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Significant Burden (significant + burden)
Selected AbstractsMental health economic studies from developing countries reviewed in the context of those from developed countriesACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2000A. Shah Objective: Mental health economic studies from developing countries were reviewed in the context of such studies from developed countries. Method: Mental health economic studies were ascertained through a systematic Medline search, chasing references at the end of papers acquired from the initial medline search and details of studies furnished by members of the WHO collaborating centre. Results: Only a small number of mental health economic studies from developing countries were identified. They were mainly cost-of-illness and cost-effectiveness studies. Conclusion: Psychiatric disorders impose a significant burden in developing countries. It is not always possible to extrapolate findings from developed countries to developing countries. Potential avenues for future research and development are discussed. [source] Certolizumab pegol: a new option for rheumatoid arthritisFUTURE PRESCRIBER, Issue 4 2009MSc Rheumatology SpR, Margaret HY Ma MBBS Rheumatoid arthritis (RA) presents a significant burden to healthcare in the UK. New biological therapies have advanced treatment but at a high cost to the NHS. Certolizumab pegol is a new TNF inhibitor, providing an additional treatment option for RA. In this article Dr Ma and Dr Choy consider the efficacy of certolizumab pegol, and where it may fit into the RA armoury. Copyright © 2009 John Wiley & Sons, Ltd. [source] A systematic review of musculoskeletal disorders among dental professionalsINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 3 2009MJ Hayes Abstract:, Musculoskeletal problems have become a significant issue for the profession of dentistry and dental hygiene. This review provides a detailed examination and discussion regarding the prevalence of musculoskeletal disorders (MSD) in dental personnel and possible causative factors. All research studies or literature reviews, which have reported on the prevalence of musculoskeletal symptoms and/or potential risk factors for this problem in dentists, dental hygienists and dental students, were selected for inclusion. Our literature suggests that the prevalence of general musculoskeletal pain ranges between 64% and 93%. The most prevalent regions for pain in dentists have been shown to be the back (36.3,60.1%) and neck (19.8,85%), while the hand and wrist regions were the most prevalent regions for dental hygienists (60,69.5%). Interestingly, we found that studies on MSDs among dental and dental hygiene students are quite limited. Many risk factors have been identified, including static and awkward posture and work practices. Overall, the review suggests that musculoskeletal problems represent a significant burden for the dental profession. More research in the form of larger studies is urgently required, to help more clearly elucidate the development of this important issue for dental hygienists and dental hygiene students. [source] Getting lost in the community: a phone survey on the community-dwelling demented people in Hong KongINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2010Timothy C. Y. Kwok Abstract Objective Research from Western countries reported that the incidence rate of dementia patients getting lost in the community ranged from 30 to 60%. It had imposed significant burden on the caregivers. In the current study, we investigated the situation on the incidents of getting lost in a densely populated as well as homogenous community environment. Methods Two hundred and fifty one caregivers of older adults with demented people who had either used dementia day care service or participated in a community survey were interviewed on the telephone. Respondents were asked on older adult's experience of getting lost in the community and their mode of care. Correlating factors of such incidents were examined. Results The overall prevalence of lost history in our subjects was 27.5%. The subjects recruited from day care center were much more likely than those recruited from the community survey to have lost history (39.2% vs. 7.5%, p,<,0.0001, ,2 test). Greater degrees of cognitive decline were associated with greater chance of having had lost episodes. Immobility was associated with lower risk. Both the older people and their caregivers had reported significant degrees of psychological disturbances after the incidents. Conclusion Demented people with greater degrees of cognitive decline and with mobility maintained are at greater risk of getting lost. Copyright © 2009 John Wiley & Sons, Ltd. [source] A review of the information and support needs of family carers of patients with chronic obstructive pulmonary diseaseJOURNAL OF CLINICAL NURSING, Issue 4 2009Ann-Louise Caress Aims and objectives., The objectives of this narrative review were to identify: (1) The information and support needs of carers of family members with chronic obstructive pulmonary disease; (2) appropriate