Patients with lower activation associated with higher costs; delivery systems should know their patients' 'scores'.

PubMed

Hibbard, Judith H; Greene, Jessica; Overton, Valerie

2013-02-01

Patient activation is a term that describes the skills and confidence that equip patients to become actively engaged in their health care. Health care delivery systems are turning to patient activation as yet another tool to help them and their patients improve outcomes and influence costs. In this article we examine the relationship between patient activation levels and billed care costs. In an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences. What's more, patient activation was a significant predictor of cost even after adjustment for a commonly used "risk score" specifically designed to predict future costs. As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients' ability and willingness to manage their health will be a relevant piece of information integral to health care providers' ability to improve outcomes and lower costs.

Sports activity following total knee arthroplasty in patients older than 60 years.

PubMed

Mayr, Hermann O; Reinhold, Maik; Bernstein, Anke; Suedkamp, Norbert P; Stoehr, Amelie

2015-01-01

In a retrospective study with a population over 65 years, sports activity was conducted 6 years after cruciate retaining (CR) total condylar knee arthroplasty (TKA) with rotating platform (RP). Eighty-one Patients (71.8±5.4years) were examined at follow-up 6.4±0.9 years postoperative. Sport was practiced 5.3 hours every week in mean. Patients were active in sports 3.5times per week. Twenty-five percent performed high impact sports, 47% medium impact sports and 52% low impact sports at follow-up. In KOOS sports 60±28 was reached, in WOMAC 12.1±15.1. It can be concluded that in this population 50% of patients were active in medium and low impact sport 6 years after surgery. However, a quarter of patients were also active in high impact sports. Copyright © 2014 Elsevier Inc. All rights reserved.

Management and prevention of acute and chronic lateral ankle instability in athletic patient populations

PubMed Central

McCriskin, Brendan J; Cameron, Kenneth L; Orr, Justin D; Waterman, Brian R

2015-01-01

Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance. PMID:25793157

Management and prevention of acute and chronic lateral ankle instability in athletic patient populations.

PubMed

McCriskin, Brendan J; Cameron, Kenneth L; Orr, Justin D; Waterman, Brian R

2015-03-18

Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.

Use of population-referenced total activity counts percentiles to assess and classify physical activity of population groups.

PubMed

Wolff-Hughes, Dana L; Troiano, Richard P; Boyer, William R; Fitzhugh, Eugene C; McClain, James J

2016-06-01

Population-referenced total activity counts per day (TAC/d) percentiles provide public health practitioners a standardized measure of physical activity (PA) volume obtained from an accelerometer that can be compared across populations. The purpose of this study was to describe the application of TAC/d population-referenced percentiles to characterize the PA levels of population groups relative to US estimates. A total of 679 adults participating in the 2011 NYC Physical Activity Transit survey wore an ActiGraph accelerometer on their hip for seven consecutive days. Accelerometer-derived TAC/d was classified into age- and gender-specific quartiles of US population-referenced TAC/d to compare differences in the distributions by borough (N=5). Males in Brooklyn, Manhattan, and Staten Island had significantly greater TAC/d than US males. Females in Brooklyn and Queens had significantly greater levels of TAC/d compared to US females. The proportion of males in each population-referenced TAC/d quartile varied significantly by borough (χ(2)(12)=2.63, p=0.002), with disproportionately more men in Manhattan and the Bronx found to be in the highest and lowest US population-referenced TAC/d quartiles, respectively. For females, there was no significant difference in US population-reference TAC/d quartile by borough (χ(2)(12)=1.09, p=0.36). These results demonstrate the utility of population-referenced TAC/d percentiles in public health monitoring and surveillance. These findings also provide insights into the PA levels of NYC residents relative to the broader US population, which can be used to guide health promotion efforts. Published by Elsevier Inc.

Use of population-referenced total activity counts percentiles to assess and classify physical activity of population groups

PubMed Central

Wolff-Hughes, Dana L.; Troiano, Richard P.; Boyer, William R.; Fitzhugh, Eugene C.; McClain, James J.

2016-01-01

Objectives Population-referenced total activity counts per day (TAC/d) percentiles provide public health practitioners a standardized measure of physical activity (PA) volume obtained from an accelerometer that can be compared across populations. The purpose of this study was to describe the application of TAC/d population-referenced percentiles to characterize the PA levels of population groups relative to US estimates. Methods A total of 679 adults participating in the 2011 NYC Physical Activity Transit survey wore an ActiGraph accelerometer on their hip for seven consecutive days. Accelerometer-derived TAC/d was classified into age- and gender-specific quartiles of US population-referenced TAC/d to compare differences in the distributions by borough (N=5). Results Males in Brooklyn, Manhattan, and Staten Island had significantly greater TAC/d than US males. Females in Brooklyn and Queens had significantly greater levels of TAC/d compared to US females. The proportion of males in each population-referenced TAC/d quartile varied significantly by borough (χ2(12)=2.63, p=0.002), with disproportionately more men in Manhattan and the Bronx found to be in the highest and lowest US population-referenced TAC/d quartiles, respectively. For females, there was no significant difference in US population-reference TAC/d quartile by borough (χ2(12)=1.09, p=0.36). Conclusions These results demonstrate the utility of population-referenced TAC/d percentiles in public health monitoring and surveillance. These findings also provide insights into the PA levels of NYC residents relative to the broader US population, which can be used to guide health promotion efforts. PMID:26876630

Integrated Population Pharmacokinetic Analysis of Rivaroxaban Across Multiple Patient Populations

PubMed Central

Zhang, Liping; Frede, Matthias; Kubitza, Dagmar; Mueck, Wolfgang; Schmidt, Stephan; Solms, Alexander; Yan, Xiaoyu; Garmann, Dirk

2018-01-01

The population pharmacokinetics (PK) of rivaroxaban have been evaluated in several population‐specific models. We developed an integrated population PK model using pooled data from 4,918 patients in 7 clinical trials across all approved indications. Effects of gender, age, and weight on apparent clearance (CL/F) and apparent volume of distribution (V/F), renal function, and comedication on CL/F, and relative bioavailability as a function of dose (F) were analyzed. Virtual subpopulations for exposure simulations were defined by age, creatinine clearance (CrCL) and body mass index (BMI). Rivaroxaban PK were adequately described by a one‐compartment disposition model with a first‐order absorption rate constant. Significant effects of CrCL, use of comedications, and study population on CL/F, age, weight, and gender on V/F, and dose on F were identified. CrCL had a modest influence on exposure, whereas age and BMI had a minor influence. The model was suitable to predict rivaroxaban exposure in patient subgroups of special interest. PMID:29660785

Population pharmacokinetics of recombinant coagulation factor VIII-SingleChain in patients with severe hemophilia A.

PubMed

Zhang, Y; Roberts, J; Tortorici, M; Veldman, A; St Ledger, K; Feussner, A; Sidhu, J

2017-06-01

Essentials rVIII-SingleChain is a unique recombinant factor VIII (FVIII) molecule. A population pharmacokinetic model was based on FVIII activity of severe hemophilia A patients. The model was used to simulate factor VIII activity-time profiles for various dosing scenarios. The model supports prolonged dosing of rVIII-SingleChain with intervals of up to twice per week. Background Single-chain recombinant coagulation factor VIII (rVIII-SingleChain) is a unique recombinant coagulation factor VIII molecule. Objectives To: (i) characterize the population pharmacokinetics (PK) of rVIII-SingleChain in patients with severe hemophilia A; (ii) identify correlates of variability in rVIII-SingleChain PK; and (iii) simulate various dosing scenarios of rVIII-SingleChain. Patients/Methods A population PK model was developed, based on FVIII activity levels of 130 patients with severe hemophilia A (n = 91 for ≥ 12-65 years; n = 39 for < 12 years) who had participated in a single-dose PK investigation with rVIII-SingleChain 50 IU kg -1 . PK sampling was performed for up to 96 h. Results A two-compartment population PK model with first-order elimination adequately described FVIII activity. Body weight and predose level of von Willebrand factor were significant covariates on clearance, and body weight was a significant covariate on the central distribution volume. Simulations using the model with various dosing scenarios estimated that > 85% and > 93% of patients were predicted to maintain FVIII activity level above 1 IU dL -1 , at all times with three-times-weekly dosing (given on days 0, 2, and 4.5) at the lowest (20 IU kg -1 ) and highest (50 IU kg -1 ) doses, respectively. For twice weekly dosing (days 0 and 3.5) of 50 IU kg -1 rVIII-SingleChain, 62-80% of patients across all ages were predicted to maintain a FVIII activity level above 1 IU dL -1 at day 7. Conclusions The population PK model adequately characterized rVIII-SingleChain PK, and the model

Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer

PubMed Central

Gomes, Edimar Pedrosa; Reboredo, Maycon Moura; Carvalho, Erich Vidal; Teixeira, Daniel Rodrigues; Carvalho, Laís Fernanda Caldi d'Ornellas; Filho, Gilberto Francisco Ferreira; de Oliveira, Julio César Abreu; Sanders-Pinheiro, Helady; Chebli, Júlio Maria Fonseca; de Paula, Rogério Baumgratz; Pinheiro, Bruno do Valle

2015-01-01

Different factors can contribute to a sedentary lifestyle among hemodialysis (HD) patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken. HD patients were more sedentary than control individuals, spending less time walking or standing and spending more time lying down. The sedentary behavior was more pronounced on dialysis days. According to the number of steps taken per day, 47.4% of hemodialysis patients were classified as sedentary against 10.5% in control group. Hemoglobin level, lower extremity muscle strength, and physical functioning of SF-36 questionnaire correlated significantly with the walking time and active time. Looking accurately at the patterns of activity in daily life, HDs patients are more sedentary, especially on dialysis days. These patients should be motivated to enhance the physical activity. PMID:26090432

Alcohol Drinking Pattern: A Comparison between HIV-Infected Patients and Individuals from the General Population.

PubMed

Ikeda, Maria Leticia R; Barcellos, Nemora T; Alencastro, Paulo R; Wolff, Fernando H; Moreira, Leila B; Gus, Miguel; Brandão, Ajacio B M; Fuchs, Flavio D; Fuchs, Sandra C

2016-01-01

Alcohol consumption is highly prevalent in the general population and among HIV-infected population. This study aimed to compare the pattern of alcohol consumption and to describe characteristics associated with heavy alcohol consumption in individuals from the general population with patients infected with HIV. Participants for this analysis came from a population-based cross-sectional study and from a consecutive sampling of patients infected with HIV. Participants aged 18 years or older were interviewed using similar questionnaires with questions pertaining to socio-demographic characteristics, alcohol consumption, smoking, physical activity, and HIV-related characteristics, among others. Blood pressure and anthropometric measures were measured using standardized procedures. Weekly alcohol consumption was more prevalent among individuals from the general population than HIV-infected patients: 57.0 vs. 31.1%, P<0.001. The prevalence of heavy episodic drinking was higher in the population sample as well: 46.1 vs. 17.0%, P<0.001. In the general population, heavy alcohol consumption was more prevalent in men. Cigarette smoking was independently associated with heavy alcohol consumption among HIV infected (Prevalence Ratio; PR = 5.9; 95%CI 2.6-13.9; P<0,001) and general population (PR = 2.6; 95%CI 1.9-3.0; P<0.001). Years at school were inversely associated with heavy alcohol consumption among HIV-infected patients and directly associated among participants from the general population, even after controlling for sex, age, skin color, and smoking. Heavy alcohol consumption is more prevalent in the general population than among HIV-infected patients. Individuals aware about their disease may reduce the amount of alcoholic beverages consumption comparatively to healthy individuals from the general population.

Active video gaming in patients with renal transplant: a pilot study

PubMed Central

2014-01-01

Background Patients with renal transplant are at higher risk of mortality from cardiovascular disease (CVD) compared with the general population. Physical activity has been shown to reduce the risk of CVD mortality in these patients. Unfortunately, barriers such as the harsh Canadian climate prevent patients from engaging in and harvesting the health benefits of physical activity. This pilot study explored active video gaming (AVG) as a way for patients with renal transplant to obtain physical activity and examined its effect on their functional status and quality of life (QOL). Main text We recruited nine patients for an 8-week prospective pilot study. All patients received a Microsoft Xbox 360™ video gaming console, a Microsoft Kinect™ sensor, and the video game Your Shape Fitness Evolved 2012. Assessment of each participant before and after the intervention included blood pressure measures, a 6-minute walk test, and the Godin Leisure Time Questionnaire (GLTQ). We analyzed all nine patients at the end of the 8-week study period, and found no changes in blood pressure or GLTQ scores. However, there was a significant increase in the 6-minute walk distance (P = 0.022), which represented a consistent increase for most patients (correlation = 0.977). In addition, participants over the age of 45 years (n = 4) were more likely to use the AVG system (P = 0.042). Conclusion AVG has the potential to improve the functional status in patients with renal transplant. Further research is required to corroborate the full health benefits of AVG in this patient population. PMID:25114788

Relative prevalence of Aboriginal patients in a Canadian uveitic population.

PubMed

Roy, Mili

2012-04-01

To determine whether the prevalence of Aboriginal patients in a consecutive series of patients with uveitis differs significantly from the prevalence of Aboriginal persons in the general population. Retrospective chart review. 133 consecutive patients with uveitis. The proportion of Aboriginal patients in a series of 133 consecutive patients with uveitis was compared to the proportion of Aboriginal persons within the general population to determine whether Aboriginal patients were under- or overrepresented in the population with uveitis, relative to their numbers in the population in general. The main outcome measure was the self-reported race of patients. The mean age, sex, and prior disease duration were also compared between Aboriginal and non-Aboriginal patients in the consecutive series. There was no significant difference (p = 0.84) between the proportion of Aboriginal persons in the uveitis population studied (22 of 133; 16.5%) compared to general population census data (15.5% Aboriginal). Mean age at presentation was 36.8 years in the Aboriginal population versus 47.3 years in the control non-Aboriginal group (p = 0.01). Mean prior disease duration was 20.3 months in the Aboriginal population versus 21.1 months in the control group (p = 0.79). The gender proportion was 68.2% female in the Aboriginal group versus 53.2% female in the non-Aboriginal group (p = 0.02). This study finds no statistically significant difference between the prevalence of Aboriginal versus non-Aboriginal persons occurring within a consecutive series of uveitis patients as compared to the general population. Mean age at presentation was significantly younger, and female preponderance was significantly greater in the Aboriginal than in the non-Aboriginal group. Prior disease duration was comparable in the 2 groups. Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study.

PubMed

Russel, M G V M; Ryan, B M; Dagnelie, P C; de Rooij, M; Sijbrandij, J; Feleus, A; Hesselink, M; Muris, J W; Stockbrugger, R

2003-03-01

The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31-246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3-13)) although no specific disease or patient characteristics were identified as associated with such difficulties. This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices.

Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study

PubMed Central

Russel, M G V M; Ryan, B M; Dagnelie, P C; de Rooij, M; Sijbrandij, J; Feleus, A; Hesselink, M; Muris, J W; Stockbrugger, R

2003-01-01

Background and aims: The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. Methods: A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. Results: In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31–246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3–13)) although no specific disease or patient characteristics were identified as associated with such difficulties. Conclusions: This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices. PMID:12584216

Measuring patient activation in Italy: Translation, adaptation and validation of the Italian version of the patient activation measure 13 (PAM13-I).

PubMed

Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea; Lozza, Edoardo; Hibbard, Judith

2015-12-23

The Patient Activation Measure (PAM13) is an instrument that assesses patient knowledge, skills, and confidence for disease self-management. This cross-sectional study was aimed to validate a culturally-adapted Italian Patient Activation Measure (PAM13-I) for patients with chronic conditions. 519 chronic patients were involved in the Italian validation study and responded to PAM13-I. The PAM 13 was translated into Italian by a standardized forward-backward translation. Data quality was assessed by mean, median, item response, missing values, floor and ceiling effects, internal consistency (Cronbach's alpha and average inter-item correlation), item-rest correlations. Rasch Model and differential item functioning assessed scale properties. Mean PAM13-I score was 66.2. Rasch analysis showed that the PAM13-I is a good measure of patient activation. The level of internal consistency was good (α = 0.88). For all items, the distribution of answers was left-skewed, with a small floor effect (range 1.7-4.5 %) and a moderate ceiling effect (range 27.6-55.0 %). The Italian version formed a unidimensional, probabilistic Guttman-like scale explaining 41 % of the variance. The PAM13-I has been demonstrated to be a valid and reliable measure of patient activation and the present study suggests its applicability to the Italian-speaking chronic patient population. The measure has good psychometric properties and appears to be consistent with the developmental nature of the patient activation phenomenon, although it presents a different ranking order of the items comparing to the American version. PAM13-I can be a useful assessment tool to evaluate interventions aimed at improving patient engagement in healthcare and to train doctors in attuning their communication to the level of patients' activation. Future research could be conducted to further confirm the validity of the PAM13-I.

Sports activities and endurance capacity of bone tumor patients after rotationplasty.

PubMed

Hillmann, Axel; Weist, Roger; Fromme, Albert; Völker, Klaus; Rosenbaum, Dieter

2007-07-01

To investigate the preferred types of sports activities of patients with rotationplasty and to measure their physiologic performance characteristics through treadmill ergometry. Cross-sectional, descriptive analysis and repeated measures of different velocities. Biomechanics research laboratory. Patients (n=61) with rotationplasty after bone tumor surgery, 30 of whom participated in a functional trial (treadmill), and a control group (n=20). Not applicable. Patients' participation in sports compared with that of the healthy population, treadmill performance at 2 or 3 different speeds, heart rate, lactate accumulation, oxygen consumption, ventilatory equivalent, efficiency, respiratory minute volume, and respiratory quotient. High activity in sports participation (85%) in most common sports (8 competitive, 17 sports club members, the remaining subjects were recreational athletes). At the same treadmill speed, lactate accumulation and all cardiorespiratory functions were higher in rotationplasty patients than in the control group. Patients can re-engage in a high level of physical activity after rotationplasty for bone tumor treatment. This physical activity is necessary if patients want to maintain or improve a desired level of sports activity.

Involving members of vulnerable populations in the development of patient decision aids: a mixed methods sequential explanatory study.

PubMed

Dugas, Michèle; Trottier, Marie-Ève; Chipenda Dansokho, Selma; Vaisson, Gratianne; Provencher, Thierry; Colquhoun, Heather; Dogba, Maman Joyce; Dupéré, Sophie; Fagerlin, Angela; Giguere, Anik M C; Haslett, Lynne; Hoffman, Aubri S; Ivers, Noah M; Légaré, France; Légaré, Jean; Levin, Carrie A; Menear, Matthew; Renaud, Jean-Sébastien; Stacey, Dawn; Volk, Robert J; Witteman, Holly O

2017-01-19

Patient decision aids aim to present evidence relevant to a health decision in understandable ways to support patients through the process of making evidence-informed, values-congruent health decisions. It is recommended that, when developing these tools, teams involve people who may ultimately use them. However, there is little empirical evidence about how best to undertake this involvement, particularly for specific populations of users such as vulnerable populations. To describe and compare the development practices of research teams that did and did not specifically involve members of vulnerable populations in the development of patient decision aids, we conducted a secondary analysis of data from a systematic review about the development processes of patient decision aids. Then, to further explain our quantitative results, we conducted semi-structured telephone interviews with 10 teams: 6 that had specifically involved members of vulnerable populations and 4 that had not. Two independent analysts thematically coded transcribed interviews. Out of a total of 187 decision aid development projects, 30 (16%) specifically involved members of vulnerable populations. The specific involvement of members of vulnerable populations in the development process was associated with conducting informal needs assessment activities (73% vs. 40%, OR 2.96, 95% CI 1.18-7.99, P = .02) and recruiting participants through community-based organizations (40% vs. 11%, OR 3.48, 95% CI 1.23-9.83, P = .02). In interviews, all developers highlighted the importance, value and challenges of involving potential users. Interviews with developers whose projects had involved members of vulnerable populations suggested that informal needs assessment activities served to center the decision aid around users' needs, to better avoid stigma, and to ensure that the topic truly matters to the community. Partnering with community-based organizations may facilitate relationships of trust and may

Barriers, benefits, and strategies for physical activity in patients with schizophrenia.

PubMed

Rastad, Cecilia; Martin, Cathrin; Asenlöf, Pernilla

2014-10-01

Patients with schizophrenia have a substantially increased risk of cardiovascular disease and premature death compared with the general population. High prevalence of an unhealthy lifestyle contributes to the increased risk in these patients. Patients with schizophrenia are often physically inactive, and there is limited knowledge on the factors, such as barriers and incentives, that can influence physical activity in this patient group. The aim was to study the perception and experience of barriers to and incentives for physical activity in daily living in patients with schizophrenia, as reported by the patients themselves. An explorative study applying conventional qualitative content analysis was conducted. A purposeful sample of 20 patients with schizophrenia or schizoaffective disorder (13 men, 7 women; 22-63 years of age) registered at 3 psychiatric outpatient clinics in Sweden were interviewed using semistructured interviews. The analysis resulted in 3 main themes: (1) barriers-factors that complicate or obstruct physical activity, (2) reward-the motivation for physical activity, and (3) helpful strategies. The results may not reflect important factors related to physical activity in older patients (>65 years of age), newly diagnosed patients, or inpatients. In accordance with patients' perceptions, there may be biopsychosocial determinants of physical activity behavior that are unique for this group of patients. Future studies should investigate whether physical activity interventions for patients with schizophrenia benefit from individual analyses of barriers and reward for physical activity in combination with the use of tailored strategies such as personal support and activity planning. © 2014 American Physical Therapy Association.

Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population

PubMed Central

2012-01-01

Background Identifying modifiable factors that influence the epidemiology of colorectal cancer incidence among multiethnic groups might be informative for the development of public health strategies targeting the disease. Minimal data exists describing the impact of physical activity on colorectal polyp risk in United States minority populations. The aim of this study is to evaluate the relationship of exercise on the prevalence of polyps in a multiethnic colorectal cancer screening population. Results We enrolled 982 patients: 558 Hispanic, 202 Asian,149 Black, and 69 White. Patients who reported exercising one or more hours weekly had a lower prevalence of any polyps (25.3% vs 33.2%, P = 0.008) as well as adenomas (13.8 vs. 18.9%, P = 0.03) compared to those who did not exercise. Black and Hispanic patients and those who were overweight or obese also had lower prevalence of polyps if they led an active lifestyle. Multivariate analysis revealed that age >55, male sex, and Black race/ethnicity were positively associated with the presence of adenomas, while a history of exercising one hour or more weekly was an independent negative predictor for the presence of adenomas anywhere in the colon (OR 0.67; 95% CI 0.4 - 0.9, P = 0.03). Conclusions Exercising one hour per week was associated with a lower prevalence of polyps and adenomas when compared to those who exercised less or not at all. An active lifestyle provides benefits to groups who are at risk for colorectal cancer, such as Blacks. It also provides significant protection to overweight and obese individuals. Public health initiatives should promote physical activity as a cancer prevention tool in multiethnic populations. Trial registration none PMID:22715975

Health and economic benefits of physical activity for patients with spinal cord injury.

PubMed

Miller, Larry E; Herbert, William G

2016-01-01

Spinal cord injury (SCI) is a traumatic, life-disrupting event with an annual incidence of 17,000 cases in the US. SCI is characterized by progressive physical deconditioning due to limited mobility and lack of modalities to allow safe physical activity that may partially offset these deleterious physical changes. Approximately, 50% of patients with SCI report no leisure-time physical activity and 15% report leisure-time physical activity below the threshold where meaningful health benefits could be realized. Collectively, about 363,000 patients with SCI, or 65% of the entire spinal cord injured population in the US, engages in insufficient physical activity and represents a target population that could derive considerable health benefits from even modest physical activity levels. Currently, the annual direct costs related to SCI exceed US$45 billion in the US. Rehabilitation protocols and technologies aimed to improve functional mobility have potential to significantly reduce the risk of medical complications and cost associated with SCI. Patients who commence routine physical activity in the first post-injury year and experience typical motor function improvements would realize US$290,000 to US$435,000 in lifetime cost savings, primarily due to fewer hospitalizations and less reliance on assistive care. New assistive technologies that allow patients with SCI to safely engage in routine physical activity are desperately needed.

Physical Activity in Patients Treated With Peritoneal Dialysis: A Protocol for a Systematic Review.

PubMed

Thangarasa, Tharshika; Imtiaz, Rameez; Hiremath, Swapnil; Zimmerman, Deborah

2017-01-01

Patients with chronic diseases are known to benefit from exercise. Despite a lack of compelling evidence, patients with end-stage kidney disease treated with peritoneal dialysis are often discouraged from participating in exercise programs that include resistance training due to concerns about the development of hernias and leaks. The actual effects of physical activity with or without structured exercise programs for these patients remain unclear. The purpose of this study is to more completely define the risks and benefits of physical activity in the end-stage kidney disease population treated with peritoneal dialysis. We will conduct a systematic review examining the effects of physical activity on end-stage kidney disease patients treated with peritoneal dialysis. For the purposes of this review, exercise will be considered a purposive subcategory of physical activity. The primary objective is to determine if physical activity in this patient population is associated with improvements in mental health, physical functioning, fatigue and quality of life and if there is an increase in adverse outcomes. With the help of a skilled librarian, we will search MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials for randomized trials and observational studies. We will include adult end-stage kidney disease patients treated with peritoneal dialysis that have participated in an exercise training program or had their level of physical activity assessed directly or by self-report. The study must include an assessment of the association between physical activity and one of our primary or secondary outcomes measures. We will report study quality using the Cochrane Risk of Bias Assessment Tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Quality across studies will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The results of this review may help to

Physical activity on prescription (PAP): self-reported physical activity and quality of life in a Swedish primary care population, 2-year follow-up.

PubMed

Rödjer, Lars; H Jonsdottir, Ingibjörg; Börjesson, Mats

2016-12-01

To study the self-reported level of physical activity (PA) and quality of life (QOL) in patients receiving physical activity on prescription (PAP) for up to 24 months. Observational study conducted in a regular healthcare setting. A primary care population in Sweden receiving physical activity on prescription as part of regular care was studied alongside a reference group. The group comprised 146 patients receiving PAP at two different primary care locations (n = 96 and 50, respectively). The reference group comprised 58 patients recruited from two different primary care centres in the same region. We used two self-report questionnaires - the four-level Saltin-Grimby Physical Activity Level Scale (SGPALS) to assess physical activity, and SF-36 to assess QOL. A significant increase in the PA level was found at six and 12 months following PAP, with an ongoing non-significant trend at 24 months (p = .09). A clear improvement in QOL was seen during the period. At 24 months, significant and clinically relevant improvements in QOL persisted in four out of eight sub-scale scores (Physical Role Limitation, Bodily Pain, General Health,Vitality) and in one out of two summary scores (Physical Component Summary). Patients receiving PAP showed an increased level of self-reported PA at six and 12 months and improved QOL for up to 24 months in several domains. The Swedish PAP method seems to be a feasible method for bringing about changes in physical activity in different patient populations in regular primary healthcare. While increased physical activity (PA) is shown to improve health, the implementation of methods designed to increase activity is still being developed. Key points The present study confirms that the Swedish physical activity on prescription (PAP) method increases the self-reported level of PA in the primary care setting at six and 12 months. Furthermore, this study shows that PAP recipients report a clinically relevant long-term improvement in quality

Population pharmacokinetics-pharmacodynamics of vedolizumab in patients with ulcerative colitis and Crohn's disease.

PubMed

Rosario, M; Dirks, N L; Gastonguay, M R; Fasanmade, A A; Wyant, T; Parikh, A; Sandborn, W J; Feagan, B G; Reinisch, W; Fox, I

2015-07-01

Vedolizumab, an anti-α(4)β(7) integrin monoclonal antibody (mAb), is indicated for treating patients with moderately to severely active ulcerative colitis (UC) and Crohn's disease (CD). As higher therapeutic mAb concentrations have been associated with greater efficacy in inflammatory bowel disease, understanding determinants of vedolizumab clearance may help to optimise dosing. To characterise vedolizumab pharmacokinetics in patients with UC and CD, to identify clinically relevant determinants of vedolizumab clearance, and to describe the pharmacokinetic-pharmacodynamic relationship using population modelling. Data from a phase 1 healthy volunteer study, a phase 2 UC study, and 3 phase 3 UC/CD studies were included. Population pharmacokinetic analysis for repeated measures was conducted using nonlinear mixed effects modelling. Results from the base model, developed using extensive phase 1 and 2 data, were used to develop the full covariate model, which was fit to sparse phase 3 data. Vedolizumab pharmacokinetics was described by a 2-compartment model with parallel linear and nonlinear elimination. Using reference covariate values, linear elimination half-life of vedolizumab was 25.5 days; linear clearance (CL(L)) was 0.159 L/day for UC and 0.155 L/day for CD; central compartment volume of distribution (V(c)) was 3.19 L; and peripheral compartment volume of distribution was 1.66 L. Interindividual variabilities (%CV) were 35% for CLL and 19% for V(c); residual variance was 24%. Only extreme albumin and body weight values were identified as potential clinically important predictors of CL(L). Population pharmacokinetic parameters were similar in patients with moderately to severely active UC and CD. This analysis supports use of vedolizumab fixed dosing in these patients. Clinicaltrials.gov Identifiers: NCT01177228; NCT00783718 (GEMINI 1); NCT00783692 (GEMINI 2); NCT01224171 (GEMINI 3). © 2015 Takeda Pharmaceuticals International Co published by John Wiley & Sons

Patterns of Mortality in Patients Treated with Dental Implants: A Comparison of Patient Age Groups and Corresponding Reference Populations.

PubMed

Jemt, Torsten; Kowar, Jan; Nilsson, Mats; Stenport, Victoria

2015-01-01

Little is known about the relationship between implant patient mortality compared to reference populations. The aim of this study was to report the mortality pattern in patients treated with dental implants up to a 15-year period, and to compare this to mortality in reference populations with regard to age at surgery, sex, and degree of tooth loss. Patient cumulative survival rate (CSR) was calculated for a total of 4,231 treated implant patients from a single clinic. Information was based on surgical registers in the clinic and the National Population Register in Sweden. Patients were arranged into age groups of 10 years, and CSR was compared to that of the reference population of comparable age and reported in relation to age at surgery, sex, and type of jaw/dentition. A similar, consistent, general relationship between CSR of different age groups of implant patients and reference populations could be observed for all parameters studied. Completely edentulous patients presented higher mortality than partially edentulous patients (P < .05). Furthermore, implant patients in younger age groups showed mortality similar to or higher than reference populations, while older patient age groups showed increasingly lower mortality than comparable reference populations for edentulous and partially edentulous patients (P < .05). A consistent pattern of mortality in different age groups of patients compared to reference populations was observed, indicating higher patient mortality in younger age groups and lower in older groups. The reported pattern is not assumed to be related to implant treatment per se, but is assumed to reflect the variation in general health of a selected subgroup of treated implant patients compared to the reference population in different age groups.

Population Activities Fund Agency (PAFA): the journey so far.

PubMed

1993-01-01

Mechanisms are needed funding Nigerian Federal efforts to implement the National Policy on Population for Development, which was approved by the Armed Forces Ruling Council in February, 1988. Subprojects of the Population Activities Fund Agency (PAFA) which were approves are: the integration of family planning (FP) into maternal and child health (MCH) the promotion of Fp through health education, tertiary centers for reproductive health, public enlightenment on population, population/family life education in primary schools, monitoring of National Population Project impact, and integration of population into planning and budgeting. The last obstacle to implementation of PAFA's activities is the signing into law the decree establishing PAFA as a parastatal. The passage is required for continued operations. The national Population for Development policy is unique in providing for quantitative targets, which has attracted the needed financial support of agencies such as the World Bank. As part of the National Population Policy, the National Population Program (NPP) is developing an effective strategy for securing funding and evaluation of subprojects that are designed and implemented b Collaborating Agencies (CAs), both private and public. NPP aims 1) to provide funds for qualified CAs through the Population Activities Fund (PAF) and Agency (PAFA); 2) to monitor PAFA, which manages PAf with the Department of Population Activities, and 3) to stimulate analysis of sociocultural constraints to fertility reduction and international comparisons, and to design innovative interventions through the Population Research Fund (PRF). PAFA funds implementing agencies at all government and nongovernment levels with approaches to population information and services. The goal of PAFA is to realize NPP objectives. The motto is "Towards an improved quality of life for every Nigerian." The mandate is to provide funding for the PAF and NPP, to monitor CAs, to provide assistance to CAs

Resonant activation of population extinctions

NASA Astrophysics Data System (ADS)

Spalding, Christopher; Doering, Charles R.; Flierl, Glenn R.

2017-10-01

Understanding the mechanisms governing population extinctions is of key importance to many problems in ecology and evolution. Stochastic factors are known to play a central role in extinction, but the interactions between a population's demographic stochasticity and environmental noise remain poorly understood. Here we model environmental forcing as a stochastic fluctuation between two states, one with a higher death rate than the other. We find that, in general, there exists a rate of fluctuations that minimizes the mean time to extinction, a phenomenon previously dubbed "resonant activation." We develop a heuristic description of the phenomenon, together with a criterion for the existence of resonant activation. Specifically, the minimum extinction time arises as a result of the system approaching a scenario wherein the severity of rare events is balanced by the time interval between them. We discuss our findings within the context of more general forms of environmental noise and suggest potential applications to evolutionary models.

Release phenomena and iterative activities in psychiatric geriatric patients

PubMed Central

Villeneuve, A.; Turcotte, J.; Bouchard, M.; Côté, J. M.; Jus, A.

1974-01-01

This survey was undertaken to assess the frequency of some of the so-called release phenomena and iterative activities in an aged psychiatric population. Three groups of geriatric psychiatric patients with diagnoses of (I) organic brain syndrome, including senile dementia (56), (II) functional psychoses, predominantly schizophrenia (51) and (III) chronic schizophrenia never treated by neuroleptics or other biologic agents (16), were compared with (IV) a control group of 32 elderly people in good physical and mental health. In general, for the manifestations studied, the geriatric psychiatric patients suffering from an organic brain syndrome and treated with neuroleptics differed notably from the control group. This latter group, although older, had few neurological signs of senescence and the spontaneous oral movements usually associated with the use of neuroleptics were absent. Release phenomena such as the grasp and pouting reflexes, as well as the stereotyped activities, were encountered significantly more frequently in patients with an organic brain syndrome than in the two other groups of patients. Our survey has yielded limited results with regard to the possible influence of type of illness and neuroleptic treatment on the incidence of release phenomena and iterative activities. PMID:4810188

Population pharmacokinetic and pharmacogenetic analysis of 6-mercaptopurine in paediatric patients with acute lymphoblastic leukaemia.

PubMed

Hawwa, Ahmed F; Collier, Paul S; Millership, Jeff S; McCarthy, Anthony; Dempsey, Sid; Cairns, Carole; McElnay, James C

2008-12-01

To investigate the population pharmacokinetics of 6-mercaptopurine (6-MP) active metabolites in paediatric patients with acute lymphoblastic leukaemia (ALL) and examine the effects of various genetic polymorphisms on the disposition of these metabolites. Data were collected prospectively from 19 paediatric patients with ALL (n = 75 samples, 150 concentrations) who received 6-MP maintenance chemotherapy (titrated to a target dose of 75 mg m(-2) day(-1)). All patients were genotyped for polymorphisms in three enzymes involved in 6-MP metabolism. Population pharmacokinetic analysis was performed with the nonlinear mixed effects modelling program (nonmem) to determine the population mean parameter estimate of clearance for the active metabolites. The developed model revealed considerable interindividual variability (IIV) in the clearance of 6-MP active metabolites [6-thioguanine nucleotides (6-TGNs) and 6-methylmercaptopurine nucleotides (6-mMPNs)]. Body surface area explained a significant part of 6-TGNs clearance IIV when incorporated in the model (IIV reduced from 69.9 to 29.3%). The most influential covariate examined, however, was thiopurine methyltransferase (TPMT) genotype, which resulted in the greatest reduction in the model's objective function (P < 0.005) when incorporated as a covariate affecting the fractional metabolic transformation of 6-MP into 6-TGNs. The other genetic covariates tested were not statistically significant and therefore were not included in the final model. The developed pharmacokinetic model (if successful at external validation) would offer a more rational dosing approach for 6-MP than the traditional empirical method since it combines the current practice of using body surface area in 6-MP dosing with a pharmacogenetically guided dosing based on TPMT genotype.

Physical activity on prescription (PAP): self-reported physical activity and quality of life in a Swedish primary care population, 2-year follow-up

PubMed Central

Rödjer, Lars; H. Jonsdottir, Ingibjörg; Börjesson, Mats

2016-01-01

Objective To study the self-reported level of physical activity (PA) and quality of life (QOL) in patients receiving physical activity on prescription (PAP) for up to 24 months. Design Observational study conducted in a regular healthcare setting. Setting A primary care population in Sweden receiving physical activity on prescription as part of regular care was studied alongside a reference group. Subjects The group comprised 146 patients receiving PAP at two different primary care locations (n = 96 and 50, respectively). The reference group comprised 58 patients recruited from two different primary care centres in the same region. Main outcome measurements We used two self-report questionnaires – the four-level Saltin-Grimby Physical Activity Level Scale (SGPALS) to assess physical activity, and SF-36 to assess QOL. Results A significant increase in the PA level was found at six and 12 months following PAP, with an ongoing non-significant trend at 24 months (p = .09). A clear improvement in QOL was seen during the period. At 24 months, significant and clinically relevant improvements in QOL persisted in four out of eight sub-scale scores (Physical Role Limitation, Bodily Pain, General Health,Vitality) and in one out of two summary scores (Physical Component Summary). Conclusion Patients receiving PAP showed an increased level of self-reported PA at six and 12 months and improved QOL for up to 24 months in several domains. The Swedish PAP method seems to be a feasible method for bringing about changes in physical activity in different patient populations in regular primary healthcare. While increased physical activity (PA) is shown to improve health, the implementation of methods designed to increase activity is still being developed. Key points The present study confirms that the Swedish physical activity on prescription (PAP) method increases the self-reported level of PA in the primary care setting at six and 12 months. Furthermore, this study shows

Segmenting lung fields in serial chest radiographs using both population-based and patient-specific shape statistics.

PubMed

Shi, Y; Qi, F; Xue, Z; Chen, L; Ito, K; Matsuo, H; Shen, D

2008-04-01

This paper presents a new deformable model using both population-based and patient-specific shape statistics to segment lung fields from serial chest radiographs. There are two novelties in the proposed deformable model. First, a modified scale invariant feature transform (SIFT) local descriptor, which is more distinctive than the general intensity and gradient features, is used to characterize the image features in the vicinity of each pixel. Second, the deformable contour is constrained by both population-based and patient-specific shape statistics, and it yields more robust and accurate segmentation of lung fields for serial chest radiographs. In particular, for segmenting the initial time-point images, the population-based shape statistics is used to constrain the deformable contour; as more subsequent images of the same patient are acquired, the patient-specific shape statistics online collected from the previous segmentation results gradually takes more roles. Thus, this patient-specific shape statistics is updated each time when a new segmentation result is obtained, and it is further used to refine the segmentation results of all the available time-point images. Experimental results show that the proposed method is more robust and accurate than other active shape models in segmenting the lung fields from serial chest radiographs.

The collaborative edge: patient empowerment for vulnerable populations.

PubMed

Safran, Charles

2003-03-01

The problems with access to care and the special needs for educational outreach for disadvantage or vulnerable populations of patients require innovation. This paper describes Baby CareLink use of information technology to support communication, consultation, and collaboration among colleagues as well as with patients, their families, and community resources. In response to the educational, emotional and communication needs of parents of premature infants and the clinicians who care for the infants and support the families, we developed Baby CareLink, a secure collaborative environment. Baby CareLink provides a nurturing environment where parents, even though remote from the Neonatal Intensive Care Unit, can actively participate in decisions surrounding their baby's care. In a southeastern hospital serving a mostly Medicaid population in a rural setting, more than 300 parents have used Baby CareLink more than 11000 times during the past year. Despite the common wisdom that Medicaid families do not have access to the Internet, approximately 85% of the parents access Baby CareLink from home, at work, from the library or other public access point. The median use of Baby CareLinks from outside the hospital by parents is 17 separate sessions. In a city hospital in the midwestern US which exclusively serves a Medicaid population, experience has been equally encouraging. More than 70 parents have initiated more than 600 secure sessions with Baby CareLink. In contrast to the rural hospital, only 35% of sessions have been initiated outside the hospital. Experience with Baby CareLink suggests that families from all walks of life will use and benefit from collaborative tools that keep them informed and involved in the care of their children. The most significant barrier to wider deployment is bandwidth limitations into the homes of most families. The care of premature infants is a great example of an area where medical knowledge and ability has grown dramatically, and where

Combining population and patient-specific characteristics for prostate segmentation on 3D CT images

NASA Astrophysics Data System (ADS)

Ma, Ling; Guo, Rongrong; Tian, Zhiqiang; Venkataraman, Rajesh; Sarkar, Saradwata; Liu, Xiabi; Tade, Funmilayo; Schuster, David M.; Fei, Baowei

2016-03-01

Prostate segmentation on CT images is a challenging task. In this paper, we explore the population and patient-specific characteristics for the segmentation of the prostate on CT images. Because population learning does not consider the inter-patient variations and because patient-specific learning may not perform well for different patients, we are combining the population and patient-specific information to improve segmentation performance. Specifically, we train a population model based on the population data and train a patient-specific model based on the manual segmentation on three slice of the new patient. We compute the similarity between the two models to explore the influence of applicable population knowledge on the specific patient. By combining the patient-specific knowledge with the influence, we can capture the population and patient-specific characteristics to calculate the probability of a pixel belonging to the prostate. Finally, we smooth the prostate surface according to the prostate-density value of the pixels in the distance transform image. We conducted the leave-one-out validation experiments on a set of CT volumes from 15 patients. Manual segmentation results from a radiologist serve as the gold standard for the evaluation. Experimental results show that our method achieved an average DSC of 85.1% as compared to the manual segmentation gold standard. This method outperformed the population learning method and the patient-specific learning approach alone. The CT segmentation method can have various applications in prostate cancer diagnosis and therapy.

Depression in Cardiovascular Patients in Middle Eastern Populations: A Literature Review.

PubMed

Donnelly, Tam Truong; Al Suwaidi, Jassim Mohd; Al-Qahtani, Awad; Asaad, Nidal; Qader, Najlaa Abdul; Singh, Rajvir; Fung, Tak Shing; Mueed, Irem; Sharara, Shima; El Banna, Noha; Omar, Sarah

2015-08-01

Cardiovascular disease (CVD) is increasing in Middle Eastern countries. Depression is associated with increased morbidity and mortality rates among cardiovascular (CV) patients. Early detection of and intervention for depression among CV patients can reduce morbidity and mortality and save health care costs. Public information on mental health care needs of Arab CV patients living in Middle East regions is scattered and limited. This literature review surveyed and summarized research studies to learn what is known about the relationship between depression and CVD in Middle Eastern populations. The information will raise awareness among health care professionals and policy makers regarding the clinical significance of depression in Arab CV patients. It might contribute to development of culturally appropriate and effective mental health care services. Multiple databases were searched and 60 articles were assessed, including studies that investigated depression in Arab CV patient populations, physiological mechanisms of depression-CVD comorbidity, and intervention strategies that affect CV risk in depressed Arab patients. We discuss the extent to which this issue has been explored in Arab populations living in Middle East regions and Arab populations living abroad. We recommend that more comprehensive and in-depth research studies be conducted with Arab cardiac patients to enable implementation of culturally appropriate and effective mental health care interventions.

A population-specific Mini-Nutritional Assessment can effectively grade the nutritional status of stroke rehabilitation patients in Taiwan.

PubMed

Tsai, Alan C; Shih, Chi-Ling

2009-01-01

To determine whether a modified version of the Mini-Nutritional Assessment without body mass index could effectively assess the nutritional risk status of stroke rehabilitation patients in Taiwan. The Mini-Nutritional Assessment was developed on the basis of clinical data of Western populations. Although widely used, its application to assess stroke rehabilitation patients has been limited. Further, to get best results, population-specific modifications to address anthropometric and lifestyle differences have been suggested, especially for non-Caucasian populations. The study assessed the nutritional status of stroke rehabilitation patients who enrolled in the Long-Term Care Service of Taipei. Strokes who were >40 years old, in the program for >1 month and cognitively able to answer the questions were recruited to participate in the study. An on-site in-person interview with structured questionnaire elicited information on personal data, disease history and healthcare use and answers to the Mini-Mental State Examination, the Activities of Daily Living and the Mini-Nutritional Assessment. Patient's nutritional status was assessed with the Mini-Nutritional Assessment in three versions: the original, population-specific (MNA-TI) and population-specific, without body mass index (MNA-TII). The original Mini-Nutritional Assessment rated 24% of patients malnourished and 57% at risk of malnutrition. Similar results, 14 and 64%, respectively, for MNA-TI; and 19 and 57%, respectively, for MNA-TII were observed. Both the original and the modified versions of the Mini-Nutritional Assessment can effectively rate the nutritional risk status of stroke rehabilitation patients in Taiwan. Version MNA-TII that adopted population-specific anthropometric cut-values but without body mass index can effectively predict the nutritional status of stroke patients. The modified scale (MNA-TII) can enhance the application of the tool and timely detection and intervention of undernutrition

Long-Term Health-Related Quality of Life in German Patients with Juvenile Idiopathic Arthritis in Comparison to German General Population.

PubMed

Barth, Swaantje; Haas, Johannes-Peter; Schlichtiger, Jenny; Molz, Johannes; Bisdorff, Betty; Michels, Hartmut; Hügle, Boris; Radon, Katja

2016-01-01

Aims of the study were to investigate health-related quality of life (HRQOL) in adult patients with former diagnosis of Juvenile Idiopathic Arthritis (JIA), to compare their HRQOL with the general population and to identify factors related to a poor outcome. In 2012, a cross-sectional survey was performed by mailing a questionnaire to a large cohort of former and current patients of the German Centre for Rheumatology in Children and Adolescents. Only adult patients (≥18 years) with a diagnosis compatible with JIA were included (n = 2592; response 66%). The questionnaire included information about HRQOL (EQ5D), disease-related questions and socio-demographics. Prevalence and 95% confidence intervals (CI) of problems with mobility, self-care, usual activities, pain and anxiety/depression were standardized to the German general population. Factors associated with low HRQOL in JIA patients were identified using logistic regression models. Sixty-two percent of the study population was female; age range was 18-73 years. In all dimensions, JIA patients reported statistically significantly more problems than the general population with largest differences in the pain dimension (JIA patients 56%; 95%CI 55-58%; general population 28%; 26-29%) and the anxiety/depression dimension (28%; 27-29% vs. 4%; 4-5%). Lower HRQOL in JIA patients was associated with female sex, older age, lower level of education, still being under rheumatic treatment and disability. HRQOL in adult JIA patients is considerably lower than in the general population. As this cohort includes historic patients the new therapeutic schemes available today are expected to improve HRQOL in future.

Population pharmacokinetic and pharmacogenetic analysis of 6-mercaptopurine in paediatric patients with acute lymphoblastic leukaemia

PubMed Central

Hawwa, Ahmed F; Collier, Paul S; Millership, Jeff S; McCarthy, Anthony; Dempsey, Sid; Cairns, Carole; McElnay, James C

2008-01-01

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECTThe cytotoxic effects of 6-mercaptopurine (6-MP) were found to be due to drug-derived intracellular metabolites (mainly 6-thioguanine nucleotides and to some extent 6-methylmercaptopurine nucleotides) rather than the drug itself.Current empirical dosing methods for oral 6-MP result in highly variable drug and metabolite concentrations and hence variability in treatment outcome. WHAT THIS STUDY ADDSThe first population pharmacokinetic model has been developed for 6-MP active metabolites in paediatric patients with acute lymphoblastic leukaemia and the potential demographic and genetically controlled factors that could lead to interpatient pharmacokinetic variability among this population have been assessed.The model shows a large reduction in interindividual variability of pharmacokinetic parameters when body surface area and thiopurine methyltransferase polymorphism are incorporated into the model as covariates.The developed model offers a more rational dosing approach for 6-MP than the traditional empirical method (based on body surface area) through combining it with pharmacogenetically guided dosing based on thiopurine methyltransferase genotype. AIMS To investigate the population pharmacokinetics of 6-mercaptopurine (6-MP) active metabolites in paediatric patients with acute lymphoblastic leukaemia (ALL) and examine the effects of various genetic polymorphisms on the disposition of these metabolites. METHODS Data were collected prospectively from 19 paediatric patients with ALL (n = 75 samples, 150 concentrations) who received 6-MP maintenance chemotherapy (titrated to a target dose of 75 mg m−2 day−1). All patients were genotyped for polymorphisms in three enzymes involved in 6-MP metabolism. Population pharmacokinetic analysis was performed with the nonlinear mixed effects modelling program (nonmem) to determine the population mean parameter estimate of clearance for the active metabolites. RESULTS The developed

Do whole body vibration exercises affect lower limbs neuromuscular activity in populations with a medical condition? A systematic review.

PubMed

Dionello, Carla Fontoura; de Souza, Patrícia Lopes; Sá-Caputo, Danubia; Morel, Danielle Soares; Moreira-Marconi, Eloá; Paineiras-Domingos, Laisa Liane; Frederico, Eric Heleno Freire Ferreira; Guedes-Aguiar, Eliane; Paiva, Patricia de Castro; Taiar, Redha; Chiementin, Xavier; Marín, Pedro J; Bernardo-Filho, Mario

2017-01-01

The use of surface electromyography (sEMG) to evaluate muscle activation when executing whole body vibration exercises (WBVE) in studies provide neuromuscular findings, in healthy and diseased populations. Perform a systematic review of the effects of WBVE by sEMG of lower limbs in non-healthy populations. The search using the defined keywords was performed in PubMed, PEDRo and EMBASE databases by three independent researchers. Applying the PRISMA statement several studies were selected according to eligibility criteria and organized for the review. Full papers were included if they described effects of WBVE for the treatment of illnesses, evaluated by sEMG of lower limbs independently on the year of the publication; in comparison or associated with other treatment and evaluation techniques. Seven publications were selected; two in spinal cord injury patients, one in Friedreich's ataxia patients, three in stroke patients and one study in breast cancer survivors. Reported effects of WBV in were muscle activation by sEMG and also on strength, blood flow and exercise resistance; even in paretic limbs. By the use of sEMG it was verified that WBVE elicits muscle activation in diseased population. These results may lead to the definition of exercise protocols to maintain or increase muscular activation. However, due to the heterogeneity of methods among studies, there is currently no consensus on the sEMG signal processing. These strategies might also induce effects on muscle strength, balance and flexibility in these and other illnesses.

Independent components of neural activity carry information on individual populations.

PubMed

Głąbska, Helena; Potworowski, Jan; Łęski, Szymon; Wójcik, Daniel K

2014-01-01

Local field potential (LFP), the low-frequency part of the potential recorded extracellularly in the brain, reflects neural activity at the population level. The interpretation of LFP is complicated because it can mix activity from remote cells, on the order of millimeters from the electrode. To understand better the relation between the recordings and the local activity of cells we used a large-scale network thalamocortical model to compute simultaneous LFP, transmembrane currents, and spiking activity. We used this model to study the information contained in independent components obtained from the reconstructed Current Source Density (CSD), which smooths transmembrane currents, decomposed further with Independent Component Analysis (ICA). We found that the three most robust components matched well the activity of two dominating cell populations: superior pyramidal cells in layer 2/3 (rhythmic spiking) and tufted pyramids from layer 5 (intrinsically bursting). The pyramidal population from layer 2/3 could not be well described as a product of spatial profile and temporal activation, but by a sum of two such products which we recovered in two of the ICA components in our analysis, which correspond to the two first principal components of PCA decomposition of layer 2/3 population activity. At low noise one more cell population could be discerned but it is unlikely that it could be recovered in experiment given typical noise ranges.

Independent Components of Neural Activity Carry Information on Individual Populations

PubMed Central

Głąbska, Helena; Potworowski, Jan; Łęski, Szymon; Wójcik, Daniel K.

2014-01-01

Local field potential (LFP), the low-frequency part of the potential recorded extracellularly in the brain, reflects neural activity at the population level. The interpretation of LFP is complicated because it can mix activity from remote cells, on the order of millimeters from the electrode. To understand better the relation between the recordings and the local activity of cells we used a large-scale network thalamocortical model to compute simultaneous LFP, transmembrane currents, and spiking activity. We used this model to study the information contained in independent components obtained from the reconstructed Current Source Density (CSD), which smooths transmembrane currents, decomposed further with Independent Component Analysis (ICA). We found that the three most robust components matched well the activity of two dominating cell populations: superior pyramidal cells in layer 2/3 (rhythmic spiking) and tufted pyramids from layer 5 (intrinsically bursting). The pyramidal population from layer 2/3 could not be well described as a product of spatial profile and temporal activation, but by a sum of two such products which we recovered in two of the ICA components in our analysis, which correspond to the two first principal components of PCA decomposition of layer 2/3 population activity. At low noise one more cell population could be discerned but it is unlikely that it could be recovered in experiment given typical noise ranges. PMID:25153730

Population pharmacokinetics of oxycodone in patients with cancer-related pain.

PubMed

Komatsu, Toshiaki; Kokubun, Hideya; Suzuki, Ai; Takayanagi, Risa; Yamada, Yasuhiko; Matoba, Motohiro; Yago, Kazuo

2012-09-01

Oxycodone is an opioid widely prescribed to cancer patients for pain relief. However, the pharmacokinetics of oxycodone has not been sufficiently examined. Therefore the aim of this work was to study population pharmacokinetics of oxycodone in patients with cancer pain. The authors analyzed 108 serum oxycodone samples of 33 individuals with nonlinear mixed-effects model (NONMEM). Population pharmacokinetics was calculated using the one-compartment model of clearance, volume of distribution, bioavailability, absorption constant rate, and lag time. An exponential error model was used to determine interindividual variability and a relative error model was applied to assess residual variability. Population pharmacokinetics of oxycodone at the end point were as follows: CL(L/h) = 10.7 × [1 + (2 - Child-Pugh Classification)] (Class: A = 0, B = 1, C = 2); V(d) (L) = 193; k(a) (h(-1)) = 0.336; T(lag) (h) = 0.859; F (%) = 63.9. Interindividual variability was CL: 30.5%, V(d): 44.6%, and F: 37.0%, and residual variability was 16.2%. As the total clearance in patients with liver dysfunction (Child-Pugh class B) was reduced to 33.3%, serum concentration of oxycodone increased by 1.5. Therefore, it became clear that dose adjustments are essential when treating patients with liver dysfunction. These findings suggest that population parameters are useful for evaluating pharmacokinetics of oxycodone in patients with cancer pain.

Physical Function and Physical Activity in Peritoneal Dialysis Patients.

