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Sample records for factor rhigf-1 treatment

  1. An Open-Label Trial of Recombinant Human Insulin-Like Growth Factor-I/Recombinant Human Insulin-Like Growth Factor Binding Protein-3 (rhIGF-1/rhIGFBP-3) in Myotonic Dystrophy Type 1

    PubMed Central

    Heatwole, Chad R.; Eichinger, Katy J.; Friedman, Deborah I.; Hilbert, James E.; Jackson, Carlayne E.; Logigian, Eric L.; Martens, William B.; McDermott, Michael P.; Pandya, Shree K.; Quinn, Christine; Smirnow, Alexis M.; Thornton, Charles A.; Moxley, Richard T.

    2012-01-01

    Objective To evaluate the safety and tolerability of recombinant human insulin-like growth factor-1 (rhIGF-1) complexed with IGF binding protein-3 (rhIGF-1/rhIGFBP-3) in patients with myotonic dystrophy type 1 (DM1). Design Open-label dose-escalation clinical trial. Setting University medical center. Participants Fifteen moderately affected ambulatory participants with genetically-proven DM1. Intervention Participants received escalating dosages of subcutaneous rhIGF-1/rhIGFBP-3 over 24 weeks followed by a 16 week washout period. Outcome Measures Serial assessments of safety, muscle mass, muscle function, and metabolic state were performed. The primary outcome variable was the ability of participants to complete 24 weeks on rhIGF-1/rhIGFBP-3 treatment. Results All participants tolerated rhIGF-1/rhIGFBP-3. There were no significant changes in muscle strength or functional outcomes measures. Lean body muscle mass measured by dual energy x-ray absorptiometry increased by 1.95 kg (p=0.0007) after treatment. Participants also experienced a mean reduction in triglyceride levels of 47 mg/dL (p=0.002), a mean increase in HDL levels of 5.0 mg/dL (p=0.03), a mean reduction in HbA1c of 0.15% (p=0.03), and a mean increase in testosterone level (in men) of 203 ng/dL (p=0.002) while on rhIGF-1/rhIGFBP-3. Mild reactions at the injection site occurred (n=9 participants), as did mild transient hypoglycemia (n=3), lightheadedness (n=2), and transient papilledema (n=1). Conclusions rhIGF-1/rhIGFBP-3 treatment was generally well tolerated in DM1. rhIGF-1/rhIGFBP-3 was associated with increased lean body mass and improvements in metabolism, but not with increased muscle strength or function. Larger randomized controlled trials would be needed to further evaluate the efficacy and safety of this medication in patients with neuromuscular disease. PMID:20837825

  2. Expression of Recombinant Human Insulin-like Growth Factor Type 1 (rhIGF-1) in Escherichia coli

    PubMed Central

    Iranpoor, Hamidreza; Omidinia, Eskandar; Vatankhah, Venus; Gharanjik, Vahid; Shahbazi, Majid

    2015-01-01

    Background: Human insulin-like growth factor type 1 (hIGF-1) is a protein consisting of 70 amino acids (MW=7.6 kDa) and mainly synthesized by liver. Mecasermin (Trade name INCRELEX) is the synthetic form of the protein which is used as an effective treatment for particular disorders such as short stature, type 1 and 2 diabetes, and wound healing. Current study was aimed to investigate the expression of human insulin-like growth factor type1 in Escherichia coli (E. coli) BL21 (DE3) expression system in order to produce an active recombinant form of the protein. Methods: For the purpose of the study, firstly codon optimization was done for hIGF-1 gene, using bioinformatics databases. Then, the gene was synthesized and inserted in pET-24a vector by a cutting strategy included NdeI and BamHI-HF enzymes. In the next step, gene was run in agarose gel and purified. The constructed expression cassette was transformed into E. coli BL21 (DE3) cells through CaCl 2 heat shock method. Identification and confirmation of the transformed colonies were performed using screening PCR method. Synthesis of hIGF-1 was induced by IPTG. The expression in induced strains was analyzed by SDS-PAGE and western blotting techniques. Confirmation of cloning and IGF-1 expression cassette was carried out through genetic engineering procedures. Results: Analysis of transformed E. coli strain with SDS-PAGE and western blotting techniques confirmed that gene was expressed in host cells. Molecular weight of the expressed protein was estimated to be 7.6 kDa. Conclusion: hIGF-1 expression cassette for cloning and expression in E. coli was designed and the protein of interest was successfully induced and identified. In addition, E. coli BL21 (DE3) can be used as a suitable host for production of recombinant hIGF-1 and this technology has a potential to be localized. PMID:26306149

  3. Insulin-like growth factor-1 stimulates regulatory T cells and suppresses autoimmune disease

    PubMed Central

    Bilbao, Daniel; Luciani, Luisa; Johannesson, Bjarki; Piszczek, Agnieszka; Rosenthal, Nadia

    2014-01-01

    The recent precipitous rise in autoimmune diseases is placing an increasing clinical and economic burden on health systems worldwide. Current therapies are only moderately efficacious, often coupled with adverse side effects. Here, we show that recombinant human insulin-like growth factor-1 (rhIGF-1) stimulates proliferation of both human and mouse regulatory T (Treg) cells in vitro and when delivered systemically via continuous minipump, it halts autoimmune disease progression in mouse models of type 1 diabetes (STZ and NOD) and multiple sclerosis (EAE) in vivo. rhIGF-1 administration increased Treg cells in affected tissues, maintaining their suppressive properties. Genetically, ablation of the IGF-1 receptor specifically on Treg cell populations abrogated the beneficial effects of rhIGF-1 administration on the progression of multiple sclerotic symptoms in the EAE model, establishing a direct effect of IGF-1 on Treg cell proliferation. These results establish systemically delivered rhIGF-1 as a specific, effective stimulator of Treg cell action, underscoring the clinical feasibility of manipulating natural tolerance mechanisms to suppress autoimmune disease. PMID:25339185

  4. Effect of polaprezinc on impaired healing of chronic gastric ulcers in adjuvant-induced arthritic rats--role of insulin-like growth factors (IGF)-1.

    PubMed

    Kato, S; Tanaka, A; Ogawa, Y; Kanatsu, K; Seto, K; Yoneda, T; Takeuchi, K

    2001-01-01

    Polaprezinc, N-(3-aminopropionyl)-L-histidinatozinc, has been shown to stimulate the production of insulin-like growth factor-1 (IGF-1) in mesenchymal cells, the polypeptide playing a role in the gastric epithelial wound repair. The present study was performed to examine the effect of polaprezinc on the impaired healing of chronic gastric ulcers in adjuvant-induced arthritic rats, in relation to IGF-1. Arthritis was induced in male Dark Agouti (DA) rats by a single injection of Freund's complete adjuvant (FCA), and the gastric ulcers were induced by thermal cauterization (70 degrees C for 30 sec) 7 days after FCA injection. Omeprazole (30 mg/kg) was administered p.o. once daily, while recombinant human IGF-1 (rhIGF-1) (30 micrograms/kg, s.c.) or polaprezinc (3-10 mg/kg, p.o.) was administered twice daily, starting from 3 days after ulceration for 14 days. The healing of gastric ulcers was significantly delayed in arthritic rats as compared to normal rats on day 10 and 17 following ulceration. The expression of IGF-1 mRNA was markedly increased in the ulcerated mucosa, but this response was apparently attenuated in arthritic rats. Repeated administration of polaprezinc accelerated the healing of gastric ulcers in both normal and arthritic rats, in a dose-dependent manner, and this effect was more pronounced in arthritic rats. Likewise, treatment with omeprazole also significantly promoted the healing of gastric ulcers in both normal and arthritic rats. On the other hand, rhIGF-1 significantly promoted the gastric ulcer healing in arthritic rats without any effect on that in normal rats. These results suggest that the impaired healing of chronic gastric ulcers in arthritic rats is, at least partly, accounted for by less expression of IGF-1, and the polaprezinc improves the delayed healing of gastric ulcers in arthritic rats, probably through an increase in IGF-1 production. PMID:11208487

  5. Involvement of insulin-like growth factor-1 and its binding proteins in proliferation and differentiation of murine bone marrow-derived macrophage precursors.

    PubMed

    Long, E; Huynh, H T; Zhao, X

    1998-10-01

    Insulin-like growth factor 1 (IGF-1) and its binding proteins (IGFBPs) are involved in proliferation and differentiation of many cell types. In the present study, the involvement of IGF-1 and IGFBPs in proliferation and differentiation of murine bone marrow-derived macrophages (BMDM) was investigated. L929-conditioned media (LCM) containing abundant macrophage colony-stimulating factor CSF-1 were used to stimulate BMDM development from their bone marrow precursors. The alteration of IGF-1 and IGFBPs during LCM-induced BMDM proliferation and differentiation was first studied. The cells were cultured in RPMI complete media containing 20% LCM for different time periods and then incubated in serum-free media for 24 h. The supernatants were collected for Western ligand blotting and immunoblotting analyses, and the cell pellets for Northern blotting analyses. The mRNA level of IGF-1 increased in a time-dependent manner. An increase of IGFBP-4 accumulation in the conditioned media was also observed during this process. However the mRNA expression of IGFBP-4 remained constant, indicating a posttranscriptional regulation of IGFBP-4 secretion and/or stability. The effects of exogenous recombinant human IGF-1 (rhIGF-1) on BMDM proliferation and differentiation were further studied. Two IGF-1 analogs (long R3 IGF-1 and des [1-3] IGF-1) were also used in parallel with regular IGF-1 to indicate the involvement of IGFBPs in BMDM development. Cells were cultured in complete media containing 20% LCM for different time periods, and then incubated in serum-free media in the presence of rhIGF-1 or its analogs for 24 h. These three forms of IGF-1 all potentiated the proliferation of freshly isolated BMDM precursors (d 0). rhIGF-1 and long R3 IGF-1, but not des (1-3) IGF-1, continued to stimulate the cell proliferation on d 1. The effects of these three forms of IGF-1 on BMDM differentiation were investigated using mannose receptor expression as a marker. Long R3 IGF-1 and des (1-3) IGF

  6. Profile of mecasermin for the long-term treatment of growth failure in children and adolescents with severe primary IGF-1 deficiency

    PubMed Central

    Fintini, Danilo; Brufani, Claudia; Cappa, Marco

    2009-01-01

    Growth hormone insensitivity syndrome (GHI) or insulin-like growth factor-1 (IGF-1) deficiency (IGFD) is characterized by deficit of IGF-1 production due to alteration of response of growth hormone (GH) receptor to GH. This syndrome is due to mutation of GH receptor or IGF-1 gene and patients affected showed no response to GH therapy. The only treatment is recombinant IGF-1 (mecasermin), which has been available since 1986, but approved in the United States by the US Food and Drug Administration only in 2005 and in Europe by the European Medicines Agency in 2007. To date, few studies are available on long-term treatment with mecasermin in IGFD patients and some of them have a very small number of subjects. In this review we discuss briefly clinical features of severe primary IGFD, laboratory findings, and indications for treatment. Results of long-term therapy with rhIGF1 (mecasermin) in patients affected by severe primary IGFD and possible side effects are explained. PMID:19707272

  7. Enhanced Production of Insulin-like Growth Factor I Protein in Escherichia coli by Optimization of Five Key Factors

    PubMed Central

    Ranjbari, Javad; Babaeipour, Valiollah; Vahidi, Hossein; Moghimi, Hamidreza; Mofid, Mohammad Reza; Namvaran, Mohammad Mehdi; Jafari, Sevda

    2015-01-01

    Human insulin-like growth factor I (hIGF-I) is a kind of growth factor with clinical significance in medicine. Up to now, E. coli expression system has been widely used as a host to produce rhIGF-1 with high yields. Batch cultures as non-continuous fermentations were carried out to overproduce rhIGF-I in E. coli. The major objective of this study is over- production of recombinant human insulin-like growth factor I (rhIGF-I) through a developed process by recruiting effective factors in order to achieve the most recombinant protein. In this study we investigated the effect of culture medium, induction temperature and amount of inducer on cell growth and IGF-1 production. Taguchi design of experiments (DOE) method was used as the statistical method. Analysis of experimental data showed that maximum production of rhIGF-I was occurred in 32y culture medium at 32 °C and 0.05 Mm IPTG. Under this condition, 0.694 g/L of rhIGF-I was produced as the inclusion bodies. Following optimization of these three factors, we have also optimized the amount of glucose and induction time in 5 liter top bench bioreactor. Full factorial design of experiment method was used for these two factors as the statistical method. 10 g/L and OD600=5 were selected as the optimum point of Glucose amount and induction time, respectively. Finally, we reached to a concentration of 1.26 g/L rhIGF-1 at optimum condition. PMID:26330880

  8. Enhanced Production of Insulin-like Growth Factor I Protein in Escherichia coli by Optimization of Five Key Factors.

    PubMed

    Ranjbari, Javad; Babaeipour, Valiollah; Vahidi, Hossein; Moghimi, Hamidreza; Mofid, Mohammad Reza; Namvaran, Mohammad Mehdi; Jafari, Sevda

    2015-01-01

    Human insulin-like growth factor I (hIGF-I) is a kind of growth factor with clinical significance in medicine. Up to now, E. coli expression system has been widely used as a host to produce rhIGF-1 with high yields. Batch cultures as non-continuous fermentations were carried out to overproduce rhIGF-I in E. coli. The major objective of this study is over- production of recombinant human insulin-like growth factor I (rhIGF-I) through a developed process by recruiting effective factors in order to achieve the most recombinant protein. In this study we investigated the effect of culture medium, induction temperature and amount of inducer on cell growth and IGF-1 production. Taguchi design of experiments (DOE) method was used as the statistical method. Analysis of experimental data showed that maximum production of rhIGF-I was occurred in 32y culture medium at 32 °C and 0.05 Mm IPTG. Under this condition, 0.694 g/L of rhIGF-I was produced as the inclusion bodies. Following optimization of these three factors, we have also optimized the amount of glucose and induction time in 5 liter top bench bioreactor. Full factorial design of experiment method was used for these two factors as the statistical method. 10 g/L and OD600=5 were selected as the optimum point of Glucose amount and induction time, respectively. Finally, we reached to a concentration of 1.26 g/L rhIGF-1 at optimum condition. PMID:26330880

  9. Treatment-refractory anxiety; definition, risk factors, and treatment challenges

    PubMed Central

    Roy-Byrne, Peter

    2015-01-01

    A sizable proportion of psychiatric patients will seek clinical evaluation and treatment for anxiety symptoms reportedly refractory to treatment. This apparent lack of response is either due to “pseudo-resistance” (a failure to have received and adhered to a recognized and effective treatment or treatments for their condition) or to true “treatment resistance.” Pseudo-resistance can be due to clinician errors in selecting and delivering an appropriate treatment effectively, or to patient nonadherence to a course of treatment. True treatment resistance can be due to unrecognized exogenous anxiogenic factors (eg, caffeine overuse, sleep deprivation, use of alcohol or marijuana) or an incorrect diagnosis (eg, atypical bipolar illness, occult substance abuse, attention deficit-hyperactivity disorder). Once the above factors are eliminated, treatment should focus on combining effective medications and cognitive behavioral therapy, combining several medications (augmentation), or employing novel medications or psychotherapies not typically indicated as first-line evidence-based anxiety treatments. PMID:26246793

  10. Treatment-refractory anxiety; definition, risk factors, and treatment challenges.

    PubMed

    Roy-Byrne, Peter

    2015-06-01

    A sizable proportion of psychiatric patients will seek clinical evaluation and treatment for anxiety symptoms reportedly refractory to treatment. This apparent lack of response is either due to "pseudo-resistance" (a failure to have received and adhered to a recognized and effective treatment or treatments for their condition) or to true "treatment resistance." Pseudo-resistance can be due to clinician errors in selecting and delivering an appropriate treatment effectively, or to patient nonadherence to a course of treatment. True treatment resistance can be due to unrecognized exogenous anxiogenic factors (eg, caffeine overuse, sleep deprivation, use of alcohol or marijuana) or an incorrect diagnosis (eg, atypical bipolar illness, occult substance abuse, attention deficit-hyperactivity disorder). Once the above factors are eliminated, treatment should focus on combining effective medications and cognitive behavioral therapy, combining several medications (augmentation), or employing novel medications or psychotherapies not typically indicated as first-line evidence-based anxiety treatments. PMID:26246793

  11. Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome

    PubMed Central

    Weber, David R.; Stanescu, Diana E.; Semple, Robert; Holland, Cheryl; Magge, Sheela N.

    2015-01-01

    Donohue syndrome (DS) is a severe form of congenital insulin resistance due to mutation(s) in the insulin receptor (INSR) gene. Given the similarities between insulin and insulin-like growth factor 1 (IGF-1) receptors, recombinant human IGF-1 (rhIGF-1) has been used to treat severe insulin resistance due to INSR mutation(s). Traditional subcutaneous therapy may be limited by the shortened IGF-1 half-life in these patients. We report the case of a female with molecularly confirmed DS treated with continuous rhIGF-1 therapy via an insulin pump. With treatment, the patient’s hemoglobin A1c decreased from 9.8% to 8.8%, and her weight increased by 0.8 kg. Development of an ovarian tumor complicated her course, but it was unclear whether this was related to rhIGF-1 therapy. Limited treatment options exist for patients with DS. The use of continuous rhIGF-1 via an insulin pump may be a viable option, although further experience is needed to establish safety and efficacy. PMID:25153212

  12. Cancer Treatment: The Cost Factor.

    PubMed

    Smith, S

    2014-12-01

    Countries in the Caribbean region have expressed concern at the rising incidence of chronic non-communicable diseases. Cancer is one of these and the cost of treating patients with this has escalated in the recent past. In this paper, the author examines colon cancer and the cost of caring for patients with this. A viewpoint with regard to the reasons for the increased cost of care of patients with cancer is advanced. The factors contributing to the increasing costs are explored. Research epistemology and the role of the pharmaceutical industry are also explored. The need for consensus decision-making with regard to choice of agent/regime is emphasized, as is the need for a deliberate cost-benefit approach. PMID:25867563

  13. Cancer Treatment: The Cost Factor

    PubMed Central

    Smith, S

    2014-01-01

    ABSTRACT Countries in the Caribbean region have expressed concern at the rising incidence of chronic non-communicable diseases. Cancer is one of these and the cost of treating patients with this has escalated in the recent past. In this paper, the author examines colon cancer and the cost of caring for patients with this. A viewpoint with regard to the reasons for the increased cost of care of patients with cancer is advanced. The factors contributing to the increasing costs are explored. Research epistemology and the role of the pharmaceutical industry are also explored. The need for consensus decision-making with regard to choice of agent/regime is emphasized, as is the need for a deliberate cost-benefit approach. PMID:25867563

  14. Factors influencing the uptake of orthodontic treatment.

    PubMed

    O'Brien, K; McComb, J L; Fox, N; Wright, J

    1996-11-01

    The aim of this investigation was to evaluate the factors that influenced the uptake of orthodontic treatment for patients who were referred for orthodontic treatment to two types of orthodontic treatment provider; a fee per item and hospital service. The following data were collected: (i) basic demographic data; (ii) the need for orthodontic treatment as measured by IOTN; and (iii) the outcome of the consultation. The data analysis with logistic regression revealed that the following variables had a predictive effect on the uptake of treatment: (i) the need for orthodontic treatment; and (ii) the patient's gender. Most of the patients that were referred and accepted for treatment had a definite need for orthodontic treatment. PMID:8985570

  15. [Host factors and viral factors in hepatitis C treatment].

    PubMed

    Sakamoto, Minoru; Enomoto, Nobuyuki

    2015-02-01

    In the interferon-based therapy for hepatitis C, host factors such as age, gender, liver fibrosis and steatosis are important as a therapeutic effect predictor, and viral factors such as HCV genotype, HCV viral load, HCV gene (IL28B, ITPA) are also important. In addition in genotype 1b, ISDR/IRRDR and core amino acid substitution are important. Also in the DAA treatment, viral factors are also important at the view of therapeutic effect and difficulty of acquisition of drug resistance mutation. In addition, the goal of treatment of hepatitis C are suppression of liver fibrosis progression and liver cancer and improvement of quality of life due to this (quality of life: QOL) and life prognosis, it is important to understand the host factors and HCV viral factors. PMID:25764672

  16. Factors affecting willingness to provide buprenorphine treatment

    PubMed Central

    Netherland, Julie; Botsko, Michael; Egan, James E.; Saxon, Andrew J.; Cunningham, Chinazo O.; Finkelstein, Ruth; Gourevitch, Mark N.; Renner, John A.; Sohler, Nancy; Sullivan, Lynn E.; Weiss, Linda; Fiellin, David A.

    2010-01-01

    Buprenorphine is an effective long-term opioid agonist treatment. As the only pharmacological treatment for opioid dependence readily available in office-based settings, buprenorphine may facilitate a historic shift in addiction treatment from treatment facilities to general medical practices. Although many patients have benefited from the availability of buprenorphine in the United States, almost half of current prescribers are addiction specialists suggesting that buprenorphine treatment has not yet fully penetrated general practice settings. We examined factors affecting willingness to offer buprenorphine treatment among physicians with different levels of prescribing experience. Based on their prescribing practices, physicians were classified as experienced, novice, or as a nonprescriber and asked to assess the extent to which a list of factors impacted their prescription of buprenorphine. Several factors affected willingness to prescribe buprenorphine for all physicians: staff training; access to counseling and alternate treatment; visit time; buprenorphine availability; and pain medications concerns. Compared with other physicians, experienced prescribers were less concerned about induction logistics and access to expert consultation, clinical guidelines, and mental health services. They were more concerned with reimbursement. These data provide important insight into physician concerns about buprenorphine and have implications for practice, education, and policy change that may effectively support widespread adoption of buprenorphine. PMID:18715741

  17. Treatment Efficacy and Risk Factors of Neurobrucellosis

    PubMed Central

    Zhao, Shigang; Cheng, Yan; Liao, Yali; Zhang, Zhelin; Yin, Xuhua; Shi, Shujun

    2016-01-01

    Background This study aimed to analyze the risk factors and treatment efficacy of neurobrucellosis. Material/Methods A cross-sectional epidemiologic survey was carried out in 557 patients with brucellosis by specially trained neurologic clinicians. Sixty-six patients with neurobrucellosis were treated with doxycycline, rifampicin, and ceftriaxone sodium as standard medication and evaluated for efficacy on a regular basis. Results (1) Symptoms improved in most patients after 6 weeks of treatment, which demonstrated a favorable efficacy. (2) Cross-sectional epidemiologic survey suggested that sex, nationality, and regional distribution were not related to nervous system damage in patients with brucellosis (P>0.05), whereas age and duration of disease were related factors. Increased age as well as a prolonged duration of disease were risk factors for nervous system damage in patients with brucellosis (P<0.05). Conclusions (1) Doxycycline, rifampicin, and third-generation cephalosporins should be considered both standard and first-choice medications for neurobrucellosis. Treatment should last for at least 6 weeks. Standardized, sufficient, and combined medication is recommended for better efficacy and prognosis. (2) Age and duration of disease are risk factors for neurobrucellosis, whereas sex, nationality, and regional distribution are not. Older patients with a prolonged duration of disease are more likely to develop neurobrucellosis. PMID:27018084

  18. Treatment Efficacy and Risk Factors of Neurobrucellosis.

    PubMed

    Zhao, Shigang; Cheng, Yan; Liao, Yali; Zhang, Zhelin; Yin, Xuhua; Shi, Shujun

    2016-01-01

    BACKGROUND This study aimed to analyze the risk factors and treatment efficacy of neurobrucellosis. MATERIAL AND METHODS A cross-sectional epidemiologic survey was carried out in 557 patients with brucellosis by specially trained neurologic clinicians. Sixty-six patients with neurobrucellosis were treated with doxycycline, rifampicin, and ceftriaxone sodium as standard medication and evaluated for efficacy on a regular basis. RESULTS (1) Symptoms improved in most patients after 6 weeks of treatment, which demonstrated a favorable efficacy. (2) Cross-sectional epidemiologic survey suggested that sex, nationality, and regional distribution were not related to nervous system damage in patients with brucellosis (P>0.05), whereas age and duration of disease were related factors. Increased age as well as a prolonged duration of disease were risk factors for nervous system damage in patients with brucellosis (P<0.05). CONCLUSIONS (1) Doxycycline, rifampicin, and third-generation cephalosporins should be considered both standard and first-choice medications for neurobrucellosis. Treatment should last for at least 6 weeks. Standardized, sufficient, and combined medication is recommended for better efficacy and prognosis. (2) Age and duration of disease are risk factors for neurobrucellosis, whereas sex, nationality, and regional distribution are not. Older patients with a prolonged duration of disease are more likely to develop neurobrucellosis. PMID:27018084

  19. Early dropout predictive factors in obesity treatment

    PubMed Central

    Michelini, Ilaria; Falchi, Anna Giulia; Grecchi, Ilaria; Montagna, Elisabetta; De Silvestri, Annalisa; Tinelli, Carmine

    2014-01-01

    Diet attrition and failure of long term treatment are very frequent in obese patients. This study aimed to identify pre-treatment variables determining dropout and to customise the characteristics of those most likely to abandon the program before treatment, thus making it possible to modify the therapy to increase compliance. A total of 146 outpatients were consecutively enrolled; 73 patients followed a prescriptive diet while 73 followed a novel brief group Cognitive Behavioural Treatment (CBT) in addition to prescriptive diet. The two interventions lasted for six months. Anthropometric, demographic, psychological parameters and feeding behaviour were assessed, the last two with the Italian instrument VCAO Ansisa; than, a semi-structured interview was performed on motivation to lose weight. To identify the baseline dropout risk factors among these parameters, univariate and multivariate logistic models were used. Comparison of the results in the two different treatments showed a higher attrition rate in CBT group, despite no statistically significant difference between the two treatment arms (P = 0.127). Dropout patients did not differ significantly from those who did not dropout with regards to sex, age, Body Mass Index (BMI), history of cycling, education, work and marriage. Regardless of weight loss, the most important factor that determines the dropout appears to be a high level of stress revealed by General Health Questionnaire-28 items (GHQ-28) score within VCAO test. The identification of hindering factors during the assessment is fundamental to reduce the dropout risk. For subjects at risk, it would be useful to dedicate a stress management program before beginning a dietary restriction. PMID:24611111

  20. [Treatment of chronic bovine endometritis and factors for treatment success].

    PubMed

    Feldmann, M; Tenhagen genannt Emming, S; Hoedemaker, M

    2005-01-01

    In a controlled field trial, 178 dairy cows with chronic endometritis and at least 21 days in lactation were randomly assigned to four different treatment groups: prostaglandin F2alpha intramuscularly (PG, 5 mg dinoprost (5 ml Dinolytic), n = 51), intrauterine antibiotics (AB; 400 mg ampicillin + 800 oxacillin (20 ml Totocillin), n = 49), intrauterine antiseptics (AS; 100 ml 4% Lotagen, n = 50); control (C, no initial treatment, n = 28). Before treatment, uterine swabs for bacteriologic examination and blood samples for determination of serum progesterone concentrations were collected. Two weeks following the first treatment, cows were reexamined. In case no clinical cure was diagnosed, treatment was repeated and control cows were treated for the first time with one of the three treatments mentioned above. The four treatment groups did not differ with respect to the clinical cure or reproductive performance. Therefore, factors that might have an influence on clinical cure and fertility were evaluated. With increasing duration of lactation, the clinical cure after a single treatment increased significantly over all treatment groups from 59.5% (treatment before day 42 postpartum) to 79.6% (treatment following day 42 postpartum) (P < 0.05). Within the PG group, a statistically significantly higher cure rate after a single treatment and first service conception rate and a lower pregnancy index were obtained when the treatment was performed following day 42 postpartum (P < 0.05). This was not the case in the other treatment groups. A retarded involution of the uterus based on the size had a negative effect on clinical cure over all groups (first treatment clinical cure: 68.2% (small uteri) vs 44.4% (large uteri); P < 0.05). Within groups, this effect was also detected, but only as a trend (P > 0.05). Isolation of Arcanobacterium (A.) pyogenes negatively influenced first treatment clinical cure over all treatment groups (79.0% vs 31.5%) and within treatment groups (P < 0

  1. Chronic migraine: risk factors, mechanisms and treatment.

    PubMed

    May, Arne; Schulte, Laura H

    2016-08-01

    Chronic migraine has a great detrimental influence on a patient's life, with a severe impact on socioeconomic functioning and quality of life. Chronic migraine affects 1-2% of the general population, and about 8% of patients with migraine; it usually develops from episodic migraine at an annual conversion rate of about 3%. The chronification is reversible: about 26% of patients with chronic migraine go into remission within 2 years of chronification. The most important modifiable risk factors for chronic migraine include overuse of acute migraine medication, ineffective acute treatment, obesity, depression and stressful life events. Moreover, age, female sex and low educational status increase the risk of chronic migraine. The pathophysiology of migraine chronification can be understood as a threshold problem: certain predisposing factors, combined with frequent headache pain, lower the threshold of migraine attacks, thereby increasing the risk of chronic migraine. Treatment options include oral medications, nerve blockade with local anaesthetics or corticoids, and neuromodulation. Well-defined diagnostic criteria are crucial for the identification of chronic migraine. The International Headache Society classification of chronic migraine was recently updated, and now allows co-diagnosis of chronic migraine and medication overuse headache. This Review provides an up-to-date overview of the classification of chronic migraine, basic mechanisms and risk factors of migraine chronification, and the currently established treatment options. PMID:27389092

  2. Growth factors for the treatment of ischemic brain injury (growth factor treatment).

    PubMed

    Larpthaveesarp, Amara; Ferriero, Donna M; Gonzalez, Fernando F

    2015-01-01

    In recent years, growth factor therapy has emerged as a potential treatment for ischemic brain injury. The efficacy of therapies that either directly introduce or stimulate local production of growth factors and their receptors in damaged brain tissue has been tested in a multitude of models for different Central Nervous System (CNS) diseases. These growth factors include erythropoietin (EPO), vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), and insulin-like growth factor (IGF-1), among others. Despite the promise shown in animal models, the particular growth factors that should be used to maximize both brain protection and repair, and the therapeutic critical period, are not well defined. We will review current pre-clinical and clinical evidence for growth factor therapies in treating different causes of brain injury, as well as issues to be addressed prior to application in humans. PMID:25942688

  3. Calciphylaxis: Risk Factors, Diagnosis, and Treatment

    PubMed Central

    Nigwekar, Sagar U.; Kroshinksy, Daniela; Nazarian, Rosalynn M.; Goverman, Jeremy; Malhotra, Rajeev; Jackson, Vicki Ann; Kamdar, Mihir M.; Steele J.R., David; Thadhani, Ravi I.

