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Social Activities (social + activity)
Selected AbstractsShort-Term Side Effects of Fractional PhotothermolysisDERMATOLOGIC SURGERY, Issue 2005Galen H. Fisher MD Objective:. To ascertain the immediate and short-term side effects of fractional photothermolysis for the treatment of a variety of skin disorders involving the face, neck, chest, and hands. Methods. Physician-administered questionnaires were given during 60 follow-up visits for fractional photothermolysis treatment for a variety of facial skin disorders in patients with skin types ranging from I to IV. The questionnaire addressed 14 possible side effects, pain, and limitation of social activities. In addition, all patients were asked about any additional side effects not mentioned in the survey. An analysis of the data was performed once 60 surveys had been collected. Results. All patients (100%) undergoing fractional photothermolysis had transient post-treatment erythema. Other frequently reported post-treatment side effects were transient and included facial edema (82%), dry skin (86.6%), flaking (60%), a few (one to three) small, superficial scratches (46.6%), pruritis (37%), and bronzing (26.6%). Other more rarely reported effects included transient increased sensitivity (10%) and acneiform eruption (10%). Most patients reported that the pain level was easily tolerated, with an average pain score of 4.6 on a scale of 10. Most patients (72%) reported limiting social engagements for an average of 2 days after treatment. There were no long-lasting adverse events noted in our survey. Conclusion. Fractional photothermolysis to treat dermatologic conditions on the face, neck, chest, and hands is a well-tolerated and safe procedure with several immediate, and slightly delayed, post-treatment side effects. In our experience, these side effects were transient and limited to erythema, edema, dry skin, flaking skin, superficial scratches, pruritis, increased sensitivity, and acneiform eruption. Importantly, we did not see the development of post-treatment scarring, herpetic activation, hypopigmentation, hyperpigmentation, persistent erythema, persistent edema, or infection. [source] Leisure Time: Do Married and Single Individuals Spend It Differently?FAMILY & CONSUMER SCIENCES RESEARCH JOURNAL, Issue 3 2004Yoon G. Lee Using data from the 1998,1999 Family Interaction, Social Capital, and Trends in Time Use Study, the authors estimated the time use of 1,151 respondents on various leisure activities (e.g., active leisure, passive leisure, and social entertainment). Onaverage, the most time was spent on active sports (12 minutes) in the active leisure category, TVuse (119 minutes) in the passive leisure category, and socializing with people (27 minutes) in the social entertainment category. Single individuals spent more time playing musical instruments, singing, acting, and dancing than married individuals. Single individuals also spent more time listening to the radio, watching TV, socializing with people, going to bars/lounges, and traveling for social activities than married individuals. Married individuals spent significantly less time for leisure activities than did single individuals. Among the sociodemographic factors, income, employment status, age, gender, and race of respondents were significant determinants of their time use for leisure. [source] Life satisfaction in older peopleGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2007Hisashi Kudo Objective: Factors influencing life satisfaction were studied in a cohort study. Methods: Life satisfaction was measured using the Philadelphia Geriatric Center (PGC) morale scale. Two thousand one hundred and fifty-one older people, approximately 99% of all older people (2165 subjects) in a rural town, Tashiro, Akita prefecture responded to the questionnaire and, after eliminating 455 for incomplete answers, 1710 subjects (79% of all older people) were entered into the present study. Approximately 10% were self-care dependent older people. Results: Female self-care independent older people showed lower morale scores than men. Morale scores in self-care independent older people decreased with age in both women and men. Morale scores of self-care independent men were higher when they were healthy, had an occupation and took part in social activities in the community; morale scores of self-care independent women were higher when they were healthy and had hobbies. Family composition, self-care dependency, income and habits for health promotion were also factors of morale scores, while education was not. Conclusions: Healthy older persons with some gender specific lifestyles had the higher morale scores. With advanced age, lifestyles do not determine the morale scores. [source] Prevalence and characteristics of older community residents with mild cognitive declineGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2002Yoshinori Fujiwara Background:, Cognitive impairment is a major health issue, but epidemiological data on mild cognitive decline have been almost absent in Japan. Methods: Of all residents aged 65 years and over living in Yoita town, Niigata Prefecture, Japan in the year 2000 (n = 1673), 1544 participated in the interview survey held at community halls or at home (92.3% response). They underwent the Mini-Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires comprising socio-demographic, psychological, physical and medical, and social activity items. Higher-level functional capacities were evaluated with the Tokyo Metropolitan Index of Competence (TMIG-Index of Competence). According to subject's age and MMSE score, all subjects were classified into 3 groups: control (MMSE,>,1 SD below age-specific means), mild cognitive decline (MMSE,,,21 and ,,1 SD below age-specific means), and severe cognitive decline (MMSE,,,20), and compared various characteristics among these groups. Results: Mean MMSE score of the subjects showed a linear decline with advancing age. Among the participants, 232 (15.2%) were classified as mild cognitive decline. Compared with the controls, the subjects with mild cognitive decline reported poorer subjective health, more depressive moods, more history of stroke, more prevalence of basic activity of daily living (BADL) disability, and lower higher-level functional capacity, even after controlling for possible confounding factors. They also reported a low level of social activities: both participating in group activities and enjoying hobbies were less frequent. Their food