PubMed

Painter, Patricia L; Agarwal, Adhish; Drummond, Micah

2017-01-01

Physical functioning (PF) and physical activity (PA) are low in patients treated with maintenance hemodialysis (MHD). Little information exists on this topic in patients treated with peritoneal dialysis (PD). The objective of this study was to compare PF and PA in patients with Stage-5 chronic kidney disease (CKD) treated with PD and in-center MHD. Physical functioning was measured in 45 prevalent PD patients using standard physical performance measures that include gait speed, chair stand, standing balance, 6-minute-walk, incremental shuttle walk and self-reported PF using the short form (SF)-36 questionnaire. Physical activity was determined from self-report and using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Scores for the short physical performance battery (SPPB) were calculated. In-center MHD patients were matched by age, gender, and diabetes status to the PD patients. Unadjusted comparisons showed significantly higher 6-minute-walk distance, shuttle-walk distance and hand-grip in the PD patients. Adjustment in multiple regression analysis resulted in only gait speed being significantly different between the groups. All test results in both groups were lower than reference values for age and gender in the general population, and were at the levels indicating impairment. Physical activity was not different between the 2 groups (average age 49 yrs), and both groups had weekly caloric expenditure from all exercise and from moderate-intensity exercise that was similar to older (> 70 yrs) community-dwelling adults. Adjusted association indicated that PA was significantly associated with shuttle-walk distance. Physical functioning and PA measures were low in both PD and MHD groups. Interventions to improve PA and PF should be strongly considered for both PD and MHD patients. Copyright © 2017 International Society for Peritoneal Dialysis.

Effects of a Web-based intervention for adults with chronic conditions on patient activation: online randomized controlled trial.

PubMed

Solomon, Michael; Wagner, Stephen L; Goes, James

2012-02-21

With almost one-half of Americans projected to have at least one chronic condition before 2020, a vital role of the health care system is to develop informed, engaged individuals who are effective self-managers of their health. Self-management interventions (SMIs) delivered face-to-face or by telephone (traditional SMIs) are associated with improved self-management knowledge, skills, and self-efficacy, which are expressed by the composite construct of patient activation, a predictor of health outcomes. Web-based interventions to support self-management across the spectrum of chronic diseases have the potential to reach a broader population of patients for extended periods than do traditional SMIs. However, evidence of the effectiveness of Web-based interventions on patient activation is sparse. High-quality studies featuring controlled comparisons of patients with different chronic conditions are needed to explore the interaction of Web-based interventions and patient activation. To explore the effect of a Web-based intervention on the patient activation levels of patients with chronic health conditions, measured as attitudes toward knowledge, skills, and confidence in self-managing health. For this 12-week study, prospective participants were selected from the patient panel of a regional health care system in the United States. The 201 eligible participants were randomly assigned to two groups. Intervention group participants had access to MyHealth Online, a patient portal featuring interactive health applications accessible via the Internet. Control participants had access to a health education website featuring various topics. Patient activation was assessed pre- and posttest using the 13-item patient activation measure. Parametric statistical models (t test, analysis of variance, analysis of covariance) were applied to draw inferences. The Web-based intervention demonstrated a positive and significant effect on the patient activation levels of participants in

The Prevalence of Type 2 Diabetes Mellitus in a Wisconsin Hmong Patient Population.

PubMed

Thao, Kevin K; Arndt, Brian; Tandias, Aman; Hanrahan, Lawrence

2015-10-01

Wisconsin's largest Asian population, the Hmong, may be at high risk for type 2 diabetes. However, there are few population-based studies investigating the prevalence of diabetes in this population. This study compared the prevalence of diabetes between Hmong and non-Hispanic white patients of the University of Wisconsin departments of family medicine, pediatrics, and internal medicine clinics. The study utilized data from the University of Wisconsin Electronic Health Record Public Health Information Exchange (UW eHealth--PHINEX). The proportion of Hmong patients diagnosed with diabetes was compared with the prevalence of diabetes in non-Hispanic white patients. Multivariate logistic regression was used to control for the differences in age, sex, body mass index (BMI), and health insurance between the two populations. The total prevalence of diabetes in the Hmong patient population was 11.3% compared to 6.0% in the non-Hispanic white patient population (P < 0.001). The prevalence of diabetes in Hmong adult patients was 19.1% compared to 7.8% in white adult patients (P =< 0.001). Compared with non-Hispanic whites, the odds ratio (95% CI) for diabetes, adjusted for age, sex, BMI, and insurance was 3.3 (2.6-4.1) for Hmong patients. Despite being one of Wisconsin's newest immigrant populations, who came from an area of the world with low rates of diabetes, the adjusted relative odds of diabetes in this clinic sample of Hmong patients is 3.3 times higher than its non-Hispanic white counterpart. The results support previous findings of significantly increased diabetes risk in the Hmong of Wisconsin.

Polycystic kidney disease among 4,436 intracranial aneurysm patients from a defined population.

PubMed

Nurmonen, Heidi J; Huttunen, Terhi; Huttunen, Jukka; Kurki, Mitja I; Helin, Katariina; Koivisto, Timo; von Und Zu Fraunberg, Mikael; Jääskeläinen, Juha E; Lindgren, Antti E

2017-10-31

To define the association of autosomal dominant polycystic kidney disease (ADPKD) with the characteristics of aneurysmal subarachnoid hemorrhage (aSAH) and unruptured intracranial aneurysm (IA) disease. We fused data from the Kuopio Intracranial Aneurysm database (n = 4,436 IA patients) and Finnish nationwide registries into a population-based series of 53 IA patients with ADPKD to compare the aneurysm- and patient-specific characteristics of IA disease in ADPKD and in the general IA population, and to identify risks for de novo IA formation. In total, there were 33 patients with ADPKD with aSAH and 20 patients with ADPKD with unruptured IAs. The median size of ruptured IAs in ADPKD was significantly smaller than in the general population (6.00 vs 8.00 mm) and the proportion of small ruptured IAs was significantly higher (31% vs 18%). Median age at aSAH was 42.8 years, 10 years younger than in the general IA population. Multiple IAs were present in 45% of patients with ADPKD compared to 28% in the general IA population. Cumulative risk of de novo IA formation was 1.3% per patient-year (vs 0.2% in the general IA population). Hazard for de novo aneurysm formation was significantly elevated in patients with ADPKD (Cox regression hazard ratio 7.7, 95% confidence interval 2.8-20; p < 0.0005). Subarachnoid hemorrhage occurs at younger age and from smaller IAs in patients with ADPKD and risk for de novo IAs is higher than in the general Eastern Finnish population. ADPKD should be considered as an indicator for long-term angiographic follow-up in patients with diagnosed IAs. © 2017 American Academy of Neurology.

Patient activation and use of an electronic patient portal.

PubMed

Ancker, Jessica S; Osorio, Snezana N; Cheriff, Adam; Cole, Curtis L; Silver, Michael; Kaushal, Rainu

2015-01-01

Electronic patient portals give patients access to personal medical data, potentially creating opportunities to improve knowledge, self-efficacy, and engagement in healthcare. The combination of knowledge, self-efficacy, and engagement has been termed activation. Our objective was to assess the relationship between patient activation and outpatient use of a patient portal. Survey. A telephone survey was conducted with 180 patients who had been given access to a portal, 113 of whom used it and 67 of whom did not. The validated patient activation measure (PAM) was administered along with questions about demographics and behaviors. Portal users were no different from nonusers in patient activation. Portal users did have higher education level and more frequent Internet use, and were more likely to have precisely 2 prescription medications than to have more or fewer. Patients who chose to use an electronic patient portal were not more highly activated than nonusers, although they were more educated and more likely to be Internet users.

Moyamoya vasculopathy - Patient demographics and characteristics in the Finnish population.

PubMed

Saarela, Marika; Mustanoja, Satu; Pekkola, Johanna; Tyni, Tiina; Hernesniemi, Juha; Kivipelto, Leena; Tatlisumak, Turgut

2017-01-01

Background and purpose Moyamoya vasculopathy, a rare steno-occlusive progressive cerebrovascular disorder, has not been thoroughly studied in Caucasian populations. We established a registry of Finnish patients treated at the Helsinki University Hospital, to collect and report demographic and clinical data. Methods We collected data both retrospectively and prospectively from all the patients with a moyamoya vasculopathy referred to our hospital between January 1987 and December 2014. All patients underwent a neurological outpatient clinic visit. Results We diagnosed 61 patients (50 females, 10 children) with moyamoya vasculopathy. The mean age at the disease-onset was 31.5 ± 17.9 years. The two most common presenting symptoms were ischemic stroke (n = 31) and hemorrhage (n = 8). Forty-four percent underwent revascularization surgery, and 70% were prescribed antithrombotic treatment. Conclusions The results support in part the Western phenotype of the disease considering the later presentation and larger female predominance compared to the Asian moyamoya vasculopathy reports. However, the proportion of ischemic strokes and hemorrhagic strokes is closer to Japanese population than German population. The absence of familial cases points to a different genetic profile in the Finnish patients.

Leisure time activities of Iranian patients with multiple sclerosis: a qualitative study

PubMed Central

Hosseini, Seyed Mohammad Sadegh; Asgari, Ali; Rassafiani, Mehdi; Yazdani, Farzaneh; Mazdeh, Mehrdokht

2016-01-01

Background: Leisure time is one of the most important aspects of life, especially for people with chronic diseases. The concept and types of leisure have frequently been evaluated in different socio-cultural populations. The aim of this study was to identify the nature of leisure activities among a sample of Iranian patients with multiple sclerosis (MS) and classify the identified types of activities in the context of Iranian culture. Methods: In this qualitative study, semi-structured interview was applied to gather data from 34 MS patients that were selected through purposive sampling. The interviews were continued up to the point of saturation. Content analysis was used to explore experiences of the interviewees regarding their leisure activities. Results: Six categories of leisure activities were extracted for the studied patients with MS i.e.physical, social, individual, art/cultural, educational and spiritual/religious. Conclusion: The results represented the range and heterogeneity of leisure activities amongst the MS patients. Considering participation in spiritual/religious and social activities as leisure time undertaking might reflect cultural diversity in the perception and use of time for recreation. For mental health promotion purposes, paying special attention to the types of activities that people of different socio-cultural background choose for their refreshment could help health care providers in giving tailored advice for patients with MS and other chronic debilitating disease. PMID:27123437

Long-Term Health-Related Quality of Life in German Patients with Juvenile Idiopathic Arthritis in Comparison to German General Population

PubMed Central

Barth, Swaantje; Haas, Johannes-Peter; Schlichtiger, Jenny; Molz, Johannes; Bisdorff, Betty; Michels, Hartmut; Hügle, Boris; Radon, Katja

2016-01-01

Objective Aims of the study were to investigate health-related quality of life (HRQOL) in adult patients with former diagnosis of Juvenile Idiopathic Arthritis (JIA), to compare their HRQOL with the general population and to identify factors related to a poor outcome. Methods In 2012, a cross-sectional survey was performed by mailing a questionnaire to a large cohort of former and current patients of the German Centre for Rheumatology in Children and Adolescents. Only adult patients (≥18 years) with a diagnosis compatible with JIA were included (n = 2592; response 66%). The questionnaire included information about HRQOL (EQ5D), disease-related questions and socio-demographics. Prevalence and 95% confidence intervals (CI) of problems with mobility, self-care, usual activities, pain and anxiety/depression were standardized to the German general population. Factors associated with low HRQOL in JIA patients were identified using logistic regression models. Results Sixty-two percent of the study population was female; age range was 18–73 years. In all dimensions, JIA patients reported statistically significantly more problems than the general population with largest differences in the pain dimension (JIA patients 56%; 95%CI 55–58%; general population 28%; 26–29%) and the anxiety/depression dimension (28%; 27–29% vs. 4%; 4–5%). Lower HRQOL in JIA patients was associated with female sex, older age, lower level of education, still being under rheumatic treatment and disability. Conclusions HRQOL in adult JIA patients is considerably lower than in the general population. As this cohort includes historic patients the new therapeutic schemes available today are expected to improve HRQOL in future. PMID:27115139

Autonomous motivation and quality of life as predictors of physical activity in patients with schizophrenia.

PubMed

Costa, Raquel; Bastos, Tânia; Probst, Michel; Seabra, André; Vilhena, Estela; Corredeira, Rui

2018-02-08

Being physically active is a complex behaviour in patients with schizophrenia. Several factors were identified as barriers to achieving active behaviours in this population. Therefore, the purpose of this study was to investigate among a number of barriers what predicts the most on physical activity (PA) in patients with schizophrenia. A total of 114 patients (28♀) with schizophrenia were included. Body mass index (BMI) was calculated. Autonomous and controlled motivation (Behavioural Regulation in Exercise Questionnaire - 3), self-esteem (Rosenberg Self-esteem scale), quality of life (World Health Organization Quality of Life Scale - Brief version) and functional exercise capacity (6-minute walk test - 6MWT) were evaluated. Multiple Regression Analysis was applied to assess the effect of these variables on Total PA per week (International Physical Activity Questionnaire - short version). Autonomous motivation and domains of quality of life were positively correlated with Total PA per week. Stepwise multiple regression analyses showed that of all the candidate factors to predict PA, autonomous motivation and global domain of quality of life were found as significant predictors. Our findings help to understand the importance of autonomous motivation and quality of life for PA in patients with schizophrenia. Knowledge about these predictors may provide guidance to improve PA behaviour in this population.

Dissemination of physical activity promotion interventions in underserved populations.

PubMed

Yancey, Antronette K; Ory, Marcia G; Davis, Sally M

2006-10-01

Achieving minimum physical activity levels of 30 or more minutes per day will require a variety of intervention strategies to engage each segment of an aging and increasingly ethnically diverse U.S. population. This article presents a focused review of the sparse literature on the diffusion of evidence-based physical activity interventions that are culturally appropriate for underserved populations. Related literature and experiential insights inform this discussion, because so few published studies report outcome data beyond the first diffusion phase of intervention development and evaluation. Three brief case studies are presented to further illustrate and exemplify key concepts and processes at several different stages in diffusing physical activity interventions. Successful engagement of underserved populations reflects a delicate balance between embracing group customs and values and recognizing the nonmonolithic nature of any sociodemographically defined group. The costs of failing to promulgate effective physical activity interventions in these groups continue to mount, in dollars, health, and lives. Researchers, practitioners, decision makers, and policymakers must partner to bridge the evidentiary gap so that the physically active lifestyle choices become the easier choices.

Assessing physical function and physical activity in patients with CKD.

PubMed

Painter, Patricia; Marcus, Robin L

2013-05-01

Patients with CKD are characterized by low levels of physical functioning, which, along with low physical activity, predict poor outcomes in those treated with dialysis. The hallmark of clinical care in geriatric practice and geriatric research is the orientation to and assessment of physical function and functional limitations. Although there is increasing interest in physical function and physical activity in patients with CKD, the nephrology field has not focused on this aspect of care. This paper provides an in-depth review of the measurement of physical function and physical activity. It focuses on physiologic impairments and physical performance limitations (impaired mobility and functional limitations). The review is based on established frameworks of physical impairment and functional limitations that have guided research in physical function in the aging population. Definitions and measures for physiologic impairments, physical performance limitations, self-reported function, and physical activity are presented. On the basis of the information presented, recommendations for incorporating routine assessment of physical function and encouragement for physical activity in clinical care are provided.

Measuring self-management of patients' and employees' health: further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics.

PubMed

Fowles, Jinnet Briggs; Terry, Paul; Xi, Min; Hibbard, Judith; Bloom, Christine Taddy; Harvey, Lisa

2009-10-01

Evaluate the Patient Activation Measure (PAM) in relation to personal characteristics in employed populations. Further validate the PAM for use in improving clinical or employer-based health-intervention programs. Data for analysis were taken from baseline survey information and health screenings collected during a randomized, controlled trial testing two different health promotion programs. Study population included 625 employees (predominantly white collar) from two companies in the northern Midwest of the United States: a large, integrated health care system and a national airline. PAM's psychometric properties are robust in two employed populations. Activation is directly related not only to health status, but also to job performance measures. The strong positive relationship of PAM to measures of healthy behavior, health information-seeking and readiness-to-change further validate the measure. Commonly, a difference of 5 points on the PAM separated healthy from less healthy behaviors. Activation can be understood in a broader population health context and need not be restricted to people with chronic illnesses. The study provides guidance on how to interpret PAM scores. The PAM can be used as part of any health-intervention program designed to improve patients' or employees' self-management skills, whether the program is clinic-based or employer-based. 2009 Elsevier Ireland Ltd.

Levels of physical activity in patients with severe psoriasis: a cross-sectional questionnaire study.

PubMed

Torres, Tiago; Alexandre, José Manuel; Mendonça, Denisa; Vasconcelos, Carlos; Silva, Berta Martins; Selores, Manuela

2014-04-01

Psoriasis is a chronic inflammatory disease associated with increased cardiovascular mortality, secondary to the increased prevalence of cardiovascular risk factors and premature atherosclerosis. Physical activity is a vital component in prevention and management of cardiovascular disease. Few studies have examined the level of physical activity in psoriasis patients, using validated questionnaires or other objective assessment tools. The aim of this study was to analyze and compare physical activity undertaken by patients with severe psoriasis and healthy controls, using the International Physical Activity Questionnaire-Short Form (IPAQ-S), a validated instrument for assessing physical activity. Ninety patients with severe plaque-type psoriasis and 160 healthy subjects were enrolled in the present study. Physical activity was evaluated using IPAQ-S. Psoriasis patients had reduced levels of physical activity compared with non-psoriasis patients, regardless of sex or whether the variable was continuous or categorical. The odds ratio for low-level physical activity for psoriasis patients, compared with controls, was 3.42 (95% CI 1.47-7.91), indicating that this severe psoriasis population did not undertake recommended levels of physical activity. Psoriasis patients exhibit decreased levels of physical activity, possibly for both psychological and physiological reasons. The lack of physical activity may contribute to the increased risk of cardiovascular disease in psoriasis patients, in addition to the intrinsic risks related to systemic inflammation and psoriasis-linked comorbidities. Regular physical activity should be encouraged in all psoriasis patients because of its beneficial effects on systemic inflammation and cardiometabolic comorbidities associated with psoriasis.

Racial disparities in tissue plasminogen activator treatment rate for stroke: a population-based study.

PubMed

Hsia, Amie W; Edwards, Dorothy F; Morgenstern, Lewis B; Wing, Jeffrey J; Brown, Nina C; Coles, Regina; Loftin, Sarah; Wein, Andrea; Koslosky, Sara S; Fatima, Sabiha; Sánchez, Brisa N; Fokar, Ali; Gibbons, M Chris; Shara, Nawar; Jayam-Trouth, Annapurni; Kidwell, Chelsea S

2011-08-01

Some prior studies have shown that racial disparities exist in intravenous tissue plasminogen activator (tPA) use for acute ischemic stroke. We sought to determine whether race was associated with tPA treatment for stroke in a predominantly black urban population. Systematic chart abstraction was performed on consecutive hospitalized patients with ischemic stroke from all 7 acute care hospitals in the District of Columbia from February 1, 2008, to January 31, 2009. Of 1044 patients with ischemic stroke, 74% were black, 19% non-Hispanic white, and 5% received intravenous tPA. Blacks were one third less likely than whites to receive intravenous tPA (3% versus 10%, P<0.001). However, blacks were also less likely than whites to present within 3 hours of symptom onset (13% versus 21%, P=0.004) and also less likely to be tPA-eligible (5% versus 13%, P<0.001). Of those who presented within 3 hours, blacks were almost half as likely to be treated with intravenous tPA than whites (27% versus 46%, P=0.023). The treatment rate for tPA-eligible patients was similar for blacks and whites (70% versus 76%, P=0.62). In this predominantly black urban population hospitalized for acute ischemic stroke, blacks were significantly less likely to be treated with intravenous tPA due to contraindications to treatment, delayed presentation, and stroke severity. Effective interventions designed to increase treatment in this population need to focus on culturally relevant education programs designed to address barriers specific to this population.

Patient-reported physical activity questionnaires: A systematic review of content and format

PubMed Central

2012-01-01

Background Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations. Methods Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers. Results 104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories. Conclusions A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context. PMID:22414164

Direct Determination of Activities for Microorganisms of Chesapeake Bay Populations

PubMed Central

Tabor, Paul S.; Neihof, Rex A.

1984-01-01

We used three methods in determination of the metabolically active individual microorganisms for Chesapeake Bay surface and near-bottom populations over a period of a year. Synthetically active bacteria were recognized as enlarged cells in samples amended with nalidixic acid and yeast extract and incubated for 6 h. Microorganisms with active electron transport systems were identified by the reduction of a tetrazolium salt electron acceptor. Microorganisms active in uptake of amino acids, thymidine, and acetate were determined by microautoradiography. In conjunction with enumeration of active organisms, a total direct count was made for each sample preparation by epifluorescence microscopy. For the majority of samples, numbers of amino acid uptake-active organisms were greater than numbers of organisms determined to be active by other direct measurements. Within a sample, the numbers of uptake-active organisms (amino acids or thymidine) and electron transport system-active organisms were significantly different for 68% of the samples. Numbers of synthetically active bacteria were generally less than numbers determined by the other direct activity measurements. The distribution of total counts in the 11 samplings showed a seasonal pattern, with significant dependence on in situ water temperature, increasing from March to September and then decreasing through February. Synthetically active bacteria and amino acid uptake-active organisms showed a significant dependence on in situ temperature, independent of the function of temperature on total counts. Numbers of active organisms determined by at least one of the methods used exceeded 25% of the total population of all samplings, and from June through September, >85% of the total population was found to be active by at least one direct activity measurement. Thus, active rather than dormant organisms compose a major portion of the microbial population in this region of Chesapeake Bay. PMID:16346659

Direct determination of activities for microorganisms of chesapeake bay populations.

PubMed

Tabor, P S; Neihof, R A

1984-11-01

We used three methods in determination of the metabolically active individual microorganisms for Chesapeake Bay surface and near-bottom populations over a period of a year. Synthetically active bacteria were recognized as enlarged cells in samples amended with nalidixic acid and yeast extract and incubated for 6 h. Microorganisms with active electron transport systems were identified by the reduction of a tetrazolium salt electron acceptor. Microorganisms active in uptake of amino acids, thymidine, and acetate were determined by microautoradiography. In conjunction with enumeration of active organisms, a total direct count was made for each sample preparation by epifluorescence microscopy. For the majority of samples, numbers of amino acid uptake-active organisms were greater than numbers of organisms determined to be active by other direct measurements. Within a sample, the numbers of uptake-active organisms (amino acids or thymidine) and electron transport system-active organisms were significantly different for 68% of the samples. Numbers of synthetically active bacteria were generally less than numbers determined by the other direct activity measurements. The distribution of total counts in the 11 samplings showed a seasonal pattern, with significant dependence on in situ water temperature, increasing from March to September and then decreasing through February. Synthetically active bacteria and amino acid uptake-active organisms showed a significant dependence on in situ temperature, independent of the function of temperature on total counts. Numbers of active organisms determined by at least one of the methods used exceeded 25% of the total population of all samplings, and from June through September, >85% of the total population was found to be active by at least one direct activity measurement. Thus, active rather than dormant organisms compose a major portion of the microbial population in this region of Chesapeake Bay.

Psychological distress in the active duty military spine patient.

PubMed

Brooks, D Ethan; Agochukwu, Uzondu F; Arrington, Edward D; Mok, James M

2013-10-01

Disorders of the spine are a substantial burden to the military health care system that degrades readiness in the overall force. Because treatment outcomes are affected by psychosocial factors, assessment of psychological distress is important for patients with spine complaints. The incidence of psychological distress in the unique military population is not well described. The purpose of this retrospective case-control study was to determine the rate of psychological distress and identify associated patient characteristics among many variables collected in the military health system. A consecutive cohort of active duty service members presenting to a spine specialty clinic was assessed as Normal, At Risk, or Distressed using the Distress and Risk Assessment Method. Of 74 active duty patients (63 male, 11 female), 43 (58%) had some level of psychological distress: 29 (39%) At Risk, 12 (16%) Distressed-Depressive, and 2 (3%) Distressed-Somatic. Multivariate regression analysis identified female gender (odds ratio [OR] 7.90), higher disability as measured by Oswestry Disability Index/Neck Disability Index (OR 8.0 per 13.8 point increase), and assignment to a Warrior Transition Unit or Medical Evaluation Board (OR 7.35) as statistically significant variables. The results indicate that active duty patients are subject to similarly high levels of psychological distress as their civilian counterparts. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

Population pharmacokinetics of intravenous Erwinia asparaginase in pediatric acute lymphoblastic leukemia patients.

PubMed

Sassen, Sebastiaan D T; Mathôt, Ron A A; Pieters, Rob; Kloos, Robin Q H; de Haas, Valérie; Kaspers, Gertjan J L; van den Bos, Cor; Tissing, Wim J E; Te Loo, Maroeska; Bierings, Marc B; Kollen, Wouter J W; Zwaan, Christian M; van der Sluis, Inge M

2017-03-01

Erwinia asparaginase is an important component in the treatment of pediatric acute lymphoblastic leukemia. A large variability in serum concentrations has been observed after intravenous Erwinia asparaginase. Currently, Dutch Childhood Oncology Group protocols dose alterations are based on trough concentrations to ensure adequate asparaginase activity (≥100 IU/L). The aim of this study was to describe the population pharmacokinetics of intravenous Erwinia asparaginase to quantify and gather insight into inter-individual and inter-occasion variability. The starting dose was evaluated on the basis of the derived population pharmacokinetic parameters. In a multicenter prospective observational study, a total of 714 blood samples were collected from 51 children (age 1-17 years) with acute lymphoblastic leukemia. The starting dose was 20,000 IU/m 2 three times a week and adjusted according to trough levels from week three onwards. A population pharmacokinetic model was developed using NONMEM ® A 2-compartment linear model with allometric scaling best described the data. Inter-individual and inter-occasion variability of clearance were 33% and 13%, respectively. Clearance in the first month of treatment was 14% higher ( P <0.01). Monte Carlo simulations with our pharmacokinetic model demonstrated that patients with a low weight might require higher doses to achieve similar concentrations compared to patients with high weight. The current starting dose of 20,000 IU/m 2 might result in inadequate concentrations, especially for smaller, lower weight patients, hence dose adjustments based on individual clearance are recommended. The protocols were approved by the institutional review boards. (Registered at NTR 3379 Dutch Trial Register; www.trialregister.nl). Copyright© Ferrata Storti Foundation.

Psychotropic and Opioid Medication Use in Older Patients With Breast Cancer Across the Care Trajectory: A Population-Based Cohort Study.

PubMed

Syrowatka, Ania; Chang, Sue-Ling; Tamblyn, Robyn; Mayo, Nancy E; Meguerditchian, Ari N

2016-11-01

Older patients with breast cancer represent a vulnerable population at higher risk of experiencing distress and pain, as well as medication-related adverse events from pharmacological treatment of these symptoms. The purpose of this study is to estimate the prevalence of psychotropic (anxiolytic, antidepressant, and antipsychotic) and opioid medication use by older women diagnosed with breast cancer. This population-based cohort study followed 19,353 women older than 65 years diagnosed with incident, nonmetastatic breast cancer in Quebec, Canada. Data were obtained from provincial, universal health and drug insurance plans covering all medical and pharmaceutical care. Descriptive statistics were calculated for demographic information, breast cancer characteristics, and treatments. Psychotropic and opioid medication use was assessed across the care trajectory: precancer baseline, active care, and first-year survivorship. There was a marked increase in the prevalence of medication use from precancer baseline to active care, followed by a decrease into first-year survivorship. Anxiolytics were used most often across the care trajectory (36.3%, 50.6%, and 44.4% at baseline, active care, and survivorship, respectively). In contrast, antipsychotic and opioid medications were sought primarily during active care (4.5- and 7-fold increases from baseline, respectively), with opioid use during active care increasing dramatically over the study period (9.0% to 40.9% from 1998 to 2010). Unlike other drugs, antidepressant use peaked in active care but persisted into survivorship (14.7%, 22.4%, and 22.3% at baseline, active care, and survivorship, respectively). A substantial proportion of older patients with breast cancer use psychotropic and opioid medications. The different patterns of medication use represent distress and pain experienced by patients across the care trajectory. Given that medication use in this vulnerable population is associated with an increased risk of

Nationwide population-based study of cause-specific death rates in patients with psoriasis.

PubMed

Salahadeen, E; Torp-Pedersen, C; Gislason, G; Hansen, P R; Ahlehoff, O

2015-05-01

Psoriasis is a common chronic disease, mediated by type 1 and 17 helper T cell-driven inflammation. Epidemiological studies have demonstrated a wide range of comorbidities and increased mortality rates. However, the current evidence on psoriasis-related mortality is limited and nationwide data have not been presented previously. In a nationwide population-based cohort we evaluated all-cause and cause-specific death rates in patients with psoriasis as compared to the general population. The entire Danish population aged 18 and above, corresponding to a total of 5,458,627 individuals (50.7% female, 40.9 years ± 19.7), including 94,069 with mild psoriasis (53% female, 42.0 ± 17.0 years) and 28,253 with severe psoriasis (53.4% female, 43.0 ± 16.5 years), was included. A total of 884,661 deaths were recorded, including 10 916 in patients with mild psoriasis and 3699 in patients with severe psoriasis. The age at time of death varied by psoriasis status, i.e. 76.5 ± 14.0, 74.4 ± 12.8 and 72.0 ± 13.4 years, for the general population, mild psoriasis and severe psoriasis respectively. In general, the highest death rates were observed in patients with severe psoriasis. Overall death rates per 1000 patient years were 13.8 [confidence interval (CI) 13.8-13.8], 17.0 (CI 16.7-17.3) and 25.4 (CI 24.6-26.3) for the general population, patients with mild psoriasis and patients with severe psoriasis respectively. This nationwide population-based study of cause-specific death rates in patients with psoriasis demonstrated reduced lifespan and increased rates of all examined specific causes of death in patients with psoriasis compared to the general population. © 2014 European Academy of Dermatology and Venereology.

Aerobic Heterotrophic Bacterial Populations of Sewage and Activated Sludge

PubMed Central

Prakasam, T. B. S.; Dondero, N. C.

1970-01-01

An activated sludge from a sewage treatment plant and a laboratory activated sludge developed on an artificial waste were compared for their ability to utilize 11 aromatic compounds. There were several significant differences between them. The laboratory sludge contained higher numbers of organisms and metabolized the aromatics to a greater extent. Laboratory activated sludges acclimated to utilization of the aromatics differed from each other in population structure and the pattern of oxygen consumption with aromatic substrates. The oxidative patterns of uncontrolled mixed populations were unreliable for investigating metabolic pathways. Extracts of the various sludges elevated the plate counts of the sludges. PMID:5418946

[Population pharmacokinetics applied to optimising cisplatin doses in cancer patients].

PubMed

Ramón-López, A; Escudero-Ortiz, V; Carbonell, V; Pérez-Ruixo, J J; Valenzuela, B

2012-01-01

To develop and internally validate a population pharmacokinetics model for cisplatin and assess its prediction capacity for personalising doses in cancer patients. Cisplatin plasma concentrations in forty-six cancer patients were used to determine the pharmacokinetic parameters of a two-compartment pharmacokinetic model implemented in NONMEN VI software. Pharmacokinetic parameter identification capacity was assessed using the parametric bootstrap method and the model was validated using the nonparametric bootstrap method and standardised visual and numerical predictive checks. The final model's prediction capacity was evaluated in terms of accuracy and precision during the first (a priori) and second (a posteriori) chemotherapy cycles. Mean population cisplatin clearance is 1.03 L/h with an interpatient variability of 78.0%. Estimated distribution volume at steady state was 48.3 L, with inter- and intrapatient variabilities of 31,3% and 11,7%, respectively. Internal validation confirmed that the population pharmacokinetics model is appropriate to describe changes over time in cisplatin plasma concentrations, as well as its variability in the study population. The accuracy and precision of a posteriori prediction of cisplatin concentrations improved by 21% and 54% compared to a priori prediction. The population pharmacokinetic model developed adequately described the changes in cisplatin plasma concentrations in cancer patients and can be used to optimise cisplatin dosing regimes accurately and precisely. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.

Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study

PubMed Central

Servy, Hervé; Molto, Anna; Sellam, Jérémie; Foltz, Violaine; Gandjbakhch, Frédérique; Hudry, Christophe; Mitrovic, Stéphane; Fautrel, Bruno; Gossec, Laure

2018-01-01

Background Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). Objective The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. Methods This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. Results A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was

Nursing Activities for Patients With Chronic Disease in Primary Care Settings: A Practice Analysis.

PubMed

Poitras, Marie-Eve; Chouinard, Maud-Christine; Gallagher, Frances; Fortin, Martin

Nurses in primary care organizations play a central role for patients with chronic disease. Lack of clarity in role description may be associated with underutilization of nurse competencies that could benefit the growing population of patients with chronic disease. The purpose of the research was to describe nursing activities in primary care settings with patients with chronic disease. A Web-based survey was sent to nurses practicing in Family Medicine Groups in the Canadian Province of Québec. Participants rated the frequency with which they carried out nursing activities in five domains: (a) global assessment, (b) care and case management, (c) health promotion, (d) nurse-physician collaboration, and (e) planning services for patients with chronic disease. Findings were summarized with descriptive statistics (means, standard deviations, and ranges). The survey was completed by 266 of the 322 nurses who received the survey (82.6%). Activities in the health promotion and global assessment of the patient domains were carried out most frequently. Planning services for patients with chronic disease were least frequently performed. This study provides a broad description of nursing activities with patients with chronic disease in primary care. The findings provide a baseline for clinicians and researchers to document and improve nursing activities for optimal practice for patients with chronic disease.

Population-wide distributions of neural activity during perceptual decision-making

PubMed Central

Machens, Christian

2018-01-01

Cortical activity involves large populations of neurons, even when it is limited to functionally coherent areas. Electrophysiological recordings, on the other hand, involve comparatively small neural ensembles, even when modern-day techniques are used. Here we review results which have started to fill the gap between these two scales of inquiry, by shedding light on the statistical distributions of activity in large populations of cells. We put our main focus on data recorded in awake animals that perform simple decision-making tasks and consider statistical distributions of activity throughout cortex, across sensory, associative, and motor areas. We transversally review the complexity of these distributions, from distributions of firing rates and metrics of spike-train structure, through distributions of tuning to stimuli or actions and of choice signals, and finally the dynamical evolution of neural population activity and the distributions of (pairwise) neural interactions. This approach reveals shared patterns of statistical organization across cortex, including: (i) long-tailed distributions of activity, where quasi-silence seems to be the rule for a majority of neurons; that are barely distinguishable between spontaneous and active states; (ii) distributions of tuning parameters for sensory (and motor) variables, which show an extensive extrapolation and fragmentation of their representations in the periphery; and (iii) population-wide dynamics that reveal rotations of internal representations over time, whose traces can be found both in stimulus-driven and internally generated activity. We discuss how these insights are leading us away from the notion of discrete classes of cells, and are acting as powerful constraints on theories and models of cortical organization and population coding. PMID:23123501

Comparison of physical activity estimates using International Physical Activity Questionnaire (IPAQ) and accelerometry in fibromyalgia patients: the Al-Andalus study.

PubMed

Benítez-Porres, Javier; Delgado, Manuel; Ruiz, Jonatan R

2013-01-01

The International Physical Activity Questionnaire (IPAQ) has been widely used to assess physical activity in healthy populations. The present study compared physical activity assessed by the long, self-administrated version of the International Physical Activity Questionnaire with physical activity assessed by accelerometry in patients with fibromyalgia. A total of 99 (five men) participants with fibromyalgia completed the International Physical Activity Questionnaire and wore an accelerometer for nine consecutive days. We analysed the correlations of physical activity expressed as min · day(-1) of light, moderate, vigorous, and moderate to vigorous (MVPA) intensity, as well as time spent sitting, by the International Physical Activity Questionnaire and accelerometry by Spearman correlations. Bland and Altman plots were performed to verify the agreements between both instruments. The results showed weak yet significant correlations (Rs = 0.15-0.39, all P < 0.05) in all physical activity intensities between the two instruments, except for sedentary time. The highest correlations were observed for physical activity at home or in garden (Rs = 0.297, P < 0.01). The results suggest that the long self-administrated International Physical Activity Questionnaire is a questionable instrument to assess physical activity in patients with fibromyalgia. Therefore, physical activity measurement in fibromyalgia patients should not be limited solely to self-reported measures.

Physical fitness and physical activity in fatigued and non-fatigued inflammatory bowel disease patients.

PubMed

Vogelaar, Lauran; van den Berg-Emons, Rita; Bussmann, Hans; Rozenberg, Robert; Timman, Reinier; van der Woude, Christien J

2015-01-01

To assess physical fitness and physical activity in inflammatory bowel disease (IBD) patients and whether fatigue is associated with impaired physical fitness and impaired physical activity. Ten patients with quiescent IBD and fatigue (fatigue group [FG]) based on the Checklist Individual Strength-Fatigue score of ≥35 were matched for age (±5 years) and sex with a non-fatigue group (NFG) with IBD. Physical fitness was measured with a cyclo-ergometric-based maximal exercise test, a submaximal 6-min walk test, and a dynamometer test to quantify the isokinetic muscle strength of the knee extensors and flexors. Level of physical activity was measured with an accelerometer-based activity monitor. The patients in both groups did not differ in regard to medication use, clinical characteristics, and body composition. However, medium-to-large effect sizes for impaired physical fitness (both cardiorespiratory fitness and muscle strength) and physical activity were seen between the patients in the FG and the NFG. Especially, intensity of physical activity was significantly lower in the FG patients compared with the NFG patients (effect size: 1.02; p = 0.037). Similar results were seen when outcomes of the FG and NFG were compared with reference values of the normal population. Fatigued IBD patients show an impaired physical fitness and physical activity compared with non-fatigued IBD patients. This gives directions for a physical component in fatigue in IBD patients. Therefore, these new insights into fatigue indicate that these patients might benefit from an exercise program to improve physical fitness and physical activity.

The Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement.

PubMed

Naal, Florian D; Miozzari, Hermes H; Kelly, Bryan T; Magennis, Erin M; Leunig, Michael; Noetzli, Hubert P

2013-01-01

To develop and validate a sports activity scale for patients with a diagnosis of femoroacetabular impingement (FAI).
 A nine level Hip Sports Activity Scale (HSAS) was constructed both in German and English languages. Fifty-nine consecutive patients undergoing surgical treatment for FAI at two centers in Switzerland and in the US completed a questionnaire set consisting of the HSAS, the University of California at Los Angeles (UCLA) activity scale and different hip joint-specific and generic outcome tools. For reliability assessment, the HSAS was completed twice about nine days apart. Evidence of reliability, validity and responsiveness was investigated by classical psychometric analyses.
 Reliability was excellent for both the German and the English versions with intraclass correlation coefficients of 0.94 and 0.96, respectively. Evidence of convergent validity was supported by moderate to high correlations with the UCLA activity scale and with the joint-specific measures used. Evidence of divergent validity was supported by low correlations with the SF-12 Mental Component Scale and the WOMAC stiffness subscale. The standardised response mean was 0.69.
 The HSAS is a reliable and valid tool to determine sports levels in patients suffering from FAI. Its use in future studies investigating outcomes in young patients with hip disease can be recommended.
 Level III, Diagnostic Studies - An independent, masked comparison with an appropriate population of patients, but reference standard not applied to all study patients.

Patient Navigation for Comprehensive Cancer Screening in High-Risk Patients Using a Population-Based Health Information Technology System: A Randomized Clinical Trial.

PubMed

Percac-Lima, Sanja; Ashburner, Jeffrey M; Zai, Adrian H; Chang, Yuchiao; Oo, Sarah A; Guimaraes, Erica; Atlas, Steven J

2016-07-01

��= .01) cancer compared with control. The proportion of overdue patients who completed any cancer screening during follow-up was higher in the intervention group (25.5% vs 17.0%; 95% CI, 4.7%-12.7%; P < .001). The intervention group had more patients completing screening for breast (23.4% vs 16.6%; 95% CI, 1.8%-12.0%; P = .009), cervical (14.4% vs 8.6%; 95% CI, 1.6%-10.5%; P = .007), and colorectal (13.7% vs 7.0%; 95% CI, 3.2%-10.4%; P < .001) cancer. Patient navigation as part of a population-based IT system significantly increased screening rates for breast, cervical, and colorectal cancer in patients at high risk for nonadherence with testing. Integrating patient navigation into population health management activities for low-income and racial/ethnic minority patients might improve equity of cancer care. clinicaltrials.gov Identifier: NCT02553538.

Smoking, cessation, and cessation counseling in patients with cancer: A population-based analysis.

PubMed

Ramaswamy, Apoorva T; Toll, Benjamin A; Chagpar, Anees B; Judson, Benjamin L

2016-04-15

Smoking is known to be carcinogenic and an important factor in the outcome of cancer treatment. However, to the authors' knowledge, smoking habits and smoking cessation counseling in patients with cancer have been poorly studied. The authors sought to analyze smoking habits among Americans diagnosed with cancer in a nationally representative dataset. The cancer supplement of the National Health Interview Survey (NHIS) in 2010 was used to obtain information regarding self-reported smoking behavior in a representative sample of the US population. Cancer history, smoking history, quitting behavior, cessation counseling, cessation approaches, and sociodemographic variables were analyzed. A total of 27,157 individuals were interviewed for the NHIS in 2010, representing 216,052,891 individuals, 7,058,135 of whom had ever smoked and 13,188,875 of whom had been told that they had cancer. Approximately 51.7% of individuals diagnosed with cancer and who were active smokers reported being counseled to quit smoking by a health professional within the previous 12 months. Cancer survivors were no more likely to quit smoking than individuals in the general population. Those diagnosed with a tobacco-related cancer were found to be no more likely to report quitting smoking than those with other types of cancers. Rates of quitting did not appear to vary based on the type of smoking cessation method used (P = .50). Patients with cancer, including those diagnosed with a tobacco-related cancer, do not appear to be more likely to quit smoking than the general population. Only approximately one-half of patients with cancer who smoke are counseled to quit. Smoking cessation in patients with cancer is an important area for intervention and investigation. © 2016 American Cancer Society.

Dog ownership and dog walking to promote physical activity and health in patients.

PubMed

Epping, Jacqueline N

2011-07-01

Lack of physical activity is a significant risk factor for many chronic diseases and conditions and is associated with significant medical costs. Approximately half of adults and more than a third of adolescents and youth in the United States do not achieve recommended levels of physical activity. Effective population-level strategies are needed to promote activities that are practical, accessible, and sustainable and that can reach a large proportion of the population. Dog walking may be such a strategy. Walking is popular, easy, and sustainable and has a low risk of injury. Owning dogs confers many health benefits, and dog walking, in particular, can help promote physical activity and improve health. Physicians and other health care providers can play a unique and integral role in promoting physical activity among patients by recommending dog walking both to dog owners and to non-dog owners as a purposeful, enjoyable, and sustainable form of regular physical activity.

Predicting Satisfaction for Unicompartmental Knee Arthroplasty Patients in an Asian Population.

PubMed

Lee, Merrill; Huang, Yilun; Chong, Hwei Chi; Ning, Yilin; Lo, Ngai Nung; Yeo, Seng Jin

2016-08-01

Despite renewed interest in unicompartmental knee arthroplasty (UKA), there is a paucity of published literature with regard to patient satisfaction after UKA within Asian populations. The purpose of this study is to identify characteristics and factors which may contribute to patient dissatisfaction after UKA in a multiracial Asian population. Seven hundred twenty-four UKAs were performed between January 2007 and April 2013. Preoperative and postoperative variables were prospectively captured, such as standardized knee scores, knee range of motion, and patient satisfaction scores. These variables were then analyzed with a multiple logistic regression model to determine statistically significant factors contributing to patients' satisfaction. Minimum duration of follow-up was 2 years, with an overall patient satisfaction rate of 92.2%. There was improvement in mean knee range of motion and across various standardized knee scores. Preoperative variables associated with patient dissatisfaction included a poorer preoperative Mental Component Summary, better preoperative knee extension, and better preoperative Oxford Knee Scores. Significant postoperative variables included better Oxford Knee Score at 6 months and Mental Component Summary at 2 years. Despite the impressive patient satisfaction rate of UKA in this Asian population, these findings suggest that there is a targeted group of patients with select preoperative factors who would benefit from preoperative counseling. Copyright © 2016 Elsevier Inc. All rights reserved.

Unilateral hemimandibular hyperactivity: Clinical features of a population of 128 patients.

PubMed

Vernucci, Roberto Antonio; Mazzoli, Valentina; Galluccio, Gabriella; Silvestri, Alessandro; Barbato, Ersilia

2018-07-01

Facial asymmetries due to unilateral condylar hyperactivity are often a challenge both for maxillo-facial surgeons and for orthodontists; the current literature shows different opinions about aetiology, classification, treatment approach and timing. We made a retrospective study on patients suffering from unilateral condylar hyperactivity between 1997 and 2015 in our Department; clinical features and treatment options were grouped and compared with literature. The descriptive analysis investigated variables like sex, age, side and direction of the asymmetry, condylar activity and type of intervention. The population was composed of 128 patients. The hemimandibular hyperactivity occurs equally in both sexes around the second decade, although the range of the first consultation goes from 7 to 49 y.o. The vertical hyperdevelopment group is almost equal to the horizontal. All the patients with horizontal hyperactivity showed negative scintigraphy and were treated with pre-surgical orthodontics and orthognathic surgery; patients with vertical hyperactivity and positive scintigraphy were treated with condylectomy and post-surgical orthodontics. In our group of patients, direction of the hyperactivity and results of the scintigraphy lead to treatment choice and timing. Further studies are necessary to explain why, in our group, all the patients with horizontal involvement are negative to scintigraphy. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities.

PubMed

Chen, Jie; Mullins, C Daniel; Novak, Priscilla; Thomas, Stephen B

2016-02-01

Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making. © 2015 Society for Public Health Education.

Barriers to physical activity in chronic hemodialysis patients: a single-center pilot study in an Italian dialysis facility.

PubMed

Fiaccadori, Enrico; Sabatino, Alice; Schito, Franco; Angella, Francesca; Malagoli, Martina; Tucci, Marco; Cupisti, Adamasco; Capitanini, Alessandro; Regolisti, Giuseppe

2014-01-01

In patients on chronic dialysis a sedentary lifestyle is a strong, yet potentially modifiable, predictor of mortality. The present single-center pilot study evaluated social, psychological and clinical barriers that may hinder physical activity in this population. We explored the association between barriers to physical activity and sedentarism in adult patients at a chronic dialysis facility in Parma, Italy. We used different questionnaries exploring participation in physical activity, physical functioning, patient attitudes and preferences, and barriers to physical activity perceived by either patients or dialysis doctors and nurses. We enrolled 104 patients, (67 males, 65%), mean age 69 years (79% of patients older than 60 years); median dialysis vintage 60 months (range 8-440); mean Charlson score 5.55, ADL (Activities of Daily Living) score 5.5. Ninety-two participants (88.5%) reported at least one barrier to physical activity. At multivariable analysis, after adjusting for age and sex, feeling to have too many medical problems (OR 2.99, 95% CI 1.27 to 7.07; P=0.012), chest pain (OR 10.78, 95% CI 1.28 to 90.28; P=0.029) and sadness (OR 2.59, 95% CI 1.10 to 6.09; P=0.030) were independently associated with physical inactivity. Lack of time for exercise counseling and the firm belief about low compliance/interest by the patients toward exercise were the most frequent barriers reported by doctors and nurses. We identified a number of patient-related and health personnel-related barriers to physical activity in patients on chronic dialysis. Solutions for these barriers should be addressed in future studies aimed at increasing the level of physical activity in this population. © 2014 S. Karger AG, Basel.

Associations between eating difficulties, nutritional status and activity of daily living in acute geriatric patients.

PubMed

Nielsen, Mie Marie; Maribo, Thomas; Westergren, Albert; Melgaard, Dorte

2018-06-01

Eating difficulties, having a poor nutritional status, and low activity of daily living are all prevalent issues in the geriatric population. The aim of this study was to explore associations between patients' eating difficulties, their nutritional status and their activity of daily living in patients aged 60 years or older who were admitted to an acute geriatric unit. A cross-sectional study was conducted between March and September 2016 at the geriatric department of North Denmark Regional Hospital, Hjørring. The inclusion criteria were: ≥ 60years old and hospitalized for a minimum of 24 h. The patients' eating difficulties were assessed using the Minimal Eating Observational Form (MEOF-II), including observations related to ingestion, deglutition and energy/appetite. Eating difficulties were determined on the basis of one or more components of the MEOF-II. Poor nutritional status was defined as an age-specific low body mass index (BMI), <20 kg/m 2 if < 70 years, or <22 kg/m 2 if ≥ 70 years. Activity of daily living was assessed using the Barthel-100 Index and defined as low (<50) or high (≥50). A total of 297 geriatric patients were included; the mean age was 83.0 (7.7) years and 56.2% of the patients were female. The prevalence of eating difficulties was 55%. Geriatric patients with eating difficulties had a risk increase of 155% of having poor nutritional status (p = 0.003). Geriatric patients with eating difficulties had a risk increase of 60% of having low activity of daily living (p < 0.001). Eating difficulties were highly prevalent in geriatric patients and were associated with poor nutritional status and reduced activity of daily living. The identification of eating difficulties may be important for nutritional interventions and maintenance or improvement of activities of daily living in the geriatric population. Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Population pharmacokinetics and pharmacodynamics of rivaroxaban in patients with non-valvular atrial fibrillation: results from ROCKET AF.

PubMed

Girgis, I G; Patel, M R; Peters, G R; Moore, K T; Mahaffey, K W; Nessel, C C; Halperin, J L; Califf, R M; Fox, K A A; Becker, R C

2014-08-01

Two once-daily rivaroxaban dosing regimens were compared with warfarin for stroke prevention in patients with non-valvular atrial fibrillation in ROCKET AF: 20 mg for patients with normal/mildly impaired renal function and 15 mg for patients with moderate renal impairment. Rivaroxaban population pharmacokinetic (PK)/pharmacodynamic (PD) modeling data from ROCKET AF patients (n = 161) are reported and are used to confirm established rivaroxaban PK and PK/PD models and to re-estimate values of the models' parameters for the current AF population. An oral one-compartment model with first-order absorption adequately described rivaroxaban PK. Age, renal function, and lean body mass influenced the PK model. Prothrombin time and prothrombinase-induced clotting time exhibited a near-linear relationship with rivaroxaban plasma concentration; inhibitory effects were observed through to 24 hours post-dose. Rivaroxaban plasma concentration and factor Xa activity had an inhibitory maximum-effect (Emax ) relationship. Renal function (on prothrombin time; prothrombinase-induced clotting time) and age (on factor Xa activity) had moderate effects on PK/PD models. PK and PK/PD models were shown to be adequate for describing the current dataset. These findings confirm the modeling and empirical results that led to the selection of doses tested against warfarin in ROCKET AF. © 2014, The American College of Clinical Pharmacology.

[The management of asymptomatic bacteriuria in different patient population].

PubMed

Ivanov, M-L; Malinverni, R

2008-11-12

Who should be screened for asymptomatic bacteriuria (AB) and who should be treated? This review updates some aspects of the management of AB in different patient populations. A systematic screening for AB is recommended for pregnant women because of a significant risk of complications. In these cases as well as before any uro-gynecologic surgical procedure treatment of AB is strongly recommended. The management of AB in immunosuppressed or transplanted patients is more controversial. In other populations treating AB is not recommended and the outcome seems to be worse in case of treatment due to possible side effects and selection of resistant organisms. Recent studies have shown a considerable gap between clinical practice and recommendations.

Clinician-targeted intervention and patient-reported counseling on physical activity.

PubMed

Carroll, Jennifer K; Winters, Paul C; Sanders, Mechelle R; Decker, Francesca; Ngo, Thanh; Sciamanna, Christopher N

2014-05-29

Limited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population. Family medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre-post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians' counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews. Both patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0-15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program. A clinician training intervention showed mixed results for 5As physical activity counseling.

Population pharmacokinetics of perphenazine in schizophrenia patients from CATIE: impact of race and smoking.

PubMed

Jin, Yuyan; Pollock, Bruce G; Coley, Kim; Miller, Del; Marder, Stephen R; Florian, Jeff; Schneider, Lon; Lieberman, Jeffrey; Kirshner, Margaret; Bies, Robert R

2010-01-01

The goal of the study was to characterize population pharmacokinetics (PPK) for perphenazine in patients with schizophrenia from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). Patients (n = 156) received 8 to 32 mg of perphenazine daily for 14 to 600 days for a total of 421 plasma concentrations measurements. Nonlinear mixed-effects modeling was used to determine PPK characteristics of perphenazine. One- and 2-compartment models with various random effect implementations and mixture distributions were evaluated. Objective function values and goodness-of-fit plots were used as model selection criteria. Age, weight, sex, race, smoking, and concomitant medications were evaluated as covariates. A 1-compartment linear model with proportional error best described the data. The population mean clearance and volume of distribution for perphenazine were 483 L/h and 18 200 L, respectively. Race and smoking status had significant impacts on perphenazine clearance estimates. In addition, the estimated population mean clearance was 48% higher in nonsmoking African Americans than in nonsmoking other races (512 L/h vs 346 L/h). Active smokers eliminated perphenazine 159 L/h faster than nonsmokers in each race. Clearances for smoking African Americans versus smokers in other races were 671 L/h versus 505 L/h, respectively.

Population and Activity of On road Vehicles in MOVES201X

EPA Science Inventory

This report documents changes to assumptions about the US national highway vehicle fleet population and activity data for the next version of the MOVES model. Fleet population and activity data is used to convert emission rates into emission inventory values and then is used to ...

Active Asteroids in the NEO Population

NASA Astrophysics Data System (ADS)

Jenniskens, Peter

2016-01-01

Some main-belt asteroids evolve into near-Earth objects. They can then experience the same meteoroid-producing phenomena as active asteroids in the main belt. If so, they would produce meteoroid streams, some of which evolve to intersect Earth's orbit and produce meteor showers at Earth. Only few of those are known. Meteoroid streams that move in orbits with Tisserand parameter well in excess of 3 are the Geminids and Daytime Sextantids of the Phaethon complex and the lesser known epsilon Pegasids. The observed activity appears to be related to nearly whole scale disintegrations, rather than dust ejection from volatile outgassing as observed in active comets. There is only a small population of asteroids with a main-belt origin that recently disintegrated into meteoroid streams.

Vitamin D status and its association with quality of life, physical activity, and disease activity in rheumatoid arthritis patients.

PubMed

Raczkiewicz, Anna; Kisiel, Bartłomiej; Kulig, Maciej; Tłustochowicz, Witold

2015-04-01

Vitamin D deficiency is common in rheumatoid arthritis (RA) and may be related to disease activity. Population-based studies have shown the influence of vitamin D deficiency on quality of life (QoL), but it was not investigated in RA patients. The aim of the study was to determine possible relationship between vitamin D deficiency, QoL, physical activity (PA), and disease activity in RA. In 97 consecutive RA patients without vitamin D supplementation (86 women and 11 men, aged 59.4 ± 12 years), serum 25-hydroxycholecalciferol (25(OH)D), calcium, phosphorus, and parathyroid hormone were measured. The patients completed Short Form 36 (SF-36), Beck Depression Inventory, and Health Assessment Questionnaire, assessed the intensity of pain, fatigue, and PA. Disease Activity Score in 28 Joints was used to assess disease activity. A comparison control group consisted of 28 osteoarthritis patients (25 women and 3 men aged 56.2 ± 15 years). Vitamin D deficiency was detected in 76.3% of RA and in 78.6% of osteoarthritis patients (P = 0.75). There was a negative correlation between 25(OH)D serum concentration and Disease Activity Score in 28 Joints in patients with active arthritis. There was a positive correlation between serum 25(OH)D and the level of PA and most aspects of SF-36, and negative correlation between serum 25(OH)D and Health Assessment Questionnaire and Beck Depression Inventory in patients with disease duration of 1 year or longer. After inclusion of PA into multivariable analysis, only the correlations between 25(OH)D and SF-36 mental subscale (MCS) and pain remained significant. Vitamin D deficiency is highly prevalent in RA patients and is associated with higher disease activity and worse QoL indices. Regular PA correlates with higher vitamin D titers and better QoL in RA. Further studies are needed to explain possible influence of vitamin D on RA activity.