    2015-01-01

    Calciphylaxis is a rare but devastating condition that has continued to challenge the medical community since its early descriptions in the scientific literature many decades ago. It is predominantly seen in chronic kidney failure patients treated with dialysis (uremic calciphylaxis) but is also described in patients with earlier stages of chronic kidney disease and with normal renal function. In this In Practice feature, we review the available medical literature regarding risk factors, diagnosis, and treatment of both uremic and non-uremic calciphylaxis. High quality evidence for the evaluation and management of calciphylaxis is lacking at this time due to its rare incidence, poorly understood pathogenesis, and the relative paucity of collaborative research efforts. We hereby provide a summary of recommendations developed by the Massachusetts General Hospital's Multi-disciplinary Calciphylaxis Team for calciphylaxis patients. PMID:25960299

  4. The role of exogenous risk factors of antituberculosis treatment failure

    PubMed Central

    LESNIC, EVELINA; USTIAN, AURELIA; POP, CARMEN MONICA

    2016-01-01

    Background and aim The Republic of Moldova reports the highest incidence of tuberculosis and the lowest treatment success rate among European region countries. In most of the patients the antituberculosis treatment failure is correlated with social risk factors (low socio-economical state, epidemiological danger characteristics) and biological factors (young age, male sex, physiological conditions, associated diseases). Clinical factors (advanced forms of tuberculosis, chronic evolution, immune disturbances), therapeutic factors (treatment errors and interruptions, individualized regimens) and administrative factors (drug interruption in supply, suboptimal treatment quality) prevail in regions with defficient in health care delivery. The association of risk factors has a higher impact than the severity of one risk factor. The risk factor assessment is very important before initiation of the treatment, for establishing the plan of risk reduction measures for increasing the success rate. The aim of the study was to determine the impact of exogenous risk factors on antituberculosis treatment failure. Methods The study was conducted on 201 patients with pulmonary tuberculosis and treatment failure and 105 patients with pulmonary tuberculosis who successfully finished the antituberculosis treatment. Selected cases were investigated according national standards. Results The treatment failure occurred in patients belonging to socially disadvantaged groups, patients with harmful habits (alcohol abuse, drug use, active smoking), patients from infectious clusters. Migration, homelessness and detention releasing imperil the quality of treatment, thus predisposing to the treatment failure. Social, educational support and the substitutive therapy and withdrawal techniques (tobacco, alcohol, psycho-active substances) must be implemented in the high risk groups in order to diminish the risk of treatment failure and to increase the treatment success rate. Conclusions The study of

  5. Factors influencing the assessment of treatment needs.

    PubMed

    Gjermo, P

    1991-07-01

    Epidemiologic surveys have provided data for health planning by estimating prevalence and incidence of diseases in populations. New ways of presenting epidemiologic data on periodontal diseases have changed our understanding of their extent and severity, and conversion of prevalence data into treatment need estimates has proved difficult. Furthermore, new concepts of the pathogenesis of periodontal diseases have questioned the validity of epidemiologic methods currently used. Treatment need assessments vary considerably between studies even when prevalence data from the same populations are similar. This may be due to lack of described goals for periodontal health. Various aspects of the concept of need for treatment are discussed. It is suggested that periodontal treatment need on a population level is defined as the intervention needed in order to change the existing periodontal condition to the described goal. Thus, treatment need assessments will have to include descriptive epidemiologic data as well as defined periodontal health goals. It is recommended that goals are described in terms compatible with the indicators used in the epidemiologic description of the disease status. PMID:1890213

  6. Anorexia Nervosa: Sociocultural Factors and Treatment.

    ERIC Educational Resources Information Center

    Williams, Jennifer

    This paper examines how the epidemiological findings of anorexia nervosa lead theorists to speculate a correlation between sociocultural factors and the development of anorexia nervosa. A section on the essential features of anorexia nervosa identifies five primary characteristics of anorexia: (1) severe weight loss; (2) a disturbance of body…

  7. Hepatocellular Carcinoma: Risk Factors, Diagnosis and Treatment

    PubMed Central

    Janevska, Dafina; Chaloska-Ivanova, Viktorija; Janevski, Vlado

    2015-01-01

    Hepatocellular carcinoma (HCC) is the most often primary cancer of the liver and is one if the leading cause of cancer-related death worldwide. The incidence of HCC has geographic distribution with the highest levels in countries with developing economies. Patients with hepatocellular carcinoma have poor prognosis despite the achievements in surgery techniques and other therapeutic procedures and it is a reason why continuous attention should be paid to this issue. This article provides an overview of this disease based on an extensive review of relevant literature. The article summarizes the current risk factors, diagnosis, staging and the management of HCC. PMID:27275318

  8. Factors contributing to poor treatment outcomes in childhood atopic dermatitis.

    PubMed

    Sokolova, Anna; Smith, Saxon D

    2015-11-01

    Atopic dermatitis (AD) is a chronic relapsing inflammatory disease of the skin and is the most common paediatric dermatological condition. While no cure is available, it can be treated effectively if adherence to a therapeutic plan is maintained. Poor adherence to treatment is common in AD and can lead to treatment failure, which has significant impacts on the patient, family and society. A comprehensive literature search was conducted to identify factors that contribute to poor treatment adherence in childhood AD and to identify possible strategies to remedy these. Identified factors leading to poor treatment adherence include: complexity of treatment regimen, lack of knowledge, impaired quality of life, dissatisfaction with treatment strategies, infrequent follow up, corticosteroid phobia and the use of complementary and alternative medicine. Effective strategies to increase treatment adherence include: caregiver education and utilisation of education adjuncts, optimisation of the patient/caregiver-clinician relationship, early and frequent follow up and improvement of patient and caregiver quality of life. PMID:25817780

  9. Fighting Gum Disease: Risk Factors, Treatment and Research

    MedlinePlus

    ... Feature: Fighting Gum Disease Risk Factors, Treatment and Research Past Issues / Fall 2010 Table of Contents Risk ... out whether it offers this service. Latest NIH Research Researchers supported by the National Institute of Dental ...

  10. Factors influencing choice of dental treatment by private general practitioners.

    PubMed

    Brennan, David S; Spencer, A John

    2002-01-01

    Service rate variations have focused attention on treatment decisions. The aims of this study were to examine factors considered in choosing treatments, to classify dentists in terms of clinical decision making, and to investigate the association of decision making with services provided. From a random sample of dentists (response rate 60.3%) treatment constraints (15.0%), periodontal status (12.1%), tooth status (11.3%), mouth status (10.1%), and patient factors (9.8%) were considered important factors across six alternative treatment pair choice scenarios. Cluster analysis of the treatment choice scenarios produced one cluster that reflected patient preferences, another that reflected treatment constraints such as cost, and a third that reflected oral health factors. Compared with the oral health cluster, dentists in the constraints cluster had higher rates (p < .05) of extractions (rate ratio [RR] = 1.49), bridge work (RR = 1.77), and dentures (RR = 1.32), whereas dentists in the patient cluster had higher restoration rates for two-surface ionomers (RR = 2.45) and resins on three or more surfaces (RR = 1.50) and other preventive services (RR = 1.78) such as oral hygiene instruction. Although a range of factors influenced treatment choice, a limited set accounted for the majority of responses, with cost a major determinant, ahead of oral health status and patient preference. Decision-making style was associated with service provision. PMID:12174535

  11. Factors Associated with Men's Assessment of Prostate Cancer Treatment Choice.

    PubMed

    Ross, Louie E; Howard, Daniel L; Bowie, Janice V; Thorpe, Roland J; Kinlock, Ballington L; Burt, Carol; LaVeist, Thomas A

    2016-06-01

    The objective of this study is to examine factors among a group of African American and White men in North Carolina and their assessment of prostate cancer treatment choice or belief that treatment chosen was best. A sample of men (N = 877) with a history of prostate cancer diagnosis was recruited from the North Carolina Cancer Registry during 2007-2008 and asked to participate in a telephone interview covering several measures about their initial prostate cancer treatment. Logistic regression was used to assess demographic, psychosocial, and clinical factors on whether they felt that they had chosen the best treatment for the disease. Respondents were majority White (52.7 %), married (75.9 %), and had surgery (67.9 %) as their initial treatment. At the bivariate level, factors associated with the belief that the treatment chosen was best were as follows: White race/ethnicity, higher levels of education, a more recent treatment date, having health insurance coverage, type of treatment received, higher levels of bother from side effects, greater contentment with their quality of life, and doctor discussions of the various treatment options. Similarly, the multivariate analysis showed increased odds of belief that the treatment chosen was the best among demographic (i.e., race/ethnicity, level of education, and health insurance coverage) as well as psychosocial and clinical variables (i.e., greater bother from side effects, greater contentment with their quality of life, and initial treatment received). Results suggest that demographic, psychosocial, and clinical factors play an important role for men in assessing their treatment choices for prostate cancer. PMID:25893926

  12. Transient cefuroxime/metronidazole treatment induced factor V antibodies

    PubMed Central

    Van den Berg, Sjoerd Adrianus Antonius; Verwer, Patricia E; Idema, René N; Van Guldener, Coen

    2014-01-01

    A 29-year-old patient presented with an appendicular infiltrate, initially treated with intravenous antibiotics, but later requiring percutaneous drainage. Both prothrombin time (PT) and activated partial thromboplastin time (aPTT) were prolonged on 3 days of antibiotic treatment and unresponsive to vitamin K or prothrombin complex concentrate. Laboratory investigation ultimately showed reduced factor V activity and factor V antibodies. In contrast to previously described cases of factor V antibodies, PT and aPTT were only mildly prolonged and residual factor V activity was still >20%. Draining of the abscess did not induce significant bleeding. Afterwards, no haemostatic medication was required. The patient was discharged from the hospital without complications. One week after cessation of the antibiotic treatment, PT and aPTT were within normal range again, with a factor V activity level of 36%. In conclusion, we present a patient with transient factor V antibodies, induced by antibiotics, without clinical bleeding tendency. PMID:25139922

  13. Breast cancer diagnosis and factors influencing treatment decisions in Ghana.

    PubMed

    Aziato, Lydia; Clegg-Lamptey, Joe Nat A

    2015-01-01

    Researchers in this study explored the reactions of women with breast cancer and identified factors influencing treatment decisions. A qualitative exploratory approach was employed. Participants were recruited from a tertiary hospital and a breast cancer support group. Purposive sampling recruited 12 women. It was found that women identified breast lesions accidentally or intentionally and that diagnosis was delayed. Emotional reactions to diagnosis included shock and sadness. Factors that influenced treatment were the influence of other people, alternative sources of treatment, faith and support, knowledge, "tuning the mind," and effects on intimacy. Health professionals should develop effective communication and counseling skills for clients. PMID:24750095

  14. A Systematic Review of Individual Motivational Factors in Orthodontic Treatment: Facial Attractiveness as the Main Motivational Factor in Orthodontic Treatment

    PubMed Central

    Broukal, Zdenek

    2014-01-01

    Introduction. Physical, mental, and social consequences of malocclusion may impact the quality of life. The aim of this review is to describe main factors motivating parents for orthodontic treatment for their children. Methods. A systematic review study design was used to identify articles analyzing different motivational factors in orthodontic treatment appearing in Medline database, EMBASE, and Google Scholar. The search terms used were teasing, motivating factors, orthodontics, malocclusion, quality of life, smile attractiveness, and perception of malocclusion. Papers selected up to May 2013 included retrospective and prospective longitudinal studies, randomized control trials, cross-sectional studies, reviews, and meta-analyses. Results. 13 articles included in this review identified aesthetics as the main motivational factor in orthodontic treatment. Children mention teeth crowding, large overbite, missing teeth, and largest maxillary anterior irregularities also as motivational factors. Parents want their children to look nice and worry of being accused of neglecting parental duties. Conclusions. Dissatisfaction with one's appearance, dentist recommendation, interest and worries of parents, and the impact of peers who wear braces rank among the main motivation factors of seeking orthodontic treatment. Understanding these factors allows better planning of resources and better assessment of the requirements and priorities of treatment. PMID:24963296

  15. Prognosis factors in the treatment of bisphosphonate-related osteonecrosis of the jaw - Prognostic factors in the treatment of BRONJ

    PubMed Central

    Nakamichi, Ikuo; Yamashita, Yoshihiro; Yamamoto, Noriaki; Yamauchi, Kensuke; Nogami, Shinnosuke; Kaneuji, Takeshi; Mitsugi, Sho; Tanaka, Kenkou; Kataoka, Yoshihiro; Sakurai, Takuma; Kiyomiya, Hiroyasu; Miyamoto, Ikuya; Takahashi, Tetsu

    2014-01-01

    Objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a relatively rare but serious side effect of bisphosphonate (BP)-based treatments. This retrospective study aimed to investigate the risk factors and predictive markers in cases where patients were refractory to a recommended conservative treatment offered in our hospital. Patients and Methods: This single-center study collated the medical records of all patients treated for BRONJ between 2004 and 2011. A complete medical history, including detailed questionnaires, was collected for all patients, focusing on identifying underlying risk factors, clinical features, location and bone marker levels of BRONJ. Results: The mean BRONJ remission rate was 57.6%, and the median duration of remission was seven months. Eighteen patients (34.6%) had persistent or progressive disease with a recommended conservative treatment for BRONJ. Notably, urinary cross-linked N-terminal telopeptide of type 1 collagen (NTX) levels in those resistant to conservative treatment tended to be lower than in patients that healed well. Conclusions: We confirm that a significant proportion of BRONJ sufferers are refractory to a recommended conservative treatment and find that anticancer drugs, periodontal disease, the level of bone exposure and the dosage of intravenous BPs (e.g. zoledronate) represent specific risk factors in BRONJ that may determine the success of a recommended conservative treatment. Additionally, the NTX levels might be able to be a prognostic factor for the conservative treatment of BRONJ; additional research is necessary. Key words:Bisphosphonate, osteonecrosis, jaw, prognostic, retrospective. PMID:24596631

  16. Cancer-related fatigue: Mechanisms, risk factors, and treatments

    PubMed Central

    Bower, Julienne E.

    2015-01-01

    Fatigue is one of the most common and distressing side effects of cancer and its treatment, and may persist for years after treatment completion in otherwise healthy survivors. Cancer-related fatigue causes disruption in all aspects of quality of life and may be a risk factor for reduced survival. The prevalence and course of fatigue in cancer patients has been well characterized, and there is growing understanding of underlying biological mechanisms. Inflammation has emerged as a key biological pathway for cancer-related fatigue, with studies documenting links between markers of inflammation and fatigue before, during, and particularly after treatment. There is considerable variability in the experience of cancer-related fatigue that is not explained by disease- or treatment-related characteristics, suggesting that host factors may play an important role in the development and persistence of this symptom. Indeed, longitudinal studies have begun to identify genetic, biological, psychosocial, and behavioral risk factors for cancer-related fatigue. Given the multi-factorial nature of cancer-related fatigue, a variety of intervention approaches have been examined in randomized controlled trials, including physical activity, psychosocial, mind-body, and pharmacological treatments. Although there is currently no gold standard for treating fatigue, several of these approaches have shown beneficial effects and can be recommended to patients. This report provides a state of the science review of mechanisms, risk factors, and interventions for cancer-related fatigue, with a focus on recent longitudinal studies and randomized trials that have targeted fatigued patients. PMID:25113839

  17. [Factors influencing psychotherapeutic treatment outcome of various syndromes].

    PubMed

    Hartmann, Sebastian; Zepf, Siegfried

    2004-12-01

    The authors investigated specific and unspecific factors influencing the psychotherapeutic treatment of various syndromes using a questionnaire which systematically replicated the Consumer Reports Study performed in the USA in 1994. The authors were particularly concerned with the degree to which certain psychotherapeutic methods - psychoanalysis, depth psychology-based psychotherapy and behavioral therapy - produced differing results following treatment of syndromes. Using cluster-analysis, two groups of syndromes could be distinguished: Patients with depressive symptoms, stress-related disorders and/or relationship problems (depression-group) and patients with anxiety disorders and/or eating-related disorders (anxiety-group). With the help of cart-analysis (Classification and Regression Trees) it was possible to identify factors influencing the improvement of symptoms. The method of treatment had not a specific effect on the improvement of symptoms. In both groups the most important predictor was the length of treatment. Furthermore in the depression group the sex of the patients and a possible restriction of the treatment by the health insurance companies influenced the treatment results and in the anxiety group the frequency of treatment and the age of the patients. PMID:15551189

  18. Rural Drug Users: Factors Associated with Substance Abuse Treatment Utilization

    PubMed Central

    Oser, Carrie B.; Leukefeld, Carl G.; Tindall, Michele Staton; Garrity, Thomas F.; Carlson, Robert G.; Falck, Russel; Wang, Jichuan; Booth, Brenda M.

    2010-01-01

    The purpose of this study is to use a modified version of Andersen’s (1968, 1995) Behavioral Model of Health Services Use to identify the correlates of the number of substance abuse treatment episodes received by rural drug users. Data were collected from face-to-face interviews with 711 drug users in rural areas of Ohio, Arkansas, and Kentucky. Descriptive analyses examine rural drug users’ substance use histories and retrospective substance abuse treatment service utilization patterns. A negative binomial regression model indicated that selected predisposing, historical health, and enabling factors were significantly associated with the utilization of substance abuse treatment among rural drug users. Despite high levels of recent and lifetime self-reported substance use among these rural drug users, treatment services were underutilized. Future studies are needed to examine the impact of the health care system and characteristics of the external environment associated with rural substance abuse treatment in order to increase utilization among drug users. PMID:20463206

  19. Risk Factors, Pathophysiology, and Treatment of Hot Flashes in Cancer

    PubMed Central

    Fisher, William I.; Johnson, Aimee K.; Elkins, Gary R.; Otte, Julie L.; Burns, Debra S.; Yu, Menggang; Carpenter, Janet S.

    2012-01-01

    Hot flashes are prevalent and severe symptoms that can interfere with mood, sleep, and quality of life for women and men with cancer. The purpose of this article is to review existing literature on the risk factors, pathophysiology, and treatment of hot flashes in persons with cancer. Electronic searches were conducted to identify relevant, English-language literature published through June 15, 2012. Results indicated that risk factors for hot flashes in cancer include patient-related factors (eg, age, race/ethnicity, educational level, smoking history, cardiovascular risk including BMI, and genetics) and disease-related factors (eg, cancer diagnosis, and dose/type of treatment). In addition, although the pathophysiology of hot flashes has remained elusive, these symptoms are likely attributable to disruptions in thermoregulation and neurochemicals. Therapies that have been offered or tested fall into 4 broad categories: pharmacological, nutraceutical, surgical, and complementary/behavioral strategies. The evidence base for this broad range of therapies varies, with some treatments not yet having been fully tested or showing equivocal results. The evidence base surrounding all therapies is evaluated to enhance hot flash treatment decision making by clinicians and patients. PMID:23355109

  20. Associations of Psychosocial Factors with the Stress of Infertility Treatment

    ERIC Educational Resources Information Center

    Schneider, Myra G.; Forthofer, Melinda S.

    2005-01-01

    This study investigated psychosocial factors thought to be associated with perceived stress over the course of infertility treatment. The research was based on secondary analysis of data from the Study of Marriage, Family, and Life Quality with a sample of 128 people who completed an infertility-related stress instrument at all three measurement…

  1. Opioid Treatment of Migraine: Risk Factors and Behavioral Issues.

    PubMed

    Stone, Melissa T; Weed, Valerie; Kulich, Ronald J

    2016-09-01

    Migraine can impact every aspect of a person's functioning. Psychological comorbidities, cognitive constructs, and behavioral responses to pain greatly impact the perception of migraine pain, treatment efficacy and outcome, and overall quality of life and functioning. Current considerations for migraine treatment emphasize the utility of the biopsychosocial model in understanding and treating migraine, noting both the importance of addressing psychological factors such as cognitive beliefs as well as psychiatric comorbidities. The guidelines for migraine treatment implicate opioid therapy as a second or third tier treatment. Guidelines and recommendations for the safe use of opioid medications among patients with chronic pain emphasize the importance of screening prior to prescribing opioid medications. Chronic opioid therapy has been shown to further levels of disability, decrease quality of life, and correlate to psychiatric comorbidities, concerns that are already present in migraine patients. While opioid treatment provides an alternative for persons with contraindications for alternative migraine treatments, it is critical that opioids be used sparingly and exclusively in conjunction with comprehensive assessment and integration of psychological treatment. PMID:27474093

  2. Factors Associated with Operative Treatment of De Quervain Tendinopathy

    PubMed Central

    Kachooei, Amir Reza; Nota, Sjoerd P.F.T; Menendez, Mariano E; Dyer, George S.M.; Ring, David

    2015-01-01

    Background: Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy. Methods: We used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist working in a hand surgery office in the treatment of 2,513 patients with de Quervain tendinopathy over a 12-year period. Survival analysis using the Kaplan-Meier method was used to compare surgery rates and time to surgery. Cox multivariable regression analysis was applied to identify factors associated with operative treatment. Results: One hundred ninety nine (7.9%) patients had surgery. The odds of operative treatment were 1.7 times greater after corticosteroid injection and varied more than 10-fold among providers. There was substantial variation in the overall rate of surgery by provider. Corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery. Conclusion: Providers have substantial influence on treatment of de Quervain tendinopathy. The use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation. PMID:26213704

  3. [Determination of prognostic factors in surgical treatment of myasthenia gravis].

    PubMed

    Schnorrer, M; Hraska, V; Spalek, P; Cársky, S

    1999-05-01

    The authors evaluated, using statistical analysis, the importance of prognostic factors in patients subjected to thymectomy on account of myasthenia gravis. The results revealed a better prognosis of the disease, if the history was less than 6 months, preoperative treatment less than 1.5 years, a histological finding of thymus hyperplasia, second clinical stage according to Ossermann and the patients age below 30 years. From the statistical analysis ensues that the prognosis of myasthenia gravis is more favourable when the case-history is shorter as a result of rapid diagnosis and when preoperative treatment is reduced to a minimum. PMID:10510623

  4. Risk Factors for Prolonged Treatment of Whiplash-Associated Disorders

    PubMed Central

    Oka, Hiroyuki; Matsudaira, Ko; Fujii, Tomoko; Okazaki, Hiroshi; Shinkai, Yukari; Tsuji, Yutaka; Tanaka, Sakae; Kato, Ryuichi

    2015-01-01

    Objectives Whiplash-associated disorders (WAD) are the most common injuries that are associated with car collisions in Japan and many Western countries. However, there is no clear evidence regarding the potential risk factors for poor recovery from WAD. Therefore, we used an online survey of the Japanese population to examine the association between potential risk factors and the persistence of symptoms in individuals with WAD. Materials and Methods An online survey was completed by 127,956 participants, including 4,164 participants who had been involved in a traffic collision. A random sample of the collision participants (n = 1,698) were provided with a secondary questionnaire. From among the 974 (57.4%) respondents to the secondary questionnaire, we selected 183 cases (intractable neck pain that was treated over a period of 6 months) and 333 controls (minor neck pain that was treated within 3 months). Multivariable logistic regression analysis was used to evaluate the potential risk factors for prolonged treatment of WAD. Results Female sex, the severity of the collision, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain were associated with a poor recovery from WAD. Conclusions In the present study, the baseline symptoms (dizziness, numbness or pain in the arms, and lower back pain) had the strongest associations with prolonged treatment for WAD, although the psychological and behavioral factors were also important. These risk factors should be considered when evaluating patients who may have the potential for poor outcomes. PMID:26147998

  5. Factors that affect adolescents' adherence to diabetes treatment.

    PubMed

    Cox, Laura; Hunt, Jane

    2015-02-01

    There is strong evidence suggesting young people with type 1 diabetes experience difficulties adhering to their treatment regimens. The purpose of this literature review is to identify reasons for a lack of compliance in adolescents to allow nurses to develop knowledge to help improve treatment adherence. A literature search was undertaken by searching databases using key terms and inclusion criteria identified. The three themes are: parental influence, peer influence and depression. Findings indicate parental influence may be the main contributing factor towards non-compliance; however, associations between themes imply non-compliance is a result of a combination of factors. Limitations have been highlighted from the articles reviewed and provide opportunity for future research. PMID:25671752

  6. Emergence agitation in children: risk factors, prevention, and treatment.

    PubMed

    Kanaya, Akihiro

    2016-04-01

    Emergence agitation (EA) in children is a major postoperative issue that increases the risk of patient self-harm, places a burden on nursing staff, and reduces parent satisfaction with treatment. Risk factors for EA include age, preoperative anxiety, patient personality, pain, anesthesia method, and surgical procedure. Sevoflurane and desflurane are widely used anesthetics due to their low blood/gas partition coefficients, but they have recently been posited as a cause of EA in children. The perioperative administration of opioids, midazolam, ketamine, alpha-2 agonist sedatives, and nonsteroidal anti-inflammatory drugs has demonstrated efficacy in the prevention and treatment of EA. Maintenance of anesthesia using propofol has also been shown to prevent EA. In children, anesthesia methods that are unlikely to cause EA should be selected, with the prompt adminstration of appropriate treatment in cases of EA. PMID:26601849

  7. Optimized radiotherapy treatment planning using the Complication Probability Factor (CPF)

    SciTech Connect

    Wolbarst, A.B.; Sternick, E.S.; Curran, B.H.; Dritschilo, A.

    1980-06-01

    A major obstacle to effective computerized optimization of radiotherapy treatment planning has been the lack of a biologically meaningful and clinically useful objective function. Our approach employs a Complication Probability Factor (CPF) based directly on radiobiological principles and clinical data. The CPF measures the likelihood that a given dose distribution will lead to serious complications in the patient as a result of damage to healthy tissue. A computerized search can be made for a treatment plan which delivers an acceptable tumoricidal dose, yet minimizes the CPF as averaged over the total volume of healthy tissue irradiated. The program is run on a PDP 11/55 in conjunction with a commercial treatment planning package.

  8. Host factors determining the efficacy of hepatitis C treatment.

    PubMed

    Chuang, Wan-Long; Yu, Ming-Lung

    2013-01-01

    Combination therapy with pegylated interferon and ribavirin is the standard of care (SOC) for the treatment of chronic hepatitis C (CHC). Treating CHC with SOC may show a sustained virological response (SVR) in approximately 50-70 % of genotype 1 CHC patients and an SVR in 70-90 % of genotype 2 CHC patients. The genotype, baseline viral load, and viral kinetics (i.e., rapid virologic response and early virologic response) can be used as predictors of response-guided therapy. Nonetheless, host factors, e.g. age, ethnicity, insulin resistance, and genetic variations, may also play important roles in the SVR in CHC patients treated with SOC. Recent genome-wide association studies have demonstrated that single-nucleotide polymorphisms near the interleukin 28B gene (IL28B) were associated with SVR to treatment with SOC in CHC patients. The IL28B polymorphisms may contribute to the viral kinetics during treatment. Asian people have favorable IL28B polymorphisms. This factor may at least partly explain the high eradication rate of hepatitis C by SOC in Asia. Combination therapy with direct-acting antivirals (DAAs) and SOC can increase the SVR rates both in treatment-naïve and treatment-experienced patients. Although the IL28B polymorphisms also affect the SVR of triple therapy with SOC and first-generation protease inhibitors, pilot studies have demonstrated that potent DAAs might overcome the influence of IL28B polymorphisms. Thus, the treatment of hepatitis C virus infection could be simplified in the near future. PMID:23104468

  9. Eroticization as a factor influencing erectile dysfunction treatment effectiveness.

    PubMed

    Kukula, K C; Jackowich, R A; Wassersug, R J

    2014-01-01

    We review both the medical and psychosocial literature on factors influencing male potency in order to better understand why erectile dysfunction (ED) treatments, PDE5 drugs in particular, are abandoned when otherwise effective. We incorporate anecdotal data from websites and list serves dedicated to helping patients deal with iatrogenic ED. Our goal is to distinguish between ED treatments that are medicalized versus eroticized, and how partner participation may influence their effectiveness. Recently it has been shown that ED treatment effectiveness is aided by the involvement of the patient's partner. This permits an erotic association between the partner and the ED 'aid'. We extend this idea to suggest that having the partner involved as early as possible in the discussion of treatment, and their presence at the time of prescription, should improve ED aid effectiveness. Eroticization of ED aids shifts the focus from a perceived disability of the patient toward the sexual pleasure provided by the partner. We further suggest that ED aids used without the partner's knowledge will undermine intimacy and ultimately the treatment's effectiveness. Unpartnered patients should be advised about the importance of informing potential partners about their use of such aids, as openness and honesty may increase intimacy in the long run. PMID:23823215

  10. Personality Traits as Risk Factors for Treatment-Resistant Depression

    PubMed Central

    Takahashi, Michio; Shirayama, Yukihiko; Muneoka, Katsumasa; Suzuki, Masatoshi; Sato, Koichi; Hashimoto, Kenji

    2013-01-01

    Background The clinical outcome of antidepressant treatment in patients with major depressive disorder (MDD) is thought to be associated with personality traits. A number of studies suggest that depressed patients show high harm avoidance, low self-directedness and cooperativeness, as measured on the Temperament and Character Inventory (TCI). However, the psychology of these patients is not well documented. Methods Psychological evaluation using Cloninger’s TCI, was performed on treatment-resistant MDD patients (n = 35), remission MDD patients (n = 31), and age- and gender-matched healthy controls (n = 174). Results Treatment-resistant patients demonstrated high scores for harm avoidance, and low scores for reward dependence, self-directedness, and cooperativeness using the TCI, compared with healthy controls and remission patients. Interestingly, patients in remission continued to show significantly high scores for harm avoidance, but not other traits in the TCI compared with controls. Moreover, there was a significant negative correlation between reward dependence and harm avoidance in the treatment-resistant depression cohort, which was absent in the control and remitted depression groups. Conclusions This study suggests that low reward dependence and to a lesser extent, low cooperativeness in the TCI may be risk factors for treatment-resistant depression. PMID:23717477

  11. Factors associated with treatment compliance in hypertension in southwest Nigeria.

    PubMed

    Osamor, Pauline E; Owumi, Bernard E

    2011-12-01

    Hypertension is an important condition among adults, affecting nearly one billion people worldwide. Treatment with appropriate medication is a key factor in the control of hypertension and reduction in associated risk of complications. However, compliance with treatment is often sub-optimal, especially in developing countries. The present study investigated the factors associated with self-reported compliance among hypertensive subjects in a poor urban community in southwest Nigeria. This community-based cross-sectional study employed a survey of a convenience sample of 440 community residents with hypertension and eight focus-group discussions (FGDs) with a subset of the participants. Of the 440 hypertensive respondents, 65.2% were women, about half had no formal education, and half were traders. Over 60% of the respondents sought care for their condition from the hospital while only 5% visited a chemist or a patent medicine vendor (PMV). Only 51% of the subjects reported high compliance. Factors associated with high self-reported compliance included: regular clinic attendance, not using non-Western prescription medication, and having social support from family members or friends who were concerned about the respondent's hypertension or who were helpful in reminding the respondent about taking medication. Beliefs about cause of hypertension were not associated with compliance. The findings of the FGDs showed that the respondents believed hypertension is curable with the use of both orthodox and traditional medicines and that a patient who 'feels well' could stop using antihypertensive medication. It is concluded that treatment compliance with antihypertensive medication remains sub-optimal in this Nigerian community. The factors associated with high self-reported compliance were identified. More research is needed to evaluate how such findings can be used for the control of hypertension at the community level. PMID:22283036

  12. Factors Associated with Treatment Compliance in Hypertension in Southwest Nigeria

    PubMed Central

    Owumi, Bernard E.

    2011-01-01

    Hypertension is an important condition among adults, affecting nearly one billion people worldwide. Treatment with appropriate medication is a key factor in the control of hypertension and reduction in associated risk of complications. However, compliance with treatment is often sub-optimal, especially in developing countries. The present study investigated the factors associated with self-reported compliance among hypertensive subjects in a poor urban community in southwest Nigeria. This community-based cross-sectional study employed a survey of a convenience sample of 440 community residents with hypertension and eight focus-group discussions (FGDs) with a subset of the participants. Of the 440 hypertensiverespondents, 65.2% were women, about half had no formal education, and half were traders. Over 60% of the respondents sought care for their condition from the hospital while only 5% visited a chemist or a patent medicine vendor (PMV). Only 51% of the subjects reported high compliance. Factors associated with high self-reported compliance included: regular clinic attendance, not using non-Western prescription medication, and having social support from family members or friends who were concerned about the respondent's hypertension or who were helpful in reminding the respondent about taking medication. Beliefs about cause of hypertension were not associated with compliance. The findings of the FGDs showed that the respondents believed hypertension is curable with the use of both orthodox and traditional medicines and that a patient who ‘feels well’ could stop using antihypertensive medication. It is concluded that treatment compliance with antihypertensive medication remains sub-optimal in this Nigerian community. The factors associated with high self-reported compliance were identified. More research is needed to evaluate how such findings can be used for the control of hypertension at the community level. PMID:22283036

  13. Growth factors in the treatment of early osteoarthritis

    PubMed Central

    Civinini, Roberto; Nistri, Lorenzo; Martini, Caterina; Redl, Birgit; Ristori, Gabriele; Innocenti, Massimo

    2013-01-01

    Summary Regenerative medicine is the science that studies the regeneration of biological tissues obtained through use of cells, with the aid of support structures and with biomolecules such as growth factors. As regards the growth factors the PRP, or the platelet-rich plasma, obtained from a withdrawal of autologous blood, concentrating the platelets, represents a safe, economical, easy to prepare and easy to apply source of growth factors. Numerous growth factors are in fact within the platelets and in particular a large number of them have a specific activity on neo-proliferation, on cartilage regeneration and in particular also an antiapoptotic effect on chondroblasts: - The PDGF which regulates the secretion and synthesis of collagen;- The EGF that causes cellular proliferation, endothelial chemotaxis and angiogenesis;- The VEGF that increases angiogenesis and vascular permeability;- The TGF-beta that stimulates the proliferation of undifferentiated MSC, stimulates chemotaxis of endothelial cells and angiogenesis;- The bFGF that promotes the growth and differentiation of chondrocytes and osteoblasts stimulates mitogenesis of mesenchymal cells, chondrocytes and osteoblasts. These properties have led to the development of studies that evaluated the efficacy of treatment of infiltrations in the knee and hip with platelet-derived growth factors. Regarding the knee it was demonstrated that in patients with moderate degree of gonarthrosis, the PRP is able to significantly reduce the pain and improve joint function, both on placebo and towards infiltrations with hyaluronic acid. The success of the treatment was proportional to the age of and inversely proportional to the severity of osteoarthritis according to Kellgren and Lawrence classification. The possibility of infiltrations guided with ultrasound into the hip led us to extend the indications also to hip arthrosis, as already showed by Sanchez. Even in coxarthrosis preliminary results at 6 and 12 months show that

  14. Factors influencing the future need for treatment of root surfaces.

    PubMed

    Ettinger, R L; Hand, J S

    1994-10-01

    This paper discusses the current status of root surface caries in the elderly population and the need for treatment of this condition in the future. Although root surface exposure and root caries have been reported for adults at all ages, the people at greatest risk for these conditions are the elderly. In the United States, life expectancy and the population aged 65 years and older has increased substantially, and the proportion of the elderly population who are dentate has increased and is projected to increase further. Utilization of dental services by the elderly is similar to that of employed adults. Interpretation of studies of the prevalence and incidence of root surface caries are difficult due to differences in sampling, definition of lesions, and reporting conventions. Root surface caries prevalence is related to age and continues to be a significant problem for this population as they age. Factors that may affect the future need for treatment are explored. PMID:7986448

  15. IMPACT OF FIVE TREATMENT FACTORS ON MUSSEL MORTALITY

    SciTech Connect

    Daniel P. Molloy

    2003-12-08

    Under this USDOE-NETL contract, the bacterium Pseudomonas fluorescens is being developed as a biocontrol agent for zebra mussels. The specific purpose of the contract is to identify factors that affect mussel kill. Test results reported herein indicate that mussel kill should not be affected by: (1) air bubbles being carried by currents through power plant pipes; (2) pipe orientation (e.g., vertical or horizontal); (3) whether the bacterial cell concentration during a treatment is constant or slightly varying; (4) whether a treatment is between 3 hr and 12 hr in duration, given that the total quantity of bacteria being applied to the pipe is a constant; and (5) whether the water temperature is between 13 C and 23 C.