intake pattern tended to be monotonous. Conclusions: Older persons with mild cognitive decline comprised a substantial proportion (15.2%) of the community-dwelling older population. In addition to lower cognitive function, they had lower levels of functional capacity and social activity. [source] Investigating the nature of formal social support provision for young mothers in a city in the North West of EnglandHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2006Angela McLeod BA (Hons) MPH Abstract Young mothers often require support to remain socially ,included' after becoming pregnant and this, in its turn, could protect their health. In this context, new policy initiatives aimed at tackling social exclusion, such as those implemented under the National Teenage Pregnancy Strategy, could be working to build social support mechanisms. The present paper addresses the issue of whether statutory services do in fact deliver ,social inclusion', through the provision of appropriate social support for young mothers. Data are drawn from semistructured interviews with service providers from a variety of different settings. The questionnaire was structured around an established model of social support, developed by M. Barrera, called the Inventory of Socially Supportive Behaviours. The study took place in a deprived inner city in North West England. Eleven participants were interviewed from seven separate organisations. The findings indicate that there were well-developed referral systems between services, with services adopting a social model of health. Much informational and emotional support was provided. What was less clear is how services are enabling social support to be developed amongst peer groups accessing the services particularly at community level. It is questionable to what extent services are able to foster the development of social support through social activities and support groups, and even whether it is appropriate to expect them to do so. In some sense, services go some way to delivering social inclusion, in that they are providing advice about income, housing and other opportunities. However, services appear to be missing an opportunity to foster social inclusion through the lack of development of supportive networks amongst groups of peers, which may have implications for the health of young mothers. [source] A prospective baseline study of frail older people before the introduction of an intermediate care serviceHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2005John Young MB MSC FRCP Abstract This paper describes the first part of a two-stage research project designed to investigate the clinical and service outcomes of a comprehensive intermediate care service. It is a baseline study of patients presenting to two elderly care departments as emergencies with the clinical syndromes of falls, incontinence, confusion or poor mobility before the introduction of a city-wide intermediate care service. The outcome measures were: mortality; disability (Barthel Index, BI); social activities (Nottingham Extended Activities of Daily Living); service use; and carer distress (General Health Questionnaire ,28). These were measured at 3, 6 and 12 months after recruitment. Eight hundred and twenty-three patients were recruited (median age = 84 years; proportion of women = 70%; proportion with cognitive impairment = 45%; median BI score = 15). There was a high mortality rate (36%), evidence for incomplete recovery, a gradual decline in independence over 12 months and a high degree of carer stress. There was little use of rehabilitation services (< 5%), about 25% required readmission to hospital by each assessment point and there was a gradual increase in institutional care admissions. These findings support a needs-based argument for a more comprehensive community service for frail older people. [source] Exploratory analysis of Chinese-American family caregivers' needs and instructional video on dressing stroke survivorsINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 5 2010Shu-Hwa LinArticle first published online: 18 AUG 2010 Abstract The aims of this project were to explore the needs of family caregivers in the Chinese-American community and to develop training videos for caregivers on dressing stroke survivors. In-depth, semi-structured, open-ended interviews were used to explore the problems of caregivers of stroke survivors. Forty participants were recruited from Chinese-American communities. Verbatim interview transcripts were coded and analyzed. Four main concerns emerged: the impact and adjustment in lifestyle for family caregivers; lack of social activities and failure to seek community support; physical and mental stress and methods to alleviate stress, such as instruction in heavy lifting and guidance for daily activities, which include dressing. An 18-min video was produced to provide instruction on dressing stroke survivors for those who need this information. Also, this article addresses the lack of social activities and information about community or public services. [source] Muscle Strength After Resistance Training Is Inversely Correlated with Baseline Levels of Soluble Tumor Necrosis Factor Receptors in the Oldest OldJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004Helle Bruunsgaard MD Objectives:, To test the hypothesis that physical exercise induces an antiinflammatory response that is associated with reduced chronic activation of the tumor necrosis factor (TNF)-alpha system in frail elders and that the increase in muscle strength after resistance training is limited by systemic low-grade inflammation. Design:, A 12-week controlled resistance-training study. Setting:, Nursing homes in Copenhagen, Denmark. Participants:, Twenty-one frail nursing home residents aged 86 to 95 completed the study. Intervention:, Ten participants were randomized to a program of resistance training of knee extensors and flexors three times a week for 12 weeks; the remaining 11 participants served as a control group who joined social activities supervised by an occupation therapist. Measurements:, Muscle strength, plasma levels of TNF-,, soluble TNF receptor (sTNFR)-1, and interleukin (IL)-6 were measured before and at the end of the intervention period. Results:, The training program improved muscle strength but did not affect plasma levels of TNF-, and sTNFR-I or IL-6. However, plasma levels of sTNFR-I at baseline were inversely correlated with the increase in muscle strength. Conclusion:, Low-grade activation of the TNF system could