interventions to support carers in their caregiving role; (3) information on carers' needs as reported in studies of patients living with COPD in the community. Background., Chronic obstructive pulmonary disease is a major health problem in the UK resulting in significant burden for patients, families and the health service. Current National Health Service policies emphasise, where medically appropriate, early discharge for acute exacerbations, hospital-at-home care and other models of community care to prevent or reduce re-hospitalisations of people with chronic conditions. Understanding carers' needs is important if health care professionals are to support carers in their caregiving role. Design., A narrative literature review. Methods., Thirty five papers were reviewed after searching electronic databases. Results., Few studies were identified which addressed, even peripherally, carers' needs for information and support, and no studies were found which described and evaluated interventions designed to enhance caregiving capacity. Several studies of hospital-at-home/early discharge, self care and home management programmes were identified which included some information on patients' living arrangements or marital status. However, there was little or no detail reported on the needs of, and in many cases, even the presence of a family carer. Conclusions., This review highlights the dearth of information on the needs of carers of chronic obstructive pulmonary disease patients and the need for future research. Relevance to clinical practice., There is little research based knowledge of the needs of carers of chronic obstructive pulmonary disease patients and interventions to assist them in providing care. This knowledge is critical to ensure that carers receive the information they need to carry out this role while maintaining their own physical and emotional health. [source] The population prevalence of adverse concentrations and associations with adiposity of liver tests among Australian adolescentsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2008Michael L Booth Aim: Paediatric overweight has a high incidence and has serious consequences for health, including non-alcoholic fatty liver disease (NAFLD). However, very little is known about NAFLD among young people, particularly from a population perspective. This paper reports the prevalence of elevated concentrations of four liver enzymes and their associations with adiposity in a representative population sample of Australian adolescents. Methods: Overnight fasting blood samples were collected from a representative population sample of 500 Grade 10 students (15-years-old) attending schools in Sydney, Australia, between February and May, 2004. Weight, height and waist girth were measured. The prevalence of adverse concentrations of the enzymes alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were described for all boys and girls and by body mass index (BMI) categories. The nature of the associations between the enzyme concentrations and indices of adiposity were characterised, and regression equations for estimating enzyme concentrations from BMI were prepared. Results: The prevalence of adverse concentrations of ALT (most likely as a result of NAFLD) and GGT were approximately 10%, while the prevalence of adverse concentrations of AST and ALP were approximately 7% and 5% respectively. The prevalence of adverse concentrations of ALT, GGT and AST increased across BMI categories, while the prevalence of adverse concentrations of ALP declined across BMI categories. Conclusions: The high prevalence of NAFLD in a population sample of healthy Australian adolescents represents a significant burden of disease. [source] Burden of parkinsonism: A population-based studyMOVEMENT DISORDERS, Issue 3 2003FRCPC, Mark Guttman MD Abstract Parkinson's disease (PD) is associated with a significant burden of illness and cost to society, which has been difficult to quantify. Our objective was to use linked administrative databases from the population of Ontario, Canada, to assess the prevalence of parkinsonism, physician- and drug-related costs, and hospital utilization for parkinsonian patients compared with age/sex matched controls. An inception cohort of parkinsonian cases from 1993/1994 was age and sex matched (1:2) to controls and followed for 6 years. Patients were identified by the diagnostic code for PD, the use of specific PD drugs, or a combination. The parkinsonian case cohort (15,304) was matched to (30,608) controls that did not have parkinsonism. The age-adjusted prevalence rates were 3.63 for men and for 3.24 women per 1,000 (increased by 5.4% for men and 9.8% for women). Physician costs were 1.4 times more, there were 1.44 times more hospital admissions, admissions were on average 1.19 times longer, and drug costs were 3.0 times more for parkinsonian cases. We conclude that the substantially higher physician and drug costs as well as hospitalization rates compared with controls clearly suggest that parkinsonism is associated with large direct costs to society. © 2002 Movement Disorder Society [source] Botulinum toxin for the