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Public Health Problem (public + health_problem)
Kinds of Public Health Problem Terms modified by Public Health Problem Selected AbstractsEffect of Orlistat in Obese Patients With Heart Failure: A Pilot StudyCONGESTIVE HEART FAILURE, Issue 3 2005Luís Beck-da-Silva MD Heart failure is the leading cause of hospitalization. Obesity is increasingly common and is a major public health problem. The aim of this study is to assess whether obese patients with heart failure can benefit from losing weight via an orlistat-assisted diet. This randomized clinical trial included obese patients with ejection fractions ,40%. Orlistat and diet counseling were compared with diet counseling alone. Twenty-one consecutive obese patients with heart failure were recruited. Significant improvement in 6-minute walk test (45.8 m; 95% confidence interval, 5.2,86.4 m; p=0.031), functional class (,0.6±0.5, p=0.014), weight loss (,8.55 kg; 95% confidence interval, ,13.0 to ,4.1 kg;p<0.001) and also significant decreases in total cholesterol (p=0.017), low-density lipoprotein cholesterol (p=0.03), and triglycerides (p=0.036) were observed in the orlistat group. Orlistat can promote significant weight loss and symptoms of relief in obese patients with heart failure, as measured by 6-minute walk test and functional capacity. The lipid profile improved. Orlistat was safe and well tolerated. [source] Persistent Orthopnea and the Prognosis of Patients in the Heart Failure ClinicCONGESTIVE HEART FAILURE, Issue 4 2004Luís Beck Da Silva MD Heart failure (HF) is a public health problem with ever-growing costs. Signs such as jugular venous pressure and third heart sound have been associated with disease prognosis. Symptoms of heart failure are frequently subjective, and their real value is often overlooked. The authors aimed to assess the relationship between orthopnea and left ventricular ejection fraction (LVEF) and hospitalization rate in patients referred to the HF clinic. One hundred fifty-three new consecutive patients referred to the HF clinic from September 2001 to July 2002 were reviewed. Information about orthopnea was available at baseline and at a 6-month to 1-year follow-up. One hundred thirty-one patients had a baseline multigated radionuclide ventriculogram scan, and 68 patients had a follow-up multigated radionuclide ventriculogram scan available. The patients were divided into groups by presence of orthopnea and compared with respect to LVEF and hospitalization rate. Patients with or without orthopnea had similar LVEFs at baseline (32%±17% vs. 33%±15%, respectively; p=NS). However, patients who were orthopnea-free at the follow-up visit had a significant LVEF improvement whereas patients with ongoing orthopnea at follow-up had no LVEF improvement (11%±13% vs. ,1%±6%; p<0.001). Patients who presented with persistent orthopnea had a significantly higher rate of hospitalization (64% vs. 15.3%; p=0.0001). Persistent orthopnea in HF patients is associated with a significantly higher rate of hospitalization and with worsening or no improvement in LVEF. Patients with persistent orthopnea may require a more aggressive approach to improve their outcome. This result may help centers with limited access to LVEF measurements to better stratify HF patients' risk. [source] Cardiac hypertrophy and failure: lessons learned from genetically engineered miceACTA PHYSIOLOGICA, Issue 1 2001Y. Takeishi Congestive heart failure is a major and growing public health problem. Because of improved survival of myocardial infarction patients produced by thrombolytic therapy or per-cutaneous revascularization it represents the only form of cardiovascular disease with significantly increased incidence and prevalence. Clinicians view this clinical syndrome as the final common pathway of diverse pathologies such as myocardial infarction and haemodynamic overload. Insights into mechanisms for heart failure historically derived from physiological and biochemical studies which identified compensatory adaptations for the haemodynamic burden associated with the pathological condition including utilization of the Frank Starling mechanism, augmentation of muscle mass, and neurohormonal activation to increase contractility. Therapy has largely been phenomenological and designed to prevent or limit the deleterious effects of these compensatory processes. More recently insights from molecular and cell biology have contributed to a more mechanistic understanding of potential causes of cardiac hypertrophy and failure. Many different analytical approaches have been employed for this purpose. These include the use of conventional animal models which permit serial observation of the onset and progression of heart failure and a sequential analysis of underlying biochemical and molecular events. Neonatal murine cardiomyocytes have been a powerful tool to examine in vitro subcellular mechanisms devoid of the confounding functional effects of multicellular preparations and heterogeneity of cell type. Finally, significant progress has been made by utilizing tissue from human cardiomyopathic hearts explanted at the time of orthotopic transplantation. Each of these methods has significant advantages and disadvantages. Arguably the greatest advance in our understanding of cardiac hypertrophy and failure over the past decade has been the exploitation of genetically engineered mice as biological reagents to study in vivo the effects of alterations in the murine genome. The power of this approach, in principle, derives from the ability to precisely overexpress or ablate a gene of interest and examine the phenotypic consequences in a cardiac specific post-natal manner. In contrast to conventional animal models of human disease which employ some form of environmental stress, genetic engineering involves a signal known molecular perturbation which produces the phenotype. [source] Prevalence and causes of fractured permanent incisors in 12-year-old suburban Nigerian schoolchildrenDENTAL TRAUMATOLOGY, Issue 3 2009Comfort A. Adekoya-Sofowora A dental trauma cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 415 (212 boys, 203 girls) 12-year-old children attending private and public secondary schools in lle-Ife, in 2004/2005 by one calibrated examiner. Garcia-Godoy's classification was used. The prevalence of traumatic dental injuries was 12.8%. There was no statistical difference in the prevalence between boys and girls P > 0.05. The most common cause