limit the increase in muscle strength after resistance training in the oldest old. Furthermore, data suggest that theantiinflammatory response induced by 12 weeks of resistance training is not sufficient to reduce chronic activation of the TNF system, but the small sample size limited this interpretation. [source] Managing infant feeding practices: the competing needs of bulimic mothers and their childrenJOURNAL OF CLINICAL NURSING, Issue 6 2009Helen Stapleton Aim., This paper seeks to explain how bulimic mothers accommodated infant feeding demands in conjunction with managing their disordered eating practices. Background., Eating disorders are chronic and disabling illnesses primarily affecting women. There are few qualitative studies describing bulimia in the context of motherhood. Design., The study employed an inductive qualitative approach. Methods., A purposive sample of childbearing women (n = 16), who self-defined as living with an eating disorder, were recruited. Data were generated from one-to-one interviews; a thematic analysis identified key issues. Results., Participants were primarily responsible for ensuring child/ren's socialisation processes, including modelling appropriate dietary behaviours and these demands often conflicted with their personal needs for food restraint. Pressures to participate in social activities with children were widely experienced as stressful especially when these events focused on food. Participants viewed early and repeated exposure to ,healthy' eating as protective against their children acquiring an eating disorder and in this respect commercial child-care facilities provided alternative environments for children to explore food-related activities. Conclusions., Participants employed a variety of strategies to ensure children's exposure to normalising influences and socialising processes. Concerns about personal competencies with respect to food preparation and storage were articulated by all participants. Relevance to clinical practice., Professionals involved with providing care to mothers and their infants are well placed to support bulimic clients and to foster confidence in their mothering skills. Early and appropriate intervention is key to effecting positive changes in bulimic patterns, with potential benefits to women's future health and well-being and that of their children. [source] Long-term continence after surgery for Hirschsprung's diseaseJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2007Anthony G Catto-Smith Abstract Aim:, Our aim was to examine the long-term bowel dysfunction that followed surgery for Hirschsprung's disease. Methods:, Of 414 patients diagnosed with Hirschsprung's disease between 1974 and 2002, 98 were interviewed using a structured questionnaire to provide an assessment of bowel function, medication, diet, physical and social limitations. Forty-two completed a prospective 4-week toileting diary and 16 underwent anorectal manometry. Results:, Four of the 98 patients had permanent stomas and 10 had Down's syndrome. Of the remaining 84 patients (mean age 12 ± 8 years, range 1.9,41.9 years), 13% (11/84) had heavy soiling by day and 17% (14/84) by night. Fifty percent reported episodic urgency, but 36% also reported episodic constipation. Stool consistency was looser in patients with a history of long segment disease. Some aspects of bowel function improved with age. Enuresis was much more frequent than expected. Sixty-four percent reported adverse reactions to foods, particularly to fruit, vegetables, fats and diary products, and 15% limited their social activities because of fecal incontinence. There were no significant differences in manometric parameters between those patients who soiled and those who did not. Conclusions:, Fecal incontinence is common after surgery for Hirschsprung's disease and has a significant impact on social activities. Some aspects of bowel function did improve with age. Adverse reactions to food were unexpectedly frequent and need to be further studied. [source] How American Children Spend Their TimeJOURNAL OF MARRIAGE AND FAMILY, Issue 2 2001Sandra L. Hofferth The purpose of this article is to examine how American children under age 13 spend their time, sources of variation in time use, and associations with achievement and behavior. Data come from the 1997 Child Development Supplement to the Panel Study of Income Dynamics. The results suggest that parents' characteristics and decisions regarding marriage, family size, and employment affect the time children spend in educational, structured, and family activities, which may affect their school achievement. Learning activities such as reading for pleasure are associated with higher achievement, as is structured time spent playing sports and in social activities. Family time spent at meals and time spent sleeping are linked to fewer behavior problems, as measured by the child's score on the Behavior Problems Index. The results support common language and myth about the optimal use of time for child development. [source] Social and Financial Resources and High-Risk Alcohol Consumption Among Older AdultsALCOHOLISM, Issue 4 2010Rudolf H. Moos Background:, This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life. Method:, A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption. Results:, Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members. Conclusions:, These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption. [source] Re-discovering practical reading activities in homes and schoolsJOURNAL OF RESEARCH IN READING, Issue 3 2001Peter Freebody This paper explores issues arising from the long-standing theoretical and empirical attention to reading as a specifiable set of psychological processes, and the consequences of this attention for parents' and educators' deliberations and practices. The argument is developed that these theorisations and research projects have both driven and been driven by the social and interactional configurations that teaching has traditionally been taken to entail. It then offers a critique of available theories and research findings from the perspective of ethnomethodology, along with a brief description of an ethnomethodological approach to reading as a co-ordinated set of practical social activities. The paper proceeds to exemplify what an ethnomethodological approach could look like, through the examination of transcripts of reading sessions. The paper concludes that theories of reading need to deal fundamentally with the practices that learners, teachers and