Anxiety and depression in cardiac patients: age differences and comparisons with the general population.

PubMed

Hinz, Andreas; Kittel, Jörg; Karoff, Marthin; Daig, Isolde

2011-01-01

Anxiety and depression are often found in cardiac patients, but also in the general population. Therefore, evaluation of these symptoms in patients requires a comparison with norm values. The purpose of this study was to explore differences between cardiac patients and the general population in age dependency of anxiety and depression, and to discuss possible reasons for these differences. A sample of German cardiac patients (n = 2,696) and a sample of the German general population (n = 2,037) were tested using the Hospital Anxiety and Depression Scale (HADS). While we confirmed a linear age trend of anxiety and depression in the general population, we observed an inverted U-shaped age dependency in the patient sample. Young patients are especially affected by anxiety and depression. Five items of the HADS that mainly contributed to the age differences were identified. Formal characteristics of these 5 items could not explain the age differences. Concerning the meaning of the items, however, most of the items refer to worrying about the future. The relatively low rates of anxiety and depression in older patients (compared with the general population) indicate that adaptation processes took place, which should be taken into account in studies concerning the psychological status of patients. Young patients need special attention when dealing with mental distress. Copyright © 2011 S. Karger AG, Basel.

Perceived barriers and benefits to physical activity in colorectal cancer patients.

PubMed

Fisher, Abigail; Wardle, J; Beeken, R J; Croker, H; Williams, K; Grimmett, C

2016-02-01

There is emerging evidence for the benefits of physical activity (PA) post-diagnosis for colorectal cancer (CRC) survivors. However, population studies suggest activity levels in these patients are very low. Understanding perceived barriers and benefits to activity is a crucial step in designing effective interventions. Patients who were between 6 months and 5 years post-diagnosis with non-metastasised disease were identified from five London (UK) hospitals. Four hundred and ninety five completed a lifestyle survey that included open-ended questions on their perceived barriers (what things would stop you from doing more physical activity?) and benefits (what do you think you would gain from doing more physical activity?). Patients also recorded their activity levels using the Godin Leisure Time Exercise Questionnaire, along with sociodemographic and treatment variables. The most commonly reported barriers related to cancer and its treatments (e.g. fatigue). Age and mobility-related comorbidities (e.g. impaired mobility) were also frequently cited. Those who reported age and mobility as barriers, or reported any barrier, were significantly less active even after adjustment for multiple confounders. The most frequently reported benefits were physiological (e.g. improving health and fitness). Cancer-related benefits (such as prevention of recurrence) were rarely reported. Those perceiving physiological benefits or perceiving any benefits were more active in unadjusted models, but associations were not significant in adjusted models. We have identified important barriers and facilitators in CRC survivors that will aid in the design of theory-based PA interventions.

Development of Activity and Participation Norms among General Adult Populations in Taiwan.

PubMed

Yen, Chia-Feng; Chiu, Tzu-Ying; Liou, Tsan-Hon; Chi, Wen-Chou; Liao, Hua-Fang; Liang, Chung-Chao; Escorpizo, Reuben

2017-06-06

Based on the International Classification of Functioning, Disability, and Health (ICF) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), The Functioning Disability Evaluation Scale-Adult version (FUNDES-Adult) began development in 2011. The FUNDES-Adult was designed to assess the difficulty level of an individual's activities and participation in daily life. There is a lack of research regarding the profile of activity and participation for the general adult population. The purposes of this study were to establish activity and participation norms for the general adult population in Taiwan and to describe, discuss, and compare the activity and participation profile with other population. A population-based survey was administered in 2013 using a computer-assisted telephone interviewing system (CATI system). Using probability proportional to size (PPS) sampling and systematic sampling with random digit dialing (RDD), 1500 adults from Taiwan's general population were selected to participate in the survey. The FUNDES-Adult with six domains and two dimensions (performance and capability) was used to obtain data on activities and participation levels. A higher domain score indicated higher participation restriction. Approximately 50% of the respondents were male, and the average age of the respondents was 45.23 years. There were no significant differences in the demographic features between the sample and the population. Among the six domains, the self-care domain score was the lowest (least restriction) and the participation domain score was the highest (most restriction). Approximately 90% of the sample scored were less than 15, and only 0.1% scored more than 80. This is the first cross-national population-based survey to assess norms of activity and participation relevant to the general population of Taiwan. As such, the results of this survey can be used as a reference for comparing the activity and participation (AP) functioning of

Patient Population Loss At A Large Pioneer Accountable Care Organization And Implications For Refining The Program.

PubMed

Hsu, John; Price, Mary; Spirt, Jenna; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Mohta, Namita; Weil, Eric; Ferris, Timothy

2016-03-01

There is an ongoing move toward payment models that hold providers increasingly accountable for the care of their patients. The success of these new models depends in part on the stability of patient populations. We investigated the amount of population turnover in a large Medicare Pioneer accountable care organization (ACO) in the period 2012-14. We found that substantial numbers of beneficiaries became part of or left the ACO population during that period. For example, nearly one-third of beneficiaries who entered in 2012 left before 2014. Some of this turnover reflected that of ACO physicians-that is, beneficiaries whose physicians left the ACO were more likely to leave than those whose physicians remained. Some of the turnover also reflected changes in care delivery. For example, beneficiaries who were active in a care management program were less likely to leave the ACO than similar beneficiaries who had not yet started such a program. We recommend policy changes to increase the stability of ACO beneficiary populations, such as permitting lower cost sharing for care received within an ACO and requiring all beneficiaries to identify their primary care physician before being linked to an ACO. Project HOPE—The People-to-People Health Foundation, Inc.

Effect of nandrolone decanonate on paraoxonase activity in hemodialysis patients.

PubMed

Ghorbanihaghjo, Amir; Argani, Hassan; Rahbaninoubar, Mohammad; Rashtchizadeh, Nadereh

2005-12-01

This study was designed to determine the effect of nandrolone decanonate (ND) on HDL-C, apolipoproteins and paraoxonase (PON) activity in stable hemodialysis patients. 64 hemodialysis patients were treated with ND at a dose of 100 mg/I.M./week for 4 months. HDL-C, Apo-AI, Apo B, concentrations and PON activity were measured before and after 2 and 4 months of treatment as well as 2 months after withdrawing the treatment. After 4 months of treatment, an elevation in the serum levels of Apo B (P<0.0001) and a marked decrease in the concentration of HDL-C (P<0.0001), Apo-AI (P<0.0001) and PON activity (P<0.0001) were found. A significant correlation between PON and both Apo-AI (r=0.270, P<0.04) and HDL-C (r=0.455, P<0.0001) and also between HDL-C and Apo-AI (r=0.305, P<0.02) were found. Results revealed the adverse effects of ND on apolipoprotein levels in our study population. It is possible that ND reduces PON activity mostly by reducing both the HDL-C and Apo-AI levels.

Average activity of excitatory and inhibitory neural populations

NASA Astrophysics Data System (ADS)

Roulet, Javier; Mindlin, Gabriel B.

2016-09-01

We develop an extension of the Ott-Antonsen method [E. Ott and T. M. Antonsen, Chaos 18(3), 037113 (2008)] that allows obtaining the mean activity (spiking rate) of a population of excitable units. By means of the Ott-Antonsen method, equations for the dynamics of the order parameters of coupled excitatory and inhibitory populations of excitable units are obtained, and their mean activities are computed. Two different excitable systems are studied: Adler units and theta neurons. The resulting bifurcation diagrams are compared with those obtained from studying the phenomenological Wilson-Cowan model in some regions of the parameter space. Compatible behaviors, as well as higher dimensional chaotic solutions, are observed. We study numerical simulations to further validate the equations.

Average activity of excitatory and inhibitory neural populations

PubMed Central

Mindlin, Gabriel B.

2016-01-01

We develop an extension of the Ott-Antonsen method [E. Ott and T. M. Antonsen, Chaos 18(3), 037113 (2008)] that allows obtaining the mean activity (spiking rate) of a population of excitable units. By means of the Ott-Antonsen method, equations for the dynamics of the order parameters of coupled excitatory and inhibitory populations of excitable units are obtained, and their mean activities are computed. Two different excitable systems are studied: Adler units and theta neurons. The resulting bifurcation diagrams are compared with those obtained from studying the phenomenological Wilson-Cowan model in some regions of the parameter space. Compatible behaviors, as well as higher dimensional chaotic solutions, are observed. We study numerical simulations to further validate the equations. PMID:27781447

Clinician-Targeted Intervention and Patient-Reported Counseling on Physical Activity

PubMed Central

Winters, Paul C.; Sanders, Mechelle R.; Decker, Francesca; Ngo, Thanh; Sciamanna, Christopher N.

2014-01-01

Introduction Limited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population. Methods Family medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre–post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians’ counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews. Results Both patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0–15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program. Conclusion A clinician training intervention showed mixed results for 5As physical activity counseling. PMID:24874781

Digital signaling decouples activation probability and population heterogeneity.

PubMed

Kellogg, Ryan A; Tian, Chengzhe; Lipniacki, Tomasz; Quake, Stephen R; Tay, Savaş

2015-10-21

Digital signaling enhances robustness of cellular decisions in noisy environments, but it is unclear how digital systems transmit temporal information about a stimulus. To understand how temporal input information is encoded and decoded by the NF-κB system, we studied transcription factor dynamics and gene regulation under dose- and duration-modulated inflammatory inputs. Mathematical modeling predicted and microfluidic single-cell experiments confirmed that integral of the stimulus (or area, concentration × duration) controls the fraction of cells that activate NF-κB in the population. However, stimulus temporal profile determined NF-κB dynamics, cell-to-cell variability, and gene expression phenotype. A sustained, weak stimulation lead to heterogeneous activation and delayed timing that is transmitted to gene expression. In contrast, a transient, strong stimulus with the same area caused rapid and uniform dynamics. These results show that digital NF-κB signaling enables multidimensional control of cellular phenotype via input profile, allowing parallel and independent control of single-cell activation probability and population heterogeneity.

Pharmacokinetics and Tolerability of Lorcaserin in Special Populations: Elderly Patients and Patients with Renal or Hepatic Impairment.

PubMed

Christopher, Ronald J; Morgan, Michael E; Tang, Yong; Anderson, Christen; Sanchez, Matilde; Shanahan, William

2017-04-01

To determine whether dosage adjustment is likely to be necessary for effective and well-tolerated use of a pharmaceutical agent, guidance documents from the US Food and Drug Administration recommend pharmacokinetics studies in patients with impaired renal or impaired hepatic function and in the elderly population. Three studies were conducted to evaluate the pharmacokinetic properties and tolerability of lorcaserin in these populations. Lorcaserin was evaluated in single-dose pharmacokinetics studies of 3 overweight/obese populations: (1) elderly (aged >65 years) patients; (2) patients with impaired renal function; and (3) those with impaired hepatic function. In elderly patients, C max was lower (geometric mean ratio [GMR], 0.83; 90% CI, 0.71-0.97), but AUC was unchanged versus adult patients. In patients with renal impairment, C max was reduced versus that in patients with normal renal function (GMR: mild impairment, 0.99 [90% CI, 0.76-1.29]; moderate, 0.70 [90% CI, 0.54-0.90]; and severe, 0.69 [90% CI, 0.53-0.89]); no trend in AUC was observed in this group versus renal impairment. In patients with hepatic impairment, C max was decreased (GMR: mild impairment, 0.92 [90% CI, 0.76-1.11]; moderate, 0.86 [90% CI, 0.71-1.04]), and AUC was increased versus patients with normal hepatic function. Based on these findings, no lorcaserin dose adjustments are necessary in elderly patients with normal renal function or in patients with mild/moderate renal or hepatic impairment. ClinicalTrials.gov identifiers: NCT00828581, NCT00828438, and NCT00828932. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

A Distribution-based Method for Assessing The Differences between Clinical Trial Target Populations and Patient Populations in Electronic Health Records

PubMed Central

Li, Y.; Ryan, P.; Zhang, Y.; Liu, F.; Gao, J.; Bigger, J.T.; Hripcsak, G.

2014-01-01

Summary Objective To improve the transparency of clinical trial generalizability and to illustrate the method using Type 2 diabetes as an example. Methods Our data included 1,761 diabetes clinical trials and the electronic health records (EHR) of 26,120 patients with Type 2 diabetes who visited Columbia University Medical Center of New-York Presbyterian Hospital. The two populations were compared using the Generalizability Index for Study Traits (GIST) on the earliest diagnosis age and the mean hemoglobin A1c (HbA1c) values. Results Greater than 70% of Type 2 diabetes studies allow patients with HbA1c measures between 7 and 10.5, but less than 40% of studies allow HbA1c<7 and fewer than 45% of studies allow HbA1c>10.5. In the real-world population, only 38% of patients had HbA1c between 7 and 10.5, with 12% having values above the range and 52% having HbA1c<7. The GIST for HbA1c was 0.51. Most studies adopted broad age value ranges, with the most common restrictions excluding patients >80 or <18 years. Most of the real-world population fell within this range, but 2% of patients were <18 at time of first diagnosis and 8% were >80. The GIST for age was 0.75. Conclusions We contribute a scalable method to profile and compare aggregated clinical trial target populations with EHR patient populations. We demonstrate that Type 2 diabetes studies are more generalizable with regard to age than they are with regard to HbA1c. We found that the generalizability of age increased from Phase 1 to Phase 3 while the generalizability of HbA1c decreased during those same phases. This method can generalize to other medical conditions and other continuous or binary variables. We envision the potential use of EHR data for examining the generalizability of clinical trials and for defining population-representative clinical trial eligibility criteria. PMID:25024761

Suicidal ideation and attempts in patients with stroke: a population-based study.

PubMed

Chung, Jae Ho; Kim, Jung Bin; Kim, Ji Hyun

2016-10-01

Stroke is known to be associated with an increase in the risk for suicide. However, there are very few population-based studies investigating the risk of suicidal ideation and attempts in patients with stroke. The purpose of this study was to compare the risk of suicidal ideation and attempts between patients with stroke and population without stroke using nationwide survey data. Individual-level data were obtained from 228,735 participants (4560 with stroke and 224,175 without stroke) of the 2013 Korean Community Health Survey. Demographic characteristics, socioeconomic status, physical health status, and mental health status were compared between patients with stroke and population without stroke. Multivariable logistic regression was performed to investigate the independent effects of the stroke on suicidal ideation and attempts. Stroke patients had more depressive mood (12.6 %) than population without stroke (5.7 %, p < 0.001). Stroke patients experienced more suicidal ideation (24.4 %) and attempts (1.3 %) than population without stroke (9.8 and 0.4 %, respectively; both p < 0.001). Stroke was found to increase the risk for suicidal ideation (OR 1.65, 95 % CI 1.52-1.79) and suicidal attempts (OR 1.64, 95 % CI 1.21-2.22), adjusting for demographics, socioeconomic factors, and physical health and mental health factors. We found that stroke increased the risk for suicidal ideation and attempts, independent of other factors that are known to be associated with suicidality, suggesting that stroke per se may be an independent risk factor for suicidality.

The KSS 2011 reflects symptoms, physical activities, and radiographic grades in a Japanese population.

PubMed

Taniguchi, Naoya; Matsuda, Shuichi; Kawaguchi, Takahisa; Tabara, Yasuharu; Ikezoe, Tome; Tsuboyama, Tadao; Ichihashi, Noriaki; Nakayama, Takeo; Matsuda, Fumihiko; Ito, Hiromu

2015-01-01

Cultural and ethnic differences are present both in subjective and objective measures of patient health, but scoring systems do not always reflect these differences, and so validation of outcomes tools in different cultural settings is important. Recently, a revised version of The Knee Society Score® (KSS 2011) was developed, but to our knowledge, the degree that this tool evaluates clinical symptoms, physical activities, and radiographic grades in the general Japanese population is not known. We therefore asked: (1) how KSS 2011 reflects knee conditions and function in the general Japanese population, in particular evaluating changes with increasing patient age; (2) can objective measures of physical function be correlated with KSS 2011; and (3) does radiographic osteoarthritis (OA) grade correlate with KSS 2011? Two hundred twenty-six people in the general Japanese population, aged 35 to 92 years, with and without knee arthritis, voluntarily participated in this cross-sectional study. Residents who had no serious disease or symptoms based on a self-assessment were recruited. This study consisted of a questionnaire including self-administered KSS 2011, physical examination, and weightbearing radiographs of the knee. Leg muscle strength, Timed Up and Go test, and body mass index (BMI) were examined in all the participants. Radiographs were graded according to the Kellgren and Lawrence scale (KL grade). Multivariable linear regression analysis showed that KSS 2011 correlated with age (coefficient: -0.30±0.12, p=0.011), BMI (coefficient: -1.47±0.42, p<0.001), leg muscle strength (coefficient: 0.41±0.13, p=0.002), and Timed Up and Go Test (coefficient: -1.96±0.92, p=0.034), but not sex, as independent variables by a stepwise method. KSS 2011 was also correlated with radiographic OA evaluated by KL grade (coefficient: -12.2±2.9, p<0.001). KSS 2011 reflects symptoms, physical activities, and radiographic OA grades of the knee in an age-dependent manner in the

A comparison of the EQ-5D-3L and ICECAP-O in an older post-acute patient population relative to the general population.

PubMed

Couzner, Leah; Crotty, Maria; Norman, Richard; Ratcliffe, Julie

2013-08-01

The measurement and valuation of quality of life forms a major component of economic evaluation in health care and is a major issue in health services research. However, differing approaches exist in the measurement and valuation of quality of life from a health economics perspective. While some instruments such as the EQ-5D-3L focus on health-related quality of life alone, others assess quality of life in broader terms, for example, the newly developed ICECAP-O. The aim of this study was to utilize two generic preference-based instruments, the EQ-5D-3L and the ICECAP-O, to measure and value the quality of life of older adult patients receiving post-acute care. An additional objective was to compare the values obtained by each instrument with those generated from two community-based general population samples. Data were collected from a clinical patient population of older adults receiving post-acute outpatient rehabilitation or residential transition care and two Australian general population samples of individuals residing in the general community. The individual responses to the ICECAP-O and EQ-5D-3L instruments were scored using recently developed Australian general population algorithms. Empirical comparisons were made of the resulting patient and general population sample values for the total population and dis-aggregated according to age (65-79 and 80+ years) and gender. A total of 1,260 participants aged 65-99 years (n = 86 clinical patient sample, n = 385 EQ-5D-3L general population sample, n = 789 ICECAP-O general population sample) completed one or both of the EQ-5D-3L and ICECAP-O instruments. As expected, the patient group demonstrated lower quality of life than the general population sample as measured by both quality-of-life instruments. The difference in values between the patient and general population groups was found to be far more pronounced for the EQ-5D-3L than for the ICECAP-O. The ICECAP-O was associated with a mean difference in values of 0

Activity-based costs of blood transfusions in surgical patients at four hospitals.

PubMed

Shander, Aryeh; Hofmann, Axel; Ozawa, Sherri; Theusinger, Oliver M; Gombotz, Hans; Spahn, Donat R

2010-04-01

Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse. To accurately determine the cost of blood in a surgical population from a health system perspective, an activity-based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third-party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model. All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per-RBC-unit costs between $522 and $1183 (mean, $761 +/- $294). These exceed previously reported estimates and were 3.2- to 4.8-fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion-related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate. Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.

A D-Optimal designed population pharmacokinetic study of oral itraconazole in adult cystic fibrosis patients

PubMed Central

Hennig, Stefanie; Waterhouse, Timothy H; Bell, Scott C; France, Megan; Wainwright, Claire E; Miller, Hugh; Charles, Bruce G; Duffull, Stephen B

2007-01-01

What is already known about this subject • Itraconazole is a triazole antifungal used in the treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis (CF). • The pharmacokinetic (PK) properties of this drug and its active metabolite have been described before, mostly in healthy volunteers. • However, only sparse information from case reports were available of the PK properties of this drug in CF patients at the start of our study. What this study adds • This study reports for the first time the population pharmacokinetic properties of itraconazole and a known active metabolite, hydroxy-itraconazole in adult patients with CF. • As a result, this study offers new dosing approaches and their pharmacoeconomic impact as well as a PK model for therapeutic drug monitoring of this drug in this patient group. • Furthermore, it is an example of a successful d-optimal design application in a clinical setting. Aim The primary objective of the study was to estimate the population pharmacokinetic parameters for itraconazole and hydroxy-itraconazole, in particular, the relative oral bioavailability of the capsule compared with solution in adult cystic fibrosis patients, in order to develop new dosing guidelines. A secondary objective was to evaluate the performance of a population optimal design. Methods The blood sampling times for the population study were optimized previously using POPT v.2.0. The design was based on the administration of solution and capsules to 30 patients in a cross-over study. Prior information suggested that itraconazole is generally well described by a two-compartment disposition model with either linear or saturable elimination. The pharmacokinetics of itraconazole and the metabolite were modelled simultaneously using NONMEM. Dosing schedules were simulated to assess their ability to achieve a trough target concentration of 0.5 mg ml−1. Results Out of 241 blood samples, 94% were taken within the defined optimal

Patient activation and disparate health care outcomes in a racially diverse sample of chronically ill older adults.

PubMed

Ryvicker, Miriam; Peng, Timothy R; Feldman, Penny Hollander

2012-11-01

The Patient Activation Measure (PAM) assesses people's ability to self-manage their health. Variations in PAM score have been linked with health behaviors, outcomes, and potential disparities. This study assessed the relative impacts of activation, socio-demographic and clinical factors on health care outcomes in a racially diverse sample of chronically ill, elderly homecare patients. Using survey and administrative data from 249 predominantly non-White patients, logistic regression was conducted to examine the effects of activation level and patient characteristics on the likelihood of subsequent hospitalization and emergency department (ED) use. Activation was not a significant predictor of hospitalization or ED use in adjusted models. Non-Whites were more likely than Whites to have a hospitalization or ED visit. Obesity was a strong predictor of both outcomes. Further research should examine potential sources of disadvantage among chronically ill homecare patients to design effective interventions to reduce health disparities in this population.

Semi-mechanistic autoinduction model of midazolam in critically ill patients: population pharmacokinetic analysis.

PubMed

Aoyama, T; Hirata, K; Yamamoto, Y; Yokota, H; Hayashi, H; Aoyama, Y; Matsumoto, Y

2016-08-01

Midazolam (MDZ) is commonly used for sedating critically ill patients. The daily dose required for adequate sedation increases in increments over 100 h after administration. The objectives of this study were to characterize the MDZ pharmacokinetics in critically ill patients and to describe the phenomenon of increasing daily dose by means of population pharmacokinetic analysis. Data were obtained from 30 patients treated in an intensive care unit. The patients received MDZ intravenously as a combination of bolus and continuous infusion. Serum MDZ concentration was assayed by high-performance liquid chromatography. Population pharmacokinetic analysis was performed using the NONMEM software package. The alteration of clearance unexplained by demographic factors and clinical laboratory data was described as an autoinduction of MDZ clearance using a semi-mechanistic pharmacokinetic-enzyme turnover model. The final population pharmacokinetic model was a one-compartment model estimated by incorporating a semi-mechanistic pharmacokinetic-enzyme turnover model for clearance, taking autoinduction into account. A significant covariate for MDZ clearance was total bilirubin. An increase in total bilirubin indicated a reduction in MDZ clearance. From simulation using the population pharmacokinetic parameters obtained in this study, MDZ clearance increased 2·3 times compared with pre-induced clearance 100 h after the start of 12·5 mg/h continuous infusion. Autoinduction and total bilirubin were significant predictors of the clearance of MDZ in this population. Step-by-step dosage adjustment using this population pharmacokinetic model may be useful for establishing a MDZ dosage regimen in critically ill patients. © 2016 John Wiley & Sons Ltd.

An assessment of patient navigator activities in breast cancer patient navigation programs using a nine-principle framework.

PubMed

Gunn, Christine M; Clark, Jack A; Battaglia, Tracy A; Freund, Karen M; Parker, Victoria A

2014-10-01

To determine how closely a published model of navigation reflects the practice of navigation in breast cancer patient navigation programs. Observational field notes describing patient navigator activities collected from 10 purposefully sampled, foundation-funded breast cancer navigation programs in 2008-2009. An exploratory study evaluated a model framework for patient navigation published by Harold Freeman by using an a priori coding scheme based on model domains. Field notes were compiled and coded. Inductive codes were added during analysis to characterize activities not included in the original model. Programs were consistent with individual-level principles representing tasks focused on individual patients. There was variation with respect to program-level principles that related to program organization and structure. Program characteristics such as the use of volunteer or clinical navigators were identified as contributors to patterns of model concordance. This research provides a framework for defining the navigator role as focused on eliminating barriers through the provision of individual-level interventions. The diversity observed at the program level in these programs was a reflection of implementation according to target population. Further guidance may be required to assist patient navigation programs to define and tailor goals and measurement to community needs. © Health Research and Educational Trust.

An Assessment of Patient Navigator Activities in Breast Cancer Patient Navigation Programs Using a Nine-Principle Framework

PubMed Central

Gunn, Christine M; Clark, Jack A; Battaglia, Tracy A; Freund, Karen M; Parker, Victoria A

2014-01-01

Objective To determine how closely a published model of navigation reflects the practice of navigation in breast cancer patient navigation programs. Data Source Observational field notes describing patient navigator activities collected from 10 purposefully sampled, foundation-funded breast cancer navigation programs in 2008–2009. Study Design An exploratory study evaluated a model framework for patient navigation published by Harold Freeman by using an a priori coding scheme based on model domains. Data Collection Field notes were compiled and coded. Inductive codes were added during analysis to characterize activities not included in the original model. Principal Findings Programs were consistent with individual-level principles representing tasks focused on individual patients. There was variation with respect to program-level principles that related to program organization and structure. Program characteristics such as the use of volunteer or clinical navigators were identified as contributors to patterns of model concordance. Conclusions This research provides a framework for defining the navigator role as focused on eliminating barriers through the provision of individual-level interventions. The diversity observed at the program level in these programs was a reflection of implementation according to target population. Further guidance may be required to assist patient navigation programs to define and tailor goals and measurement to community needs. PMID:24820445

Anxiety and depression among patients with chronic obstructive pulmonary disease and general population in rural Nepal.

PubMed

Thapa, Niresh; Maharjan, Muna; Shrestha, Tirtha Man; Gauchan, Srijana; Pun, Prakash; Thapa, Yam Bahadur

2017-12-12

Anxiety and depression are usually under diagnosed among the patients with Chronic Obstructive Pulmonary Disease (COPD), which has a negative impact on patient quality of life through restriction of activities, loss of independence, and decreased social functioning. The purpose of this study was to describe the levels and characteristics of anxiety and depression in patients with COPD in Nepal as compared to the general population. A hospital-based observational comparative analytical study was conducted in the United Mission Hospital, Tansen and the Okhaldhunga Community Hospital, Okhaldhunga, Nepal from June 1st 2015 to April 15th 2016. A convenience sample of two groups of participants were recruited: patients with COPD (study group) and visitors to the facility (comparison group). Anxiety and depression were measured with the Beck Anxiety and Depression Inventory Scale. A total of 198 individuals participated in the study; 93 with COPD and 105 from the general population. The mean age of the respondents was 58.24 ± 12.04 (40-82) years. The mean scores for anxiety and depression in COPD group were 23.76± 9.51 and 27.72± 9.37 respectively, while in comparison group, the mean score for anxiety was 8.01± 6.83 and depression was 11.60 ± 8.42. Both anxiety and depression scores were statistically significant between the groups with p value <0.001. Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Early assessment and multi-model treatment of anxiety and depression should be part of management in COPD.

Increased risk of chronic liver disease in patients with bipolar disorder: A population-based study.

PubMed

Hsu, Jer-Hwa; Chien, I-Chia; Lin, Ching-Heng

2016-01-01

This study aimed to investigate the prevalence and incidence of chronic liver disease in patients with bipolar disorder. We used a random sample of 766,427 subjects aged ≥18 years from the National Health Research Institute database in the year 2005. Subjects with at least one primary diagnosis of bipolar disorder in 2005 were identified. Patients with a primary or secondary diagnosis of chronic liver disease were also defined. We compared the prevalence and associated factors of chronic liver disease between patients with bipolar disorder and the general population in 2005. We also compared the incidence of chronic liver disease in patients with bipolar disorder and the general population from 2006 to 2010. The prevalence of chronic liver disease in patients with bipolar disorder (13.9%) was 2.68 times higher than that of the general population (5.8%) in 2005. The average annual incidence of chronic liver disease in patients with bipolar disorder from 2006 to 2010 was also higher than that of the general population (2.95% vs. 1.73%; risk ratio: 1.71; 95% confidence interval: 1.46-2.01). Patients with bipolar disorder had a significantly higher prevalence and incidence of chronic liver disease than those in the general population, and younger patients with bipolar disorder have a much higher prevalence and incidence than those in the general population. Male sex, second-generation antipsychotic or antidepressant use, and hyperlipidemia were associated factors for chronic liver disease in patients with bipolar disorder. Copyright © 2016 Elsevier Inc. All rights reserved.

Internal models for interpreting neural population activity during sensorimotor control

PubMed Central

Golub, Matthew D; Yu, Byron M; Chase, Steven M

2015-01-01

To successfully guide limb movements, the brain takes in sensory information about the limb, internally tracks the state of the limb, and produces appropriate motor commands. It is widely believed that this process uses an internal model, which describes our prior beliefs about how the limb responds to motor commands. Here, we leveraged a brain-machine interface (BMI) paradigm in rhesus monkeys and novel statistical analyses of neural population activity to gain insight into moment-by-moment internal model computations. We discovered that a mismatch between subjects’ internal models and the actual BMI explains roughly 65% of movement errors, as well as long-standing deficiencies in BMI speed control. We then used the internal models to characterize how the neural population activity changes during BMI learning. More broadly, this work provides an approach for interpreting neural population activity in the context of how prior beliefs guide the transformation of sensory input to motor output. DOI: http://dx.doi.org/10.7554/eLife.10015.001 PMID:26646183

Population Pharmacokinetics and Therapeutic Efficacy of Febuxostat in Patients with Severe Renal Impairment.

PubMed

Hira, Daiki; Chisaki, Yugo; Noda, Satoshi; Araki, Hisazumi; Uzu, Takashi; Maegawa, Hiroshi; Yano, Yoshitaka; Morita, Shin-Ya; Terada, Tomohiro

2015-01-01

The aim of the present study was to determine the influence of severe renal dysfunction (estimated glomerular filtration rate <30 ml/min/1.73 m(2), including hemodialysis) on the pharmacokinetics and therapeutic effects of febuxostat using a population pharmacokinetic analysis. This study recruited patients with hyperuricemia who were initially treated with allopurinol, but were switched to febuxostat, and it consists of 2 sub-studies: a pharmacokinetic study (26 patients) and retrospective efficacy evaluation study (51 patients). The demographic and clinical data of patients were collected from electronic medical records. Plasma febuxostat concentrations were obtained at each hospital visit. Population pharmacokinetic modeling was performed with NONMEM version 7.2. A total of 128 plasma febuxostat concentrations from 26 patients were used in the population pharmacokinetic analysis. The data were best described by a 1-compartment model with first order absorption. Covariate analysis revealed that renal function did not influence the pharmacokinetics of febuxostat, whereas actual body weight significantly influenced apparent clearance and apparent volume of distribution. The retrospective efficacy analysis showed the favorable therapeutic response of febuxostat switched from allopurinol in patients with moderate to severe renal impairment. No serious adverse event associated with febuxostat was observed irrespective of renal function. The population pharmacokinetic analysis and therapeutic analysis of febuxostat revealed that severe renal dysfunction had no influence on the pharmacokinetic parameters of febuxostat. These results suggest that febuxostat is tolerated well by patients with severe renal impairment. © 2015 S. Karger AG, Basel.

Broadened population-level frequency tuning in the auditory cortex of tinnitus patients.

PubMed

Sekiya, Kenichi; Takahashi, Mariko; Murakami, Shingo; Kakigi, Ryusuke; Okamoto, Hidehiko

2017-03-01

Tinnitus is a phantom auditory perception without an external sound source and is one of the most common public health concerns that impair the quality of life of many individuals. However, its neural mechanisms remain unclear. We herein examined population-level frequency tuning in the auditory cortex of unilateral tinnitus patients with similar hearing levels in both ears using magnetoencephalography. We compared auditory-evoked neural activities elicited by a stimulation to the tinnitus and nontinnitus ears. Objective magnetoencephalographic data suggested that population-level frequency tuning corresponding to the tinnitus ear was significantly broader than that corresponding to the nontinnitus ear in the human auditory cortex. The results obtained support the hypothesis that pathological alterations in inhibitory neural networks play an important role in the perception of subjective tinnitus. NEW & NOTEWORTHY Although subjective tinnitus is one of the most common public health concerns that impair the quality of life of many individuals, no standard treatment or objective diagnostic method currently exists. We herein revealed that population-level frequency tuning was significantly broader in the tinnitus ear than in the nontinnitus ear. The results of the present study provide an insight into the development of an objective diagnostic method for subjective tinnitus. Copyright © 2017 the American Physiological Society.

Evaluation of peripheral neutrophil functions in aggressive periodontitis patients and their family members in Indian population: An assessment of neutrophil chemotaxis, phagocytosis, and microbicidal activity

PubMed Central

Bhansali, Rahul Suresh; Yeltiwar, Ramreddy Krishnarao; Bhat, Kishore

2017-01-01

Background: Association of neutrophil function abnormalities with localized aggressive periodontitis (LAP) has been reported in Indian population. There are no published studies on the familial aggregation of aggressive periodontitis (AP) and neutrophil function abnormalities associated with it in Indian population. The present study aimed to assess neutrophil chemotaxis, phagocytosis, and microbicidal activity in AP patients and their family members of Indian origin, who may or may not be suffering from AP. Materials and Methods: Eighteen families with a total of 51 individuals (18 probands, 33 family members) were included. Neutrophil chemotaxis was evaluated against an alkali-soluble casein solution using Wilkinson's method. Phagocytosis and microbicidal activity assay were performed using Candida albicans as an indicator organism. Statistical Analysis Used: The magnitude of association between the presence of defective neutrophil function and LAP or GAP was calculated using odds ratio and relative risk. Total incidence of AP, and in particular, LAP in the families attributable to the presence of defective neutrophil function was calculated by attributable risk. Results: The association between depressed neutrophil chemotaxis and presence of AP and LAP or GAP in all the family members (n = 51) was found to be significant (P < 0.05) while that for phagocytic and microbicidal activity were observed to be nonsignificant. Conclusion: The results of the present study suggest high incidence of AP (LAP and GAP) within families was associated with depressed neutrophil chemotaxis. High prevalence of depressed neutrophil chemotaxis in the family members (61%) of LAP probands exhibiting depressed chemotaxis suggests that the observed abnormalities in neutrophil functions may also be inherited by the family members. PMID:29551862

Population Pharmacokinetics of Artesunate and Dihydroartemisinin following Intra-Rectal Dosing of Artesunate in Malaria Patients

PubMed Central

Simpson, Julie A; Agbenyega, Tsiri; Barnes, Karen I; Perri, Gianni Di; Folb, Peter; Gomes, Melba; Krishna, Sanjeev; Krudsood, Srivicha; Looareesuwan, Sornchai; Mansor, Sharif; McIlleron, Helen; Miller, Raymond; Molyneux, Malcolm; Mwenechanya, James; Navaratnam, Visweswaran; Nosten, Francois; Olliaro, Piero; Pang, Lorrin; Ribeiro, Isabela; Tembo, Madalitso; van Vugt, Michele; Ward, Steve; Weerasuriya, Kris; Win, Kyaw; White, Nicholas J

2006-01-01

Background Intra-rectal artesunate has been developed as a potentially life-saving treatment of severe malaria in rural village settings where administration of parenteral antimalarial drugs is not possible. We studied the population pharmacokinetics of intra-rectal artesunate and the relationship with parasitological responses in patients with moderately severe falciparum malaria. Methods and Findings Adults and children in Africa and Southeast Asia with moderately severe malaria were recruited in two Phase II studies (12 adults from Southeast Asia and 11 children from Africa) with intensive sampling protocols, and three Phase III studies (44 children from Southeast Asia, and 86 children and 26 adults from Africa) with sparse sampling. All patients received 10 mg/kg artesunate as a single intra-rectal dose of suppositories. Venous blood samples were taken during a period of 24 h following dosing. Plasma artesunate and dihydroartemisinin (DHA, the main biologically active metabolite) concentrations were measured by high-performance liquid chromatography with electrochemical detection. The pharmacokinetic properties of DHA were determined using nonlinear mixed-effects modelling. Artesunate is rapidly hydrolysed in vivo to DHA, and this contributes the majority of antimalarial activity. For DHA, a one-compartment model assuming complete conversion from artesunate and first-order appearance and elimination kinetics gave the best fit to the data. The mean population estimate of apparent clearance (CL/F) was 2.64 (l/kg/h) with 66% inter-individual variability. The apparent volume of distribution (V/F) was 2.75 (l/kg) with 96% inter-individual variability. The estimated DHA population mean elimination half-life was 43 min. Gender was associated with increased mean CL/F by 1.14 (95% CI: 0.36–1.92) (l/kg/h) for a male compared with a female, and weight was positively associated with V/F. Larger V/Fs were observed for the patients requiring early rescue treatment compared

Factors associated with delay in trauma team activation and impact on patient outcomes.

PubMed

Connolly, Rory; Woo, Michael Y; Lampron, Jacinthe; Perry, Jeffrey J

2017-09-05

Trauma code activation is initiated by emergency physicians using physiological and anatomical criteria, mechanism of injury, and patient demographic factors. Our objective was to identify factors associated with delayed trauma team activation. We assessed consecutive cases from a regional trauma database from January 2008 to March 2014. We defined a delay in trauma code activation as a time greater than 30 minutes from the time of arrival. We conducted univariate analysis for factors potentially influencing trauma team activation, and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay, and time to operative management. Patients totalling 846 were included for our analysis; 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group (p=0.01). Patients were over age 70 years in 7.6% in the early activation group versus 17.1% in the delayed group (p=0.04). There was no significant difference in sex, type of injury, injury severity, or time from injury between the two groups. There was no significant difference in mortality, median length of stay, or median time to operative management. Delayed activation is linked with increasing age with no clear link to increased mortality. Given the severe injuries in the delayed cohort that required activation of the trauma team, further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made.

Health state utilities among contemporary prostate cancer patients on active surveillance.

PubMed

Loeb, Stacy; Curnyn, Caitlin; Walter, Dawn; Fagerlin, Angela; Siebert, Uwe; Mühlberger, Nick; Braithwaite, R Scott; Schwartz, Mark D; Lepor, Herbert; Sedlander, Erica

2018-04-01

Active surveillance (AS) is the most rapidly expanding management option for favorable-risk prostate cancer (PCa). Early studies suggested substantial decrements in utility (quality of life weights) from disease-related anxiety. Our objective was to determine utilities for contemporary AS patients using different instruments. We performed a systematic review of PubMed, PMC and OVID for utility measurements in modern AS patients. We then examined utilities among 37 men on AS participating in focus groups between 2015-2016 using the generic EurQol five dimensions questionnaire (EQ-5D-3L) and Patient Oriented Prostate Utility Scale (PORPUS), a PCa-specific instrument. The systematic review found previous studies with utilities for PCa treatment and historical watchful waiting populations, but none specifically in contemporary AS. In our AS population, the mean EQ-5D-3L score was 0.90±0.16 (median, 1.00; range, 0.21-1.00) and PORPUS was 0.98±0.03 (median, 0.99; range, 0.84-1.00). The Spearman correlation between the EQ-5D-3L and PORPUS was 0.87 (P<0.0001), and 38% of patients had a difference >0.1 between instruments. Most contemporary AS patients had high utility scores suggesting that they perceive themselves in good health without a major decrement in quality of life from the disease. However, some patients had substantial differences in utility measured with generic versus disease-specific instruments. Further study is warranted into the optimal instrument for utility assessment in contemporary AS patients.

Validation of the DRAGON Score in a Chinese Population to Predict Functional Outcome of Intravenous Thrombolysis-Treated Stroke Patients.

PubMed

Zhang, Xinmiao; Liao, Xiaoling; Wang, Chunjuan; Liu, Liping; Wang, Chunxue; Zhao, Xingquan; Pan, Yuesong; Wang, Yilong; Wang, Yongjun

2015-08-01

The DRAGON score predicts functional outcome of ischemic stroke patients treated with intravenous thrombolysis. Our aim was to evaluate its utility in a Chinese stroke population. Patients with acute ischemic stroke treated with intravenous thrombolysis were prospectively registered in the Thrombolysis Implementation and Monitor of acute ischemic Stroke in China. We excluded patients with basilar artery occlusion and missing data, leaving 970 eligible patients. We calculated the DRAGON score, and the clinical outcome was measured by the modified Rankin Scale at 3 months. Model discrimination was quantified by calculating the C statistic. Calibration was assessed using Pearson correlation coefficient. The C statistic was .73 (.70-.76) for good outcome and .75 (.70-.79) for miserable outcome. Proportions of patients with good outcome were 94%, 83%, 70%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 3%, 9%, and 50% for 0 to 1, 2, 3, and 8 to 10 points, respectively. There was high correlation between predicted and observed probability of 3-month favorable and miserable outcome in the external validation cohort (Pearson correlation coefficient, .98 and .98, respectively, both P < .0001). The DRAGON score showed good performance to predict functional outcome after tissue-type plasminogen activator treatment in the Chinese population. This study demonstrated the accuracy and usability of the DRAGON score in the Chinese population in daily practice. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Cognition in patients with burn injury in the inpatient rehabilitation population.

PubMed

Purohit, Maulik; Goldstein, Richard; Nadler, Deborah; Mathews, Katie; Slocum, Chloe; Gerrard, Paul; DiVita, Margaret A; Ryan, Colleen M; Zafonte, Ross; Kowalske, Karen; Schneider, Jeffrey C

2014-07-01

To analyze potential cognitive impairment in patients with burn injury in the inpatient rehabilitation population. Rehabilitation patients with burn injury were compared with the following impairment groups: spinal cord injury, amputation, polytrauma and multiple fractures, and hip replacement. Differences between the groups were calculated for each cognitive subscale item and total cognitive FIM. Patients with burn injury were compared with the other groups using a bivariate linear regression model. A multivariable linear regression model was used to determine whether differences in cognition existed after adjusting for covariates (eg, sociodemographic factors, facility factors, medical complications) based on previous studies. Inpatient rehabilitation facilities. Data from Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury (N=5347) were compared with other rehabilitation populations (N=668,816). Not applicable. Comparison of total cognitive FIM scores and subscales (memory, verbal comprehension, verbal expression, social interaction, problem solving) for patients with burn injury versus other rehabilitation populations. Adults with burn injuries had an average total cognitive FIM score ± SD of 26.8±7.0 compared with an average FIM score ± SD of 28.7±6.0 for the other groups combined (P<.001). The subscale with the greatest difference between those with burn injury and the other groups was memory (5.1±1.7 compared with 5.6±1.5, P<.001). These differences persisted after adjustment for covariates. Adults with burn injury have worse cognitive FIM scores than other rehabilitation populations. Future research is needed to determine the impact of this comorbidity on patient outcomes and potential interventions for these deficits. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Pharmacokinetics of Antibiotics in Sub-Saharan African Patient Populations: A Systematic Review.

PubMed

Bos, Jeannet C; van Hest, Reinier M; Prins, Jan M

2017-08-01

In sub-Saharan Africa (SSA), severe febrile illness accounts for a large majority of medical admissions. SSA patients may also suffer from cachexia and organ dysfunction resulting from tuberculosis, hepatitis B, and hypertension. It is hard to tell how these conditions influence the pharmacokinetics (PK) of antibiotics in this population. The aim of this systematic review was to summarize antibiotic PK data of SSA adult patient populations to clarify whether inappropriate drug concentrations that may also lead to antimicrobial resistance are likely to occur. An electronic search was conducted in Ovid MEDLINE, Embase, and the African Index Medicus collecting studies from 1946 to May 2016. Reviewers independently selected studies reporting outcome data on volume of distribution (V), clearance, and half-life. Relevant information was abstracted and quality assessed. Twelve studies were selected, addressing 6 antibiotic classes. There were 6 studies on fluoroquinolones and 1 on β-lactam antibiotics. Nine out of 12 originated from South Africa and 6 of those dealt with intensive care unit (ICU) populations. The quality of most studies was low. Studies on amikacin, teicoplanin, and ertapenem (n = 4) displayed a pattern of a large V with low drug concentrations. Fluoroquinolone PK changes were less prominent and more diverse whereas the probability of pharmacodynamic target attainment was low for the treatment of tuberculosis in South Africa. Interindividual variability of V was high for 10/12 studies. Antibiotic PK data of SSA adult patient populations are scarce, but disease-induced inappropriate drug concentrations do occur. Data from non-ICU, severely ill patients, and β-lactam data are particularly lacking, whereas β-lactam antibiotics are commonly used, and typically vulnerable to disease-induced PK changes. Studies investigating the PK and pharmacodynamics of β-lactam antibiotics in severely ill, adult SSA patient populations are needed to improve local

Population dietary habits and physical activity modification with age.

PubMed

Schröder, H; Marrugat, J; Covas, M; Elosua, R; Pena, A; Weinbrenner, T; Fito, M; Vidal, M A; Masia, R

2004-02-01

The aim of the present study was to analyse the relation between age and both dietary habits and leisure-time physical activity, and to determine nutrient inadequacy of aged groups in our population. Cross-sectional study. A random sample of the 25-74-y-old population of Gerona, Spain. A total of 838 men and 910 women were selected from among the general population according to the 1991 census. Analysis of dietary habits, including amount and type of alcohol consumption, and detailed evaluation of leisure-time physical activity. Nutrient densities of carbohydrates, vitamin B(1), vitamin B(12), vitamin C, vitamin E, folate, potassium, iron, magnesium, copper, and dietary fiber increased significantly (P<0.05) with age in both genders, whereas an inverse trend was observed for total fat, saturated fatty acids, cholesterol, and sodium. Multiple linear regression analysis revealed a direct association of healthy dietary habits, characterized through a composite dietary score, with age after adjusting for several confounders both in men and women (P<0.001). This score was composed of folate, vitamin C, vitamin E, beta-carotene, dietary fibre, cholesterol, saturated fatty acids, and sodium. In all, 29 and 10% of male and female subjects aged 65-74 y, respectively, reported inadequate intakes of six or more of 16 nutrients. Total leisure-time physical activity increased with age in men (P<0.002), and was not different among female age groups. Dietary behaviours and levels of physical activity spent during leisure time indicate a healthy lifestyle of the aged men and women in the present population. Nutrient inadequacy observed in some aged men and women, however, deserves particular intervention of health-care programmes for this growing part of our society.

Medical resource use and expenditure in patients with chronic heart failure: a population-based analysis of 88 195 patients.

PubMed

Farré, Nuria; Vela, Emili; Clèries, Montse; Bustins, Montse; Cainzos-Achirica, Miguel; Enjuanes, Cristina; Moliner, Pedro; Ruiz, Sonia; Verdú-Rotellar, Jose Maria; Comín-Colet, Josep

2016-09-01

Heart failure (HF) is one of the diseases with greater healthcare expenditure. However, little is known about the cost of HF at a population level. Hence, our aim was to study the population-level distribution and predictors of healthcare expenditure in patients with HF. This was a population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on 31 December 2012 (n = 88 195). We evaluated 1-year healthcare resource use and expenditure using the Health Department (CatSalut) surveillance system that collects detailed information on healthcare usage for the entire population. Mean age was 77.4 (12) years; 55% were women. One-year mortality rate was 14%. All-cause emergency department visits and unplanned hospitalizations were required at least once in 53.4% and 30.8% of patients, respectively. During 2013, a total of €536.2 million were spent in the care of HF patients (7.1% of the total healthcare budget). The main source of expenditure was hospitalization (39% of the total) whereas outpatient care represented 20% of the total expenditure. In the general population, outpatient care and hospitalization were the main expenses. In multivariate analysis, younger age, higher presence of co-morbidities, and a recent HF or all-cause hospitalization were independently associated with higher healthcare expenditure. In Catalonia, a large portion of the annual healthcare budget is devoted to HF patients. Unplanned hospitalization represents the main source of healthcare-related expenditure. The knowledge of how expenditure is distributed in a non-selected HF population might allow health providers to plan the distribution of resources in patients with HF. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings.

PubMed

Napoles, Tessa M; Burke, Nancy J; Shim, Janet K; Davis, Elizabeth; Moskowitz, David; Yen, Irene H

2017-12-01

We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing

Multiplicative and additive modulation of neuronal tuning with population activity affects encoded information

PubMed Central

Arandia-Romero, Iñigo; Tanabe, Seiji; Drugowitsch, Jan; Kohn, Adam; Moreno-Bote, Rubén

2016-01-01

Numerous studies have shown that neuronal responses are modulated by stimulus properties, and also by the state of the local network. However, little is known about how activity fluctuations of neuronal populations modulate the sensory tuning of cells and affect their encoded information. We found that fluctuations in ongoing and stimulus-evoked population activity in primate visual cortex modulate the tuning of neurons in a multiplicative and additive manner. While distributed on a continuum, neurons with stronger multiplicative effects tended to have less additive modulation, and vice versa. The information encoded by multiplicatively-modulated neurons increased with greater population activity, while that of additively-modulated neurons decreased. These effects offset each other, so that population activity had little effect on total information. Our results thus suggest that intrinsic activity fluctuations may act as a `traffic light' that determines which subset of neurons are most informative. PMID:26924437

Associations of B cell-activating factor (BAFF) and anti-BAFF autoantibodies with disease activity in multi-ethnic Asian systemic lupus erythematosus patients in Singapore.

PubMed

Howe, H S; Thong, B Y H; Kong, K O; Chng, H H; Lian, T Y; Chia, F L; Tay, K S S; Lau, T C; Law, W G; Koh, E T; Leung, B P

2017-09-01

To measure the levels of B cell-activating factor (BAFF) and endogenous anti-BAFF autoantibodies in a cohort of multi-ethnic Asian systemic lupus erythematosus (SLE) patients in Singapore, to determine their correlation with disease activity. Serum samples from 121 SLE patients and 24 age- and sex-matched healthy controls were assayed for BAFF and anti-BAFF immunoglobulin (Ig)G antibody levels by enzyme-linked immunosorbent assay (ELISA). The lowest reliable detection limit for anti-BAFF-IgG antibody levels was defined as 2 standard deviations (s.d.) from blank. Correlation of serum BAFF and anti-BAFF IgG levels with disease activity [scored by SLE Activity Measure revised (SLAM-R)], and disease manifestations were determined in these 121 patients. SLE patients had elevated BAFF levels compared to controls; mean 820 ± 40 pg/ml and 152 pg ± 45/ml, respectively [mean ± standard error of the mean (s.e.m.), P < 0·01], which were correlated positively with anti-dsDNA antibody levels (r = 0·253, P < 0·03), and SLAM-R scores (r = 0·627, P < 0·01). In addition, SLE patients had significantly higher levels of anti-BAFF IgG, which were correlated negatively with disease activity (r = -0·436, P < 0·01), levels of anti-dsDNA antibody (r = -0·347, P < 0·02) and BAFF (r = -0·459, P < 0·01). The majority of patients in this multi-ethnic Asian SLE cohort had elevated levels of BAFF and anti-BAFF antibodies. Anti-BAFF autoantibody levels correlated negatively with clinical disease activity, anti-dsDNA and BAFF levels, suggesting that they may be disease-modifying. Our results provide further information about the complexity of BAFF pathophysiology in different SLE disease populations and phenotypes, and suggest that studies of the influence of anti-cytokine antibodies in different SLE populations will be required when selecting patients for trials using targeted anti-cytokine therapies. © 2017 British Society for

Using eHealth to improve health literacy among the patient population.

PubMed

Landry, Kathryn E

2015-01-01

There is no denying the global influence of eHealth, in its various forms, on the health care system in the 21st Century. Health care professionals are often familiar with technological tools used to enhance health outcomes by assisting clinicians in meeting the needs of the patient population. In an age of social media, web-based information, and material available literally in an instant, it is crucial for nurses to use and proactively share their knowledge regarding accessing and finding credible sources of online health information with the patient population. By improving health literacy among consumers, self-sufficiency and competence can be developed and promoted to improve health outcomes, placing the patient in a participatory starring role of managing and improving his or her overall well-being.

Detecting bladder fullness through the ensemble activity patterns of the spinal cord unit population in a somatovisceral convergence environment.

PubMed

Park, Jae Hong; Kim, Chang-Eop; Shin, Jaewoo; Im, Changkyun; Koh, Chin Su; Seo, In Seok; Kim, Sang Jeong; Shin, Hyung-Cheul

2013-10-01

Chronic monitoring of the state of the bladder can be used to notify patients with urinary dysfunction when the bladder should be voided. Given that many spinal neurons respond both to somatic and visceral inputs, it is necessary to extract bladder information selectively from the spinal cord. Here, we hypothesize that sensory information with distinct modalities should be represented by the distinct ensemble activity patterns within the neuronal population and, therefore, analyzing the activity patterns of the neuronal population could distinguish bladder fullness from somatic stimuli. We simultaneously recorded 26-27 single unit activities in response to bladder distension or tactile stimuli in the dorsal spinal cord of each Sprague-Dawley rat. In order to discriminate between bladder fullness and tactile stimulus inputs, we analyzed the ensemble activity patterns of the entire neuronal population. A support vector machine (SVM) was employed as a classifier, and discrimination performance was measured by k-fold cross-validation tests. Most of the units responding to bladder fullness also responded to the tactile stimuli (88.9-100%). The SVM classifier precisely distinguished the bladder fullness from the somatic input (100%), indicating that the ensemble activity patterns of the unit population in the spinal cord are distinct enough to identify the current input modality. Moreover, our ensemble activity pattern-based classifier showed high robustness against random losses of signals. This study is the first to demonstrate that the two main issues of electroneurographic monitoring of bladder fullness, low signals and selectiveness, can be solved by an ensemble activity pattern-based approach, improving the feasibility of chronic monitoring of bladder fullness by neural recording.

Real-time web-based assessment of total population risk of future emergency department utilization: statewide prospective active case finding study.

PubMed

Hu, Zhongkai; Jin, Bo; Shin, Andrew Y; Zhu, Chunqing; Zhao, Yifan; Hao, Shiying; Zheng, Le; Fu, Changlin; Wen, Qiaojun; Ji, Jun; Li, Zhen; Wang, Yong; Zheng, Xiaolin; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

2015-01-13

An easily accessible real-time Web-based utility to assess patient risks of future emergency department (ED) visits can help the health care provider guide the allocation of resources to better manage higher-risk patient populations and thereby reduce unnecessary use of EDs. Our main objective was to develop a Health Information Exchange-based, next 6-month ED risk surveillance system in the state of Maine. Data on electronic medical record (EMR) encounters integrated by HealthInfoNet (HIN), Maine's Health Information Exchange, were used to develop the Web-based surveillance system for a population ED future 6-month risk prediction. To model, a retrospective cohort of 829,641 patients with comprehensive clinical histories from January 1 to December 31, 2012 was used for training and then tested with a prospective cohort of 875,979 patients from July 1, 2012, to June 30, 2013. The multivariate statistical analysis identified 101 variables predictive of future defined 6-month risk of ED visit: 4 age groups, history of 8 different encounter types, history of 17 primary and 8 secondary diagnoses, 8 specific chronic diseases, 28 laboratory test results, history of 3 radiographic tests, and history of 25 outpatient prescription medications. The c-statistics for the retrospective and prospective cohorts were 0.739 and 0.732 respectively. Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. Cluster analysis in both the retrospective and prospective analyses revealed discrete subpopulations of high-risk patients, grouped around multiple "anchoring" demographics and chronic conditions. With the Web-based population risk-monitoring enterprise dashboards, the effectiveness of the active case finding algorithm has been validated by clinicians and caregivers in Maine. The active case finding model and associated real-time Web-based app were designed to track the evolving nature of total population risk, in a

Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability.