  16. Gynecologic cancer treatment: risk factors for therapeutically induced neoplasia

    SciTech Connect

    Messerschmidt, G.L.; Hoover, R.; Young, R.C.

    1980-07-15

    Therapeutic intervention in a course of illness, while producing the desired result, also may have some adverse long-term effects on the patient. Second malignancies are one of the known complications of therapy. The treatments of gynecologic cancers by surgery, irradiation and chemotherapy have been associated with subsequent neoplasms. The use of normal skin from the thigh to fabricate an artificial vagina has resulted in more squamous cell carcinomas than expected. Alkylating agents used in the treatment of ovarian cancer and other diseases have been shown to lead to an increased risk of leukemia. The incidence of lymphoma and uterine, urinary bladder and colon carcinomas has been associated with prior irradiation for gynecologic disease. The literature regarding the therapeutically induced risk factors in gynecologic therapy is reviewed and areas of our knowledge that require more investigation are identified.

  17. [Risk factors for hyperammonemia during mFOLFOX6 treatment].

    PubMed

    Misumi, Nobuhiro; Goto, Takashi; Miyoshi, Takanori; Hiraike, Mikako; Shirasawa, Hiromi; Saito, Ooki; Nishino, Takashi; Oudo, Masaharu

    2013-04-01

    Patients undergoing mFOLFOX6 treatment were classified into a hyperammonemia group (NH3 group) or a non-hyperammonemia group (Non-NH3 group) in order to investigate risk factors related to the onset of hyperammonemia. The NH3 group demonstrated significantly lower lymphocyte counts, hemoglobin and albumin levels, and estimated glomerular filtration rates compared to the Non-NH3 group, suggesting that the NH3 group was experiencing renal dysfunction and loss of skeletal muscle mass due to malnutrition. Amino acid fractionation in the NH3 group revealed high urea levels, and delayed urea excretion was identified. Fluorocitric acid, a fluorouracil metabolite, inhibits aconitase in the tricarboxylic acid cycle. In addition, decreased renal urea transporter function due to renal impairment leads to delayed urea excretion. These factors may induce secondary decreases in urea cycle function, leading to hyperammonemia. PMID:23848016

  18. Intranasal epidermal growth factor treatment rescues neonatal brain injury

    PubMed Central

    Scafidi, Joseph; Hammond, Timothy R.; Scafidi, Susanna; Ritter, Jonathan; Jablonska, Beata; Roncal, Maria; Szigeti-Buck, Klara; Coman, Daniel; Huang, Yuegao; McCarter, Robert J.; Hyder, Fahmeed; Horvath, Tamas L.; Gallo, Vittorio

    2014-01-01

    There are no clinically relevant treatments available that improve function in the growing population of very preterm infants (<32 weeks gestation) with neonatal brain injury. Diffuse white matter injury (DWMI) is a common finding in these children and results in chronic neurodevelopmental impairments1,2. As shown recently, failure in oligodendrocyte progenitor cell maturation contributes to DWMI3. In a previous study, we demonstrated that epidermal growth factor receptor (EGFR) plays an important role in oligodendrocyte development4. Here, we examine whether enhanced epidermal growth factor receptor (EGFR) signaling stimulates the endogenous response of EGFR-expressing progenitor cells during a critical period after brain injury, and promotes cellular and behavioral recovery in the developing brain. Using an established model of very preterm brain injury, we demonstrate that selective overexpression of human (h)EGFR in oligodendrocyte lineage cells or the administration of intranasal heparin binding EGF immediately after injury decreases oligodendroglia death, enhances generation of new oligodendrocytes from progenitor cells (OPCs) and promotes functional recovery. Furthermore, these interventions diminish ultrastructural abnormalities and alleviate behavioral deficits on white matter-specific paradigms. Inhibition of EGFR signaling with a molecularly targeted agent used for cancer therapy demonstrates that EGFR activation is an important contributor to oligodendrocyte regeneration and functional recovery after DWMI. Thus, our study provides direct evidence that targeting EGFR in OPCs at a specific time after injury is clinically feasible and applicable for the treatment of premature children with white matter injury. PMID:24390343

  19. Targeting the opioid growth factor: opioid growth factor receptor axis for treatment of human ovarian cancer.

    PubMed

    Zagon, Ian S; Donahue, Renee; McLaughlin, Patricia J

    2013-05-01

    The opioid growth factor (OGF) - opioid growth factor receptor (OGFr) axis is a biological pathway that is present in human ovarian cancer cells and tissues. OGF, chemically termed [Met(5)]-enkephalin, is an endogenous opioid peptide that interfaces with OGFr to delay cells moving through the cell cycle by upregulation of cyclin-dependent inhibitory kinase pathways. OGF inhibitory activity is dose dependent, receptor mediated, reversible, protein and RNA dependent, but not related to apoptosis or necrosis. The OGF-OGFr axis can be targeted for treatment of human ovarian cancer by (i) administration of exogenous OGF, (ii) genetic manipulation to over-express OGFr and (iii) use of low dosages of naltrexone, an opioid antagonist, which stimulates production of OGF and OGFr for subsequent interaction following blockade of the receptor. The OGF-OGFr axis may be a feasible target for treatment of cancer of the ovary (i) in a prophylactic fashion, (ii) following cytoreduction or (iii) in conjunction with standard chemotherapy for additive effectiveness. In summary, preclinical data support the transition of these novel therapies for treatment of human ovarian cancer from the bench to bedside to provide additional targets for treatment of this devastating disease. PMID:23856908

  20. Risk factor adapted treatment of Hodgkin's lymphoma: strategies and perspectives.

    PubMed

    Loeffler, M; Pfreundschuh, M; Rühl, U; Hiller, E; Gerhartz, H; Roloff, R; Adler, M; Schoppe, W; Hagen-Aukamp, U; Schmitt, G

    1989-01-01

    In a national multicenter trial in the Federal Republic of Germany, patients with Hodgkin's lymphoma in stages I, II and IIIA presenting with large mediastinal tumor (MT), extranodal (E), or massive spleen (S) involvement received a combined modality treatment with 2x (COPP + ABVD) followed by 20 or 40 Gy EF radiation (HD1 protocol). By October 1987, 89 patients aged 15-60 years had finished therapy and were evaluable for response. Of these 74 (83%) achieved complete remission (CR). After 3 years freedom from treatment failure (FFTF) is 80% (+/- 8%, 95% confidence interval) and survival (SV) 92% (+/- 6%, 95% confidence interval). In a univariate and multivariate analysis using FFTF as endpoint we could not identify any particularly prominent prognostic risk factor among the following examined: stage, constitutional symptoms, MT, E stage, S involvement, age, sex, histology, laparotomy, erythrocyte sedimentation rate (ESR), leukocytes, lymphocytes, and alkaline phosphatase (AP). These data suggest that the inclusion criteria have selected a fairly homogeneous group of patients with respect to prognosis. In a separate trial (HD3 protocol) patients in stages IIIB/IV received induction chemotherapy with 3x (COPP + ABVD). Patients in complete remission (CR) received consolidation therapy by either radiotherapy (20 Gy IF) or further chemotherapy (COPP + ABVD). Patients not in CR received salvage therapy (40Gy in the case of persisting nodal disease, or else 4x CEVD chemotherapy). By October 1987, 137 patients had finished therapy and were evaluable for response. Of these 86 (63%) achieved CR after induction chemotherapy. Including salvage therapy a total of 104 patients (76%) achieved CR. After 3 years FFTF is 56% (+/- 10%, 95% confidence interval) and SV 84% (+/- 8%, 95% confidence interval). Univariate and multivariate prognostic risk factor analyses were performed using FFTF as endpoint. Sex, age, stage, splenectomy, bone marrow, and liver and bone involvement had no

  1. Client engagement in psychotherapeutic treatment and associations with client characteristics, therapist characteristics, and treatment factors.

    PubMed

    Holdsworth, Emma; Bowen, Erica; Brown, Sarah; Howat, Douglas

    2014-07-01

    Client engagement has been associated with positive psychotherapeutic outcomes, yet it is relatively under-theorized. The aims of this review were to establish how client engagement with psychotherapeutic interventions targeting psychological or behavioral change has been operationally defined and assessed, and the associated client characteristics, therapist characteristic, and treatment factors. Seventy-nine studies were selected for review, revealing inconsistent definitions and assessments of engagement and a broad array of client characteristics and treatment factors investigated. Attendance was frequently used as a proxy for engagement, but may not be reliable. Participation or involvement in conjunction with homework compliance which reflects clients' efforts within and between sessions may more reliably reflect engagement. The findings of associations between client characteristics and engagement variables were equivocal, although clients' capacities to address their problems tended to be positively associated with engagement. Nearly all therapist characteristics, particularly therapists' interpersonal skills, and most treatment factors, particularly strengths-based approaches and the therapeutic relationship, were positively associated with engagement. A theory of engagement that characterizes the function and inter-relations of variables across different psychotherapeutic settings is needed. PMID:25000204

  2. The rise of food allergy: Environmental factors and emerging treatments.

    PubMed

    Benedé, Sara; Blázquez, Ana Belen; Chiang, David; Tordesillas, Leticia; Berin, M Cecilia

    2016-05-01

    Food allergy has rapidly increased in prevalence, suggesting an important role for environmental factors in disease susceptibility. The immune response of food allergy is characterized by IgE production, and new findings from mouse and human studies indicate an important role of the cytokine IL-9, which is derived from both T cells and mast cells, in disease manifestations. Emerging evidence suggests that route of exposure to food, particularly peanut, is important. Exposure through the skin promotes sensitization while early exposure through the gastrointestinal tract promotes tolerance. Evidence from mouse studies indicate a role of the microbiome in development of food allergy, which is supported by correlative human studies showing a dysbiosis in food allergy. There is no approved treatment for food allergy, but emerging therapies are focused on allergen immunotherapy to provide desensitization, while pre-clinical studies are focused on using adjuvants or novel delivery approaches to improve efficacy and safety of immunotherapy. PMID:27322456

  3. Intranasal epidermal growth factor treatment rescues neonatal brain injury

    NASA Astrophysics Data System (ADS)

    Scafidi, Joseph; Hammond, Timothy R.; Scafidi, Susanna; Ritter, Jonathan; Jablonska, Beata; Roncal, Maria; Szigeti-Buck, Klara; Coman, Daniel; Huang, Yuegao; McCarter, Robert J.; Hyder, Fahmeed; Horvath, Tamas L.; Gallo, Vittorio

    2014-02-01

    There are no clinically relevant treatments available that improve function in the growing population of very preterm infants (less than 32 weeks' gestation) with neonatal brain injury. Diffuse white matter injury (DWMI) is a common finding in these children and results in chronic neurodevelopmental impairments. As shown recently, failure in oligodendrocyte progenitor cell maturation contributes to DWMI. We demonstrated previously that the epidermal growth factor receptor (EGFR) has an important role in oligodendrocyte development. Here we examine whether enhanced EGFR signalling stimulates the endogenous response of EGFR-expressing progenitor cells during a critical period after brain injury, and promotes cellular and behavioural recovery in the developing brain. Using an established mouse model of very preterm brain injury, we demonstrate that selective overexpression of human EGFR in oligodendrocyte lineage cells or the administration of intranasal heparin-binding EGF immediately after injury decreases oligodendroglia death, enhances generation of new oligodendrocytes from progenitor cells and promotes functional recovery. Furthermore, these interventions diminish ultrastructural abnormalities and alleviate behavioural deficits on white-matter-specific paradigms. Inhibition of EGFR signalling with a molecularly targeted agent used for cancer therapy demonstrates that EGFR activation is an important contributor to oligodendrocyte regeneration and functional recovery after DWMI. Thus, our study provides direct evidence that targeting EGFR in oligodendrocyte progenitor cells at a specific time after injury is clinically feasible and potentially applicable to the treatment of premature children with white matter injury.

  4. Gynecologic cancer treatment: risk factors for therapeutically induced neoplasia

    SciTech Connect

    Messerschmidt, G.L.; Hoover, R.; Young, R.C.

    1981-07-15

    Therapeutic intervention in a course of illness, while producing the desired result, also may have some adverse long-term effects on the patient. Second malignancies are one of the known complications of therapy. The treatments of gynecologic cancers by surgery, irradiation and chemotherapy have been associated with subsequent neoplasms. Care must be exercised in associating previous therapy and a subsequent malignancy. Naturally occurring second cancers must be separated from those which are iatrogenic. Associations in the literature have been made involving malignancies as a sequelae of prior gynecologic therapy. The use of normal skin from the thigh to fabricate an artificial vagina has resulted in more squamous cell carcinomas than expected. Alkylating agents used in the treatment of ovarian cancer and other diseases have been shown to lead to an increased risk of leukemia. Irradiation therapy, however, has not yet been shown to be related to leukemia in cervical cancer patients. The incidence of lymphoma and uterine, urinary bladder and colon carcinomas has been associated with prior irradiation for gynecologic disease. The literature regarding the therapeutically induced risk factors in gynecologic therapy is reviewed and areas of our knowledge that require more investigation are identified.

  5. Patient factors influencing dermal filler complications: prevention, assessment, and treatment

    PubMed Central

    De Boulle, Koenraad; Heydenrych, Izolda

    2015-01-01

    While rare, complications do occur with the esthetic use of dermal fillers. Careful attention to patient factors and technique can do much to avoid these complications, and a well-informed practitioner can mitigate problems when they do occur. Since cosmetic surgery is usually an elective process, requested by the patient, clinical trials are complex to organize and run. For this reason, an international group of practicing physicians in the field of esthetics came together to share knowledge and to try and produce some informed guidance for their colleagues, considering the literature and also pooling their own extensive clinical experience. This manuscript aims to summarize the crucial aspects of patient selection, including absolute contraindications as well as situations that warrant caution, and also covers important considerations for the pre- and posttreatment periods as well as during the procedure itself. Guidance is given on both immediate and long-term management of adverse reactions. The majority of complications are related to accepting patients inappropriate for treatment or issues of sterility, placement, volume, and injection technique. It is clear that esthetic practitioners need an in-depth knowledge of all aspects of treatment with dermal fillers to achieve optimal outcomes for their patients. PMID:25926750

  6. High-Altitude Illnesses: Physiology, Risk Factors, Prevention, and Treatment

    PubMed Central

    Taylor, Andrew T.

    2011-01-01

    High-altitude illnesses encompass the pulmonary and cerebral syndromes that occur in non-acclimatized individuals after rapid ascent to high altitude. The most common syndrome is acute mountain sickness (AMS) which usually begins within a few hours of ascent and typically consists of headache variably accompanied by loss of appetite, nausea, vomiting, disturbed sleep, fatigue, and dizziness. With millions of travelers journeying to high altitudes every year and sleeping above 2,500 m, acute mountain sickness is a wide-spread clinical condition. Risk factors include home elevation, maximum altitude, sleeping altitude, rate of ascent, latitude, age, gender, physical condition, intensity of exercise, pre-acclimatization, genetic make-up, and pre-existing diseases. At higher altitudes, sleep disturbances may become more profound, mental performance is impaired, and weight loss may occur. If ascent is rapid, acetazolamide can reduce the risk of developing AMS, although a number of high-altitude travelers taking acetazolamide will still develop symptoms. Ibuprofen can be effective for headache. Symptoms can be rapidly relieved by descent, and descent is mandatory, if at all possible, for the management of the potentially fatal syndromes of high-altitude pulmonary and cerebral edema. The purpose of this review is to combine a discussion of specific risk factors, prevention, and treatment options with a summary of the basic physiologic responses to the hypoxia of altitude to provide a context for managing high-altitude illnesses and advising the non-acclimatized high-altitude traveler. PMID:23908794

  7. Pain in Breast Cancer Treatment: Aggravating Factors and Coping Mechanisms

    PubMed Central

    Guerreiro Godoy, Maria de Fatima; Pereira de Godoy, Livia Maria; Barufi, Stelamarys; de Godoy, José Maria Pereira

    2014-01-01

    The objective of this study was to evaluate pain in women with breast cancer-related lymphedema and the characteristics of aggravating factors and coping mechanisms. The study was conducted in the Clinica Godoy, São Jose do Rio Preto, with a group of 46 women who had undergone surgery for the treatment of breast cancer. The following variables were evaluated: type and length of surgery; number of radiotherapy and chemotherapy sessions; continued feeling of the removed breast (phantom limb), infection, intensity of pain, and factors that improve and worsen the pain. The percentage of events was used for statistical analysis. About half the participants (52.1%) performed modified radical surgery, with 91.3% removing only one breast; 82.6% of the participants did not perform breast reconstruction surgery. Insignificant pain was reported by 32.60% of the women and 67.3% said they suffered pain; it was mild in 28.8% of the cases (scale 1–5), moderate in 34.8% (scale 6–9), and severe in 4.3%. The main mechanisms used to cope with pain were painkillers in 41.30% of participants, rest in 21.73%, religious ceremonies in 17.39%, and chatting with friends in 8.69%. In conclusion, many mastectomized patients with lymphedema complain of pain, but pain is often underrecognized and undertreated. PMID:25349741

  8. Treatment of rheumatoid arthritis with tumour necrosis factor inhibitors

    PubMed Central

    Mewar, Devesh; Wilson, Anthony G

    2011-01-01

    Advances in our understanding of the key mediators of chronic inflammation and tissue damage characteristic of rheumatoid arthritis (RA) have resulted in the development of novel therapies primarily targeting pro-inflammatory cytokines. Inhibitors of tumour necrosis factor (TNF) are the most widely used of the biological therapies at present with five different agents currently available; four are based on monoclonal anti-TNF antibodies and a soluble TNF receptor-Fc fusion protein. Long-term use of these molecules has proven to be highly effective in the majority of patients; however, around one-third have a suboptimal response potentially leading to further cartilage and bone damage, furthermore these agents are expensive compared with conventional therapies such as methotrexate. Many recent studies have attempted to identify therapeutic response biomarkers of TNF inhibitors which could be used to improve therapeutic targeting. The presence of rheumatoid factor and anti-cyclic citullinated protein antibodies, present in around 65% of RA patients, are associated with a poorer response to anti-TNF agents. Poorer response is also associated with levels of C-reactive protein and cartilage degradation product at initiation of treatment. Intriguingly, genetic studies of variants of TNF and of genes encoding members of the Toll-like receptors, nuclear factor-kappa B and p38 mitogen-activated protein kinase signalling families have been associated with response to individual anti-TNF agents. Continued advances in technologies such as ultra high throughput sequencing and proteomics should facilitate the discovery of additional biomarkers of response to anti-TNF resulting in improved disease control and quality of life for RA patients and reduced costs for healthcare funders. PMID:21039421

  9. Predictive Risk Factors in the Treatment of Gestational Diabetes Mellitus

    PubMed Central

    Aktun, Lebriz Hale; Yorgunlar, Betul; Karaca, Nilay; Akpak, Yaşam Kemal

    2015-01-01

    OBJECTIVE This study aims to investigate predictive risk factors in the treatment of gestational diabetes mellitus (GDM). PATIENTS AND METHODS A total of 256 pregnant women who underwent 75 g oral glucose tolerance test (OGTT) during 24–28 weeks of pregnancy were included according to the World Health Organization criteria. Demographic characteristics of the patients, including age, parity, family history of diabetes, body weight before pregnancy, and body weight at the diagnosis of GDM, were recorded. Fasting insulin and hemoglobin A1c (HbA1c) values at the time of diagnosis were evaluated. The patients were divided into two groups: those requiring insulin treatment (insulin group, n = 89) and those receiving diet therapy (diet group, n = 167) during pregnancy according to the American Diabetes Association recommendations. RESULTS A total of 34.76% of the pregnant women with GDM required insulin treatment. The mean age of these patients was significantly higher compared to the diet group (34.9 ± 0.6 years vs. 31.9 ± 0.6 years; P = 0.004). Body mass index before pregnancy was also significantly higher in the insulin group than that in the diet group (32 ± 0.9 kg/m2 vs. 29 ± 0.7 kg/m2; P = 0.004). Fasting blood glucose (FBG) during OGTT was 105.6 ± 2.1 mg/dL and 96.7 ± 1.1 mg/dL in the insulin group and diet group, respectively (P < 0.001). There was no significant difference in fasting plasma glucose during OGTT between the groups (P = 0.069), while plasma glucose at two hours was 161.1 ± 6.8 mg/dL in the insulin group and 145.1 ± 3.7 mg/dL in the diet group (P = 0.027). At the time of diagnosis, HbA1c values were significantly higher in the insulin group compared to the diet group (5.3 ± 0.1 vs. 4.9 ± 0.1; P = 0.001). There was no significant difference in FBG and homeostasis model assessment-insulin resistance values between the groups (P = 0.908, P = 0.073). CONCLUSION Our study results suggest that age, family history of diabetes, body weight before

  10. Intraventricular hemorrhage and ICH outcomes: Severity factor and treatment target

    PubMed Central

    Hanley, Daniel F.

    2009-01-01

    Background and Purpose This review focuses on the emerging principles of ICH management, emphasizing the natural history and treatment of intraventricular hemorrhage. The translational and clinical findings from recent randomized clinical trials are defined and discussed. Summary of Review Brain hemorrhage is the most severe of the major stroke subtypes. Extension of the hemorrhage into the ventricles (a 40% occurrence) can happen early or late in the sequence of events. Epidemiologic data demonstrate the amount of blood in the ventricles relates directly to the degree of injury and likelihood of survival. Secondary tissue injury processes related to intraventricular bleeding can be reversed by removal of clot in animals. Specific benefits of removal include limitation of inflammation, edema, and cell death as well as restoration of CSF flow, ICP homeostasis, improved consciousness, and shortening of ICU stay. Limited clinical knowledge exists about the benefits of IVH removal in humans, as organized attempts to remove blood have not been undertaken in large clinical trials on a generalized scale. New tools to evaluate the volume and location of IVH and to test the benefits/risks of removal have been employed in the clinical domain. Initial efforts are encouraging that increased survival and functional improvement can be achieved. Little controversy exists regarding the need to scientifically investigate treatment of this severity factor. Conclusions Animal models demonstrate clot removal can improve the acute and long term consequences of intraventricular extension from ICH by employing minimally invasive techniques coupled to rt-PA mediated clot lysis. The most recent human clinical trials show that severity of initial injury and the long term consequences of blood extending into the ventricles are clearly related to the amount of bleeding into the ventricular system. The failure of the last two pivotal brain hemorrhage RCTs may well relate to the consequences of

  11. Risk factors for healing of duodenal ulcer under antacid treatment: do ulcer patients need individual treatment?

    PubMed

    Massarrat, S; Müller, H G; Schmitz-Moormann, P

    1988-03-01

    In order to identify the risk factors affecting the healing of duodenal ulcer, a clinical trial with effective dose of antacid was carried out in 53 patients. Duration of ulcer history, number of relapses, duration of the last and present relapse, number, duration and severity of pain attacks in the present ulcer relapse, pain radiation to back, vomiting, appetite, smoking habit, intake of analgesics and previous haemorrhage were registered. Number of ulcers, ulcer depth, bublar narrowing, erosions, duodenitis at initial endoscopy and healing of ulcer were assessed by one endoscopist. Basic and peak acid output were measured. The extent of duodenitis on the site opposite the ulcer was determined by histological examination. Sixty per cent of the duodenal ulcers were healed after three weeks. By univariate analysis, the following factors affect the healing; pain radiation to back and pain duration during treatment (p less than 0.001), multiple or deep ulcers, narrowing of duodenal bulb (p less than 0.01), number of pain attacks and poor appetite (p less than 0.05). By the stepwise logistic regression model, the following factors were selected as predictors for healing of duodenal ulcer with 76% correct classification: pain radiation to back (p = 0.002), deep ulcer (p = 0.013), multiple ulcers (p = 0.028). Number of cigarettes/day (p less than 0.007) and male sex (p = 0.036). By this model, the prediction of healing could be accurately assessed in 78% in a new sample. Individual treatment should be carried out on the basis of these factors. PMID:3356359

  12. Treatment Modifications and Treatment-Limiting Toxicities or Side Effects: Risk Factors and Temporal Trends.

    PubMed

    Pantazis, Nikos; Psichogiou, Mina; Paparizos, Vassilios; Gargalianos, Panagiotis; Chini, Maria; Protopapas, Konstantinos; Sipsas, Nikolaos V; Panos, George; Chrysos, George; Sambatakou, Helen; Katsarou, Olga; Touloumi, Giota

    2015-07-01

    Combined antiretroviral treatment (cART) modifications are often required due to treatment failure or side effects. We investigate cART regimens' durability, frequency of treatment-limiting adverse events, and potential risk factors and temporal trends. Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). Statistical analyses were based on survival techniques, allowing for multiple contributions per individual. Overall, 2,756 individuals, aged >15 years, initiated cART. cART regimens were grouped by their initiation date into four calendar periods (1995-1998, 1999-2002, 2003-2006, and 2007+). Median [95% confidence interval (CI)] time to first treatment modification was 2.11 (1.95-2.33) years; cumulative probabilities at 1 year were 31.6%, 29.0%, 33.1%, and 29.6% for the four periods, respectively. cART modifications were less frequent in more recent years (adjusted HR=0.96 per year; p<0.001). Longer treatment duration was associated with lower HIV-RNA, higher CD4 counts, and being previously ART naive. cART modifications due to treatment failure became less frequent in recent years (adjusted HR=0.91 per year; p<0.001). Estimated (95% CI) 1 year cumulative probabilities of treatment-limiting side effects were 16.4% (12.0-21.3%), 19.3% (15.6-23.3%), 24.9% (20.3-29.7%), and 21.1% (13.4-29.9%) for the four periods, respectively, with no significant temporal trends. Risk of side effects was lower in nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens or triple nucleoside reverse transcriptase inhibitor (NRTI)-based cART regimens. Treatment modifications have become less frequent in more recent years. This could be partly attributed to the lower risk for side effects of NNRTI-based cART regimens and mainly to the improved efficacy of newer drugs. However, the rate of drugs substitutions due to adverse events remains substantially high. PMID:25950848

  13. Factors Associated with Methadone Treatment Duration: A Cox Regression Analysis

    PubMed Central

    Peng, Ching-Yi; Chao, En; Lee, Tony Szu-Hsien

    2015-01-01

    This study examined retention rates and associated predictors of methadone maintenance treatment (MMT) duration among 128 newly admitted patients in Taiwan. A semi-structured questionnaire was used to obtain demographic and drug use history. Daily records of methadone taken and test results for HIV, HCV, and morphine toxicology were taken from a computerized medical registry. Cox regression analyses were performed to examine factors associated with MMT duration. MMT retention rates were 80.5%, 68.8%, 53.9%, and 41.4% for 3, 6, 12, and 18 months, respectively. Excluding 38 patients incarcerated during the study period, retention rates were 81.1%, 73.3%, 61.1%, and 48.9% for 3 months, 6 months, 12 months, and 18 months, respectively. No participant seroconverted to HIV and 1 died during the 18-months follow-up. Results showed that being female, imprisonment, a longer distance from house to clinic, having a lower methadone dose after 30 days, being HCV positive, and in the New Taipei city program predicted early patient dropout. The findings suggest favorable MMT outcomes of HIV seroincidence and mortality. Results indicate that the need to minimize travel distance and to provide programs that meet women’s requirements justify expansion of MMT clinics in Taiwan. PMID:25875531

  14. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies.

    PubMed

    Dessinioti, Clio; Katsambas, Andreas

    2013-01-01

    Seborrheic dermatitis (SD) is a common skin condition seen frequently in clinical practice. The use of varying terms such as sebopsoriasis, seborrheic dermatitis, seborrheic eczema, dandruff, and pityriasis capitis reflects the complex nature of this condition. Despite its frequency, much controversy remains regarding the pathogenesis of SD. This controversy extends to its classification in the spectrum of cutaneous diseases, having being classified as a form of dermatitis, a fungal disease, or an inflammatory disease, closely related with psoriasis. Some have postulated that SD is caused by Malassezia yeasts, based on the observation of their presence in affected skin and the therapeutic response to antifungal agents. Others have proposed that Malassezia is incidental to a primary inflammatory dermatosis that resulted in increased cell turnover, scaling, and inflammation in the epidermis, similar to psoriasis. The presence of host susceptibility factors, permitting the transition of M furfur to its pathogenic form, may be associated with immune response and inflammation. Metabolites produced by Malassezia species, including oleic acid, malssezin, and indole-3-carbaldehyde, have been implicated. SD also has been traditionally considered to be a form of dermatitis based on the presence of Malassezia in healthy skin, the absence the pathogenic mycelial form of Malassezia yeasts in SD, and its chronic course. As a result, proposed treatments vary, ranging from topical corticosteroids to topical antifungals and antimicrobial peptides. PMID:23806151

  15. Factors influencing biological treatment of MTBE contaminated ground water

    SciTech Connect

    Stringfellow, William T.; Hines Jr., Robert D.; Cockrum, Dirk K.; Kilkenny, Scott T.

    2001-09-14

    Methyl tert-butyl ether (MTBE) contamination has complicated the remediation of gasoline contaminated sites. Many sites are using biological processes for ground water treatment and would like to apply the same technology to MTBE. However, the efficiency and reliability of MTBE biological treatment is not well documented. The objective of this study was to examine the operational and environmental variables influencing MTBE biotreatment. A fluidized bed reactor was installed at a fuel transfer station and used to treat ground water contaminated with MTBE and gasoline hydrocarbons. A complete set of chemical and operational data was collected during this study and a statistical approach was used to determine what variables were influencing MTBE treatment efficiency. It was found that MTBE treatment was more sensitive to up-set than gasoline hydrocarbon treatment. Events, such as excess iron accumulation, inhibited MTBE treatment, but not hydrocarbon treatment. Multiple regression analysis identified biomass accumulation and temperature as the most important variables controlling the efficiency of MTBE treatment. The influent concentration and loading of hydrocarbons, but not MTBE, also impacted MTBE treatment efficiency. The results of this study suggest guidelines for improving MTBE treatment. Long cell retention times in the reactor are necessary for maintaining MTBE treatment. The onset of nitrification only occurs when long cell retention times have been reached and can be used as an indicator in fixed film reactors that conditions favorable to MTBE treatment exist. Conversely, if the reactor can not nitrify, it is unlikely to have stable MTBE treatment.

  16. 26 CFR 1.864-8T - Treatment of related person factoring income (temporary).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 9 2011-04-01 2011-04-01 false Treatment of related person factoring income... December 30, 1996 § 1.864-8T Treatment of related person factoring income (temporary). (a) Applicability—(1... the factoring business. Y resells the receivable to FPHC. Because FPHC has indirectly acquired...

  17. Factors Related to Attendance Rates in Obesity-Treatment-Groups.

    ERIC Educational Resources Information Center

    Packer, Eugene R.; Popler, Kenneth

    1979-01-01

    Examines personal, psychological, physical, and social characteristics of persons seeking group treatment for obesity and correlates these variables with their subsequent attendance. The best candidates for continuing in treatment have completed more schooling, have been obese longer, and are less depressed, more self-sufficient, and less…

  18. Skin Cancer: Biology, Risk Factors & Treatment | NIH MedlinePlus the Magazine

    MedlinePlus

    ... Javascript on. Feature: Skin Cancer Skin Cancer: Biology, Risk Factors & Treatment Past Issues / Summer 2013 Table of ... May spread to other parts of the body Risk Factors When you're told that you have ...