parents display as they engage in and ,bring off' as reading sessions, as phenomena to be explained in their own right, rather than as representations of available theories. [source] Psoriasis: is the impairment to a patient's life cumulative?JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 9 2010AB Kimball Abstract Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient's life , relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self-perpetuating social disconnection and failure to achieve a ,full life potential' in some patients. Health-related quality of life studies have quantified the burden of psoriasis providing predominantly cross-sectional data and point-in-time images of patients' lives rather than assessing the possible cumulative disability over a patient's lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co-morbidities and stigma over a patient's life course, we propose the concept of ,Cumulative Life Course Impairment' (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co-morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health-related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case,control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from ,Life Course Epidemiology' to psoriasis research. [source] Systematic review: frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsiaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009A. P. S. HUNGIN Summary Background, Upper gastrointestinal symptoms impose a substantial illness burden and management costs. Understanding perceptions and reasons for seeking healthcare is a prerequisite for meeting patients' needs effectively. Aim, To review systematically findings on consultation frequencies for gastro-oesophageal reflux disease (GERD) and dyspepsia and patients' reasons for consultation. Methods, Systematic literature searches. Results, Reported consultation rates ranged from 5.4% to 56% for GERD and from 26% to 70% for dyspepsia. Consultation for GERD was associated with increased symptom severity and frequency, interference with social activities, sleep disturbance, lack of timetabled work, higher levels of comorbidity, depression, anxiety, phobia, somatization and obsessionality. Some consulted because of fears that their symptoms represented serious disease; others avoided consultation because of this. Inconsistent associations were seen with medication use. Patients were less likely to consult if they felt that their doctor would trivialize their symptoms. Few factors were consistently associated with dyspepsia consultation. However, lower socio-economic status and Helicobacter pylori infection were associated with increased consultation. Conclusion, Patients' perceptions of their condition, comorbid factors and external reasons such as work and social factors are related to consultation rates for GERD. Awareness of these factors can guide the clinician towards a more effective strategy than one based on drug therapy alone. [source] Health-related quality of life of food allergic patients: comparison with the general population and other diseasesALLERGY, Issue 2 2010B. M. J. Flokstra-de Blok To cite this article: Flokstra-de Blok BMJ, Dubois AEJ, Vlieg-Boerstra BJ, Oude Elberink JNG, Raat H, DunnGalvin A, Hourihane JO'B, Duiverman EJ. Health-related quality of life of food allergic patients: comparison with the general population and other diseases. Allergy 2010; 65: 238,244. Abstract Background:, To date no studies have compared generic health-related quality of life (HRQL) of food allergic patients from childhood to adulthood with that of the general population or patients with other chronic diseases. The aim of this study was to compare generic HRQL of food allergic patients with the general population and other diseases. Methods:, Generic HRQL questionnaires (CHQ-CF87 and RAND-36) were completed by 79 children, 74 adolescents and 72 adults with food allergy. The generic HRQL scores were compared with scores from published studies on the general population and patients with asthma, irritable bowel syndrome (IBS), diabetes mellitus (DM) and rheumatoid arthritis (RA). Results:, Food allergic children and adolescents reported fewer limitations in school work due to behavioural problems (P , 0.013), but food allergic adolescents and adults reported more pain (P = 0.020), poorer overall health (P < 0.001), more limitations in social activities (P < 0.001) and less vitality (P = 0.002) than individuals from the general population. Food allergic patients reported poorer generic HRQL than patients with DM, but better generic HRQL than patients with RA, asthma and IBS. Conclusion:, HRQL is impaired in food allergic adolescents and adults, compared to the general population, and it is intermediate in magnitude between DM and RA, asthma and IBS. Children show the least impact on generic HRQL from food allergy. [source] Other-Repetition as a Resource for Participation in the Activity of Playing a Video GameMODERN LANGUAGE JOURNAL, Issue 2 2009ARJA PIIRAINEN MARSH This article offers an empirically based contribution to the growing body of studies using Conversation Analysis (CA) as a tool for analyzing second/foreign language learning in and through interaction. Building on a sociointeractional view of learning as grounded in the structures of participation in social activities, we apply CA methods to examine the affordances offered by interaction during the activity of playing a video game for additional language learning. We focus on one type of interactional practice, lexical and prosodic repetition, as a recurring resource through which players attend to the game and collaboratively build their understanding and experience of game events. We argue that other-repetition offers participants a resource for not only interpreting the game but also for engaging with the second language, analyzing it, and putting it to use in ways that enable players to display and develop their linguistic and interactional competence. [source] Health-Care Policy for Korean ElderlyNURSING & HEALTH SCIENCES, Issue 3 2002Young Hee Choi Due to advances in medicine and economic development, the percentage of Korean elderly is increasing markedly. If preparation is not made for the coming aged society, there is a possibility that the development of the Korean nation will be hindered. The increase in the number of the elderly is increasing the social/national burden of providing medical care for the elderly. Meanwhile, with the trend toward the nuclear family, the increase of female