of injuries was falls (49.1%), followed by traffic accidents (13.2%), collision against objects or people (11.3%) and misuse of teeth 9.4%. The commonest type of injury was enamel fracture alone (9.9%), followed by enamel-dentine fracture (4.8%). Majority of the accidents occurred at home (60.4%), followed by school (26.4%). The prevalence of traumatic dental injuries was on the increase among suburban Nigerian children in Ile-Ife and it has a potential to be considered an emerging public health problem. [source] Anxiety disorders and risk for suicide attempts: findings from the Baltimore Epidemiologic Catchment area follow-up study,DEPRESSION AND ANXIETY, Issue 6 2008James M. Bolton M.D. Abstract Our objective was to determine whether the presence of an anxiety disorder was a risk factor for future suicide attempts. Data were drawn from the 13-year follow-up Baltimore Epidemiological Catchment Area survey (n=1,920). Multiple logistic regression analysis was used to determine the association between baseline anxiety disorders (social phobia, simple phobia, obsessive-compulsive disorder, panic attacks, or agoraphobia) and subsequent onset suicide attempts. The presence of one or more anxiety disorders at baseline was significantly associated with subsequent onset suicide attempts (adjusted odds ratio 2.20, 95% confidence interval 1.04,4.64) after controlling for sociodemographic variables and all baseline mental disorders assessed in the survey. These findings suggest that anxiety disorders are independent risk factors for suicide attempts, and underscore the importance of anxiety disorders as a serious public health problem. Depression and Anxiety 0:1,5, 2007. Published 2007 Wiley-Liss. [source] The mental health of female sex workersACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010W. Rössler Rössler W, Koch U, Lauber C, Hass A-K, Altwegg M, Ajdacic-Gross V, Landolt K. The mental health of female sex workers. Objective:, There is limited information available about the mental health of female sex workers. Therefore, we aimed to make a comprehensive assessment of the mental status of female sex workers over different outdoors and indoors work settings and nationalities. Method:, As the prerequisites of a probability sampling were not given, a quota-sampling strategy was the best possible alternative. Sex workers were contacted at different locations in the city of Zurich. They were interviewed with a computerized version of the World Health Organization Composite International Diagnostic Interview. Additional information was assessed in a structured face-to-face interview. Results:, The 193 interviewed female sex workers displayed high rates of mental disorders. These mental disorders were related to violence and the subjectively perceived burden of sex work. Conclusion:, Sex work is a major public health problem. It has many faces, but ill mental health of sex workers is primarily related to different forms of violence. [source] PALLIATIVE CARE, PUBLIC HEALTH AND JUSTICE: SETTING PRIORITIES IN RESOURCE POOR COUNTRIESDEVELOPING WORLD BIOETHICS, Issue 3 2009CRAIG BLINDERMAN ABSTRACT Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries. [source] Posttraumatic stress disorder as a risk factor for obesity among male military veteransACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2007W. V. R. Vieweg Objective:, Obesity is a significant public health problem in the United States, particularly among military veterans with multiple risk factors. Heretofore, posttraumatic stress disorder (PTSD) has not clearly been identified as a risk factor for this condition. Method:, We accessed both a national and local database of PTSD veterans. Results:, Body mass index (BMI) was greater (P < 0.0001) among male military veterans (n = 1819) with PTSD (29.28 ± 6.09 kg/m2) than those veterans (n = 44 959) without PTSD (27.61 ± 5.99 kg/m2) in a sample of randomly selected veterans from the national database. In the local database of male military veterans with PTSD, mean BMI was in the obese range (30.00 ± 5.65) and did not vary by decade of life (P = 0.242). Conclusion:, Posttraumatic stress disorder may be a risk factor for overweight and obesity among male military veterans. [source] Type 2 diabetes mellitus, impaired glucose tolerance and associated factors in a rural Palestinian villageDIABETIC MEDICINE, Issue 10 2000A. Husseini SUMMARY Aims To investigate the prevalence of Type 2 diabetes mellitus and impaired glucose tolerance (IGT) and to identify risk factors associated with diabetes in a rural Palestinian village. Methods A cross-sectional, population-based study investigating 500 adults aged 30,65 years (response rate 85%) determined the diabetes status using the oral glucose tolerance test (OGTT). A standard questionnaire, a simple clinical examination and laboratory tests assessed blood lipids, blood pressure, waist-to-hip ratio (WHR), body mass index (BMI) and other risk factors for diabetes Results The prevalence of Type 2 diabetes was 9.8% (95% confidence interval 7.3,12.3) and IGT 8.6% (6.1,11.1), while the prevalence standardized to the European population was 11.6% (8.8,14.4) for Type 2 diabetes and 10.3% (7.6,13.0) for IGT. Age, positive family history, high triglycerides level, and high WHR were significantly associated with Type 2 diabetes. Conclusions Of the factors associated with diabetes, WHR and triglycerides levels are potentially modifiable, and should be addressed by preventive health activities. The high prevalence of Type 2 diabetes mellitus and its potential increase as a result of the ageing of the Palestinian population constitutes a major public health problem. [source] Pathological gambling: an increasing public health problemACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2001Article first published online: 7 JUL 200 Gambling has always existed, but only recently has it taken on the endlessly variable and accessible forms we know today. Gambling takes place when something valuable , usually money , is staked on the outcome of an event that is entirely unpredictable. It was only two decades ago that pathological gambling was formally recognized as a mental disorder, when it was included in the DSM-III in 1980. For most people, gambling is a relaxing activity with no negative consequences. For others, however, gambling becomes excessive. Pathological gambling is a disorder that manifests itself through the irrepressible urge to wager money. This disorder ultimately dominates the