  19. On temporomandibular disorders. Time trends, associated factors, treatment need and treatment outcome.

    PubMed

    Köhler, Alkisti Anastassaki

    2012-01-01

    During the last few decades, and especially during the 1990s, an increase in musculoskeletal pain conditions and stress-related ill-health has been observed in Sweden. At the same time, an improvement in the oral health of the population has been noted. The overall aim of this thesis was to acquire knowledge relating to possible time trends for the presence of temporomandibular disorders (TMD) in the population. A further objective was to study factors that possibly influence the presence of these disorders and the outcome of their treatment. Studies I-III are based on a series of repeated cross-sectional population-based investigations. Three independent samples of 130 individuals in the age groups of 3, 5, 10, 15, 20, 30, 40, 50, 60 and 70 years were randomly selected from the inhabitants of the city of Jönköping, Sweden in 1983, 1993 and 2003. The total participation rate was 21%, 22% and 29% respectively. The participants were examined using a questionnaire, interview and a clinical examination of the stomatognathic system regarding the presence of symptoms and signs indicative of TMD. Study IV is a retrospective survey of a clinical sample of patients referred to and treated at the Department of Stomatognathic Physiology, The Institute for Postgraduate Dental Education, Jönköping, in 1995-2002. The overall frequencies of symptoms and the rates for some clinical signs and consequently of an estimated treatment need in adults increased during the study period. In 2003, the prevalence of frequent headache in 20-year-olds, mainly females, had markedly increased. The reports of bruxism among adults increased from 1983 to 2003. Awareness of bruxism and self-perceived health impairment were associated with TMD symptoms and signs. A favourable treatment outcome was observed for the majority of patients with common TMD sub-diagnoses and no strong predictors of treatment outcome were found. In conclusion, the results suggest some time trends towards an increased

  20. Antiangiogenic mechanisms and factors in breast cancer treatment

    PubMed Central

    Castañeda-Gill, Jessica M.; Vishwanatha, Jamboor K.

    2016-01-01

    Breast cancer is known to metastasize in its latter stages of existence. The different angiogenic mechanisms and factors that allow for its progression are reviewed in this article. Understanding these mechanisms and factors will allow researchers to design drugs to inhibit angiogenic behaviors and control the rate of tumor growth. PMID:27013929

  1. Common and Specific Factors Approaches to Home-Based Treatment: I-FAST and MST

    ERIC Educational Resources Information Center

    Lee, Mo Yee; Greene, Gilbert J.; Fraser, J. Scott; Edwards, Shivani G.; Grove, David; Solovey, Andrew D.; Scott, Pamela

    2013-01-01

    Objectives: This study examined the treatment outcomes of integrated families and systems treatment (I-FAST), a moderated common factors approach, in reference to multisystemic therapy (MST), an established specific factor approach, for treating at risk children and adolescents and their families in an intensive community-based setting. Method:…

  2. Cervical Cancer: A Review of the Psychosocial Factors Following Treatment.

    ERIC Educational Resources Information Center

    Gilliland, Kevin Clark

    Cervical cancer is a diagnosis that has a profound psychosocial impact, constituting a physical and emotional crisis for patients as well as family. In general, research indicates that the choice of treatment and the stage of the disease are instrumental in determining the psychosocial adjustment. Disruptions are likely to occur in self-esteem,…

  3. Client Judgement of Therapist Characteristics: A Factor in Treatment Outcome.

    ERIC Educational Resources Information Center

    Chambers, Alycia A.; And Others

    This study, based on Strong's (1968) model of therapy as social influence, focused on the relationship between clients' judgments of therapists' characteristics and the outcomes of their treatment for generalized anxiety. Thirty subjects and 15 therapists met in 12 individual therapy sessions using Progressive Relaxation Training combined with…

  4. Factors Affecting Treatment Acceptability for Psychostimulant Medication versus Psychoeducational Intervention.

    ERIC Educational Resources Information Center

    Stinnett, Terry A.; Crawford, Stephanie A.; Gillespie, Marci D.; Cruce, Michael K.; Langford, Courtney A.

    2001-01-01

    Examines future teachers' judgments of acceptability for two common treatments for children with the Attention Deficit Hyperactivity Disorder (ADHD) label. In this study, the ADHD label evoked greater expectations of attentional difficulties even when the pattern of functioning was similar to nonlabeled children. On the other hand, children with…

  5. Factors Associated with Effectiveness of Treatment and Reproductive Outcomes in Patients with Thin Endometrium Undergoing Estrogen Treatment

    PubMed Central

    Liu, Si-Miao; Zhou, Yuan-Zheng; Wang, Han-Bi; Sun, Zheng-Yi; Zhen, Jing-Ran; Shen, Keng; Deng, Cheng-Yan; Lang, Jing-He

    2015-01-01

    Background: Thin endometrium is associated with poor reproductive outcomes; estrogen treatment can increase endometrial thickness (EMT). The aim of this retrospective cohort study was to investigate the factors influencing the effectiveness of estrogen treatment and reproductive outcomes after the treatment in patients with thin endometrium. Methods: Relevant clinical data of 101 patients with thin endometrium who had undergone estrogen treatment were collected. Possible factors influencing the effectiveness of treatment were analyzed retrospectively by logistic regression analysis. Eighty-seven infertile women without thin endometrium who had undergone assisted reproduction served as controls. The cases and controls were matched for age, assisted reproduction method, and number of embryos transferred. Reproductive outcomes of study and control groups were compared using Student's t-test and the Chi-square test. Results: At the end of estrogen treatment, EMT was ≥8 mm in 93/101 patients (92.1%). Effectiveness of treatment was significantly associated with maximal pretreatment EMT (P = 0.017) and treatment duration (P = 0.004). The outcomes of assisted reproduction were similar in patients whose treatment was successful in increasing EMT to ≥8 mm and the control group. The rate of clinical pregnancy in patients was associated with the number of good-quality embryos transferred in both fresh (P = 0.005) and frozen-thawed (P = 0.000) embryo transfer cycles. Conclusions: Thinner EMT before estrogen treatment requires longer treatment duration and predicts poorer treatment outcomes. The effectiveness of treatment depends on the duration of estrogen administration. Assisted reproductive outcomes of patients whose treatment is successful (i.e., achieves an EMT ≥8 mm) are similar to those of controls. The quality of embryos transferred is an important predictor of assisted reproductive outcomes in patients treated successfully with exogenous estrogen. PMID:26612292

  6. Risk Factors in Adolescent Substance Abuse: Treatment and Management Implications.

    ERIC Educational Resources Information Center

    Thomas, Connie S.; Schandler, Steven L.

    1996-01-01

    Discusses research on adolescent substance abuse risk factors and their role in the management of adolescent substance abuse disorders. A selective literature review suggests specific intervention strategies; no generic approach fits all adolescent substance-use clients. Effective techniques require individual assessments, including the context in…

  7. Prospective Risk Factors and Treatment Outcomes among Adolescents in DATOS-A.

    ERIC Educational Resources Information Center

    Galaif, Elisha R.; Hser, Yih-Ing; Grella, Christine E.; Joshi, Vandana

    2001-01-01

    Relationships between risk factors and outcomes were examined for Drug Abuse Treatment Outcome Studies for Adolescents participants. For outpatient drug-free participants, drug use severity predicted less treatment retention; family drug involvement predicted more alcohol use after treatment. For residential participants, family drug involvement…

  8. Factors affecting ionizing radiation phytosanitary treatments, and implications for research and generic treatments

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Phytosanitary irradiation (PI) treatments are promising measures to overcome quarantine barriers to trade and are currently used in several countries. Although PI has advantages compared with other treatments, one disadvantage bedevils research approval/application: organisms may remain alive afte...

  9. Factors Related to Successful Misoprostol Treatment for Early Pregnancy Failure

    PubMed Central

    Creinin, Mitchell D.; Huang, Xiangke; Westhoff, Carolyn; Barnhart, Kurt; Gilles, Jerry M.; Zhang, Jun

    2006-01-01

    OBJECTIVE To identify potential predictors for treatment success in medical management with misoprostol for early pregnancy failure. METHODS We conducted a planned secondary analysis of data from a multicenter trial that compared medical and surgical management of early pregnancy failure. Medical management consisted of misoprostol 800 μg vaginally on study day 1, with a repeat dose if indicated on day 3. Women returned on days 3 and 15, and a telephone interview was conducted on day 30. Failure was defined as suction aspiration for any reason within 30 days. Demographic, historical, and outcome variables were included in univariable analyses of success. Multivariable analyses were conducted using clinical site, gestational age, and variables for which the univariable analysis resulted in a P < .1 to determine predictors of overall treatment success and first-dose success. RESULTS Of the 491 women who received misoprostol, 485 met the criteria for this secondary analysis. Lower abdominal pain or vaginal bleeding within the last 24 hours, Rh-negative blood type, and nulliparity were predictive of overall success. However, only vaginal bleeding within the last 24 hours and parity of 0 or 1 were predictive of first-dose success. Overall success exceeds 92% in women who have localized abdominal pain within the last 24 hours, Rh-negative blood type, or the combination of vaginal bleeding in the past 24 hours and nulliparity. CONCLUSION Misoprostol treatment for early pregnancy failure is highly successful in select women, primarily those with active bleeding and nulliparity. Clinicians and patients should be aware of these differences when considering misoprostol treatment. PMID:16582130

  10. Factors affecting the performance of stormwater treatment wetlands.

    PubMed

    Carleton, J N; Grizzard, T J; Godrej, A N; Post, H E

    2001-04-01

    Data from 35 studies on 49 wetland systems used to treat stormwater runoff or runoff-impacted surface waters were examined and compared in order to identify any obvious trends that may aid future stormwater treatment wetland design efforts. Despite the intermittent nature of hydrologic and pollutant inputs from stormwater runoff, our analysis demonstrates that steady-state first-order plug-flow models commonly used to analyze wastewater treatment wetlands can be adapted for use with stormwater wetlands. Long-term pollutant removals are analyzed as functions of long-term mean hydraulic loading rate and nominal detention time. First-order removal rate constants for total phosphorus, ammonia, and nitrate generated in this fashion are demonstrated to be similar to values reported in the literature for wastewater treatment wetlands. Constituent removals are also demonstrated via regression analyses to be functions of the ratio of wetland area to watershed area. Resulting equations between these variables can be used as preliminary design tools in the absence of more site-specific details, with the understanding that they should be employed cautiously. PMID:11317903

  11. Breast cancer: major risk factors and recent developments in treatment.

    PubMed

    Majeed, Wafa; Aslam, Bilal; Javed, Ijaz; Khaliq, Tanweer; Muhammad, Faqir; Ali, Asghar; Raza, Ahmad

    2014-01-01

    Breast cancer is the most common in women worldwide, with some 5-10% of all cases due to inherited mutations of BRCA1 and BRCA2 genes. Obesity, hormone therapy and use of alcohol are possible causes and over-expression of leptin in adipose tissue may also play a role. Normally surgery, radiation therapy and chemotherapy allow a good prognosis where screening measures are in place. New hope in treatment measures include adjuvant therapy, neoadjuvant therapy, and introduction of mono-clonal antibodies and enzyme inhibitors. PMID:24870721

  12. Predictors of treatment outcome among Asian pathological gamblers (PGs): clinical, behavioural, demographic, and treatment process factors.

    PubMed

    Guo, Song; Manning, Victoria; Thane, Kyaw Kyaw Wai; Ng, Andrew; Abdin, Edimansyah; Wong, Kim Eng

    2014-03-01

    Research on predictors of treatment outcome among pathological gamblers (PGs) is inconclusive and dominated by studies from Western countries. Using a prospective longitudinal design, the current study examined demographic, clinical, behavioural and treatment programme predictors of gambling frequency at 3, 6 and 12-months, among PGs treated at an addiction clinic in Singapore. Measures included the Hospital anxiety and depression scale, gambling symptom assessment scale (GSAS), personal well-being index (PWI), treatment perception questionnaire and gambling readiness to change scale. Treatment response in relation to changes in symptom severity, personal wellbeing and abstinence were also assessed. Abstinence rates were 38.6, 46.0 and 44.4 % at 3, 6 and 12-months respectively. Significant reductions in gambling frequency, GSAS, and improvement in PWI were reported between baseline and subsequent outcome assessments, with the greatest change occurring in the initial three months. No demographic, clinical, behavioural or treatment programme variable consistently predicted outcome at all three assessments, though treatment satisfaction was the most frequent significant predictor. However, being unemployed, having larger than average debts, poor treatment satisfaction and attending fewer sessions at the later stages of treatment were associated with significantly poorer outcomes, up to 1-year after initiating treatment. These findings show promise for the effectiveness of a CBT-based treatment approach for the treatment of predominantly Chinese PGs. Clinical implications and suggestions for future research are discussed. Taken together, the findings suggest early treatment satisfaction is paramount in improving short-term outcomes, with baseline gambling behaviour and treatment intensity playing a more significant role in the longer term. PMID:22945784

  13. Clinical preference for factors in treatment of geriatric depression

    PubMed Central

    Riepe, Matthias W

    2015-01-01

    Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists) were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69%) returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials. PMID:25565848

  14. Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments

    PubMed Central

    Landi, Francesco; Calvani, Riccardo; Tosato, Matteo; Martone, Anna Maria; Ortolani, Elena; Savera, Giulia; Sisto, Alex; Marzetti, Emanuele

    2016-01-01

    Older people frequently fail to ingest adequate amount of food to meet their essential energy and nutrient requirements. Anorexia of aging, defined by decrease in appetite and/or food intake in old age, is a major contributing factor to under-nutrition and adverse health outcomes in the geriatric population. This disorder is indeed highly prevalent and is recognized as an independent predictor of morbidity and mortality in different clinical settings. Even though anorexia is not an unavoidable consequence of aging, advancing age often promotes its development through various mechanisms. Age-related changes in life-style, disease conditions, as well as social and environmental factors have the potential to directly affect dietary behaviors and nutritional status. In spite of their importance, problems related to food intake and, more generally, nutritional status are seldom attended to in clinical practice. While this may be the result of an “ageist” approach, it should be acknowledged that simple interventions, such as oral nutritional supplementation or modified diets, could meaningfully improve the health status and quality of life of older persons. PMID:26828516

  15. Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments.

    PubMed

    Landi, Francesco; Calvani, Riccardo; Tosato, Matteo; Martone, Anna Maria; Ortolani, Elena; Savera, Giulia; Sisto, Alex; Marzetti, Emanuele

    2016-02-01

    Older people frequently fail to ingest adequate amount of food to meet their essential energy and nutrient requirements. Anorexia of aging, defined by decrease in appetite and/or food intake in old age, is a major contributing factor to under-nutrition and adverse health outcomes in the geriatric population. This disorder is indeed highly prevalent and is recognized as an independent predictor of morbidity and mortality in different clinical settings. Even though anorexia is not an unavoidable consequence of aging, advancing age often promotes its development through various mechanisms. Age-related changes in life-style, disease conditions, as well as social and environmental factors have the potential to directly affect dietary behaviors and nutritional status. In spite of their importance, problems related to food intake and, more generally, nutritional status are seldom attended to in clinical practice. While this may be the result of an "ageist" approach, it should be acknowledged that simple interventions, such as oral nutritional supplementation or modified diets, could meaningfully improve the health status and quality of life of older persons. PMID:26828516

  16. Transient ischemic attack: Part II. Risk factor modification and treatment.

    PubMed

    Simmons, B Brent; Gadegbeku, Annette B; Cirignano, Barbara

    2012-09-15

    Interventions following a transient ischemic attack are aimed at preventing a future episode or stroke. Hypertension, current smoking, obesity, physical inactivity, diabetes mellitus, and dyslipidemia are all well-known risk factors, and controlling these factors can have dramatic effects on transient ischemic attack and stroke risk. For patients presenting within 48 hours of resolution of transient ischemic attack symptoms, advantages of hospital admission include rapid diagnostic evaluation and early intervention to reduce the risk of stroke. For long-term prevention of future stroke, the American Heart Association/American Stroke Association recommends antiplatelet agents, statins, and carotid artery intervention for advanced stenosis. Aspirin, extended-release dipyridamole/aspirin, and clopidogrel are acceptable first-line antiplatelet agents. Statins have also been shown to reduce the risk of stroke following transient ischemic attack, with maximal benefit occurring with at least a 50 percent reduction in low-density lipoprotein cholesterol level or a target of less than 70 mg per dL (1.81 mmol per L). For those with transient ischemic attack and carotid artery stenosis, carotid endarterectomy is recommended if stenosis is 70 to 99 percent, and perioperative morbidity and mortality are estimated to be less than 6 percent. PMID:23062044

  17. Conceptual factors in the treatment of paraphilias: a preliminary report.

    PubMed

    Schwartz, M F; Masters, W H

    1983-01-01

    The purpose of this paper is to discuss conceptual components of treating paraphilia. Detailed description of the treatment interventions will be published subsequently. The format of the psychotherapy has components similar to the programs for sexual dysfunction and homosexual dissatisfaction therapy. Intensive short-term directive conjoint therapy remains essential. The therapeutic model focuses on the paraphilia as an interpersonal relationship disorder which is manifested as an unproductive and sometimes addictive means of coping with stress, particularly engendered by discomfort with intimacy in adult erotic relationships. The basic model of psychotherapy includes specific intervention directed at potential social skill deficits, changing erotic imagery, attitude and cognitive restructuring, self-esteem difficulties, dating anxiety, sexual dysfunction, intimacy issues and addictive behavior, all of which encourage mastery, self-assertion, self-responsibility and communication skills within the context of a relationship. PMID:6663637

  18. Review article: Risk factors for poor outcome following surgical treatment for rotator cuff tear.

    PubMed

    Sahni, V; Narang, A M

    2016-08-01

    The Medline database was searched using key words: 'rotator cuff', 'tear', and 'treatment'. 12 studies that involved (1) surgical treatment for rotator cuff tear, (2) measurement of pre- and post-operative pain score, functional score, and/or patient satisfaction, (3) patients that failed to improve functionally or had poor satisfaction, (4) preoperative examination of risk factors that could lead to poor outcome, and (5) a minimum follow-up of 6 months were reviewed to identify risk factors associated with poor outcome following surgical treatment for rotator cuff tear. The most common risk factor was tear size, followed by open compensation claim, age, and time from injury to surgery. PMID:27574276

  19. High-Risk Offenders Participating in Court-Supervised Substance Abuse Treatment: Characteristics, Treatment Received, and Factors Associated with Recidivism

    PubMed Central

    Huang, David; Hser, Yih-Ing

    2011-01-01

    High-risk offenders treated by California’s Proposition 36 court-supervised drug treatment initiative account for a disproportionate number of re-arrests (Hawken 2008) undermining the many successes of the program, yet little is known about their characteristics, treatment experiences, or factors that influence re-arrest. To better understand this group, self-reported and administrative data were analyzed on 78 high-risk (five or more convictions in the previous 5 years) and 1,009 low-risk offenders enrolled during 2004. At intake, high-risk offenders were younger, more were male, and more had prior contact with psychiatric and criminal justice systems. Treatment received and the proportion recidivated during the 30-months after treatment assessment were similar across groups, but high-risk offenders had a greater number of re-arrests. The number of re-arrests was increased by high-risk classification, but decreased by receipt of more treatment services and longer treatment length. Moreover, the number of re-arrests was highest among high-risk offenders with shorter treatment lengths, whereas it was similar to that among low-risk offenders if treatment length was longer. To reduce recidivism among high-risk offenders in court-supervised drug treatment, consideration of psychiatric problems and criminal history is needed, as is receipt of sufficient treatment. PMID:21479770

  20. Neonatal fibroblast growth factor treatment enhances cocaine sensitization.

    PubMed

    Clinton, Sarah M; Turner, Cortney A; Flagel, Shelly B; Simpson, Danielle N; Watson, Stanley J; Akil, Huda

    2012-11-01

    Growth factors are critical in neurodevelopment and neuroplasticity, and recent studies point to their involvement in addiction. We previously reported increased levels of basic fibroblast growth factor (FGF2) in high novelty/drug-seeking rats (bred high responders, bHR) compared to low novelty/drug-seeking rats(bred low responders, bLRs). The present study asked whether an early life manipulation of the FGF system(a single FGF2 injection on postnatal day 2) can impact cocaine sensitization and associated neurobiological markers in adult bHR/bLR animals. Neonatal FGF2- and vehicle-treated bHR/bLR rats were sensitized to cocaine(7 daily injections, 15 mg/kg/day, i.p.) in adulthood. Neonatal FGF2 markedly increased bLRs' typically low psychomotor sensitization to cocaine (day 7 locomotor response to cocaine), but had little effect on bHRs' cocaine sensitization. Gene expression studies examined dopaminergic molecules as well as FGF2 and the FGFR1 receptor in cocaine naïve animals, to investigate possible neurobiological alterations induced by neonatal FGF2 exposure that may influence behavioral response to cocaine. bLRs showed decreased tyrosine hydroxylase in the ventral tegmental area (VTA), decreased D1 and increased D2 receptor expression in the nucleus accumbens core, as well as decreased FGF2 in the VTA, substantia nigra, accumbens core, and caudate putamen compared to bHRs. Neonatal FGF2 selectively increased D1 receptor and FGF2 mRNA in the accumbens core of bLRs, which may contribute to their heightened cocaine sensitization. Our results suggest increased FGF2 in the mesodopaminergic circuit (as in baseline bHRs and neonatal FGF2-exposed bLRs vs. baseline bLRs) enhances an individual's susceptibility to cocaine sensitization and may increase vulnerability to drug seeking and addiction. PMID:22819969

  1. Neonatal Fibroblast Growth Factor Treatment Enhances Cocaine Sensitization

    PubMed Central

    Clinton, Sarah M.; Turner, Cortney A.; Flagel, Shelly B.; Simpson, Danielle N.; Watson, Stanley J.; Akil, Huda

    2012-01-01

    Growth factors are critical in neurodevelopment and neuroplasticity, and recent studies point to their involvement in addiction. We previously reported increased levels of basic fibroblast growth factor (FGF2) in high novelty/drug-seeking rats (bred High Responders, bHR) compared to low novelty/drug-seeking rats (bred Low Responders, bLRs). The present study asked whether an early life manipulation of the FGF system (a single FGF2 injection on postnatal day 2) can impact cocaine sensitization and associated neurobiological markers in adult bHR/bLR animals. Neonatal FGF2- and vehicle-treated bHR/bLR rats were sensitized to cocaine (7 daily injections, 15 mg/kg/day, i.p.) in adulthood. Neonatal FGF2 markedly increased bLRs’ typically low psychomotor sensitization to cocaine (day 7 locomotor response to cocaine), but had little effect on bHRs’ cocaine sensitization. Gene expression studies examined dopaminergic molecules as well as FGF2 and the FGFR1 receptor in cocaine naïve animals, to investigate possible neurobiological alterations induced by neonatal FGF2 exposure that may influence behavioral response to cocaine. bLRs showed decreased tyrosine hydroxylase in the ventral tegmental area (VTA), decreased D1 and increased D2 receptor expression in the nucleus accumbens core, as well as decreased FGF2 in the VTA, substantia nigra, accumbens core, and caudate putamen compared to bHRs. Neonatal FGF2 selectively increased D1 receptor and FGF2 mRNA in the accumbens core of bLRs, which may contribute to their heightened cocaine sensitization. Our results suggest increased FGF2 in the mesodopaminergic circuit (as in baseline bHRs and neonatal FGF2-exposed bLRs vs. baseline bLRs) enhances an individual’s susceptibility to cocaine sensitization and may increase vulnerability to drug seeking and addiction. PMID:22819969

  2. [Tubo-peritoneal factor of infertility: diagnosis and treatment].

    PubMed

    Muzii, L; Sereni, M I; Battista, C; Zullo, M A; Tambone, V; Angioli, R

    2010-01-01

    Infertility, defined as the inability to conceive despite regular unprotected sexual intercourse over 12 years, affects approximately 10% of the fertile population. The commonest cause of tubal damage is pelvic inflammatory disease (PID), which in the developed world is caused mainly by Chlamydia trachomatis infection. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Other causes of tubal damage include postsurgical adhesions or endometriosis. Tubal patency can be diagnosed by hysterosalpingography (HSG) or laparoscopy with chromopertubation. Surgery represents the best therapeutic approach for tubal pathology, with a term pregnancy rate of 70% after surgery in selected patients, while the latest results in Italy of assisted reproductive technology (ART) report a live birth rate per cycle of 13.8%. In conclusion, tubal reconstructive surgery remains an important option for many couples and surgery should be the fi rst line approach for a correct diagnosis and treatment of tubal infertility. PMID:20393685

  3. Sharks: a potential source of antiangiogenic factors and tumor treatments.

    PubMed

    Cho, Jung; Kim, Young

    2002-12-01

    Since angiogenesis is a key feature of tumor growth, inhibiting this process is one way to treat cancer. Cartilage is a natural source of material with strong antiangiogenic activity. This report reviews knowledge of the anticancer properties of shark cartilage and clinical information on drugs such as neovastat and squalamine. Because their entire endoskeleton is composed of cartilage, sharks are thought to be an ideal source of angiogenic and tumor growth inhibitors. Shark cartilage extract has shown antiangiogenic and antitumor activities in animals and humans. The oral administration of cartilage extract was efficacious in reducing angiogenesis. Purified antiangiogenic factors from shark cartilage, such as U-995 and neovastat (AE-941), also showed antiangiogenic and antitumor activity. AE-941 is under phase III clinical investigation. Squalamine, a low molecular weight aminosterol, showed strong antitumor activity when combined with chemotherapeutic materials. The angiogenic tissue inhibitor of metalloprotease 3 (TIMP-3) and tumor suppressor protein (snm23) genes from shark cartilage were cloned and characterized. PMID:14961226

  4. Risk Factors for Death during Pulmonary Tuberculosis Treatment in Korea: A Multicenter Retrospective Cohort Study

    PubMed Central

    2014-01-01

    The data regarding risk factors for death during tuberculosis (TB) treatment are inconsistent, and few studies examined this issue in Korea. The purpose of this study was to evaluate baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea. A multicenter retrospective cohort study of 2,481 patients who received TB treatment at eight hospitals from January 2009 to December 2010 was performed. Successful treatment included cure (1,129, 45.5%) and treatment completion (1,204, 48.5%) in 2,333 patients (94.0%). Unsuccessful treatment included death (85, 3.4%) and treatment failure (63, 2.5%) occurred in 148 patients (6.0%). In multivariate analysis, male sex, anemia, dyspnea, chronic heart disease, malignancy, and intensive care unit (ICU) admission were significant risk factors for death during TB treatment. Therefore, male sex, anemia, dyspnea, chronic heart disease, malignancy, and ICU admission could be baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea. Graphical Abstract PMID:25246740

  5. Risk Factors, Treatment and Research | NIH MedlinePlus the Magazine

    MedlinePlus

    ... Feature: Fighting Gum Disease Risk Factors, Treatment and Research Past Issues / Fall 2010 Table of Contents Risk ... out whether it offers this service. Latest NIH Research Researchers supported by the National Institute of Dental ...

  6. Burnout among corrections-based drug treatment staff: impact of individual and organizational factors.

    PubMed

    Garner, Bryan R; Knight, Kevin; Simpson, D Dwayne

    2007-10-01

    As a result of limited budgets, many treatment programs are forced to operate for extended periods at or beyond their capacity. The resulting pressure and stress on treatment staff can be taxing and lead to serious problems, including job burnout. Although the concept of burnout within other social service professions has been broadly researched, less attention has been given to burnout among drug abuse treatment staff, especially among corrections-based drug treatment staff. The goal of this article is to extend this area of research by exploring the impact of individual factors and organizational factors on burnout. Findings revealed that although a number of factors were related to staff burnout, younger counselor age, lower adaptability, poorer clarity of agency mission, and higher stress were most significant. Ways in which treatment programs might address these issues affecting staff burnout are discussed. PMID:17615435

  7. Mecasermin rinfabate: insulin-like growth factor-I/insulin-like growth factor binding protein-3, mecaserimin rinfibate, rhIGF-I/rhIGFBP-3.

    PubMed

    2005-01-01

    Insmed is developing mecasermin rinfabate, a recombinant complex of insulin-like growth factor-I (rhIGF-I) and binding protein-3 (rhIGFBP-3) [insulin-like growth factor-I/insulin-like growth factor binding protein-3, rhIGF-I/rhIGFBP-3, SomatoKine], for a number of metabolic and endocrine indications. In the human body, IGF-I circulates in the blood bound to a binding protein-3 (IGFBP-3), which regulates the delivery of IGF-I to target tissues, and particular proteases clip them apart in response to stresses and release IGF-I as needed. IGF-I, a naturally occurring hormone, is necessary for normal growth and metabolism. For the treatment of IGF-I deficiency, it is desirable to administer IGF-I bound to IGFBP-3 to maintain the normal equilibrium of these proteins in the blood. Mecasermin rinfabate (rhIGF-I/rhIGFBP-3) mimics the effects of the natural protein complex in the bloodstream and would augment the natural supply of these linked compounds. The most advanced indication in development of mecasermin rinfabate is the treatment of severe growth disorders due to growth hormone insensitivity syndrome (GHIS), also called Laron syndrome. GHIS is a genetic condition in which patients do not produce adequate quantities of IGF because of a failure to respond to the growth hormone signal. This results in a slower growth rate and short stature. Mecasermin rinfabate also has potential as replacement therapy for IGF-I, which may become depleted in indications such as major surgery, organ damage/failure, traumatic injury, cachexia and severe burn trauma. It also has potential for the treatment of osteoporosis. Mecasermin rinfabate was developed by Celtrix using its proprietary recombinant protein production technology. Subsequently, Celtrix was acquired by Insmed Pharmaceuticals on 1 June 2000. Insmed and Avecia of the UK have signed an agreement for manufacturing mecasermin rinfabate and its components, rhIGF-1 and rhIGFBP-3. CGMP clinical production of mecasermin rinfabate

  8. Somatomedin-1 binding protein-3: insulin-like growth factor-1 binding protein-3, insulin-like growth factor-1 carrier protein.

    PubMed

    2003-01-01

    Somatomedin-1 binding protein-3 [insulin-like growth factor-1 binding protein-3, SomatoKine] is a recombinant complex of insulin-like growth factor-1 (rhIGF-1) and binding protein-3 (IGFBP-3), which is the major circulating somatomedin (insulin-like growth factor) binding protein; binding protein-3 regulates the delivery of somatomedin-1 to target tissues. Somatomedin-1 binding protein-3 has potential as replacement therapy for somatomedin-1 which may become depleted in indications such as major surgery, organ damage/failure and traumatic injury, resulting in catabolism. It also has potential for the treatment of osteoporosis; diseases associated with protein wasting including chronic renal failure, cachexia and severe trauma; and to attenuate cardiac dysfunction in a variety of disease states, including after severe burn trauma. Combined therapy with somatomedin-1 and somatomedin-1 binding protein-3 would prolong the duration of action of somatomedin-1 and would reduce or eliminate some of the undesirable effects associated with somatomedin-1 monotherapy. Somatomedin-1 is usually linked to binding protein-3 in the normal state of the body, and particular proteases clip them apart in response to stresses and release somatomedin-1 as needed. Therefore, somatomedin-1 binding protein-3 is a self-dosing system and SomatoKine would augment the natural supply of these linked compounds. Somatomedin-1 binding protein-3 was developed by Celtrix using its proprietary recombinant protein production technology. Subsequently, Celtrix was acquired by Insmed Pharmaceuticals on June 1 2000. Insmed and Avecia, UK, have signed an agreement for the manufacturing of SomatoKine and its components, IGF-1 and binding protein-3. CGMP clinical production of SomatoKine and its components will be done in Avecia's Advanced Biologics Centre, Billingham, UK, which manufactures recombinant-based medicines and vaccines with a capacity of up to 1000 litres. In 2003, manufacturing of SomatoKine is

  9. Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure

    PubMed Central

    Persson, Saga; Rouvelas, Ioannis; Kumagai, Koshi; Song, Huan; Lindblad, Mats; Lundell, Lars; Nilsson, Magnus; Tsai, Jon A.