participation in social activities, and the increase of elderly who live alone, it is difficult for nursing homes alone to solve the problem of providing support for the elderly. Long-term medical treatment and care of the elderly has become the responsibility of both the government and society. Under these conditions, the Korean policy for elderly patients can be classified broadly into home care, community care, and institutional care. In order to prepare for the aged society, deficient facilities need to be supplemented and home care and community care need to be expanded so as to increase the communities' ability to support the elderly . Homes, communities, government and the private sector should work together to provide integrated welfare and health care to the elderly. [source] A possible role of social activity to explain differences in publication output among ecologistsOIKOS, Issue 4 2008Publication output is the standard by which scientific productivity is evaluated. Despite a plethora of papers on the issue of publication and citation biases, no study has so far considered a possible effect of social activities on publication output. One of the most frequent social activities in the world is drinking alcohol. In Europe, most alcohol is consumed as beer and, based on well known negative effects of alcohol consumption on cognitive performance, I predicted negative correlations between beer consumption and several measures of scientific performance. Using a survey from the Czech Republic, that has the highest per capita beer consumption rate in the world, I show that increasing per capita beer consumption is associated with lower numbers of papers, total citations, and citations per paper (a surrogate measure of paper quality). In addition I found the same predicted trends in comparison of two separate geographic areas within the Czech Republic that are also known to differ in beer consumption rates. These correlations are consistent with the possibility that leisure time social activities might influence the quality and quantity of scientific work and may be potential sources of publication and citation biases. [source] Perseverance by Older People in Their Management of Chronic Pain: A Qualitative StudyPAIN MEDICINE, Issue 3 2007Beatrice Sofaer-Bennett PhD, Cert Couns ABSTRACT Introduction., Many older people suffer from degenerative and chronic diseases resulting in chronic pain. It is important for health professionals and researchers to gain insights into experiences of chronic pain sufferers, so that they may understand the patient's perspective and instigate appropriate treatments. Aim., This study set out to gain insights into older people's perceptions about the effect of chronic pain on their lives and how they self-manage it. Design., A qualitative approach to generating data based on Grounded Theory was chosen. Sixty-three people between the ages of 60 and 87 years participated and were interviewed using audiotape. The interviews were transcribed and subsequently analyzed, and the material was coded and collapsed into themes constituting the final grounded theory. Results., As the data collection progressed, a major theme of perseverance emerged, supported by two subthemes: ,,keeping occupied, and ,,a focus on social activities. It became apparent that the participants were determined to get on with their lives. Those with strong social links appeared to have a more positive outlook on life. Conclusions., "Keeping going" was a priority for most of the participants. It may be beneficial to identify the ways in which older people persevere despite chronic pain. It is important for health professionals to appreciate the social factors which are important to, and valued by, older people who experience chronic pain. [source] Latest news and product developmentsPRESCRIBER, Issue 8 2007Article first published online: 23 JUL 200 Lamotrigine for partial, valproate for generalised A large UK trial has shown that lamotrigine is the most effective choice in the treatment of partial epilepsy (Lancet 2007;369: 1000-15). The SANAD trial, commissioned by the National Institute for Health Research's Health Technology Assessment programme, randomised 1721 patients (for whom carbamazepine monotherapy would have been the treatment of choice) to treatment with carbamazepine, gabapentin, lamotrigine, oxcarbazepine (Trileptal) or topiramate (Topamax). Lamotrigine was associated with a longer time to treatment failure, though time to 12-month remission favoured carbamazepine. Over four years' follow-up, lamotrigine was numerically but not significantly superior. The authors concluded lamotrigine is clinically superior to carbamazepine for partial epilepsy A second arm of the trial, yet to be published, evaluated the treatment of generalised epilepsy and found valproate to be clinically most effective, though topiramate was cost effective for some patients. Chronic pain common in nursing homes Most residents in nursing homes say they have long- term pain but only one in seven say a health professional has ever discussed its treatment with them, according to a report by the Patients' Association (www.patients-association.org.uk). Pain in Older People ,A Hidden Problem was a qualitative study of 77 older residents in care homes in England. Most were frail and suffered long-term illness. The study found that 85 per cent of residents said they were often troubled by aches or pains and these lasted over a year in 74 per cent. Most described their pain as moderate (33 per cent) or severe (38 per cent) but 8 per cent said it was excruciating. Many reported limitations on mobility and social activities despite a high level of stoicism. All but one were taking medication to relive pain; one-third experienced adverse effects but 78 per cent believed drugs offered the most effective treatment. One-quarter said a doctor or nurse had discussed how to stop their pain worsening, and 15 per cent said they had discussed how to treat their pain. Visits from GPs appeared to be uncommon. Atherothrombotic events despite treatment Between one in five and one in seven of high-risk patients experience atherothrombotic events despite evidence-based treatment, the REACH study has shown (J Am Med Assoc 2007;297:1197-1206). REACH (REduction of Atherothrombosis for Continued Health) is an international observational study involving 68 236 patients with atherothrombotic disease or at least three risk factors. Most were taking conventional evidence-based medication. After one year, the incidence of