gambler's life, and has a multitude of negative consequences for both the gambler and the people they interact with, i.e. friends, family members, employers. In many ways, gambling might seem a harmless activity. In fact, it is not the act of gambling itself that is harmful, but the vicious cycle that can begin when a gambler wagers money they cannot afford to lose, and then continues to gamble in order to recuperate their losses. The gambler's ,tragic flaw' of logic lies in their failure to understand that gambling is governed solely by random, chance events. Gamblers fail to recognize this and continue to gamble, attempting to control outcomes by concocting strategies to ,beat the game'. Most, if not all, gamblers try in some way to predict the outcome of a game when they are gambling. A detailed analysis of gamblers' selfverbalizations reveals that most of them behave as though the outcome of the game relied on their personal ,skills'. From the gambler's perspective, skill can influence chance , but in reality, the random nature of chance events is the only determinant of the outcome of the game. The gambler, however, either ignores or simply denies this fundamental rule (1). Experts agree that the social costs of pathological gambling are enormous. Changes in gaming legislation have led to a substantial expansion of gambling opportunities in most industrialized countries around the world, mainly in Europe, America and Australia. Figures for the United States' leisure economy in 1996 show gross gambling revenues of $47.6 billion, which was greater than the combined revenue of $40.8 billion from film box offices, recorded music, cruise ships, spectator sports and live entertainment (2). Several factors appear to be motivating this growth: the desire of governments to identify new sources of revenue without invoking new or higher taxes; tourism entrepreneurs developing new destinations for entertainment and leisure; and the rise of new technologies and forms of gambling (3). As a consequence, prevalence studies have shown increased gambling rates among adults. It is currently estimated that 1,2% of the adult population gambles excessively (4, 5). Given that the prevalence of gambling is related to the accessibility of gambling activities, and that new forms of gambling are constantly being legalized throughout most western countries, this figure is expected to rise. Consequently, physicians and mental health professionals will need to know more about the diagnosis and treatment of pathological gamblers. This disorder may be under-diagnosed because, clinically, pathological gamblers usually seek help for the problems associated with gambling such as depression, anxiety or substance abuse, rather than for the excessive gambling itself. This issue of Acta Psychiatrica Scandinavica includes the first national survey of problem gambling completed in Sweden, conducted by Volberg et al. (6). This paper is based on a large sample (N=9917) with an impressively high response rate (89%). Two instruments were used to assess gambling activities: the South Oaks Gambling Screen-Revised (SOGS-R) and an instrument derived from the DSM-IV criteria for pathological gambling. Current (1 year) and lifetime prevalence rates were collected. Results show that 0.6% of the respondents were classified as probable pathological gamblers, and 1.4% as problem gamblers. These data reveal that the prevalence of pathological gamblers in Sweden is significantly less than what has been observed in many western countries. The authors have pooled the rates of problem (1.4%) and probable pathological gamblers (0.6%), to provide a total of 2.0% for the current prevalence. This 2% should be interpreted with caution, however, as we do not have information on the long-term evolution of these subgroups of gamblers; for example, we do not know how many of each subgroup will become pathological gamblers, and how many will decrease their gambling or stop gambling altogether. Until this information is known, it would be preferable to keep in mind that only 0.6% of the Swedish population has been identified as pathological gamblers. In addition, recent studies show that the SOGS-R may be producing inflated estimates of pathological gambling (7). Thus, future research in this area might benefit from the use of an instrument based on DSM criteria for pathological gambling, rather than the SOGS-R only. Finally, the authors suggest in their discussion that the lower rate of pathological gamblers obtained in Sweden compared to many other jurisdictions may be explained by the greater availability of games based on chance rather than games based on skill or a mix of skill and luck. Before accepting this interpretation, researchers will need to demonstrate that the outcomes of all games are determined by other factor than chance and randomness. Many studies have shown that the notion of randomness is the only determinant of gambling (1). Inferring that skill is an important issue in gambling may be misleading. While these are important issues to consider, the Volberg et al. survey nevertheless provides crucial information about gambling in a Scandinavian country. Gambling will be an important issue over the next few years in Sweden, and the publication of the Volberg et al. study is a landmark for the Swedish community (scientists, industry, policy makers, etc.). This paper should stimulate interesting discussions and inspire new, much-needed scientific investigations of pathological gambling. Acta Psychiatrica Scandinavica Guido Bondolfi and Robert Ladouceur Invited Guest Editors References 1.,LadouceurR & WalkerM. The cognitive approach to understanding and treating pathological gambling. In: BellackAS, HersenM, eds. Comprehensive clinical psychology. New York: Pergamon, 1998:588 , 601. 2.,ChristiansenEM. Gambling and the American economy. In: FreyJH, ed. Gambling: socioeconomic impacts and public policy. Thousand Oaks, CA: Sage, 1998:556:36 , 52. 3.,KornDA & ShafferHJ. Gambling and the health of the public: adopting a public health perspective. J Gambling Stud2000;15:289 , 365. 4.,VolbergRA. Problem gambling in the United States. J Gambling Stud1996;12:111 , 128. 5.,BondolfiG, OsiekC, FerreroF. Prevalence estimates of pathological gambling in Switzerland. Acta Psychiatr Scand2000;101:473 , 475. 6.,VolbergRA, AbbottMW, RönnbergS, MunckIM. Prev-alence and risks of pathological gambling in Sweden. Acta Psychiatr Scand2001;104:250 , 256. 7.,LadouceurR, BouchardC, RhéaumeNet al. Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults?J Gambling Stud2000;16:1 , 24. [source] Overview of treatment of acute migraineDRUG DEVELOPMENT RESEARCH, Issue 7 2007Arthur H. Elkind Abstract Acute migraine is a major public health problem with a significant economic burden secondary to short-term disability and absenteeism. Treatment of acute migraine is always challenging for primary care physicians and family practitioners, as there are no set universal guidelines for the treatment of acute migraine. In acute migraine treatment, nonsteroidal anti-inflammatory drugs (NSAIDs), migraine-specific medications, and adjunctive medications are used, depending on the severity of acute migraine attacks. Treatment of acute migraine has changed drastically since the introduction of the triptans. However, even after the introduction of triptans, nearly one-half of migraine sufferers are still being treated with over-the-counter medications. In this literature review, we mention drugs that are being used in the treatment of acute migraine and their level of evidence recommended by the U.S. Headache Consortium. This article gives special emphasis to pharmacokinetics and clinical characteristics of all available triptans. Drug Dev Res 68:441,448, 2007. © 2008 Wiley-Liss, Inc. [source] The Global Diversion of Pharmaceutical DrugsADDICTION, Issue 9 2010Opiate treatment, the diversion of pharmaceutical opiates: a clinician's perspective ABSTRACT Aim To provide a clinician's perspective on the problem of diversion of prescribed pharmaceuticals. Methods The paper provides a personal account of working in a treatment context where diversion from opioid substitution treatment (OST) became a political issue potentially compromising the continued delivery of OST. It summarizes evidence on the impact of diversion, and measures to contain it, from the United Kingdom 1986,2006, Australia 1996,2008 and the United States and France from the mid-1990s. Results Opioid diversion to the black market occurs in proportion to the amount of opioids prescribed to be taken without supervision, and in inverse proportion to the availability of heroin. Diversion for OST programmes using supervision of dosing is less than diversion of opioids prescribed for pain, which is now a growing public health problem. Adverse consequences of diversion include opioid overdose fatalities, an increased incidence of addiction (particularly in jurisdictions where heroin is scarce) and compromising the public acceptance of long-term opioid prescribing. All long-term opioid prescribing requires monitoring of risk and appropriate dispensing arrangements,including dilution of methadone take-aways, supervision of administration for high-risk patients and random urine testing. Clinical guidelines influence practice, although prescribing often deviates from guidelines. Conclusion Clinical guidelines and clinical audit to enhance compliance with guidelines are helpful in maintaining the quality and integrity of the treatment system, and can contribute to keeping diversion within acceptable levels. [source] Anabolic,androgenic steroid dependence: an emerging disorderADDICTION, Issue 12 2009Gen Kanayama ABSTRACT Aims Anabolic,androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects. Method We present an illustrative case of AAS dependence, followed by a summary of the human and animal literature on this topic, based on publications known to us or obtained by searching the PubMed database. Results About 30% of AAS users appear to develop a dependence syndrome, characterized by chronic AAS use despite adverse effects on physical, psychosocial or occupational functioning. AAS dependence shares many features with classical drug dependence. For example, hamsters will self-administer AAS, even to the point of death, and both humans and animals exhibit a well-documented AAS withdrawal syndrome, mediated by neuroendocrine and cortical neurotransmitter systems. AAS dependence may particularly involve opioidergic mechanisms. However, AAS differ from classical drugs in that they produce little immediate reward of acute intoxication, but instead a delayed effect of muscle gains. Thus standard diagnostic criteria for substance dependence, usually crafted for acutely intoxicating drugs, must be adapted slightly for cumulatively acting drugs such as AAS. Conclusions AAS dependence is a valid diagnostic entity, and probably a growing public health problem. AAS dependence may share brain mechanisms with other forms of substance dependence, especially opioid dependence. Future studies are needed to characterize AAS dependence more clearly, identify risk factors for this syndrome and develop treatment strategies. [source] Out-of-hospital Care of Critical Drug Overdoses Involving Cardiac ArrestACADEMIC EMERGENCY MEDICINE, Issue 1 2004Valentine L. Paredes MD Objectives: Death from acute drug poisoning, also termed drug overdose, is a substantial public health problem. Little is known regarding the role of emergency medical services (EMS) in critical drug poisonings. This study investigates the involvement and potential mortality benefit of EMS for critical drug poisonings, characterized by cardiovascular collapse requiring cardiopulmonary resuscitation (CPR). Methods: The study population was composed of death events caused by acute drug poisoning, defined as poisoning deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in King County, Washington, during the year 2000. Results: Eleven persons were successfully resuscitated and 234 persons died from cardiac arrest caused by acute drug poisoning, for a total of 245 cardiac events. The EMS responded to 79.6% (195/245), attempted resuscitation in 34.7% (85/245), and successfully resuscitated 4.5% (11/245) of all events. Among the 85 persons for whom EMS attempted resuscitation, opioids, cocaine, and alcohol were the predominant drugs involved, although over half involved multiple drug classes. Among the 11 persons successfully resuscitated, return of circulation was achieved in six following EMS cardiopulmonary resuscitation alone, in one following CPR and defibrillation, and in the remaining four after additional advanced life support. Conclusions: In this community, EMS was involved in the majority of acute drug poisonings characterized by cardiovascular collapse and may potentially lower total mortality by approximately 4.5%. The results show that, in some survivors, return of spontaneous circulation may be achieved with CPR