PubMed

Struyf, Filip; Cagnie, Barbara; Cools, Ann; Baert, Isabel; Brempt, Jolien Van; Struyf, Pieter; Meeus, Mira

2014-04-01

Various studies have investigated scapulothoracic muscle activity and recruitment patterns in relation to shoulder complaints in different populations, but a consensus review is lacking. To systematically review the state of the art regarding scapulothoracic muscle activity and recruitment timing in subjects with shoulder pain compared to pain free controls. Systematic review. The search for relevant articles was performed in Pubmed and Web of Science, including Web of Knowledge, using key words related to shoulder pain, scapulothoracic muscle activity or recruitment timing. Articles were included till November 2012. Case-control studies concerning the scapulothoracic region and muscle recruitment using electromyography (EMG) were included. Articles regarding rotator cuff muscles or neck-shoulder pathologies or studies handling a treatment outcome, were excluded. The methodological quality of the articles was assessed using appropriate risk of bias criteria for case-control studies. A total of 12 articles were included in the systematic review, containing patients with Shoulder Impingement Syndrome (SIS) or glenohumeral instability. In patients with SIS 3 out of 6 articles showed increased upper trapezius muscle (UT) activity, 3 out of 5 studies showed decreased lower trapezius muscle (LT) activity and 3 out of 5 articles showed decreased serratus anterior muscle (SA) activity. Patients with glenohumeral instability showed contradictory results on scapulothoracic muscle activity patterns. In both SIS and glenohumeral instability patients, no consensus was found on muscle recruitment timing. Patients with SIS and glenohumeral instability display numerous variations in scapulothoracic muscle activity compared to healthy controls. In the SIS-group, the LT and SA muscle activity is decreased. In addition, the UT muscle activity is increased among the SIS patients, whereas no clear change is seen among patients with glenohumeral instability. Although the scapulothoracic

Bacterial meningitis in patients with HIV: A population-based prospective study.

PubMed

van Veen, Kiril E B; Brouwer, Matthijs C; van der Ende, Arie; van de Beek, Diederik

2016-03-01

We studied occurrence, disease course, and prognosis of community-acquired bacterial meningitis in HIV-infected adults in the Netherlands. We performed a nationwide, prospective cohort study. Patients over 16 years old with bacterial meningitis were included. Data on patient history, symptoms and signs on admission, laboratory findings, radiologic examination, treatment, and outcome were collected prospectively. For HIV-positive patients additional information was collected retrospectively. From March 2006 to December 2013, 1354 episodes of community-acquired meningitis were included in the cohort. Thirteen patients were HIV-infected (1.0%). The annual incidence of bacterial meningitis was 8.3-fold higher (95%CI 4.6-15.1, P < 0.001) among HIV-infected patients as compared to the general population (10.79 [95%CI 5.97-19.48] vs 1.29 [95%CI 1.22-1.37] per 100.000 patients per year). Predisposing factors (other than HIV), clinical symptoms and signs, ancillary investigations, causative organisms and outcome were comparable between HIV-infected and patients without HIV infection. HIV-infected patients in the Netherlands have a 8.3-fold higher risk for bacterial meningitis as compared to the general population despite cART therapy. Clinical presentation and outcome of patients with acute bacterial meningitis with and without HIV are similar. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Assessment of physical activity, capacity and nutritional status in elderly peritoneal dialysis patients.

PubMed

Cupisti, Adamasco; D'Alessandro, Claudia; Finato, Viviana; Del Corso, Claudia; Catania, Battista; Caselli, Gian Marco; Egidi, Maria Francesca

2017-05-30

This study aimed to evaluate the prevalence of sedentarism, and to assess physical capacity and nutritional status in a cohort of older patients on peritoneal dialysis (PD), with respect to age-matched non-dialysis CKD population, using highly accessible, simple methods, namely the Rapid Assessment of Physical activity (RAPA) test and the 30″ Sit-to-stand (STS) test. This cross-sectional multicenter study included 151 renal patients older than 60 years; 71 pts. (44 m, age 72 ± 7 yrs) were on PD and 80 pts. (63 m, age 74 ± 7 yrs) were affected by 3-4 stage CKD. The prevalence of sedentary/underactive patients was double of that of the active patients as assessed by RAPA test, both in the PD (65.3%) and in the CKD (67.5%) cohort. The 30"STS test showed a reduced physical performance in both groups: 84.5% of PD patients and 87.5% of CKD patients did not reach the expected number of stands by age and gender. A malnutrition-inflammation score (MIS) ≥ 6 occurred in 37 % of PD patients and in 2.5 % of CKD patients. In PD patients, an independent significant association was observed between 30"STS test and MIS (beta -0.510, p = 0.013), as well as between RAPA and MIS (beta -0.544, p = 003) and phase angle (beta -0.506, p = 0.028). A high prevalence of low- performance capacity and sedentarism has been detected among elderly patients on PD or with CKD stage 3-4. Apart from age, a condition of malnutrition-inflammation was the major determinant of poor physical activity and capacity in PD patients. Better body composition seems to be positively associated with physical activity in PD and with physical capacity in CKD patients. Routine clinical management should include a close evaluation of nutritional status and evaluation of physical activity and capacity which can be easily assessed by RAPA and 30″STS tests.

Estimation of Population Number via Light Activities on Night-Time Satellite Images

NASA Astrophysics Data System (ADS)

Turan, M. K.; Yücer, E.; Sehirli, E.; Karaş, İ. R.

2017-11-01

Estimation and accurate assessment regarding population gets harder and harder day by day due to growth of world population in a fast manner. Estimating tendencies to settlements in cities and countries, socio-cultural development and population numbers is quite difficult. In addition to them, selection and analysis of parameters such as time, work-force and cost seems like another difficult issue. In this study, population number is guessed by evaluating light activities in İstanbul via night-time images of Turkey. By evaluating light activities between 2000 and 2010, average population per pixel is obtained. Hence, it is used to estimate population numbers in 2011, 2012 and 2013. Mean errors are concluded as 4.14 % for 2011, 3.74 % for 2012 and 3.04 % for 2013 separately. As a result of developed thresholding method, mean error is concluded as 3.64 % to estimate population number in İstanbul for next three years.

Efficacy of Cladribine Tablets in high disease activity subgroups of patients with relapsing multiple sclerosis: A post hoc analysis of the CLARITY study.

PubMed

Giovannoni, Gavin; Soelberg Sorensen, Per; Cook, Stuart; Rammohan, Kottil W; Rieckmann, Peter; Comi, Giancarlo; Dangond, Fernando; Hicking, Christine; Vermersch, Patrick

2018-04-01

In the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study, Cladribine Tablets significantly improved clinical and magnetic resonance imaging (MRI) outcomes (vs placebo) in patients with relapsing-remitting multiple sclerosis. Describe two clinically relevant definitions for patients with high disease activity (HDA) at baseline of the CLARITY study (utility verified in patients receiving placebo) and assess the treatment effects of Cladribine Tablets 3.5 mg/kg compared with the overall study population. Outcomes of patients randomised to Cladribine Tablets 3.5 mg/kg or placebo were analysed for subgroups using HDA definitions based on high relapse activity (HRA; patients with ⩾2 relapses during the year prior to study entry, whether on DMD treatment or not) or HRA plus disease activity on treatment (HRA + DAT; patients with ⩾2 relapses during the year prior to study entry, whether on DMD treatment or not, PLUS patients with ⩾1 relapse during the year prior to study entry while on therapy with other DMDs and ⩾1 T1 Gd+ or ⩾9 T2 lesions). In the overall population, Cladribine Tablets 3.5 mg/kg reduced the risk of 6-month-confirmed Expanded Disability Status Scale (EDSS) worsening by 47% vs placebo. A risk reduction of 82% vs placebo was seen in both the HRA and HRA + DAT subgroups (vs 19% for non-HRA and 18% for non-HRA + DAT), indicating greater responsiveness to Cladribine Tablets 3.5 mg/kg in patients with HDA. There were consistent results for other efficacy endpoints. The safety profile in HDA patients was consistent with the overall CLARITY population. Patients with HDA showed clinical and MRI responses to Cladribine Tablets 3.5 mg/kg that were generally better than, or at least comparable with, the outcomes seen in the overall CLARITY population.

Physical activity and frailty as indicators of cardiorespiratory reserve and predictors of surgical prognosis: General and digestive surgery population characterization.

PubMed

Dana, F; Capitán, D; Ubré, M; Hervás, A; Risco, R; Martínez-Pallí, G

2018-01-01

Frailty and low physical activity and cardiorespiratory reserve are related to higher perioperative morbimortality. The crucial step in improving the prognosis is to implement specific measures to optimize these aspects. It is critical to know the magnitude of the problem in order to implement preoperative optimization programmes. To characterize surgical population in a university hospital. All patients undergoing preoperative evaluation for abdominal surgery with admission were prospectively included during a 3-month period. Level of physical activity, functional capacity, frailty and emotional state were assessed using score tests. Additionally, physical condition was evaluated using 5 Times Sit-to-Stand Test. Demographic, clinical and surgical data were collected. One hundred and forty patients were included (60±15yr-old, 56% male, 25% ASA III or IV). Forty-nine percent of patients were proposed for oncologic surgery and 13% of which had received neoadjuvant treatment. Seventy percent of patients presented a low functional capacity and were sedentary. Eighteen percent of patients were considered frail and more than 50% completed the 5 Times Sit-to-Stand Test at a higher time than the reference values adjusted to age and sex. Advanced age, ASA III/IV, sedentarism, frailty and a high level of anxiety and depression were related to a lower functional capacity. The surgical population of our area has a low functional reserve and a high index of sedentary lifestyle and frailty, predictors of postoperative morbidity. It is mandatory to implement preoperative measures to identify population at risk and prehabilitation programmes, considered highly promising preventive interventions towards improving surgical outcome. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Population and Activity of On-road Vehicles in MOVES2014 ...

EPA Pesticide Factsheets

This report describes the sources and derivation for on-road vehicle population and activity information and associated adjustments as stored in the MOVES2014 default databases. Motor Vehicle Emission Simulator, the MOVES2014 model, is a set of modeling tools for estimating emissions produced by on-road (cars, trucks, motorcycles, etc.) and nonroad (backhoes, lawnmowers, etc.) mobile sources. The national default activity information in MOVES2014 provides a reasonable basis for estimating national emissions. However, the uncertainties and variability in the default data contribute to the uncertainty in the resulting emission estimates. Properly characterizing emissions from the on-road vehicle subset requires a detailed understanding of the cars and trucks that make up the vehicle fleet and their patterns of operation. The MOVES model calculates emission inventories by multiplying emission rates by the appropriate emission-related activity, applying correction (adjustment) factors as needed to simulate specific situations, and then adding up the emissions from all sources (populations) and regions. This report describes the sources and derivation for on-road vehicle population and activity information and associated adjustments as stored in the MOVES2014 default databases. Motor Vehicle Emission Simulator, the MOVES2014 model, is a set of modeling tools for estimating emissions produced by on-road (cars, trucks, motorcycles, etc.) and nonroad (backhoes, law

A novel method of estimating cost of therapy by using patient population characteristics: analysis of fluoroquinolones in various populations with different distributions of renal function.

PubMed

Enzweiler, Kevin A; Bosso, John A; White, Roger L

2003-07-01

Formulary decisions regarding a given drug class are often made in the absence of patient outcome and/or sophisticated pharmacoeconomic data. Analyses that consider factors beyond simple acquisition costs may be useful in such situations. For example, the cost implications of using manufacturers' recommendations for dosing in patients with renal dysfunction may be important, depending on the distribution of various levels of renal function within a patient population. Using four 1000-patient populations representing different renal function distributions and a fifth population of our medical center's distribution, we determined the costs of therapy for intravenous and oral levofloxacin, gatifloxacin, and moxifloxacin for a 10-day course of therapy for community-acquired pneumonia. Costs considered were average wholesale prices (AWPs), 50% of AWP, or same daily price, plus intravenous dose preparation and administration costs when applicable. Costs for each renal function distribution were examined for significant differences with an analysis-of-variance test. Also, costs of failing to adjust dosing regimens for decreased renal function were determined. Differences in fluoroquinolone costs (AWP, 50% AWP, or when matched as the same daily price) among the populations were found. When considering same daily prices, differences among populations ranged from about 35,000 dollars with intravenous gatifloxacin to more than 51,000 dollars for intravenous levofloxacin (all fluoroquinolones, p>0.05). Within a population, differences in costs among the intravenous fluoroquinolones ranged from 47,000-99,000 dollars. Rank orders of the drugs and population costs of therapy were affected by the pricing structure used and varied by the specific population and drug. Differences among the fluoroquinolones or populations were much smaller (<2100 dollars) when considering oral regimens. Costs potentially incurred by failing to adjust dosing for renal function were substantial

Erectile Dysfunction in Patients with Sleep Apnea--A Nationwide Population-Based Study.

PubMed

Chen, Chia-Min; Tsai, Ming-Ju; Wei, Po-Ju; Su, Yu-Chung; Yang, Chih-Jen; Wu, Meng-Ni; Hsu, Chung-Yao; Hwang, Shang-Jyh; Chong, Inn-Wen; Huang, Ming-Shyan

2015-01-01

Increased incidence of erectile dysfunction (ED) has been reported among patients with sleep apnea (SA). However, this association has not been confirmed in a large-scale study. We therefore performed a population-based cohort study using Taiwan National Health Insurance (NHI) database to investigate the association of SA and ED. From the database of one million representative subjects randomly sampled from individuals enrolled in the NHI system in 2010, we identified adult patients having SA and excluded those having a diagnosis of ED prior to SA. From these suspected SA patients, those having SA diagnosis after polysomnography were defined as probable SA patients. The dates of their first SA diagnosis were defined as their index dates. Each SA patient was matched to 30 randomly-selected, age-matched control subjects without any SA diagnosis. The control subjects were assigned index dates as their corresponding SA patients, and were ensured having no ED diagnosis prior to their index dates. Totally, 4,835 male patients with suspected SA (including 1,946 probable SA patients) were matched to 145,050 control subjects (including 58,380 subjects matched to probable SA patients). The incidence rate of ED was significantly higher in probable SA patients as compared with the corresponding control subjects (5.7 vs. 2.3 per 1000 patient-year; adjusted incidence rate ratio = 2.0 [95% CI: 1.8-2.2], p<0.0001). The cumulative incidence was also significantly higher in the probable SA patients (p<0.0001). In multivariable Cox regression analysis, probable SA remained a significant risk factor for the development of ED after adjusting for age, residency, income level and comorbidities (hazard ratio = 2.0 [95%CI: 1.5-2.7], p<0.0001). In line with previous studies, this population-based large-scale study confirmed an increased ED incidence in SA patients in Chinese population. Physicians need to pay attention to the possible underlying SA while treating ED patients.

A geodemographic analysis of the Denplan patient population in the North West Region.

PubMed

Tickle, M; Blinkhorn, A S; Brown, P J; Matthews, R

2000-11-11

To provide a preliminary descriptive investigation of Denplan patients in the North West Region, by plotting the age/gender and payment banding distribution, and to identify the area types where Denplan patients live and the areas in the North West Region where Denplan practices are most likely to thrive. North West Region of England The study included Denplan patients resident in the North West Region. Age/gender and payment banding frequency distributions were constructed. A market penetration ranking report using the Target Market level of the Super Profiles geodemographic classification was produced by a spreadsheet analysis in Microsoft Excel. A Lorenz curve was plotted to graphically represent the output of the market penetration analysis. Following the market penetration analysis the enumeration districts (EDs) of the six top ranked Target Markets in the North West Region were identified and mapped out across the Region. Finally, the number and percentage of EDs in the six top ranked Target Markets were identified for each health authority in the Region. 47,106 patients were registered with Denplan. In all but one 5-year age band (16-20-year-olds) female patients were in the majority. Patients were concentrated (40.5%) into the 40-55 age group. Nearly 50% (22,329) of patients were allocated to the second lowest payment banding. Under 0.5% of patients (N = 199) were categorised into the highest payment band. The Target Markets at the top of the penetration ranking were more affluent in nature, with a strong rural element and an older demographic profile as part of their descriptive titles. At the bottom of the ranking deprived area types with young demographic profiles predominated. About one half (49.9%) of Denplan patients were present in just over a quarter (25.7%) of the total population of the North West Region. The Lorenz curve demonstrated that Super Profiles at Target Market level had an effectiveness of 37.9% in segmenting the population of the North

Chromospheric Activity in Population II Giants

NASA Technical Reports Server (NTRS)

Harper, Graham M.

2004-01-01

One of the mysteries of Population II giants is that they still show chromospheric emission despite their great age. The global dynamo which was active during their main-sequence lifetimes is expected to become extremely weak through magnetic rotational braking. The nature of the observed emission is not understood; although acoustic shock waves might provide the heating, acoustic waves are not predicted to drive the observed mass loss - which in turn requires the dissipation of magneto-hydrodynamic waves. This program was designed to search for the faint stellar H Ly beta emission wings and the fluorescent Fe II and H2 emission from one of the brightest, metal poor, Population II stars. These FUSE diagnostics, when combined with existing UV and optical spectra, help determine the major radiative cooling channels for the chromosphere. This observation was to complement that previously planned for the mildly metal deficient giant alpha Boo (K2 III). However, alpha Boo has yet to be observed with FUSE.

Estimation of physical activity by different questionnaires in overweight subjects and patients with Type 2 diabetes mellitus: relationship with anthropometric and metabolic variables.

PubMed

Babić, Z; Deskin, M; Muacević-Katanec, D; Erdeljić, V; Misigoj-Duraković, M; Metelko, Z

2004-10-01

This study assessed the level of physical activity in overweight and obese subjects, and overweight and obese patients with Type 2 diabetes mellitus (T2DM). It also compared their physical activity level with that of the general population and investigated benefits of physical activity on anthropometric and metabolic parameters and blood pressure in the studied groups of patients using Baecke's questionnaire and the Lipid Research Clinics Physical Activity (LRC PA) questionnaire. The two questionnaires were also compared in the evaluation of benefits. Physical activity level and other parameters (body weight, body height, body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, lipoprotein and creatinine concentrations in the blood, concentration of fasting glucose and HbA1c in the blood, albuminuria-to-creatinuria ratio) of 136 subjects and their relationships were investigated during their out-patient visits. No difference in physical activity level was found among the four groups of investigated patients. The comparison between the level of physical activity in the investigated patients and the general population obtained by Baecke's questionnaire revealed a lower sports index in all groups of investigated men and obese women with diabetes mellitus. Our results confirm the benefit of physical activity on a high number of investigated parameters in the studied patients. The Baecke's questionnaire was found to estimate the effects of physical activity on metabolic and anthropometric parameters, as well as blood pressure, better than the LRC PA questionnaire, especially the two-point scoring system. LRC PA and especially Baecke's questionnaires are valuable aids in the estimation of physical activity level and its benefits in overweight and obese patients and patients with T2DM.

Risk and Prognosis of Bacteremia and Fungemia Among Peritoneal Dialysis Patients: A Population-Based Cohort Study.

PubMed

Dalgaard, Lars Skov; Nørgaard, Mette; Povlsen, Johan Vestergaard; Jespersen, Bente; Jensen-Fangel, Søren; Ellermann-Eriksen, Svend; Østergaard, Lars; Schønheyder, Henrik Carl; Søgaard, Ole Schmeltz

♦ BACKGROUND: The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). ♦ OBJECTIVE: The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients and a comparison cohort. A secondary objective was to compare causative agents and 30-day post-BAF mortality between PD patients and the comparison cohort. ♦ METHODS: Design: Observational cohort study. Central and North Denmark regions. patients who initiated PD during 1995 - 2010. For each patient we sampled up to 10 controls from the general population matched on age, sex, and municipality. ♦ MAIN OUTCOME: Data on positive blood cultures were retrieved from electronic microbiology databases covering the 2 regions. We calculated incidence rates (IRs) of first-time BAF for PD patients and population controls. Incidence-rate ratios (IRRs) were calculated to compare these rates. Thirty-day mortality was estimated by Kaplan-Meier analysis. ♦ RESULTS: Among 1,024 PD patients and 10,215 population controls, we identified 75 and 282 episodes of BAF, respectively. Incidence rates of BAF were 4.7 (95% confidence interval [CI], 3.8 - 5.9) per 100 person-years of follow-up (PYFU) in PD patients and 0.5 (95% CI, 0.4 - 0.5) per 100 PYFU in population controls (IRR = 10.4; 95% CI, 8.1 - 13.5). In PD patients, the most frequent microorganisms were Escherichia coli (18.7%) and Staphylococcus aureus (13.3%). Escherichia coli (27.3%) also ranked first among population controls. Thirty-day mortality following BAF was 20.8% (95% CI, 12.6 - 31.0) and 20.7% (95% CI, 16.3 - 25.9) among PD patients and population controls, respectively. ♦ CONCLUSIONS: Peritoneal dialysis patients are at markedly higher risk of BAF than population controls. Causative agents and the 30-day post-BAF mortality were similar in the 2 cohorts. Copyright © 2016 International Society for Peritoneal Dialysis.

Who are medical marijuana patients? Population characteristics from nine California assessment clinics.

PubMed

Reinarman, Craig; Nunberg, Helen; Lanthier, Fran; Heddleston, Tom

2011-01-01

Marijuana is a currently illegal psychoactive drug that many physicians believe has substantial therapeutic uses. The medical literature contains a growing number of studies on cannabinoids as well as case studies and anecdotal reports suggesting therapeutic potential. Fifteen states have passed medical marijuana laws, but little is known about the growing population of patients who use marijuana medicinally. This article reports on a sample of 1,746 patients from a network of nine medical marijuana evaluation clinics in California. Patients completed a standardized medical history form; evaluating physicians completed standardized evaluation forms. From this data we describe patient characteristics, self-reported presenting symptoms, physician evaluations, other treatments tried, other drug use, and medical marijuana use practices. Pain, insomnia, and anxiety were the most common conditions for which evaluating physicians recommended medical marijuana. Shifts in the medical marijuana patient population over time, the need for further research, and the issue of diversion are discussed.

Rheumatoid arthritis disease activity and vitamin D deficiency in an Asian resident population.

PubMed

Quraishi, Mohammed K; Badsha, Humeira

2016-04-01

We aimed to assess the prevalence of vitamin D deficiency and its association with rheumatoid arthritis (RA) disease activity in a UAE population. Forty-five consecutive subjects were prospectively recruited during the early summer with their clinical examination and Health Assessment Questionnaire (HAQ) being recorded at a clinic appointment, along with their blood sample being taken for the 25-hydroxyvitamin D (25(OH)D) total test. Thirty-five (76%) patients claimed to be exposed to sunlight for < 30 min daily. The prevalence of vitamin D insufficiency (20-30 ng/mL) and deficiency (< 20 ng/mL) was 36% and 29%, respectively. RA patients who exposed their hands and feet (29 ng/mL) or more (34 ng/mL) to the sunlight had serum vitamin D levels higher than those who exposed their hands alone (18 ng/mL) or less (19 ng/mL) (P < 0.05). The variations in vitamin D levels due to skin color did not reach significance. No significant correlation was seen between serum vitamin D levels and Disease Activity Score (DAS28) or HAQ scores. A direct relationship was observed between HAQ scores and DAS28 scores (P < 0.05). We highlight the importance of skin exposure to sunlight in a conservative dressing culture. No association was observed between vitamin D and disease activity. However, the high prevalence of vitamin D deficiency may negatively impact on bone health of these patients in the future. © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Physical activity counseling intervention at a federally qualified health center: improves autonomy-supportiveness, but not patients' perceived competence.

PubMed

Carroll, Jennifer K; Fiscella, Kevin; Epstein, Ronald M; Sanders, Mechelle R; Winters, Paul C; Moorhead, S Anne; van Osch, Liesbeth; Williams, Geoffrey C

2013-09-01

To assess the effect of a pilot intervention to promote clinician-patient communication about physical activity on patient ratings of their perceived competence for physical activity and their clinicians' autonomy-supportiveness. Family medicine clinicians (n=13) at two urban community health centers were randomized to early or delayed (8 months later) communication training groups. The goal of the training was to teach the 5As (Ask, Advise, Agree, Assist, Arrange) for physical activity counseling. Outcome measures were changes in patient perceptions of autonomy support (modified Health Care Climate Questionnaire, mHCCQ) and perceived competence (Perceived Competence Scale for physical activity, PCS) completed via surveys at baseline, post-intervention and six-month follow-up. Patients (n=326) were mostly female (70%) and low income. Using a generalized estimating equations model (GEE) with patients nested within clinician, patient perceived autonomy support increased at post-intervention compared to baseline (mean HCCQ scores 3.68-4.06, p=0.03). There was no significant change in patient perceived competence for physical activity. A clinician-directed intervention increased patient perceptions of clinician autonomy support but not patient perceived competence for physical activity. Clinicians working with underserved populations can be taught to improve their autonomy supportiveness, according to patient assessments of their clinicians. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Global Account of Barriers and Facilitators of Physical Activity Among Patients with Diabetes Mellitus: A Narrative Review of the Literature.

PubMed

Adeniyi, Ade F; Anjana, Ranjit M; Weber, Mary B

2016-01-01

With diabetes rates escalating globally, there is the need for a better integration of all aspects of diabetes care for improved population outcomes. An understanding, not only of regional but global literature on physical activity barriers and its facilitators is important if healthcare providers and policy makers are to create programs tailored to their populations. Herein, we report the results of a narrative review of the global barriers and facilitators of physical activity for patients with diabetes mellitus. An in-depth literature search was conducted to identify English-language studies that examined physical activity barriers and associated facilitators among patients with diabetes mellitus. Major electronic literature databases that were searched included Google Scholar, PubMed, Hub-Med, and Highwire. Studies were available from Africa, Asia, Australia, Europe, and, predominantly North America. A total of 34 predominantly internal barriers emerged globally. The most commonly reported were time constrains, fear of provoking additional disorders, exercise venue and weather related barriers. Facilitators of physical activity were reported for most of the internal barriers (e.g. time constraints, lack of knowledge etc) while the external barriers (e.g. weather, environmental pollution etc) received only a minimal attention. Globally, patients with diabetes are confronted with an enormous number of physical activity barriers. Unlike the robust solutions proffered for the internal barriers, the literature is largely silent about solutions to the external barriers, which though fewer, may be highly influential. Additional data is needed to better understand physical activity behaviors in populations outside of North America.

Population Pharmacokinetic and Pharmacodynamic Analysis of Belimumab Administered Subcutaneously in Healthy Volunteers and Patients with Systemic Lupus Erythematosus.

PubMed

Struemper, Herbert; Thapar, Mita; Roth, David

2017-09-08

Intravenous belimumab 10 mg/kg every 4 weeks is indicated in patients with active, autoantibody-positive systemic lupus erythematosus receiving standard systemic lupus erythematosus care. Subcutaneous 200-mg weekly administration, which may prove more convenient for patients and improve adherence, is currently under investigation. The objective of this study was to characterize the population pharmacokinetics and exposure-efficacy response of subcutaneous belimumab in a pooled analysis of pharmacokinetic data [phase I: BEL114448 (NCT01583530) and BEL116119 (NCT01516450) in healthy subjects (n = 134); phase III: BEL112341 (NCT01484496) in adults with systemic lupus erythematosus (n = 554)] and pharmacodynamic data [BEL112341 in adults with systemic lupus erythematosus (n = 833)]. Non-linear mixed-effects modeling (NONMEM®) was used to develop a population pharmacokinetic model and perform a covariate analysis. Subsequently, exploratory exposure-response analysis and logistic regression modeling was performed based on the individual parameter estimates of the population pharmacokinetic model. Population-pharmacokinetic parameters for subcutaneous belimumab were consistent with those for intravenous belimumab and other immunoglobulin G1 monoclonal antibodies. Pharmacokinetic parameters and subcutaneous belimumab exposure were consistent between healthy subjects and patients with systemic lupus erythematosus, and no evidence for target-mediated disposition of belimumab was found. Subcutaneous belimumab steady-state exposure was achieved after ~11 weeks; subcutaneous belimumab steady-state minimum concentration exceeded that of intravenous belimumab after <4 weeks, and average steady-state concentration was similar to that achieved following intravenous administration. In patients with moderate-to-severe systemic lupus erythematosus, subcutaneous belimumab 200 mg once weekly plus standard of care significantly improved the systemic lupus erythematosus

Safety, Antitumor Activity, and Immune Activation of Pegylated Recombinant Human Interleukin-10 (AM0010) in Patients With Advanced Solid Tumors.

PubMed

Naing, Aung; Papadopoulos, Kyriakos P; Autio, Karen A; Ott, Patrick A; Patel, Manish R; Wong, Deborah J; Falchook, Gerald S; Pant, Shubham; Whiteside, Melinda; Rasco, Drew R; Mumm, John B; Chan, Ivan H; Bendell, Johanna C; Bauer, Todd M; Colen, Rivka R; Hong, David S; Van Vlasselaer, Peter; Tannir, Nizar M; Oft, Martin; Infante, Jeffrey R

2016-10-10

Purpose Interleukin-10 (IL-10) stimulates the expansion and cytotoxicity of tumor-infiltrating CD8+ T cells and inhibits inflammatory CD4+ T cells. Pegylation prolongs the serum concentration of IL-10 without changing the immunologic profile. This phase I study sought to determine the safety and antitumor activity of AM0010. Patients and Methods Patients with selected advanced solid tumors were treated with AM0010 in a dose-escalation study, which was followed by a renal cell cancer (RCC) dose-expansion cohort. AM0010 was self-administered subcutaneously at doses of 1 to 40 μg/kg once per day. Primary end points were safety and tolerability; clinical activity and immune activation were secondary end points. Results In the dose-escalation and -expansion cohorts, 33 and 18 patients, respectively, were treated with daily subcutaneous injection of AM0010. AM0010 was tolerated in a heavily pretreated patient population. Treatment-related adverse events (AEs) included anemia, fatigue, thrombocytopenia, fever, and injection site reactions. Grade 3 to 4 nonhematopoietic treatment-related AEs, including rash (n = 2) and transaminitis (n = 1), were observed in five of 33 patients. Grade 3 to 4 anemia or thrombocytopenia was observed in five patients. Most treatment-related AEs were transient or reversible. AM0010 led to systemic immune activation with elevated immune-stimulatory cytokines and reduced transforming growth factor beta in the serum. Partial responses were observed in one patient with uveal melanoma and four of 15 evaluable patients with RCC treated at 20 μg/kg (overall response rate, 27%). Prolonged stable disease of at least 4 months was observed in four patients, including one with colorectal cancer with disease stabilization for 20 months. Conclusion AM0010 has an acceptable toxicity profile with early evidence of antitumor activity, particularly in RCC. These data support the further evaluation of AM0010 both alone and in combination with other immune

Impact of the 2012 London Olympic and Paralympic Games on physical activity of rheumatology patients.

PubMed

Müther, Michael; Williamson, Marie; Williamson, Lyn

2014-10-01

Lack of physical activity in the general population is one of the biggest health challenges we face. For rheumatology patients, and other patients with chronic disease, exercise is an essential part of disease management. However, very few patients exercise effectively.One of the aspirations of the London 2012 Olympic/Paralympic Games was to catalyze people into long-term physical activity. We surveyed our rheumatology patients at 3 high-profile times in the year after the Olympics. Two hundred fifty-three patients were enrolled within the study; the largest diagnosis subgroup being rheumatoid arthritis (36%). Ninety-five percent of our patients regard exercise as beneficial; 36% still think it does harm. Most common barriers to exercise were pain (53%), tiredness (44%), and lack of time (36%). Forty-five percent exercise daily, mostly just walking. Twnety-seven patients (16%) were motivated by the 2012 Olympic and Paralympic Games toward physical activity. They were mostly motivated by athletics' individual stories (67%), taking part in a big sports festival (11%) and demonstration of top sporting levels (4%). Eighteen patients in total (7%) increased their amount of exercise in response to the London 2012 Olympic and Paralympic Games. There was no difference between patient diagnostic groups. Only a small minority of patients increased their amount of exercise in response to the 2012 Olympic and Paralympic Games. The message about the importance of physical exercise to health needs to be clear, unambiguous, and consistent, because a significant number of patients still think that physical activity does harm. Big sporting events such as the London 2012 Olympic and Paralympic Games can be used as an opportunity to remind patients that physical activity does good and is not harmful. Athletes' individual stories could be used in future as part of a strategy to encourage exercise for all patients.

Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment.

PubMed

Regolisti, Giuseppe; Maggiore, Umberto; Sabatino, Alice; Gandolfini, Ilaria; Pioli, Sarah; Torino, Claudia; Aucella, Filippo; Cupisti, Adamasco; Pistolesi, Valentina; Capitanini, Alessandro; Caloro, Giorgia; Gregorini, Mariacristina; Battaglia, Yuri; Mandreoli, Marcora; Dani, Lucia; Mosconi, Giovanni; Bellizzi, Vincenzo; Di Iorio, Biagio Raffaele; Conti, Paolo; Fiaccadori, Enrico

2018-01-01

In hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff's attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population. In this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff's attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff's attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile-Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers. Most barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 ["Feeling too old", 95% Confidence Interval: -9.4 to -0.8] and -15.6 ["Ulcers on legs and feet", 95%CI: -24.8 to -6.5]. We found a significant interaction between staff's attitude and barriers (adjusted P values ranging between 0.03 ["I do not believe that it is physician's or nurse's role providing advice on exercise to patients on dialysis"] and 0.001 ["I do not often ask patients about exercise"]). A beneficial effect of a proactive staff's attitude was evident only in patients not endorsing barriers. Barriers and non-proactive staff's attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff's attitude.

Recurrent Shoulder Instability in a Young, Active, Military Population and Its Professional Implications.

PubMed

Flint, James H; Pickett, Adam; Owens, Brett D; Svoboda, Steven J; Peck, Karen Y; Cameron, Kenneth L; Biery, John; Giuliani, Jeffrey; Rue, John-Paul

Shoulder instability is a topic of significant interest within the sports medicine literature, particularly regarding recurrence rates and the ideal treatment indications and techniques. Little has been published specifically addressing the occupational implications of symptomatic recurrent shoulder instability. Previous arthroscopic repair will continue to be a significant predisposing factor for recurrent instability in a young, active population, and that recurrent instability may have a negative effect on college graduation and postgraduate occupational selection. Case series. Level 4. We conducted a retrospective review of approved medical waivers for surgical treatment of anterior shoulder dislocation or instability prior to matriculation at the US Military Academy or the US Naval Academy for the graduating classes of 2010 to 2013. Statistical analysis was performed to determine the incidence and risk factors for recurrence and to determine the impact on graduation rate and occupation selection. Fifty-nine patients were evaluated; 34% developed recurrent anterior instability. Patients with previous arthroscopic repair had a significantly higher incidence of recurrence (38%, P = 0.044). Recurrent shoulder instability did not significantly affect graduation rates or self-selected occupation ( P ≥ 0.05). There is a significant rate of recurrent shoulder instability after primary surgical repair, particularly among young, active individuals. In addition, arthroscopic repair resulted in a significantly higher recurrence rate compared with open repair in our population. Surgical repair for shoulder instability should not necessarily preclude young individuals from pursuing (or being considered for) occupations that may place them at greater risk of recurrence. The risk of recurrent instability is greater than the rate typically described, which may suggest that some subpopulations are at greater risk than others. A unique data point regarding instability is the

Home blood-pressure monitoring among hypertensive patients in an Asian population.

PubMed

Tan, N C; Khin, L W; Pagi, R

2005-07-01

Hypertension is a principal cause of mortality and morbidity in Singapore. The use of home blood-pressure monitoring (HBPM) to assess hypertensive control with digital devices in the local multi-racial population is unknown. The study determined the factors associated with hypertensive patients' use of HBPM in primary care in a multi-racial Asian population. Randomized cross-sectional questionnaire survey of hypertensive patients managed in a district polyclinic. A model predicting use of HBPM was constructed by univariate and multivariate logistic regression. A total of 224 eligible subjects were randomly selected from 1943 patients. Response rate was 78.1% (n = 175). In all, 61.7% of them were aware of HBPM but only 24% used HBPM. Using multivariate analysis by stepwise backward regression, the final fitted model showed that HBPM was associated with higher patients' socioeconomic status: (adjusted OR for middle-income status = 2.85, 95% CI: 1.2-6.78, P = 0.018; adjusted OR for high-income status = 3.46, 95% CI: 1.22-9.87, P = 0.020) and their documented diastolic BP (adjusted OR for diastolic BP > 80 mmHg = 2.26, 95% CI: 1.06-4.82, P = 0.034). Nonusers cited failure to recognize benefits (54.1%), lack of HBPM awareness (29.3%), understanding of device operation (18.8%) and perception of inaccuracy (10.5%) as deterrents. 76.2% of users were satisfied with HBPM but lacked knowledge in maintenance of devices. In conclusion, 61.7% of the study population were aware of HBPM but only 24% used it. Patients' failure to recognize benefits, lack of awareness, cost and perception of inaccuracy were barriers. Higher socioeconomic status and patient's documented diastolic BP correlated with HBPM usage.

Level of Physical Activity and In-Hospital Course of Patients with Acute Coronary Syndrome

PubMed Central

Jorge, Juliana de Goes; Santos, Marcos Antonio Almeida; Barreto Filho, José Augusto Soares; Oliveira, Joselina Luzia Menezes; de Melo, Enaldo Vieira; de Oliveira, Norma Alves; Faro, Gustavo Baptista de Almeida; Sousa, Antônio Carlos Sobral

2016-01-01

Background Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the modern world. A sedentary lifestyle, present in 85% of the Brazilian population, is considered a risk factor for the development of coronary artery disease. However, the correlation of a sedentary lifestyle with cardiovascular events (CVE) during hospitalization for ACS is not well established. Objective To evaluate the association between physical activity level, assessed with the International Physical Activity Questionnaire (IPAQ), with in-hospital prognosis in patients with ACS. Methods Observational, cross-sectional, and analytical study with 215 subjects with a diagnosis of ACS consecutively admitted to a referral hospital for cardiac patients between July 2009 and February 2011. All volunteers answered the short version of the IPAQ and were observed for the occurrence of CVE during hospitalization with a standardized assessment conducted by the researcher and corroborated by data from medical records. Results The patients were admitted with diagnoses of unstable angina (34.4%), acute myocardial infarction (AMI) without ST elevation (41.4%), and AMI with ST elevation (24.2%). According to the level of physical activity, the patients were classified as non-active (56.3%) and active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence of in-hospital complications was associated with the length of hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR = 2.54), and was independent of age, systolic blood pressure, and prior congestive heart failure. Conclusion A physically active lifestyle reduces the risk of CVE during hospitalization in patients with ACS. PMID:26690692

Patient satisfaction with community pharmacy: comparing urban and suburban chain-pharmacy populations.

PubMed

Malewski, David F; Ream, Aimrie; Gaither, Caroline A

2015-01-01

Patient satisfaction with pharmaceutical care can be a strong predictor of medication and other health-related outcomes. Less understood is the role that location of pharmacies in urban or suburban environments plays in patient satisfaction with pharmacy and pharmacist services. The purpose of this study was to serve as a pilot examining urban and suburban community pharmacy populations for similarities and differences in patient satisfaction. Community pharmacy patients were asked to self-administer a 30-question patient satisfaction survey. Fifteen questions addressed their relationship with the pharmacist, 10 questions addressed satisfaction and accessibility of the pharmacy, and five questions addressed financial concerns. Five urban and five suburban pharmacies agreed to participate. Data analysis included descriptive statistics and chi-square analysis. Most patients reported high levels of satisfaction. Satisfaction with pharmacist relationship and service was 70% or higher with no significant differences between locations. There were significant differences between the urban and suburban patients regarding accessibility of pharmacy services, customer service and some patient/pharmacist trust issues. The significant differences between patient satisfaction in the suburban and urban populations warrant a larger study with more community pharmacies in other urban, suburban and rural locations to better understand and validate study findings. Copyright © 2015 Elsevier Inc. All rights reserved.

Anthropometric and Laboratory Variables Related to Weight Loss-Comparison of Heart Failure Patients with Tumor Patients and Control Population.

PubMed

Letilovic, Tomislav; Vrhovac, Radovan; Krznarić, Željko

2017-01-01

Body weight loss is an important feature of heart failure (HF) and tumors. It is related to both reduced survival and adverse reactions to therapy in both of these conditions. The mechanisms of body weight loss in patients with HF and tumors are considered to be similar. Yet, studies comparing those two populations are generally lacking. The aim of this study was to compare anthropometric and laboratory data, related to weight loss, between patients with chronic HF and patients with different tumors as well as control population. Laboratory and anthropometric data on 143 consecutive patients with chronic HF and malignant diseases as well as data for 20 controls were collected. Patients with HF had lower levels of C-reactive protein (CRP) and albumin compared to controls. Anthropometric measurements revealed lower body mass index (BMI), muscle strength, mid-arm circumference, and waist circumference in patients with HF compared to controls. Measurements of biceps, triceps, subscapular, and suprailiac skinfolds were also lower in HF group. Compared to solid tumor group, HF patients had lower levels of CRP and higher levels of hemoglobin. Solid tumor patients had lower values of BMI and subscapular skinfold thickness, as well as higher muscle strength compared to HF group. Finally, compared to patients with solid hematological tumors, HF group had lower levels of albumin, lower muscle strength, as well as lower mid-arm circumference. We found differences in anthropometric and laboratory features, related to weight loss, in patients with HF compared to control population that were expected. On the other hand, observed differences in HF group compared to patients with various tumors could imply different pathophysiological mechanisms of weight loss between those groups. Such data could serve as a cornerstone for studies with larger numbers of patients and deeper pathophysiological insight.

Maturation of Cerebellar Purkinje Cell Population Activity during Postnatal Refinement of Climbing Fiber Network.

PubMed

Good, Jean-Marc; Mahoney, Michael; Miyazaki, Taisuke; Tanaka, Kenji F; Sakimura, Kenji; Watanabe, Masahiko; Kitamura, Kazuo; Kano, Masanobu

2017-11-21

Neural circuits undergo massive refinements during postnatal development. In the developing cerebellum, the climbing fiber (CF) to Purkinje cell (PC) network is drastically reshaped by eliminating early-formed redundant CF to PC synapses. To investigate the impact of CF network refinement on PC population activity during postnatal development, we monitored spontaneous CF responses in neighboring PCs and the activity of populations of nearby CF terminals using in vivo two-photon calcium imaging. Population activity is highly synchronized in newborn mice, and the degree of synchrony gradually declines during the first postnatal week in PCs and, to a lesser extent, in CF terminals. Knockout mice lacking P/Q-type voltage-gated calcium channel or glutamate receptor δ2, in which CF network refinement is severely impaired, exhibit an abnormally high level of synchrony in PC population activity. These results suggest that CF network refinement is a structural basis for developmental desynchronization and maturation of PC population activity. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Drug prescription patterns in patients with Addison's disease: a Swedish population-based cohort study.

PubMed

Björnsdottir, Sigridur; Sundström, Anders; Ludvigsson, Jonas F; Blomqvist, Paul; Kämpe, Olle; Bensing, Sophie

2013-05-01

There are no published data on drug prescription in patients with Addison's disease (AD). Our objective was to describe the drug prescription patterns in Swedish AD patients before and after diagnosis compared with population controls. We conducted a population-based cohort study in Sweden. Through the Swedish National Patient Register and the Swedish Prescribed Drug Register, we identified 1305 patients with both a diagnosis of AD and on combination treatment with hydrocortisone/cortisone acetate and fludrocortisone. Direct evidence of the AD diagnosis from patient charts was not available. We identified 11 996 matched controls by the Register of Population. We determined the ratio of observed to expected number of patients treated with prescribed drugs. Overall, Swedish AD patients received more prescribed drugs than controls, and 59.3% of the AD patients had medications indicating concomitant autoimmune disease. Interestingly, both before and after the diagnosis of AD, patients used more gastrointestinal medications, antianemic preparations, lipid-modifying agents, antibiotics for systemic use, hypnotics and sedatives, and drugs for obstructive airway disease (all P values < .05). Notably, an increased prescription of several antihypertensive drugs and high-ceiling diuretics was observed after the diagnosis of AD. Gastrointestinal symptoms and anemia, especially in conjunction with autoimmune disorders, should alert the physician about the possibility of AD. The higher use of drugs for cardiovascular disorders after diagnosis in patients with AD raises concerns about the replacement therapy.

A Chaperone Enhances Blood α-Glucosidase Activity in Pompe Disease Patients Treated With Enzyme Replacement Therapy

PubMed Central

Parenti, Giancarlo; Fecarotta, Simona; la Marca, Giancarlo; Rossi, Barbara; Ascione, Serena; Donati, Maria Alice; Morandi, Lucia Ovidia; Ravaglia, Sabrina; Pichiecchio, Anna; Ombrone, Daniela; Sacchini, Michele; Pasanisi, Maria Barbara; De Filippi, Paola; Danesino, Cesare; Della Casa, Roberto; Romano, Alfonso; Mollica, Carmine; Rosa, Margherita; Agovino, Teresa; Nusco, Edoardo; Porto, Caterina; Andria, Generoso

2014-01-01

Enzyme replacement therapy is currently the only approved treatment for Pompe disease, due to acid α-glucosidase deficiency. Clinical efficacy of this approach is variable, and more effective therapies are needed. We showed in preclinical studies that chaperones stabilize the recombinant enzyme used for enzyme replacement therapy. Here, we evaluated the effects of a combination of enzyme therapy and a chaperone on α-glucosidase activity in Pompe disease patients. α-Glucosidase activity was analyzed by tandem-mass spectrometry in dried blood spots from patients treated with enzyme replacement therapy, either alone or in combination with the chaperone N-butyldeoxynojirimycin given at the time of the enzyme infusion. Thirteen patients with different presentations (3 infantile-onset, 10 late-onset) were enrolled. In 11 patients, the combination treatment resulted in α-glucosidase activities greater than 1.85-fold the activities with enzyme replacement therapy alone. In the whole patient population, α-glucosidase activity was significantly increased at 12 hours (2.19-fold, P = 0.002), 24 hours (6.07-fold, P = 0.001), and 36 hours (3.95-fold, P = 0.003). The areas under the curve were also significantly increased (6.78-fold, P = 0.002). These results suggest improved stability of recombinant α-glucosidase in blood in the presence of the chaperone. PMID:25052852

Population pharmacokinetics of levofloxacin in Korean patients.

PubMed

Kiem, Sungmin; Ryu, Sung-Mun; Lee, Yun-Mi; Schentag, Jerome J; Kim, Yang-Wook; Kim, Hyeon-Kuk; Jang, Hang-Jae; Joo, Yong-Don; Jin, Kyubok; Shin, Jae-Gook; Ghim, Jong-Lyul

2016-08-01

Levofloxacin (LVFX) has different effects depending on the area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) ratio. While AUC can be expressed as dose/clearance (CL), we measured serial concentrations of LVFX in Koreans and tried to set a Korean-specific equation, estimating the CL of the antibiotic. In total, 38 patients, aged 18-87 years, received once daily intravenous LVFX doses of 500 mg or 250 mg, depending on their renal function. Four plasma samples were obtained according to a D optimal sampling design. The population pharmacokinetic (PK) parameters of LVFX were estimated using non-linear mixed-effect modeling (NONMEM, ver. 7.2). The CL of LVFX was dependent on creatinine clearance (CLCR) as a covariate. The mean population PK parameters of LVFX in Koreans were as follows: CL (l/hour) = 6.19 ×  (CLCR/75)(1.32). The CL of LVFX in Koreans is expected to be lower than that in Western people.

Return-to-Duty Rates Following Minimally Invasive Spine Surgery Performed on Active Duty Military Patients in an Ambulatory Surgery Center.

PubMed

Granger, Elder; Prada, Stefan; Bereczki, Zoltan; Weiss, Michael; Wade, Chip; Davis, Reginald

2018-05-21

Low back pain is a primary health care utilization driver in the US population. Health care evaluation visits for low back pain are as common as medical evaluation for the common cold. Low back pain is the most common reason for reductions in activities of daily living and work activity in the general population. Although these statistics are compelling, in the military population, there is arguably a significantly greater economic impact on the military population, as the cost to train, retain, and deploy a service member is a tremendous cost. The current study retrospectively examines surgical outcomes, return to duty, and patient-centric outcomes among 82 active duty or reserve military patients who underwent an outpatient minimally invasive spine surgery Laminotomy Foraminotomy Decompression for the treatment of lumbar spinal stenosis in an ambulatory surgery center. Overall, our results indicate that within the 82 active duty military service members, 100% of the service members return to duty within 3 mo. Additionally, there was a significant reduction in self-reported pain and disability 12 mo postoperative, whereas the average length of surgery was 62 min with an average estimated blood loss of 30.64 mL. The current study indicates that minimally invasive procedures for the treatment of lumbar spinal stenosis in an ambulatory surgery center setting are an effective option for active duty servicemen to reduce return-to-duty rates and symptomatic back-related pain and disability.

Interventional differences among Huntington's disease patients by disease progression in commercial and medicaid populations.

PubMed

Anderson, Karen E; Divino, Victoria; DeKoven, Mitch; Langbehn, Douglas; Warner, John H; Giuliano, Joseph; Lee, Won Chan

2014-01-01

Huntington's disease (HD) is a progressive neurodegenerative disease that spans distinct disease stages over 15-20 years. Various interventions are available which may allow patients to live outside of a nursing home for a longer time. However, little is known about use of these interventions by disease stage and by insurance type. We compared use of interventions among early, middle and late stages of HD in commercial (C) and Medicaid (M) health insurance populations. HD patients (ICD-9-CM 333.4) were identified from Thomson Reuters' MarketScan C and M database (2002-2009) and hierarchically grouped into disease stages based upon the presence of defining clinical markers. A total of 1,272 HD patients (752/520 C/M) were identified. While stage distribution was nearly uniform in the C database - 34.0/35.5/34.0% (early/middle/late stage) - in the M population the majority were late stage (74.0%). Overall mean age was similar between C and M populations. Among late-stage patients, more M patients resided in a nursing home (M:73.8% v. C:40.6%) and received hospice care (M:18.4% v. C:11.3%). Physical therapy (PT) and home assistance were the most frequent interventions used by middle-stage patients, however more C patients received PT (C:64.0% v. M:37.1%) while more M patients received home assistance (M:75.3% v. C:53.2%). Among late-stage patients, PT was also higher in the C population (56.3% v. 48.3%). More M patients had assistive devices at home in both middle (M:25.8% v. C:9.7%) and late stages (M:35.6% v.C:23.4%). Apparent interventional differences emerged which varied by disease stage and insurance type.

Population Pharmacokinetics of Vancomycin in Patients Undergoing Allogeneic Hematopoietic Stem-Cell Transplantation.

PubMed

Okada, Akira; Kariya, Misato; Irie, Kei; Okada, Yutaka; Hiramoto, Nobuhiro; Hashimoto, Hisako; Kajioka, Ryosuke; Maruyama, Chika; Kasai, Hidefumi; Hamori, Mami; Nishimura, Asako; Shibata, Nobuhito; Fukushima, Keizo; Sugioka, Nobuyuki

2018-05-15

Vancomycin is a commonly used antimicrobial agent for patients undergoing allogeneic hematopoietic stem-cell transplantation (allo-HSCT). Vancomycin has large inter- and intraindividual pharmacokinetic variability, which is mainly described by renal function; various studies have indicated that vancomycin pharmacokinetics are altered in special populations. However, little is known regarding vancomycin pharmacokinetics in patients undergoing allo-HSCT. Therefore, we aimed to develop a population pharmacokinetic (PopPK) model of vancomycin in patients undergoing allo-HSCT for effective and safe antimicrobial therapy and to develop a vancomycin dosing nomogram for a vancomycin optimal-dosing strategy. In total, 285 observations from 95 patients undergoing allo-HSCT were available. The final PopPK parameter estimates were central volume of distribution (V1, L), 39.2; clearance (L/h), 4.25; peripheral volume of distribution (V2, L), 56.1; and intercompartmental clearance (L/h), 1.95. The developed vancomycin model revealed an increase in V1 and V2 compared with those in the general population that consisted of patients with methicillin-resistant Staphylococcus aureus. Moreover, serum creatinine was reduced because of an increase in the plasma fraction because of destruction of hematopoietic stem cells accompanying allo-HSCT pretreatment, suggesting that the Cockcroft-Gault equation-based creatinine clearance value was overestimated. To our knowledge, this is the first PopPK study to develop a dosing nomogram for vancomycin in patients undergoing allo-HSCT and was proven to be useful in optimizing the dosage and dosing interval of vancomycin in these patients. This strategy will provide more useful information for vancomycin therapy with an evidence-based dose adjustment. © 2018, The American College of Clinical Pharmacology.

Concurrent Validity of a Self-Reported Physical Activity “Vital Sign” Questionnaire With Adult Primary Care Patients

PubMed Central

Joy, Elizabeth A.; Gren, Lisa H.; Shaw, Janet M.

2016-01-01

Introduction No tool currently used by primary health care providers to assess physical activity has been evaluated for its ability to determine whether or not patients achieve recommended levels of activity. The purpose of this study was to assess concurrent validity of physical activity self-reported to the brief (<30 sec) Physical Activity “Vital Sign” questionnaire (PAVS) compared with responses to the lengthier (3–5 min), validated Modifiable Activity Questionnaire (MAQ). Methods Agreement between activity reported to the PAVS and MAQ by primary care patients at 2 clinics in 2014 was assessed by using percentages and κ coefficients. Agreement consisted of meeting or not meeting the 2008 Aerobic Physical Activity Guidelines for Americans (PA Guidelines) of the US Department of Health and Human Services. We compared self-reported usual minutes per week of moderate-to-vigorous physical activity among patients at a primary care clinic in 2014 who reported to PAVS and to MAQ by using Pearson correlation and Bland–Altman plots of agreement. Results Among 269 consenting patients who reported physical activity, PAVS results agreed with those of MAQ 89.6% of the time and demonstrated good agreement in identifying patients who did not meet PA Guidelines recommendations (κ = 0.55, ρ = 0.57; P < .001). Usual minutes per week of moderate-to-vigorous physical activity reported to PAVS had a high positive correlation with the same reported to MAQ (r = 0.71; P < .001). Conclusion PAVS may be a valid tool for identifying primary care patients who need counseling about physical activity. PAVS should be assessed further for agreement with repeated objective measures of physical activity in the patient population. PMID:26851335

Physical activity in an indigenous Ecuadorian forager-horticulturalist population as measured using accelerometry.

