risk factors provide the opportunity of preventive approaches. [source] The DPT-1 trial: a negative result with lessons for future type 1 diabetes preventionDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 4 2002Professor Paolo Pozzilli Abstract The author comments on the DPT-1 Trial and why the observed negative outcome in preventing diabetes in first-degree relatives of type 1 diabetic patients by parenteral insulin administration may have occurred and what can be gathered from this large study. There were three main lessons to be learned from the DPT-1 Trial as follows. (1) Large preventive trials of type 1 diabetes are feasible in first-degree relatives of type 1 diabetic patients and other preventive approaches may be now envisaged. (2) The natural history of type 1 diabetes, at least in its final years before clinical onset, has been elucidated and reiterates the relevance of our present predictive tools (autoantibodies) for identifying individuals at risk for the disease. (3) Strict follow-up of enrolled subjects in trials permits an earlier diagnosis of the disease with less frequency of ketoacidosis and implementation of insulin therapy when higher C-peptide levels are present. DPT-1 has paved the way on how to proceed and new trials will be planned benefiting from such experience. Copyright © 2002 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||