treatment of lower urinary tract symptoms: A reviewNEUROUROLOGY AND URODYNAMICS, Issue 1 2005A. Sahai Abstract Aims To review the available literature on the application of botulinum toxin in the urinary tract, with particular reference to its use in treating detrusor overactivity (DO). Methods Botulinum toxin, overactive bladder (OAB), detrusor instability, DO, detrusor sphincter dyssynergia (DSD), and lower urinary tract dysfunction were used on Medline Services as a source of articles for the review process. Results DO poses a significant burden on patients and their quality of life. Traditionally patients have been treated with anti-cholinergic drugs if symptomatic, however, a significant number find this treatment either ineffective or intolerable due to side effects. Recent developments in this field have instigated new treatment options, including botulinum toxin, for patients' refractory to first line medication. Botulinum toxin, one of the most poisonous substances known to man, is a neurotoxin produced by the bacterium Clostridium botulinum. Botulinum toxin injections into the external urethral sphincter to treat detrusor sphincter dyssynergia has been successfully used for some years but recently its use has expanded to include voiding dysfunction. Intradetrusal injections of botulinum toxin into patients with detrusor overactivity and symptons of the overactive bladder have resulted in significant increases in mean maximum cystometric capacity and detrusor compliance with a reduction in mean maximum detrusor pressures. Subjective and objective assessments in these patients has shown significant improvements that last for 9,12 months. Repeated injections have had the same sustained benefits. Conclusions Application of botulinum toxin in the lower urinary tract has produced promising results in treating lower urinary tract dysfunction, which needs further evaluation with randomised, placebo-controlled trials. © 2004 Wiley-Liss, Inc. [source] Is There a Role for Statins in Atrial Fibrillation?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2009DAVID E. DAWE M.D. 3-Hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins) are some of the most commonly prescribed drugs in the world. While lipid modification remains the primary function of statins, there has been increasing interest in its potential pleiotropic effects, particularly as an anti-inflammatory agent in its role as an antiarrhythmic. Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and carries with it a significant burden in both morbidity and mortality. Treatment for AF currently involves either rate or rhythm control where both have demonstrable associated risks. Rate control necessitates anticoagulation, which can cause life-threatening bleeding, while rhythm control has a poor side-effect profile that may lead to greater mortality and may not completely eliminate the need for anticoagulation. Considering this pressing need for novel therapeutic interventions in AF, this long overdue systematic review explores the potential role of statins in the treatment and prevention of AF. Physicians, especially cardiologists, need to be aware of the host of currently available literature and, more importantly, need to be stimulated to generate discussion and formulate studies that will help debate the issues under the most erudite standards. [source] Probabilistic cross-link analysis and experiment planning for high-throughput elucidation of protein structurePROTEIN SCIENCE, Issue 12 2004Xiaoduan Ye Abstract Emerging high-throughput techniques for the characterization of protein and protein-complex structures yield noisy data with sparse information content, placing a significant burden on computation to properly interpret the experimental data. One such technique uses cross-linking (chemical or by cysteine oxidation) to confirm or select among proposed structural models (e.g., from fold recognition, ab initio prediction, or docking) by testing the consistency between cross-linking data and model geometry. This paper develops a probabilistic framework for analyzing the information content in cross-linking experiments, accounting for anticipated experimental error. This framework supports a mechanism for planning experiments to optimize the information gained. We evaluate potential experiment plans using explicit trade-offs among key properties of practical importance: discriminability, coverage, balance, ambiguity, and cost. We devise a greedy algorithm that considers those properties and, from a large number of combinatorial possibilities, rapidly selects sets of experiments expected to discriminate pairs of models efficiently. In an application to residue-specific chemical cross-linking, we demonstrate the ability of our approach to plan experiments effectively involving combinations of cross-linkers and introduced mutations. We also describe an experiment plan for the bacteriophage , Tfa chaperone protein in which we plan dicysteine mutants for discriminating threading models by disulfide formation. Preliminary results from a subset of the planned experiments are consistent and demonstrate the practicality