PubMed

Madimenos, Felicia C; Snodgrass, J Josh; Blackwell, Aaron D; Liebert, Melissa A; Sugiyama, Lawrence S

2011-01-01

Minimal information on physical activity is available for non-Western populations undergoing the transition to a market economy. This is unfortunate given the importance of these data for understanding health issues such as the global obesity epidemic. We consider the utility of using accelerometry technology to examine activity patterns and energy use regulation among indigenous Shuar, an Ecuadorian forager-horticulturalist population undergoing economic and lifestyle change. We investigate sex differences in Shuar activity patterns and the effects of reproductive status on activity. Finally, we discuss the potential of accelerometry use in human biology research. Physical activity levels were measured using Actical accelerometers in 49 indigenous Shuar adults (23 males, 26 females) from a rural Ecuadorian community. Female participants were in various reproductive states including pregnant, lactating, and nonpregnant/nonlactating. Activity counts (AC), activity energy expenditure (AEE), and physical activity levels (PAL) were significantly higher (P < 0.05) in males than females. Significant differences in energy expenditure were found among pregnant or lactating females and males with pregnant or lactating partners (P < 0.001). Males with pregnant or lactating partners also had significantly higher activity levels than did other men (P < 0.01). Shuar activity levels are relatively low compared to other non-Western populations. Despite increasing market integration, pregnant and lactating females seem to be adopting a strategy noted in other subsistence populations where male participation in subsistence activities increases to compensate for their partners' elevated reproductive costs. Despite certain limitations, use of accelerometry in human biology research shows promise. Copyright © 2011 Wiley-Liss, Inc.

Physical activity in an indigenous Ecuadorian forager-horticulturalist population as measured using accelerometry

PubMed Central

Madimenos, Felicia C.; Snodgrass, J. Josh; Blackwell, Aaron D.; Liebert, Melissa A.; Sugiyama, Lawrence S.

2011-01-01

Objective Minimal information on physical activity is available for non-Western populations undergoing the transition to a market economy. This is unfortunate given the importance of these data for understanding health issues such as the global obesity epidemic. We consider the utility of using accelerometry technology to examine activity patterns and energy use regulation among indigenous Shuar, an Ecuadorian forager-horticulturalist population undergoing economic and lifestyle change. We investigate sex differences in Shuar activity patterns and the effects of reproductive status on activity. Finally, we discuss the potential of accelerometry use in human biology research. Methods Physical activity levels were measured using Actical accelerometers in 49 indigenous Shuar adults (23 males, 26 females) from a rural Ecuadorian community. Female participants were in various reproductive states including pregnant, lactating, and non-pregnant/non-lactating. Results Activity counts (AC), activity energy expenditure (AEE), and physical activity levels (PAL) were significantly higher (P < 0.05) in males than females. Significant differences in energy expenditure were found among pregnant or lactating females and males with pregnant or lactating partners (P < 0.001). Males with pregnant or lactating partners also had significantly higher activity levels than did other men (P < 0.01). Conclusions Shuar activity levels are relatively low compared to other non-Western populations. Despite increasing market integration, pregnant and lactating females seem to be adopting a strategy noted in other subsistence populations where male participation in subsistence activities increases to compensate for their partners’ elevated reproductive costs. Despite certain limitations, use of accelerometry in human biology research shows promise. PMID:21538650

Population pharmacokinetics of ticagrelor and AR-C124910XX in patients with prior myocardial infarction
.

PubMed

Röshammar, Daniel; Bergstrand, Martin; Andersson, Tomas; Storey, Robert F; Hamrén, Bengt

2017-05-01

The population pharmacokinetics of ticagrelor and its active metabolite AR-C124910XX were characterized following ticagrelor 60 mg or 90 mg twice daily oral long-term treatment in 4,426 patients with a history of myocardial infarction. The ticagrelor and AR-C124910XX plasma concentration-time data were described by one-compartment models with first-order absorption or metabolite formation and elimination. Systemic exposure to ticagrelor and AR-C124910XX were stable over time. Ticagrelor apparent clearance (CL/F) was 17 L/h for the 60-mg and 15.4 L/h for the 90-mg dose. The CL/F of AR-C124910XX was 11.1 L/h for the 60-mg and 9.95 L/h for the 90-mg dose. Both ticagrelor and AR-C124910XX CL/F were independently influenced by body weight, sex, age, smoking, and Japanese ethnicity. Female sex and age > 75 years were the only categorical covariates, having more than 20% effect on AR-C124910XX CL/F. Ticagrelor CL/F was 6% higher and 11% lower, whereas AR-C124910XX CL/F was 26% higher and 34% lower for patients weighing 110 and 50 kg, respectively, compared with an 83 kg patient. The small differences in exposure to both ticagrelor and AR-C124910XX between demographic subgroups were in accordance with the consistent efficacy and safety outcomes observed across the population. The results were similar to those observed previously in patients with acute coronary syndromes.
.

Daily physical activity in stable heart failure patients.

PubMed

Dontje, Manon L; van der Wal, Martje H L; Stolk, Ronald P; Brügemann, Johan; Jaarsma, Tiny; Wijtvliet, Petra E P J; van der Schans, Cees P; de Greef, Mathieu H G

2014-01-01

Physical activity is the only nonpharmacological therapy that is proven to be effective in heart failure (HF) patients in reducing morbidity. To date, little is known about the levels of daily physical activity in HF patients and about related factors. The objectives of this study were to (a) describe performance-based daily physical activity in HF patients, (b) compare it with physical activity guidelines, and (c) identify related factors of daily physical activity. The daily physical activity of 68 HF patients was measured using an accelerometer (SenseWear) for 48 hours. Psychological characteristics (self-efficacy, motivation, and depression) were measured using questionnaires. To have an indication how to interpret daily physical activity levels of the study sample, time spent on moderate- to vigorous-intensity physical activities was compared with the 30-minute activity guideline. Steps per day was compared with the criteria for healthy adults, in the absence of HF-specific criteria. Linear regression analyses were used to identify related factors of daily physical activity. Forty-four percent were active for less than 30 min/d, whereas 56% were active for more than 30 min/d. Fifty percent took fewer than 5000 steps per day, 35% took 5000 to 10 000 steps per day, and 15% took more than 10 000 steps per day. Linear regression models showed that New York Heart Association classification and self-efficacy were the most important factors explaining variance in daily physical activity. The variance in daily physical activity in HF patients is considerable. Approximately half of the patients had a sedentary lifestyle. Higher New York Heart Association classification and lower self-efficacy are associated with less daily physical activity. These findings contribute to the understanding of daily physical activity behavior of HF patients and can help healthcare providers to promote daily physical activity in sedentary HF patients.

Does the population living in Roma settlements differ in physical activity, smoking and alcohol consumption from the majority population in Slovakia?

PubMed

Babinská, Ingrid; Gecková, Andrea Madarasová; Jarcuska, Peter; Pella, Daniel; Mareková, Mária; Stefková, Gabriela; Veselská, Zuzana Dankulincová

2014-03-01

Several studies have revealed a high prevalence of risk factors associated with unhealthy lifestyle among individuals with lower socioeconomic status. In Slovakia, one of the most socially and health-disadvantaged groups is the Roma minority. The aim of this study is to explore differences in physical activity, smoking and alcohol consumption between the population living in Roma settlements and the majority population in Slovakia. Data from the cross-sectional epidemiological HepaMeta study conducted in Slovakia in 2011 were used. The sample consisted of 452 Roma (mean age = 34.7; 35.2% men) and 403 non-Roma (mean age = 33.5; 45.9% men) respondents. The differences in health-related behaviour between the population living in Roma settlements and the majority population were analysed using logistic models separately for males and females. These data show a clear difference between the population living in Roma settlements and the majority population with regard to leisure-time physical activity (only in women) and smoking, although not alcohol consumption. The prevalence of leisure-time physical activities such as walking or some other type of sport was significantly lower among Roma women than among non-Roma women. Men and women living in Roma settlements are more likely to smoke on a daily basis and they are heavier smokers in comparison with the majority population. HepaMeta study did not find differences in alcohol consumption between the Roma and non-Roma men. However, Roma women reported less frequent recent drinking and binge-drinking of 6 or more doses of alcohol on a single occasion. The higher prevalence of unhealthy lifestyle activities among Roma seem to contribute to these inequalities in cardiovascular diseases morbidity and mortality in comparison with the majority population.

Prevalence of monosodium urate deposits in a population of rheumatoid arthritis patients with hyperuricemia.

PubMed

Petsch, Christina; Araujo, Elizabeth G; Englbrecht, Matthias; Bayat, Sara; Cavallaro, Alexander; Hueber, Axel J; Lell, Michael; Schett, Georg; Manger, Bernhard; Rech, Juergen

2016-06-01

To investigate the prevalence of monosodium urate (MSU) crystal deposits, indicative for gout, in a population of rheumatoid arthritis (RA) patients with concomitant hyperuricemia and to analyze the clinical and disease-specific characteristics of RA patients who exhibit MSU crystal deposits. Overall, 100 consecutive patients with the diagnosis of RA and a serum urate level above 6mg/dl underwent dual energy computed tomography (DECT) of both feet and hands to search for MSU crystals in a prospective study between October 2011 and July 2013. Presence and extent of MSU crystal deposits on DECT was assessed by automated volume measurement. Demographic and disease-specific characteristics were recorded and included into two logistic regression models to test for the factors associated with MSU crystal deposits in RA. Hyperuricemic RA patients were mostly male (55%), over 60 years of age (63 ± 11 years), had established disease (8.7 ± 10.5 years) and a mean disease activity score 28 (DAS 28) of 3.2. In total, 20 out of 100 patients displayed MSU crystal deposits in DECT. Interestingly, the majority (70%) of the RA patients positive for MSU crystal deposits were seronegative RA patients. Hence, every third seronegative RA patient had MSU crystal deposits. According to logistic regression model analysis, seronegative status correlated positively with presence of urate deposits (p = 0.019). These data show that a considerable number of RA patients display periarticular MSU crystal deposits. Seronegative patients were shown to be predominantly affected with every third patient being positive for urate deposits. Copyright © 2016 Elsevier Inc. All rights reserved.

Disease outcome of inflammatory bowel disease patients: general outline of a Europe-wide population-based 10-year clinical follow-up study.

PubMed

Wolters, Frank L; Russel, Maurice G; Sijbrandij, Jildou; Schouten, Leo J; Odes, Selwyn; Riis, Lene; Munkholm, Pia; Langholz, Ebbe; Bodini, Paolo; O'Morain, Colm; Katsanos, Kostas; Tsianos, Epameinondas; Vermeire, Severine; Van Zeijl, Gilbert; Limonard, Charles; Hoie, Ole; Vatn, Morten; Moum, Bjørn; Stockbrügger, Reinhold W

2006-01-01

To give a general outline of a 10-year clinical follow-up study of a population-based European cohort of inflammatory bowel disease (IBD) patients and to present the first results in terms of clinical outcome parameters and risk factors. A population-based cohort of newly, prospectively, diagnosed cases was initiated between 1991 and 1993. The 2201 patients with IBD (706 had Crohn's disease (CD), 1379 had ulcerative colitis (UC) and 116 had indeterminate colitis) originated from 20 different areas in 11 different European countries and Israel. For the 10-year follow-up of this cohort, electronic data-collecting instruments were made available through an Internet-based website. Data concerning vital status, disease activity, medication use, surgical events, cancer, pregnancy, fertility, quality of life and health-care costs were gathered. A blood sample was obtained from patients and controls to perform genotypic characterization. Thirteen centres from eight European countries and Israel participated. In 958 (316 CD and 642 UC) out of a total of 1505 IBD patients (64%) from these 13 centres, a complete dataset was obtained at follow-up. Even though an increased mortality risk was observed in CD patients 10 years after diagnosis, a benign disease course was observed in this patient group in terms of disease recurrence. A correlation between ASCA and CARD15 variants in CD patients and complicated disease course was observed. A north-south gradient was observed regarding colectomy rates in UC patients. Direct costs were found to be highest in the first year after diagnosis and greater in CD patients than in UC patients, with marked differences between participating countries. This 10-year clinical follow-up study of a population-based European cohort of IBD patients provides updated information on disease outcome of these patient groups.

Risk of cancer in patients with genital warts: A nationwide, population-based cohort study in Taiwan

PubMed Central

Cho, Ching-Yi; Lo, Yu-Cheng; Hung, Miao-Chiu; Lai, Chou-Cheng; Chen, Chun-Jen

2017-01-01

Background Condyloma acuminata currently affects around 1% of sexually active adults, and its incidence is increasing. The coexistence of genital warts (GW) and certain cancers and an association between human papillomavirus (HPV) and various malignancies have been reported. Therefore, we conducted this large national study to analyze the risk of malignancies among men and women with GW in Taiwan. Methods and findings Between January 2000 and December 2013, approximately 3 million patients were reported to the National Health Insurance Research Database of Taiwan. Of these patients, 21,763 were diagnosed with GW. In the same time period, a total of 213,541 cancer cases were reported to the registry, of which 1002 were recorded among patients with GW. The age-specific incidence rates of GW and standardized incidence ratios (SIRs) of malignancies compared to the general population were calculated. Women acquired GW earlier than men, with a mean age at diagnosis of 32.63±12.78 years. The highest incidence rate for both genders peaked at 20–29 years. Of the 1002 patients with GW and malignancies, the SIR was 1.95 (95%CI 1.83–2.07). The most markedly increased risk was found for HPV-related cancers, with a SIR of 9.74 (95%CI 3.70–15.77). Significantly elevated risks were also noted for smoking-related cancers, anogenital cancers, cervix in situ, colon, rectum, lung, kidney, and prostate cancers. Most cancers developed within 10 years after the diagnosis of GW. Conclusions Patients with GW have an increased risk of HPV-related cancers, especially anogenital malignancies in Taiwan. The elevated risk of other cancers highlights differences in exposure and risk factors among patients with GW compared to the general population. Cancer screening and HPV vaccination programs should be emphasized for at-risk patients. PMID:28806741

Health Related Quality of Life in a Dutch Rehabilitation Population: Reference Values and the Effect of Physical Activity.

PubMed

Krops, Leonie A; Jaarsma, Eva A; Dijkstra, Pieter U; Geertzen, Jan H B; Dekker, Rienk

2017-01-01

To establish reference values for Health Related Quality of Life (HRQoL) in a Dutch rehabilitation population, and to study effects of patient characteristics, diagnosis and physical activity on HRQoL in this population. Former rehabilitation patients (3169) were asked to fill in a questionnaire including the Dutch version of the RAND-36. Differences between our rehabilitation patients and Dutch reference values were analyzed (t-tests). Effects of patient characteristics, diagnosis and movement intensity on scores on the subscales of the RAND-36 were analyzed using block wise multiple regression analyses. In total 1223 patients (39%) returned the questionnaire. HRQoL was significantly poorer in the rehabilitation patients compared to Dutch reference values on all subscales (p<0.001) except for health change (p = 0.197). Longer time between questionnaire and last treatment was associated with a smaller health change (p = 0.035). Higher age negatively affected physical functioning (p<0.001), social functioning (p = 0.004) and health change (p = 0.001). Diagnosis affected outcomes on all subscales except role limitations physical, and mental health (p ranged <0.001 to 0.643). Higher movement intensity was associated with better outcomes on all subscales except for mental health (p ranged <0.001 to 0.190). HRQoL is poorer in rehabilitation patients compared to Dutch reference values. Physical components of HRQoL are affected by diagnosis. In rehabilitation patients an association between movement intensity and HRQoL was found. For clinical purposes, results of this study can be used as reference values for HRQoL in a rehabilitation setting.

Population genetic structuring of methicillin-resistant Staphylococcus aureus clone EMRSA-15 within UK reflects patient referral patterns

PubMed Central

Reuter, Sandra; Scriberras, James; Reynolds, Rosy; Brown, Nicholas M.; Török, M. Estée; James, Richard; Network, East of England Microbiology Research; Aanensen, David M.; Bentley, Stephen D.; Holden, Matthew T. G.; Parkhill, Julian; Spratt, Brian G.; Peacock, Sharon J.

2017-01-01

Antibiotic resistance forms a serious threat to the health of hospitalised patients, rendering otherwise treatable bacterial infections potentially life-threatening. A thorough understanding of the mechanisms by which resistance spreads between patients in different hospitals is required in order to design effective control strategies. We measured the differences between bacterial populations of 52 hospitals in the United Kingdom and Ireland, using whole-genome sequences from 1085 MRSA clonal complex 22 isolates collected between 1998 and 2012. The genetic differences between bacterial populations were compared with the number of patients transferred between hospitals and their regional structure. The MRSA populations within single hospitals, regions and countries were genetically distinct from the rest of the bacterial population at each of these levels. Hospitals from the same patient referral regions showed more similar MRSA populations, as did hospitals sharing many patients. Furthermore, the bacterial populations from different time-periods within the same hospital were generally more similar to each other than contemporaneous bacterial populations from different hospitals. We conclude that, while a large part of the dispersal and expansion of MRSA takes place among patients seeking care in single hospitals, inter-hospital spread of resistant bacteria is by no means a rare occurrence. Hospitals are exposed to constant introductions of MRSA on a number of levels: (1) most MRSA is received from hospitals that directly transfer large numbers of patients, while (2) fewer introductions happen between regions or (3) across national borders, reflecting lower numbers of transferred patients. A joint coordinated control effort between hospitals, is therefore paramount for the national control of MRSA, antibiotic-resistant bacteria and other hospital-associated pathogens. PMID:29026654

Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction.

PubMed

Miyamoto, Takamichi; Obayashi, Tohru; Hattori, Eijirou; Yamauchi, Yasuteru; Niwa, Akihiro; Isobe, Mitsuaki

2010-03-01

The clinical course of elderly patients with acute myocardial infarction (AMI) can sometimes unexpectedly result in an adverse outcome even when therapy appears to be successful. We suspect that specific factors may characterize this worsening of status during hospitalization. This study examines whether the pre-hospital physical activity status of the elderly treated with percutaneous coronary intervention (PCI) for AMI affects their in-hospital course. We studied 110 consecutive patients, aged 80 or older, who had undergone emergent PCI for AMI. Patients were divided into two groups based on clinical presentation: Better Killip class (Killip classes I and II) and Worse Killip class (Killip classes III and IV). Patients were also divided into two groups based on pre-hospital physical activity status, determined retrospectively by review of medical records: Good physical activity (n=57) comprising those able to go out alone independently and Poor physical activity comprising those mainly confined to home (n=53). The overall in-hospital mortality rate was 9.1% for the study population. The Worse Killip class group had a higher in-hospital mortality rate than the Better Killip class group (27.8% vs 5.4%, respectively; p=0.0102). In addition, the Poor physical activity group had a higher in-hospital mortality rate than the Good physical activity group (15.1% vs. 3.5%, respectively; p=0.047). These data suggest that pre-hospital physical activity status in elderly patients with AMI may affect in-hospital mortality as well as Killip class.

Activities of the Population Centre during 1979-80: a retrospect.

PubMed

Talwar, P P

1980-01-01

Activities of the Population Center in Lucknow are described. Studies designed to identify factors hindering the progress of the family welfare program are of 4 types. 1) Studies of operational and managerial aspects of the family welfare program service units include work on such topics as the determinants of effectiveness of subcenters in Uttar Pradesh, standardization of materials at rural service centers, factors affecting utilization and performance of primary health centers and subcenters, and effectiveness of auxiliary nurse midwives in delivering maternal and child health services. 2) Studies of effectiveness of program services include such topics as attitude toward vasectomy during the Emergency Period, collection of vital statistics by Community Health Volunteers, and comparisons of Lippes Loop insertions by doctors and paramedics. 3) Studies of education and communication activities include research into mass radio listening and newspaper reading habits and use of local first aid workers to motivate family planning acceptors. 4) Studies of involvement of different organizations in family welfare activities. Another group of studies conducted at the center was designed to evaluate the impact of the India Population Project and included surveys and analysis of secondary data. Population Center collaboration with other organizations and participation in professional meetings is also described, as is the proposed work for 1980-81.

A restricted population of CB1 cannabinoid receptors with neuroprotective activity.

PubMed

Chiarlone, Anna; Bellocchio, Luigi; Blázquez, Cristina; Resel, Eva; Soria-Gómez, Edgar; Cannich, Astrid; Ferrero, José J; Sagredo, Onintza; Benito, Cristina; Romero, Julián; Sánchez-Prieto, José; Lutz, Beat; Fernández-Ruiz, Javier; Galve-Roperh, Ismael; Guzmán, Manuel

2014-06-03

The CB1 cannabinoid receptor, the main molecular target of endocannabinoids and cannabis active components, is the most abundant G protein-coupled receptor in the mammalian brain. Of note, CB1 receptors are expressed at the synapses of two opposing (i.e., GABAergic/inhibitory and glutamatergic/excitatory) neuronal populations, so the activation of one and/or another receptor population may conceivably evoke different effects. Despite the widely reported neuroprotective activity of the CB1 receptor in animal models, the precise pathophysiological relevance of those two CB1 receptor pools in neurodegenerative processes is unknown. Here, we first induced excitotoxic damage in the mouse brain by (i) administering quinolinic acid to conditional mutant animals lacking CB1 receptors selectively in GABAergic or glutamatergic neurons, and (ii) manipulating corticostriatal glutamatergic projections remotely with a designer receptor exclusively activated by designer drug pharmacogenetic approach. We next examined the alterations that occur in the R6/2 mouse, a well-established model of Huntington disease, upon (i) fully knocking out CB1 receptors, and (ii) deleting CB1 receptors selectively in corticostriatal glutamatergic or striatal GABAergic neurons. The data unequivocally identify the restricted population of CB1 receptors located on glutamatergic terminals as an indispensable player in the neuroprotective activity of (endo)cannabinoids, therefore suggesting that this precise receptor pool constitutes a promising target for neuroprotective therapeutic strategies.

Hip resurfacing in patients under thirty years old: an attractive option for young and active patients.

PubMed

Krantz, Nicolas; Miletic, Bruno; Migaud, Henri; Girard, Julien

2012-09-01

Metal-on-metal hip resurfacing is offered as an alternative to traditional hip arthroplasty for young, active adults with advanced osteoarthritis. The concept of hip resurfacing is considered very attractive for this specific population (hard-on-hard bearing component with a large femoral head limiting the risk of dislocation, and allowing femoral bone stock preservation). A prospective clinical trial was designed to investigate the outcome of hip resurfacing in young patients (under 30 years old). We studied 24 hips in 22 patients. Mean age at operation was 24.9 years (range 17.1-29.9). No patient was lost to follow-up. There was no revision at average follow-up of 50.6 months (44-59). Mean UCLA activity score improved from 5.5 (1-9) pre-operatively to 7.6 (1-10) postoperatively (p < 0.001). Mean Harris hip score increased from 43.9 (19-67) to 89.3 (55-100) (p < 0.001). Radiological analysis discerned no osteolysis and no implant migration. The absence of short-term complications, such as mechanical failure or dislocation, is encouraging and leads us to think that mid-term results will be satisfactory. Moreover, the specific advantages of hip resurfacing (bone stock preservation, excellent stability, low risk of dislocation, large-diameter head) make the procedure a very attractive option for young subjects.

Patient Loyalty in a Mature IDS Market: Is Population Health Management Worth It?

PubMed Central

Carlin, Caroline S

2014-01-01

Objective To understand patient loyalty to providers over time, informing effective population health management. Study Setting Patient care-seeking patterns over a 6-year timeframe in Minnesota, where care systems have a significant portion of their revenue generated by shared-saving contracts with public and private payers. Study Design Weibull duration and probit models were used to examine patterns of patient attribution to a care system and the continuity of patient affiliation with a care system. Clustering of errors within family unit was used to account for within-family correlation in unobserved characteristics that affect patient loyalty. Data Collection The payer provided data from health plan administrative files, matched to U.S. Census-based characteristics of the patient's neighborhood. Patients were retrospectively attributed to health care systems based on patterns of primary care. Principal Findings I find significant patient loyalty, with past loyalty a very strong predictor of future relationship. Relationships were shorter when the patient's health status was complex and when the patient's care system was smaller. Conclusions Population health management can be beneficial to the care system making this investment, particularly for patients exhibiting prior continuity in care system choice. The results suggest that co-located primary and specialty services are important in maintaining primary care loyalty. PMID:24461030

Patient loyalty in a mature IDS market: is population health management worth it?

PubMed

Carlin, Caroline S

2014-06-01

To understand patient loyalty to providers over time, informing effective population health management. Patient care-seeking patterns over a 6-year timeframe in Minnesota, where care systems have a significant portion of their revenue generated by shared-saving contracts with public and private payers. Weibull duration and probit models were used to examine patterns of patient attribution to a care system and the continuity of patient affiliation with a care system. Clustering of errors within family unit was used to account for within-family correlation in unobserved characteristics that affect patient loyalty. The payer provided data from health plan administrative files, matched to U.S. Census-based characteristics of the patient's neighborhood. Patients were retrospectively attributed to health care systems based on patterns of primary care. I find significant patient loyalty, with past loyalty a very strong predictor of future relationship. Relationships were shorter when the patient's health status was complex and when the patient's care system was smaller. Population health management can be beneficial to the care system making this investment, particularly for patients exhibiting prior continuity in care system choice. The results suggest that co-located primary and specialty services are important in maintaining primary care loyalty. © Health Research and Educational Trust.

Meniscal injuries in the young, athletically active patient.

PubMed

Poulsen, Matthew R; Johnson, Darren L

2011-02-01

Meniscal injuries are common in young physically active individuals, particularly those who are involved in contact level 1 sports that involve frequent pivoting, such as soccer and American football. This is a unique population because of their high physical activity at a young age, and it is important that correct diagnosis and appropriate treatment are provided, as the medial and lateral menisci are essential for normal knee function. In this article, we review the anatomy and function of the meniscus, the epidemiology of meniscal tears, and mechanism(s) of injury. Important concomitant injuries are also discussed. When making a diagnosis, relevant patient history, physical examination, and appropriate imaging studies are required. Nonoperative treatment is rarely successful for treating meniscal tears in young athletes, and therefore repair of the torn menisci is often required. We also discuss partial resection (which should only be performed when repair is not possible), as well as rehabilitation protocols after repair has been performed. All of these factors associated with meniscal injuries are important for a physician when diagnosing and treating these often complex injuries.

Reproducibility and validity of the French version of the long international physical activity questionnaire in patients with type 2 diabetes.

PubMed

Crinière, Lise; Lhommet, Claire; Caille, Agnes; Giraudeau, Bruno; Lecomte, Pierre; Couet, Charles; Oppert, Jean-Michel; Jacobi, David

2011-08-01

Increasing physical activity and decreasing sedentary time are cornerstones in the management of type 2 diabetes (T2DM). However, there are few instruments available to measure physical activity in this population. We translated the long version of the International Physical Activity Questionnaire (IPAQ-L) into French and studied its reproducibility and validity in patients with T2DM. Reproducibility was studied by 2 telephone administrations, 8 days apart. Concurrent validity was tested against pedometry for 7 days during habitual life. One-hundred forty-three patients with T2DM were recruited (59% males; age: 60.9 ± 10.5 years; BMI: 31.2 ± 5.2 kg/m2; HbA1c: 7.4 ± 1.2%). Intraclass correlation coefficients (95% CI) for repeated administration (n = 126) were 0.74 (0.61-0.83) for total physical activity, 0.72 (0.57-0.82) for walking, and 0.65 (0.51-0.78) for sitting time. Total physical activity and walking (MET-min·week-1) correlated with daily steps (Spearman r = .24 and r = .23, respectively, P < .05). Sitting time (min·week-1) correlated negatively with daily steps in women (r = -0.33; P < .05). Our French version of the IPAQ-L appears reliable to assess habitual physical activity and sedentary time in patients with T2DM, confirming previous data in nonclinical populations.

Increased risk of chronic obstructive pulmonary disease in patients with bipolar disorder: A population-based study.

PubMed

Hsu, Jer-Hwa; Chien, I-Chia; Lin, Ching-Heng

2017-10-01

We conducted this nationwide study to examine the prevalence and incidence of chronic obstructive pulmonary disease (COPD) among patients with bipolar disorder in Taiwan. We used a random sample of 766,427 subjects who were aged ≥18 years in 2005. Patients with at least one primary diagnosis of bipolar disorder were identified. Study participants with one primary or secondary diagnosis of COPD for either ambulatory or inpatient care were also identified. We compared the prevalence of COPD in patients with bipolar disorder and the general population in 2005. In addition, we further investigated this cohort from 2006 to 2010 to detect incident cases of COPD in patients with bipolar disorder compared with the general population. The factors associated with COPD among patients with bipolar disorder were also analyzed. The prevalence of COPD in patients with bipolar disorder was higher than in the general population in 2005 (5.68% vs. 2.88%, odds ratio 2.03; 95% confidence interval, 1.53-2.67). The average annual incidence of COPD in patients with bipolar disorder was also higher than in the general population (2.03% vs. 1.03%, risk ratio 1.94; 95% confidence interval, 1.65-2.29) from 2006 to 2010. Some risk factors for COPD such as substance use, obesity, or lifestyle pattern were not available in this study. Patients with bipolar disorder had a higher prevalence and incidence of COPD compared with the general population. Higher prevalence of COPD among bipolar patients was associated with increased age, males, hypertension, and second-generation antidepressant use. Copyright © 2017 Elsevier B.V. All rights reserved.

The relationship of quality of life and distress in prostate cancer patients compared to the general population.

PubMed

Zenger, Markus; Lehmann-Laue, Antje; Stolzenburg, Jens-Uwe; Schwalenberg, Thilo; Ried, Alexander; Hinz, Andreas

2010-06-30

The aim of this study is two-fold. The first part compares quality of life (QoL) data of prostate cancer patients with those of a representative and age-specific sample of the general population and analyzes the influence of cancer related as well as socio-demographic parameters on QoL. Secondly, differences in QoL depending on the experienced psychological distress will be shown both in prostate cancer patients and in the general population. A sample of 265 prostate cancer patients completed both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale (HADS) during their stay in the hospital. A total HADS cut off score of 15 was used to indicate psychological distress and significant emotional concerns in patients and men of the general population. The results of the patients were compared with those of the general population (N=444). Prostate cancer patients reported significantly worse levels of social and emotional functioning as well as more symptoms like insomnia, constipation and diarrhea compared to the general population. Patients and men of the general population with a total HADS score >/=15 reported lower QoL in all sub-scales except for diarrhea in comparison to people without distress. Psychological distress is accompanied by lower QoL and therefore should be taken into consideration when QoL is assessed. Furthermore, clinicians should be trained by professionals to detect distress in their patients and to pay more attention to their emotional concerns, which are strongly associated with the patients' well-being and QoL during their stay in hospital.

Increased Risk of Cerebrovascular Disease Among Patients With Neurofibromatosis Type 1: Population-Based Approach.

PubMed

Terry, Anna R; Jordan, Justin T; Schwamm, Lee; Plotkin, Scott R

2016-01-01

Although neurofibromatosis type 1 (NF1) may be associated with an incompletely understood vasculopathy, relative odds of stroke in this population is not known. Using the 1998 to 2009 US Nationwide Inpatient Sample, we performed a case-control study matching cases of NF1 to controls without such a diagnosis. We then compared the odds of stroke between the 2 groups. We used multivariable logistic regression to adjust for known or suspected confounders. NF1 was associated with younger mean age at the time of stroke (41 versus 48) and a lower prevalence of stroke risk factors among adult patients. Pediatric patients with NF1, however, were more likely to have hypertension. Patients with NF1 were significantly more likely to be diagnosed with any stroke (odds ratio, 1.2; P<0.0001) than the general population. The odds of intracerebral hemorrhage were greatest among hemorrhagic stroke types analyzed (odds ratio, 1.9; P<0.0001). In the pediatric NF1 population, the odds of intracerebral hemorrhage were more dramatically elevated (odds ratio, 8.1; P<0.0001). The odds of ischemic stroke were also increased with NF1 in the pediatric (odds ratio, 3.4; P<0.0001) but not in the adult population. When compared with the general population, the odds of any type of stroke are significantly increased for patients with NF1, both adult and pediatric. This risk is most notable for hemorrhagic strokes although it is also increased for ischemic strokes in children. Physicians should be aware of the increased risk of stroke in this population, and consider stroke as a potential cause of new neurological symptoms. © 2015 American Heart Association, Inc.

Hand hygiene compliance in patients under contact precautions and in the general hospital population.

PubMed

Almaguer-Leyva, Martín; Mendoza-Flores, Lidia; Medina-Torres, Ana Gabriela; Salinas-Caballero, Ana Gabriela; Vidaña-Amaro, Jose Antonio; Garza-Gonzalez, Elvira; Camacho-Ortiz, Adrián

2013-11-01

Hand hygiene (HH) is the single most important intervention for preventing hospital-acquired infections. Contact precautions are a series of actions that infection control units take to reduce the transmission of nosocomial pathogens. We conducted an observational study of HH compliance. Observations were stratified as opportunities in patients under contact precautions and in the general hospital population. Trained infection control personnel performed all direct evaluations. A total of 3,270 opportunities were recorded. HH compliance was statistically higher in patients on contact precautions than in the overall population (70.3% vs 60.4%; P = .0001). Critical care areas had higher HH compliance when patients were isolated by contact precautions. Medical wards were statistically lower in HH when patients were under contact precautions. Respiratory technicians had the highest HH compliance in both overall performance and in patients under contact precautions. Medical students had a lower HH compliance in both evaluations (P < .001). We noted greater compliance with HH practices when patients were under contact precaution in comparison with the overall hospital population. The difference was stronger in intensive care areas and lower among medical students. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Physical Activity Monitoring in Patients with Chronic Obstructive Pulmonary Disease

PubMed Central

Liao, Shu-Yi; Benzo, Roberto; Ries, Andrew L.; Soler, Xavier

2014-01-01

Reduced physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality (e.g. exacerbations) and eventually leads to disability, depression, and social and physical isolation. Measuring PA in this population is important to accurately characterize COPD and to help clinicians during a baseline evaluation and patient follow-up. Also, it may help increase adherence to PA programs. There are reliable objective and subjective methods available to measure PA. Recently, several new monitors have been developed that have improved accuracy of such measurements. Because these devices provide real-time feedback, they may help to improve participant self-motivation strategies and reinforce daily lifestyle modifications, one of the main goals in COPD management. This review focuses on describing available instruments to measure PA, specifically in patients with COPD. The reliability, validity, advantages, limitations, and clinical applications of questionnaires, pedometers, and accelerometers are discussed. Finally, based on current published literature, we propose recommendations about which methods may be most useful in different research or clinical settings. PMID:28848818

Altered pain sensitivity and axioscapular muscle activity in neck pain patients compared with healthy controls.

PubMed

Christensen, S W; Hirata, R P; Graven-Nielsen, T

2017-11-01

Previous studies have indicated that neck pain patients feel increased symptoms following upper limb activities, and altered axioscapular muscle function has been proposed as a contributing factor. Pain sensitivity and muscle activity, during arm movements, were assessed in neck pain patients and controls. Patients with ongoing insidious-onset neck pain (IONP, N = 16) and whiplash-associated disorders (WAD, N = 9) were included along with sex- and age-matched controls (N = 25). Six series of repeated arm abductions were performed during electromyographic (EMG) recordings from eight bilateral muscles. The first and last three series were separated by 8 min and 42 s, respectively. Each series consisted of three slow and three fast movements. Pressure pain thresholds (PPTs) were recorded bilaterally from neck, head and arm at baseline, after the third and sixth movement series. Pain intensity was recorded on an electronic visual analogue scale (VAS). Larger pain areas and higher VAS scores were found in patients compared with controls (p < 0.001), and in patients, the VAS scores increased in the course of movements (p < 0.02). PPTs were lower in patients compared with controls at all sites (p < 0.03), and these decreased during arm movements in the IONP group (p < 0.03), while increasing at head and neck sites in controls (p < 0.04). During the slow movements, increasing serratus anterior EMG activity was found in the series with short breaks in-between for the WAD group compared with IONP and controls (p < 0.001). Axioscapular movement caused different responses in pain sensitivity and muscle activity between neck pain patient groups compared with controls. Neck pain patients report increased symptoms following upper limb activities. This study shows that repeated arm movements caused differentiated responses in pain sensitivity and muscle activity between subgroups of neck pain patient and asymptomatic controls. Such findings may be of great

Population pharmacokinetics of olmesartan following oral administration of its prodrug, olmesartan medoxomil: in healthy volunteers and hypertensive patients.

PubMed

Yoshihara, Kazutaka; Gao, Yuying; Shiga, Hiroshi; Wada, D Russell; Hisaoka, Masafumi

2005-01-01

Olmesartan medoxomil (CS-866) is a new orally active angiotensin II receptor antagonist that is highly selective for the AT1 receptor subtype. To develop a population pharmacokinetic model for olmesartan (RNH-6270), the active metabolite of olmesartan medoxomil, in healthy volunteers and hypertensive patients, and to evaluate effects of covariates on the apparent oral clearance (CL/F), with particular emphasis on the effect of race. Retrospective analysis of data from 12 phase I-III trials in the US, Europe and Japan. Eighty-nine healthy volunteers and 383 hypertensive patients. Nonlinear mixed-effects modelling was used to evaluate 7911 olmesartan plasma sample concentrations. The covariates included age, bodyweight, sex, race (Westerners [including Caucasians and Hispanics] versus Japanese), patient status (hypertensive patients versus healthy volunteers), serum creatinine level as an index of renal function and serum chemistry data as indices of hepatic function. The pharmacokinetic data of olmesartan were well described by a two-compartment linear model with first-order absorption and an absorption lag-time, parameterised in terms of CL/F (6.66 L/h for a typical male Western hypertensive patient), absorption rate constant (1.46h-1), elimination rate constant (0.193h-1), rate constant from the central to peripheral compartment (0.061h-1), rate constant from the peripheral to central compartment (0.079h-1) and absorption lag-time (0.427h). Analysis of covariates showed that age, bodyweight, sex, patient status and renal function were factors influencing the clearance of olmesartan. The population pharmacokinetic analysis of olmesartan showed that: (i) severe renal impairment (serum creatinine >265 micromol/L [approximately 3 mg/dL]) could cause a clearance decrease of > or =30%; (ii) older age, lower bodyweight and being female were determinants of lower clearance but their effects on olmesartan clearance were within 20%; (iii) no statistically significant

Neural signatures of attention: insights from decoding population activity patterns.

PubMed

Sapountzis, Panagiotis; Gregoriou, Georgia G

2018-01-01

Understanding brain function and the computations that individual neurons and neuronal ensembles carry out during cognitive functions is one of the biggest challenges in neuroscientific research. To this end, invasive electrophysiological studies have provided important insights by recording the activity of single neurons in behaving animals. To average out noise, responses are typically averaged across repetitions and across neurons that are usually recorded on different days. However, the brain makes decisions on short time scales based on limited exposure to sensory stimulation by interpreting responses of populations of neurons on a moment to moment basis. Recent studies have employed machine-learning algorithms in attention and other cognitive tasks to decode the information content of distributed activity patterns across neuronal ensembles on a single trial basis. Here, we review results from studies that have used pattern-classification decoding approaches to explore the population representation of cognitive functions. These studies have offered significant insights into population coding mechanisms. Moreover, we discuss how such advances can aid the development of cognitive brain-computer interfaces.

Factors associated with absenteeism, presenteeism and activity impairment in patients in the first years of RA.

PubMed

Bansback, Nick; Zhang, Wei; Walsh, David; Kiely, Patrick; Williams, Richard; Guh, Daphne; Anis, Aslam; Young, Adam

2012-02-01

To understand the impact of the early years of RA on all aspects of work productivity, and determine how this is related to clinical markers. Previous research on work productivity has examined predominantly early retirement and absenteeism. The impact of reduced work performance (presenteeism) and activity impairment is less well understood in early RA populations. Working patients enrolled in an RA inception cohort were recruited into a nested study. A questionnaire incorporating the Work Productivity and Activity Impairment (WPAI) instrument was administered with a number of clinical outcomes, including the Multidimensional Health Assessment Questionnaire (MD-HAQ) and scales for pain, fatigue and patient assessment of disease patient global assessment (PtGA). Analysis included 150 RA patients, with the mean age at onset being 48 years (s.d. 10 years) and disease duration from symptom onset being 49 months. Patients had relatively mild disease: MD-HAQ (0.6), pain (3.6), PtGA (3.6) and fatigue (4.6). Of the 92% patients working for pay, 19% reported missing work (absenteeism) in the past week due to their health, accounting for 46% of their working time. Even while at work, ∼25% of actual hours was lost due to poor health, while outside work 33% of patients' regular daily activities were prevented. In multivariate analyses, disease severity was associated with the presence of absenteeism, presenteeism and activity impairment. Patients able to self-schedule their work had lower presenteeism and activity impairment. Productivity loss is common in patients in the first years of RA who are in paid work and was associated with work characteristics and adverse clinical outcomes.

Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics.

PubMed

Pozzilli, Paolo; Battelino, Tadej; Danne, Thomas; Hovorka, Roman; Jarosz-Chobot, Przemyslawa; Renard, Eric

2016-01-01

The level of glycaemic control necessary to achieve optimal short-term and long-term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid-acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid-acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost-effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid-acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin infusion on patients

Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics

PubMed Central

Battelino, Tadej; Danne, Thomas; Hovorka, Roman; Jarosz‐Chobot, Przemyslawa; Renard, Eric

2015-01-01

Summary The level of glycaemic control necessary to achieve optimal short‐term and long‐term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid‐acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health‐related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid‐acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost‐effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid‐acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin

Impact of Physical Activity Interventions on Blood Pressure in Brazilian Populations

PubMed Central

Bento, Vivian Freitas Rezende; Albino, Flávia Barbizan; de Moura, Karen Fernandes; Maftum, Gustavo Jorge; dos Santos, Mauro de Castro; Guarita-Souza, Luiz César; Faria Neto, José Rocha; Baena, Cristina Pellegrino

2015-01-01

Background High blood pressure is associated with cardiovascular disease, which is the leading cause of mortality in the Brazilian population. Lifestyle changes, including physical activity, are important for lowering blood pressure levels and decreasing the costs associated with outcomes. Objective Assess the impact of physical activity interventions on blood pressure in Brazilian individuals. Methods Meta-analysis and systematic review of studies published until May 2014, retrieved from several health sciences databases. Seven studies with 493 participants were included. The analysis included parallel studies of physical activity interventions in adult populations in Brazil with a description of blood pressure (mmHg) before and after the intervention in the control and intervention groups. Results Of 390 retrieved studies, eight matched the proposed inclusion criteria for the systematic review and seven randomized clinical trials were included in the meta-analysis. Physical activity interventions included aerobic and resistance exercises. There was a reduction of -10.09 (95% CI: -18.76 to -1.43 mmHg) in the systolic and -7.47 (95% CI: -11.30 to -3.63 mmHg) in the diastolic blood pressure. Conclusions Available evidence on the effects of physical activity on blood pressure in the Brazilian population shows a homogeneous and significant effect at both systolic and diastolic blood pressures. However, the strength of the included studies was low and the methodological quality was also low and/or regular. Larger studies with more rigorous methodology are necessary to build robust evidence. PMID:26016783

Alterations in the Fecal Microbiota of Patients with HIV-1 Infection: An Observational Study in A Chinese Population

PubMed Central

Ling, Zongxin; Jin, Changzhong; Xie, Tiansheng; Cheng, Yiwen; Li, Lanjuan; Wu, Nanping

2016-01-01

The available evidence suggests that alterations in gut microbiota may be tightly linked to the increase in microbial translocation and systemic inflammation in patients with human immunodeficiency virus 1 (HIV-1) infection. We profiled the fecal microbiota as a proxy of gut microbiota by parallel barcoded 454-pyrosequencing in 67 HIV-1-infected patients (32 receiving highly active antiretroviral therapy [HAART] and 35 HAART naïve) and 16 healthy controls from a Chinese population. We showed that α-diversity indices did not differ significantly between the healthy control and HIV-1-infected patients. The ratio of Firmicutes/Bacteroidetes increased significantly in HIV-1-infected patients. Several key bacterial phylotypes, including Prevotella, were prevalent in HIV-1-infected patients; whereas Phascolarctobacterium, Clostridium XIVb, Dialister and Megamonas were significantly correlated with systemic inflammatory cytokines. After short-term, effective HAART, the viral loads of HIV-1 were reduced; however, the diversity and composition of the fecal microbiota were not completely restored. and the dysbiosis remained among HIV-1-infected subjects undergoing HAART. Our detailed analysis demonstrated that dysbiosis of fecal microbiota might play an active role in HIV-1 infection. Thus, new insights may be provided into therapeutics that target the microbiota to attenuate the progression of HIV disease and to reduce the risk of gut-linked disease in HIV-1-infected patients. PMID:27477587

Patient Populations, Clinical Associations, and System Efficiency in Healthcare Delivery System

NASA Astrophysics Data System (ADS)

Liu, Yazhuo

The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes' perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease' correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

Using the social cognitive theory to understand physical activity among dialysis patients.

PubMed

Patterson, Megan S; Umstattd Meyer, M Renée; Beaujean, A Alexander; Bowden, Rodney G

2014-08-01

The purpose of this study was to use the social cognitive theory (SCT) constructs self-efficacy, outcome expectations, and self-regulation to better understand associations of physical activity (PA) behaviors among dialysis patients after controlling for demographic and health-related factors. This study was cross-sectional in design. Participants (N = 115; mean age = 61.51 years, SD = 14.01) completed self-report questionnaires during a regularly scheduled dialysis treatment session. Bivariate and hierarchical linear regression analyses were conducted to examine relationships among SCT constructs and PA. Significant relationships between PA and self-efficacy (r = .336), self-regulation (r = .280), and outcome expectations (r = .265) were detected among people on dialysis in bivariate analyses. Hierarchical linear regression revealed significant increases in variance explained for the addition of self-efficacy, self-regulation, and covariates (p < .01). Younger age, self-efficacy, and self-regulation were associated (p < .10) with greater participation in physical activity in the final model (R² = .272). Conclusion/Implication: This research supports the use of SCT in understanding PA among people undergoing dialysis treatment. The findings of this study can help health educators and health care practitioners better understand PA and how to promote it among this population. Future research should further investigate which activities dialysis patients participate in across the life span of their disease. Future PA programs should focus on increasing a patient's self-efficacy and self-regulation.

Employment among Patients with Multiple Sclerosis-A Population Study

PubMed Central

Bøe Lunde, Hanne Marie; Telstad, Wenche; Grytten, Nina; Kyte, Lars; Aarseth, Jan; Myhr, Kjell-Morten; Bø, Lars

2014-01-01

Objective To investigate demographic and clinical factors associated with employment in MS. Methods The study included 213 (89.9%) of all MS patients in Sogn and Fjordane County, Western Norway at December 31st 2010. The patients underwent clinical evaluation, structured interviews and completed self-reported questionnaires. Demographic and clinical factors were compared between patients being employed versus patients being unemployed and according to disease course of MS. Logistic regression analysis was used to identify factors independently associated with current employment. Results After a mean disease duration of almost 19 years, 45% of the population was currently full-time or part- time employed. Patients with relapsing –remitting MS (RRMS) had higher employment rate than patients with secondary (SPMS) and primary progressive (PPMS). Higher educated MS patients with lower age at onset, shorter disease duration, less severe disability and less fatigue were most likely to be employed. Conclusions Nearly half of all MS patients were still employed after almost two decades of having MS. Lower age at onset, shorter disease duration, higher education, less fatigue and less disability were independently associated with current employment. These key clinical and demographic factors are important to understand the reasons to work ability in MS. The findings highlight the need for environmental adjustments at the workplace to accommodate individual ’s needs in order to improve working ability among MS patients. PMID:25054972

Employment among patients with multiple sclerosis-a population study.

PubMed

Bøe Lunde, Hanne Marie; Telstad, Wenche; Grytten, Nina; Kyte, Lars; Aarseth, Jan; Myhr, Kjell-Morten; Bø, Lars

2014-01-01

To investigate demographic and clinical factors associated with employment in MS. The study included 213 (89.9%) of all MS patients in Sogn and Fjordane County, Western Norway at December 31st 2010. The patients underwent clinical evaluation, structured interviews and completed self-reported questionnaires. Demographic and clinical factors were compared between patients being employed versus patients being unemployed and according to disease course of MS. Logistic regression analysis was used to identify factors independently associated with current employment. After a mean disease duration of almost 19 years, 45% of the population was currently full-time or part- time employed. Patients with relapsing -remitting MS (RRMS) had higher employment rate than patients with secondary (SPMS) and primary progressive (PPMS). Higher educated MS patients with lower age at onset, shorter disease duration, less severe disability and less fatigue were most likely to be employed. Nearly half of all MS patients were still employed after almost two decades of having MS. Lower age at onset, shorter disease duration, higher education, less fatigue and less disability were independently associated with current employment. These key clinical and demographic factors are important to understand the reasons to work ability in MS. The findings highlight the need for environmental adjustments at the workplace to accommodate individual 's needs in order to improve working ability among MS patients.

When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto.

PubMed

Kuster, Stefan P; Katz, Kevin C; Blair, Joanne; Downey, James; Drews, Steven J; Finkelstein, Sandy; Fowler, Rob; Green, Karen; Gubbay, Jonathan; Hassan, Kazi; Lapinsky, Stephen E; Mazzulli, Tony; McRitchie, Donna; Pataki, Janos; Plevneshi, Agron; Powis, Jeff; Rose, David; Sarabia, Alicia; Simone, Carmine; Simor, Andrew; McGeer, Allison

2011-07-28

There is a paucity of data about the clinical characteristics that help identify patients at high risk of influenza infection upon ICU admission. We aimed to identify predictors of influenza infection in patients admitted to ICUs during the 2007/2008 and 2008/2009 influenza seasons and the second wave of the 2009 H1N1 influenza pandemic as well as to identify populations with increased likelihood of seasonal and pandemic 2009 influenza (pH1N1) infection. Six Toronto acute care hospitals participated in active surveillance for laboratory-confirmed influenza requiring ICU admission during periods of influenza activity from 2007 to 2009. Nasopharyngeal swabs were obtained from patients who presented to our hospitals with acute respiratory or cardiac illness or febrile illness without a clear nonrespiratory aetiology. Predictors of influenza were assessed by multivariable logistic regression analysis and the likelihood of influenza in different populations was calculated. In 5,482 patients, 126 (2.3%) were found to have influenza. Admission temperature ≥38°C (odds ratio (OR) 4.7 for pH1N1, 2.3 for seasonal influenza) and admission diagnosis of pneumonia or respiratory infection (OR 7.3 for pH1N1, 4.2 for seasonal influenza) were independent predictors for influenza. During the peak weeks of influenza seasons, 17% of afebrile patients and 27% of febrile patients with pneumonia or respiratory infection had influenza. During the second wave of the 2009 pandemic, 26% of afebrile patients and 70% of febrile patients with pneumonia or respiratory infection had influenza. The findings of our study may assist clinicians in decision making regarding optimal management of adult patients admitted to ICUs during future influenza seasons. Influenza testing, empiric antiviral therapy and empiric infection control precautions should be considered in those patients who are admitted during influenza season with a diagnosis of pneumonia or respiratory infection and are either febrile

Factors Influencing Norvancomycin Concentration in Plasma and Cerebrospinal Fluid in Patients After Craniotomy and Dosing Guideline: A Population Approach.

PubMed

Li, Xingang; Wu, Yuanxing; Sun, Shusen; Wang, Qiang; Zhao, Zhigang

2018-01-01

Antibacterial spectrum and activity of norvancomycin are comparable with vancomycin, and it has been widely used in China. Norvancomycin can penetrate into the cerebrospinal fluid (CSF) through the damaged blood-brain barrier in patients after craniotomy. Because higher inter-individual variability was observed, we aimed to identify factors related to drug concentration to guide clinicians with norvancomycin dosing. After craniotomy, patients with an indwelling catheter in the operational area/ventricle were intravenously administered norvancomycin. Venous blood and CSF specimens were collected at a scheduled time for measuring drug concentrations. Blood and CSF data were fitted simultaneously with the use of the nonlinear fixed-effects modeling method to develop the population pharmacokinetic model. Covariate analysis was applied to select candidate factors associated with pharmacokinetic parameters. A model-based simulation was performed to find optimized regimens for different subgroups of patients. A 3-compartmental model (central, peripheral, and CSF compartments) with 2 elimination pathways (drug elimination from the kidney and CSF outflow) was developed to characterize the in vivo process of norvancomycin. The covariate analysis identified that weight and drainage amount were strongly associated with the central volume and the drug clearance from CSF, respectively. Goodness-of-fit and model validation suggested that the proposed model was acceptable. A dosage regimen table was created for specific patient populations with different weights and drainage amounts to facilitate clinical application. We identified 2 clinical markers associated with plasma and CSF concentrations. The proposed simulation may be useful to clinicians for norvancomycin dosing in this specific population with normal kidney function. Copyright © 2018. Published by Elsevier Inc.

Expected values for pedometer-determined physical activity in older populations

PubMed Central

2009-01-01

The purpose of this review is to update expected values for pedometer-determined physical activity in free-living healthy older populations. A search of the literature published since 2001 began with a keyword (pedometer, "step counter," "step activity monitor" or "accelerometer AND steps/day") search of PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL), SportDiscus, and PsychInfo. An iterative process was then undertaken to abstract and verify studies of pedometer-determined physical activity (captured in terms of steps taken; distance only was not accepted) in free-living adult populations described as ≥ 50 years of age (studies that included samples which spanned this threshold were not included unless they provided at least some appropriately age-stratified data) and not specifically recruited based on any chronic disease or disability. We identified 28 studies representing at least 1,343 males and 3,098 females ranging in age from 50–94 years. Eighteen (or 64%) of the studies clearly identified using a Yamax pedometer model. Monitoring frames ranged from 3 days to 1 year; the modal length of time was 7 days (17 studies, or 61%). Mean pedometer-determined physical activity ranged from 2,015 steps/day to 8,938 steps/day. In those studies reporting such data, consistent patterns emerged: males generally took more steps/day than similarly aged females, steps/day decreased across study-specific age groupings, and BMI-defined normal weight individuals took more steps/day than overweight/obese older adults. The range of 2,000–9,000 steps/day likely reflects the true variability of physical activity behaviors in older populations. More explicit patterns, for example sex- and age-specific relationships, remain to be informed by future research endeavors. PMID:19706192

A non-synonymous SNP in the NOS2 associated with septic shock in patients with sepsis in Chinese populations.