the combined endpoint of cardiovascular death, myocardial infarction, stroke or hospitalisation for atherothrombotic events was approximately 15 per cent for patients with coronary artery disease or cardiovascular disease, and 21 per cent in patients with peripheral artery disease and established coronary disease. Event rates increased with the number of vascular beds affected, rising to 26 per cent in patients with three symptomatic arterial disease locations. Extended CD prescribing by nurses and pharmacists The Medicines and Healthcare products Regulatory Agency (MHRA) is consulting on expanding the prescribing of controlled drugs (CDs) by nonmedical prescribers. Currently, nurse independent prescribers can prescribe 12 CDs, including diamorphine and morphine, but pharmacist independent prescribers may not prescribe any CDs. The proposal is to allow both professions to prescribe any CDs within their competence, with the exception of cocaine, diamorphine or dipipanone for the management of addiction. The closing date for consultation is 15 June. Consultation is also underway on expanding the range of CDs nurses and pharmacists can prescribe under a patient group direction (PGD), and their use for pain relief. The closing date for consultation is 20 April. Intrinsa: transdermal testosterone for women A transdermal formulation of testosterone has been introduced for the treatment of low sexual desire associated with distress in women who have experienced an early menopause following hysterectomy involving a bilateral oophorectomy and are receiving concomitant oestrogen therapy. Manufacturer Procter & Gamble says that Intrinsa, a twice-weekly patch, delivers testosterone 300µg every 24 hours, achieving premenopausal serum testosterone levels. Clinical trials showed that Intrinsa reduced distress in 65-68 per cent and increased satisfying sexual activity in 51-74 per cent of women. A month's treatment (eight patches) costs £28.00. Fish oil for secondary ,not primary ,prevention of CHD Supplementing statin therapy with eicosapentaenoic acid (EPA) reduces the risk of major coronary events in patients with coronary heart disease (CHD) ,but not in patients with no history of CHD Lancet 2007;369:1090-8). The five-year study in 18 645 patients with total cholesterol levels of 6.5mmol per litre or greater found that the incidence of sudden cardiac death, fatal and nonfatal myocardial infarction in CHD patients treated with EPA plus a statin was 8.7 per cent compared with 10.7 per cent with a statin alone (relative risk reduction 19 per cent). A similar relative risk reduction in patients with no CHD was not statistically significant. There was no difference in mortality between the groups but EPA did reduce unstable angina and nonfatal coronary events. Department pilots information prescriptions The Department of Health has announced 20 sites to pilot information prescriptions prior to a nationwide roll-out in 2008. The prescriptions will guide people with long-term conditions such as diabetes and cancer to sources of support and information about their condition. The Department hopes the project will increase patients' understanding of their discussions with health professionals, empower them to locate the information they need, and provide long-term support. NPSA guidelines for safer prescribing The National Patient Safety Agency (www.npsa.nhs.uk) has published five guidelines to improve medication safety in the NHS. Targeting ,high-risk issues', the guidance covers anticoagulant prescribing, liquid medicines for oral or enteral administration, injectable medicines, epidural injections and infusions, and paediatric intravenous infusions. The implementation of each guide is supported by additional tools and resources. Better adherence not matched to outcomes A systematic review has found that interventions can increase adherence to prescribed medication but there is no evidence that clinical outcomes also improve (Arch Intern Med 2007;167:540-9). The review of 37 trials identified 20 reporting increased adherence. The most effective interventions were behavioural changes to reduce dose demands and those involving monitoring and feedback. Improvements in clinical outcomes were variable and did not correspond to changes in adherence. Antidepressant plus mood stabiliser no better US investigators have found that combining a mood stabiliser with an antidepressant is no more effective than a mood stabiliser alone in preventing mood changes (N Engl J Med 2007; published online 28 March, doi.10.1056/NEJMoa064135). The study found durable recovery occurred in 23.5 per cent of patients treated with a mood stabiliser and adjunctive antidepressant therapy for six months compared with 27.3 per cent of those taking a mood stabiliser plus placebo. [source] Determinants of disability in everyday activities differ in primary and cervicogenic headaches and in low back painPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2006GYÖNGYI GESZTELYI md Abstract The aim of this study was to test whether the association between disability and depressive symptoms in patients with cervicogenic headache is similar to that found in primary headaches or to the pattern found in low back pain. During a 2-year period, 716 consecutive patients with the clinical diagnosis of cervicogenic headache (n = 182), low back pain (n = 116), migraine (n = 231), tension-type headache (n = 176), and cluster headache (n = 11) filled in the Beck Depression Inventory (BDI). Disability was scored by the migraine disability score questionnaire reflecting the number of days with lost or decreased work, household and social activities. Non-parametric tests and multiple general regression were used for statistical analysis. In multivariate testing, significant independent determinants of disability were pain frequency, pain intensity and the severity of depressive symptoms in migraine and tension-type headache; pain frequency and the BDI score in cervicogenic headache, and pain frequency alone in low back pain. Disability is related to pain frequency in all pain syndromes evaluated in the present study. The level of disability is associated with the severity of pain only in primary headaches, but not in pain syndromes of vertebral origin (cervicogenic headache and low back pain). Disability is associated with the severity of depressive symptoms in all headache types but not in low back pain. Both the location and the etiology of pain have importance in determining the interrelationship between pain characteristics, depression