    2016-01-01

    Background and study aim: The endoscopic placement of self-expandable metallic esophageal stents (SEMS) has become the preferred primary treatment for esophageal anastomotic leakage in many institutions. The aim of this study was to investigate possible risk factors for failure of SEMS-based therapy in patients with esophageal anastomotic leakage. Patients and methods: Beginning in 2003, all patients with an esophageal leak were initially approached and assessed for temporary closure with a SEMS. Until 2014, all patients at the Karolinska University Hospital with a leak from an esophagogastric or esophagojejunal anastomosis were identified. Data regarding the characteristics of the patients and leaks and the treatment outcomes were compiled. Failure of the SEMS treatment strategy was defined as death due to the leak or a major change in management strategy. The risk factors for treatment failure were analyzed with simple and multivariable logistic regression statistics. Results: A total of 447 patients with an esophagogastric or esophagojejunal anastomosis were identified. Of these patients, 80 (18 %) had an anastomotic leak, of whom 46 (58 %) received a stent as first-line treatment. In 29 of these 46 patients, the leak healed without any major change in treatment strategy. Continuous leakage after the application of a stent, decreased physical performance preoperatively, and concomitant esophagotracheal fistula were identified as independent risk factors for failure with multivariable logistic regression analysis. Conclusion: Stent treatment for esophageal anastomotic leakage is successful in the majority of cases. Continuous leakage after initial stent insertion, decreased physical performance preoperatively, and the development of an esophagotracheal fistula decrease the probability of successful treatment. PMID:27092321

  10. Therapeutic targets of multiple angiogenic factors for the treatment of cancer and metastasis.

    PubMed

    Cao, Yihai; Liu, Qi

    2007-01-01

    Like any growing healthy tissues, tumors build up their blood vessels by three mechanisms: angiogenesis, vasculogenesis, and intersucception. Vascular endothelial growth factor-A (VEGF-A) is one of the key factors responsible for stimulation and maintenance of the disorganized, leaky, and torturous tumor vasculature. In addition to VEGF-A, tumors produce multiple other factors to stimulate blood vessel growth. These include members in the platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), VEGF-C, insulin-like growth factor (IGF), angiopoietin (Ang), and hepatocyte growth factor (HGF) families. Recent studies show that these angiogenic factors can also promote lymphangiogenesis and potentially lymphatic metastasis. Understanding the roles of individual and combined angiogenic factors in promoting tumor angiogenesis is crucial for defining therapeutic targets and antiangiogenic drug development for the treatment of cancer. PMID:17419947

  11. Physician, Patient and Contextual Factors Affecting Treatment Decisions in Older Adults with Cancer: A Literature Review

    PubMed Central

    Tariman, J. D.; Berry, D. L.; Cochrane, B.; Doorenbos, A.; Schepp, K.

    2010-01-01

    Purpose/Objectives To review physician, patient, and contextual factors that affect treatment decision-making in older adults diagnosed with cancer and relate these factors to theoretical models of decision-making. Data Sources PubMed (1966-April 2010), PsycINFO (1967-April 2010) and CINAHL (1982-April 2010) databases were searched to access relevant medical, psychological and nursing literature. Data Synthesis Physician factors in treatment decisions include physician personal beliefs and values, expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors include personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors include availability of caregiver, lack of insurance, poor financial status, and geographical barrier. The interplay of physician, patient, and contextual factors are not well understood. Existing models of decision-making are not sufficient to explicate TDM process in older adults diagnosed with cancer. Conclusions Clinical studies in older adult patient population using a longitudinal and prospective design are needed to examine real-time interplay of patient, physician, and contextual factors and to better understand how these divergent factors influenced actual treatment decisions. Implications for Nursing Oncology nurses can advocate for a patient’s autonomy during TDM by coaching them to seek evidence-based discussion of various treatment options, benefits and risks assessments, and truthful discussion of the probability of success for each treatment option from their physicians. Oncology nurses must promote an informed treatment decisions that are consistent with a patient’s personal preference and values within the limits of the patient’s personal contexts. PMID:22201670

  12. Factors Associated with the Severity of Gambling Problems in a Community Gambling Treatment Agency

    ERIC Educational Resources Information Center

    Namrata, Raylu; Oei, Tian P. S.

    2009-01-01

    Factors (demographics, gambling behaviors and comorbid problems) that may be related to the severity of gambling problems were investigated among 440 problem gamblers seeking treatment in an Australian outpatient treatment agency. The participants were divided into sub-threshold pathological gamblers (SPGs; N = 104) and pathological gamblers (PGs;…

  13. Intergenerational Differences and Similarities in Life-Sustaining Treatment Attitudes and Decision Factors.

    ERIC Educational Resources Information Center

    Mills, Terry L.; Wilmoth, Janet M.

    2002-01-01

    A cross-sectional sample of three-generation families was used to evaluate life-sustaining medical treatment attitudes and decision factors. Results show that the older generation perceived mental capacity, family burden, and pain as most important considerations. Among the middle generation the type of life-sustaining treatment was important. The…

  14. Factors that Affect Treatment Expectations of Outpatients with Substance Use Problems

    ERIC Educational Resources Information Center

    Raylu, Namrata; Kaur, Inderjit

    2012-01-01

    The study assessed treatment expectations (TE) of outpatients with substance use problems as well as factors that affect their TE. Participants were 200 outpatients presenting at three community based substance abuse treatment services. Results of general linear modelling analyses showed that outpatients with substance use problems have higher…

  15. OPAT for cellulitis: its benefits and the factors that predispose to longer treatment.

    PubMed

    Zhang, J; Moore, E; Bousfield, R

    2016-06-01

    This retrospective study investigated the demographics and treatment outcomes of patients with cellulitis receiving outpatient parenteral antibiotic therapy (OPAT) between 2010 and 2014 in Cambridge University Hospitals. The rate of treatment failure (as indicated by the readmission to hospital) was low, at 5.5%. Risk factors associated with a longer duration of OPAT treatment included: immunosuppression, peripheral vascular disease, obesity, lymphoedema, previous cellulitis and diabetes. PMID:27084095

  16. A Comparison of Therapeutic Factors in Two Group Treatment Modalities: Verbal and Art Therapy.

    ERIC Educational Resources Information Center

    Shechtman, Zipora; Perl-Dekel, Ofra

    2000-01-01

    Compares therapeutic factors in verbal and art group psychotherapy in a psychiatric day-treatment clinic in Israel. Results only partly support the differences between modalities, but do reveal significant differences between participants with only a few interactions between participants and modalities. All therapeutic factors appear in both…

  17. The Impact of Risk Factors on the Treatment of Adolescent Sex Offenders

    ERIC Educational Resources Information Center

    Kelley, Sharon M.; Lewis, Kathy; Sigal, Janet

    2004-01-01

    The authors investigated the impact that 5 selected risk factors have on the treatment outcome of adolescent male sex offenders. The results indicated that the greatest risk factor among sex offenders was having a mother who had a substance abuse problem. Study participants were 35 adolescent boys in a New Jersey residential facility for…

  18. Youth Depression in the Family Context: Familial Risk Factors and Models of Treatment

    ERIC Educational Resources Information Center

    Sander, Janay B.; McCarty, Carolyn A.

    2005-01-01

    Research on parent risk factors, family environment, and familial involvement in the treatment of depression in children and adolescents is integrated, providing an update to prior reviews on the topic. First, the psychosocial parent and family factors associated with youth depression are examined. The literature indicates that a broad array of…

  19. The Common Factors, Empirically Validated Treatments, and Recovery Models of Therapeutic Change

    ERIC Educational Resources Information Center

    Reisner, Andrew D.

    2005-01-01

    I review the Common Factors Model, the Empirically Validated Therapy Model, and the Recovery Model of therapeutic change and effectiveness. In general, psychotherapy appears to be effective and common factors account for more of the variance than do specific techniques. However, in some areas, particularly in the treatment of anxiety disorders,…

  20. Treatment Options for Liquid Radioactive Waste. Factors Important for Selecting of Treatment Methods

    SciTech Connect

    Dziewinski, J.J.

    1998-09-28

    The cleanup of liquid streams contaminated with radionuclides is obtained by the selection or a combination of a number of physical and chemical separations, processes or unit operations. Among those are: Chemical treatment; Evaporation; Ion exchange and sorption; Physical separation; Electrodialysis; Osmosis; Electrocoagulation/electroflotation; Biotechnological processes; and Solvent extraction.

  1. An ontology for factors affecting tuberculosis treatment adherence behavior in sub-Saharan Africa

    PubMed Central

    Ogundele, Olukunle Ayodeji; Moodley, Deshendran; Pillay, Anban W; Seebregts, Christopher J

    2016-01-01

    Purpose Adherence behavior is a complex phenomenon influenced by diverse personal, cultural, and socioeconomic factors that may vary between communities in different regions. Understanding the factors that influence adherence behavior is essential in predicting which individuals and communities are at risk of nonadherence. This is necessary for supporting resource allocation and intervention planning in disease control programs. Currently, there is no known concrete and unambiguous computational representation of factors that influence tuberculosis (TB) treatment adherence behavior that is useful for prediction. This study developed a computer-based conceptual model for capturing and structuring knowledge about the factors that influence TB treatment adherence behavior in sub-Saharan Africa (SSA). Methods An extensive review of existing categorization systems in the literature was used to develop a conceptual model that captured scientific knowledge about TB adherence behavior in SSA. The model was formalized as an ontology using the web ontology language. The ontology was then evaluated for its comprehensiveness and applicability in building predictive models. Conclusion The outcome of the study is a novel ontology-based approach for curating and structuring scientific knowledge of adherence behavior in patients with TB in SSA. The ontology takes an evidence-based approach by explicitly linking factors to published clinical studies. Factors are structured around five dimensions: factor type, type of effect, regional variation, cross-dependencies between factors, and treatment phase. The ontology is flexible and extendable and provides new insights into the nature of and interrelationship between factors that influence TB adherence. PMID:27175067

  2. [Neoadjuvant treatment in human epidermal growth factor receptor 2-positive breast cancer].

    PubMed

    Liu, Yinhua; Liu, Shiwei; Zhang, Hong; Xu, Ling; Li, Ting; Duan, Xuening

    2015-12-01

    Breast cancer is the most prevalent malignancy among females worldwide. Human epidermal growth factor receptor 2 (HER2)-positive breast cancer represents a subtype with aggressive behavior, poor response to treatment and unfavorable prognosis. Anti-HER2-based neoadjuvant treatment has improved clinical outcomes of patients with HER2-positive disease. Pathological complete response (pCR) after neoadjuvant treatment indicates a favorable prognosis. With the development of HER2-targeted therapy and neoadjuvant treatment, numerous studies focus on the predictive factors of pCR or therapeutic resistance of anti-HER2 therapy. Identification of novel predictive factors in HER2-positive breast cancer, such as tumor-infiltrating lymphocytes, will be helpful for clinical decision. PMID:26850663

  3. Factors associated with non-treatment or delayed treatment seeking in OCD sufferers: a review of the literature.

    PubMed

    García-Soriano, Gemma; Rufer, Michael; Delsignore, Aba; Weidt, Steffi

    2014-12-15

    Obsessive-compulsive disorder (OCD) is a disabling disorder that can be successfully treated. However, a high percentage of sufferers neither ask for nor receive treatment for their symptoms, or they delay seeking treatment. The factors underlying the treatment-seeking behaviour of OCD patients are still not clear. This review includes 12 studies published before April 2014 that analyse the possible variables related to the delayed help-seeking behaviour of OCD patients. Studies showed that individuals who asked for help were more impaired and reported poorer quality of life. Help-seeking behaviour was associated with greater insight, severity, specific obsessive-compulsive symptoms, such as aggressive and other unpleasant obsessions, and comorbidity. Common barriers to seeking treatment were shame about the symptoms or about asking for treatment, not knowing where to find help, or inconveniences associated with treatment. Inconsistencies among the reviewed studies highlight the need to further evaluate the variables that keep OCD patients from seeking help. The review highlights the need for educational campaigns designed to detect underdiagnosed OCD individuals and improve access to mental health services, which could shorten delays in seeking treatment and, therefore, reduce the personal and financial costs of OCD. Guidelines for educational programs and future lines of research are discussed. PMID:25108591

  4. The role of plasma-derived factor VIII/von Willebrand factor concentrates in the treatment of hemophilia A patients.

    PubMed

    Auerswald, Günter; Spranger, Torsten; Brackmann, Hans-Hermann

    2003-06-01

    Besides preventing bleeding episodes, common goals of the treatment of hemophilia include integrating of patients into a normal social life and optimizing their quality of life. Sufficient amounts of factor VIII (FVIII) concentrates, whether recombinant or plasma-derived, are continuously needed. Guidelines for quality assurance of treatment will be a cornerstone to maintain optimal clinical management of patients especially considering financial aspects. Advances in manufacturing technologies have made possible general availability of modern concentrates for the management of hemophilia A patients. Safety, cost and continuous supply of concentrates must be considered when deciding on a product for replacement therapy. As todays' products have reached an excellent margin of safety with regard to virus transmission, the development and treatment of inhibitors is currently the main concern for physicians and patients. The incidence of inhibitors is influenced by various patient-related factors such as mutation type or severity of the disease. Plasma-derived FVIII concentrates containing von Willebrand factor (VWF) may have clinical advantages over pure FVIII concentrates with regard to inhibitor development and inhibitor eradication. Clinical trials comparing FVIII/VWF concentrates with pure FVIII concentrates are lacking, thus a lower inhibitor incidence has not yet been proven. Data from Germany on immune tolerance induction with FVIII/VWF concentrates indicate higher success rates with these than with pure FVIII concentrates. In addition FVIII/VWF concentrates are the therapy of choice when immune tolerance therapy with pure FVIII products is not successful. PMID:12826531

  5. Factors associated with marketable milk production recovery after treatment of naturally occurring acute coliform mastitis.

    PubMed

    Shinozuka, Yasunori; Kaneko, Sohei; Kurose, Tomoyasu; Watanabe, Aiko; Kuruhara, Kana; Kawai, Kazuhiro

    2016-06-01

    Milk production loss after recovery from acute coliform mastitis causes major economic losses for dairy industries. Declines in milk production and composition are caused by multiple factors, including cow factors, microorganisms and treatments, but the influence of each factor has not been determined. To investigate risk factors for milk loss after treatment for acute coliform mastitis, multiple logistic regression analyses were conducted in 53 clinical cases. Systemic administration of fluoroquinolone was significantly associated with recovery of marketable milk production. The time to slaughter was significantly shorter in cows with complete loss of quarter milk production than in cows that produced marketable milk. In this study, we identified factors associated with increased risk of milk production loss. PMID:26860356

  6. Factors associated with marketable milk production recovery after treatment of naturally occurring acute coliform mastitis

    PubMed Central

    SHINOZUKA, Yasunori; KANEKO, Sohei; KUROSE, Tomoyasu; WATANABE, Aiko; KURUHARA, Kana; KAWAI, Kazuhiro

    2016-01-01

    Milk production loss after recovery from acute coliform mastitis causes major economic losses for dairy industries. Declines in milk production and composition are caused by multiple factors, including cow factors, microorganisms and treatments, but the influence of each factor has not been determined. To investigate risk factors for milk loss after treatment for acute coliform mastitis, multiple logistic regression analyses were conducted in 53 clinical cases. Systemic administration of fluoroquinolone was significantly associated with recovery of marketable milk production. The time to slaughter was significantly shorter in cows with complete loss of quarter milk production than in cows that produced marketable milk. In this study, we identified factors associated with increased risk of milk production loss. PMID:26860356

  7. [Limiting factors in the class III camouflage treatment: a potential protocol].

    PubMed

    Chaques Asensi, José

    2016-06-01

    The Class III skeletal malocclusion has been traditionally treated with a combined approach of orthodontics and orthognathic surgery or with a strategy of orthodontic camouflage. Some severe cases can be identified as ideal candidates for a surgical treatment whereas some others can be handled with orthodontics alone, with a reasonable expectation of an acceptable result. However, the problem remains for the borderline patient. In fact, limited information is available in the literature regarding the identification of the factors that can help in establishing the limits for one treatment modality or the other. Furthermore, the quantification of some of these factors, for practical purposes, is practically missing or very seldom suggested. Therefore, the decision making process remains a subjective reflection based on the "good clinical sense" of the orthodontist or just reduced to an "educated guess". In order to add some information, hopefully useful in deciding the most suitable treatment option for the individual patient, we propose a clinical protocol based on four different factors. Namely: the skeletal discrepancy, the occlusal discrepancy, the periodontal condition and facial aesthetics. For each one of these factors several parameters will be evaluated and, for some of them, an attempt to provide some reference numerical values will be made. Finally, clinical examples will be presented to illustrate the concepts discussed and the treatment alternatives, final treatment plan and treatment outcome will be analyzed for each one of them. PMID:27358006

  8. Factors predicting retention in treatment: 10-year experience of a methadone maintenance treatment (MMT) clinic in Israel.

    PubMed

    Peles, Einat; Schreiber, Shaul; Adelson, Miriam

    2006-05-20

    The aims were to identify predictors of treatment retention in an Israeli methadone maintenance treatment (MMT) clinic, and to compare the findings to other international settings. We prospectively studied 492 patients admitted since 1993 through 10 years to an Israeli MMT clinic associated with a university-affiliated tertiary care medical center. Analyses (Kaplan Meier and Cox regression) included methadone dose and urinalysis results (for methadone, cocaine, opiates, benzodiazepines, THC, amphetamines) of each patient in the first month and after 1 year in treatment (or during the last month if the stay was >3 months and <1 year) and patients' characteristics (modified ASI). The 1-year retention rate was 74.4%; 65.8% stopped opiate abuse after 1 year in treatment. On admission, 13.6% of patients had used cocaine: there was a net decrease of 61.6% after 1 year. Factors predicting prolonged retention in MMT treatment (Cox regression) were daily methadone dose of 100mg or greater, negative urine for opiates after 1 year, and being a parent on admission. We conclude that our good outcome results (high rate of retention after 1 year (74.4%), high proportion of opiate abuse cessation (65.8%), and net reduction in cocaine abuse, similar to normal standards in other MMT clinics elsewhere in the world, justify the expansion of the MMT clinic network in Israel in order to make treatment available to all those who need it. A protocol favoring higher methadone dosage as appropriate is recommended. PMID:16219428

  9. Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review

    PubMed Central

    Treuer, Tamás; Méndez, Luis; Montgomery, William; Wu, Shenghu

    2016-01-01

    The purpose of this paper was to systematically review the literature related to research about the factors affecting treatment adherence and discontinuation of atomoxetine in pediatric, adolescent, and adult patients with attention-deficit/hyperactivity disorder (ADHD). Medline was systematically searched using the following prespecified terms: “ADHD”, “Adherence”, “Compliance”, “Discontinuation”, and “Atomoxetine”. We identified 31 articles that met all inclusion and exclusion criteria. The findings from this review indicate that persistence and adherence to atomoxetine treatment were generally high. Factors found to influence adherence and nonadherence to atomoxetine treatment in ADHD in this review include age, sex, the definition of response used, length of treatment, initial dose of treatment, comorbid conditions, and reimbursement. Tolerability was cited as an important reason for treatment discontinuation. More research is needed to understand those factors that can help to identify patients at risk for poor adherence and interventions that could improve treatment adherence early in the stage of this illness to secure a better long-term prognosis. PMID:27217754

  10. Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review.

    PubMed

    Treuer, Tamás; Méndez, Luis; Montgomery, William; Wu, Shenghu

    2016-01-01

    The purpose of this paper was to systematically review the literature related to research about the factors affecting treatment adherence and discontinuation of atomoxetine in pediatric, adolescent, and adult patients with attention-deficit/hyperactivity disorder (ADHD). Medline was systematically searched using the following prespecified terms: "ADHD", "Adherence", "Compliance", "Discontinuation", and "Atomoxetine". We identified 31 articles that met all inclusion and exclusion criteria. The findings from this review indicate that persistence and adherence to atomoxetine treatment were generally high. Factors found to influence adherence and nonadherence to atomoxetine treatment in ADHD in this review include age, sex, the definition of response used, length of treatment, initial dose of treatment, comorbid conditions, and reimbursement. Tolerability was cited as an important reason for treatment discontinuation. More research is needed to understand those factors that can help to identify patients at risk for poor adherence and interventions that could improve treatment adherence early in the stage of this illness to secure a better long-term prognosis. PMID:27217754

  11. Epidermal Growth Factor and Epidermal Growth Factor Receptor: The Yin and Yang in the Treatment of Cutaneous Wounds and Cancer

    PubMed Central

    Bodnar, Richard J.

    2013-01-01

    Significance Epidermal growth factor (EGF) and EGF receptor (EGFR) play an essential role in wound healing through stimulating epidermal and dermal regeneration. The development of new therapies for enhancing wound healing has included the use of EGF. In addition, EGFR inhibitors (EGFRis) have become a therapeutic option for the treatment of cancer. Thus, therapies targeting EGF/EGFR are useful for the treatment of both cutaneous wounds and cancer. Recent Advances Identification of EGFR as a regulator of normal and pathological cell function has allowed for the development of EGFRis for the treatment of cancer and topical administration of EGF to enhance wound healing. Critical Issues The use of EGFRi has emerged as an option for metastatic cancers. These drugs induce dermatological toxicity, a papulopustular rash that is pruritic and painful; chronic use may negatively impact wound healing. Currently, there is no standard therapy to alleviate the side effects caused by EGFRi administration except to reduce or eliminate EGFRi usage. Therefore, side effects from these drugs should be taken into consideration on patients prone to develop chronic wounds and with cutaneous injuries. Future Directions There is a need for adjunctive treatment to eliminate dermatological toxicity from EGFRi use. The development of new downstream targets of EGFR may be a rational strategy to reduce potential cutaneous side effects and provide a better strategy for the treatment of cancer. Until then, the topical use of EGF could be used to ameliorate dermatological lesions caused by EGFRi. PMID:24527320

  12. Factors predicting choice of treatment for menorrhagia in gynaecology outpatient clinics.

    PubMed

    Vuorma, Sirkku; Rissanen, Pekka; Aalto, Anna Mari; Kujansuu, Erkki; Hurskainen, Ritva; Teperi, Juha

    2003-04-01

    The aim of this prospective study was to investigate factors predicting choice of treatment for excessive menstrual bleeding, with special emphasis on women's pre-treatment preference. A cohort of women with heavy menstruation and their treatment process in gynaecology outpatient clinics were followed-up for 1yr. A total of 383 35-54-yr-old women attending 14 Finnish hospitals participated. They completed a questionnaire before their first outpatient clinic visit, and postal follow-ups were conducted 3 and 12 months later. Information on treatment(s) during the follow-up was taken from medical records and questionnaires. The choice between hysterectomy and conservative treatments, and fulfillment of pre-treatment preference were the main outcome measures. During the 1-yr follow-up, 51% (n=196) of the women underwent hysterectomy and nine were still awaiting it, 12% (n=44) had a minor surgical procedure, 11% (n=41) had oral medication, 9% (n=33) used a hormonal intrauterine system, and nine women changed preventive method. Forty-two women (11%) reported having had no treatment. Data on previous treatments suggested that conservative treatment modalities were under-used. Most of the treatment decisions were made within the first 3-month period. Women's pre-treatment preference was the strongest predictor of chosen treatment. Unemployment, irregular periods and anxiety decreased the probability of a decision for hysterectomy, while pelvic pain and inconvenience due to bleeding increased it. The treatment plan accorded with pre-treatment preference in 72% of the women preferring hysterectomy and in 74% of those preferring a conservative option. PMID:12639582

  13. Treatment Outcome and Associated Factors among Tuberculosis Patients in Debre Tabor, Northwestern Ethiopia: A Retrospective Study.

    PubMed

    Melese, Addisu; Zeleke, Balew; Ewnete, Biniam

    2016-01-01

    Background. Assessing the outcomes of tuberculosis (TB) treatment is an important indicator for evaluation of the effectiveness of tuberculosis control programs. In Ethiopia, directly observed treatment short course (DOTS) was included in the national tuberculosis control program as a strategy but little is known about its effectiveness in the study area. Therefore, this study was aimed at assessing the treatment outcomes of TB patients and associated factors in Debre Tabor, northwest Ethiopia. Methods. A retrospective study was conducted among TB patients for the period from May 2008 to April 2013 at Debre Tabor Health Center, northwest Ethiopia. Data were entered and analyzed using SPSS version 20.0. Descriptive statistics were used to generate frequency tables and figures. Logistic regressions were used to identify factors associated with treatment outcomes at P value ≤ 0.05. Results. Out of 339 patients (197 males and 142 females) registered for antituberculosis treatment in Debre Tabor Health Center, only 303 patients were included in the treatment outcome analysis and 87.1% had successful treatment outcome while 12.9% had unsuccessful treatment outcome. In the multivariate logistic regression analysis, the odds of successful treatment outcome were higher among patients ≥45 years of age (AOR = 3.807, 95% CI: 1.155-12.544) and lower among females (AOR = 0.347, 95% CI: 0.132-0.917), rural residents (AOR = 0.342, 95% CI: 0.118-0.986), and negative smear result at the second month of treatment (AOR = 0.056, 95% CI: 0.005-0.577) as compared to their counterparts. Conclusion. The treatment outcome of all forms of tuberculosis patients in Debre Tabor health center was satisfactory as expected from effective implementation of DOTS. Although the observed successful treatment outcome was in agreement with the national target, follow-up of patients during the course of treatment to trace the treatment outcomes of transferred-out patients and assessment of other

  14. Treatment Outcome and Associated Factors among Tuberculosis Patients in Debre Tabor, Northwestern Ethiopia: A Retrospective Study

    PubMed Central

    Zeleke, Balew; Ewnete, Biniam

    2016-01-01

    Background. Assessing the outcomes of tuberculosis (TB) treatment is an important indicator for evaluation of the effectiveness of tuberculosis control programs. In Ethiopia, directly observed treatment short course (DOTS) was included in the national tuberculosis control program as a strategy but little is known about its effectiveness in the study area. Therefore, this study was aimed at assessing the treatment outcomes of TB patients and associated factors in Debre Tabor, northwest Ethiopia. Methods. A retrospective study was conducted among TB patients for the period from May 2008 to April 2013 at Debre Tabor Health Center, northwest Ethiopia. Data were entered and analyzed using SPSS version 20.0. Descriptive statistics were used to generate frequency tables and figures. Logistic regressions were used to identify factors associated with treatment outcomes at P value ≤ 0.05. Results. Out of 339 patients (197 males and 142 females) registered for antituberculosis treatment in Debre Tabor Health Center, only 303 patients were included in the treatment outcome analysis and 87.1% had successful treatment outcome while 12.9% had unsuccessful treatment outcome. In the multivariate logistic regression analysis, the odds of successful treatment outcome were higher among patients ≥45 years of age (AOR = 3.807, 95% CI: 1.155–12.544) and lower among females (AOR = 0.347, 95% CI: 0.132–0.917), rural residents (AOR = 0.342, 95% CI: 0.118–0.986), and negative smear result at the second month of treatment (AOR = 0.056, 95% CI: 0.005–0.577) as compared to their counterparts. Conclusion. The treatment outcome of all forms of tuberculosis patients in Debre Tabor health center was satisfactory as expected from effective implementation of DOTS. Although the observed successful treatment outcome was in agreement with the national target, follow-up of patients during the course of treatment to trace the treatment outcomes of transferred-out patients and assessment of

  15. Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy

    SciTech Connect

    Fagedet, Dorothee; Thony, Frederic; Timsit, Jean-Francois; Rodiere, Mathieu; Monnin-Bares, Valerie; Ferretti, Gilbert R.; Vesin, Aurelien; Moro-Sibilot, Denis

    2013-02-15

    To demonstrate the effectiveness of endovascular treatment (EVT) with self-expandable bare stents for malignant superior vena cava syndrome (SVCS) and to analyze predictive factors of EVT efficacy. Retrospective review of the 164 patients with malignant SVCS treated with EVT in our hospital from August 1992 to December 2007 and followed until February 2009. Endovascular treatment includes angioplasty before and after stent placement. We used self-expandable bare stents. We studied results of this treatment and looked for predictive factors of clinical efficacy, recurrence, and complications by statistical analysis. Endovascular treatment was clinically successful in 95% of cases, with an acceptable rate of early mortality (2.4%). Thrombosis of the superior vena cava was the only independent factor for EVT failure. The use of stents over 16 mm in diameter was a predictive factor for complications (P = 0.008). Twenty-one complications (12.8%) occurred during the follow-up period. Relapse occurred in 36 patients (21.9%), with effective restenting in 75% of cases. Recurrence of SVCS was significantly increased in cases of occlusion (P = 0.01), initial associated thrombosis (P = 0.006), or use of steel stents (P = 0.004). Long-term anticoagulant therapy did not influence the risk of recurrence or complications. In malignancy, EVT with self-expandable bare stents is an effective SVCS therapy. These results prompt us to propose treatment with stents earlier in the clinical course of patients with SVCS and to avoid dilatation greater than 16 mm.

  16. Factors Related to Incomplete Treatment of Breast Cancer in Kumasi, Ghana

    PubMed Central

    Obrist, Mark; Osei-Bonsu, Ernest; Ahwah, Baffour; Watanabe-Galloway, Shinobu; Merajver, Sofia D.; Schmid, Kendra; Soliman, Amr S.

    2014-01-01

    Purpose The burden of cancer in Africa is an enlarging public health challenge. Breast cancer in Ghana is the second most common cancer among Ghanaian women and the proportion of diagnosed patients who complete prescribed treatment is estimated to be very limited, thereby potentially adding to lower survival and poor quality of life after diagnosis. The objective of this study was to identify the patient and system factors related to incomplete treatment of breast cancer among patients. Methods This study was conducted at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. We interviewed 117 breast cancer patients and next of kin of breast cancer patients diagnosed from 2008 to 2010. Results Islamic religion, seeking treatment with traditional healers, and lack of awareness about national health insurance coverage of breast cancer treatment were predictors of incomplete treatment. Conclusions The results of this study support that Ghanaian women with diagnosed breast cancer have multiple addressable and modifiable patient factors that may deter them from completing the prescribed treatment. The results highlight the need for developing and testing specific interventions about the importance of completing treatment with a special focus on addressing religious, cultural, and system navigation barriers in developing countries. PMID:25282667

  17. Factors associated with probation officers' use of criminal justice coercion to mandate alcohol treatment.

    PubMed

    Polcin, Douglas L; Greenfield, Thomas K

    2003-08-01

    Alcohol problems are widespread among individuals in county criminal justice probation systems. However, it is unclear why only a small fraction of these problem drinkers receive treatment. In this study, self-administered questionnaires were mailed to 145 probation officers in nine California counties to identify factors that predicted probation officers' use of coercion to mandate alcohol treatment. The questionnaire measured characteristics of probation officers, characteristics of their caseloads, and perceptions about their departments. Principle components analysis combined some of the items into six factor-based scales. Multiple regression analyses identified two significant predictors of use of coercion into treatment: a belief that treatment was effective and a belief that one's peers in the department were using coercion frequently. Implications for increasing treatment entry of probationers with drinking problems include educating probation officers about the effectiveness of substance abuse treatment in general and about coerced treatment in particular. Probation departments are encouraged to develop management styles that facilitate shared normative beliefs about assessing and managing alcohol problems among probationers. PMID:14510045

  18. Assessing the risk factors for difficult-to-treat depression and treatment-resistant depression.

    PubMed

    Gaynes, Bradley

    2016-02-01

    Depression is the leading cause of disability among people across the globe, according to the World Health Organization. Among those who have been diagnosed, many fail to achieve remission after following recommended antidepressant medication and psychosocial therapies. In particular, difficult-to-treat and treatment-resistant depression may cause severe impairments for patients, including diminished cognitive functioning, increased medical bills, and decreased workplace performance, as well as an increased risk of developing comorbid illnesses. However, many tools are available to clinicians for identifying treatment-resistant depression, including rating scales such as the 9-question Patient Health Questionnaire (PHQ-9) and the Quick Inventory of Depressive Symptomatology (QIDS-SR16), as well as clinical evidence related to risk factors for difficult-to-treat or treatment-resistant depression. Accurately identifying treatment-resistant depression is the first step toward changing treatment regimens to help patients achieve remission. PMID:26829431

  19. Diffuse alveolar hemorrhage and recombinant factor VIIa treatment in pediatric patients

    PubMed Central

    2016-01-01

    Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or autoimmune disorders. The current treatment options, which include corticosteroids, transfusions, extracorporeal membrane oxygenation (ECMO), and immunosuppressants, have been limited and largely unsuccessful. Recombinant activated factor VII (rFVIIa) has been successfully administered, either systemically or bronchoscopically, to adults for the treatment of DAH, but there are few data on its use in pediatric patients. The current literature in the PubMed database was reviewed to evaluate the efficacy and risk of rFVIIa treatment for DAH in pediatric patients. This review discusses the diagnosis and treatment of DAH, as well as a new treatment paradigm that includes rFVIIa. Additionally, the risks and benefits of off-label use of rFVIIa in pediatric patients are discussed. PMID:27186216

  20. Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality

    PubMed Central

    Gomes, Nathália Mota de Faria; Bastos, Meire Cardoso da Mota; Marins, Renata Magliano; Barbosa, Aline Alves; Soares, Luiz Clóvis Parente; de Abreu, Annelise Maria de Oliveira Wilken; Souto Filho, João Tadeu Damian

    2015-01-01

    Objectives. To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB) patients. Methods. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. Results. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment of treatment included male gender (OR = 2.05; 95% CI = 1.15–3.65) and nonadherence to previous treatment (OR = 3.14; 95% CI = 1.96–5.96). In addition, the presence of extrapulmonary TB was a protective factor (OR = 0.33, 95% CI = 0.14–0.76). The following risk factors were associated with mortality: age over 40 years (OR = 2.61, 95% CI = 1.76–3.85), coinfection with HIV (OR = 6.01, 95% CI = 3.78–9.56), illiteracy (OR = 1.88, 95% CI = 1.27–2.75), the presence of severe extrapulmonary TB (OR = 2.33, 95% CI = 1.24–4.38), and retreatment after relapse (OR = 1.95, 95% CI = 1.01–3.75). Conclusions. Male gender and retreatment after abandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with HIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we suggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure and TB-associated mortality. PMID:26600948

  1. Correlates of Parental Differential Treatment: Parental and Contextual Factors during Middle Childhood

    ERIC Educational Resources Information Center

    Atzaba-Poria, Naama; Pike, Alison

    2008-01-01

    The current study examined whether parental and contextual risk factors contribute to mothers' and fathers' differential treatment (MDT/FDT) when accounting for sibling dyad characteristics. Also explored was whether family type (single mothers vs. 2 parents) moderated the links between the parental and contextual correlates and MDT. One hundred…

  2. Eating Disorders in Female College Athletes: Risk Factors, Prevention, and Treatment

    ERIC Educational Resources Information Center

    Pearson, Frances C.; Rivers, Tara C.