alone, suggesting a different pathophysiology in drug poisoning compared with cardiac arrest due to heart disease. [source] Why do we need an Addiction supplement focused on methamphetamine?ADDICTION, Issue 2007Richard A. Rawson ABSTRACT Methamphetamine is a substantial public health problem in many communities in the United States and in other parts of the world. In order to bring new knowledge about methamphetamine to policy makers, clinicians and researchers, this volume has compiled a set of articles containing new information about the drug and its effects. The articles contain information presented by researchers at two special methamphetamine meetings sponsored by the National Institute on Drug Abuse in 2005. [source] Placebo-corrected efficacy of modern antiepileptic drugs for refractory epilepsy: Systematic review and meta-analysisEPILEPSIA, Issue 1 2010Stefan Beyenburg Summary Although adjunctive treatment with modern antiepileptic drugs (AEDs) is standard care in refractory epilepsy, it is unclear how much of the effect can be attributed directly to the AEDs and how much to the beneficial changes seen with placebo. Therefore, we performed a systematic review and meta-analysis of the evidence to determine the placebo-corrected net efficacy of adjunctive treatment with modern AEDs on the market for refractory epilepsy. Of 317 potentially eligible articles reviewed in full text, 124 (39%) fulfilled eligibility criteria. After excluding 69 publications, 55 publications of 54 studies in 11,106 adults and children with refractory epilepsy form the basis of evidence. The overall weighted pooled-risk difference in favor of AEDs over placebo for seizure-freedom in the total sample of adults and children was 6% [95% confidence interval (CI) 4,8, z = 6.47, p < 0.001] and 21% (95% CI 19,24, z = 17.13, p < 0.001) for 50% seizure reduction. Although the presence of moderate heterogeneity may reduce the validity of the results and limit generalizations from the findings, we conclude that the placebo-corrected efficacy of adjunctive treatment with modern AEDs is disappointingly small and suggest that better strategies of finding drugs are needed for refractory epilepsy, which is a major public health problem. [source] Impacts of federal precursor chemical regulations on methamphetamine arrestsADDICTION, Issue 4 2005James K. Cunningham ABSTRACT Aims The US government regulated precursor chemicals, ephedrine and pseudoephedrine, multiple times to limit methamphetamine production/availability and thus methamphetamine problems. Research has found that the regulations reduced methamphetamine hospital admissions, but authors have argued that other problems were unaffected. This study examines whether the regulations impacted methamphetamine arrests. Design ARIMA-intervention time-series analysis with control series. Setting California (1982,2001). Measurements Dependent variable series: monthly methamphetamine arrests. Control series: monthly marijuana arrests and cocaine/heroin arrests. Interventions Bulk powder ephedrine and pseudoephedrine: regulated November 1989. Products containing ephedrine as the single active medicinal ingredient: regulated August 1995. Pseudoephedrine products: regulated October 1997. Large-scale producers used ephedrine and pseudoephedrine in these forms. Ephedrine combined with other active medicinal ingredients (e.g. various cold medicines),used mainly by small-scale producers: regulated October 1996. Findings The regulation targeting small-scale producers (1996) had no significant impact. In contrast, methamphetamine arrests stopped rising and dropped 31% to 45% each of the three times precursor chemicals used by large-scale producers were regulated. Within 3 years of the bulk powder regulation (1989) and again within 2 years of the ephedrine single ingredient regulation (1995), arrests fully rebounded. During the 4 years following the last regulation (pseudoephedrine products, 1997) arrests only partially rebounded. These effects parallel those reported on hospital admissions. The control series were generally unaffected. Conclusions Precursor regulations targeting large-scale producers impacted methamphetamine arrests, a criminal justice problem, much as they impacted the public health problem of methamphetamine hospital admissions. Ongoing research is needed to determine whether these problems eventually fully rebound from the last regulation. [source] Mineral metabolism disturbances in patients with chronic kidney diseaseEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 8 2007B. Kestenbaum Abstract Background Kidney disease, especially chronic kidney disease (CKD), is a worldwide public health problem with serious adverse health consequences for affected individuals. Secondary hyperparathyroidism, a disorder characterized by elevated serum parathyroid hormone levels, and alteration of calcium and phosphorus homeostasis are common metabolic complications of CKD that may impact cardiovascular health. Materials and methods Here, we systematically review published reports from recent observational studies and clinical trials that examine markers of altered mineral metabolism and clinical outcomes in patients with CKD. Results Mineral metabolism disturbances begin early during the course of chronic kidney disease, and are associated with cardiovascular disease and mortality in observational studies. Vascular calcification is one plausible mechanism connecting renal-related mineral metabolism with cardiovascular risk. Individual therapies to correct mineral metabolism disturbances have been associated with clinical benefit in some observational studies; clinical trials directed at more comprehensive control of this problem are warranted. Conclusions There exists a potential to improve outcomes for patients with CKD through increased awareness of the Bone Metabolism and Disease guidelines set forth by the National Kidney Foundation,Kidney Disease Outcomes Quality Initiative. Future studies may include more aggressive therapy with a combination of agents that address vitamin D deficiency, parathyroid hormone and phosphorus excess, as well as novel agents that modulate circulating promoters and inhibitors of calcification. [source] REVIEW: Norepinephrine and stimulant addictionADDICTION BIOLOGY, Issue 2 2009Mehmet Sofuoglu ABSTRACT No pharmacotherapies are approved for stimulant use disorders, which are an important public health problem. Stimulants increase synaptic levels of the monoamines dopamine (DA), serotonin and norepinephrine (NE). Stimulant reward is attributable mostly to increased DA in the reward circuitry, although DA stimulation alone cannot explain the rewarding effects of stimulants. The noradrenergic system, which uses NE as the main chemical messenger, serves multiple brain functions including arousal, attention, mood, learning, memory and stress response. In pre-clinical models of addiction, NE is critically involved in mediating stimulant effects including sensitization, drug discrimination and reinstatement of drug seeking. In clinical studies, adrenergic blockers have shown promise as treatments for cocaine abuse and dependence, especially in patients experiencing severe withdrawal symptoms. Disulfiram, which blocks NE synthesis, increased the number of cocaine-negative urines in five randomized clinical trials. Lofexidine, an ,2 -adrenergic agonist, reduces the craving induced by stress and drug cues in drug users. In addition, the NE transporter (NET) inhibitor atomoxetine attenuates some of d-amphetamine's subjective and physiological effects in humans. These findings warrant further studies evaluating noradrenergic medications as treatments for stimulant addiction. [source] Injuries Related to Snow Blowers in the United States: 2002 Through 2008ACADEMIC EMERGENCY MEDICINE, Issue 5 2010Bart Hammig PhD Abstract Objectives:, The objective was to examine injuries related to the use of a snow blower among patients treated in an emergency department (ED). Methods:, Data were obtained from the National Electronic Injury Surveillance System (NEISS) for the years 2002,2008. National estimates of ED visits for injuries associated with the use of a snow blower were obtained, and descriptive epidemiologic characteristics assessed. Results:, From 2002 through 2008, there were an estimated 32,307 ED visits for injuries related to the use of a snow blower in the United States. Older adults had a higher proportion of ED visits for such injuries than younger age groups. The majority of injuries involved injuries to the hand, with 42% of cases diagnosed with fractures and 20% resulting in amputations. Conclusions:, Findings indicate that injuries from snow blowers remain a public health problem. Efforts to reduce injury incidence are discussed in accordance with inherent challenges of prevention of injuries associated with these products. ACADEMIC EMERGENCY MEDICINE 2010; 17:566,569 © 2010 by the Society for Academic Emergency Medicine [source] Marchiafava,Bignami disease: two cases with favourable outcomeEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2001J. Helenius Marchiafava,Bignami disease (MBD) is a rare disorder of an unknown aetiology but strongly associated with alcoholism. MBD primarily affects the corpus callosum leading to confusion, dysarthria, seizures and frequently to death. Over 250 cases from all races and from almost all nationalities have been reported, most cases being alcoholics. We report two cases with a favourable outcome. Magnetic resonance imaging (MRI) demonstrated a typical lesion of the corpus callosum, in both patients. The patients, a 44-year-old male and a 40-year-old female, presented with depressed consciousness and a variety of other symptoms, but finally made a reasonably good recovery leading to home discharge. To the best of our knowledge, only one additional case of MBD from Scandinavia has been published. As alcoholism is a major public health problem in Scandinavia, we assume that MBD is underdiagnosed and/or under-reported. Non-specific general symptoms and encephalopathy in an alcoholic may harbour undiagnosed MBD. We suggest that the incidence of MBD may be higher and its prognosis may be milder than generally believed. [source] Medicinal plants and the treatment of diabetes in Senegal: survey with patientsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2008Amadou Moctar Dièye Abstract Diabetes is the most common metabolic disorder worldwide and is a major public health problem. Its frequency increases every day in all countries. However, in developing African countries, few people have access to drugs. In addition, in Africa, traditional beliefs induce people to use medicinal plants whenever they have health problems. Thus, many people in these developing countries use plants for the treatment of diabetes. Yet, few studies are focused on the knowledge and attitudes of the users on medicinal plants in Africa in general and in Senegal in particular. Hence we undertook this survey on the use of medicinal plants for the treatment of diabetes in Senegal in order to make recommendations which could contribute to the increase of the value of herbal medicines in developing countries. We did a cross-sectional survey by direct interview at a university teaching hospital, in Dakar with a representative sample of 220 patients. Forty-one plants were used by the patients and the two most frequently cited were Moringa oleifera Lam (65.90%) and Sclerocarya birrea (A. Rich) Hochst (43.20%). Patients gave several reasons for using medicinal plants (traditional treatment: 40%, efficacy: 32%, low cost: 20%). The principal suppliers of plants were tradesmen in the market (66.8%) and traditional therapists (5%). Sixty-five per cent of patients think that medicinal plants are efficient for the treatment of diabetes and 20% have reported adverse effects which could be caused by medicinal plants. In conclusion, many people in our study think that medicinal plants are efficient for the treatment of diabetes, which requires research work by scientists in developing countries in this field in order to prove their efficacy and innocuousness. [source] A review of social and behavioral efforts at oral cancer preventions in IndiaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2004Erich M. Sturgis MD Abstract Background. Oral cancer is a major public health problem in South-Central Asia, home to one fifth of the world's population. In most regions of India, it is the most common cancer in men and the third most common cancer in women. Prevention is an effective tool to reduce disease burden on society and may offer particular advantages in developing countries. Methods. The primary and secondary oral cancer prevention efforts in India were reviewed and presented. In addition, the scope of the oral cancer problem and the tobacco industry in India are discussed, and the chief etiologies in the region are summarized. Results and Conclusions. The effectiveness of these prevention