and disability. [source] Suicidal ideation and associated factors among community-dwelling elders in TaiwanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 4 2005YUNG-CHIEH YEN md Abstract, The purpose of the present study was to explore the suicidal ideation of community-dwelling elderly and the factors associated with their intention to commit suicide. Using a multilevel stratified sampling strategy, 1000 elderly subjects were recruited (aged 65,74 years old) in Taiwan during the year 2001. The degree of depression and its correlates were assessed. Suicidal ideation was measured by asking respondents if they had had any suicidal thoughts in the previous week. In all, 16.7% of respondents reported suicidal ideation within the past week; its occurrence was related to sex, religious belief, employment status, marital status, average family monthly income, physical health status, depressive symptoms, and community activity participation. Further multivariate logistic regression revealed that, aside from depressive symptoms and a lower level of education, no community participation in the past 6 months was significantly associated with the appearance of suicidal ideation. The prevalence of suicidal ideation among the elderly in Taiwan is higher than in Western countries. Participation in social activities is negatively associated with elderly suicidal ideation. The dimension of social participation deserves further exploration and should be considered in community mental health promotion interventions for elderly people. [source] Measuring social activities and social function in long-term cancer survivors who received hematopoietic stem cell transplantationPSYCHO-ONCOLOGY, Issue 5 2010Karen L. Syrjala Abstract Objective: Cancer survivors report deficits in social functioning even years after completing treatment. Commonly used measures of social functioning provide incomplete understanding of survivors' social behavior. This study describes social activities of survivors and evaluates the psychometric properties of the Social Activity Log (SAL) in a cohort of long-term survivors of hematopoietic stem cell transplantation (HSCT) for cancer. Methods: One hundred and two (5,20 year) survivors completed the SAL, Short-Form-36 Health Survey (SF-36), and other patient-reported outcomes. Principal components analysis determined the factor structure of the SAL along with correlations and regressions to establish validity. Results: Principal component analysis yielded three factors in the SAL: ,non-contact events' (e.g. telephone calls), ,regular events' (e.g. played cards), and ,special events' (e.g. concerts), which explained 59% of the total variance. The SAL possessed good internal consistency (Cronbach's ,=0.82). SF-36 social function and SAL were moderately correlated (r=0.31). In linear regressions, physical function and depression explained 16% of the variance in the SAL (P<0.001), while physical function, depression, and fatigue predicted 55% of the variance in SF-36 social function (P<0.001). Conclusions: Results support the use of the SAL as a measure of social activity in cancer survivors who received HSCT. Although the SAL is designed to measure social behaviors, SF-36 social function assesses subjective experience and is more strongly associated with depression and fatigue. The SAL appears to be a promising tool to understand the behavioral social deficits reported by long-term survivors of cancer. Copyright © 2009 John Wiley & Sons, Ltd. [source] A real reason for patients with pseudobulbar affect to smileANNALS OF NEUROLOGY, Issue 2 2007Howard J. Rosen MD Pseudobulbar affect (PBA) is a dramatic disorder of emotional expression and regulation characterized by uncontrollable episodes of laughing and crying that often cause embarrassment, curtailment of social activities, and reduction in quality of life. The disorder occurs in patients with brain injury caused by many types of neurological disease, including stroke, tumors, and neurodegenerative gray and white matter disorders. Although the pathophysiology is unknown, PBA may relate to release of brainstem emotional control centers from regulation by the frontal lobes. Diagnosis of PBA can be difficult and relies on careful characterization of episodes and differentiation from depression. Although there are no US Food and Drug Administration,approved treatments for PBA, several agents have been shown to be effective, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and a new agent containing dextromethorphan and quinidine. The growing number of treatment options, some of great benefit to patients, highlights the importance of accurate diagnosis of this disorder. Ann Neurol 2007 [source] Unsuspected or Unacknowledged Depressive Symptoms in Young Adult Emergency Department PatientsACADEMIC EMERGENCY MEDICINE, Issue 4 2009Michelle H. Biros MD Abstract Objectives:, The objective was to determine the frequency of unsuspected or unacknowledged depressive symptoms among young adult emergency department (ED) patients. Methods:, The Beck Depression Inventory-II (BDI-II) and a demographic/lifestyle questionnaire were administered to a cross-section of medically stable, English-speaking young adult ED patients (aged 18,23 years) with nonpsychiatric chief complaints. The frequency of moderate to severe depressive symptoms was determined. Group results were analyzed with descriptive statistics; multivariate analysis assessed for patient characteristics associated with depressive symptoms. Results:, A total of 2,898 patients were screened; 2,255 were eligible for enrollment, and 1,264 enrolled (56%; 64% female, 42% African American; mean age = 21 [±1.7] years). Twenty-nine percent had BDI-II scores consistent with moderate to severe depressive symptoms. Patient characteristics associated with depressive symptoms included knowledge of someone who had intentionally hurt him- or herself (odds ratio [OR] = 2) or died a violent nonaccidental death (OR = 1.4), low personal income (OR = 1.8), chronic health issues (OR = 1.7), cigarette smoking (OR = 1.6), and African American race (OR = 1.5). Those who attended school (OR = 0.5), engaged in frequent social activities (OR = 0.5), or drove a car (OR = 0.7) were less likely to have depressive symptoms. Patients lacked insight into their depressive symptoms. Conclusions:, There is a high prevalence of depressive symptoms in young adult ED patients. Young adults often do not recognize, or are reluctant to acknowledge, depressive symptoms. Specific patient characteristics