    2006-01-01

    Female athletes are at risk for developing eating disorders because of the pressures that are placed on them by society, their peers, their coaches, and the sports culture itself. This paper reviews the literature on the risk factors involved and various methods of prevention and treatment. The authors conclude that individual and group approaches…

  3. Behavioral Activation Therapy for Depressed Cancer Patients: Factors Associated with Treatment Outcome and Attrition

    ERIC Educational Resources Information Center

    Hopko, D. R.; Robertson, S. M. C.; Colman, L.

    2008-01-01

    In recent years there has been increased focus on evaluating the efficacy of psychosocial interventions for cancer patients. Among the several limitations inherent to these programs of research, few studies have targeted patients with well-diagnosed clinical depression and little is known about factors that best predict treatment outcome and…

  4. Factors Associated with Recruitment and Screening in the Treatment for Adolescents with Depression Study (TADS)

    ERIC Educational Resources Information Center

    May, Diane E.; Hallin, Mary J.; Kratochvil, Christopher J.; Puumala, Susan E.; Smith, Lynette S.; Reinecke, Mark A.; Silva, Susan G.; Weller, Elizabeth B.; Vitiello, Benedetto; Breland-Noble, Alfiee; March, John S.

    2007-01-01

    Objective: To examine factors associated with eligibility and randomization and consider the efficiency of recruitment methods. Method: Adolescents, ages 12 to 17 years, were telephone screened (N = 2,804) followed by in-person evaluation (N = 1,088) for the Treatment for Adolescents With Depression Study. Separate logistic regression models,…

  5. Longitudinal Risk Factors for Intimate Partner Violence among Men in Treatment for Alcohol Use Disorders

    ERIC Educational Resources Information Center

    Taft, Casey T.; O'Farrell, Timothy J.; Doron-Lamarca, Susan; Panuzio, Jillian; Suvak, Michael K.; Gagnon, David R.; Murphy, Christopher M.

    2010-01-01

    Objective: This study examined static and time-varying risk factors for perpetration of intimate partner violence (IPV) among men in treatment for alcohol use disorders. Method: Participants were 178 men diagnosed with alcohol abuse or dependence and their partners. Most (85%) of the men were European American; their average age was 41.0 years.…

  6. Factors Associated with Recent Suicide Attempts in Clients Presenting for Addiction Treatment

    ERIC Educational Resources Information Center

    Penney, Alexander; Mazmanian, Dwight; Jamieson, John; Black, Nancy

    2012-01-01

    Factors associated with recent suicide attempts were examined in clients who sought treatment at an addictions facility between 2001 and 2008. Clients who reported being hospitalized for attempting suicide in the past year (n = 76) were compared to all other clients (n = 5914) on demographic, mental health, substance use, and problem gambling…

  7. The importance of oncogenic transcription factors for oral cancer pathogenesis and treatment.

    PubMed

    Yedida, Govinda Raju; Nagini, Siddavaram; Mishra, Rajakishore

    2013-08-01

    Oral squamous cell carcinoma is a major cause of morbidity and mortality worldwide. Current experimental evidence shows that most important risk factors for oral cancer include tobacco use and excessive alcohol consumption and less well-defined risks include viral infection and a diet deficient in antioxidants. The positive correlation between various risk/etiologic factors of oral cancer and the activation of various transcription factors (TFs) has been reported in the literature. Although initially, TFs were considered to be very difficult targets for use in clinical treatment, recent technological advances have provided the ability to control these factors of cancer progression. This review focuses on the role of oncogenic transcription factors in oral cancer, their modes of activation through various biological pathways, the promises and pitfalls in viewing them as potent oncotargets, the way they can be controlled based on the current understanding, and the future research to be done in this area. PMID:23619350

  8. Factors Associated with Recidivism among Corrections-Based Treatment Participants in Rural and Urban Areas.

    PubMed

    Staton-Tindall, Michele; Harp, Kathi L H; Winston, Erin; Webster, J Matthew; Pangburn, Kevin

    2015-09-01

    The majority of corrections-based treatment outcome studies focus on individuals paroling to urban areas; thus there is a significant gap in the literature on outcomes, including recidivism, among individuals paroling to non-urban and rural communities. This study examines differences in factors associated with recidivism among former corrections-based treatment participants living in urban and rural communities following release. Analyses focused on secondary data collected from treatment participants in one southeastern state over a four year period between July 2006 and June 2010 including both baseline (treatment intake) and follow-up data (12-months post-release). Findings indicated that individuals in urban areas were 2.4 times more likely to recidivate than rural individuals. Other factors identified in separate rural and urban analyses also emerged as significant predictors in the overall model including age, gender, race, employment and drug use. Overall, these findings suggest that corrections-based treatment participants living in urban and rural areas following release may share similar risk factors for recidivism. However, rural areas may be protective for returning to custody despite the presence of some of these risks. PMID:25858761

  9. Women-specific factors to consider in risk, diagnosis and treatment of cardiovascular disease

    PubMed Central

    Miller, Virginia M

    2015-01-01

    In the era of individualized medicine, gaps in knowledge remain about sex-specific risk factors, diagnostic and treatment options that might reduce mortality from cardiovascular disease (CVD) and improve outcomes for both women and men. In this review, contributions of biological mechanisms involving the sex chromosomes and the sex hormones on the cardiovascular system will be discussed in relationship to the female-specific risk factors for CVD: hypertensive disorders of pregnancy, menopause and use of hormonal therapies for contraception and menopausal symptoms. Additionally, sex-specific factors to consider in the differential diagnosis and treatment of four prevalent CVDs (hypertension, stroke, coronary artery disease and congestive heart failure) will be reviewed with emphasis on areas where additional research is needed. PMID:25776297

  10. Influence of Patient and Treatment Factors on Adherence to Adjuvant Endocrine Therapy in Breast Cancer

    PubMed Central

    Bender, Catherine M.; Gentry, Amanda L.; Brufsky, Adam M.; Casillo, Frances E.; Cohen, Susan M.; Dailey, Meredith M.; Donovan, Heidi S.; Dunbar-Jacob, Jacqueline; Jankowitz, Rachel C.; Rosenzweig, Margaret Q.; Sherwood, Paula R.; Sereika, Susan M.

    2014-01-01

    Purpose/Objectives To comprehensively assess the patient and illness or treatment factors that may predict nonadherence to adjuvant endocrine therapy and to explore whether an interaction occurs between these factors in women with breast cancer. Design Repeated-measures design. Setting The Outpatient Services of the Women's Cancer Program at the University of Pittsburgh Cancer Institute and participants' homes. Sample 91 women with early-stage breast cancer who received endocrine therapy. Methods Adherence was assessed continuously for the first 18 months of endocrine therapy. Patient and illness or treatment factors were assessed at four time points (Time 1 to Time 4). Time 1 (baseline) was within two weeks prior to the initiation of endocrine therapy. Times 2–4 occurred at six-month intervals, as many as 18 months after Time 1. Main Research Variables Adherence, patient factors, and illness or treatment factors. Findings Adherence to endocrine therapy declined significantly during the first 18 months of treatment in women with breast cancer. The presence of negative mood and symptoms before starting treatment predicted nonadherence to endocrine therapy over time. Perceptions of financial hardship, symptoms, disease stage, and more complex medication regimens intensified the effect of negative mood on adherence over time. Conclusions Women with breast cancer may be at risk for nonadherence to prescribed endocrine therapy if they experience depression or anxiety and symptoms prior to initiating therapy. Implications for Nursing Oncology nurses should be alert to women with breast cancer who are depressed or anxious or who are experiencing symptoms. Management of negative mood and symptoms may result in better adherence. PMID:24769592

  11. Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success.

    PubMed

    Vogl, Thomas J; Naguib, Nagy N N; Nour-Eldin, Nour-Eldin A; Bechstein, Wolf O; Zeuzem, Stefan; Trojan, Jörg; Gruber-Rouh, Tatjana

    2012-08-01

    The aim of the study was to evaluate the effectiveness of transarterial chemoembolization (TACE) with four chemotherapeutic protocols in terms of local tumor control and survival of patients with unresectable cholangiocarcinoma (CCC) and to identify the prognostic factors governing treatment success. In the single-centre study, 115 patients (mean ages = 60.4 years) with unresectable CCC were repeatedly treated with TACE. In total, 819 chemoembolization sessions were performed in 4 week intervals with a mean of 7.1 (range, 3-30) sessions per patient. The chemotherapeutic used was Mitomycin C only in 20.9% of patients, Gemcitabine only in 7%, Mitomycin C with Gemcitabine in 47% and combination of Gemcitabine, Mitomycin C and Cisplatin in 25.1%. Local tumor response was evaluated by MRI according to RECIST. Survival data were calculated according to the Kaplan-Meier method. Prognostic factors for patient's survival were evaluated using log-rank-test. The local tumor controls were: partial response 8.7%, stable disease 57.4% and progressive disease 33.9% of patients. The median and mean survival times from the start of TACE were 13 and 20.8 months. Survival rate from the start of TACE was 52% after 1-year, 29% after 2-years and 10% after 3-years. Initial tumor response, high tumor vascularity and Child-Pugh class A were statistically significant factors for patient's survival. No statistically significant difference between patients treated with different chemotherapy protocols was noted. In conclusion, TACE is a palliative and safe treatment option for patients with unresectable CCC. Child Pugh class B, tumor hypovascularity and initially progressive disease were poor prognostic factors for patient survival. PMID:21976289

  12. Factors contributing to the treatment duration of diphenylcyclopropenone immunotherapy for periungual warts.

    PubMed

    Park, Hyung Kwon; Kim, Joung Soo

    2016-01-01

    Diphenylcyclopropenone (DPCP) immunotherapy has been shown to be efficacious for the treatment of warts, especially periungual warts for which destructive techniques are limited. However, factors affecting the duration of treatment of periungual warts have not been studied. A total of 61 patients with periungual warts who were completely cured with DPCP immunotherapy were included in this study. Age, sex, disease duration, location (fingernail, toenail, or both), number of warts, diameter of the largest wart, application number for sensitization and two types of sensitization reactions, erythema and blister index (EBI), and pruritus index were evaluated. Multiple linear regression analysis was performed to find correlations of these variables with the treatment duration. Of the nine variables, application number for sensitization (regression coefficient = 3.251 and 2.428, respectively) and EBI (regression coefficient = -9.950 and -9.694, respectively) were independent factors significantly affecting both the total duration of treatment and the duration of treatment after sensitization (p < 0.05, respectively). The sample size was limited. A shorter sensitization period and more severe EBI of the sensitization reaction contribute to a shorter time required for a complete cure in the treatment of periungual warts with DPCP immunotherapy. PMID:26556040

  13. Factors associated with the prescription of "traditional" or "biological" systemic treatment in psoriasis.

    PubMed

    Tabolli, Stefano; Paradisi, Andrea; Giannantoni, Patrizia; Gubinelli, Emanuela; Abeni, Damiano

    2015-02-01

    Abstract The choice of an adequate psoriasis treatment is critical to good disease management and to overall patient health. It is estimated that about 20-30% of patients requires systemic treatment: "traditional" (methotrexate, acitretina and cyclosporin) or "biological" (etanercept, adalimumab and infliximab). Clinical records of 784 outpatients with psoriasis were analyzed. 51.5% received traditional treatments and 48.5% a biological treatment. Males were 67.8% of patients. Psoriatic arthritis was observed in 37.3%. Females and younger patients were more likely to receive biological treatments. No differences were observed for Body Mass Index or for presence of comorbidities. Patients with psoriatic arthritis were also more frequently prescribed biological drug treatment. In a multivariate logistic regression model, only the older age-group (≥60 years) had a statistically significant OR (p=0.001) with a reduction of about 80% the likelihood of receiving biological treatment compared to the younger age-group (<40 years). Patients with a PASI score ≥20 and patients with arthritis have a probability to be prescribed biologics about five times higher than the other patients. In conclusion, younger age, psoriatic arthritis and the previous use of systemic drugs are factors associated with the use of biological treatment rather than the traditional systemic drugs. PMID:24559128

  14. Clinical and neurobiological factors in the management of treatment refractory attention-deficit hyperactivity disorder.

    PubMed

    Shim, Se-Hoon; Yoon, Hee-Jung; Bak, Jeongjae; Hahn, Sang-Woo; Kim, Yong-Ku

    2016-10-01

    Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent mental disorder of childhood, which often continues into adolescence and adulthood. Stimulants such as methylphenidate (MPH) and non-stimulants such as atomoxetine are effective medications for the treatment of ADHD. However, about 30% of patients do not respond to these medications. Pharmacological treatment for ADHD, although highly effective, is associated with marked variabilities in clinical response, optimal dosage needed and tolerability. This article provides an overview of up-to-date knowledge regarding the clinical and neurobiological factors which contribute to and help predict treatment-refractory ADHD. Pharmacogenetic, pharmacogenomics and neuroimaging studies are still controversial with respect to determining the associations between response to medication and genetic factors, thereby resulting in hypotheses that differences in the genetic factors and neuroimaging findings contribute to treatment outcome. Much research on the potential role of genotype in pharmacological effects has focused on the catecholaminergic gene related to executive functions. Many neuroimaging studies have also reported a relationship between treatment response and common patterns of brain structure or activity according to various genetic polymorphisms. When children, adolescents and adults with ADHD do not respond to MPH, we should consider additional pharmacological options, including other classes of psychostimulants, the nonstimulant atomoxetine, bupropion, tricyclic antidepressant, clonidine, guanfacine and lisdexamphetamine. Prudent choice of an appropriate medication and active engagement of children, parents, and teachers in daily management may help to ensure long-term adherence. Therefore, additional research might help to optimize the treatment of children, adolescents and adults with ADHD and to find new options for the treatment of patients who do not respond to stimulants and the other

  15. Psychological factors and treatment effectiveness in resistant anxiety disorders in highly comorbid inpatients

    PubMed Central

    Ociskova, Marie; Prasko, Jan; Latalova, Klara; Kamaradova, Dana; Grambal, Ales

    2016-01-01

    Background Anxiety disorders are a group of various mental syndromes that have been related with generally poor treatment response. Several psychological factors may improve or hinder treatment effectiveness. Hope has a direct impact on the effectiveness of psychotherapy. Also, dissociation is a significant factor influencing treatment efficiency in this group of disorders. Development of self-stigma could decrease treatment effectiveness, as well as several temperamental and character traits. The aim of this study was to explore a relationship between selected psychological factors and treatment efficacy in anxiety disorders. Subjects and methods A total of 109 inpatients suffering from anxiety disorders with high frequency of comorbidity with depression and/or personality disorder were evaluated at the start of the treatment by the following scales: the Mini-International Neuropsychiatric Interview, the Internalized Stigma of Mental Illness scale, the Adult Dispositional Hope Scale, and the Temperament and Character Inventory – revised. The participants, who sought treatment for anxiety disorders, completed the following scales at the beginning and end of an inpatient-therapy program: Clinical Global Impression (objective and subjective) the Beck Depression Inventory – second edition, the Beck Anxiety Inventory, and the Dissociative Experiences Scale. The treatment consisted of 25 group sessions and five individual sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy. There was no randomization to the type of group-therapy program. Results Greater improvement in psychopathology, assessed by relative change in objective Clinical Global Impression score, was connected with low initial dissociation level, harm avoidance, and self-stigma, and higher amounts of hope and self-directedness. Also, individuals without a comorbid personality disorder improved considerably more than comorbid patients. According to

  16. Factors influencing treatment team recommendations to review tribunals for forensic psychiatric patients.

    PubMed

    Martin, Krystle; Martin, Erica

    2016-07-01

    It is the responsibility of forensic psychiatric hospitals to detain and treat patients, gradually reintegrating them into society; decisions to release patients must balance risk to the public with maintaining the least restrictive environment for patients. Little is known about the factors considered when making such decisions and whether these factors have been empirically linked to future risk of violence. The current study explores the factors predictive of forensic treatment teams' recommendations for patients under the care of the Ontario Review Board (ORB). Factors differ depending on level of security; decisions on medium secure units were influenced by the presence of active symptoms and patients' overall violence risk level and decisions made on minimum secure units were influenced by the number of critical incidents that occurred within the recommendation year. Understanding the factors used to make recommendations to the ORB tribunal helps treatment teams to reflect on their own decision-making practices. Furthermore, the results serve to inform us about factors that influence length of stay for forensic psychiatric patients. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27147124

  17. Understanding Factors Associated with Early Therapeutic Alliance in PTSD Treatment: Adherence, Childhood Sexual Abuse History, and Social Support

    ERIC Educational Resources Information Center

    Keller, Stephanie M.; Zoellner, Lori A.; Feeny, Norah C.

    2010-01-01

    Objective: Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as…

  18. Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia.

    PubMed

    Genné, D; Sommer, R; Kaiser, L; Saaïdia, A; Pasche, A; Unger, P F; Lew, D

    2006-03-01

    To determine the causes of treatment failure and to evaluate the prognostic factors in patients hospitalized for community-acquired pneumonia, a prospective, observational study of 228 adult patients hospitalized for a community-acquired pneumonia in the University Hospital of Geneva and the La Chaux-de-Fonds Community Hospital, Switzerland, was conducted. The percentage of patients who failed to improve (as defined by guidelines of the Infectious Disease Society of America) and the causes of treatment failure were assessed, and patients who failed to improve under antimicrobial therapy were compared with those who did improve. In the 54 (24%) patients who failed to improve, a mean increase in length of hospitalization of 4 days was observed. Most causes of treatment failure could be attributed to host factors (61%) rather than to the pathogen (16%) or to an inappropriate antibiotic regimen (3%). After adjusting for potentially confounding variables, concomitant neoplasia (OR 3.25; 95%CI 1.11-9.56), neurological disease (OR 2.34; 95%CI 1.07-5.13), and aspiration pneumonia (OR 2.97; 95%CI 29-6.86]) were associated with failure to improve, whereas monocytosis improved prognosis (OR 0.40; 95%CI 0.20-0.80). Almost one out of four patients hospitalized for community-acquired pneumonia failed to respond to empirical antibiotic treatment. Aspiration pneumonia, concomitant neoplasia, and neurological disease were factors positively associated with failure to improve, whereas monocytosis was linked to a better prognosis. PMID:16528540

  19. Clinical Presentation, Risk Factors, and Treatment Modalities of Hepatocellular Carcinoma: A Single Tertiary Care Center Experience

    PubMed Central

    AlZunaitan, Mohammed; Al Ghobain, Mohammed; Al Muaikeel, Mohamed; Al Olayan, Ashwaq; Azzumeea, Fahad; AlAlwan, Abduljaleel; AlGhamdi, Hamdan

    2016-01-01

    Objective. To investigate the risk factors, clinical characteristics, treatment modalities, and outcomes in Saudi patients with HCC and propose points for early detection of the disease. Methods. Patients were stratified according to underlying risk factors for the development of HCC. Barcelona Clinic Liver Cancer (BCLC) was used for cancer staging. Treatment was classified into surgical resection/liver transplantation; locoregional ablation therapy; transarterial embolization; systemic chemotherapy; and best supportive care. Results. A total of 235 patients were included. Males had higher tumor size and incidence of portal vein thrombosis. Viral hepatitis was a risk factor in 75.7%. The most common BCLC stages were B (34.5%) and A (33.6%), and the most common radiological presentation was a single nodule of less than 5 cm. Metastases were present in 13.2%. Overall, 77 patients (32.8%) underwent a potentially curative treatment as the initial therapy. The most commonly utilized treatment modality was chemoembolization with 113 sessions in 71 patients. The overall median survival was 15.97 ± 27.18 months. Conclusion. HCC in Saudi Arabia is associated with high prevalence of HCV. Potentially curative therapies were underutilized in our patients. Cancer stage BCLC-B was the most frequent (34.5%) followed by BCLC-A (33.6%). The overall median survival was shorter than other studies. PMID:27525001

  20. Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

    PubMed Central

    KÜHNÖL, JULIA; KÜHNÖL, CASPAR; VORDERMARK, DIRK

    2016-01-01

    Brain metastases (BM) from breast cancer are associated with high morbidity and a poor prognosis. The aim of this study was to analyse the role of radiotherapy in treatment of BM from breast cancer in the context of modern local therapy modalities, current systemic treatment options and prognostic factors. A retrospective analysis of 86 consecutive female patients treated with radiotherapy for BM from breast cancer between 2000 and 2010 was conducted. Patient and treatment characteristics were registered and survival data calculated. All patients received whole-brain radiotherapy (WBRT) with a median dose of 36 Gy, and 19 patients were treated with an additional boost; this included fractionated schemes (median dose, 18 Gy) and radiosurgery (5 and 17 Gy). The median overall survival time from the start of WBRT was 4.1 months in the present cohort. Patients receiving a boost survived 19.7 months in comparison to 3.1 months for patients treated with WBRT alone (P<0.001). Other factors that improved overall survival, based on a univariate analysis, were dose of WBRT and number of BM. There was no statistical evidence for the influence of the human epidermal growth factor receptor 2 status on survival in the current study. The administration of boost treatment following WBRT was also identified as a significant factor influencing survival on multivariate analysis (P=0.030). In conclusion, radiotherapy affects the survival time of patients with BM from breast cancer. In particular, the implementation of boost treatment following WBRT in selected patients seems to extend survival time. PMID:27123095

  1. Factors Associated with Treatment Failure in Vertebral Osteomyelitis Requiring Spinal Instrumentation

    PubMed Central

    Arnold, Ryan; Croft, Lindsay; Gilliam, Bruce L.

    2014-01-01

    Patients with vertebral osteomyelitis may require instrumentation for spinal stabilization. Determining the optimal duration and type of antimicrobial therapy for these patients is challenging. The aim of this study was to examine risk factors for treatment failure, in particular antimicrobial duration, in a cohort of patients requiring spinal instrumentation for vertebral osteomyelitis. We conducted a retrospective cohort study of all patients with vertebral osteomyelitis who had spinal instrumentation between January 2002 and January 2012 at the University of Maryland Medical Center. The primary outcome measure was treatment failure >4 weeks postoperatively. We identified 131 patients with vertebral osteomyelitis requiring spinal instrumentation, 94 of whom had >4 weeks of follow-up and were included in the primary analysis. Treatment failure occurred in 22 of the 94 patients (23%) at a median of 4 months after surgery. Among patients who failed therapy, 20 of 22 failed within 1 year of surgery. Cervical and thoracic infection sites and the presence of negative cultures were associated with fewer treatment failures. Addition of rifampin and the use of chronic suppressive antimicrobials did not affect treatment failure rate. Twenty-three percent of patients with spinal instrumentation for vertebral osteomyelitis experienced treatment failure. Treatment failure almost always occurred within the first year of spinal instrumentation. PMID:24277039

  2. Peroxidation due to cryoprotectant treatment is a vital factor for cell survival in Arabidopsis cryopreservation.

    PubMed

    Ren, Li; Zhang, Di; Jiang, Xiang-Ning; Gai, Ying; Wang, Wei-Ming; Reed, Barbara M; Shen, Xiao-Hui

    2013-11-01

    Cryopreservation can be a safe and cost-effective tool for the long-term storage of plant germplasm. In Arabidopsis, the ability to recover from cryogenic treatment was lost as growth progressed. Growth could be restored in 48-h seedlings, whereas 72-h seedlings died after cryogenic treatment. Why seedling age and survival are negatively correlated is an interesting issue. A comparative transcriptomics was performed to screen differentially expressed genes between 48- and 72-h seedlings after exposure to cryoprotectant. Among differentially expressed genes, oxidative stress response genes played important roles in cryoprotectant treatment, and peroxidation was a key factor related to cell survival. Seedlings underwent more peroxidation at 72-h than at 48-h. A comprehensive analysis indicated that peroxidation injured membrane systems leading to photophosphorylation and oxidative phosphorylation damage. Furthermore, the apoptosis-like events were found in cryogenic treatment of Arabidopsis seedlings. 48- and 72-h seedlings underwent different degrees of membrane lipid peroxidation during cryoprotectant treatment, and reducing the injury of oxidative stress was an important factor to successful cryopreservation. This study provided a novel insight of genetic regulatory mechanisms in cryopreservation, and established an excellent model to test and evaluate the effect of exogenous antioxidants and conventional cryoprotectants in plant cryopreservation. PMID:24094052

  3. Dissatisfaction with dentofacial appearance and the normative need for orthodontic treatment: determinant factors

    PubMed Central

    de Almeida, Anderson Barbosa; Leite, Isabel Cristina Gonçalves; Melgaço, Camilo Aquino; Marques, Leandro Silva

    2014-01-01

    Objective This study aims at assessing the normative need for orthodontic treatment and the factors that determine the subjective impact of malocclusion on 12-year-old Brazilian school children. Methods A total of 451 subjects (215 males and 236 females) were randomly selected from private and public schools of Juiz de Fora, Brazil. The collected data included sociodemographic information and occlusal conditions. The esthetic subjective impact of malocclusion was assessed by means of the Orthodontic Aesthetic Subjective Impact Score - OASIS, whereas the malocclusion and the need for orthodontic treatment were assessed by means of the Dental Aesthetic Index (DAI) and the Index of Orthodontic Treatment Need-Aesthetic Component (IOTN-AC). Results Prevalence of normative need for orthodontic treatment was 65.6% (n = 155), and prevalence of orthodontic esthetic subjective impact was 14.9%. The following variables showed significant association with esthetic subjective impact of malocclusion: female (p = 0.042; OR = 0.5; CI = 0.2-0.9), public school student (p = 0.002; OR = 6.8; CI = 1.9-23.8), maxillary overjet ≥ 4 mm (p = 0.037; OR = 1.7; CI = 1-3) and gingival smile ≥ 4 mm (p = 0.008; OR = 3.4; CI = 1.3-8.8). Conclusion The normative need for orthodontic treatment overestimated the perceived need. Occlusal and sociocultural factors influenced the dissatisfaction of schoolchildren with their dentofacial appearance. PMID:25162576

  4. Prognostic factors and treatment results of pediatric Hodgkin's lymphoma: A single center experience.

    PubMed

    Büyükkapu-Bay, Sema; Çorapçıoğlu, Funda; Aksu, Görkem; Anık, Yonca; Demir, Hakan; Erçin, Cengiz

    2015-01-01

    The aim of this study was to assess the demographic, clinic data, prognostic factors and treatment/follow-up results of children who were diagnosed with Hodgkin lymphoma and followed in our center of Pediatric Oncology, Kocaeli University Medical Faculty, Kocaeli, Turkey, for 10 years. This retrospective study evaluated 41 patients with Hodgkin lymphoma who were younger than 18 years-old. All patients were treated with risked adapted ABVD (Adriamycin, Bleomycin, Vincristine, Dacarbazine) chemotherapy and also received involved field radiotherapy. Thirty-two patients (78%) were males and 9 (22%) were females, with a mean age of 10.7±4.0 years. The histopathological diagnosis was mixed cellular type in 51.2% of the patients. B symptoms (unexplained fever, unexplained weight loss, drenching night sweats) were present in 53.7% of the patients and 36.6% of the patients were at advanced stage at the time of the diagnosis. The 3-year overall and event-free survival rates were 88% and 5-year overall and event-free survival rates were 88%, 78%. Age, stage, treatment risk groups, presence of B symptoms and hematological parameters had no significant effect on overall and event-free survival in univariate analysis while bulky disease was the only significant factor on overall survival. Our treatment policy was succesful regarding the similar survival rates in the treatment risk groups, however novel treatment strategies adopting the early response with the reduction of adverse effects are planned in the near future. PMID:27186698

  5. Factors Determining Water Treatment Behavior for the Prevention of Cholera in Chad

    PubMed Central

    Lilje, Jonathan; Kessely, Hamit; Mosler, Hans-Joachim

    2015-01-01

    Cholera is a well-known and feared disease in developing countries, and is linked to high rates of morbidity and mortality. Contaminated drinking water and the lack of sufficient treatment are two of the key causes of high transmission rates. This article presents a representative health survey performed in Chad to inform future intervention strategies in the prevention and control of cholera. To identify critical psychological factors for behavior change, structured household interviews were administered to N = 1,017 primary caregivers, assessing their thoughts and attitudes toward household water treatment according to the Risk, Attitude, Norm, Ability, and Self-regulation model. The intervention potential for each factor was estimated by analyzing differences in means between groups of current performers and nonperformers of water treatment. Personal risk evaluation for diarrheal diseases and particularly for cholera was very low among the study population. Likewise, the perception of social norms was found to be rather unfavorable for water treatment behaviors. In addition, self-reported ability estimates (self-efficacy) revealed some potential for intervention. A mass radio campaign is proposed, using information and normative behavior change techniques, in combination with community meetings focused on targeting abilities and personal commitment to water treatment. PMID:25918206

  6. Factors determining water treatment behavior for the prevention of cholera in Chad.

    PubMed

    Lilje, Jonathan; Kessely, Hamit; Mosler, Hans-Joachim

    2015-07-01

    Cholera is a well-known and feared disease in developing countries, and is linked to high rates of morbidity and mortality. Contaminated drinking water and the lack of sufficient treatment are two of the key causes of high transmission rates. This article presents a representative health survey performed in Chad to inform future intervention strategies in the prevention and control of cholera. To identify critical psychological factors for behavior change, structured household interviews were administered to N = 1,017 primary caregivers, assessing their thoughts and attitudes toward household water treatment according to the Risk, Attitude, Norm, Ability, and Self-regulation model. The intervention potential for each factor was estimated by analyzing differences in means between groups of current performers and nonperformers of water treatment. Personal risk evaluation for diarrheal diseases and particularly for cholera was very low among the study population. Likewise, the perception of social norms was found to be rather unfavorable for water treatment behaviors. In addition, self-reported ability estimates (self-efficacy) revealed some potential for intervention. A mass radio campaign is proposed, using information and normative behavior change techniques, in combination with community meetings focused on targeting abilities and personal commitment to water treatment. PMID:25918206

  7. Factors influencing the cognitive and neural effects of hormone treatment during aging in a rodent model

    PubMed Central

    Chisholm, Nioka C.; Juraska, Janice M.

    2013-01-01

    Whether hormone treatment alters brain structure or has beneficial effects on cognition during aging has recently become a topic of debate. Although previous research has indicated that hormone treatment benefits memory in menopausal women, several newer studies have shown no effect or detrimental effects. These inconsistencies emphasize the need to evaluate the role of hormones in protecting against age-related cognitive decline in an animal model. Importantly, many studies investigating the effects of estrogen and progesterone on cognition and related brain regions have used young adult animals, which respond differently than aged animals. However, when only the studies that have examined the effects of hormone treatment in an aging model are reviewed, there are still varied behavioral and neural outcomes. This article reviews some of the important factors that can influence the behavioral and neural outcomes of hormone treatment including the type of estrogen administered, whether or not estrogen is combined with progesterone and if so, the type of progesterone used, as well as the route, mode, and length of treatment. How these factors influence cognitive outcomes highlights the importance of study design and avoiding generalizations from a small number of studies. PMID:23419893

  8. Treatment, Material, Care, and Patient-Factors in Contact Lens-Related Dry Eye

    PubMed Central

    Ramamoorthy, Padmapriya; Sinnott, Loraine T.; Nichols, Jason J.