PubMed

Wang, Zhifu; Feng, Kai; Yue, Maoxing; Lu, Xiaoguang; Zheng, Qihan; Zhang, Hongxing; Zhai, Yun; Li, Peiyao; Yu, Lixia; Cai, Mi; Zhang, Xiumei; Kang, Xin; Shi, Weihai; Xia, Xia; Chen, Xi; Cao, Pengbo; Li, Yuanfeng; Chen, Huipeng; Ling, Yan; Li, Yuxia; He, Fuchu; Zhou, Gangqiao

2013-03-01

Sepsis represents a systemic inflammatory response to infection and its sequelae include severe sepsis, septic shock, multiple organ dysfunction syndrome (MODS) and death. Studies in mice and humans indicate that the inducible nitric oxide synthase (iNOS, NOS2) plays an important role in the development of sepsis and its sequelae. It was reported that several single nucleotide polymorphisms (SNPs) within NOS2 could influence the production or activity of NOS2. In this study, we assessed whether SNPs within NOS2 gene were associated with severity of sepsis in Chinese populations. A case-control study was conducted, which included 299 and 280 unrelated patients with sepsis recruited from Liaoning and Jiangsu provinces in China, respectively. Six SNPs within NOS2 were genotyped using Sequenom MassARRAY system. The associations between the SNPs and risk of sepsis complications were estimated by a binary logistic regression model adjusted for confounding factors. Functional assay was performed to assess the biological significance. The GA + AA genotype of a non-synonymous SNP in the exon 16 of NOS2 (rs2297518: G>A) was significantly associated with increased susceptibility to septic shock compared with GG genotype in Liaoning population (OR = 3.29, 95% CI = 1.40-7.72, P = 0.0047). This association was confirmed in the Jiangsu population (OR = 3.49, 95% CI = 1.57-7.79, P = 0.0019). Furthermore, the functional assay performed in the immortalized lymphocyte cell lines indicated that the at-risk GA genotype had a tendency of higher NOS2 activity than the GG genotype (P = 0.32). Our findings suggest that the NOS2 rs2297518 may play a role in mediating the susceptibility to septic shock in patients with sepsis in Chinese populations.

Changes in quality of life over time--Dutch haemodialysis patients and general population compared.

PubMed

Mazairac, Albert H A; de Wit, G Ardine; Penne, E Lars; van der Weerd, Neelke C; de Jong, Boudewijn; Grooteman, Muriel P C; van den Dorpel, Marinus A; Buskens, Erik; Dekker, Friedo W; Nubé, Menso J; Ter Wee, Piet M; Boeschoten, Els W; Bots, Michiel L; Blankestijn, Peter J

2011-06-01

Improving the health-related quality of life (HRQOL) for haemodialysis patients is a considerable challenge. The aim of the present study was to compare changes in HRQOL in haemodialysis patients with those observed in the general population over a 10-year period and explore factors that might explain possible differences. We compared 126 haemodialysis patients assessed in 1995 in the Netherlands Cooperative Study on the Adequacy of Dialysis-1 (NECOSAD-I) with 515 patients enrolled in 2006 in the ongoing Convective Transport Study (CONTRAST). Changes in HRQOL in these cohorts were compared with two representative samples from the general Dutch population, assessed in 1992 (n = 1,063) and 2001 (n = 10,600). HRQOL was measured with the SF-36 questionnaire. Differences in HRQOL were analysed with ANCOVA to adjust for demographic variables. To assess possible differences, we used multivariable regression analysis. HRQOL in haemodialysis patients in 2006 [CONTRAST, mean age 63 ± 14 years (SD), 62% male] was significantly better than in 1995 (NECOSAD-I, 59 ± 16 years, 53% male) in four domains of the SF-36: bodily pain (+ 5 points, P = 0.009), vitality (+ 7, P < 0.001), role-emotional (+ 14, P < 0.001) and mental health (+ 8, P < 0.001), after adjusting for demographic variables. This increment could partly be explained by improved haemoglobin and phosphate levels. Compared to the general population, HRQOL improvement was most outspoken in two domains: bodily pain (+ 6, P = 0.01) and role-emotional (+ 8, P = 0.007). This study showed an improvement of HRQOL in haemodialysis patients over an 11-year period of time, independent of global changes in the general population.

Characterization of the CPAP-treated patient population in Catalonia

PubMed Central

Gavaldá, Ricard; Teixidó, Ivan; Woehrle, Holger; Rué, Montserrat; Solsona, Francesc; Escarrabill, Joan; Colls, Cristina; García-Altés, Anna; de Batlle, Jordi; Sánchez de-la-Torre, Manuel

2017-01-01

There are different phenotypes of obstructive sleep apnoea (OSA), many of which have not been characterised. Identification of these different phenotypes is important in defining prognosis and guiding the therapeutic strategy. The aim of this study was to characterise the entire population of continuous positive airway pressure (CPAP)-treated patients in Catalonia and identify specific patient profiles using cluster analysis. A total of 72,217 CPAP-treated patients who contacted the Catalan Health System (CatSalut) during the years 2012 and 2013 were included. Six clusters were identified, classified as “Neoplastic patients” (Cluster 1, 10.4%), “Metabolic syndrome patients” (Cluster 2, 27.7%), “Asthmatic patients” (Cluster 3, 5.8%), “Musculoskeletal and joint disorder patients” (Cluster 4, 10.3%), “Patients with few comorbidities” (Cluster 5, 35.6%) and “Oldest and cardiac disease patients” (Cluster 6, 10.2%). Healthcare facility use and mortality were highest in patients from Cluster 1 and 6. Conversely, patients in Clusters 2 and 4 had low morbidity, mortality and healthcare resource use. Our findings highlight the heterogeneity of CPAP-treated patients, and suggest that OSA is associated with a different prognosis in the clusters identified. These results suggest the need for a comprehensive and individualised approach to CPAP treatment of OSA. PMID:28934303

Feature selection for wearable smartphone-based human activity recognition with able bodied, elderly, and stroke patients.

PubMed

Capela, Nicole A; Lemaire, Edward D; Baddour, Natalie

2015-01-01

Human activity recognition (HAR), using wearable sensors, is a growing area with the potential to provide valuable information on patient mobility to rehabilitation specialists. Smartphones with accelerometer and gyroscope sensors are a convenient, minimally invasive, and low cost approach for mobility monitoring. HAR systems typically pre-process raw signals, segment the signals, and then extract features to be used in a classifier. Feature selection is a crucial step in the process to reduce potentially large data dimensionality and provide viable parameters to enable activity classification. Most HAR systems are customized to an individual research group, including a unique data set, classes, algorithms, and signal features. These data sets are obtained predominantly from able-bodied participants. In this paper, smartphone accelerometer and gyroscope sensor data were collected from populations that can benefit from human activity recognition: able-bodied, elderly, and stroke patients. Data from a consecutive sequence of 41 mobility tasks (18 different tasks) were collected for a total of 44 participants. Seventy-six signal features were calculated and subsets of these features were selected using three filter-based, classifier-independent, feature selection methods (Relief-F, Correlation-based Feature Selection, Fast Correlation Based Filter). The feature subsets were then evaluated using three generic classifiers (Naïve Bayes, Support Vector Machine, j48 Decision Tree). Common features were identified for all three populations, although the stroke population subset had some differences from both able-bodied and elderly sets. Evaluation with the three classifiers showed that the feature subsets produced similar or better accuracies than classification with the entire feature set. Therefore, since these feature subsets are classifier-independent, they should be useful for developing and improving HAR systems across and within populations.

Feature Selection for Wearable Smartphone-Based Human Activity Recognition with Able bodied, Elderly, and Stroke Patients

PubMed Central

2015-01-01

Human activity recognition (HAR), using wearable sensors, is a growing area with the potential to provide valuable information on patient mobility to rehabilitation specialists. Smartphones with accelerometer and gyroscope sensors are a convenient, minimally invasive, and low cost approach for mobility monitoring. HAR systems typically pre-process raw signals, segment the signals, and then extract features to be used in a classifier. Feature selection is a crucial step in the process to reduce potentially large data dimensionality and provide viable parameters to enable activity classification. Most HAR systems are customized to an individual research group, including a unique data set, classes, algorithms, and signal features. These data sets are obtained predominantly from able-bodied participants. In this paper, smartphone accelerometer and gyroscope sensor data were collected from populations that can benefit from human activity recognition: able-bodied, elderly, and stroke patients. Data from a consecutive sequence of 41 mobility tasks (18 different tasks) were collected for a total of 44 participants. Seventy-six signal features were calculated and subsets of these features were selected using three filter-based, classifier-independent, feature selection methods (Relief-F, Correlation-based Feature Selection, Fast Correlation Based Filter). The feature subsets were then evaluated using three generic classifiers (Naïve Bayes, Support Vector Machine, j48 Decision Tree). Common features were identified for all three populations, although the stroke population subset had some differences from both able-bodied and elderly sets. Evaluation with the three classifiers showed that the feature subsets produced similar or better accuracies than classification with the entire feature set. Therefore, since these feature subsets are classifier-independent, they should be useful for developing and improving HAR systems across and within populations. PMID:25885272

Population Pharmacokinetics of Ceftizoxime Administered by Continuous Infusion in Clinically Ill Adult Patients

PubMed Central

Facca, Bryan; Frame, Bill; Triesenberg, Steve

1998-01-01

Ceftizoxime is a widely used beta-lactam antimicrobial agent, but pharmacokinetic data for use with clinically ill patients are lacking. We studied the population pharmacokinetics of ceftizoxime in 72 clinically ill patients at a community-based, university-affiliated hospital. A population pharmacokinetic model for ceftizoxime was created by using a prospective observational design. Ceftizoxime was administered by continuous infusion to treat patients with proven or suspected bacterial infections. While the patients were receiving infusions of ceftizoxime, serum samples were collected for pharmacokinetic analysis with the nonlinear mixed-effect modeling program NONMEM. In addition to clearance and volume of distribution, various comorbidities were examined for their influence on the kinetics. All 72 subjects completed the study, and 114 serum samples were collected. Several demographic and comorbidity variables, namely, age, weight, serum creatinine levels, congestive heart failure, and long-term ventilator dependency, had a significant impact on the estimate for ceftizoxime clearance. A mixture model, or two populations for estimation of ceftizoxime clearance, was discovered. One population presented with an additive clearance component of 1.6 liters per h. In addition, a maximizer function for serum creatinine levels was found. In summary, two models for ceftizoxime clearance, mixture and nonmixture, were found and are presented. Clearance for ceftizoxime can be estimated with commonly available clinical information and the models presented. From the clearance estimates, the dose of ceftizoxime to maintain the desired concentration in serum can be determined. Work is needed to validate the model for drug clearance and to evaluate its predictive performance. PMID:9661021

[Stigmatizing Attitudes towards Cancer Patients--Results of a Representative Population Survey].

PubMed

Ernst, Jochen; Brähler, Elmar; Hinz, Andreas; Friedrich, Michael; Lehmann-Laue, Antje; Mehnert, Anja; Weißflog, Gregor

2016-03-01

To investigate stigmatizing attitudes towards cancer patients in the general population and to examine their association with socio-structural characteristics and perceived causes of disease. We recruited a representative sample from the German general population (n=2420; mean age: 52 years; 54% women). Stigmatizing attitudes were assessed with a 9-item scale. Predictors of stigmatizing attitudes were identified using a regression analysis. Agreement with stigmatization items ranged from 3.6% (item: work together with a cancer patient) to 18.9% (item: use the same dishes as a cancer patient). Perceived causes of disease with a high levels of personal responsibility showed only weak correlations with stigmatizing attitudes (all r<0.31) and were partially statistical significant (e. g. food intake) or not significant (e. g. alcohol). The strongest predictors of stigmatizing attitudes were lack of cancer-related experiences (Beta=-0,26), age <60 years (Beta=0,1) and the assumption that one cannot protect oneself from cancer (Beta=0,11) (all p<0.001). Further predictors were male gender and living in rural area (p<0.01). The results demonstrate a need for further research and the development of valid methodological instruments to assess stigmatization towards cancer patients. © Georg Thieme Verlag KG Stuttgart · New York.

Physical activity in patients with advanced-stage cancer: a systematic review of the literature.

PubMed

Albrecht, Tara A; Taylor, Ann Gill

2012-06-01

The importance of physical activity for chronic disease prevention and management has become generally well accepted. The number of research interventions and publications examining the benefits of physical activity for patients with cancer has been rising steadily. However, much of that research has focused on the impact of physical activity either prior to or early in the cancer diagnosis, treatment, and survivorship process. Research focusing on the effects of physical activity, specifically for patients with advanced-stage cancer and poorer prognostic outcomes, has been addressed only recently. The purpose of this article is to examine the state of the science for physical activity in the advanced-stage disease subset of the cancer population. Exercise in a variety of intensities and forms, including yoga, walking, biking, and swimming, has many health benefits for people, including those diagnosed with cancer. Research has shown that, for people with cancer (including advanced-stage cancer), exercise can decrease anxiety, stress, and depression while improving levels of pain, fatigue, shortness of breath, constipation, and insomnia. People diagnosed with cancer should discuss with their oncologist safe, easy ways they can incorporate exercise into their daily lives.

Association between a catechol-o-methyltransferase polymorphism and obsessive-compulsive disorder in the Afrikaner population.

PubMed

Niehaus, D J; Kinnear, C J; Corfield, V A; du Toit, P L; van Kradenburg, J; Moolman-Smook, J C; Weyers, J B; Potgieter, A; Seedat, S; Emsley, R A; Knowles, J A; Brink, P A; Stein, D J

2001-06-01

It has been proposed that the catechol-o-methyl transferase gene (COMT) may play a role in the pathogenesis of obsessive-compulsive disorder (OCD). Whereas studies in a North American population showed that the low activity (L) allele of a functional polymorphism in COMT was associated with OCD in male patients, this result was not supported by studies in a Japanese population. The present association study assessed the risk for OCD conferred by this COMT polymorphism in a geographically different patient group, namely, the relatively genetically homogeneous Afrikaner population of South Africa. Fifty-four unrelated OCD patients and fifty-four sex-matched controls were recruited from the same Afrikaner community. Patients and controls were phenotyped (DSM-IV) and genotyped for a NlaIII polymorphism with H (high activity) or L (low activity) alleles in the COMT gene. The H/L genotype was significantly more common than expected in the OCD patient group (P = 0.0017). Replication studies with related individuals may be useful in discovering factors underpinning the H/L genotype abundance in the Afrikaner population. These results emphasise the need for further studies in genetically homogeneous populations to help define the complex etiology of this disease.

Development of a scale to assess cancer stigma in the non-patient population

PubMed Central

2014-01-01

Background Illness-related stigma has attracted considerable research interest, but few studies have specifically examined stigmatisation of cancer in the non-patient population. The present study developed and validated a Cancer Stigma Scale (CASS) for use in the general population. Methods An item pool was developed on the basis of previous research into illness-related stigma in the general population and patients with cancer. Two studies were carried out. The first study used Exploratory factor analysis to explore the structure of items in a sample of 462 postgraduate students recruited through a London university. The second study used Confirmatory factor analysis to confirm the structure among 238 adults recruited through an online market research panel. Internal reliability, test-retest reliability and construct validity were also assessed. Results Exploratory factor analysis suggested six subscales, representing: Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility and Financial Discrimination. Confirmatory factor analysis confirmed this structure with a 25-item scale. All subscales showed adequate to good internal and test-retest reliability in both samples. Construct validity was also good, with mean scores for each subscale varying in the expected directions by age, gender, experience of cancer, awareness of lifestyle risk factors for cancer, and social desirability. Means for the subscales were consistent across the two samples. Conclusions These findings highlight the complexity of cancer stigma and provide the Cancer Stigma Scale (CASS) which can be used to compare populations, types of cancer and evaluate the effects of interventions designed to reduce cancer stigma in non-patient populations. PMID:24758482

Development of a scale to assess cancer stigma in the non-patient population.

PubMed

Marlow, Laura A V; Wardle, Jane

2014-04-23

Illness-related stigma has attracted considerable research interest, but few studies have specifically examined stigmatisation of cancer in the non-patient population. The present study developed and validated a Cancer Stigma Scale (CASS) for use in the general population. An item pool was developed on the basis of previous research into illness-related stigma in the general population and patients with cancer. Two studies were carried out. The first study used Exploratory factor analysis to explore the structure of items in a sample of 462 postgraduate students recruited through a London university. The second study used Confirmatory factor analysis to confirm the structure among 238 adults recruited through an online market research panel. Internal reliability, test-retest reliability and construct validity were also assessed. Exploratory factor analysis suggested six subscales, representing: Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility and Financial Discrimination. Confirmatory factor analysis confirmed this structure with a 25-item scale. All subscales showed adequate to good internal and test-retest reliability in both samples. Construct validity was also good, with mean scores for each subscale varying in the expected directions by age, gender, experience of cancer, awareness of lifestyle risk factors for cancer, and social desirability. Means for the subscales were consistent across the two samples. These findings highlight the complexity of cancer stigma and provide the Cancer Stigma Scale (CASS) which can be used to compare populations, types of cancer and evaluate the effects of interventions designed to reduce cancer stigma in non-patient populations.

Relationship between physical activity and depression and anxiety symptoms: a population study.

PubMed

De Mello, Marco Tulio; Lemos, Valdir de Aquino; Antunes, Hanna Karen Moreira; Bittencourt, Lia; Santos-Silva, Rogerio; Tufik, Sergio

2013-07-01

There are few studies evaluating the association between practice of physical activity and mood in a population sample. This study evaluated the frequency of symptoms of depression and anxiety in the population of the city of Sao Paulo and their association with the report of practice of regular physical activity. This survey was conducted with the adult population of Sao Paulo between July and December of 2007. The sample was composed of 1042 volunteers (both genders) with a mean age of 41.9±14.4 years. The volunteers were evaluated using the Beck Depression Inventory, the Beck Anxiety Inventory, and two simple questions designed to evaluate and classify physical activity. Socioeconomic status was also determined according to Brazil's Economic Classification Criterion. People who do not engage in physical activity are two times more likely to exhibit symptoms of depression (PR: 2.1) and anxiety (PR: 2.5) compared with those who regularly practice physical activity and a higher prevalence of symptoms for anxiety (9.8%) and depression (10.9%) was observed among those claiming to not practice regular physical activity and 63.2% related did not practice any physical activity regularly. Altogether, these results suggest that people who do not practice physical activity have a higher chance of exhibiting symptoms of depression and anxiety when compared to those who perform physical activity regularly. In this sense, regular physical activity must be encouraged, and this incentive should be routine in both current and future public health policies. Although the methodology in the present study does not allow assigning a relation of cause and effect, we observed associations between symptoms of depression, anxiety and physical activity. Copyright © 2013 Elsevier B.V. All rights reserved.

Cross-cultural validation of the parent-patient activation measure in low income Spanish- and English-speaking parents.

PubMed

DeCamp, Lisa Ross; Leifheit, Kathryn; Shah, Harita; Valenzuela-Araujo, Doris; Sloand, Elizabeth; Polk, Sarah; Cheng, Tina L

2016-12-01

(1) To measure healthcare activation among low-income parents by language (English/Spanish); and (2) to assess the psychometrics of the Parent-Patient Activation Measure (P-PAM) in the study population. We surveyed parents/guardians of publicly-insured children who were established patients at a pediatrics clinic for ≥6months. Surveys included the Parent-Patient Activation Measure (P-PAM), a 13-item measure adapted from the well-validated Patient Activation Measure (PAM). Of 316 surveys, 68% were completed in Spanish. Mean activation score in the English-language survey group was 79.1 (SD 16.2); mean score in the Spanish-language group was 70.7 (SD 17.9) (p<0.001). Scale reliability was high (English α=0.90; Spanish α=0.93). The P-PAM had acceptable test-retest reliability, but no previously reported PAM factor structure fit the study data adequately for either language. Healthcare activation among low-income parents was greater for parents surveyed in English compared with those surveyed in Spanish. The P-PAM has acceptable reliability and validity in English and Spanish, but a different factor structure than the PAM. Activation as measured by the P-PAM may not have the same associations with or impact on health/healthcare outcomes in pediatrics compared with adults owing to possible measure differences between the P-PAM and PAM. Published by Elsevier Ireland Ltd.

Acute Moderate Exercise Does Not Further Alter the Autonomic Nervous System Activity in Patients with Sickle Cell Anemia

PubMed Central

Waltz, Xavier; Sinnapah, Stéphane; Lemonne, Nathalie; Etienne-Julan, Maryse; Soter, Valérie; Hue, Olivier; Hardy-Dessources, Marie-Dominique; Barthélémy, Jean-Claude; Connes, Philippe

2014-01-01

A decreased global autonomic nervous system (ANS) activity and increased sympathetic activation in patients with sickle cell anemia (SCA) seem to worsen the clinical severity and could play a role in the pathophysiology of the disease, notably by triggering vaso-occlusive crises. Because exercise challenges the ANS activity in the general population, we sought to determine whether a short (<15 min) and progressive moderate exercise session conducted until the first ventilatory threshold had an effect on the ANS activity of a group of SCA patients and a group of healthy individuals (CONT group). Temporal and spectral analyses of the nocturnal heart rate variability were performed before and on the 3 nights following the exercise session. Standard deviation of all normal RR intervals (SDNN), total power, low frequencies (LF) and high frequencies powers (HF) were lower but LF/HF was higher in SCA patients than in the CONT group. Moderate exercise did not modify ANS activity in both groups. In addition, no adverse clinical events occurred during the entire protocol. These results imply that this kind of short and moderate exercise is not detrimental for SCA patients. PMID:24740295

The relationship of quality of life and distress in prostate cancer patients compared to the general population

PubMed Central

Zenger, Markus; Lehmann-Laue, Antje; Stolzenburg, Jens-Uwe; Schwalenberg, Thilo; Ried, Alexander; Hinz, Andreas

2010-01-01

Background: The aim of this study is two-fold. The first part compares quality of life (QoL) data of prostate cancer patients with those of a representative and age-specific sample of the general population and analyzes the influence of cancer related as well as socio-demographic parameters on QoL. Secondly, differences in QoL depending on the experienced psychological distress will be shown both in prostate cancer patients and in the general population. Material and Methods: A sample of 265 prostate cancer patients completed both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale (HADS) during their stay in the hospital. A total HADS cut off score of 15 was used to indicate psychological distress and significant emotional concerns in patients and men of the general population. The results of the patients were compared with those of the general population (N=444). Results: Prostate cancer patients reported significantly worse levels of social and emotional functioning as well as more symptoms like insomnia, constipation and diarrhea compared to the general population. Patients and men of the general population with a total HADS score ≥15 reported lower QoL in all sub-scales except for diarrhea in comparison to people without distress. Discussion: Psychological distress is accompanied by lower QoL and therefore should be taken into consideration when QoL is assessed. Furthermore, clinicians should be trained by professionals to detect distress in their patients and to pay more attention to their emotional concerns, which are strongly associated with the patients’ well-being and QoL during their stay in hospital. PMID:20628652

Incidence of fractures among epilepsy patients: a population-based retrospective cohort study in the General Practice Research Database.

PubMed

Souverein, Patrick C; Webb, David J; Petri, Hans; Weil, John; Van Staa, Tjeerd P; Egberts, Toine

2005-02-01

To compare the incidence of various fractures in a cohort of patients with epilepsy with a reference cohort of patients not having epilepsy. Patients were included in the epilepsy cohort if they had at least one diagnosis of epilepsy in their medical history and had sufficient evidence of "active" epilepsy (use of antiepileptic drugs, diagnoses) after the practice was included in the General Practice Research Database (GPRD). Two reference patients were sampled for each patient with epilepsy from the same practice. Primary outcome was the occurrence of any fracture during follow-up. Poisson regression analysis was used to estimate incidence density ratios (IDRs). The study population comprised 40,485 and 80,970 patients in the epilepsy and reference cohorts, respectively. The median duration of follow-up was approximately 3 years. The overall incidence rate in the epilepsy cohort was 241.9 per 10,000 person-years. This rate was about twice as high as that in reference cohort: age- and sex-adjusted IDR, 1.89 (95% CI, 1.81-1.98). When comparing IDRs among the different groups of fractures, the highest relative-risk estimate was found for hip and femur fractures (adjusted IDR, 2.79; 95% CI, 2.41-3.24). IDRs were consistently elevated across age and sex groups and across fracture subtypes. The overall risk of fractures was nearly twice as high among patients with epilepsy compared with the general population. The relative fracture risk was highest for hip and femur. Further study is necessary to elucidate whether this elevated risk is due to the disease, the use of antiepileptic drugs, or both.

Cost-effectiveness of population-level physical activity interventions: a systematic review.

PubMed

Laine, Johanna; Kuvaja-Köllner, Virpi; Pietilä, Eija; Koivuneva, Mikko; Valtonen, Hannu; Kankaanpää, Eila

2014-01-01

This systematic review synthesizes the evidence on the cost-effectiveness of population-level interventions to promote physical activity. A systematic literature search was conducted between May and August 2013 in four databases: PubMed, Scopus, Web of Science, and SPORTDiscus. Only primary and preventive interventions aimed at promoting and maintaining physical activity in wide population groups were included. An economic evaluation of both effectiveness and cost was required. Secondary interventions and interventions targeting selected population groups or focusing on single individuals were excluded. Interventions were searched for in six different categories: (1) environment, (2) built environment, (3) sports clubs and enhanced access, (4) schools, (5) mass media and community-based, and (6) workplace. The systematic search yielded 2058 articles, of which 10 articles met the selection criteria. The costs of interventions were converted to costs per person per day in 2012 U.S. dollars. The physical activity results were calculated as metabolic equivalent of task hours (MET-hours, or MET-h) gained per person per day. Cost-effectiveness ratios were presented as dollars per MET-hours gained. The intervention scale and the budget impact of interventions were taken into account. The most efficient interventions to increase physical activity were community rail-trails ($.006/MET-h), pedometers ($.014/MET-h), and school health education programs ($.056/MET-h). Improving opportunities for walking and biking seems to increase physical activity cost-effectively. However, it is necessary to be careful in generalizing the results because of the small number of studies. This review provides important information for decision makers.

Clinical research in small genomically stratified patient populations.

PubMed

Martin-Liberal, J; Rodon, J

2017-07-01

The paradigm of early drug development in cancer is shifting from 'histology-oriented' to 'molecularly oriented' clinical trials. This change can be attributed to the vast amount of tumour biology knowledge generated by large international research initiatives such as The Cancer Genome Atlas (TCGA) and the use of next generation sequencing (NGS) techniques developed in recent years. However, targeting infrequent molecular alterations entails a series of special challenges. The optimal molecular profiling method, the lack of standardised biological thresholds, inter- and intra-tumor heterogeneity, availability of enough tumour material, correct clinical trials design, attrition rate, logistics or costs are only some of the issues that need to be taken into consideration in clinical research in small genomically stratified patient populations. This article examines the most relevant challenges inherent to clinical research in these populations. Moreover, perspectives from the Academia point of view are reviewed as well as initiatives to be taken in forthcoming years. Copyright © 2017 Elsevier Ltd. All rights reserved.

Declared and real physical activity in patients with type 2 diabetes mellitus as assessed by the International Physical Activity Questionnaire and Caltrac accelerometer monitor: a potential tool for physical activity assessment in patients with type 2 diabetes mellitus.

PubMed

Mynarski, W; Psurek, A; Borek, Z; Rozpara, M; Grabara, M; Strojek, K

2012-10-01

The aims of this study were to assess and compare declared and real volume of physical activity (PA), and to evaluate correlations of these measurements with glycemic control (HbA1c) and body mass index (BMI), in patients with type 2 diabetes mellitus (T2DM). A group of 31 (16 women and 15 men) type 2 diabetic patients treated with insulin monotherapy, from (mean age=54 ± 3.6 years, BMI=29.7 ± 4.8 kg/m(2), T2DM treatment=9 ± 8 years, HbA1c 7 ± 1%) and not professionally active (unemployed or retired) was recruited. An assessment of energy cost (EC) of their weekly PA using International Physical Activity Questionnaire (IPAQ), and an accelerometer assessment was performed. Total energy expenditure of the declared weekly PA, calculated from the IPAQ (DPA) was 2513 ± 1349 METmin/week, and 2428 ± 1348, for male and female participants, respectively (p > 0.05). EC of the real PA (RPA), registered with the accelerometer was 4552 ± 2028 kcal/week, and 4032 ± 2288 kcal/week, for males, and females, respectively. Patients who demonstrated a high DPA, based on their IPAQ score, showed a significantly higher RPA, as registered by the accelerometer (p < 0.05). HbA1c and BMI did not correlate with their PA measurements. Our findings indicate that the IPAQ may serve as a potential tool for physical activity assessment with no further requirement for more sophisticated methods. Our results suggest that habitual physical activity has no impact on glycemic control and BMI in type 2 diabetic patients. However, further studies on a larger population are needed to explore these issues. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Patient engagement with research: European population register study.

PubMed

McKevitt, Christopher; Fudge, Nina; Crichton, Siobhan; Bejot, Yannick; Daubail, Benoît; Di Carlo, Antonio; Fearon, Patricia; Kolominsky-Rabas, Peter; Sheldenkar, Anita; Newbound, Sophie; Wolfe, Charles D A

2015-12-01

Lay involvement in implementation of research evidence into practice may include using research findings to guide individual care, as well as involvement in research processes and policy development. Little is known about the conditions required for such involvement. To assess stroke survivors' research awareness, use of research evidence in their own care and readiness to be involved in research processes. Cross sectional survey of stroke survivors participating in population-based stroke registers in six European centres. The response rate was 74% (481/647). Reasons for participation in register research included responding to clinician request (56%) and to 'give something back' (19%); however, 20% were unaware that they were participating in a stroke register. Research awareness was generally low: 57% did not know the purpose of the register they had been recruited to; 73% reported not having received results from the register they took part in; 60% did not know about any research on stroke care. Few participants (7.6%) used research evidence during their consultations with a doctor. The 34% of participants who were interested in being involved in research were younger, more highly educated and already research aware. Across Europe, stroke survivors already participating in research appear ill informed about stroke research. Researchers, healthcare professionals and patient associations need to improve how research results are communicated to patient populations and research participants, and to raise awareness of the relationship between research evidence and increased quality of care. © 2014 John Wiley & Sons Ltd.

Using Commercial Activity Monitors to Measure Gait in Patients with Suspected iNPH: Implications for Ambulatory Monitoring

PubMed Central

Gaglani, Shiv; Haynes, M Ryan; Hoffberger, Jamie B; Rigamonti, Daniele

2015-01-01

Objectives: This study seeks to validate the use of activity monitors to detect and record gait abnormalities, potentially identifying patients with idiopathic normal pressure hydrocephalus (iNPH) prior to the onset of cognitive or urinary symptoms. Methods: This study compared the step counts of four common activity monitors (Omron Step Counter HJ-113, New Lifestyles 2000, Nike Fuelband, and Fitbit Ultra) to an observed step count in 17 patients with confirmed iNPH. Results: Of the four devices, the Fitbit Ultra (Fitbit, Inc., San Francisco, CA) provided the most accurate step count. The correlation with the observed step count was significantly higher (p<0.009) for the Fitbit Ultra than for any of the other three devices. Conclusions: These preliminary findings suggest that existing activity monitors have variable efficacy in the iNPH patient population and that the MEMS tri-axial accelerometer and algorithm of the Fitbit Ultra provides the most accurate gait measurements of the four devices tested. PMID:26719825

Using Commercial Activity Monitors to Measure Gait in Patients with Suspected iNPH: Implications for Ambulatory Monitoring.

PubMed

Gaglani, Shiv; Moore, Jessica; Haynes, M Ryan; Hoffberger, Jamie B; Rigamonti, Daniele

2015-11-17

This study seeks to validate the use of activity monitors to detect and record gait abnormalities, potentially identifying patients with idiopathic normal pressure hydrocephalus (iNPH) prior to the onset of cognitive or urinary symptoms. This study compared the step counts of four common activity monitors (Omron Step Counter HJ-113, New Lifestyles 2000, Nike Fuelband, and Fitbit Ultra) to an observed step count in 17 patients with confirmed iNPH. Of the four devices, the Fitbit Ultra (Fitbit, Inc., San Francisco, CA) provided the most accurate step count. The correlation with the observed step count was significantly higher (p<0.009) for the Fitbit Ultra than for any of the other three devices. These preliminary findings suggest that existing activity monitors have variable efficacy in the iNPH patient population and that the MEMS tri-axial accelerometer and algorithm of the Fitbit Ultra provides the most accurate gait measurements of the four devices tested.

Venous Thromboembolism and Cerebrovascular Events in Patients with Giant Cell Arteritis: A Population-Based Retrospective Cohort Study

PubMed Central

Crowson, Cynthia S.; Makol, Ashima; Ytterberg, Steven R.; Saitta, Antonino; Salvarani, Carlo; Matteson, Eric L.; Warrington, Kenneth J.

2016-01-01

Objective To investigate the incidence of venous thromboembolism (VTE) and cerebrovascular events in a community-based incidence cohort of patients with giant cell arteritis (GCA) compared to the general population. Methods A population-based inception cohort of patients with incident GCA between January 1, 1950 and December 31, 2009 in Olmsted County, Minnesota and a cohort of non-GCA subjects from the same population were assembled and followed until December 31, 2013. Confirmed VTE and cerebrovascular events were identified through direct medical record review. Results The study population included 244 patients with GCA with a mean ± SD age at diagnosis of 76.2 ± 8.2 years (79% women) and an average length of follow-up of 10.2 ± 6.8 years. Compared to non-GCA subjects of similar age and sex, patients diagnosed with GCA had a higher incidence (%) of amaurosis fugax (cumulative incidence ± SE: 2.1 ± 0.9 versus 0, respectively; p = 0.014) but similar rates of stroke, transient ischemic attack (TIA), and VTE. Among patients with GCA, neither baseline characteristics nor laboratory parameters at diagnosis reliably predicted risk of VTE or cerebrovascular events. Conclusion In this population-based study, the incidence of VTE, stroke and TIA was similar in patients with GCA compared to non-GCA subjects. PMID:26901431

Discordance of somatic mutations between Asian and Caucasian patient populations with gastric cancer

PubMed Central

Jia, Feifei; Teer, Jamie K.; Knepper, Todd C.; Lee, Jae K.; Zhou, Hong-Hao; He, Yi-Jing; McLeod, Howard L.

2017-01-01

Background Differences in response to cancer treatments have been observed among racially and ethnically diverse gastric cancer patient populations. In the era of targeted therapy, mutation profiling of cancer is a crucial aspect of making therapeutic decisions. Mapping driver gene mutations for the gastric cancer patient population as a whole has significant potential to advance precision therapy. Methods Gastric cancer patient cases with sequencing data (total n=473) were obtained from The Cancer Genome Atlas (TCGA; n=295), Moffitt Cancer Center Total Cancer Care™ (TCC; n=33), and three published studies (n=145). Relevant somatic mutation frequency data were obtained from cBioPortal, TCC database and in-house analysis tool, and relevant publication Results We have found somatic mutation rates of several driver genes significantly vary between gastric cancer patients of Asian and Caucasian descent, with substantial variation across different geographic regions. Non-parametric statistical tests were performed to examine significant differences in protein-altering somatic mutations between Asian and Caucasian gastric cancer patient groups. Frequencies of somatic mutations of 5 genes were APC(Asian: Caucasian 6.06% vs. 14.40%, p=0.0076) ARIDIA(20.7% vs. 32.1%, p=0.01) KMT2A(4.04% vs. 12.35%, p=0.003) PIK3CA(9.6% vs. 18.52%, p=0.01) PTEN(2.52% vs. 9.05%, p=0.008), showing significant differences between Asian and Caucasian gastric cancer patients. Conclusions Our study has found significant differences in protein-altering somatic mutation frequencies in diverse geographic populations. In particular, we found that the somatic patterns may offer better insight and important opportunities for both targeted drug development and precision therapeutic strategies between Asian and Caucasian gastric cancer patients. PMID:28039579

Discordance of Somatic Mutations Between Asian and Caucasian Patient Populations with Gastric Cancer.

PubMed

Jia, Feifei; Teer, Jamie K; Knepper, Todd C; Lee, Jae K; Zhou, Hong-Hao; He, Yi-Jing; McLeod, Howard L

2017-04-01

Differences in response to cancer treatments have been observed among racially and ethnically diverse gastric cancer (GC) patient populations. In the era of targeted therapy, mutation profiling of cancer is a crucial aspect of making therapeutic decisions. Mapping driver gene mutations for the GC patient population as a whole has significant potential to advance precision therapy. GC patients with sequencing data (N = 473) were obtained from The Cancer Genome Atlas (TCGA; n = 295), Moffitt Cancer Center Total Cancer Care™ (TCC; n = 33), and three published studies (n = 145). In addition, relevant somatic mutation frequency data were obtained from cBioPortal, the TCC database, and an in-house analysis tool, as well as relevant publications. We found that the somatic mutation rates of several driver genes vary significantly between GC patients of Asian and Caucasian descent, with substantial variation across different geographic regions. Non-parametric statistical tests were performed to examine the significant differences in protein-altering somatic mutations between Asian and Caucasian GC patient groups. The frequencies of somatic mutations of five genes were: APC (Asian: Caucasian 6.06 vs. 14.40%, p = 0.0076), ARIDIA (20.7 vs. 32.1%, p = 0.01), KMT2A (4.04 vs. 12.35%, p = 0.003), PIK3CA (9.6 vs. 18.52%, p = 0.01), and PTEN (2.52 vs. 9.05%, p = 0.008), showing significant differences between Asian and Caucasian GC patients. Our study found significant differences in protein-altering somatic mutation frequencies in diverse geographic populations. In particular, we found that the somatic patterns may offer better insight and important opportunities for both targeted drug development and precision therapeutic strategies between Asian and Caucasian GC patients.

Physical activity and quality of life in long-term hospitalized patients with severe mental illness: a cross-sectional study.

PubMed

Deenik, Jeroen; Kruisdijk, Frank; Tenback, Diederik; Braakman-Jansen, Annemarie; Taal, Erik; Hopman-Rock, Marijke; Beekman, Aartjan; Tak, Erwin; Hendriksen, Ingrid; van Harten, Peter

2017-08-18

Increasing physical activity in patients with severe mental illness is believed to have positive effects on physical health, psychiatric symptoms and as well quality of life. Till now, little is known about the relationship between physical activity and quality of life in long-term hospitalized patients with severe mental illness and knowledge of the determinants of behavioural change is lacking. The purpose of this study was to elucidate the relationship between objectively measured physical activity and quality of life, and explore modifiable psychological determinants of change in physical activity in long-term hospitalized patients with severe mental illness. In 184 inpatients, physical activity was measured using an accelerometer (ActiGraph GTX+). Quality of life was assessed by EuroQol-5D and WHOQol-Bref. Attitude and perceived self-efficacy towards physical activity were collected using the Physical Activity Enjoyment Scale and the Multidimensional Self Efficacy Questionnaire, respectively. Patient and disease characteristics were derived retrospectively from electronic patient records. Associations and potential predictors were analysed using hierarchical regression. Physical activity was positively related with and a predictor of all quality of life outcomes except on the environmental domain, independent of patient and disease characteristics. However, non-linear relationships showed that most improvement in quality of life lies in the change from sedentary to light activity. Attitude and self-efficacy were not related to physical activity. Physical activity is positively associated with quality of life, especially for patients in the lower spectrum of physical activity. An association between attitude and self-efficacy and physical activity was absent. Therefore, results suggest the need of alternative, more integrated and (peer-)supported interventions to structurally improve physical activity in this inpatient population. Slight changes from sedentary

Quality of life in elderly patients with an ostomy - a study from the population-based PROFILES registry.

PubMed

Verweij, N M; Bonhof, C S; Schiphorst, A H W; Maas, H A; Mols, F; Pronk, A; Hamaker, M E

2018-04-01

Ostomies are being placed frequently in surgically treated elderly patients with colorectal cancer (CRC). An insight into the (potential) impact of ostomies on quality of life (QoL) could be useful in patient counselling as well as in the challenging shared treatment decision-making. Patients with CRC diagnosed between 2000 and 2009 and registered in the population-based Eindhoven Cancer Registry received a QoL questionnaire (EORTC QLQ-C30) in 2010. In addition, QoL was compared with an age- and sex-matched normative population. The study included 2299 CRC patients, of whom 494 had an ostomy. No differences were found in reported ostomy-related problems between patients aged ≤65, 66-75 and ≥76 years. Ostomy patients aged 66-75 and ≥76 years reported significantly lower physical functioning compared with those without an ostomy. In the elderly (those aged ≥76 years) ostomates reported a worse physical and social functioning compared with the normative population. All these differences were of small clinical relevance. The impact of an ostomy seems to be more prominent in younger (≤75 years old) ostomates, as they experience more functional limitations and a decrease in global health status compared with younger nonostomy patients and the normative population. Although elderly (≥76 years old) patients with an ostomy report significantly more limitations in functioning compared with a normative population and elderly CRC patients without an ostomy, the clinical relevance of this finding is limited. In contrast, the impact of an ostomy is more prominent in younger patients. Thus, age itself is not a reason for withholding an ostomy. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

Some Chronic Rhinosinusitis Patients Have Significantly Elevated Populations of Seven Fungi in their Sinuses

EPA Science Inventory

Abstract: Objectives/Hypothesis: To measure the populations of 36 fungi in the homes and sinuses of chronic rhinosinusitis (CRS) and non-CRS patients. Study Design: Single-blind cross-sectional study. Methods: Populations of 36 fungi were measured in sinus samples and in the home...

Population pharmacokinetic modeling of furosemide in patients with hypertension and fluid overload conditions.

PubMed

Kodati, Devender; Yellu, Narsimhareddy

2017-06-01

Furosemide is a loop diuretic drug frequently indicated in hypertension and fluid overload conditions such as congestive heart failure and hepatic cirrhosis. The purpose of the study was to establish a population pharmacokinetic model for furosemide in Indian hypertensive and fluid overload patients, and to evaluate effects of covariates on the volume of distribution (V/F) and oral clearance (CL/F) of furosemide. A total of 188 furosemide plasma sample concentrations from 63 patients with hypertension or fluid overload conditions were collected in this study. The population pharmacokinetic model for furosemide was built using Phoenix NLME 1.3 software. The covariates included age, sex, body surface area, bodyweight, height and creatinine clearance (CRCL). The pharmacokinetic data of furosemide was adequately explained by a two-compartment linear pharmacokinetic model with first-order absorption and an absorption lag-time. The mean values of CL/F and Vd/F of furosemide in the patients were 15.054Lh -1 and 4.419L, respectively. Analysis of covariates showed that CRCL was significantly influencing the clearance of furosemide. The final population pharmacokinetic model was demonstrated to be appropriate and effective and it can be used to assess the pharmacokinetic parameters of furosemide in Indian patients with hypertension and fluid overload conditions. Copyright © 2017. Published by Elsevier Urban & Partner Sp. z o.o.

Prefrontal cortex activity during swallowing in dysphagia patients.

PubMed

Lee, Jun; Yamate, Chisato; Taira, Masato; Shinoda, Masamichi; Urata, Kentaro; Maruno, Mitsuru; Ito, Reio; Saito, Hiroto; Gionhaku, Nobuhito; Iinuma, Toshimitsu; Iwata, Koichi

2018-05-24

Prefrontal cortex activity is modulated by flavor and taste stimuli and changes during swallowing. We hypothesized that changes in the modulation of prefrontal cortex activity by flavor and taste were associated with swallowing movement and evaluated brain activity during swallowing in patients with dysphagia. To evaluate prefrontal cortex activity in dysphagia patients during swallowing, change in oxidized hemoglobin (z-score) was measured with near-infrared spectroscopy while dysphagia patients and healthy controls swallowed sweetened/unsweetened and flavored/unflavored jelly. Total z-scores were positive during swallowing of flavored/unsweetened jelly and negative during swallowing of unflavored/sweetened jelly in controls but negative during swallowing of sweetened/unsweetened and flavored/unflavored jelly in dysphagia patients. These findings suggest that taste and flavor during food swallowing are associated with positive and negative z-scores, respectively. Change in negative and positive z-scores may be useful in evaluating brain activity of dysphagia patients during swallowing of sweetened and unsweetened food.

The prevalence and determinants of active tuberculosis among diabetes patients in Cape Town, South Africa, a high HIV/TB burden setting.

PubMed

Berkowitz, Natacha; Okorie, Adaeze; Goliath, Rene; Levitt, Naomi; Wilkinson, Robert J; Oni, Tolu

2018-04-01

Studies addressing the association between diabetes mellitus (DM) and tuberculosis (TB) in sub-Saharan Africa are limited. We assessed the prevalence of active TB among DM patients at a primary care clinic, and identified risk factors for prevalent TB. A cross-sectional study was conducted in adult DM patients attending a clinic in Khayelitsha, Cape Town. Participants were screened for active TB (symptom screening and microbiological diagnosis) and HIV. Among 440 DM patients screened, the active TB prevalence was 3.0% (95% CI 1.72-5.03). Of the 13 prevalent TB cases, 53.9% (n = 7; 95% CI 27.20-78.50) had no TB symptoms, and 61.5% (n = 8; 95% CI 33.30-83.70) were HIV-1 co-infected. There were no significant differences in either fasting plasma glucose or HbA 1c levels between TB and non-TB participants. On multivariate analysis, HIV-1 infection (OR 11.3, 95% CI 3.26-39.42) and hemoptysis (OR 31.4, 95% CI 3.62-273.35) were strongly associated with prevalent active TB, with no differences in this association by age or gender. The prevalence of active TB among DM patients was 4-fold higher than the national prevalence; suggesting the need for active TB screening, particularly if hemoptysis is reported. Our results highlight the importance of HIV screening in this older population group. The high prevalence of sub-clinical TB among those diagnosed with TB highlights the need for further research to determine how best to screen for active TB in high-risk TB/HIV population groups and settings. Copyright © 2018. Published by Elsevier B.V.

Assessment of clinical manifestations, disease activity and organ damage in 996 Korean patients with systemic lupus erythematosus: comparison with other Asian populations.

PubMed

Joo, Young Bin; Bae, Sang Cheol

2015-02-01

To describe the clinical manifestations, disease activity and organ damage in Korean patients with systemic lupus erythematosus (SLE). American College of Rheumatology (ACR) criteria, SLE Disease Activity Index (SLEDAI), and Systemic Lupus International Collaborating Clinics/ACR damage index (SDI) were assessed in patients with SLE from 1998 to 2012. A total of 996 SLE patients were analyzed. The common accrual of ACR criteria included: immunologic (93%), hematologic (93%), arthritic (66%) and nephritic (50%). In the inception cohort over 10 years of follow-up (n = 120), the number of ACR criteria increased significantly (5.0 ± 1.2 to 5.7 ± 1.3), and nephritis, serositis and neuropsychiatric symptoms tended to increase continuously over time. SLEDAI-2K decreased significantly (5.6 ± 3.4 to 4.1 ± 1.2), but the percentage of patients with SLEDAI scores ≥ 12 did not decrease over time. The common organ damages were musculoskeletal (14.9%) and renal (11.1%). The mean SDI score increased significantly (0.4 ± 0.8 to 1.1 ± 1.6) and renal damage had two peaks in 1 and 6-10 years, musculoskeletal and neuropsychiatric damage were predominant from 1 to 5 years, and ophthalmic damage increased sharply over 10 years. Compared to other Asian cohorts, disease activity was lower and organ damage was less in our Korean cohort. Nephritis, serositis and neuropsychiatric symptoms increased continuously over time. Overall disease activity decreased significantly, but a small portion of severe disease activity continued during the disease course. The most common organ damage was musculoskeletal. The time in organ damage development varied, which reflects the possible causality, such as disease itself and/or treatment. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Criterion validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) for use in patients with rheumatoid arthritis: comparison with the SenseWear Armband.

PubMed

Tierney, M; Fraser, A; Kennedy, N

2015-06-01

The International Physical Activity Questionnaire Short Form (IPAQ-SF) is a self-report questionnaire commonly used in patients with rheumatoid arthritis (RA) to measure physical activity. However, despite its frequent use in patients with RA, its validity has not been ascertained in this population. The aim of this study was to examine the criterion validity of energy expenditure from physical activity recorded with the IPAQ-SF in patients with RA compared with the objective criterion measure, the SenseWear Armband (SWA) which has been validated previously in this population. Cross-sectional criterion validation study. Regional hospital outpatient setting. Twenty-two patients with RA attending outpatient rheumatology clinics. Subjects wore an SWA for 7 full consecutive days and completed the IPAQ-SF. Energy expenditure from physical activity recorded by the SWA and the IPAQ-SF. Energy expenditure from physical activity recorded by the IPAQ-SF and the SWA showed a small, non-significant correlation (r=0.407, P=0.60). The IPAQ-SF underestimated energy expenditure from physical activity by 41% compared with the SWA. This was corroborated using Bland and Altman plots, as the IPAQ-SF was found to overestimate energy expenditure from physical activity in nine of the 22 individuals, and underestimate energy expenditure from physical activity in the remaining 13 individuals. The IPAQ-SF has limited use as an accurate and absolute measure for estimating energy expenditure from physical activity in patients with RA. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Bioremediation of hydrocarbon degradation in a petroleum-contaminated soil and microbial population and activity determination.

PubMed

Wu, Manli; Li, Wei; Dick, Warren A; Ye, Xiqiong; Chen, Kaili; Kost, David; Chen, Liming

2017-02-01

Bioremediation of hydrocarbon degradation in petroleum-polluted soil is carried out by various microorganisms. However, little information is available for the relationships between hydrocarbon degradation rates in petroleum-contaminated soil and microbial population and activity in laboratory assay. In a microcosm study, degradation rate and efficiency of total petroleum hydrocarbons (TPH), alkanes, and polycyclic aromatic hydrocarbons (PAH) in a petroleum-contaminated soil were determined using an infrared photometer oil content analyzer and a gas chromatography mass spectrometry (GC-MS). Also, the populations of TPH, alkane, and PAH degraders were enumerated by a modified most probable number (MPN) procedure, and the hydrocarbon degrading activities of these degraders were determined by the Biolog (MT2) MicroPlates assay. Results showed linear correlations between the TPH and alkane degradation rates and the population and activity increases of TPH and alkane degraders, but no correlation was observed between the PAH degradation rates and the PAH population and activity increases. Petroleum hydrocarbon degrading microbial population measured by MPN was significantly correlated with metabolic activity in the Biolog assay. The results suggest that the MPN procedure and the Biolog assay are efficient methods for assessing the rates of TPH and alkane, but not PAH, bioremediation in oil-contaminated soil in laboratory. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health related quality of life in patients with neuroendocrine tumors compared with the general Norwegian population.

PubMed

Haugland, Trude; Vatn, Morten H; Veenstra, Marijke; Wahl, Astrid Klopstad; Natvig, Gerd Karin

2009-08-01

Health related quality of life (HRQoL) was characterized among patients with neuroendocrine tumor (NET) and compared with the general Norwegian population. A cross sectional, comparative design was chosen, and the samples comprised 196 NET patients and 5,258 individuals from the general Norwegian population. We used Chi-square cross tab calculations to evaluate sociodemographic characteristics, T-tests for independent samples and Analysis of Variance (ANOVA) in order to compare HRQoL (SF-36) scores across a range of background variables. Furthermore, T-tests were used to analyze differences in HRQoL scores between the samples. NET patients demonstrated significantly lower on all HRQoL subscales when compared with the general population with the lowest values on general health, physical limitation and vitality. Individuals above 70 years reported lower scores on physical functioning and physical limitations compared with those who were younger. Individuals with higher levels of education reported increased physical functioning compared with those with less education and full-time or part-time workers described higher physical functioning and less physical limitations compared with those who were retired. All SF-36 HRQoL scores were significantly lower among the NET patients when compared with the general population. Assistance from health personnel to NET patients should focus on those domains.

Alterations of brain activity in fibromyalgia patients.

PubMed

Sawaddiruk, Passakorn; Paiboonworachat, Sahattaya; Chattipakorn, Nipon; Chattipakorn, Siriporn C

2017-04-01

Fibromyalgia is a chronic pain syndrome, characterized by widespread musculoskeletal pain with diffuse tenderness at multiple tender points. Despite intense investigations, the pathophysiology of fibromyalgia remains elusive. Evidence shows that it could be due to changes in either the peripheral or central nervous system (CNS). For the CNS changes, alterations in the high brain area of fibromyalgia patients have been investigated but the definite mechanisms are still unclear. Magnetic Resonance Imaging (MRI) and Functional Magnetic Resonance (fMRI) have been used to gather evidence regarding the changes of brain morphologies and activities in fibromyalgia patients. Nevertheless, due to few studies, limited knowledge for alterations in brain activities in fibromyalgia is currently available. In this review, the changes in brain activity in various brain areas obtained from reports in fibromyalgia patients are comprehensively summarized. Changes of the grey matter in multiple regions such as the superior temporal gyrus, posterior thalamus, amygdala, basal ganglia, cerebellum, cingulate cortex, SII, caudate and putamen from the MRI as well as the increase of brain activities in the cerebellum, prefrontal cortex, anterior cingulate cortex, thalamus, somatosensory cortex, insula in fMRI studies are presented and discussed. Moreover, evidence from pharmacological interventions offering benefits for fibromyalgia patients by reducing brain activity is presented. Because of limited knowledge regarding the roles of brain activity alterations in fibromyalgia, this summarized review will encourage more future studies to elucidate the underlying mechanisms involved in the brains of these patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Population pharmacokinetics and dosing simulations of imipenem in serious bacteraemia in immunocompromised patients with febrile neutropenia.

PubMed

Jaruratanasirikul, Sutep; Wongpoowarak, Wibul; Jullangkoon, Monchana; Samaeng, Maseetoh

2015-02-01

The aims of this study were to i) reveal the population pharmacokinetics; and ii) assess the probability of target attainment (PTA) and cumulative fraction of response (CFR) (defined as the expected population PTA for a specific drug dose and a specific population of microorganisms) of imipenem in febrile neutropenic patients with bacteraemia. Ten patients were randomised into two groups: Group I received a 0.5-h infusion of 0.5 g of imipenem every 6 h (q6h) for 8 doses; and Group II received a 4-h infusion of 0.5 g q6h for 8 doses. A Monte Carlo simulation was performed to determine the PTA. The volume of distribution and total clearance of imipenem were 20.78 ± 1.35 l and 23.19 ± 1.34 l/h, respectively. Only a 4-h infusion of 1 g q6h regimen achieved a PTA >93% for 80% T>MIC for a MIC of 2 μg/ml. A 4-h infusion of all simulated regimens and a 0.5-h infusion of 0.5 g q6h and 1 g q6h achieved targets (CFR ≥ 90%) against Escherichia coli and Klebsiella spp. However, against Pseudomonas aeruginosa and Acinetobacter spp., no regimens achieved their targets. In conclusion, the results indicate that a higher than manufacturer's dosage recommendation is required to maximize the activity of imipenem. Copyright © 2014 Japanese Pharmacological Society. Production and hosting by Elsevier B.V. All rights reserved.

New insights into the pharmacokinetics and metabolism of (R,S)-ifosfamide in cancer patients using a population pharmacokinetic-metabolism model.

PubMed

Di Marco, M P; Wainer, I W; Granvil, C L; Batist, G; Ducharme, M P

2000-06-01

To describe the pharmacokinetics of R- and S-Ifosfamide (IFF), and their respective 2 and 3 N-dechloroethylated (DCE) metabolites (R2-, R3-, S2, S3-DCE-IFF) in cancer patients. (R,S)-IFF was administered (1.5 g/m2) daily for 5 days in 13 cancer patients. Plasma and urine samples were collected and analyzed using an enantioselective GC-MS method. An average of 97 observations per patient were simultaneously fitted using a pharmacokinetic-metabolism (PK-MB) model. A population PK analysis was performed using an iterative 2-stage method (IT2S). Auto-induction of IFF metabolism was observed over the 5 day period. Increases were seen in IFF clearance (R: 4 vs. 7 L/h; S: 5 vs. 10 L/h), and in the formation of DCE (R: 7 vs. 9%; S: 14 vs. 19%) and active metabolites (4-OHM-IFF; R: 71 vs. 77%; S: 67 vs. 71%). A novel finding of this analysis was that the renal excretion of the DCE metabolites was also induced. This population PK-MB model for (R,S)-IFF may be useful in the optimization of patient care, and gives new insight into the metabolism of (R,S)-IFF.