may be useful in deciding which young adults should undergo ED screening for depression. [source] Economic, Social, and Psychological Factors Associated With Health-Related Quality of Life of Chronic Hemodialysis Patients in Northern Taiwan: A Multicenter StudyARTIFICIAL ORGANS, Issue 1 2009Tze-Wah Kao Abstract This study evaluated the associations between economic, social, psychological factors, and health-related quality of life of hemodialysis patients. Cross-sectional study design was used. End-stage renal disease patients who had received maintenance hemodialysis for more than 2 months at 14 centers in northern Taiwan were invited to participate. Demographic, economic, and psychosocial data of patients were collected. Depression was assessed by the Beck Depression Inventory. Health-related quality of life was measured by the Medical Outcomes Study Short-Form 36. Multivariable linear regression analyses were performed. Eight hundred sixty-one patients (373 males, mean age 59.4 ± 13.2 years) completed the study. Higher monthly income was positively associated with role emotional and mental health (P < 0.05), and so was increased frequency of social activities with social functioning (P < 0.05). The more worries, the stronger the inverse associations with social functioning (P < 0.05) and mental health (P < 0.01). Higher depression scores were associated with lower scores of all Short-Form 36 dimensions (P < 0.01). Higher monthly income and increased social activities are associated with better health-related quality of life, whereas more worries and higher depression scores are associated with worse health-related quality of life of hemodialysis patients. [source] Women with obstetric fistula in Ethiopia: a 6-month follow up after surgical treatmentBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2008A Browning Objective, To quantify surgical and quality of life outcomes 6 months after obstetric fistula repair. Design, A prospective study. Women were examined and questioned at discharge and at follow-up appointment. Setting, The Barhirdar Hamlin Fistula Centre, a dedicated unit treating women with obstetric fistula in northern Ethiopia. Population, All women admitted to the Barhirdar Hamlin Fistula Centre suffering from vesicovaginal (WF) and rectovaginal fistulae (RVF). Methods, All women were asked to return for a follow-up appointment 6 months after surgical treatment. A standardised questionnaire and examination were used and information entered into a database. Main outcomes measures, Urinary and anal continence status; extent of return to previous family situation, employment, social activities and reproductive capabilities. Results, Continence status at discharge was largely maintained at 6 months and quality of life was improved. Many of those incontinent on discharge improved; a small number apparently cured at discharge had later recurrence of incontinence. Conclusions, Surgical treatment for obstetric fistula is successful in maintaining continence and improving quality of life of women at 6-months follow up. [source] Quality of life issues for South Africans with acne vulgarisCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2005A. Mosam Summary The adverse effects of acne on the psyche have been established in patients from ,first world' countries. There has been no in depth study in predominantly black patients from Africa addressing this issue. This was a prospective cross-sectional study of acne patients attending a dermatology unit in KwaZulu-Natal, South Africa. A questionnaire was completed and acne graded by the Global Acne Grading scale. Psychological morbidity and quality of life (QOL) were assessed by the General Health Questionnaire and Dermatology Specific Quality of Life Questionnaires, respectively. We found that clinical severity was not associated with patient perception or psychological distress. The QOL measures such as feelings, social activities, performance at work or school, activities of daily living and overall mental health were found to be associated with distress with associated P -values of 0.0002, 0.0168, 0.0032, 0.033 and <,0.0001, respectively. The severity of acne was not associated with psychological distress. Painful and bleeding lesions were associated with distress levels; P = 0.042 and P = 0.019, respectively. In conclusion, South African patients with acne vulgaris suffer significant psychological distress, which affects the quality of their lives. [source] Anxiety and depression among abstainers and low-level alcohol consumers.ADDICTION, Issue 9 2009The Nord-Trøndelag Health Study ABSTRACT Aims The aim of this study was to examine the levels of anxiety and depression among individuals consuming low levels of alcohol. Design Prospective and cross-sectional population-based study. Setting and participants This study employed data from the Nord-Trøndelag Health Survey (HUNT-2, n = 38 930). Measurements Alcohol consumption was measured by self-report of usual alcohol consumption during a 2-week period. Low-level alcohol consumption was defined as self-reported abstainers and non-abstainers currently consuming no alcohol. Anxiety and depression were measured using the Hospital Anxiety and Depression Rating Scale. Potential explanatory variables included somatic illness and symptoms, health-related behaviour, socio-economic status and social activity. In a subsample (n = 20 337), we also looked at the impact of previous heavy drinking among abstainers ('sick-quitting'). Findings A U-shaped association between alcohol consumption and the risk of anxiety and depression was found. Abstention was related to increased odds for both case-level anxiety [1.34, 95% confidence interval (CI) 1.19,1.52] and depression (1.52, 95% CI 1.30,1.77). This association was accounted for partly by adjustments for socio-economic status, social network, somatic illness, age (depression only), gender (anxiety only) and ,sick-quitting'. We also identified significant differences between participants who label themselves as abstainers compared to those who report no usual alcohol consumption, but who do not label themselves as abstainers. Conclusions The risk of case-level anxiety and depression is elevated in individuals with low alcohol consumption compared to those with moderate consumption. Individuals who label themselves as abstainers are at particularly increased risk. This increased risk cannot fully be explained by somatic illness, social activity or ,sick-quitting'. [source] | ||||||||||||||||||||||||||||||||||||||||