    2009-01-01

    PURPOSE To examine the effect of general contact lens and material characteristics, care solutions, treatment and patient-related factors on contact lens-related dry eye. METHODS The data were derived from the Contact Lens and Dry Eye Study, designed as a cross-sectional and nested case-control study including 360 subjects. In separate statistical models, logistic regression was used to examine general contact lens characteristics, specific hydrogel lens materials, care solutions, and patient-related factors associated with dry eye status (controlled for age, gender, and current treatments). RESULTS Several factors were significantly associated with dry eye, including treatment factors such as a recent contact lens refitting (OR = 5.75, 95% CI = 2.14 to 15.46) and use of artificial tears/rewetting drops (OR = 1.09, 95% CI = 1.02 to 1.16), and currently worn materials including FDA group II (OR = 2.98, 95% CI = 1.14 to 6.19) and IV (OR = 1.87, 95% CI = 1.08 to 3.24). Significant patient-related factors included decreased overall satisfaction (OR = 3.57, 95% CI = 2.08 to 5.88,), dry eye in the absence of contact lens wear (OR = 6.54, 95% CI = 2.57 to 16.62), reduced daily lens wear duration (OR = 1.16, 95% CI = 1.06 to 1.26), and reduced ability to wear lenses as long as desired (OR = 2.44, 95% CI = 1.30 to 4.54). Care solutions were not significant. CONCLUSIONS The strong association of common treatment factors with dry eye status in contact lens wearers suggests that these treatments are not entirely effective. The use of high water content materials was strongly related to dry eye in lens wearers, while care solutions were not. Contact lens-related dry eye was also associated with several patient-related factors such as greater ocular discomfort (without lenses), dissatisfaction, and inability to wear lenses for desired durations. PMID:18677240

  9. Implications of Our Developing Understanding of Risk and Protective Factors in the Treatment of Adult Male Sexual Offenders

    ERIC Educational Resources Information Center

    Thornton, David

    2013-01-01

    This paper summarizes our developing knowledge of factors that contribute added risk of sexual recidivism (risk factors) and factors that are associated with a reduced risk of sexual recidivism (protective factors). Specific implications for the design of future treatment programs are drawn. This information is contrasted with the common foci of…

  10. The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses

    PubMed Central

    Akkurt, Mehmet Özgür; Yalçın, Serenat Eris; Akkurt, İltaç; Tatar, Burak; Yavuz, And; Yalçın, Yakup; Akgül, Mehmet Akif; Kayıkçıoğlu, Fulya

    2015-01-01

    Objective The aim of our study is to assess the risk factors for medical treatment failure and to predict the patients who will require the surgical therapy as well as to predict the factors affecting treatment success. Material and Methods This was a cross-sectional study including 76 women with tubo-ovarian abscesses (TOA) who were either conservatively or surgically treated and were admitted to two gynecology units over a 4-year period. The demographic characteristics of the patients, gynecologic and obstetric histories, size and localization of abscesses were recorded. Gentamicin plus clindamycin treatment protocol was implemented for all patients. Ampicillin treatment was added in three patients with the positive culture of Actinomyces. Response to treatment was evaluated after 48–72 h. Patients who fail to respond to medical treatment required surgery or percutaneous drainage. We compared clinical and laboratory factors between the groups. Results In surgery group, patients were significantly older than the others (44.9±5.4 versus 39.1±7.6 years). Fifty-six patients (74%) responded to antibiotics and 20 of the patients required surgical intervention. Patients treated with antibiotics were hospitalized for an average of 6.32±2.8 days versus 12.75±5.6 days for those who required surgery (p=0.021). Patients who were surgically treated had a mean size of TOA of 67.9±11.2 mm versus 53.6±9.4 mm for those treated with antibiotics alone (p=0.036). There were no significant differences between groups in laboratory parameters, except for initial white blood cell (WBC) counts. The complications of surgery included in descending order of frequency blood transfusions, surgical wound infections, bowel injury, and bladder injury. Conclusion An increased size of pelvic mass, higher initial WBC counts, advanced age, and smoking were all associated with failed response to conservative treatment. It is important to identify the risk factors to distinguish patients who

  11. Diffuse large B-cell lymphoma of the breast: prognostic factors and treatment outcomes

    PubMed Central

    Sun, Yao; Joks, Monika; Xu, Li-Ming; Chen, Xiu-Li; Qian, Dong; You, Jin-Qiang; Yuan, Zhi-Yong

    2016-01-01

    Background The breast is a rare site of extranodal involvement of diffuse large B-cell lymphoma (DLBCL). We aimed to assess the clinical characteristics, prognostic factors, and treatment outcomes of breast DLBCL. Patients and methods We retrospectively analyzed 113 patients (from our institution and the literature) between 1973 and 2014. The primary end point was overall survival (OS). Kaplan–Meier OS curves were compared with the log-rank test. Cox regression analysis was applied to determine the prognostic factors for OS, progression-free survival (PFS), local control (LC), and cause-specific survival (CSS). Results A total of 113 patients were included in the study: 42 cases from our hospital and 71 cases from 12 publications. The median age at diagnosis was 58 years. With a median follow-up time of 39.2 months, the estimated 5-year OS, PFS, LC, and CSS were 71.4%, 58.8%, 75.6%, and 74.9%, respectively. In multivariate analysis, more than four cycles of chemotherapy, having localized cancer, lumpectomy with or without axillary lymph node (ALN) dissection, and low to low-to-intermediate International Prognostic Index were favorable factors for OS. For PFS, significant prognostic factors were rituximab use, B symptoms, and tumor size. As for the local group, lumpectomy with or without ALN dissection and more than four cycles of chemotherapy were favorable factors for OS. Tumor size >4 cm and nonuse of rituximab were adverse factors for PFS. Twenty-one patients (18.6%) developed local relapse and 33 (29.2%) developed systemic relapse. Eight patients had central nervous system relapse (7.3%). Conclusion Our results reveal that local and extended staging criteria can reflect the different prognosis and treatment outcomes of breast DLBCL. Rituximab use, lumpectomy, and more than four cycles of chemotherapy are recommended as a treatment regimen. However, further study is warranted to validate our data. PMID:27103833

  12. Vasculitis complicating granulocyte colony stimulating factor treatment of leukopenia and infection in Felty's syndrome.

    PubMed

    Farhey, Y D; Herman, J H

    1995-06-01

    Recombinant myeloid growth factors have been increasingly used in recent years to combat induced and disease associated neutropenia. Their application in the management of Felty's syndrome with intercurrent infection has raised concern that resultant neutrophilia and activation of a diverse array of polymorphonuclear cell functions may have an adverse effect on the rheumatoid disease process. We describe a patient with Felty's syndrome receiving short term treatment with recombinant human granulocyte colony stimulating factor (GCSF), who then developed acute renal failure in conjunction with leukocytoclastic vasculitis and presumptive gout. We address the issue of "adding fuel to the fire" and review reported implications of GCSF in induction of vasculitis. PMID:7545756

  13. Risk factors for gun-related behaviors among urban out-of-treatment substance using women.

    PubMed

    Johnson, Sharon D; Cottler, Linda B; Ben Abdallah, Arbi; O'Leary, Catina

    2012-09-01

    We examine the prevalence and factors associated with lifetime gun-carrying among 858 urban out-of-treatment substance using women using data collected between 2000 and 2004 in a large Midwestern city. Instruments assessed gun ownership, carrying and access, psychopathology and personal lifestyle risk factors. Analyses were conducted using logistic regression. Illegal activities for income and lifetime violent victimization were the most significant predictors of gun carrying. The implications for practice and future research are discussed along with the study's limitations. The work was supported by grants from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. PMID:22693947

  14. Epidermal growth factor treatment decreases mortality and is associated with improved gut integrity in sepsis.

    PubMed

    Clark, Jessica A; Clark, Andrew T; Hotchkiss, Richard S; Buchman, Timothy G; Coopersmith, Craig M

    2008-07-01

    Epidermal growth factor (EGF) is a cytoprotective peptide that has healing effects on the intestinal mucosa. We sought to determine whether systemic administration of EGF after the onset of sepsis improved intestinal integrity and decreased mortality. FVB/N mice were subjected to either sham laparotomy or 2 x 23 cecal ligation and puncture (CLP). Septic mice were further randomized to receive injection of either 150 microg kg(-1) d(-1) (i.p.) EGF or 0.9% saline (i.p.). Circulating EGF levels were decreased after CLP compared with sham animals but were unaffected by giving exogenous EGF treatment. In contrast, intestinal EGF levels increased after CLP and were further augmented by exogenous EGF treatment. Intestinal EGF receptor was increased after CLP, whether assayed by immunohistochemistry, real-time polymerase chain reaction, or Western blot, and exogenous EGF treatment decreased intestinal EGF receptor. Villus length decreased 2-fold between sham and septic animals, and EGF treatment resulted in near total restitution of villus length. Sepsis decreased intestinal proliferation and increased intestinal apoptosis. This was accompanied by increased expression of the proapoptotic proteins Bid and Fas-associated death domain, as well as the cyclin-dependent kinase inhibitor p21 cip1/waf Epidermal growth factor treatment after the onset of sepsis restored both proliferation and apoptosis to levels seen in sham animals and normalized expression of Bid, Fas-associated death domain, and p21 cip1/waf . To determine whether improvements in gut homeostasis were associated with a decrease in sepsis-induced mortality, septic mice with or without EGF treatment after CLP were followed 7 days for survival. Mortality decreased from 60% to 30% in mice treated with EGF after the onset of sepsis (P < 0.05). Thus, EGF may be a potential therapeutic agent for the treatment of sepsis in part due to its ability to protect intestinal integrity. PMID:18004230

  15. How do treatment seeking overweight youth and their parent describe weight promoting factors in their family?

    PubMed Central

    Lyles, Annmarie; Riesch, Susan K.; Sanders, Linda; Sass-DeRuyter, Suzanne M.; Birchmeier, Becky; Kotula, Kelly

    2012-01-01

    The aim of this pilot study is to describe youth and parents perceptions of potential weight promoting factors among families seeking treatment for youth overweight. We identified two important gaps in the vast multi-disciplinary literature: (a) a lack of studies addressing both the youth and the parent perceptions about family factors that are potentially weight-promoting and (b) a lack of interventions that community health nurses could deliver specifically targeting families seeking treatment for overweight youth. Focus group data were content analyzed. Broad themes included: (a) Mixed Messages, (b) Food and Exercise as Battleground, (c) Problem Solving, and (d) Social Aspects of Youth Overweight. We conclude that youth and parents could benefit from community health nursing interventions to implement healthcare professionals' recommendations incorporating all family members and creating and maintaining an accepting and demanding family climate. PMID:23136859

  16. Advances in the diagnosis and treatment of tumor necrosis factor receptor-associated periodic syndrome.

    PubMed

    Aguado-Gil, L; Irarrazaval-Armendáriz, I; Pretel-Irazabal, M

    2013-09-01

    Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is a rare autosomal dominant disease included in the group of autoinflammatory syndromes. It is characterized by recurrent episodes of fever and inflammation in different regions of the body. The main clinical manifestations are myalgia, migratory erythematous rash, periorbital edema, and abdominal pain. The diagnosis is reached using gene analysis and prognosis depends on the appearance of amyloidosis secondary to the recurrent episodes of inflammation. Tumor necrosis factor inhibitors and corticosteroids are the most widely used treatments. In recent years, significant advances have been made in the diagnosis and treatment of TRAPS, thanks to a better understanding of its pathogenesis. Dermatologists must be aware that the skin manifestations of TRAPS are particularly important, as they are often diagnostic. PMID:23891452

  17. Application of insulin-like growth factor-1 in the treatment of inner ear disorders.

    PubMed

    Yamamoto, Norio; Nakagawa, Takayuki; Ito, Juichi

    2014-01-01

    Sensorineural hearing loss (SNHL) is considered an intractable disease, given that hair and supporting cells (HCs and SCs) of the postnatal mammalian cochlea are unable to regenerate. However, with progress in regenerative medicine in the 21st century, several innovative approaches for achieving regeneration of inner ear HCs and SCs have become available. These methods include stem cell transplantation, overexpression of specific genes, and treatment with growth factors. Insulin-like growth factor-1 (IGF-1) is one of the growth factors that are involved in the development of the inner ear. Treatment with IGF-1 maintains HC numbers in the postnatal mammalian cochlea after various types of HC injuries, with activation of two major pathways downstream of IGF-1 signaling. In the aminoglycoside-treated neonatal mouse cochlear explant culture, promotion of the cell-cycle in SCs as well as inhibition of HC apoptosis was observed in the IGF-1-treated group. Activation of downstream molecules was observed in SCs and, in turn, SCs contribute to the maintenance of HC numbers. Using comprehensive analysis of the gene expression, the candidate effector molecules of the IGF-1 signaling pathway in the protection of HCs were identified as Netrin1 and Gap43. Based on these studies, a clinical trial has sought to investigate the effects of IGF-1 on SNHL. Sudden SNHL (SSHL) that was refractory to systemic steroids was treated with IGF-1 in a gelatin hydrogel and the outcome was compared with a historical control of hyperbaric oxygen therapy. The proportion of patients showing hearing improvement was significantly higher in the IGF-1-treatment group at 24 weeks after treatment than in the control group. A randomized clinical trial is ongoing to compare the effect of IGF-1 treatment with that of intra-tympanic steroids for SSHL that is refractory to systemic steroids. PMID:25309440

  18. Application of insulin-like growth factor-1 in the treatment of inner ear disorders

    PubMed Central

    Yamamoto, Norio; Nakagawa, Takayuki; Ito, Juichi

    2014-01-01

    Sensorineural hearing loss (SNHL) is considered an intractable disease, given that hair and supporting cells (HCs and SCs) of the postnatal mammalian cochlea are unable to regenerate. However, with progress in regenerative medicine in the 21st century, several innovative approaches for achieving regeneration of inner ear HCs and SCs have become available. These methods include stem cell transplantation, overexpression of specific genes, and treatment with growth factors. Insulin-like growth factor-1 (IGF-1) is one of the growth factors that are involved in the development of the inner ear. Treatment with IGF-1 maintains HC numbers in the postnatal mammalian cochlea after various types of HC injuries, with activation of two major pathways downstream of IGF-1 signaling. In the aminoglycoside-treated neonatal mouse cochlear explant culture, promotion of the cell-cycle in SCs as well as inhibition of HC apoptosis was observed in the IGF-1-treated group. Activation of downstream molecules was observed in SCs and, in turn, SCs contribute to the maintenance of HC numbers. Using comprehensive analysis of the gene expression, the candidate effector molecules of the IGF-1 signaling pathway in the protection of HCs were identified as Netrin1 and Gap43. Based on these studies, a clinical trial has sought to investigate the effects of IGF-1 on SNHL. Sudden SNHL (SSHL) that was refractory to systemic steroids was treated with IGF-1 in a gelatin hydrogel and the outcome was compared with a historical control of hyperbaric oxygen therapy. The proportion of patients showing hearing improvement was significantly higher in the IGF-1-treatment group at 24 weeks after treatment than in the control group. A randomized clinical trial is ongoing to compare the effect of IGF-1 treatment with that of intra-tympanic steroids for SSHL that is refractory to systemic steroids. PMID:25309440

  19. Factors associated with seeking treatment for postpartum morbidities in rural India

    PubMed Central

    Singh, Aditya; Kumar, Abhishek

    2014-01-01

    OBJECTIVES: To understand the prevalence of postpartum morbidities and factors associated with treatment-seeking behaviour among currently married women aged 15-49 residing in rural India. METHODS: We used data from the nationally representative District Level Household Survey from 2007-2008. Cross-tabulation was used to understand the differentials for the prevalence of postpartum morbidities and treatment-seeking behaviours across selected background characteristics. Two-level binary logistic regression was applied to understand the factors associated with treatment-seeking behaviour. RESULTS: Approximately 39.8% of rural women suffered from at least one of the six postpartum morbidities including high fever, lower abdominal pain, foul-smelling vaginal discharge, excessive bleeding, convulsions, and severe headache. Morbidities were more prevalent among poor, illiterate, Muslim, and high-parity women. About 55.1% of these rural women sought treatment/consultation for their problems. The odds of seeking treatment/consultation increased as economic status and years of schooling among both the woman and her husband increased. Poor, uneducated, unemployed, Hindu, and tribal women were less likely to seek treatment/consultation for postpartum morbidities than their counterparts were. The odds of seeking treatment/consultation decreased as the distance to the nearest private health facility increased. Most women visited a private hospital (46.3%) or a friend/family member’s home (20.8%) for treatment/consultation. Only a small percentage visited publicly funded health institutions such as a primary health centre (8.8%), community health centre (6.5%), health sub-centre (2.8%), or district hospital (13.1%). Rural women from the northeast region of India were 50% less likely to seek treatment/consultation than women from the central region were. CONCLUSIONS: Providing antenatal and delivery care, and ensuring nearby government healthcare facilities are available to

  20. Treatment of cardiovascular risk factors to prevent cognitive decline and dementia: a systematic review

    PubMed Central

    Ligthart, Suzanne A; Moll van Charante, Eric P; Van Gool, Willem A; Richard, Edo

    2010-01-01

    Background: Over the last decade, evidence has accumulated that vascular risk factors increase the risk of Alzheimer disease (AD). So far, few randomized controlled trials have focused on lowering the vascular risk profile to prevent or postpone cognitive decline or dementia. Objective: To systematically perform a review of randomized controlled trials (RCTs) evaluating drug treatment effects for cardiovascular risk factors on the incidence of dementia or cognitive decline. Selection criteria: RCTs studying the effect of treating hypertension, dyslipidemia, hyperhomocysteinemia, obesity, or diabetes mellitus (DM) on cognitive decline or dementia, with a minimum follow-up of 1 year in elderly populations. Outcome measure: Cognitive decline or incident dementia. Main results: In the identified studies, dementia was never the primary outcome. Statins (2 studies) and intensified control of type II DM (1 study) appear to have no effect on prevention of cognitive decline. Studies on treatment of obesity are lacking, and the results of lowering homocysteine (6 studies) are inconclusive. There is some evidence of a preventive effect of antihypertensive medication (6 studies), but results are inconsistent. Conclusion: The evidence of a preventive treatment effect aimed at vascular risk factors on cognitive decline and dementia in later life is scarce and mostly based on secondary outcome parameters. Several important sources of bias such as differential dropout may importantly affect interpretation of trial results. PMID:20859546

  1. Potential Risk Factors Associated With Vascular Diseases in Patients Receiving Treatment for Hypertension

    PubMed Central

    Kim, Hyunjung; Park, Joonhong; Chae, Hyojin; Lee, Gun Dong; Lee, Sang Yoon; Lee, Jong Min; Oh, Yong-Seog

    2016-01-01

    Background Currently, the hypertension (HTN) patients undergo appropriate medical treatment, and traditional risk factors are highly controlled. Therefore, potential risk factors of atherosclerotic vascular diseases (AVD) and venous thromboembolisms (VTE) in HTN should be reconsidered. We investigated thrombophilic genetic mutations and existing biomarkers for AVD or VTE in HTN patients receiving treatment. Methods A total of 183 patients were enrolled: AVD with HTN (group A, n=45), VTE with HTN (group B, n=62), and HTN patients without any vascular diseases (group C, n=76). The lipid profile, homocysteine (Hcy) levels, D-dimers, fibrinogen, antithrombin, lupus anticoagulant, and anti-cardiolipin antibody (aCL) were evaluated. Prothrombin G20210A, Factor V G1691A, and methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C were analyzed. Results All patients revealed wild type prothrombin G20210A and Factor V G1691A polymorphisms. The frequency of MTHFR polymorphisms was 677CT (n=84, 45.9%); 677TT (n=46, 25.1%); 1298AC (n=46, 25.1%); and 1298CC (n=2, 1.1%). The MTHFR 677TT genotype tended to increase the odds ratio (OR) to AVD events in HTN patients (OR 2.648, confidence interval 0.982-7.143, P=0.05). The group A demonstrated significantly higher Hcy levels (P=0.009), fibrinogen (P=0.004), and platelet counts (P=0.04) than group C. Group B had significantly higher levels of D-dimers (P=0.0001), platelet count (P=0.0002), and aCL (P=0.02) frequency than group C. Conclusions The MTHFR 677TT genotype and Hcy level could be potential risk factors associated with development of AVD in HTN patients receiving treatment. D-dimer and aCL might be useful to estimate the occurrence of VTE in them. PMID:26915609

  2. Tumor necrosis factor antagonists in the treatment of multicentric reticulohistiocytosis: Current clinical evidence.

    PubMed

    Zhao, Hongjun; Wu, Chunmei; Wu, Mengyun; Zhou, Yaou; Zhu, Honglin; Li, Yisha; You, Yunhui; Luo, Hui; Wang, Lijing; Zuo, Xiaoxia

    2016-07-01

    Multicentric reticulohistiocytosis (MRH) is a rare and debilitating systemic disorder characterized by cutaneous nodules and destructive polyarthritis. Due to its unknown etiology, the treatment of MRH varies with different rates of success, which causes treatment options to be rather independent and empirical. In the present study, a case of a 48‑year‑old woman with a 12‑month history of polyarthralgia and skin nodules was reported. Biopsy samples, which were obtained from her skin eruption exhibited dermal infiltration with histiocytes and multinucleated giant cells. Immunohistochemical staining indicated positivity for CD68. The patient was diagnosed with MRH and treated with a combination therapy of infliximab, prednisolone and methotrexate. Her symptoms improved markedly within 2 weeks. Following the results of this case study, a systematic review of 17 cases of MRH treated with tumor necrosis factor (TNF) antagonists was performed, and the efficacy of anti‑TNF treatment in MRH was analyzed. PMID:27175854

  3. Tumor necrosis factor antagonists in the treatment of multicentric reticulohistiocytosis: Current clinical evidence

    PubMed Central

    ZHAO, HONGJUN; WU, CHUNMEI; WU, MENGYUN; ZHOU, YAOU; ZHU, HONGLIN; LI, YISHA; YOU, YUNHUI; LUO, HUI; WANG, LIJING; ZUO, XIAOXIA

    2016-01-01

    Multicentric reticulohistiocytosis (MRH) is a rare and debilitating systemic disorder characterized by cutaneous nodules and destructive polyarthritis. Due to its unknown etiology, the treatment of MRH varies with different rates of success, which causes treatment options to be rather independent and empirical. In the present study, a case of a 48-year-old woman with a 12-month history of polyarthralgia and skin nodules was reported. Biopsy samples, which were obtained from her skin eruption exhibited dermal infiltration with histiocytes and multinucleated giant cells. Immunohistochemical staining indicated positivity for CD68. The patient was diagnosed with MRH and treated with a combination therapy of infliximab, prednisolone and methotrexate. Her symptoms improved markedly within 2 weeks. Following the results of this case study, a systematic review of 17 cases of MRH treated with tumor necrosis factor (TNF) antagonists was performed, and the efficacy of anti-TNF treatment in MRH was analyzed. PMID:27175854

  4. A narrative review of factors influencing detection and treatment of depression in Vietnam

    PubMed Central

    2013-01-01

    Depression is among the most common psychiatric conditions in primary health care, and constitutes an important part of the global disease burden. However, it is difficult to obtain comparable data on depression worldwide and models for treatment and intervention need to be locally adapted. We conducted a narrative review of research literature on factors that influence depression screening, diagnosis and treatment among the Vietnamese population. This explorative approach included studies describing: a) culturally or contextually specific risk-factors for depression; b) any depression treatment seeking or treatment acceptability/adherence aspects or; c) depression screening among Vietnamese patients. We searched the PubMed and Cinahl databases, as well as relevant Vietnamese peer-reviewed journals and this produced 20 articles that were included in the review. Our findings indicate the importance of considering somatic symptoms when screening for depression in Vietnam as well as the use of culturally adapted and dimensional screening instruments. Our study confirms that depression reflects chronic social adversity, and thus an approach to mental health management that focuses solely on individual pathology will fail to address its important social causes. Further studies should elucidate whether neurasthenia is a commonly used illness label among Vietnamese patients that coincides with depression. The tendency among Vietnamese to seek traditional Vietnamese medicine and meditation practice when experiencing emotional distress was supported by our findings. PMID:23647977

  5. Prevalence, Awareness, Treatment, Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013.

    PubMed

    Yang, Li; Yan, Jing; Tang, Xinhua; Xu, Xiaoling; Yu, Wei; Wu, Haibin

    2016-01-01

    To investigate the prevalence, awareness, treatment, control of hypertension and their associated factors in southern China. A cross-sectional survey was conducted in 5 cities of urban areas and 5 counties of rural areas in Southern China in 2013, a stratified multistage random sampling method was used to select a representative sample. Recruitment included a total of 19254 participants aged 15 or older. Socio-demographic profiles, examinations were administrated on each subject. Multilevel logistic regression models were used to identify the risk factors of hypertension, awareness, treatment, and control. Overall, the prevalence of hypertension and pre-hypertension are 24.59% and 32.11%, respectively in southern China. Among all the hypertensive patients, 67.43% were aware of their condition, 55.76% took anti-hypertension medication recent two weeks, and 30.79% had their blood pressure controlled. Compared with male, female hypertensive patients had higher rates of hypertension awareness, treatment and control. Age, gender, marital status, living areas, education, BMI, waist circumference, visceral adipose index (VAI), high body fat percentage (BFP) and family hypertension history correlated with the prevalence of hypertension. SBP/DBP increased with VAI and BFP increasing. There is an increasing prevalence of hypertension and high pre-hypertension in the general population in southern China, but levels of awareness, treatment, and control remain relatively low, especially for young and middle-aged population. Innovative strategies including of adopting appropriate anti-hypertensive medication therapy and healthy lifestyles should be taken. PMID:26784948

  6. Knowledge, Treatment, Control, and Risk Factors for Hypertension among Adults in Southern Iran

    PubMed Central

    Zinat Motlagh, Sayed Fazel; Chaman, Reza; Ghafari, Sayed Rashid; Parisay, Zafar; Golabi, Mohamad Reza; Eslami, Ahmad Ali; Babouei, Amin

    2015-01-01

    Hypertension is the first and the most common risk factor to diseases such as cardiovascular, stroke, and renal diseases. The aim of this study was to determine the factors relevant to hypertension knowledge, treatment, and control in southern Iran. In this cross-sectional study, conducted in Kohgiluye Boyer-Ahmad province, south of Iran, a total of 1836 hypertension patients were randomly selected to participate voluntarily in the study. Hypertension treatment and its control were defined during study. In addition, knowledge about hypertension was measured by hypertension knowledge level scale (HK-LS). Treatment rates were 75.5 and 37.7 percent for female and male, respectively. Habitat, education, income, family history with hypertension, smoking, and time of diagnosis to the disease were found to be related to the treatment of the disease. Control rates were 30.7 and 31.4 for males and females, respectively. Habitat, education, and time of diagnosis to the disease were related to control. Over 50 percent of patients had average knowledge on hypertension. Considering the low rate of control and knowledge on hypertension among patients, health care providers should reinforce their services to improve appropriate knowledge level among elders and, also, plan comprehensive programs to promote health in order to encourage patients change and reform their life style. PMID:26783454

  7. Novel Aurora/vascular endothelial growth factor receptor dual kinase inhibitor as treatment for hepatocellular carcinoma.

    PubMed

    Nakao, Keisuke; Tanaka, Shinji; Miura, Tomoya; Sato, Kota; Matsumura, Satoshi; Aihara, Arihiro; Mitsunori, Yusuke; Ban, Daisuke; Ochiai, Takanori; Kudo, Atsushi; Arii, Shigeki; Tanabe, Minoru

    2015-08-01

    We previously identified Aurora B kinase as the only independent factor predictive of the aggressive recurrence of hepatocellular carcinoma (HCC). In this preclinical study, JNJ-28841072, a novel Aurora/vascular endothelial growth factor receptor dual kinase inhibitor, was evaluated for treatment of HCC. In vitro and in vivo effects of JNJ-28841072 were analyzed using human HCC cell cultures and xenograft models. An orthotopic liver xenograft model was used for the pharmacobiological effects on Aurora kinase and vascularization in hepatic tumors. JNJ-28841072 suppressed in vitro phosphorylation of histone H3 with induction of cell polyploidy and death in a dose-dependent manner (IC50  = 0.8-1.2 μM). In s.c. human HCC xenografts, remarkable inhibition of tumor growth was observed after JNJ-28841072 treatment (P = 0.0005). In orthotopic liver xenografts, the treatment with JNJ-28841072 significantly suppressed in vivo phosphorylation of histone H3 (P = 0.0008), vessel formation (P = 0.018), normoxic area (P = 0.0001), and hepatoma growth (P = 0.038). Our preclinical studies indicate that JNJ-28841072 is a promising novel therapeutic approach for the treatment of HCC. It might be worthy of evaluation in further studies. PMID:26011703

  8. Prevalence, Awareness, Treatment, Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013

    PubMed Central

    Tang, Xinhua; Xu, Xiaoling; Yu, Wei; Wu, Haibin

    2016-01-01

    To investigate the prevalence, awareness, treatment, control of hypertension and their associated factors in southern China. A cross-sectional survey was conducted in 5 cities of urban areas and 5 counties of rural areas in Southern China in 2013, a stratified multistage random sampling method was used to select a representative sample. Recruitment included a total of 19254 participants aged 15 or older. Socio-demographic profiles, examinations were administrated on each subject. Multilevel logistic regression models were used to identify the risk factors of hypertension, awareness, treatment, and control. Overall, the prevalence of hypertension and pre-hypertension are 24.59% and 32.11%, respectively in southern China. Among all the hypertensive patients, 67.43% were aware of their condition, 55.76% took anti-hypertension medication recent two weeks, and 30.79% had their blood pressure controlled. Compared with male, female hypertensive patients had higher rates of hypertension awareness, treatment and control. Age, gender, marital status, living areas, education, BMI, waist circumference, visceral adipose index (VAI), high body fat percentage (BFP) and family hypertension history correlated with the prevalence of hypertension. SBP/DBP increased with VAI and BFP increasing. There is an increasing prevalence of hypertension and high pre-hypertension in the general population in southern China, but levels of awareness, treatment, and control remain relatively low, especially for young and middle-aged population. Innovative strategies including of adopting appropriate anti-hypertensive medication therapy and healthy lifestyles should be taken. PMID:26784948

  9. Pre-treatment factors associated with detecting additional brain metastases at stereotactic radiosurgery.

    PubMed

    Wardak, Zabi; Augustyn, Alexander; Zhu, Hong; Mickey, Bruce E; Whitworth, Louis A; Madden, Christopher J; Barnett, Samuel L; Abdulrahman, Ramzi E; Nedzi, Lucien A; Timmerman, Robert D; Choe, Kevin S

    2016-06-01

    The number of brain metastases identified on diagnostic magnetic resonance imaging (MRI) is a key factor in consideration of stereotactic radiosurgery (SRS). However, additional lesions are often detected on high-resolution SRS-planning MRI. We investigated pre-treatment clinical characteristics that are associated with finding additional metastases at SRS. Patients treated with SRS for brain metastases between the years of 2009-2014 comprised the study cohort. All patients underwent frame-fixed, 1 mm thick MRI on the day of SRS. Patient, tumor, and treatment characteristics were analyzed for an association with increase in number of metastases identified on SRS-planning MRI. 289 consecutive SRS cases were analyzed. 725 metastases were identified on pre-treatment MRI and 1062 metastases were identified on SRS-planning MRI. An increase in the number of metastases occurred in 34 % of the cases. On univariate analysis, more than four metastases and the diameter of the largest lesion were significantly associated with an increase in number of metastases on SRS-planning MRI. When stratified by the diameter of the largest lesion into <2, 2-3, or ≥3 cm, additional metastases were identified in 37, 29, and 18 %, respectively. While this increase in the number of metastases is largely due to the difference in imaging technique, the number and size of the metastases were also associated with finding additional lesions. These clinical factors may be considered when determining treatment options for brain metastases. PMID:26966096

  10. Risk Factors for Treatment Failure of Polymyxin B Monotherapy for Carbapenem-Resistant Klebsiella pneumoniae Infections

    PubMed Central

    Dubrovskaya, Yanina; Scipione, Marco R.; Esaian, Diana; Phillips, Michael S.; Papadopoulos, John; Mehta, Sapna A.