Genetic Diversity in Introduced Golden Mussel Populations Corresponds to Vector Activity

PubMed Central

Ghabooli, Sara; Zhan, Aibin; Sardiña, Paula; Paolucci, Esteban; Sylvester, Francisco; Perepelizin, Pablo V.; Briski, Elizabeta; Cristescu, Melania E.; MacIsaac, Hugh J.

2013-01-01

We explored possible links between vector activity and genetic diversity in introduced populations of Limnoperna fortunei by characterizing the genetic structure in native and introduced ranges in Asia and South America. We surveyed 24 populations: ten in Asia and 14 in South America using the mitochondrial cytochrome c oxidase subunit I (COI) gene, as well as eight polymorphic microsatellite markers. We performed population genetics and phylogenetic analyses to investigate population genetic structure across native and introduced regions. Introduced populations in Asia exhibit higher genetic diversity (H E = 0.667–0.746) than those in South America (H E = 0.519–0.575), suggesting higher introduction effort for the former populations. We observed pronounced geographical structuring in introduced regions, as indicated by both mitochondrial and nuclear markers based on multiple genetic analyses including pairwise ФST, F ST, Bayesian clustering method, and three-dimensional factorial correspondence analyses. Pairwise F ST values within both Asia (F ST = 0.017–0.126, P = 0.000–0.009) and South America (F ST = 0.004–0.107, P = 0.000–0.721) were lower than those between continents (F ST = 0.180–0.319, P = 0.000). Fine-scale genetic structuring was also apparent among introduced populations in both Asia and South America, suggesting either multiple introductions of distinct propagules or strong post-introduction selection and demographic stochasticity. Higher genetic diversity in Asia as compared to South America is likely due to more frequent propagule transfers associated with higher shipping activities between source and donor regions within Asia. This study suggests that the intensity of human-mediated introduction vectors influences patterns of genetic diversity in non-indigenous species. PMID:23533614

Depression, Hopelessness and Social Support among Breast Cancer Patients: in Highly Endogamous Population

PubMed Central

Bener, Abdulbari; Alsulaiman, Reem; Doodson, Lisa; Agathangelou, Tony

2017-01-01

Aim: The aim of this study was to assess the relationship between different demographic variables, hopelessness, depression and social support of Breast cancer patients in Qatari’s population. Design: This is an observational cohort hospital based study. Subjects and Methods: The study included 678 breast cancer patients. The questionnaires included a demographic questionnaire, the Beck Hopelessness Scale (BHS), Back Depression Scale (BDS) and Multidimensional Scale of Perceived Social Support (MSPSS). The demographic questionnaire was used to assess patients’ basic information including gender, age, marital status, education, family size, and place of residence. Medical information regarding cancer stage, the time passed since diagnosis, treatment, and duration of disease were recorded. Results: The mean age of the studied women was 47.7±10.2 years. Among the studied patients, 34.7% were Qataris and 65.3% were Arab expatriates. Nearly 39.2% of the patients were in pre-menopausal status and 60.8% in post-menopausal status. 86.1% of women were married. 14.6% were illiterate women, 20.9% were university graduates and 37.2% were housewives. Smoking habit was less common in studied Arab women (9.1%), but, sheesha smoking was more common, 17.7%. Daily physical activity indicated 25.7% were walking 30 minutes per-day and 14% were walking 60 minutes per day. 30.4% of them had consanguineous parents. Breast feeding was practiced among 67.7% of women and over 73% were considered overweight and obese. Furthermore, over 75% of breast cancer women were at the Stage 3 (40.9%) and Stage 4 (35.8%) of cancer. The percentage of patients who underwent mastectomy and lumpectomy were 49.3 % and 50.7%, respectively. It was observed that 27.7% of BDI patients had moderate depression and 19.5% of the BDI patients had severe depression and with mean and standard deviation 25.1±7.7. Also, the mean and SD of BDI for consanguineous has showed statistically significant 28.4±5.7 than

Depression, Hopelessness and Social Support among Breast Cancer Patients: in Highly Endogamous Population

PubMed

Bener, Abdulbari; Alsulaiman, Reem; Doodson, Lisa; Agathangelou, Tony

2017-07-27

Aim: The aim of this study was to assess the relationship between different demographic variables, hopelessness, depression and social support of Breast cancer patients in Qatari’s population. Design: This is an observational cohort hospital based study. Subjects and Methods: The study included 678 breast cancer patients. The questionnaires included a demographic questionnaire, the Beck Hopelessness Scale (BHS), Back Depression Scale (BDS) and Multidimensional Scale of Perceived Social Support (MSPSS). The demographic questionnaire was used to assess patients’ basic information including gender, age, marital status, education, family size, and place of residence. Medical information regarding cancer stage, the time passed since diagnosis, treatment, and duration of disease were recorded. Results: The mean age of the studied women was 47.7±10.2 years. Among the studied patients, 34.7% were Qataris and 65.3% were Arab expatriates. Nearly 39.2% of the patients were in pre-menopausal status and 60.8% in post-menopausal status. 86.1% of women were married. 14.6% were illiterate women, 20.9% were university graduates and 37.2% were housewives. Smoking habit was less common in studied Arab women (9.1%), but, sheesha smoking was more common, 17.7%. Daily physical activity indicated 25.7% were walking 30 minutes per-day and 14% were walking 60 minutes per day. 30.4% of them had consanguineous parents. Breast feeding was practiced among 67.7% of women and over 73% were considered overweight and obese. Furthermore, over 75% of breast cancer women were at the Stage 3 (40.9%) and Stage 4 (35.8%) of cancer. The percentage of patients who underwent mastectomy and lumpectomy were 49.3 % and 50.7%, respectively. It was observed that 27.7% of BDI patients had moderate depression and 19.5% of the BDI patients had severe depression and with mean and standard deviation 25.1±7.7. Also, the mean and SD of BDI for consanguineous has showed statistically significant 28.4±5.7 than

ENDOCRINE ACTIVE SUBSTANCES AND DOSE-RESPONSE FOR INDIVIDUALS AND POPULATIONS

EPA Science Inventory

Endocrine Active Substances and Dose-Response for Individuals and Populations
Hugh A. Barton

Abstract for IUPAC-SCOPE article

Dose-response characteristics for endocrine disruption have been major focuses in efforts to understand potential impacts on human and ec...

Population and Activity of On-road Vehicles in MOVES2014

EPA Science Inventory

This report describes the sources and derivation for on-road vehicle population and activity information and associated adjustments as stored in the MOVES2014 default databases. Motor Vehicle Emission Simulator, the MOVES2014 model, is a set of modeling tools for estimating emiss...

Decreased CD8-p56lck activity in peripheral blood T-lymphocytes from patients with hereditary haemochromatosis.

PubMed

Arosa, F A; da Silva, A J; Godinho, I M; ter Steege, J C; Porto, G; Rudd, C E; de Sousa, M

1994-05-01

Hereditary haemochromatosis (HH) is an autosomal recessive disease linked to certain MHC class-I specificities. The disease is characterized by increased iron absorption and, in some patients, abnormally low numbers of CD8+ T cells in the periphery. We were interested in whether CD4- and CD8-associated p56lck kinase activities were altered in patients with HH. In a study of 18 patients with HH (with and without low numbers of CD8+ cells), the level of autophosphorylation of the CD8-associated p56lck as well as its phosphotransferase activity, as determined by phosphorylation of an exogenous substrate, was significantly reduced by two- to three-fold relative to a control population of 23 healthy blood donors (P < 6 x 10(-7). CD8-p56lck activity was decreased in 16 out of 18 patients (ranging from 1.5- to 10-fold decrease). By contrast, the level of CD4-p56lck activity did not show an overall decrease relative to controls. In addition to an occasional decrease in the amount of CD8-associated lck, HH patient-derived T cells showed a consistent decrease in the relative CD8-p56lck specific activity. Immunofluorescence staining showed further that the difference could not be accounted by a discrepancy in the expression of CD8 alpha alpha or CD8 alpha beta complexes or MHC class I molecules. Decreased CD8-p56lck activity was seen both in patients undergoing intensive phlebotomy treatment and in patients in maintenance therapy (i.e. patients who had reached normal levels of iron stores), indicating that this abnormality does not appear to be corrected by iron depletion. To our knowledge, this is the first demonstration of an abnormality in a src-like receptor associated kinase in a human disease state linked to MHC class-I antigens.

Personal and environmental correlates of active travel and physical activity in a deprived urban population

PubMed Central

Ogilvie, David; Mitchell, Richard; Mutrie, Nanette; Petticrew, Mark; Platt, Stephen

2008-01-01

Apart from access to local amenities, environmental characteristics may have limited influence on active travel in deprived urban populations characterised by a low level of car ownership, in which people may have less capacity for making discretionary travel choices than the populations studied in most published research on the environmental correlates of physical activity. PMID:18752663

Enhanced activity of carbohydrate- and lipid-metabolizing enzymes in insecticide-resistant populations of the maize weevil, Sitophilus zeamais.

PubMed

Araújo, R A; Guedes, R N C; Oliveira, M G A; Ferreira, G H

2008-08-01

Insecticide resistance is frequently associated with fitness disadvantages in the absence of insecticides. However, intense past selection with insecticides may allow the evolution of fitness modifier alleles that mitigate the cost of insecticide resistance and their consequent fitness disadvantages. Populations of Sitophilus zeamais with different levels of susceptibility to insecticides show differences in the accumulation and mobilization of energy reserves. These differences may allow S. zeamais to better withstand toxic compounds without reducing the beetles' reproductive fitness. Enzymatic assays with carbohydrate- and lipid-metabolizing enzymes were, therefore, carried out to test this hypothesis. Activity levels of trehalase, glycogen phosphorylase, lipase, glycosidase and amylase were determined in two insecticide-resistant populations showing (resistant cost) or not showing (resistant no-cost) associated fitness cost, and in an insecticide-susceptible population. Respirometry bioassays were also carried out with these weevil populations. The resistant no-cost population showed significantly higher body mass and respiration rate than the other two populations, which were similar. No significant differences in glycogen phosphorylase and glycosidase were observed among the populations. Among the enzymes studied, trehalase and lipase showed higher activity in the resistant cost population. The results obtained in the assays with amylase also indicate significant differences in activity among the populations, but with higher activity in the resistant no-cost population. The inverse activity trends of lipases and amylases in both resistant populations, one showing fitness disadvantage without insecticide exposure and the other not showing it, may underlay the mitigation of insecticide resistance physiological costs observed in the resistant no-cost population. The higher amylase activity observed in the resistant no-cost population may favor energy storage

Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population.

PubMed

Raich, Peter C; Whitley, Elizabeth M; Thorland, William; Valverde, Patricia; Fairclough, Diane

2012-10-01

Barriers to timely resolution of abnormal cancer screening tests add to cancer health disparities among low-income, uninsured, and minority populations. We conducted a randomized trial to evaluate the impact of lay patient navigators on time to resolution and completion of follow-up testing among patients with abnormal screening tests in a medically underserved patient population. Denver Health, the safety-net health care system serving Denver, is one of 10 performance sites participating in the Patient Navigation Research Program. Of 993 eligible subjects with abnormal screening tests randomized to navigation and no-navigation (control) arms and analyzed, 628 had abnormal breast screens (66 abnormal clinical breast examinations, 304 BIRADS 0, 200 BIRADS 3, 58 BIRADS 4 or 5) whereas 235 had abnormal colorectal and 130 had abnormal prostate screens. Time to resolution was significantly shorter in the navigated group (stratified log rank test, P < 0.001). Patient navigation improved diagnostic resolution for patients presenting with mammographic BIRADS 3 (P = 0.0003) and BIRADS 0 (P = 0.09), but not BIRADS 4/5 or abnormal breast examinations. Navigation shortened the time for both colorectal (P = 0.0017) and prostate screening resolution (P = 0.06). Participant demographics included 72% minority, 49% with annual household income less than $10,000, and 36% uninsured. Patient navigation positively impacts time to resolution of abnormal screening tests for breast, colorectal, and prostate cancers in a medically underserved population. By shortening the time to and increasing the proportion of patients with diagnostic resolution patient navigation could reduce disparities in stage at diagnosis and improve cancer outcomes. 2012 AACR

Rehospitalization in a national population of home health care patients with heart failure.

PubMed

Madigan, Elizabeth A; Gordon, Nahida H; Fortinsky, Richard H; Koroukian, Siran M; Piña, Ileana; Riggs, Jennifer S

2012-12-01

Patients with heart failure (HF) have high rates of rehospitalization. Home health care (HHC) patients with HF are not well studied in this regard. The objectives of this study were to determine patient, HHC agency, and geographic (i.e., area variation) factors related to 30-day rehospitalization in a national population of HHC patients with HF, and to describe the extent to which rehospitalizations were potentially avoidable. Chronic Condition Warehouse data from the Centers for Medicare & Medicaid Services. Retrospective cohort design. The 2005 national population of HHC patients was matched with hospital and HHC claims, the Provider of Service file, and the Area Resource File. The 30-day rehospitalization rate was 26 percent with 42 percent of patients having cardiac-related diagnoses for the rehospitalization. Factors with the strongest association with rehospitalization were consistent between the multilevel model and Cox proportional hazard models: number of prior hospital stays, higher HHC visit intensity category, and dyspnea severity at HHC admission. Substantial numbers of rehospitalizations were judged to be potentially avoidable. The persistently high rates of rehospitalization have been difficult to address. There are health care-specific actions and policy implications that are worth examining to improve rehospitalization rates. © Health Research and Educational Trust.

Validity of the International Physical Activity Questionnaire and the Singapore Prospective Study Program physical activity questionnaire in a multiethnic urban Asian population.

PubMed

Nang, Ei Ei Khaing; Gitau Ngunjiri, Susan Ayuko; Wu, Yi; Salim, Agus; Tai, E Shyong; Lee, Jeannette; Van Dam, Rob M

2011-10-13

Physical activity patterns of a population remain mostly assessed by the questionnaires. However, few physical activity questionnaires have been validated in Asian populations. We previously utilized a combination of different questionnaires to assess leisure time, transportation, occupational and household physical activity in the Singapore Prospective Study Program (SP2). The International Physical Activity Questionnaire (IPAQ) has been developed for a similar purpose. In this study, we compared estimates from these two questionnaires with an objective measure of physical activity in a multi-ethnic Asian population. Physical activity was measured in 152 Chinese, Malay and Asian Indian adults using an accelerometer over five consecutive days, including a weekend. Participants completed both the physical activity questionnaire in SP2 (SP2PAQ) and IPAQ long form. 43 subjects underwent a second set of measurements on average 6 months later to assess reproducibility of the questionnaires and the accelerometer measurements. Spearman correlations were used to evaluate validity and reproducibility and correlations for validity were corrected for within-person variation of accelerometer measurements. Agreement between the questionnaires and the accelerometer measurements was also evaluated using Bland Altman plots. The corrected correlation with accelerometer estimates of energy expenditure from physical activity was better for the SP2PAQ (vigorous activity: r = 0.73; moderate activity: r = 0.27) than for the IPAQ (vigorous activity: r = 0.31; moderate activity: r = 0.15). For moderate activity, the corrected correlation between SP2PAQ and the accelerometer was higher for Chinese (r = 0.38) and Malays (r = 0.57) than for Indians (r = -0.09). Both questionnaires overestimated energy expenditure from physical activity to a greater extent at higher levels of physical activity than at lower levels of physical activity. The reproducibility for moderate activity (accelerometer

Physiological and Psychological Challenges of Increasing Physical Activity and Exercise in Patients at Risk of Diabetic Foot Ulcers: A Critical Review

PubMed Central

Crews, Ryan T.; Schneider, Kristin L.; Yalla, Sai V.; Reeves, Neil D.; Vileikyte, Loretta

2017-01-01

Obesity and a sedentary lifestyle are common challenges among individuals at risk of diabetic foot ulcers (DFUs). While substantial research exists on physical activity interventions in adults with diabetes, those at greatest risk for foot ulceration were often excluded or not well-represented. Both at-risk patients and their clinicians may be hesitant to increase physical activity due to their perception of DFU risks. Physical activity is not contraindicated for those at risk of DFU, yet patients at risk present with unique barriers to initiating increases in physical activity. This review focuses upon the physiological and psychological challenges of increasing physical activity and exercise in patients at risk of DFUs. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, DFU risk-specific beliefs and emotions, and research to date on exercise interventions in this population are all discussed. Additionally, recommendations for implementing and researching physical activity interventions for individuals at risk for DFU are provided. PMID:27155091

The timing of general population and patient suicide in England, 1997-2012.

PubMed

Cavanagh, Brendan; Ibrahim, Saied; Roscoe, Alison; Bickley, Harriet; While, David; Windfuhr, Kirsten; Appleby, Louis; Kapur, Nav

2016-06-01

There have been conflicting findings on temporal variation in suicide risk and few have examined the phenomenon in clinical populations. The study investigated seasonal and other temporal patterns using national data. Data on 73,591 general population and 19,318 patient suicide deaths in England between 1997 and 2012 were collected through the National Confidential Inquiry into Suicide examining suicide rates in relation to month of the year, day of the week, and individual days of national or religious significance. Suicide incidence fell over successive months of the year and there was evidence of an overall spring peak. Monday was associated with the highest suicide rates and in the patient population this effect appeared to be more pronounced in those aged over 50 or those who lived alone. Suicide risk was significantly lower during Christmas, particularly for women. There was a peak in suicide on New Year's Day in the general population. Other 'special days' were not associated with a change in suicide incidence. We were limited to identifying associations between the variables investigated and were unable to explore causal mechanisms. We did not carry out comprehensive multi-variable adjustment in our regression models. There is substantial seasonal and temporal variation in suicide deaths, and there appears to be some evidence in the clinical as well as the general population in England. Clinical services should be aware of the risk of suicide just after the weekend, especially in people who live alone, and the potential need for closer supervision during this period. Copyright © 2016 Elsevier B.V. All rights reserved.

Exploring the concept of medication discrepancy within the context of patient safety to improve population health.

PubMed

Murphy, Catherine R; Corbett, Cynthia L; Setter, Stephen M; Dupler, Alice

2009-01-01

Medication discrepancy is a concept often used in discussions about medication safety but has neither been fully explained nor clearly defined in the literature. This article explores medication discrepancy as it relates to patient safety and population health in the management of medications. Literature review reveals 2 main aspects of discrepancies in medication management; prescribing issues and patient adherence to regimens. Further development of the concept of medication discrepancy can be beneficial to the theorist, researcher, or clinician. Conceptual clarity about the various aspects of medication discrepancy in the context of patient safety has the potential to enhance quality improvement efforts and patient outcomes to improve population health.

Increased expression of low density granulocytes in juvenile-onset systemic lupus erythematosus patients correlates with disease activity.

PubMed

Midgley, A; Beresford, M W

2016-04-01

Neutrophils are implicated in a wide range of non-infectious inflammatory conditions. A subset of neutrophils in the peripheral circulation of systemic lupus erythematosus (SLE) patients has been described and termed low density granulocytes (LDGs). This study investigates the expression of LDG in juvenile-onset SLE (JSLE) patients compared to controls, and any correlations with disease activity.Neutrophils and LDGs were isolated from JSLE (n = 13) and paediatric non-inflammatory control patients (n = 12). Cell populations were assessed and compared using flow cytometry and morphological analysis. Standard clinical data, which included disease activity markers/scores, were collected for each patient.Significantly increased LDG expression (%mean ± SEM, range) was observed in JSLE patients (10.4 ± 3.26, 3.41-36.3) compared to controls (2.4 ± 0.44, 0.36-5.27; p = 0.005). A statistically significant positive correlation was observed between LDG expression and the British Isles Lupus Activity Group (correlation coefficient 0.685; p = 0.010) and SLE Disease Activity Index (correlation coefficient 0.567; p = 0.043) and the biomarker of dsDNA-antibodies (correlation coefficient 0.590; p = 0.043).Here we observe increased expression in LDGs in JSLE patients, which correlate with dsDNA antibody concentration and scores of disease activity. These correlations indicate that the increased LDG expression observed in this study may have a potential role in the pathogenesis of JSLE, and may be a useful biomarker. © The Author(s) 2015.

Concanavalin A-induced and spontaneous suppressor cell activities in peripheral blood lymphocytes and spleen cells from gastric cancer patients.

PubMed

Toge, T; Hamamoto, S; Itagaki, E; Yajima, K; Tanada, M; Nakane, H; Kohno, H; Nakanishi, K; Hattori, T

1983-11-01

In 173 gastric cancer patients, activities of Concanavalin-A-induced suppressor cells (Con-AS) and spontaneous suppressor cells (SpS) in peripheral blood lymphocytes (PBL), splenic vein lymphocytes (SVL), and spleen cells (SCs) were investigated. Suppressions by Con-AS in PBL were significantly effective in patients of Stages III and IV, while suppressions by SpS were effective in patients with recurrent tumors. Thus, in PBLs of cancer patients, suppressor precursors, which are considered to be activated in vitro by Concanavalin-A, seemed to appear with the advances of the disease, and SpS activities, which could be already activated in vivo, seemed to increase in the terminal stage. In SCs, increased activities of Con-AS, but normal activities of SpS, were observed, and these suppressor-cell populations consisted of glass nonadherent cells. Suppressor activities of SCs would be due to suppressor T-cells, not to other types of cells. Furthermore, Con-AS existed in the medium-sized lymphocytes, which were fractionated on the basis of cell size, while SpS in the large-sized lymphocytes. A higher proportion of T-cells, bearing Fc receptors for IgG, was observed in the larger-sized lymphocyte fractions. Cell numbers in the large-sized lymphocyte fraction tended to increase with the advances of tumors. From these results, it is suggested that higher presence of suppressor precursors and the increase of SpS activities may occur in cancer patients, depending on the tumor advancing.

Commercial filming of patient care activities in hospitals.

PubMed

Geiderman, Joel M; Larkin, Gregory L

2002-07-17

Commercial filming of patient care activities is common in hospital settings. This article reviews common circumstances in which patients are commercially filmed, explores the potential positive and negative aspects of filming, and considers the ethical and legal issues associated with commercial filming of patients in hospital settings. We examine the competing goals of commercial filming and the duties of journalists vs the rights of patients to privacy. Current standards and recommendations for commercial filming of patient care activities are reviewed and additional recommendations are offered.

OVERCOMING BARRIERS To DIVERSITY IN CHIROPRACTIC PATIENT AND PRACTITIONER POPULATIONS: A COMMENTARY.

PubMed

Young, Kenneth J

2015-01-01

Increasing the diversity of practitioner and patient populations has been identified as a worthy goal in the chiropractic profession, which has predominantly white male practitioners and white female patients in the USA. Toward that end, 'diversity' has been the topic of several papers and was the theme of a 2012 conference of chiropractic educators. However, generally just the microcosm of the interactions of practitioners with patients or teachers with students has been discussed. The macrocosm of larger societal issues and government policies has not been broached. Examples of issues and policies that affect diversity within a profession include portrayals of, and value judgements on diversity by the media and politicians, as well as public funding for healthcare and education. Diversity was defined in this paper to mean differences in race, sex, sexual orientation, economic status, ethnicity, religion and other life circumstances in a population. The purpose of this paper is to raise awareness of evidence that social issues and government policy affect the diversity of practitioners and patients, and to suggest that the barriers to diversity present in these realms be addressed with a cogent, profession-wide effort in order to help increase the diversity of people involved with chiropractic.

Real world heart failure epidemiology and outcome: A population-based analysis of 88,195 patients

PubMed Central

Vela, Emili; Clèries, Montse; Bustins, Montse; Cainzos-Achirica, Miguel; Enjuanes, Cristina; Moliner, Pedro; Ruiz, Sonia; Verdú-Rotellar, José María; Comín-Colet, Josep

2017-01-01

Background Heart failure (HF) is frequent and its prevalence is increasing. We aimed to evaluate the epidemiologic features of HF patients, the 1-year follow-up outcomes and the independent predictors of those outcomes at a population level. Methods and results Population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on December 31st, 2012. Patients were divided in 3 groups: patients without a previous HF hospitalization, patients with a remote (>1 year) HF hospitalization and patients with a recent (<1 year) HF admission. We analyzed 1year all-cause and HF hospitalizations, and all-cause mortality. Logistic regression was used to identify the independent predictors of each of those outcomes. A total of 88,195 patients were included. Mean age was 77 years, 55% were women. Comorbidities were frequent. Fourteen percent of patients had never been hospitalized, 71% had a remote HF hospitalization and 15% a recent hospitalization. At 1-year follow-up, all-cause and HF hospitalization were 53% and 8.8%, respectively. One-year all-cause mortality rate was 14%, and was higher in patients with a recent HF hospitalization (24%). The presence of diabetes mellitus, atrial fibrillation or chronic kidney disease was independently associated with all-cause and HF hospitalization and all-cause mortality. Hospital admissions and emergency department visits the previous year were also found to be independently associated with the three study outcomes. Conclusions Outcomes are different depending on the HF population studied. Some comorbidity, an all-cause hospitalization or emergency department visit the previous year were associated with a worse outcome. PMID:28235067

Real world heart failure epidemiology and outcome: A population-based analysis of 88,195 patients.

PubMed

Farré, Núria; Vela, Emili; Clèries, Montse; Bustins, Montse; Cainzos-Achirica, Miguel; Enjuanes, Cristina; Moliner, Pedro; Ruiz, Sonia; Verdú-Rotellar, José María; Comín-Colet, Josep

2017-01-01

Heart failure (HF) is frequent and its prevalence is increasing. We aimed to evaluate the epidemiologic features of HF patients, the 1-year follow-up outcomes and the independent predictors of those outcomes at a population level. Population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on December 31st, 2012. Patients were divided in 3 groups: patients without a previous HF hospitalization, patients with a remote (>1 year) HF hospitalization and patients with a recent (<1 year) HF admission. We analyzed 1year all-cause and HF hospitalizations, and all-cause mortality. Logistic regression was used to identify the independent predictors of each of those outcomes. A total of 88,195 patients were included. Mean age was 77 years, 55% were women. Comorbidities were frequent. Fourteen percent of patients had never been hospitalized, 71% had a remote HF hospitalization and 15% a recent hospitalization. At 1-year follow-up, all-cause and HF hospitalization were 53% and 8.8%, respectively. One-year all-cause mortality rate was 14%, and was higher in patients with a recent HF hospitalization (24%). The presence of diabetes mellitus, atrial fibrillation or chronic kidney disease was independently associated with all-cause and HF hospitalization and all-cause mortality. Hospital admissions and emergency department visits the previous year were also found to be independently associated with the three study outcomes. Outcomes are different depending on the HF population studied. Some comorbidity, an all-cause hospitalization or emergency department visit the previous year were associated with a worse outcome.

Assessing the impact of heart failure specialist services on patient populations.

PubMed

Lyratzopoulos, Georgios; Cook, Gary A; McElduff, Patrick; Havely, Daniel; Edwards, Richard; Heller, Richard F

2004-05-24

The assessment of the impact of healthcare interventions may help commissioners of healthcare services to make optimal decisions. This can be particularly the case if the impact assessment relates to specific patient populations and uses timely local data. We examined the potential impact on readmissions and mortality of specialist heart failure services capable of delivering treatments such as b-blockers and Nurse-Led Educational Intervention (N-LEI). Statistical modelling of prevented or postponed events among previously hospitalised patients, using estimates of: treatment uptake and contraindications (based on local audit data); treatment effectiveness and intolerance (based on literature); and annual number of hospitalization per patient and annual risk of death (based on routine data). Optimal treatment uptake among eligible but untreated patients would over one year prevent or postpone 11% of all expected readmissions and 18% of all expected deaths for spironolactone, 13% of all expected readmisisons and 22% of all expected deaths for b-blockers (carvedilol) and 20% of all expected readmissions and an uncertain number of deaths for N-LEI. Optimal combined treatment uptake for all three interventions during one year among all eligible but untreated patients would prevent or postpone 37% of all expected readmissions and a minimum of 36% of all expected deaths. In a population of previously hospitalised patients with low previous uptake of b-blockers and no uptake of N-LEI, optimal combined uptake of interventions through specialist heart failure services can potentially help prevent or postpone approximately four times as many readmissions and a minimum of twice as many deaths compared with simply optimising uptake of spironolactone (not necessarily requiring specialist services). Examination of the impact of different heart failure interventions can inform rational planning of relevant healthcare services.

Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients.

PubMed

Kim, Sang Hyuck; Yun, Jae Moon; Chang, Chong Bum; Piao, Heng; Yu, Su Jong; Shin, Dong Wook

2016-12-28

To assess the prevalence of possible risk factors of upper gastrointestinal bleeding (UGIB) and their age-group specific trend among the general population and osteoarthritis patients. We utilized data from the National Health Insurance Service that included claims data and results of the national health check-up program. Comorbid conditions (peptic ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal reflux disease), concomitant drugs (aspirin, clopidogrel, cilostazol, non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI), personal habits (smoking, and alcohol consumption) were considered as possible UGIB risk factors. We randomly imputed the prevalence of infection in the data considering the age-specific prevalence of Helicobacter pylori ( H. pylori ) infection in Korea. The prevalence of various UGIB risk factors and the age-group specific trend of the prevalence were identified. Prevalence was compared between osteoarthritis patients and others. A total of 801926 subjects (93855 osteoarthritis patients) aged 20 and above were included. The prevalence of individual and concurrent multiple risk factors became higher as the age increased. The prevalence of each comorbid condition and concomitant drug were higher in osteoarthritis patients. Thirty-five point zero two percent of the overall population and 68.50% of osteoarthritis patients had at least one or more risk factors of UGIB. The prevalence of individual and concurrent multiple risk factors in younger age groups were also substantial. Furthermore, when personal habits (smoking, and alcohol consumption) and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in younger age groups. Prevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis. Physicians should consider

Association of prolidase activity, oxidative parameters, and presence of atrial fibrillation in patients with mitral stenosis.

PubMed

Rabus, Murat; Demirbag, Recep; Yildiz, Ali; Tezcan, Orhan; Yilmaz, Remzi; Ocak, A Riza; Alp, Mete; Erel, Ozcan; Aksoy, Nurten; Yakut, Cevat

2008-07-01

Mitral stenosis (MS) is a common cause of atrial fibrillation (AF). Oxidative stress and inflammation factors were shown to be involved in atrial remodeling. The study aim was to compare the oxidative parameters and prolidase activity in severe MS patients with and without AF. The study population was comprised of 33 patients with MS and sinus rhythm (group I), 27 patients with MS and AF (group II), and 25 healthy controls (group III). Plasma prolidase activity, total antioxidant capacity (TAC), total oxidative status (TOS), and oxidative stress index (OSI) were determined. Additionally, we measured tissue TOS and TAC in patients with mitral valve replacement. TAC and OSI were higher, but TOS and prolidase were lower in patients with MS than control (all p <0.001). These parameters were similar in group I and group II (ANOVA p >0.05). Tissue TAC was significantly lower in group II than group I (0.015 +/- 0.01 vs. 0.026 +/- 0.01 mmol Trolox equiv/L, p = 0.014), tissue TOS was similar between groups I and II (0.24 +/- 0.06 vs. 0.22 +/- 0.05 mmol Trolox equiv/L, p = 0.161). Presence of AF was correlated with systolic blood pressure, left atrial diameter, plasma TAC, tissue TAC, plasma TOS, plasma OSI, and plasma prolidase activity. Tissue TAC level (beta = -0.435, p = 0.006) and left atrial diameter (beta = 0.460, p = 0.003) were independently related with presence of AF in patients with MS. This study suggested that the presence of AF in patients with severe MS may be associated with the plasma prolidase activity, tissue and plasma oxidative parameters.

Information in Support of Population Activities.

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Paris (France).

As part of UNESCO's World Population Year, information services in support of population programs are explained and listed. The information system of the International Planned Parenthood Federation is described and the management of population literature discussed. Information needs of population workers and special aspects of the training and…

Incremental healthcare resource utilization and costs in US patients with Cushing's disease compared with diabetes mellitus and population controls.

PubMed

Broder, Michael S; Neary, Maureen P; Chang, Eunice; Ludlam, William H

2015-12-01

Resource utilization and costs in Cushing's disease (CD) patients have not been studied extensively. We compared CD patients with diabetes mellitus (DM) patients and population-based controls to characterize differences in utilization and costs. Using 2008-2012 MarketScan® database, we identified three patient groups: (1) CD patients; (2) DM patients; and (3) population-based control patients without CD. DM and control patients were matched to CD patients by age, gender, region, and review year in a 2:1 ratio. Outcomes included annual healthcare resource utilization and costs. There were 1852 CD patients, 3704 DM patients and 3704 controls. Mean age was 42.9 years; 78.2 % were female. CD patients were hospitalized more frequently (19.3 %) than DM patients (11.0 %, p < .001) or controls (5.6 %, p < .001). CD patients visited the ED more frequently (25.4 %) than DM patients (21.1 %, p < .001) or controls (14.3 %, p < .001). CD patients had more office visits than DM patients (19.1 vs. 10.7, p < .001) or controls (7.1, p < .001). CD patients on average filled more prescriptions than DM patients (51.7 vs. 42.7, p < .001) or controls (20.5, p < .001). Mean total healthcare costs for CD patients were $26,269 versus $12,282 for DM patients (p < .001) and $5869 for controls (p < .001). CD patients had significantly higher annual rates of healthcare resource utilization compared to matched DM patients and population controls without CD. CD patient costs were double DM costs and quadruple control costs. This study puts into context the additional burdens of CD over DM, a common, chronic endocrine condition affecting multiple organ systems, and population controls.

Simulated rRNA/DNA Ratios Show Potential To Misclassify Active Populations as Dormant

DOE Office of Scientific and Technical Information (OSTI.GOV)

Steven, Blaire; Hesse, Cedar; Soghigian, John

The use of rRNA/DNA ratios derived from surveys of rRNA sequences in RNA and DNA extracts is an appealing but poorly validated approach to infer the activity status of environmental microbes. To improve the interpretation of rRNA/DNA ratios, we performed simulations to investigate the effects of community structure, rRNA amplification, and sampling depth on the accuracy of rRNA/DNA ratios in classifying bacterial populations as “active” or “dormant.” Community structure was an insignificant factor. In contrast, the extent of rRNA amplification that occurs as cells transition from dormant to growing had a significant effect (P < 0.0001) on classification accuracy, withmore » misclassification errors ranging from 16 to 28%, depending on the rRNA amplification model. The error rate increased to 47% when communities included a mixture of rRNA amplification models, but most of the inflated error was false negatives (i.e., active populations misclassified as dormant). Sampling depth also affected error rates (P < 0.001). Inadequate sampling depth produced various artifacts that are characteristic of rRNA/DNA ratios generated from real communities. These data show important constraints on the use of rRNA/DNA ratios to infer activity status. Whereas classification of populations as active based on rRNA/DNA ratios appears generally valid, classification of populations as dormant is potentially far less accurate.« less

Simulated rRNA/DNA Ratios Show Potential To Misclassify Active Populations as Dormant

DOE PAGES

Steven, Blaire; Hesse, Cedar; Soghigian, John; ...

2017-03-31

The use of rRNA/DNA ratios derived from surveys of rRNA sequences in RNA and DNA extracts is an appealing but poorly validated approach to infer the activity status of environmental microbes. To improve the interpretation of rRNA/DNA ratios, we performed simulations to investigate the effects of community structure, rRNA amplification, and sampling depth on the accuracy of rRNA/DNA ratios in classifying bacterial populations as “active” or “dormant.” Community structure was an insignificant factor. In contrast, the extent of rRNA amplification that occurs as cells transition from dormant to growing had a significant effect (P < 0.0001) on classification accuracy, withmore » misclassification errors ranging from 16 to 28%, depending on the rRNA amplification model. The error rate increased to 47% when communities included a mixture of rRNA amplification models, but most of the inflated error was false negatives (i.e., active populations misclassified as dormant). Sampling depth also affected error rates (P < 0.001). Inadequate sampling depth produced various artifacts that are characteristic of rRNA/DNA ratios generated from real communities. These data show important constraints on the use of rRNA/DNA ratios to infer activity status. Whereas classification of populations as active based on rRNA/DNA ratios appears generally valid, classification of populations as dormant is potentially far less accurate.« less

Magnetoencephalographic Mapping of Epileptic Spike Population Using Distributed Source Analysis: Comparison With Intracranial Electroencephalographic Spikes.

PubMed

Tanaka, Naoaki; Papadelis, Christos; Tamilia, Eleonora; Madsen, Joseph R; Pearl, Phillip L; Stufflebeam, Steven M

2018-04-27

This study evaluates magnetoencephalographic (MEG) spike population as compared with intracranial electroencephalographic (IEEG) spikes using a quantitative method based on distributed source analysis. We retrospectively studied eight patients with medically intractable epilepsy who had an MEG and subsequent IEEG monitoring. Fifty MEG spikes were analyzed in each patient using minimum norm estimate. For individual spikes, each vertex in the source space was considered activated when its source amplitude at the peak latency was higher than a threshold, which was set at 50% of the maximum amplitude over all vertices. We mapped the total count of activation at each vertex. We also analyzed 50 IEEG spikes in the same manner over the intracranial electrodes and created the activation count map. The location of the electrodes was obtained in the MEG source space by coregistering postimplantation computed tomography to MRI. We estimated the MEG- and IEEG-active regions associated with the spike populations using the vertices/electrodes with a count over 25. The activation count maps of MEG spikes demonstrated the localization associated with the spike population by variable count values at each vertex. The MEG-active region overlapped with 65 to 85% of the IEEG-active region in our patient group. Mapping the MEG spike population is valid for demonstrating the trend of spikes clustering in patients with epilepsy. In addition, comparison of MEG and IEEG spikes quantitatively may be informative for understanding their relationship.

Patient Activation: Public Libraries and Health Literacy

ERIC Educational Resources Information Center

Malachowski, Margot

2011-01-01

Patient activation is a new term for a perennial problem. People know what they need to do for their health: exercise, eat right, and get enough rest--but how are they motivated to actually do these things? This is what patient activation is. From this author's vantage point as a medical librarian, public libraries are well-placed to be part of…

Mortality and cardiovascular diseases risk in patients with Barrett's oesophagus: a population-based nationwide cohort study.

PubMed

Erichsen, R; Horvath-Puho, E; Lund, J L; Dellon, E S; Shaheen, N J; Pedersen, L; Davey Smith, G; Sørensen, H T

2017-04-01

Patients with Barrett's oesophagus may be at increased risk of mortality overall, and cardiovascular disease has been suggested as the main underlying cause of death. To examine cause-specific mortality and risk of cardiovascular events among patients with Barrett's oesophagus. Utilising existing Danish data sources (1997-2011), we identified all patients with histologically verified Barrett's oesophagus (n = 13 435) and 123 526 members of the general population matched by age, sex and individual comorbidities. We calculated cause-specific mortality rates and incidence rates of cardiovascular diseases. We then compared rates between patients with Barrett's oesophagus and the general population comparison cohort, using stratified Cox proportional hazard regression. Patients with Barrett's oesophagus had a 71% increased risk of overall mortality. The cause-specific mortality rate per 1000 person-years for patients with Barrett's oesophagus was 8.5 for cardiovascular diseases, 14.7 for non-oesophageal cancers, and 5.4 for oesophageal cancer. Compared to the general population cohort, corresponding hazard ratios were 1.26 (95% confidence interval (CI): 1.15-1.38), 1.77 (95% CI: 1.65-1.90), and 19.4 (95% CI: 16.1-23.4), respectively. The incidence rates of cardiovascular diseases per 1000 person-years for Barrett's oesophagus patients and for persons from the general population cohort, respectively, varied from 0.4 and 0.2 for subarachnoid bleeding (hazard ratio 1.10, 95% CI: 0.87-1.39) to 8.1 and 5.9 for congestive heart failure (hazard ratio 1.33, 95% CI: 1.21-1.46). Prophylactic measures targeted at cardiovascular diseases and non-oesophageal cancers potentially could be more important than measures against oesophageal cancer, for improving prognosis among patients with Barrett's oesophagus. © 2017 John Wiley & Sons Ltd.

Increasing Physical Activity in Patients with Arthritis: A Tailored Health Promotion Program

PubMed Central

Ehrlich-Jones, Linda; Mallinson, Trudy; Fischer, Heidi; Bateman, Jillian; Semanik, Pamela A.; Spring, Bonnie; Ruderman, Eric; Chang, Rowland W.

2010-01-01

Objective Despite recent studies showing the benefit of physical activity for people with arthritis, the vast majority of persons with arthritis are not sufficiently physically active. The purpose of this report is to describe a tailored health promotion intervention aimed at increasing physical activity among persons with arthritis. The intervention is designed to be useful for health systems and insurers interested in a chronic disease management program that could be disseminated to large populations of arthritis patients. Methods The intervention is carried out by a clinician who is designated as the client’s physical activity advocate. The approach emphasizes motivational interviewing, individualized goal setting, tailored strategies for increasing physical activity and for monitoring progress, and a plan of 2 years of follow-up. The intervention includes a standardized assessment of barriers to and strengths supporting increased lifestyle physical activity. A randomized, controlled trial is underway to evaluate the efficacy and cost-effectiveness of this intervention. Conclusion This intervention is unique in that it implements a program tailored to the individual that focuses on lifestyle physical activity and long-term monitoring. The approach recognizes that persons with arthritis present with varying levels of motivation for change in physical activity and that behavior change can take a long time to become habitual. PMID:20696695

Patients with multiple sclerosis do not necessarily consume more alcohol or tobacco than the general population.

PubMed

Fragoso, Yara Dadalti; Gomes, Sidney; Goncalves, Marcus Vinicius M; Machado, Suzana C Nunes; Morales, Rogerio de Rizo; Oliveira, Francisco Tomas M de; Oliveira, João Filipe de; Olmo, Neide R Simoes; Parolin, Monica K Fiuza; Siquineli, Fabio; Stoney, Patrick N

2015-10-01

Purpose Recent papers suggest that patients with multiple sclerosis (MS) are prone to alcohol misuse. This may be due to the combination of a lifelong and disabling disease with a psychiatric profile typical of MS. The objective of the present study was to assess these findings in a culturally different population of patients with MS.Method The present case-control transversal study assessed 168 patients with MS and 168 control subjects from Brazil.Results There were no evidence that patients with MS drank more alcohol or, smoked more than did controls. In fact, control subjects had a significantly higher alcohol consumption. The only trait associated to higher alcohol consumption was anxiety, both for patients and controls.Conclusion Unlike previous reports in the literature, patients with MS in our study did not drink or smoked more than a control population.

Acceptability and Feasibility of Physical Activity Assessment Methods for an Appalachian Population

PubMed Central

Tarasenko, Yelena N.; Howell, Britteny M.; Studts, Christina R.; Strath, Scott J.; Schoenberg, Nancy E.

2015-01-01

Nowhere is improving understanding and accurate assessment of physical activity more important for disease prevention and health promotion than among health disparities populations such as those residing in rural and Appalachian regions. To enhance accurate assessment of physical activity and potentially improve intervention capacity, we conducted a mixed-methods study examining the acceptability and feasibility of self-report physical activity questionnaires, pedometers, and accelerometers among rural Appalachian children, adolescents, and adults. Most participants reported positive experiences with all three physical activity assessment tools. Several acceptability ratings differed by age group and by sex within each age group. With very few exceptions, no significant differences in acceptability were found by race, education, employment status, health status, BMI categories, income levels, or insurance status within age groups or overall. Several factors may impact the choice of the physical activity assessment method, including target population age, equipment cost, researcher burden, and potential influence on physical activity levels. Children and adolescents appear to have more constraints on when they can wear pedometers and accelerometers. While pedometers are inexpensive and convenient, they may influence physical activity levels, rather than simply measure them. Accelerometers, while less influential on behavior, consume extensive resources, including high purchase costs and researcher burden. PMID:25608476

Psychological distress, iron deficiency, active disease and female gender are independent risk factors for fatigue in patients with ulcerative colitis

PubMed Central

Jonefjäll, Börje; Simrén, Magnus; Lasson, Anders; Öhman, Lena; Strid, Hans

2017-01-01

Background Patients with ulcerative colitis often report fatigue. Objectives To investigate prevalence of and risk factors for fatigue in patients with ulcerative colitis with active disease and during deep remission. Methods In this cross-sectional study, disease activity was evaluated with endoscopy and calprotectin, and patients were classified as having active disease (n = 133) or being in deep remission (n = 155). Blood samples were analysed to assess anaemia, iron deficiency and systemic immune activity. Patients completed questionnaires to assess fatigue, psychological distress, gastrointestinal symptoms and quality of life. Results The prevalence of high fatigue (general fatigue ≥ 13, Multidimensional Fatigue Inventory) was 40% in the full study population. Among patients with high fatigue, female gender and iron deficiency were more prevalent, and these patients had more severe disease activity and reported higher levels of anxiety, depression and decreased quality of life compared with patients with no/mild fatigue. A logistic regression analysis identified probable psychiatric disorder (odds ratio (OR) (confidence interval) 6.1 (3.1–12.2)), iron deficiency (OR 2.5 (1.2–5.1)), active disease (OR 2.2 (1.2–3.9)) and female gender (OR 2.1 (1.1–3.7)) as independent risk factors for high fatigue. Similar results were found concerning psychological distress, gender and quality of life, but immune markers did not differ in patients in deep remission with high vs. no/mild fatigue. Conclusions Probable psychiatric disorder, iron deficiency, active disease and female gender are independent risk factors for high fatigue in patients with ulcerative colitis. Low-grade immune activity does not seem to be the cause of fatigue among patients in deep remission. PMID:29435325

Fibromyalgia in patients with thyroid autoimmunity: prevalence and relationship with disease activity.

PubMed

Haliloglu, Sema; Ekinci, Bilge; Uzkeser, Hulya; Sevimli, Hakan; Carlioglu, Ayse; Macit, Pinar Mazlum

2017-07-01

Fibromyalgia (FM) is a syndrome characterised by chronic musculoskeletal pain, tenderness and other somatic symptoms. The prevalence of FM is approximately 2-7% in the general global population and is 30-40% in the population of Hashimoto thyroiditis (HT) with a structural pathology. In 2010, new classification criteria for FM were proposed, as an alternative to the American College of Rheumatology (ACR) 1990 criteria. The objectives of the present study were to identify the prevalence of FM in the HT population and evaluate the associated features by using the new diagnostic criteria. The study group included 79 consecutive patients with HT with or without FM. Recorded data included age, gender, laboratory parameters, sociodemographic features and clinical findings, presence of somatic symptoms, and disease activity indices. The prevalence of FM in patients with HT was 62%. Antithyroid peroxidase antibody (TPOAb) positivity, duration of disease, and waist circumference were significantly associated with concomitant FM (p = 0.000, p = 0.000, and p = 0.015, respectively). A strong positive correlation was noted between fibromyalgia impact questionnaire (FIQ) scores and disease duration, age, values of thyroid-stimulating hormone (TSH) and TPOAb, waist circumference and marital status. TPOAb was found to be independent of body mass index, age and TSH. Concomitant FM is a common clinical problem in HT and its recognition is important for the optimal management of the disease. The new set of diagnostic criteria for FM reinforces this situation. Consideration of the FM component in the management of HT increases the likelihood of treatment success.

Association between Time of Day of Sports-Related Physical Activity and the Onset of Acute Myocardial Infarction in a Chinese Population.

PubMed

Zhao, Shan; Zhang, Zhen; Long, Qingqing; Ma, Yao; Lian, Xiaoqing; Yang, Yang; Gao, Wei; Chen, Zhong; Wang, Liansheng

2016-01-01

To investigate the association between the time of day of sports-related physical activity and the onset of acute myocardial infarction (AMI) in a coronary artery disease (CAD) population in China. Between February 2014 and March 2015, a total of 696 patients from Nanjing, China, who had CAD were studied and divided into two groups (Non-AMI and AMI groups). The work-related activity and sports-related physical activity information were obtained from a self-reporting predesigned patient questionnaire. Sports-related physical activity was associated with a lower risk of the onset of AMI, after adjusting the established and potential confounders, with an adjusted odds ratio (OR) of 0.67 (95% CI, 0.47-0.94) compared with those who did not have any sports-related physical activity. A dose-response relationship was observed for intensity, duration, and frequency of sports-related physical activity. Further stratification analysis revealed that the protective effects of sports-related physical activity were significant in the morning and evening groups, and patients who exercised in the evening were at a lower risk of AMI than those doing sports-related physical activity in the morning. The adjusted ORs for doing sports-related physical activity in the morning and evening groups were 0.60(0.36-0.98) and 0.56(0.37-0.87), respectively, compared with inactivity (all P<0.05). On the occurrence of AMI, doing sports-related physical activity in the evening had an adjusted OR of 0.93 (95% CI, 0.54-1.64, P = 0.824) compared with in the morning group. Sports-related physical activity is associated with a lower risk of onset of AMI than inactivity in Chinese people. For CAD patients, we suggest they participate in sports-related physical activity of high intensity, long duration, and high frequency. Doing sports-related physical activity in the evening and in the morning have similar benefits on the prevention of the onset of AMI.

Seroepidemiological study of Toxoplasma gondii infection in a population of Iranian epileptic patients.

PubMed

Babaie, Jalal; Sayyah, Mohammad; Gharagozli, Kourosh; Mostafavi, Ehsan; Golkar, Majid

2017-01-01

Epilepsy is one of the most common neurologic disorders. Underlying cause of epilepsy is unknown in 60 % of the patients. Toxoplasma gondii is an intracellular parasite which is capable of forming tissue cysts in brain of chronically infected hosts including humans. Some epidemiological studies suggested an association between toxoplasmosis and acquisition of epilepsy. In this study we determined seroprevalence of latent Toxoplasma infection in a population of Iranian epileptic patients. Participants were classified in three groups as Iranian epileptic patients (IEP, n = 414), non-epileptic patients who had other neurologic disorders (NEP, n = 150), and healthy people without any neurologic disorders (HP, n = 63). The presence of anti- Toxoplasma IgG antibodies and IgG titer in the sera were determined by ELISA method. Anti- T. gondii IgG seroprevalence obtained 35.3 %, 34.7 % and 38.1 % in IEP, NEP and HP, respectively. The seroprevalence rate was not significantly different among the three groups (P = 0.88). Anti- T. gondii IgG titer was 55.7 ± 78, 52.4 ± 74 and 69.7 ± 92 IU/ml in IEP, NEP and HP, respectively. There was not any statistically significant difference in the antibody titer between the study groups (P = 0.32). The rate of T. gondii infection in epileptic patients was not higher than non-epileptic patients and healthy people in the Iranian population.

Risk of fragility fracture among patients with sarcoidosis: a population-based study 1976-2013.

PubMed

Ungprasert, P; Crowson, C S; Matteson, E L

2017-06-01

Incidence of fragility fracture of a population-based cohort of 345 patients with sarcoidosis was compared with age and sex-matched comparators. The incidence of fragility fracture was higher among patients with sarcoidosis with hazard ratio (HR) of 2.18. Several chronic inflammatory disorders increase the risk of fragility fracture. However, little is known about the risk of fragility fracture in patients with sarcoidosis. This study was conducted using a previously identified population-based cohort of 345 patients with incident sarcoidosis from Olmsted County, Minnesota. Diagnosis of sarcoidosis required physician diagnosis supported by biopsy showing non-caseating granuloma, radiographic evidence of intrathoracic sarcoidosis, and compatible clinical presentations without evidence of other granulomatous diseases. Sex and age-matched subjects randomly selected from the same underlying population were used as comparators. Medical records of cases and comparators were reviewed for baseline characteristics and incident fragility fracture. Fragility fractures were observed in 34 patients with sarcoidosis, corresponding to a cumulative incidence of 5.6% at 10 years, while 18 fragility fractures were observed among comparators for a cumulative incidence of 2.4% at 10 years. The HR of fragility fractures among cases compared with comparators was 2.18 (95% confidence interval [CI], 1.23-3.88). The risk of fragility fracture by site was significantly higher among patients with sarcoidosis, and was due to a higher rate of distal forearm fracture (HR 3.58; 95% CI 1.53-8.40). Statistically non-significant increased risk was also observed in proximal femur (HR 1.66; 95% CI 0.45-6.06) and proximal humerus (HR 3.27; 95% CI 0.66-16.21). Risk of vertebral fracture was not increased (HR 1.00; 95% CI 0.32-3.11). Patients with sarcoidosis have an increased risk of fragility fracture which is primarily driven by the higher incidence of distal forearm fracture.

SEGMENTING CT PROSTATE IMAGES USING POPULATION AND PATIENT-SPECIFIC STATISTICS FOR RADIOTHERAPY.

PubMed

Feng, Qianjin; Foskey, Mark; Tang, Songyuan; Chen, Wufan; Shen, Dinggang

2009-08-07

This paper presents a new deformable model using both population and patient-specific statistics to segment the prostate from CT images. There are two novelties in the proposed method. First, a modified scale invariant feature transform (SIFT) local descriptor, which is more distinctive than general intensity and gradient features, is used to characterize the image features. Second, an online training approach is used to build the shape statistics for accurately capturing intra-patient variation, which is more important than inter-patient variation for prostate segmentation in clinical radiotherapy. Experimental results show that the proposed method is robust and accurate, suitable for clinical application.

Reduction in pedometer-determined physical activity in the adult Danish population from 2007 to 2012.

PubMed

Matthiessen, Jeppe; Andersen, Elisabeth Wreford; Raustorp, Anders; Knudsen, Vibeke Kildegaard; Sørensen, Mette Rosenlund

2015-07-01

To examine the development in pedometer-determined physical activity from 2007-2008 to 2011-2012 in the adult Danish population. The study population comprised two random samples of 18-75-year-old individuals who took part in cross-sectional studies in 2007-2008 (n=224) and 2011-2012 (n=1515). Pedometer data (sealed Yamax SW 200) were obtained for seven consecutive days. Data for 1624 participants (48.2% men) were included in the analysis. An overall step-defined activity level was examined based on a graduated step index (sedentary, low active, somewhat active, active, highly active). The pedometer-determined outcomes were analysed using regression models. A borderline significant decline (p=0.077) from 8788 to 8341 steps/day (-446 (95% confidence intervals -50, 943)) was found between 2007-2008 and 2011-2012. Furthermore, a 23.7% (95% confidence intervals -41.7%, -0.1%) lower overall step-defined activity level was observed in 2011-2012 compared to 2007-2008. These changes were primarily due to a reduced level of activity among women. The proportion of individuals taking ⩾10,000 steps/day decreased non-significantly from 34.8% to 29.3%, whereas the proportion taking <5000 steps/day did not differ between survey periods. This nationally representative survey suggests an overall reduction in the physical activity level among Danish adults. The reduction was due to a shift in the population distribution from higher to lower levels of activity. If this shift is true, it is worrying from a public health perspective. Our study result needs, however, to be confirmed by other population studies. © 2015 the Nordic Societies of Public Health.

[Vitamin B12 levels in the patient population attending an urban health centre in Madrid].