efforts provides an excellent social/behavioral model for similar programs in other developing countries. Furthermore, similar programs may also be applicable to certain populations in schools or industries in the developed world. © 2004 Wiley Periodicals, Inc. Head Neck26: 937,944, 2004 [source] A Pivotal Moment in 50 Years of Headache History: The First American Migraine StudyHEADACHE, Issue 5 2008Stewart J. Tepper MD Objective., To describe the magnitude and distribution of the public health problem posed by migraine in the United States by examining migraine prevalence, attack frequency, and attack-related disability by gender, age, race, household income, geographic region, and urban vs rural residence. Design., In 1989, a self-administered questionnaire was sent to a sample of 15,000 households. A designated member of each household initially responded to the questionnaire. Each household member with severe headache was asked to respond to detailed questions about symptoms, frequency, and severity of headaches. Setting., A sample of households selected from a panel to be representative of the US population in terms of age, gender, household size, and geographic area. Participants., After a single mailing, 20,468 subjects (63.4% response rate) between 12 and 80 Years of age responded to the survey. Respondents and nonrespondents did not differ by gender, household income, region of the country, or urban vs rural status. Whites and the elderly were more likely to respond. Migraine headache cases were identified on the basis of reported symptoms using established diagnostic criteria. Results., In total, 17.6% of females and 5.7% of males were found to have 1 or more migraine headaches per year. The prevalence of migraine varied considerably by age and was highest in both men and women between the ages of 35 to 45 years. Migraine prevalence was strongly associated with household income; prevalence in the lowest-income group (less than $10,000) was more than 60% higher than in the 2 highest-income groups (greater than or equal to $30,000). The proportion of migraine sufferers who experienced moderate to severe disability was not related to gender, age, income, urban vs rural residence, or region of the country. In contrast, the frequency of headaches was lower in higher-income groups. Attack frequency was inversely related to disability. Conclusions., A projection to the US population suggests that 8.7 million females and 2.6 million males suffer from migraine headache with moderate to severe disability. Of these, 3.4 million females and 1.1 million males experience 1 or more attacks per month. Females between ages 30 and 49 years from lower-income households are at especially high risk of having migraines and are more likely than other groups to use emergency care services for their acute condition. [source] Etiology and Distribution of Headaches in Two Brazilian Primary Care UnitsHEADACHE, Issue 3 2000Marcelo E. Bigal MD Objectives.,To determine (a) which patients seek primary care services with a complaint of headache, (b) the percentages of the various types of headache in this population, and (c) the impact of the care provided to these patients on the basic health care network. Background.,Headache is one of the most frequent symptoms reported in medical practice, resulting in significant medical services costs and loss of patient productivity, as well as reduced quality of life. Methods.,A prospective study was conducted in two towns (Ribeirão Preto and São Carlos) in the State of São Paulo, Brazil. The participants in the study consisted of 6006 patients (52.4% women) with highly varied acute symptoms. The patients ranged in age from 14 to 98 years. Results.,Headache as the main complaint was reported by 561 (9.3%) of the patients considered, with 312 (55.6%) of those patients presenting with primary headache, 221 (39.4%) with headaches secondary to systemic disorders, and 28 (5.0%) with headaches secondary to neurological disorders. Migraine, the most prevalent primary headache, accounted for 45.1% of patients reporting headache as the single symptom. The most frequent etiologies of headaches secondary to systemic disorders were fever, acute hypertension, and sinusitis. The most frequent headaches secondary to neurological disorders were posttraumatic headaches, headaches secondary to cervical disease, and expansive intracranial processes. Of the 26 cases of drug abuse, 20 were secondary to alcohol (hangover). Headaches secondary to systemic disorders were more frequent in the extreme age ranges. Conclusions.,Headache is a very frequent symptom among patients seen at primary health care units and should be considered a public health problem. The dissemination of the diagnostic criteria of the International Headache Society among primary health care physicians is urgently needed in order to avoid the repeated return of patients or their referral to more differentiated emergency units, which overburden an already insufficient health care network. [source] A health inequalities perspective on violence against womenHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2007Cathy Humphreys PhD BSocWk Abstract The present paper argues that the physical and mental health consequences of gender-based violence constitute a major public health problem in the UK and a source of significant health inequality. The concept of violence against women is explored alongside brief examples of the mental and physical health impact of this violence. While the impact on women's health is relatively uncontested, the extent to which social divisions such as poverty, class and minority ethnic status create specific vulnerabilities to violence are more controversial. A widely held view within the movement to support survivors within the UK has been that violence against women cuts across class and ethnicity, and is found in all communities and classes. A more nuanced discussion of the way in which poverty and ethnic background may create particular vulnerabilities is explored. Disentangling cause and consequence, and also the barriers to help-seeking for minority ethnic women are discussed. The role of social workers in addressing the way in which violence against women is both ubiquitous but marginal in their caseloads is discussed, and appropriate interventions to respond to health inequality issues are proposed. [source] Sleep apnea and dialysis therapies: Things that go bump in the night?HEMODIALYSIS INTERNATIONAL, Issue 4 2007Mark