of planning. Our methods provide the experimenter with a valuable tool (available from the authors) for understanding and optimizing cross-linking experiments. [source] The impact of follicular (FL) and other indolent non-Hodgkin's lymphomas (NHL) on work productivity,a preliminary analysisPSYCHO-ONCOLOGY, Issue 5 2009Matthew C. Cheung Abstract Introduction: Although much is known about the efficacy, toxicity, and direct costs of treatment for follicular lymphoma (FL), there is no data assessing the impact of this diagnosis on the work productivity of affected individuals. Methods: We conducted a cross-sectional survey study of consecutive patients attending a malignant haematology clinic at a large multi-disciplinary cancer centre. Patients with a diagnosis of FL or other indolent non-Hodgkin's lymphoma completed questionnaires assessing health status, work productivity, and activity impairment. Results: Eighty-four patients completed the survey study (95% response). Patients who continued to work reported a minimal impact on their work productivity (10%±standard deviation SD 20; 0%=no effect and 100%=complete impairment of activity) and on their daily activities (13%±SD 25) attributable to their cancer. Prior to lymphoma diagnosis, over 71% of patients were working while 14% were retired. At the time of survey administration, only 41% of patients were still able to work with a significant proportion of patients having transitioned to retirement (36%), sick leave (10%), or unemployment (4%). On multivariate analysis, significant activity impairment (daily activity impairment>50%) was predicted by poor self-rated health status (OR 32.1; 95% CI: 5.9,174.2; p<0.0001) and active chemotherapy treatment (OR 14.5; 95% CI: 0.91,230.9; p=0.059). Conclusions: Although few patients with indolent lymphoma identified significant impairment in productivity, many were unable to continue employment following diagnosis, needed to miss days from work, or imposed a significant burden on caregivers. The greatest impact on activity is apparent in patients who rate their health status as poor and in those who are currently receiving systemic therapy. Copyright © 2008 John Wiley & Sons, Ltd. [source] Mother,child joint activity and behaviour problems of pre-school childrenTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 7 2003Kumari Chandani Galboda-Liyanage Background: Behaviour problems are common among pre-school children, and a substantial proportion persist, causing significant burden to the family, schools and health services. Relatively little research has addressed the effects of positive parenting on behaviour disorder in pre-school children, particularly in larger population-based studies. Method: A cross-sectional postal survey of a representative, population-based sample of 800 mothers of 3½-year-old children living in an outer London Borough was carried out to assess the association between mother,child joint activity and behaviour problems of pre-school children. The response rate was 70%. Results: Lower levels of mother,child joint activity remained independently associated with behaviour problems of pre-school children both on a binary and a continuous scale after adjusting for a wide range of household, maternal and child circumstances. The association between low levels of mother,child joint activities and behaviour problems of the children was stronger in the presence of social problems in the family. Conclusion: Possible causal pathways and directions for future research and intervention are discussed. [source] Gene therapy for lysosomal storage diseases: the lessons and promise of animal modelsTHE JOURNAL OF GENE MEDICINE, Issue 5 2004N. Matthew Ellinwood Abstract There are more than 40 different forms of inherited lysosomal storage diseases (LSDs) known to occur in humans and the aggregate incidence has been estimated to approach 1 in 7000 live births. Most LSDs are associated with high morbidity and mortality and represent a significant burden on patients, their families, and health care providers. Except for symptomatic therapies, many LSDs remain untreatable, and gene therapy is among the only viable treatment options potentially available. Therapies for some LSDs do exist, or are under evaluation, including heterologous bone marrow transplantation (BMT), enzyme replacement therapy (ERT), and substrate reduction therapy (SRT), but these treatment options are associated with significant concerns, including high morbidity and mortality (BMT), limited positive outcomes (BMT), incomplete response to therapy (BMT, ERT, and SRT), life-long therapy (ERT, SRT), and cost (BMT, ERT, SRT). Gene therapy represents a potential alternative therapy, albeit a therapy with its own attendant concerns. Animal models of LSDs play a critical role in evaluating the efficacy and safety of therapy for many of these conditions. Naturally occurring animal homologs of LSDs have been described in the mouse, rat, dog, cat, guinea pig, emu, quail, goat, cattle, sheep, and pig. In this review we discuss those animal models that have been used in gene therapy experiments and those with promise for