PubMed

Camarero-Shelly, M

2018-04-01

Vitamin B 12 levels are usually measured in Primary Care when the patients have symptoms or risk factors associated with its deficiency, mostly in the elderly. However, no evidence has been found to support the recommendation of screening in the general population. The aim of this study is to assess the relevance of having extended the screening of vitamin B 12 deficiency to a younger population, after observing an increase in the prescription of this injected vitamin in a population under 65 years, by analysing the vitamin B 12 values obtained. A descriptive, retrospective, observational study was conducted on a sample consisting of 5,531 patients from Barajas Health Primary Centre, Madrid, between 2008 and 2012, and on whom a blood test was performed for any reason, with values of vitamin B 12 . A deficiency was found in 9.1% (SD 2.3) of the patients, of whom 49.4% were less than 65 years. The deficiencies were associated (P<.001, 95% CI) with age, dementia, changes in blood red cell counts, memory, and with the taking of metformin and proton pump inhibitors (P=.007). The prevalence of vitamin B 12 deficiency in our served population is similar in patients older and younger than 65 years. The extended screening was relevant. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

THA Using Metal-on-Metal Articulation in Active Patients Younger Than 50 Years

PubMed Central

Bonnomet, François; Clavert, Philippe; Laffargue, Philippe; Migaud, Henri

2008-01-01

The main concern of patients with longer life expectancies and of patients who are younger and more active is the longevity of their total hip arthroplasty. We retrospectively reviewed 83 cementless total hip arthroplasties in 73 patients implanted with metal-on-metal articulation. All patients were younger than 50 years old (average age, 41 years) at the time of the index procedure, and 80% of the patients had an activity level graded 4 or 5 when measured with the system of Devane et al. A 28-mm Metasul articulation was used with three different cementless titanium acetabular components. At the most recent followup (average, 7.3 years), the average Merle d’Aubigné-Postel score improved from a preoperative 11.1 points to 17.4 points. We observed no radiographic evidence of component loosening. Ten acetabular components had lucency limited to one zone. The 10-year survivorship with the end point of revision (ie, exchange of at least one prosthetic or bearing component) was 100% (95% confidence interval, 90%–100%). Metasul bearings with cementless acetabular components remain promising in this high-risk younger patient population. However, additional followup strategies are recommended to determine any possible long-term deleterious effects associated with the dissemination of metallic ions. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196415

Signals of monocyte activation in patients with SLE.

PubMed Central

Kávai, M; Zsindely, A; Sonkoly, I; Major, M; Demján, I; Szegedi, G

1983-01-01

The Fc receptor mediated reaction, the beta-glucuronidase and the lactic dehydrogenase activities of monocytes and the serum lysozyme level were tested together with the circulating immune complex content of patients with systemic lupus erythematosus. Simultaneously with the increasing FC receptor-mediated reaction and the elevated enzyme activities of patient monocytes, the secretion of lysozyme and the immune complex content of the sera were higher than those of the controls. A positive correlation was demonstrated between the Fc receptor-mediated reaction, the beta-glucuronidase activity, the lysozyme secretion and the immune complex content of the sera. Thus, the monocytes of patients appeared to be activated by the circulating immune complexes. PMID:6839541

Fidaxomicin versus Vancomycin as a First-Line Treatment for Clostridium difficile-Associated Diarrhea in Specific Patient Populations: A Pharmacoeconomic Evaluation.

PubMed

Reveles, Kelly R; Backo, Jennifer L; Corvino, Frank A; Zivkovic, Marko; Broderick, Kelly C

2017-12-01

The reduction in recurrent Clostridium difficile-associated diarrhea (CDAD) with fidaxomicin therapy may reduce hospital readmissions and lead to lower overall CDAD costs. However, studies assessing the cost-effectiveness of fidaxomicin as first-line therapy from the U.S. hospital perspective are lacking. This study evaluated the costs associated with utilizing fidaxomicin or vancomycin as a first-line therapy for CDAD in specific patient populations from a U.S. hospital perspective. A decision-analytic model was developed to estimate total costs (hospitalization and drug costs) associated with using fidaxomicin or vancomycin as first-line therapy for a first episode and up to two recurrences of CDAD in five patient populations: general population, elderly, patients receiving concomitant antibiotics, and patients with renal impairment or cancer. The total cost of CDAD treatment using fidaxomicin first line in the general population was $14,442 per patient versus $14,179 per patient with vancomycin first line. In subgroup analyses, fidaxomicin use resulted in total hospital cost savings of $616 per patient in patients with cancer and $312 in patients with concomitant antibiotic use; vancomycin use was associated with total hospital cost savings of $243 per patient in the elderly and $371 in patients with renal impairment. Fidaxomicin as first-line CDAD therapy is associated with similar total costs as compounded vancomycin oral solution in the general population. In elderly and renally impaired patients, slight increases in hospital cost were observed with fidaxomicin therapy, and in patients with cancer or concomitant antibiotic use, hospital cost savings were observed. © 2017 Pharmacotherapy Publications, Inc.

Unveiling changes in the landscape of patient populations in cancer early drug development

PubMed Central

Hierro, Cinta; Azaro, Analía; Argilés, Guillem; Elez, Elena; Gómez, Patricia; Carles, Joan; Rodon, Jordi

2017-01-01

The introduction of new Molecularly Targeted Agents (MTA) has changed the landscape in Early Drug Development (EDD) over the last two decades, leading to an improvement in clinical trial design. Previous Phase 1 (Ph1) studies with cytotoxics focused on safety objectives, only recruiting heavily pre-treated cancer patients, have been left behind. In this review, we will illustrate the slow although unstoppable change that has increasingly been observed in those populations candidate to participate in EDD trials with the advent of MTA. As more evidence regarding oncogene addiction becomes available, molecular-biomarker driven selection has been implemented among Molecularly-Selected Population (MSP) studies. New Window-Of-Opportunity (WOO) and Phase 0 (Ph0) studies have been developed in order to assess whether a MTA produces the hypothetical proposed biological effect. The rising need of getting early pharmacokinetics and pharmacodynamics data has led to the conduction of Healthy Volunteer (HV) studies, in part favoured for the particular and different toxicity profile of these MTA. However, several challenges will need to be addressed in order to boost the implementation of these new clinical trial designs in the forthcoming years. Among the problems to overcome, we would highlight a better coordination effort between centers for ensuring adequate patient accrual among small patient populations and a deepening into the ethics implied in enrolling patients in studies with no therapeutic intent. However, these tribulations will be certainly compensated by the possibility of opening a new horizon of treatment for diseases with dismal prognosis. PMID:27835915

Predicting dementia in primary care patients with a cardiovascular health metric: a prospective population-based study.

PubMed

Hessler, Johannes Baltasar; Ander, Karl-Heinz; Brönner, Monika; Etgen, Thorleif; Förstl, Hans; Poppert, Holger; Sander, Dirk; Bickel, Horst

2016-07-26

Improving cardiovascular health possibly decreases the risk of dementia. Primary care practices offer a suitable setting for monitoring and controlling cardiovascular risk factors in the older population. The purpose of the study is to examine the association of a cardiovascular health metric including six behaviors and blood parameters with the risk of dementia in primary care patients. Participants (N = 3547) were insurants aged ≥55 of the largest German statutory health insurance company, who were enrolled in a six-year prospective population-based study. Smoking, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose were assessed by general practitioners at routine examinations. Using recommended cut-offs for each factor, the patients' cardiovascular health was classified as ideal, moderate, or poor. Behaviors and blood parameters sub-scores, as well as a total score, were calculated. Dementia diagnoses were retrieved from health insurance claims data. Results are presented as hazard ratios (HRs) and 95% confidence intervals (95% CIs). Over the course of the study 296 new cases of dementia occurred. Adjusted for age, sex, and education, current smoking (HR = 1.77, 95% CI 1.09-2.85), moderate (1.38, 1.05-1.81) or poor (1.81, 1.32-2.47) levels of physical activity, and poor fasting glucose levels (1.43, 1.02-2.02) were associated with an increased risk of dementia. Body mass index, blood pressure, and cholesterol were not associated with dementia. Separate summary scores for behaviors and blood values, as well as a total score showed no association with dementia. Sensitivity analyses with differently defined endpoints led to similar results. Due to complex relationships of body-mass index and blood pressure with dementia individual components cancelled each other out and rendered the sum-scores meaningless for the prediction of dementia.

Comparison of various risk indicators among patients with chronic and aggressive periodontitis in davangere population

PubMed Central

Vandana, Kharidhi Laxman; Nadkarni, Rahul Dilip; Guddada, Kaveri

2015-01-01

Background: The aim of the present study was to compare various risk indicators of chronic periodontitis (CP) and aggressive periodontitis (AP) among patients of Davangere population. Materials and Methods: Totally, 89 CP and 90 AP patients were selected from outpatient Department of Periodontics, College of Dental Sciences, Davangere. Various clinical parameters proven to be risk indicators were determined for each patient such as age, gender, occupation, oral hygiene habits, personal habits, income, level of education, place of residence, frequency of dental visits, various oral hygiene indices, gingival status, wasting diseases, malocclusion, laboratory investigations, and the results were subjected to statistical analysis. Results: This study demonstrated that AP is manifested early in life in susceptible individuals. Proven risk indicators for AP and CP in the present study population included young age, place of residence, income and education levels, frequency of dental visits. Patients with AP had better oral hygiene habits and oral hygiene index results than patients with CP. Paan chewing and smoking could be considered as risk factors, both in CP and AP cases. The similar association of plaque scores but higher bleeding tendency in AP patients supported the fact of higher susceptibility of AP patients to periodontal breakdown. Malocclusion being present in the majority of cases could also be put forth as a risk factor for AP and CP. Conclusion: This study identifies the different risk indicators for CP and AP and demonstrates the need for constructing nationwide oral health promotion programs to improve the level of oral health awareness and standards in Indian population. PMID:26392693

Perceptions of Oncologists, Healthcare Policy Makers, Patients and the General Population on the Value of Pharmaceutical Treatments in Oncology.

PubMed

Sacristán, José A; Lizan, Luís; Comellas, Marta; Garrido, Pilar; Avendaño, Cristina; Cruz-Hernández, Juan J; Espinosa, Javier; Dilla, Tatiana

2016-11-01

The purpose of this study was to explore the main factors explaining the relative weight of the different attributes that determine the value of oncologic treatments from the different perspectives of healthcare policy makers (HCPM), oncologists, patients and the general population in Spain. Structured interviews were conducted to assess: (1) the importance of the attributes on treatment choice when comparing a new cancer drug with a standard cancer treatment; (2) the importance of survival, quality of life (QoL), costs and innovation in cancer; and (3) the most worrying side effects related to cancer drugs. A total of 188 individuals participated in the study. For all participants, when choosing treatments, the best rated characteristics were greater efficacy, greater safety, treatment adaptation to patients' individual requirements and the rapid reincorporation of patients to their daily activities. There were important differences among participants in their opinion about survival, QoL and cost. In general, oncologists, patients, and the general population gave greater value to gains in QoL than healthcare policy makers. Compared to other participants healthcare policy makers gave greater importance to the economic impact related to oncology treatments. Gains in QoL, survival, safety, cost and innovation are perceived differently by different groups of stakeholders. It is recommended to consider the perspective of different stakeholders in the assessment of a new cancer drugs to obtain more informed decisions when deciding on the most appropriate treatment to use. Eli Lilly & Co, Madrid (Spain).

Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases.

PubMed

Maron, Barry J; Chaitman, Bernard R; Ackerman, Michael J; Bayés de Luna, Antonio; Corrado, Domenico; Crosson, Jane E; Deal, Barbara J; Driscoll, David J; Estes, N A Mark; Araújo, Claudio Gil S; Liang, David H; Mitten, Matthew J; Myerburg, Robert J; Pelliccia, Antonio; Thompson, Paul D; Towbin, Jeffrey A; Van Camp, Steven P

2004-06-08

A group of relatively uncommon but important genetic cardiovascular diseases (GCVDs) are associated with increased risk for sudden cardiac death during exercise, including hypertrophic cardiomyopathy, long-QT syndrome, Marfan syndrome, and arrhythmogenic right ventricular cardiomyopathy. These conditions, characterized by diverse phenotypic expression and genetic substrates, account for a substantial proportion of unexpected and usually arrhythmia-based fatal events during adolescence and young adulthood. Guidelines are in place governing eligibility and disqualification criteria for competitive athletes with these GCVDs (eg, Bethesda Conference No. 26 and its update as Bethesda Conference No. 36 in 2005). However, similar systematic recommendations for the much larger population of patients with GCVD who are not trained athletes, but nevertheless wish to participate in any of a variety of recreational physical activities and sports, have not been available. The practicing clinician is frequently confronted with the dilemma of designing noncompetitive exercise programs for athletes with GCVD after disqualification from competition, as well as for those patients with such conditions who do not aspire to organized sports. Indeed, many asymptomatic (or mildly symptomatic) patients with GCVD desire a physically active lifestyle with participation in recreational and leisure-time activities to take advantage of the many documented benefits of exercise. However, to date, no reference document has been available for ascertaining which types of physical activity could be regarded as either prudent or inadvisable in these subgroups of patients. Therefore, given this clear and present need, this American Heart Association consensus document was constituted, based largely on the experience and insights of the expert panel, to offer recommendations governing recreational exercise for patients with known GCVDs.

Diel Variation in Population Size and Ice Nucleation Activity of Pseudomonas syringae on Snap Bean Leaflets.

PubMed

Hirano, S S; Upper, C D

1989-03-01

The extent to which diel changes in the physical environment affect changes in population size and ice nucleation activity of Pseudomonas syringae on snap bean leaflets was determined under field conditions. To estimate bacterial population size and ice nucleation activity, bean leaflets were harvested at 2-h intervals during each of three 26-h periods. A tube nucleation test was used to assay individual leaflets for ice nuclei. Population sizes of P. syringae were determined by dilution plating of leaflet homogenates. The overall diel changes in P. syringae population sizes differed during each of the 26-h periods. In one 26-h period, there was a continuous increase in the logarithm of P. syringae population size despite intense solar radiation, absence of free moisture on leaf surfaces, and low relative humidity during the day. A mean doubling time of approximately 4.9 h was estimated for the 28-fold increase in P. syringae population size that occurred from 0900 to 0900 h during the 26-h period. However, doubling times of 3.3 and 1.9 h occurred briefly during this period from 1700 to 2300 h and from 0100 to 0700 h, respectively. Thus, growth rates of P. syringae in association with leaves in the field were of the same order of magnitude as optimal rates measured in the laboratory. The frequency with which leaflets bore ice nuclei active at -2.0, -2.2, and -2.5 degrees C varied greatly within each 26-h period. These large diel changes were inversely correlated primarily with the diel changes in air temperature and reflected changes in nucleation frequency rather than changes in population size of P. syringae. Thus, the response of bacterial ice nucleation activity to the physical environment was distinct from the changes in population size of ice nucleation-active P. syringae.

Effect of ethnicity, dietary intake and physical activity on plasma adiponectin concentrations among malaysian patients with type 2 diabetes mellitus.

PubMed

Chin, Koo Hui; Sathyasurya, Daniel Robert; Abu Saad, Hazizi; Jan Mohamed, Hamid Jan B

2013-01-01

The Malaysian Health and morbidity Survey (2006) reported the highest prevalence of type 2 diabetes mellitus (T2DM) among the Indian population compared to the Malay and Chinese populations. Many studies have supported the important role of adiponectin in insulin-sensitizing, which is associated with T2DM. These studies have raised a research question whether the variation in prevalence is related to the adiponectin concentrations or the lifestyle factors. The purpose of this study is to determine whether the adiponectin concentrations differ between the Malay, Chinese and the Indian populations with T2DM. It is to investigate the association of adiponectin concentrations with ethnicity, dietary intake and physical activity too. In this cross-sectional study, a total of 210 T2DM patients with mean (SD) age of 56.73 (10.23) years were recruited from Penang, Malaysia. Data on demographic background, medical history, anthropometry (weight, height, visceral fat, percentage of body fat and waist circumference), dietary intake (3 days 24 hours diet recall) and physical activity (International Physical Activity Questionnaire) were obtained accordingly. Plasma adiponectin and routine laboratory tests (fasting blood sugar, HbA1c, total cholesterol, LDL, HDL and triglyceride) were performed according to standard procedure. After adjustment for physical activity and dietary intakes, the Indian population had significantly lower adiponectin concentrations (P = 0.003) when compared with the Malay and the Chinese populations, The Indian population also had significantly higher value of HbA1c (P = 0.017) and significantly lower HDL (P = 0.013). Plasma adiponectin concentrations was significantly associated with ethnicity (P = 0.011), dietary carbohydrate (P = 0.003) and physical activity total MET score (P = 0.026), after medical history, age, sex, total cholesterol and visceral fat adjusted. However, dietary carbohydrate and physical activity did not show significantly

Sarcopenia and physical activity in older male cardiac patients.

PubMed

Izawa, Kazuhiro P; Watanabe, Satoshi; Oka, Koichiro; Kasahara, Yusuke; Morio, Yuji; Hiraki, Koji; Hirano, Yasuyuki; Omori, Yutaka; Suzuki, Norio; Kida, Keisuke; Suzuki, Kengo; Akashi, Yoshihiro J

2016-11-01

There is little information on the association of sarcopenia with physical activity in elderly cardiac patients. This study determined differences in physical activity and cutoff values for physical activity according to the presence or absence of sarcopenia in elderly male cardiac patients. Sixty-seven consecutive men aged ≥65 years with cardiac disease were enrolled. We defined sarcopenia using the European Working Group on Sarcopenia in Older People algorithm. Patients were divided into the sarcopenia group (n=25) and the non-sarcopenia group (n=42). In the patients with and without sarcopenia of physical activities were evaluated to determine cutoff values of physical activity. After adjusting for patient characteristics, both the average daily number of steps (3361.43±793.23 vs. 5991.55±583.57 steps, P=0.021) and the average daily energy expenditure of physical activity (71.84±22.19 vs. 154.57±16.18kcal, P=0.009) were significantly lower in the sarcopenia versus non-sarcopenia group. Receiver-operating characteristic analysis identified a cutoff value for steps of physical activity of 3551.80steps/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.44 and a cutoff value for energy expenditure of physical activity of 85.17kcal/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.27. Physical activity in the male cardiac patients with sarcopenia was significantly lower than that in those without sarcopenia. The cutoff values reported here may be useful values to aid in the identification of elderly male cardiac patients with sarcopenia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Population and Human Development: A Course Curriculum Including Lesson Plans, Activities and Bibliography.

ERIC Educational Resources Information Center

Murphy, Elaine M.

This course outline suggests materials and learning activities on the interrelated causes and consequences of population growth and other population concerns. Designed to educate general college audiences, it is also intended for use as a preservice course for teachers. In addition, the course can be modified for high school students. The course…

Systemic levels of neuropeptide Y and dipeptidyl peptidase activity in Ewing sarcoma patients – associations with tumor phenotype and survival

PubMed Central

Tilan, Jason U.; Krailo, Mark; Barkauskas, Donald A.; Galli, Susana; Mtaweh, Haifa; Long, Jessica; Wang, Hongkun; Hawkins, Kirsten; Lu, Congyi; Jeha, Dima; Izycka-Swieszewska, Ewa; Lawlor, Elizabeth R.; Toretsky, Jeffrey A.; Kitlinska, Joanna

2014-01-01

Background Ewing sarcoma (ES) is driven by fusion of the EWS gene with an ETS transcription factor, most often FLI1. Neuropeptide Y (NPY) is an EWS-FLI1 transcriptional target. NPY is highly expressed in ES and exerts opposing effects, ranging from ES cell death to angiogenesis and cancer stem cell propagation. The functions of NPY are regulated by dipeptidyl peptidase IV (DPPIV), a hypoxia-inducible enzyme that cleaves the peptide and activates its growth-promoting actions. The goal of this study was to determine clinically relevant functions of NPY by identifying the associations between its concentrations and DPP activity in patients and ES phenotype. Methods NPY concentrations and DPP activity were measured in serum samples from 223 patients with localized and 9 patients with metastatic ES provided by Children’s Oncology Group. Results Serum NPY levels were elevated in ES patients, as compared to healthy control and osteosarcoma populations, independently of the EWS-ETS translocation type. Significantly higher NPY concentrations were detected in ES patients with tumors of pelvic and bone origin. A similar trend was observed in patients with metastatic ES. There was no effect of NPY on survival in patients with localized ES. DPP activity in sera of ES patients was not significantly different from healthy control and osteosarcoma patients. However, high DPP levels were associated with improved survival. Conclusion Systemic NPY is elevated in ES patients and its high levels associate with unfavorable disease features. DPPIV in patients’ sera is derived from non-tumoral sources and its high activity correlates with improved survival. PMID:25387699

Experimentally increasing sedentary behavior results in increased anxiety in an active young adult population.

PubMed

Edwards, Meghan K; Loprinzi, Paul D

2016-11-01

Knowledge regarding the effects of sedentary behavior on anxiety has resulted mainly from observational studies. The purpose of this study was to examine the effects of a free-living, sedentary behavior-inducing randomized controlled intervention on anxiety symptoms. Participants confirmed to be active (i.e., acquiring 150min/week of physical activity) via self-report and accelerometry were randomly assigned into a sedentary behavior intervention group (n=26) or a control group (n=13). For one week, the intervention group eliminated exercise and minimized steps to ≤5000 steps/day whereas the control group continued their normal physical activity levels. Both groups completed the Overall Anxiety Severity Impairment Scale (OASIS) pre- and post-intervention, with higher OASIS scores indicating worse overall anxiety. The intervention group resumed normal physical activity levels for one week post-intervention and then completed the survey once more. A significant group x time interaction effect was observed (F(1,37)=11.13; P=.002), with post-hoc contrast tests indicating increased OASIS scores in the intervention group in Visit 2 compared with Visit 1. That is, we observed an increase in anxiety levels when participants increased their sedentary behavior. OASIS scores significantly decreased from Visit 2 to Visit 3 (P=.001) in the intervention group. A one-week sedentary behavior-inducing intervention has deleterious effects on anxiety in an active, young adult population. To prevent elevated anxiety levels among active individuals, consistent regular physical activity may be necessary. Clinicians treating inactive patients who have anxiety may recommend a physical activity program in addition to any other prescribed treatment. Copyright © 2016 Elsevier B.V. All rights reserved.

Population pharmacokinetics of intravenous acetaminophen in Japanese patients undergoing elective surgery.

PubMed

Imaizumi, Tsuyoshi; Obara, Shinju; Mogami, Midori; Iseki, Yuzo; Hasegawa, Makiko; Murakawa, Masahiro

2017-06-01

Intravenous (i.v.) acetaminophen is administered during surgery for postoperative analgesia. However, little information is available on the pharmacokinetics of i.v. acetaminophen in Japanese patients undergoing surgery under general anesthesia. The study was approved by the Institutional Review Board and registered at UMIN-CTR (UMIN000013418). Patients scheduled to undergo elective surgery under general anesthesia were enrolled after obtaining written informed consent. During surgery, 1 g of i.v. acetaminophen was administered over 15, 60, or 120 min. Acetaminophen concentrations (15 or 16 samples per case) were measured at time points from 0-480 min after the start of administration (liquid chromatography-mass spectrometry/tandem mass spectrometry; limit of quantitation 0.1 μg/mL). The predictive performance of three published pharmacokinetic models was evaluated. Population pharmacokinetics were also analyzed using a nonlinear mixed-effect model based on the NONMEM program. Data from 12 patients who underwent endoscopic or lower limb procedures were analyzed (male/female = 7/5, median age 55 years, weight 63 kg). Anesthesia was maintained with remifentanil and propofol or sevoflurane. The pharmacokinetic model of i.v. acetaminophen reported by Würthwein et al. worked well. Using 185 datapoints, the pharmacokinetics of i.v. acetaminophen were described by a two-compartment model with weight as a covariate but not age, sex, or creatinine clearance. The median prediction error and median absolute prediction error of the final model were -1 and 10%, respectively. A population pharmacokinetic model of i.v. acetaminophen in Japanese patients was constructed, with performance within acceptable ranges.

Association between helplessness, disability, and disease activity with health-related quality of life among rheumatoid arthritis patients in a multiethnic Asian population.

PubMed

Kwan, Yu Heng; Koh, Ee Tzun; Leong, Khai Pang; Wee, Hwee-Lin

2014-08-01

To investigate the association between helplessness, disability, and disease activity with health-related quality of life (HRQoL) in a multiethnic cohort of rheumatoid arthritis (RA) patients in Singapore. This cross-sectional study was conducted at Tan Tock Seng Hospital, Department of Rheumatology, Allergy and Immunology, from October 2010 to October 2011. All patients fulfilled the American College of Rheumatology 1987 criteria for RA. Socio-demographics, clinical, and patient-reported outcome (PRO) variables were collected. HRQoL outcomes were Short Form 36 (SF-36) physical and mental component summary (PCS and MCS) scores and Short Form 6 Dimensions (SF-6D) utilities. Stepwise multiple linear regression analyses were performed using HRQoL outcomes as dependent variables in separate models and with adjustment for helplessness (Rheumatology Attitudes Index, RAI), disability (Health Assessment Questionnaire, HAQ), and disease activity (Disease Activity in 28 joints) followed by socio-demographic, clinical, and PRO variables. Complete data were provided by 473 consenting subjects [mean (SD) age: 60.02 (11.04) years, 85 % female, 77 % Chinese]. After adjustment for all measured covariates, only RAI and HAQ scores remained significantly associated with SF-36 MCS (β: -0.9, p < 0.001; β: -7.0, p < 0.001) and SF-6D utilities (β: -0.005, p < 0.001; β: -0.081, p < 0.001), respectively, while only HAQ scores were significantly associated with SF-36 PCS (β: -7.7, p < 0.001). Interventions to address the sense of helplessness and to prevent or reduce disability could improve HRQoL of RA patients.

Fibromyalgia in patients with other rheumatic diseases: prevalence and relationship with disease activity.

PubMed

Haliloglu, Sema; Carlioglu, Ayse; Akdeniz, Derya; Karaaslan, Yasar; Kosar, Ali

2014-09-01

Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain and the presence of specific tender points. The prevalence of FM has been estimated at 2-7 % of the general global population. The presence of FM in several rheumatic diseases with a structural pathology has been reported as 11-30 %. The objectives of this study were to determine the prevalence of FM and to evaluate the possible relationship between FM existence and disease activity among rheumatic diseases. The study group included 835 patients--197 rheumatoid arthritis (RA), 67 systemic lupus erythematosus (SLE), 119 ankylosing spondylitis (AS), 238 osteoarthritis (OA), 14 familial Mediterranean fever (FMF), 53 Behçet's disease (BD), 71 gout, 25 Sjögren's syndrome (SS), 20 vasculitis, 29 polymyalgia rheumatica (PMR), and two polymyositis (PM)--with or without FM. Recorded information included age, gender, laboratory parameters, presence of fatigue, and disease activity indexes. The prevalence of FM in patients with rheumatologic diseases was found to be 6.6 % for RA, 13.4 % for SLE, 12.6 % for AS, 10.1 % for OA, 5.7 % for BD, 7.1 % for FMF, 12 % for SS, 25 % for vasculitis, 1.4 % for gout, and 6.9 % for PMR. One out of two patients with PM was diagnosed with FM. Some rheumatologic cases (AS, OA) with FM were observed mostly in female patients (p = 0.000). Also, there were significant correlations between disease activity indexes and Fibromyalgia Impact Questionnaire scores for most rheumatologic patients (RA, AS, OA, and BD) (p < 0.05; respectively, r = 0.6, 0.95, 0.887, and 1). Concomitant FM is a common clinical problem in rheumatologic diseases, and its recognition is important for the optimal management of these diseases. Increased pain, physical limitations, and fatigue may be interpreted as increased activity of these diseases, and a common treatment option is the prescription of higher doses of biologic agents or corticosteroids. Considerations of the FM component in the management

Efficacy and safety of secukinumab in Asian patients with active ankylosing spondylitis: 52-week pooled results from two phase 3 studies.

PubMed

Wei, James C-C; Baeten, Dominique; Sieper, Joachim; Deodhar, Atul; Bhosekar, Vaishali; Martin, Ruvie; Porter, Brian

2017-05-01

To evaluate efficacy and safety of secukinumab in Asian patients with active ankylosing spondylitis (AS) via a pooled subgroup analysis from two phase 3 studies, MEASURE 1 (NCT01358175) and MEASURE 2 (NCT01649375). In MEASURE 1, patients were randomized to intravenous secukinumab 10 mg/kg or placebo at baseline, Weeks 2 and 4, followed by subcutaneous (s.c.) secukinumab 150 mg, 75 mg or placebo every 4 weeks (q4w) at Week 8. In MEASURE 2, patients were randomized to s.c. secukinumab 150 mg, 75 mg or placebo at baseline, Weeks 1, 2 and 3, and q4w starting at Week 4. Efficacy outcomes were SpondyloArthritis International Society (ASAS) 20/40, high-sensitivity C-reactive protein (hsCRP), ASAS5/6, Bath Ankylosing Spondylitis Disease Activity Index, Short Form-36 physical component summary, AS quality of life (QoL), ASAS partial remission, and Ankylosing Spondylitis Disease Activity Score - CRP at Weeks 16 and 52. Due to lack of efficacy, the secukinumab 75 mg dose in MEASURE 2 was excluded from this pooled Asian subgroup analysis. Safety analysis included patients who received ≥ 1 dose of study treatment. Of 517 patients enrolled into the MEASURE studies, 69 (13.3%) were Asians: 46 in pooled secukinumab and 23 in placebo. At Week 16, ASAS20/40 responses in Asian patients were 69.6%/43.5% with pooled secukinumab versus 26.1%/17.4% with placebo, which were comparable with rates reported in the overall study population. Secukinumab improved predefined efficacy endpoints at Week 16, with responses sustained through Week 52. Secukinumab was well tolerated in Asian patients, with a safety profile consistent with that reported in the overall study population. Secukinumab improved signs and symptoms, physical function, and disease-specific QoL in Asian patients with active AS. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Correlation of BAT activity with thyroid metabolic activity in patients with fibromyalgia

NASA Astrophysics Data System (ADS)

Costa, A. P. C.; Maia, J. M.; Brioschi, M. L.; Machado, J. E. M. M.

2017-03-01

The objective of this research is to correlate the brown fat activity (BAT) with the metabolic activity of thyroid in patients with fibromyalgia syndrome (FS). For the development of the research, it was select a database containing 132 patients of a thermography clinic, male and female, with age over 18 years old; where the images selected were anteroposterior orthostasis top and anteroposterior in cervical extension. In the program Flir Report, it was possible to demarcate the region of the left and right interscapular and thyroid of each patient by getting the respective temperatures, in addition to view the hyper-radiation ("signal of mantle") in the interscapular. Temperature was organized in table format, and statistical analysis was performed in the program Microcal Origin 6.0. As conclusion, it was found that the greater the metabolic activity of thyroid in patients with fibromyalgia, the greater will be the metabolic rate of brown fat (BAT).

Validation of the Regicor Short Physical Activity Questionnaire for the Adult Population

PubMed Central

Molina, Luis; Sarmiento, Manuel; Peñafiel, Judith; Donaire, David; Garcia-Aymerich, Judith; Gomez, Miquel; Ble, Mireia; Ruiz, Sonia; Frances, Albert; Schröder, Helmut; Marrugat, Jaume; Elosua, Roberto

2017-01-01

Objective To develop and validate a short questionnaire to estimate physical activity (PA) practice and sedentary behavior for the adult population. Methods The short questionnaire was developed using data from a cross-sectional population-based survey (n = 6352) that included the Minnesota leisure-time PA questionnaire. Activities that explained a significant proportion of the variability of population PA practice were identified. Validation of the short questionnaire included a cross-sectional component to assess validity with respect to the data collected by accelerometers and a longitudinal component to assess reliability and sensitivity to detect changes (n = 114, aged 35 to 74 years). Results Six types of activities that accounted for 87% of population variability in PA estimated with the Minnesota questionnaire were selected. The short questionnaire estimates energy expenditure in total PA and by intensity (light, moderate, vigorous), and includes 2 questions about sedentary behavior and a question about occupational PA. The short questionnaire showed high reliability, with intraclass correlation coefficients ranging between 0.79 to 0.95. The Spearman correlation coefficients between estimated energy expenditure obtained with the questionnaire and the number of steps detected by the accelerometer were as follows: 0.36 for total PA, 0.40 for moderate intensity, and 0.26 for vigorous intensity. The questionnaire was sensitive to detect changes in moderate and vigorous PA (correlation coefficients ranging from 0.26 to 0.34). Conclusion The REGICOR short questionnaire is reliable, valid, and sensitive to detect changes in moderate and vigorous PA. This questionnaire could be used in daily clinical practice and epidemiological studies. PMID:28085886

Methods of Suicide among Cancer Patients: A Nationwide Population-Based Study

ERIC Educational Resources Information Center

Chung, Kuo-Hsuan; Lin, Herng-Ching

2010-01-01

A 3-year nationwide population-based data set was used to explore methods of suicide (violent vs. nonviolent) and possible contributing factors among cancer patients in Taiwan. A total of 1,065 cancer inpatients who committed suicide were included as our study sample. The regression shows that those who had genitourinary cancer were 0.55 times (p…

[Cigarette smoking among economically active population].

PubMed

Kaleta, Dorota; Korytkowski, Przemyslaw; Makowiec-Dabrowska, Teresa

2013-01-01

Tobacco smoking is one of the major risk factors for chronic diseases and results in huge economic and social costs. The aim of the study was to evaluate the prevalence of smoking. Moreover, we evaluated the association between selected socioeconomic factors and tobacco smoking among economically active individuals. The study population covered 2254 economically active men and 1666 women. Data were derived from the Global Adult Tobacco Survey (GATS). About 37.3% of men and 28.2% of women smoke regularly. Daily smoking was significantly associated with low level of education in men (primary vs. high education OR = 3.2, 95% CI: 1.9-5.3; p < 0.001; vocational vs. high education: OR = 2.1, 95% CI: 1.5-3.0; p < 0.001) and women (primary vs. high education OR = 2.8, CI: 1.4-5.5; p < 0.01; vocational vs. high education: OR = 1.9, 95% CI: 1.2-2.9; p < 0.01). Daily smoking was significantly associated with age of women (40-49 years vs. 20-29 years OR = 1.64, 95% CI: 1.1-2.44; p < 0.01), lack of awareness of health effects of smoking in both genders (men unaware vs. aware: OR = 2.9, 95% CI: 1.8-4.6; p < 0.01 and women unaware vs. aware: OR = 2.9, 95% CI: 1.5-5.7; p < 0.01). Smoking was associated with lack of complete smoking bans at workplaces of respondents. Comprehensive interventions are needed to reduce the prevalence of smoking among economically active individuals.

Evaluating digestion efficiency in full-scale anaerobic digesters by identifying active microbial populations through the lens of microbial activity

NASA Astrophysics Data System (ADS)

Mei, Ran; Narihiro, Takashi; Nobu, Masaru K.; Kuroda, Kyohei; Liu, Wen-Tso

2016-09-01

Anaerobic digestion is a common technology to biologically stabilize wasted solids produced in municipal wastewater treatment. Its efficiency is usually evaluated by calculating the reduction in volatile solids, which assumes no biomass growth associated with digestion. To determine whether this assumption is valid and further evaluate digestion efficiency, this study sampled 35 digester sludge from different reactors at multiple time points together with the feed biomass in a full-scale water reclamation plant at Chicago, Illinois. The microbial communities were characterized using Illumina sequencing technology based on 16S rRNA and 16S rRNA gene (rDNA). 74 core microbial populations were identified and represented 58.7% of the entire digester community. Among them, active populations were first identified using the ratio of 16S rRNA and 16S rDNA (rRNA/rDNA) for individual populations, but this approach failed to generate consistent results. Subsequently, a recently proposed mass balance model was applied to calculate the specific growth rate (μ), and this approach successfully identified active microbial populations in digester (positive μ) that could play important roles than those with negative μ. It was further estimated that 82% of microbial populations in the feed sludge were digested in comparison with less than 50% calculated using current equations.

Does arthroscopic rotator cuff repair improve patients' activity levels?

PubMed

Baumgarten, Keith M; Chang, Peter S; Dannenbring, Tasha M; Foley, Elaine K

2018-06-04

Rotator cuff repair decreases pain, improves range of motion, and increases strength. Whether these improvements translate to an improvement in a patient's activity level postoperatively remains unknown. The Shoulder Activity Level is a valid and reliable outcomes survey that can be used to measure a patient's shoulder-specific activity level. Currently, there are no studies that examine the effect of rotator cuff repair on shoulder activity level. Preoperative patient-determined outcomes scores collected prospectively on patients undergoing rotator cuff repair were compared with postoperative scores at a minimum of 2 years. These scores included the Shoulder Activity Level, Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, and simple shoulder test. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. Included were 281 shoulders from 273 patients with a mean follow-up of 3.7 years. The postoperative median Western Ontario Rotator Cuff Index (42 vs. 94), American Shoulder and Elbow Surgeons (41 vs. 95), Single Assessment Numeric Evaluation (30 vs. 95), and simple shoulder test (4 vs. 11) scores were statistically significantly improved compared with preoperative scores (P < .0001). The postoperative median Shoulder Activity Level score decreased compared with the preoperative score (12 vs. 11; P < .0001). Patients reported a statistically significant deterioration of their Shoulder Activity Level score after rotator cuff repair compared with their preoperative scores, although disease-specific and joint-specific quality of life scores all had statistically significantly improvement. This study suggests that patients generally have (1) significant improvements in their quality of life and (2) small deteriorations in activity level after arthroscopic rotator cuff repair. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of

Physical activity of elderly patients after total hip arthroplasty.

PubMed

Cukras, Zbigniew; Praczko, Katarzyna; Kostka, Tomasz; Jegier, Anna

2007-01-01

Total hip arthroplasty (THA) is the most common method of treatment of severe hip osteoarthritis. There is little data concerning the physical activity of total hip arthroplasty patients in Poland and investigations to explore this area are useful. The aim of the study was to describe the post-operative physical activity of total hip arthroplasty patients. A total of 146 adult people were examined, among which 28 men and 41 women had undergone total hip arthroplasty due to primary osteoarthritis of the hip, while another 32 men and 41 women matched for age who had not undergone hip surgery for osteoarthritis served as controls. The physical activity of study participants was assessed with the 7-Day Physical Activity Recall Questionnaire. All participants were also asked about the type and amount of physical activity they engaged in to maintain good health. Physical activity measured as the total amount of calories expended through physical activity per week was similar in the post-THA patients compared to the controls. The only differences were a smaller amount of calories expended during low-intensity physical activity by men after total hip arthroplasty compared to men who had not undergone surgery for osteoarthritis and a smaller amount of calories expended through high-intensity physical activity by women after total hip arthroplasty compared to female controls. The kinds of recreational physical activity most commonly practised by patients a mean of two years after total hip arthroplasty were marching, bicycling and general body conditioning exercises (usually the continuation of exercises recommended during post-operative rehabilitation). The percentage of post-THA patients undertaking physical activity for the prevention of non-communicable diseases was low. Physical activity should be more effectively encouraged in patients after total hip arthroplasty.

Ecto-5′-Nucleotidase Activity in Human T Cell Subsets. DECREASED NUMBERS OF ECTO-5′-NUCLEOTIDASE POSITIVE CELLS FROM BOTH OKT4+ AND OKT8+ CELLS IN PATIENTS WITH HYPOGAMMAGLOBULINEMIA

PubMed Central

Thompson, Linda F.; Saxon, Andrew; O'Connor, Richard D.; Fox, Robert I.

1983-01-01

T lymphocytes from control subjects were separated into subsets using monoclonal antibodies of the OKT series and complement lysis and analyzed for ecto-5′-nucleotidase activity both by quantitative radiochemical assay and a histochemical stain. T cells from 15 control subjects contained 54±4% OKT4+ (helper/inducer) cells and 32±3% OKT8+ (cytotoxic/suppressor) cells. Total T cell ecto-5′-nucleotidase activity was 10.9±2.1 nmol/h per 106 cells with 25±7% positive by histochemical stain. Ecto-5′-nucleotidase activity in OKT4-enriched populations was 5.43±1.8 nmol/h per 106 cells with 14±2% positive by histochemical stain; that in OKT8-enriched populations was 17.1±5.9 nmol/h per 106 cells with 35±8% positive by histochemical stain. Two of four patients with congenital agammaglobulinemia and four of seven patients with common variable immunodeficiency had decreased proportions of OKT4+ T cells with corresponding increases in the proportions of OKT8+ T cells (OKT4/OKT8 = 0.60 to 1.0 as compared with 1.7±0.2 for control subjects). All four patients with congenital agammaglobulinemia, and three of seven patients with common variable immunodeficiency also had low T cell ecto-5′-nucleotidase activity (<5.5 nmol/h per 106 cells). Ecto-5′-nucleotidase activity in OKT4- enriched populations isolated from four patients with low total T cell activity was 2.85±0.90 nmol/h per 106 cells with 10±4% positive by histochemical stain; that in OKT8-enriched populations was 6.82±1.7 nmol/h per 106 cells with 7.5±3% positive by histochemical stain. Thus, the number of ecto-5′-nucleotidase positive cells is decreased, especially in the OKT8+ subpopulation, and the low total T cell ecto-5′-nucleotidase activity seen in these patients is due to fewer positive cells rather than to substantially less activity per cell. Our data indicate that ecto-5′-nucleotidase activity defines two subpopulations of T lymphocytes (ecto-5′-nucleotidase positive and negative

A population-based study of demographical variables and ability to perform activities of daily living in adults with osteogenesis imperfecta.

PubMed

Wekre, Lena Lande; Frøslie, Kathrine Frey; Haugen, Lena; Falch, Jan A

2010-01-01

To describe demographical variables, and to study functional ability to perform activities of daily life in adults with osteogenesis imperfecta (OI). Population-based study. Ninety-seven patients aged 25 years and older, 41 men and 56 women, were included. For the demographical variables, comparison was made to a matched control-group (475 persons) from the Norwegian general population. Structured interviews concerning social conditions, employment and educational issues and clinical examination were performed. The Sunnaas Activities of Daily Living (ADL) Index was used to assess the ability to perform ADL. The prevalence of clinical manifestations according to Sillence was in accordance with other studies. Demographical variables showed that most adults with OI are married and have children. They had a higher educational level than the control group, but the employment rate was significantly lower. However, the rate of employed men was similar in both groups. Adult persons with OI achieved a high score when tested for ADL. Adults with OI are well educated compared with the general population, and most of them are employed. High scores when tested for ADL indicate that most of them are able to live their lives independently, even though there are some differences according to the severity of the disorder.

[Population].

PubMed

1979-01-01

Data on the population of Venezuela between 1975 and 1977 are presented in descriptive tables and graphs. Information is included on the employed population according to category, sex, and type of economic activity, and by sex, age, and area on the employment rate and the total, the economically active, and the unemployed population.

Mortality in HIV-hepatitis C co-infected patients in Canada compared to the general Canadian population (2003-2013).

PubMed

Klein, Marina B; Rollet-Kurhajec, Kathleen C; Moodie, Erica E M; Yaphe, Sean; Tyndall, Mark; Walmsley, Sharon; Gill, John; Martel-Laferriere, Valerie; Cooper, Curtis

2014-08-24

Recent studies suggest all-cause mortality in HIV mono-infected patients approaches that of the general population. We aimed to compare participants in the Canadian Co-infection Cohort to the general population to determine if co-infected patients have had similar improvements in mortality. Prospective multicentre cohort study. Between 2003 and 2013, deaths were captured using specific case reports and through linkage to provincial vital statistics for participants lost to follow-up. Standardized mortality ratios (SMRs) were calculated using age, sex and province-specific mortality rates from the Canadian Human Mortality Database, 2009, and compared across behavioural and clinical characteristics of participants at their most recent visit. Among the 1150 patients, we observed 133 deaths over 3351 person-years (4.0 per 100 person-years, 95% confidence interval 3.3, 4.6). SMRs (95% confidence interval) were: 12.1(10.1, 14.2) overall; 9.3 (7.5, 11.1) for men and 19.4 (12.7, 26.2) for women. CD4 cell counts below 200 cells/μl [25.5 (17.7, 33.3)], active injection drug use [19.9 (13.9, 25.9)] and smoking [14.9 (12.1, 17.7)] were strongly associated with excess mortality. Lowest SMRs were seen for those who had spontaneous [4.5 (-0.6, 9.5)] or treatment-induced clearance of hepatitis C virus (HCV) infection [5.1 (1.3, 8.8)]. Conversely, high SMRs were seen with advanced liver disease [17.0 (11.7, 22.3)]. In no category did SMRs approach mortality seen in the general Canadian population. HIV-HCV co-infected persons remain at markedly increased risk for death despite antiretroviral therapy. Interventions targeting modifiable risk factors such as substance use, smoking, adherence to antiretrovirals and timely provision of HCV therapy could substantially reduce death rates.

Evaluation of spondylarthritis activity by patients and physicians: ASDAS, BASDAI, PASS, and flares in 200 patients.

PubMed

Godfrin-Valnet, Marie; Prati, Clément; Puyraveau, Marc; Toussirot, Eric; Letho-Gyselink, Hélène; Wendling, Daniel

2013-07-01

In patients with spondyloarthritis, to determine Ankylosing Spondylitis Disease Activity Score (ASDAS) cutoffs matching the patient-acceptable symptom state (PASS) and patient-reported levels of disease activity, to assess associations between disease activity levels and presence of depression, and to identify ASDAS and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) cutoffs indicating a flare and indicating a remission. Prospective single-center study of patients meeting ASAS criteria for spondyloarthritis receiving follow-up at the Besançon teaching hospital, France, between February 2011 and February 2012. In each patient, the BASDAI, ASDAS, Bath Ankylosing Spondylitis Functional Index (BASFI), patient-acceptable symptom state (PASS) and signs of depression were assessed. Receiver-operating characteristic (ROC) curves were drawn to identify the ASDAS cutoffs separating different levels of disease activity. The kappa coefficient was computed to evaluate agreement between patients and physicians regarding the presence of flares. Two hundred patients with a mean age of 44.4 ± 12.5 years and mean disease duration of 12.9 ± 10.5 years were included. Mean BASDAI was 4.1 ± 2.2, mean ASDAS-C-reactive protein (CRP) was 2.4 ± 1, mean BASFI was 3.3 ± 2.7, and 58.9% of patients reported being in the PASS. The PASS was associated with BASDAI values inferior or equal to 4.1 and ASDAS-CRP values inferior or equal to 2.3. Mild patient-reported disease activity was associated with BASDAI values inferior or equal to 3.8 and ASDAS-CRP values inferior or equal to 2.3; corresponding values for high patient-reported disease activity were superior to 5.2 and superior to 3.1. Among patients reporting high disease activity, 64.5% had Beck Depression Inventory scores consistent with severe depression. At the time of the visit, 36.9% of the patients and 28.3% of the physicians felt there was a flare. Cutoffs indicating a flare were superior or equal to 5.2 for the BASDAI

Exploring Contextual Factors and Patient Activation: Evidence from a Nationally Representative Sample of Patients with Depression

ERIC Educational Resources Information Center

Chen, Jie; Mortensen, Karoline; Bloodworth, Robin

2014-01-01

Patient activation has been considered as a "blockbuster drug of the century." Patients with mental disorders are less activated compared to patients with other chronic diseases. Low activation due to mental disorders can affect the efficiency of treatment of other comorbidities. Contextual factors are significantly associated with…

Bringing state-of-the-art diagnostics to vulnerable populations: The use of a mobile screening unit in active case finding for tuberculosis in Palawan, the Philippines.

PubMed

Morishita, Fukushi; Garfin, Anna Marie Celina Gonzales; Lew, Woojin; Oh, Kyung Hyun; Yadav, Rajendra-Prasad; Reston, Janeth Cuencaho; Infante, Lenie Lucio; Acala, Maria Rebethia Crueldad; Palanca, Dean Lim; Kim, Hee Jin; Nishikiori, Nobuyuki

2017-01-01

Globally, case detection of tuberculosis (TB) has stabilized in recent years. Active case finding (ACF) has regained an increased attention as a complementary strategy to fill the case detection gap. In the Philippines, the DetecTB project implemented an innovative ACF strategy that offered a one-stop diagnostic service with a mobile unit equipped with enhanced diagnostic tools including chest X-ray (CXR) and Xpert®MTB/RIF (Xpert). The project targeted the rural poor, the urban poor, prison inmates, indigenous population and high school students. This is a retrospective review of TB screening data from 25,103 individuals. A descriptive analysis was carried out to compare screening and treatment outcomes across target populations. Univariate and multivariate analyses were performed to identify predictors of TB for each population. The composition of bacteriologically-confirmed cases by smear and symptom status was further investigated. The highest yield with lowest number needed to screen (NNS) was found in prison (6.2%, NNS: 16), followed by indigenous population (2.9%, NNS: 34), the rural poor (2.2%, NNS: 45), the urban poor (2.1%, NNS: 48), and high school (0.2%, NNS: 495). The treatment success rate for all populations was high with 89.5% in rifampicin-susceptible patients and 83.3% in rifampicin-resistant patients. A relatively higher loss to follow-up rate was observed in indigenous population (7.5%) and the rural poor (6.4%). Only cough more than two weeks showed a significant association with TB diagnosis in all target populations (Adjusted Odds Ratio ranging from 1.71 to 6.73) while other symptoms and demographic factors varied in their strength of association. The urban poor had the highest proportion of smear-positive patients with cough more than two weeks (72.0%). The proportion of smear-negative (Xpert-positive) patients without cough more than two weeks was the highest in indigenous population (39.3%), followed by prison inmates (27.7%), and the

Incidence of Sudden Cardiac Death in a Young Active Population

PubMed Central

Farioli, Andrea; Christophi, Costas A; Quarta, Candida Cristina; Kales, Stefanos N

2015-01-01

Background Little is known about the burden of sudden cardiac death (SCD) among active, presumably healthy persons. We investigated the incidence of SCD among US male career firefighters. Methods and Results All on-duty SCDs among US male career firefighters between 1998 and 2012 were identified from the US Fire Administration and the US National Institute for Occupational Safety and Health databases. Age-specific incidence rates (IRs) of SCD with 95% CIs were computed. A joinpoint model was fitted to analyze the trend in IR and to help estimate the annual percentage change of SCD rates over the years. The effects of seasonality were assessed through a Poisson regression model. We identified 182 SCDs; based on 99 available autopsy reports, the leading underlying cause of death was coronary heart disease (79%). The overall IR was 18.1 SCDs per 100 000 person-years. The age-specific IRs of SCD ranged between 3.8 (for those aged 18 to 24 years) and 45.2 (for those aged 55 to 64 years) per 100 000 person-years. The annual rate of SCD steadily declined over time (annual percentage change −3.9%, 95% CI −5.8 to −2.0). SCD events were more frequent during January (peak-to-low ratio 1.70; 95% CI 1.09 to 2.65). In addition, the IR was 3 times higher during high-risk duties compared with low-risk duties. IRs among firefighters were lower than those observed among the US general population and US military personnel. Conclusions SCD risk in this active working population is overestimated using statistics from the general population. To address public health questions among these subpopulations, more specific studies of active adults should be conducted. PMID:26066031

Active pulmonary tuberculosis case detection and treatment among floating population in China: an effective pilot.

PubMed

Li, Xinxu; Zhang, Hui; Jiang, Shiwen; Wang, Jia; Liu, Xiaoqiu; Li, Weibin; Yao, Hongyan; Wang, Lixia

2010-12-01

China has more and more floating population because of reform and opening-up. As one of the high burden countries in tuberculosis (TB) control in the world, China has to face more challenges about the TB case detection and treatment among floating population in China. Aim to evaluate the effect of case detection and treatment of the Floating Population TB Control Pilot Project from Global Fund Round Five (GFR5) TB Control Program in China. During October 2006 to September 2008, the pilot project was implemented gradually in 60 counties in Tianjin, Shanghai, Jiangsu, Zhejiang, Fujian, Shandong and Guangdong. All quarterly reports of the pilot project were collected, and these materials were summarized and analyzed. In seven coastal provinces, 19,584 active pulmonary TB (PTB) cases were registered among floating population in 2 years. Among the active PTB cases, 87.2% were 15-45 years old, and 62.8% were male. In second year, 15,629 active PTB cases were registered, and the overall registration rate was 68 per 100,000 people. DOT treatments were provided for 18,125 active PTB cases in 2 years, and overall DOT treatment rate was 92.6%. There were 3,955 active PTB cases registered in first year, and the overall cure rate was 86.0%. Through the implementation of the pilot project, the TB case detection and treatment among floating population have been enhanced in pilot areas of China. The useful experience and results from the pilot project have been being gradually generalized nationally.

Effect of a performance improvement CME activity on management of patients with diabetes.

PubMed

Bird, Gary C; Marian, Kathy; Bagley, Bruce

2013-01-01

Primary care in the United States faces unprecedented challenges from an aging population and the accompanying prevalence of chronic disease. In response, continuing medical education (CME) initiatives have begun to adopt the principles of performance improvement (PI) into their design, although currently there is a dearth of evidence from national initiatives supporting the effectiveness of this methodology. The specific aim of this study was to demonstrate the value of a national PI-CME activity to improve the performance of physicians treating patients with diabetes. We analyzed data from the American Academy of Family Physicians' METRIC® PI-CME activity in a cohort of family physician learners. The study utilized the 3-stage design standard approved for PI-CME. Baseline and follow-up performance data across a range of clinical and systems-based measures were compared in aggregate. Data were assessed for 509 learners who completed the activity. Statistically significant changes occurred both for self-assessment of a range of practice aspects and for diabetes care measures. Learners recognized that the organization of their practices had improved, and mechanisms were in place for better staff feedback, as well as aspects of patient self-management. Based on the clinical data obtained from 11 538 patient charts, 6 out of 8 diabetes measures were significantly improved. The activity appears to have had a positive, measurable impact on the medical practice of learners and suggests that, when appropriately designed and executed, PI-CME on a national scale can be a useful vehicle to influence performance change in physicians and to inform future CME activities. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Smoking paradox in the development of psoriatic arthritis among patients with psoriasis: a population-based study.

PubMed

Nguyen, Uyen-Sa D T; Zhang, Yuqing; Lu, Na; Louie-Gao, Qiong; Niu, Jingbo; Ogdie, Alexis; Gelfand, Joel M; LaValley, Michael P; Dubreuil, Maureen; Sparks, Jeffrey A; Karlson, Elizabeth W; Choi, Hyon K

2018-01-01

Smoking is associated with an increased risk of psoriatic arthritis (PsA) in the general population, but not among patients with psoriasis. We sought to clarify the possible methodological mechanisms behind this paradox. Using 1995-2015 data from The Health Improvement Network, we performed survival analysis to examine the association between smoking and incident PsA in the general population and among patients with psoriasis. We clarified the paradox using mediation analysis and conducted bias sensitivity analyses to evaluate the potential impact of index event bias and quantify its magnitude from uncontrolled/unmeasured confounders. Of 6.65 million subjects without PsA at baseline, 225 213 participants had psoriasis and 7057 developed incident PsA. Smoking was associated with an increased risk of PsA in the general population (HR 1.27; 95% CI 1.19 to 1.36), but with a decreased risk among patients with psoriasis (HR 0.91; 95% CI 0.84 to 0.99). Mediation analysis showed that the effect of smoking on the risk of PsA was mediated almost entirely through its effect on psoriasis. Bias-sensitivity analyses indicated that even when the relation of uncontrolled confounders to either smoking or PsA was modest (both HRs=~1.5), it could reverse the biased effect of smoking among patients with psoriasis (HR=0.9). In this large cohort representative of the UK general population, smoking was positively associated with PsA risk in the general population, but negatively associated among patients with psoriasis. Conditioning on a causal intermediate variable (psoriasis) may even reverse the association between smoking and PsA, potentially explaining the smoking paradox for the risk of PsA among patients with psoriasis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Physiological correlates to spontaneous physical activity variability in obese patients with already treated sleep apnea syndrome.