L. UNRUH Abstract Sleep apnea has been linked to excessive daytime sleepiness, depressed mood, hypertension, and cardiovascular disease in the general population. The prevalence of severe sleep apnea in the conventional thrice-weekly hemodialysis population has been estimated to be more than 50%. Sleep apnea leads to repetitive episodes of hypoxemia, hypercapnia, sleep disruption, and activation of the sympathetic nervous system. The hypoxemia, arousals, and intrathoracic pressure changes associated with sleep apnea lead to sympathetic activation, endothelial dysfunction, oxidative stress, and inflammation. Because sleep apnea has been shown to be widespread in the conventional dialysis population, it may be that sleep apnea contributes substantially to the sleepiness, poor quality of life, and cardiovascular disease found in this population. The causal links between conventional dialysis and sleep apnea remain speculative, but there are likely multiple factors related to volume status and azotemia that contribute to the high rate of severe sleep apnea in dialysis patients. Both nocturnal automated peritoneal dialysis and nocturnal hemodialysis have been associated with reduced severity of sleep apnea. Nocturnal dialysis modalities may provide tools to increase our understanding of the uremic sleep apnea and may also provide therapeutic alternatives for end-stage renal disease patients with severe sleep apnea. In conclusion, sleep apnea is an important, but overlooked, public health problem for the dialysis population. The impact of sleep apnea treatment in this high-risk population may include reduced sleepiness, better mood and blood pressure, and lowered risk of cardiovascular disease. [source] Regulation of innate immunity against hepatitis C virus infectionHEPATOLOGY RESEARCH, Issue 2 2008Takeshi Saito Chronic hepatitis C virus (HCV) infection is a global public health problem. HCV infection is treated with type I interferon (IFN), a natural product that is produced by cells during virus infection as a result of innate immune signaling events. The secreted IFN alert the surrounding cells to turn on an "antiviral state" that resists infection. In general, the role of innate immune response is to suppress viral replication and to induce cytokines and other factors that promote adaptive immunity and the resolution of infection. The mechanisms by which the innate immune response and IFN actions limit HCV infection are not well defined, but are likely to involve the function of specific IFN-stimulated genes. HCV also copesintensively with immune responses in order to establish persistent infection. Recent studies reveal that a other viruses use similar tactics to regulate the antiviral innate immune response. In the case of HCV, innate immune signaling is strictly controlled by the viral NS3/4A protease, resulting in the disruption of IFN production. Here, we summarize the current understanding of how HCV evades the innate immune system. [source] Gallbladder cancer: a morphological and molecular updateHISTOPATHOLOGY, Issue 2 2009Robert David Goldin Gallbladder cancer (GBC) shows a marked geographical variation in its incidence, with the highest figures being seen in India and Chile and relatively low levels in many Western countries. Risk factors for its development include the presence of gallstones, infection and the presence of an anomalous pancreatobiliary ductal junction. It can arise from either a pathway involving metaplasia or dysplasia or one in which there is a pre-existing adenoma. The former is the more common and, because it is often not associated with a macroscopically recognizable lesion, leads to the recommendation that all gallbladders need to be examined microscopically. Accurate staging of invasive cancers is essential to determine prognosis and treatment, and this requires extensive tumour sampling. A number of genetic alterations have been identified in the preinvasive and invasive stages of GBC and they support the morphological evidence of there being two pathways by which tumours develop. Some of these genetic changes are associated with particular risk factors. For example, cases with anomalous pancreatobiliary ductal junction show a higher frequency of K-ras mutations. Some changes are associated with differences in prognosis. For example, cancers without expression of p21 but with expression for p27 have a better prognosis, whereas those that express c-erb-B2 have a worse one. Work has also been done on identifying clinical, imaging and other factors that indicate that patients have a higher risk of having GBC. This is particularly important in high-incidence areas in which GBC is a significant public health problem. [source] The challenge of ST-segment elevation myocardial infarctionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2007M. Cohen Summary Background/introduction:, Acute coronary syndromes (ACS) represent a spectrum of ischaemic myocardial events that share a similar pathophysiology. ST-segment elevation myocardial infarction (STEMI), the most severe form of ACS short of sudden cardiac death, is a significant public health problem with an estimated 500,000 STEMI events every year in the United States. Treatment/therapy:, The mortality and morbidity associated with STEMI is significant. Early reperfusion therapy is the most important aspect of the treatment of STEMI. There are two main methods of reperfusion therapy: percutaneous coronary intervention (PCI) and fibrinolytic therapy, with PCI being the preferred method. In addition to standard reperfusion therapy, antithrombotics (unfractionated heparin and low molecular weight heparins) and antiplatelet agents (aspirin, clopidogrel and glycoprotein IIb/IIIa inhibitors) are critical adjuncts, effective in the treatment of acute STEMI. Conclusions:, The survival of patients with STEMI depends on rapid diagnosis and optimal early treatment. Guidelines for the management of patients with STEMI recommend PCI within 90 min of presentation and that fibrinolytics are administered within 30 min. However, only a fraction of patients undergo reperfusion within the recommended time. Improvements in protocols for identifying STEMI cases are therefore required to allow reperfusion therapy to be initiated sooner. Secondary prevention is another important aspect of STEMI management, and patients should be encouraged to adopt strategies that reduce the risk of subsequent ischaemic events. [source] | ||||||||||||||||||||||||||||||||||||||||