future evaluations. Copyright © 2004 John Wiley & Sons, Ltd. [source] REVIEW ARTICLE: Chlamydia trachomatis, a Hidden Epidemic: Effects on Female Reproduction and Options for TreatmentAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 6 2010Alison J. Carey Citation Carey AJ, Beagley KW. Chlamydia trachomatis, a hidden epidemic: effects on the female reproduction and options for treatment. Am J Reprod Immunol 2010 The number of genital tract Chlamydia trachomatis infections is steadily increasing worldwide, with approximately 50,70% of infections asymptomatic. There is currently no uniform screening practice, current antibiotic treatment has failed to prevent the increased incidence, and there is no vaccine available. We examined studies on the epidemiology of C. trachomatis infections, the effects infections have on the female reproductive tract and subsequent reproductive health and what measures are being taken to reduce these problems. Undetected or multiple infections in women can lead to the development of severe reproductive sequelae, including pelvic inflammatory disease and tubal infertility. There are two possible paradigms of chlamydial pathogenesis, the cellular and immunological paradigms. While many vaccine candidates are being extensively tested in animal models, they are still years from clinical trials. With no vaccine available and antibiotic treatment unable to halt the increased incidence, infection rates will continue to increase and cause a significant burden on health care systems. [source] Hormonal control of diabetes type 2 after surgery: Clinical and experimental evaluationASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2009EE Frezza Abstract Diabetes mellitus (DM) type 2 now afflicts over 170 million people worldwide, a number expected to surpass 220 million by 2010. DM and its associated complications is a significant burden to public health care funding. In 2007, $US174 billion was spent in the United States, according to the American Diabetic Society. The morbidly obese have high serum leptin and insulin levels and low ghrelin levels, which have been associated with altered satiety. Exercise, medical therapy and dieting usually do not result in long-term weight loss or euglycemia. Bariatric surgery yields euglycemia for many patients, but its mechanism has yet to be fully elucidated. Our preliminary studies showed resolution of DM after both gastric bypass (GBP) and sleeve gastrectomy (SG), more so than after gastric banding. GBP significantly reduces ghrelin levels in the morbidly obese, perhaps as a result of exhausting ghrelin production in the stomach. A reduction in serum ghrelin levels would be expected after SG, which extirpates the ghrelin-producing cells by removing the fundus. This question has not, to our knowledge, been fully explored with regard to the relationship between ghrelin and other hormones. [source] Breast cancer survivors in the United StatesCANCER, Issue 9 20092005-201, Geographic Variability, Time Trends Abstract BACKGROUND: Breast cancer continues to place a significant burden on the healthcare system. Regional prevalence measures are instrumental in the development of cancer control policies. Very few population-based cancer registries are able to provided local, long-term incidence and follow-up information that permits the direct calculation of prevalence. Model-based prevalence estimates are an alternative when this information is lacking or incomplete. The current work represents a comprehensive collection of female breast cancer prevalence from 2005 to 2015 in the United States and the District of Columbia (DC). METHODS: Breast cancer prevalence estimates were derived from state-specific cancer mortality and survival data using a statistical package called the Mortality-Incidence Analysis Model or MIAMOD. Cancer survival models were derived from the Surveillance, Epidemiology, and End Results Program data and were adjusted to represent state-specific survival. Comparisons with reported incidence for 39 states and DC had validated estimates. RESULTS: By the year 2010, 2.9 million breast cancer survivors are predicted in the US, equaling 1.85% of the female population. Large variability in prevalent percentages was reported between states, ranging from 1.4% to 2.4% in 2010. Geographic variability was reduced when calculating age-standardized prevalence proportions or cancer survivors by disease duration, including 0 to 2 years and 2 to 5 years. The residual variability in age-adjusted prevalence was explained primarily by the state-specific, age-adjusted breast cancer incidence rates. State-specific breast cancer survivors are expected to increase from 16% to 51% in the decennium from 2005 to 2015 and by 31% at the national level. CONCLUSIONS: To the authors' knowledge, the current study is the first to provide systematic estimations of breast cancer prevalence in all US states through 2015. The estimated levels and time trends were consistent with the available population-based data on breast cancer incidence, prevalence, and population aging. Cancer 2009. © 2009 American Cancer Society. [source] | ||||||||||