    2013-01-01

    Polymyxins are reserved for salvage therapy of infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Though synergy has been demonstrated for the combination of polymyxins with carbapenems or tigecycline, in vitro synergy tests are nonstandardized, and the clinical effect of synergy remains unclear. This study describes outcomes for patients with CRKP infections who were treated with polymyxin B monotherapy. We retrospectively reviewed the medical records of patients with CRKP infections who received polymyxin B monotherapy from 2007 to 2011. Clinical, microbiology, and antimicrobial treatment data were collected. Risk factors for treatment failure were identified by logistic regression. Forty patients were included in the analysis. Twenty-nine of 40 (73%) patients achieved clinical cure as defined by clinician-documented improvement in signs and symptoms of infections, and 17/32 (53%) patients with follow-up culture data achieved microbiological cure. End-of-treatment mortality was 10%, and 30-day mortality was 28%. In a multivariate analysis, baseline renal insufficiency was associated with a 6.0-fold increase in clinical failure after adjusting for septic shock (odds ratio [OR] = 6.0; 95% confidence interval [CI] = 1.22 to 29.59). Breakthrough infections with organisms intrinsically resistant to polymyxins occurred in 3 patients during the treatment. Eighteen of 40 (45%) patients developed a new CRKP infection a median of 23 days after initial polymyxin B treatment, and 3 of these 18 infections were polymyxin resistant. The clinical cure rate achieved in this retrospective study was 73% of patients with CRKP infections treated with polymyxin B monotherapy. Baseline renal insufficiency was a risk factor for treatment failure after adjusting for septic shock. Breakthrough infections with organisms intrinsically resistant to polymyxin B and development of resistance to polymyxin B in subsequent CRKP isolates are of concern. PMID:23959321

  11. Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment

    PubMed Central

    Casals, M.; Caminero, J. A.; García-García, J. M.; Jiménez-Fuentes, M. A.; Medina, J. F.; Millet, J. P.; Ruiz-Manzano, J.; Caylá, J.

    2016-01-01

    Objective To determine the case-fatality rate (CFR) at the end of the intensive phase of tuberculosis (TB) treatment, and factors associated with fatality. Methods TB patients diagnosed between 2006 and 2013 were followed-up during treatment. We computed the CFR at the end of the intensive phase of TB treatment, and the incidence of death per 100 person-days (pd) of follow-up. We performed survival analysis using the Kaplan-Meier method and Cox regression, and calculate hazard ratios (HR) and 95% confidence intervals (CI). Results A total of 5,182 patients were included, of whom 180 (3.5%) died; 87 of these deaths (48.3%) occurred during the intensive phase of treatment, with a CFR of 1.7%. The incidence of death was 0.028/100 pd. The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;CI:4.8–283.4); being retired (HR = 2.4;CI:1.1–5.1); having visited the emergency department (HR = 3.1;CI:1.2–7.7); HIV infection (HR = 3.4;CI:1.6–7.2); initial standard treatment with 3 drugs (HR = 2.0;CI:1.2–3.3) or non-standard treatments (HR = 2.68;CI:1.36–5.25); comprehension difficulties (HR = 2.8;CI:1.3–6.1); and smear-positive sputum (HR = 2.3-CI:1.0–4.8). Conclusion There is a non-negligible CFR during the intensive phase of TB, whose reduction should be prioritised. The CFR could be a useful indicator for evaluating TB programs. PMID:27487189

  12. Incidence and risk factors of renal hematoma: a prospective study of 1,300 SWL treatments.

    PubMed

    Schnabel, M J; Gierth, M; Chaussy, C G; Dötzer, K; Burger, M; Fritsche, H M

    2014-06-01

    Shock wave lithotripsy (SWL) is the gold standard for the treatment of upper urinary tract stones. Despite being relatively non-invasive, SWL can cause renal hematoma (RHT). The aim of this study was to determine incidence and risk factors for RHT following SWL. 857 patients were included in a prospectively maintained database. The observation period spans from 2007 to 2012. 1,324 procedures were performed due to kidney stones. Treatment protocol included power ramping and shock wave frequency of 60-90 per minute as well as an ultrasound check within 3 days of SWL for all patients. Patients with RHT were analyzed, and treatment characteristics were compared with the complete population in a non-statistical manner due to the low event count. RHTs after SWL, sized between 2.6 × 0.6 cm and 17 × 15 cm, were verified in seven patients (0.53%). In four patients, the RHT was asymptomatic. Three patients developed pain after SWL treatment due to a RHT. In one patient surgical intervention was necessary due to a symptomatic RHT, the kidney was preserved. The risk of RHT following SWL treatment of kidney stones is about 0.5%. Clinically relevant or symptomatic RHTs occur in 0.23%, RHTs requiring surgical intervention are extremely rare. Older age and vascular comorbidities appear to be risk factors for the development of RHT. The technical characteristics of SWL treatment and intake of low-dose acetylsalicylic acid due to an imperative cardiologic indication do not appear to influence the risk. Prospective studies are warranted. PMID:24419328

  13. Substance abuse and batterer programmes in California, USA: factors associated with treatment outcomes

    PubMed Central

    Timko, Christine; Valenstein, Helen; Stuart, Gregory L.; Moos, Rudolf H.

    2015-01-01

    The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes. PMID:25470658

  14. Substance abuse and batterer programmes in California, USA: factors associated with treatment outcomes.

    PubMed

    Timko, Christine; Valenstein, Helen; Stuart, Gregory L; Moos, Rudolf H

    2015-11-01

    The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes. PMID:25470658

  15. [Distribution and influence factors of Anammox bacteria in sewage treatment systems].

    PubMed

    Zheng, Bingyu; Peng, Yongzhen; Zhang, Liang; Yang, Anming; Zhang, Shujun

    2014-12-01

    Nitrogen removal techniques based on Anammox process are developing rapidly these years. The distribution and diversity of Anammox have become important research directions. A variety of Anammox have been detected till now, of which only Kuenenia and Brocadia are often detected in wastewater treatment systems. In addition, in a single niche there is only one type of Anammox bacteria. However, the distribution mechanism and transformation of Anammox bacteria in different niches are still ambiguous. Therefore, the distribution of Anammox in various conditions was summarized and analyzed in this article. And the key factors influencing the distribution of Anammox were concluded, including substrate concentration and the specific growth rate, sludge properties and microbial niche, the joint action and influence of multiple factors. The engineering significance research on the distribution and influencing factors of Anammox bacteria in the sewage system and proposed research prospects were expounded. PMID:26016371

  16. Educational status-related disparities in awareness, treatment and control of cardiovascular risk factors in India

    PubMed Central

    Gupta, Rajeev; Sharma, Krishna Kumar; Gupta, Bal Kishan; Gupta, Arvind; Gupta, Revant R; Deedwania, Prakash C

    2015-01-01

    Objective To determine association of socioeconomic status, defined by educational status (ES), with awareness, treatment and control of cardiovascular risk factors. Methods We performed an epidemiological study at 11 cities in India using cluster sampling. 6198 subjects (3426 men, 2772 women, response 62%, age 48±10 years) were evaluated for sociodemographic, lifestyle, anthropometric and biochemical factors. ES was categorised according to years of schooling into low (≤10 years), medium (11–15 years) and high (>15 years). Risk factors were diagnosed according to current guidelines. Awareness, treatment and control status were determined for hypertension, diabetes and hypercholesterolaemia. For smoking/tobacco use, quit rate was determined. Descriptive statistics are reported. Results Age-adjusted and sex-adjusted prevalence (%) of various risk factors in low, medium and high ES subjects was hypertension 31.8, 29.5 and 34.1, diabetes 14.5, 15.3 and 14.3, hypercholesterolaemia 24.0, 23.9 and 27.3, and smoking/tobacco use 24.3, 14.4 and 19.0. Significantly increasing trends with low, medium and high ES were observed for hypertension awareness (30.7, 37.8, 47.0), treatment (24.3, 29.2, 35.5) and control (7.8, 11.6, 15.5); diabetes awareness (47.2, 51.5, 56.4), treatment (38.3, 41.3, 46.0) and control (18.3, 15.3, 22.8); hypercholesterolaemia awareness (8.9, 22.4, 18.4), treatment (4.1, 6.2, 7.9) and control (2.8, 3.2, 6.9), as well as for smoking/tobacco quit rates (1.6, 2.8, 5.5) (χ2 for trend, p<0.05). Conclusions Low ES subjects in India have lower awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia and smoking quit rates. PMID:27326202

  17. Factors associated with compliance with community directed treatment with ivermectin for onchocerciasis control in Southwestern Ethiopia

    PubMed Central

    2010-01-01

    Background Although ivermectin is distributed free of charge through the African Programme for Onchocerciasis Control (APOC), not all eligible individuals within communities receive the annual treatment. This poses a serious threat to efforts aimed to control onchocerciasis. This study attempts to determine factors associated with compliance to Community Directed Treatment with Ivermectin (CDTI) and provides a basis for trying to understand how best to sustain long-term compliance in order to achieve success in the control of onchocerciasis. Methods An unmatched case-control study was conducted in Bebeka coffee plantation southwest Ethiopia. Cases were, compliant i.e., those individuals who had been registered on the relevant treatment registers and had taken all the five annual doses of Ivermectin. Controls were non-compliant, i.e. those individuals who had been recorded in the relevant treatment registers during the first treatment round(2003), and did not take at least two doses of which one being in the last treatment round (2007). Data were collected using a pre-tested interviewer administered structured questionnaire. Data were edited, cleaned, coded and analyzed using SPSS version 12.0.1 for Microsoft Windows. Multiple logistic regression models was used to identify factors associated with compliance to ivermectin. Results From the total of 456 individuals selected for administration of the survey questionnaire, 450(225 cases and 225 controls) were contacted and completed the study 2 refused and 4 were unavailable. Five factors associated with compliance were identified: high risk perception [Adjusted Odds Ratio(AOR) = 1.98, 95% Confidence Interval (CI), 1.32-2.95], one's family support [AOR = 1.86, 95% CI, 1.22-2.84], perceiving that the Community Drug Distributors (CDDs) are doing their work well [AOR = 2.84, 95% CI, 1.50-5.37] and perceiving measuring height is the best way to determine a person's treatment dose [AOR = 6.37, 95% CI, 2.10-19.29] are

  18. Dendritic cell vaccination for glioblastoma multiforme: review with focus on predictive factors for treatment response

    PubMed Central

    Dejaegher, Joost; Van Gool, Stefaan; De Vleeschouwer, Steven

    2014-01-01

    Glioblastoma multiforme (GBM) is the most common and most aggressive type of primary brain cancer. Since median overall survival with multimodal standard therapy is only 15 months, there is a clear need for additional effective and long-lasting treatments. Dendritic cell (DC) vaccination is an experimental immunotherapy being tested in several Phase I and Phase II clinical trials. In these trials, safety and feasibility have been proven, and promising clinical results have been reported. On the other hand, it is becoming clear that not every GBM patient will benefit from this highly personalized treatment. Defining the subgroup of patients likely to respond to DC vaccination will position this option correctly amongst other new GBM treatment modalities, and pave the way to incorporation in standard therapy. This review provides an overview of GBM treatment options and focuses on the currently known prognostic and predictive factors for response to DC vaccination. In this way, it will provide the clinician with the theoretical background to refer patients who might benefit from this treatment.

  19. Are there any factors influencing the course of multistage treatment in Hirschsprung's disease?

    PubMed Central

    Błaszczyński, Michał; Moryciński, Sebastian; Porzucek, Witold; Mańkowski, Przemysław

    2016-01-01

    Introduction Surgical treatment of Hirschsprung's disease may be performed in a single step, or in stages with a temporary stoma. The therapy depends on the clinical condition of the patient and the severity of symptoms. Planned multistage treatment is carried out in two or three steps. Aim To analyse our 15 years of experience with multistage surgery for the treatment of Hirschsprung's disease, to identify multistage-related factors influencing the course of surgery and hospitalisation, and to evaluate the probability of complications during multistage treatment. Material and methods The study material was collected on the basis of documentation of patients treated during the years 2000 to 2014. The parameters concerning surgery and hospitalisation were statistically analysed. Results Twenty nine patients were treated with multistage surgery using the following methods: Duhamel-Martin and Transanal Endorectal Pull-Through (TEPT). There were significant correlations (p < 0.05) between length of resected intestine and operative time. Classification and Regression Tree (CRT) was used to classify the operated children depending on the presentence of complications after surgery. Conclusions The incidence of complications during multistage treatment for both methods was comparable. It is difficult to objectively compare the Duhamel-Martin and TEPT techniques because of the different indicators for their use in multistage surgery. Intestinal adhesions were the most common complication after definitive surgery. Younger age of the operated patients was associated with greater risk of adhesion formation. PMID:27350842

  20. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment.

    PubMed

    Chen, Jia-Xiang; Lai, Ling-Feng; Zheng, Kuang; Li, Guo-Xiong; He, Xu-Ying; Li, Liang-Ping; Duan, Chuan-Zhi

    2015-09-01

    The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely. PMID:26100332

  1. A combined model of human erythropoiesis and granulopoiesis under growth factor and chemotherapy treatment

    PubMed Central

    2014-01-01

    Background Haematotoxicity of conventional chemotherapies often results in delays of treatment or reduction of chemotherapy dose. To ameliorate these side-effects, patients are routinely treated with blood transfusions or haematopoietic growth factors such as erythropoietin (EPO) or granulocyte colony-stimulating factor (G-CSF). For the latter ones, pharmaceutical derivatives are available, which differ in absorption kinetics, pharmacokinetic and -dynamic properties. Due to the complex interaction of cytotoxic effects of chemotherapy and the stimulating effects of different growth factor derivatives, optimal treatment is a non-trivial task. In the past, we developed mathematical models of thrombopoiesis, granulopoiesis and erythropoiesis under chemotherapy and growth-factor applications which can be used to perform clinically relevant predictions regarding the feasibility of chemotherapy schedules and cytopenia prophylaxis with haematopoietic growth factors. However, interactions of lineages and growth-factors were ignored so far. Results To close this gap, we constructed a hybrid model of human granulopoiesis and erythropoiesis under conventional chemotherapy, G-CSF and EPO applications. This was achieved by combining our single lineage models of human erythropoiesis and granulopoiesis with a common stem cell model. G-CSF effects on erythropoiesis were also implemented. Pharmacodynamic models are based on ordinary differential equations describing proliferation and maturation of haematopoietic cells. The system is regulated by feedback loops partly mediated by endogenous and exogenous EPO and G-CSF. Chemotherapy is modelled by depletion of cells. Unknown model parameters were determined by fitting the model predictions to time series data of blood counts and cytokine profiles. Data were extracted from literature or received from cooperating clinical study groups. Our model explains dynamics of mature blood cells and cytokines after growth-factor applications in

  2. Childhood Tuberculosis in a Sub-Saharan Tertiary Facility: Epidemiology and Factors Associated with Treatment Outcome

    PubMed Central

    Kinsiona, Christian; Fueza, Serge Bisuta; Kokolomami, Jack; Bolie, Grace; Lumbala, Paul

    2016-01-01

    Childhood tuberculosis (TB) is a diagnostic challenge in developing countries, and patient outcome can be influenced by certain factors. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Kinshasa. Documentary and analytical studies were conducted using clinical and exploratory data for children aged up to 15 years who were admitted to the University Clinics of Kinshasa for TB. Data are presented as frequencies and averages, and binary and logistic regression analyses were performed. Of 283 children with TB, 82 (29.0%) had smear-negative TB, 40 (14.1%) had smear-positive TB, 159 (56.1%) had extra-pulmonary TB (EPTB), 2 (0.7%) had multidrug-resistant TB (MDR-TB), 167 (59.0%) completed treatment, 30 (10.6%) were cured, 7 (2.5%) failed treatment, 4 (1.4%) died, 55 (19.4%) were transferred to health centers nearest their home, and 20 (7.0%) were defaulters. In the binary analysis, reported TB contacts (p = 0.048), type of TB (p = 0.000), HIV status (p = 0.050), Ziehl-Nielsen test result (p = 0.000), Lowenstein culture (p = 0.004) and chest X-ray (p = 0.057) were associated with outcome. In the logistic regression, none of these factors was a significant predictor of outcome. Tertiary level care facilities must improve the diagnosis and care of patients with childhood TB, which justifies the development of alternative diagnostic techniques and the assessment of other factors that potentially affect outcome. PMID:27101146

  3. Childhood Tuberculosis in a Sub-Saharan Tertiary Facility: Epidemiology and Factors Associated with Treatment Outcome.

    PubMed

    Aketi, Loukia; Kashongwe, Zacharie; Kinsiona, Christian; Fueza, Serge Bisuta; Kokolomami, Jack; Bolie, Grace; Lumbala, Paul; Diayisu, Joseph Shiku

    2016-01-01

    Childhood tuberculosis (TB) is a diagnostic challenge in developing countries, and patient outcome can be influenced by certain factors. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Kinshasa. Documentary and analytical studies were conducted using clinical and exploratory data for children aged up to 15 years who were admitted to the University Clinics of Kinshasa for TB. Data are presented as frequencies and averages, and binary and logistic regression analyses were performed. Of 283 children with TB, 82 (29.0%) had smear-negative TB, 40 (14.1%) had smear-positive TB, 159 (56.1%) had extra-pulmonary TB (EPTB), 2 (0.7%) had multidrug-resistant TB (MDR-TB), 167 (59.0%) completed treatment, 30 (10.6%) were cured, 7 (2.5%) failed treatment, 4 (1.4%) died, 55 (19.4%) were transferred to health centers nearest their home, and 20 (7.0%) were defaulters. In the binary analysis, reported TB contacts (p = 0.048), type of TB (p = 0.000), HIV status (p = 0.050), Ziehl-Nielsen test result (p = 0.000), Lowenstein culture (p = 0.004) and chest X-ray (p = 0.057) were associated with outcome. In the logistic regression, none of these factors was a significant predictor of outcome. Tertiary level care facilities must improve the diagnosis and care of patients with childhood TB, which justifies the development of alternative diagnostic techniques and the assessment of other factors that potentially affect outcome. PMID:27101146

  4. Epidermal growth factor treatment decreases mortality and is associated with improved gut integrity in sepsis

    PubMed Central

    Clark, Jessica A.; Clark, Andrew T.; Hotchkiss, Richard S.; Buchman, Timothy G.; Coopersmith, Craig M.

    2007-01-01

    Epidermal growth factor (EGF) is a cytoprotective peptide that has healing effects on the intestinal mucosa. We sought to determine whether systemic administration of EGF following the onset of sepsis improved intestinal integrity and decreased mortality. FVB/N mice were subjected to either sham laparotomy or 2×23 cecal ligation and puncture (CLP). Septic mice were further randomized to receive intraperitoneal injection of either 150 μg/kg/day EGF or 0.9% saline. Circulating EGF levels were decreased following CLP compared to sham animals but were unaffected by giving exogenous EGF treatment. In contrast, intestinal EGF levels increased following CLP, and were further augmented by exogenous EGF treatment. Intestinal EGF-receptor (EGF-R) was increased following CLP whether assayed by immunohistochemistry, real-time PCR or western blot, and exogenous EGF treatment decreased intestinal EGF-R. Villus length decreased 2-fold between sham and septic animals, and EGF treatment resulted in near total restitution of villus length. Sepsis decreased intestinal proliferation and increased intestinal apoptosis. This was accompanied by increased expression of the pro-apoptotic proteins Bid and FADD, as well as the cyclin-dependent kinase inhibitor p21cip1/waf. EGF treatment after the onset of sepsis restored both proliferation and apoptosis to levels seen in sham animals and normalized expression of Bid, FADD, and p21cip1/waf. To determine whether improvements in gut homeostasis were associated with a decrease in sepsis-induced mortality, septic mice with or without EGF treatment after CLP were followed seven days for survival. Mortality decreased from 60% to 30% in mice treated with EGF after the onset of sepsis (p<0.05). EGF may thus be a potential therapeutic agent for the treatment of sepsis, in part due to its ability to protect intestinal integrity. PMID:18004230

  5. Factors related with symptom duration until diagnosis and treatment of symptomatic colorectal cancer

    PubMed Central

    2013-01-01

    Background Colorectal cancer (CRC) survival depends mostly on stage at the time of diagnosis. However, symptom duration at diagnosis or treatment have also been considered as predictors of stage and survival. This study was designed to: 1) establish the distinct time-symptom duration intervals; 2) identify factors associated with symptom duration until diagnosis and treatment. Methods This is a cross-sectional study of all incident cases of symptomatic CRC during 2006–2009 (795 incident cases) in 5 Spanish regions. Data were obtained from patients’ interviews and reviews of primary care and hospital clinical records. Measurements: CRC symptoms, symptom perception, trust in the general practitioner (GP), primary care and hospital examinations/visits before diagnosis, type of referral and tumor characteristics at diagnosis. Symptom Diagnosis Interval (SDI) was calculated as time from first CRC symptoms to date of diagnosis. Symptom Treatment Interval (STI) was defined as time from first CRC symptoms until start of treatment. Nonparametric tests were used to compare SDI and STI according to different variables. Results Symptom to diagnosis interval for CRC was 128 days and symptom treatment interval was 155. No statistically significant differences were observed between colon and rectum cancers. Women experienced longer intervals than men. Symptom presentation such as vomiting or abdominal pain and the presence of obstruction led to shorter diagnostic or treatment intervals. Time elapsed was also shorter in those patients that perceived their first symptom/s as serious, disclosed it to their acquaintances, contacted emergencies services or had trust in their GPs. Primary care and hospital doctor examinations and investigations appeared to be related to time elapsed to diagnosis or treatment. Conclusions Results show that gender, symptom perception and help-seeking behaviour are the main patient factors related to interval duration. Health service performance also

  6. Factors Associated With Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana.

    PubMed

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A; Akingbola, Titilola S; Hewlett, Sandra A; Tayo, Bamidele O; Cole, Helen V; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-08-01

    Background Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study evaluated duration and factors that influenced waiting time from first presentation to start of definitive treatment. Method We conducted a hospital-based retrospective study of 205 breast cancer patients starting definitive treatment at Korle Bu Teaching Hospital between May and December 2013. We used descriptive statistics to summarize patient characteristics. Mann-Whitney U and Kruskal-Wallis tests and Spearman rank correlation were performed to examine the patients, health system, and health worker factors associated with median waiting time. Poisson regression was used to examine the determinants of waiting time. Results The mean age of the patients was 51.1 ± 11.8 years. The median waiting time was 5 weeks. The determinants of waiting time were level of education, age, income, marital status, ethnicity, disease stage, health insurance status, study sites, time interval between when biopsy was requested and when results were received and receipt of adequate information from health workers. Conclusion A prolonged waiting time to treatment occurs for breast cancer patients in Ghana, particularly for older patients, those with minimal or no education, with lower income, single patients, those with late disease, those who are insured, and who did not receive adequate information from the health workers. Time to obtain biopsy reports should be shortened. Patients and providers need education on timely treatment to improve prognosis. PMID:27091222

  7. Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011

    PubMed Central

    Shahrezaei, Marzieh; Maracy, Mohammad Reza; Farid, Fariba

    2015-01-01

    Background: Regarding cases of infectious diseases tuberculosis (TB) is the most important cause of death and according to the DALY criteria, this disease has the seventh position in global disease ranking. In this study, we aim to determine the risk factors, which have a significant effect on the treatment completion and mortality of TB patients. Methods: This study is a retrospective cohort study. The sample is made up of registered TB patients in the Isfahan Province from 2006 to 2011. Information of the patients was collected from their files in health centers in the Isfahan Province. Variables such as age, sex, weight, nationality, residence, type of TB, imprisonment, human immunodeficiency virus, TB case were measured. Descriptive statistics (including frequency, percentage, mean and standard deviation) and statistical analysis (including Cox proportional hazard model) were used. Results: The result showed that imprisonment (hazard ratio [HR] = 4.76, P = 0.019), age (HR = 4.44, P = 0.001) and the TB case (HR = 2.73, P = 0.037) of pulmonary TB had significant impacts on mortality of the patients, also in the case of treatment completion, the TB case (HR = 0.34, P < 0.001) proved to have a significant impact on completion of the treatment. Type of extra-pulmonary TB in extra-pulmonary TB patients also had an effect on treatment completion. Conclusions: We can conclude that factors such as age, imprisonment, TB case and type of extra-pulmonary TB are effective on the treatment completion and mortality of the patients. It may be useful for policy makers to make more control of high-risk patients. PMID:26445638

  8. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    PubMed Central

    Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

    2016-01-01

    Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition. PMID:27625723

  9. Factors affecting sphincter-preserving resection treatment for patients with low rectal cancer

    PubMed Central

    SUN, ZHENQIANG; YU, XIANBO; WANG, HAIJIANG; MA, MING; ZHAO, ZELIANG; WANG, QISAN

    2015-01-01

    The aim of the present study was to identify the factors associated with the use of sphincter-preserving resection (SPR) surgery for the treatment of low rectal cancer. A total of 330 patients with histopathologically confirmed low rectal cancer were divided into two groups, namely the abdominoperineal resection (APR) and sphincter-preserving (SP) groups. For SPR factor analysis, the χ2 test was performed as the univariate analysis, while a logistic regression test was conducted as the multivariate analysis. Of the 330 patients, 192 cases (58.18%) received SPR surgery and 138 cases (41.82%) underwent an APR. Univariate analysis results revealed that the sphincter-preserving factor was significantly associated with age, gender, ethnicity, body mass index (BMI), total infiltrated circumference, distance of the tumor from the anal verge (DTAV), depth of invasion and tumor grade (P<0.05). However, there were no statistically significant associations with family medical history, diabetes history, venous tumor embolism, growth type, tumor length, lymphatic metastasis and level of preoperative carcinoembryonic antigen (P>0.05). Multivariate analysis indicated that the sphincter-preserving factor was strongly associated with DTAV and the depth of invasion, with significant statistical difference (P<0.05). Therefore, selecting SPR surgery for patients with low rectal cancer is dependent on age, gender, ethnicity, BMI, the total infiltrated circumference, DTAV, depth of invasion and tumor grade. In addition, DTAV and the depth of invasion are independent risk factors for the selection of SPR surgery. PMID:26622341

  10. Distribution of Hepatitis C Risk Factors and HCV Treatment Outcomes among Central Canadian Aboriginal

    PubMed Central

    Parmar, Parmvir; Corsi, Daniel J.; Cooper, Curtis

    2016-01-01

    Background. Aboriginal Canadians face many lifestyle risk factors for hepatitis C exposure. Methods. An analysis of Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Canada) patients between January 2000 and August 2013 was performed. HCV infection risk factors and HCV treatment outcomes were assessed. Socioeconomic status markers were based on area-level indicators linked to postal codes using administrative databases. Results. 55 (2.8%) Aboriginal and 1923 (97.2%) non-Aboriginal patients were evaluated. Aboriginals were younger (45.6 versus 49.6 years, p < 0.01). The distribution of gender (63.6% versus 68.3% male), HIV coinfection (9.1% versus 8.1%), advanced fibrosis stage (29.2% versus 28.0%), and SVR (56.3% versus 58.9%) was similar between groups. Aboriginals had a higher number of HCV risk factors, (mean 4.2 versus 3.1, p < 0.001) with an odds ratio of 2.5 (95% confidence interval: 1.4–4.4) for having 4+ risk factors. This was not explained after adjustment for income, social deprivation, and poor housing. Aboriginal status was not related to SVR. Aboriginals interrupted therapy more often due to loss to follow-up, poor adherence, and substance abuse (25.0% versus 4.6%). Conclusion. Aboriginal Canadians have higher levels of HCV risk factors, even when adjusting for socioeconomic markers. Despite facing greater barriers to care, SVR rates were comparable with non-Aboriginals. PMID:27446875

  11. Inflammation and cancer-related fatigue: Mechanisms, contributing factors, and treatment implications

    PubMed Central

    Bower, Julienne E.; Lamkin, Donald M.

    2014-01-01

    Fatigue is one of the most common and distressing side effects of cancer and its treatment, and may persist for years after treatment completion in otherwise healthy survivors. Guided by basic research on neuro-immune interactions, a growing body of research has examined the hypothesis that cancer-related fatigue is driven by activation of the pro-inflammatory cytokine network. In this review, we examine the current state of the evidence linking inflammation and cancer-related fatigue, drawing from recent human research and from experimental animal models probing effects of cancer and cancer treatment on inflammation and fatigue. In addition, we consider two key questions that are currently driving research in this area: what are the neural mechanisms of fatigue, and what are the biological and psychological factors that influence the onset and/or persistence of inflammation and fatigue in cancer patients and survivors? Identification of the mechanisms driving cancer-related fatigue and associated risk factors will facilitate the development of targeted interventions for vulnerable patients. PMID:22776268

  12. Subclinical Hypothyroidism after 131I-Treatment of Graves’ Disease: A Risk Factor for Depression?

    PubMed Central

    Yu, Jing; Tian, Ai-Juan; Yuan, Xin; Cheng, Xiao-Xin

    2016-01-01

    Objectives Although it is well accepted that there is a close relationship between hypothyroidism and depression, previous studies provided inconsistent or even opposite results in whether subclinical hypothyroidism (SCH) increased the risk of depression. One possible reason is that the etiology of SCH in these studies was not clearly distinguished. We therefore investigated the relationship between SCH resulting from 131I treatment of Graves’ disease and depression. Design And Methods The incidence of depression among 95 patients with SCH and 121 euthyroid patients following 131I treatment of Graves’ disease was studied. The risk factors of depression were determined with multivariate logistic regression analysis. Thyroid hormone replacement therapy was performed in patients with thyroid-stimulating hormone (TSH) levels exceeding 10 mIU/L. Results Patients with SCH had significantly higher Hamilton Depression Scale scores, serum TSH and thyroid peroxidase antibody (TPOAb) levels compared with euthyroid patients. Multivariate logistic regression analysis revealed SCH, Graves’ eye syndrome and high serum TPO antibody level as risk factors for depression. L-thyroxine treatment is beneficial for SCH patients with serum TSH levels exceeding 10 mIU/L. Conclusions The results of the present study demonstrated that SCH is prevalent among 131I treated Graves’ patients. SCH might increase the risk of developing depression. L-thyroxine replacement therapy helps to resolve depressive disorders in SCH patients with TSH > 10mIU/L. These data provide insight into the relationship between SCH and depression. PMID:27135245

  13. Patient and program factors that bridge the detoxification-treatment gap: a structured evidence review.

    PubMed

    Timko, Christine; Below, Maureen; Schultz, Nicole R; Brief, Deborah; Cucciare, Michael A

    2015-05-01

    Although completion of detoxification (detox) and a successful transition from detox to substance use disorder (SUD) treatment and/or mutual-help groups are associated with better SUD outcomes, many patients do not complete detox or do not receive SUD care following detox. The purpose of this structured evidence review, summarizing data extraction on a yield of 26 articles, is to identify patient, program, and system factors associated with the outcomes of completion of alcohol detox and successful transitions from alcohol detox to SUD treatment and mutual-help group participation. The review found wide variability among studies in the rates at which patients complete a detox episode (45 to 95%) and enter SUD treatment or mutual-help groups after detox (14 to 92%). Within program factors, behavioral practices that contribute to both detox completion and transitioning to SUD care after detox entail involving the patient's family and utilizing motivational-based approaches. Such practices should be targeted at younger patients, who are less likely to complete detox. Although more studies using a randomized controlled trial design are needed, the evidence suggests that barriers to detox completion and transition to SUD care can be overcome to improve patient outcomes. PMID:25530425

  14. Sulfur mustard-induced neutropenia: treatment with granulocyte colony-stimulating factor.

    PubMed

    Anderson, Dana R; Holmes, Wesley W; Lee, Robyn B; Dalal, Stephen J; Hurst, Charles G; Maliner, Beverly I; Newmark, Jonathan; Smith, William J

    2006-05-01

    Although best known as a blistering agent, sulfur mustard (HD) can also induce neutropenia in exposed individuals, increasing their susceptibility to infection. Granulocyte colony-stimulating factor (G-CSF) and pegylated G-CSF (peg-G-CSF) have been approved by the U.S. Food and Drug Administration as hematopoietic growth factors to treat chemotherapy-induced neutropenia. The goal of this study was to determine the effectiveness of G-CSF and peg-G-CSF in ameliorating HD-induced neutropenia. African green monkeys (Chlorocebus aethiops) were challenged with HD and, at 1, 3, 5, or 7 days after exposure, G-CSF therapy (10 microg/kg per day for 21 days) was initiated. Peg-G-CSF (300 microg/kg, single treatment) was similarly tested, with treatment given at 3 days after exposure. Untreated HD-exposed animals recovered from neutropenia 28 days after exposure, whereas G-CSF- or peg-G-CSF-treated animals recovered 8 to 19 days after exposure (p < 0.05). These results indicate that G-CSF or peg-G-CSF may provide Food and Drug Administration-approved treatments that will reduce the duration of HD-induced neutropenia. PMID:16761898

  15. Vascular endothelial growth factor inhibitors: investigational therapies for the treatment of psoriasis

    PubMed Central

    Weidemann, Anja K; Crawshaw, Ania A; Byrne, Emily; Young, Helen S

    2013-01-01

    Psoriasis is a common inflammatory autoimmune condition in which environmental factors and genetic predisposition contribute to the development of disease in susceptible individuals. Angiogenesis is known to be a key pathogenic feature of psoriasis. Local and systemic elevation of vascular endothelial growth factor (VEGF)-A has been demonstrated in the skin and plasma of patients with psoriasis and is known to correlate with improvement following some traditional psoriasis treatments. A number of VEGF inhibitors are licensed for the treatment of malignancies and eye disease and isolated case reports suggest that some individuals with psoriasis may improve when exposed to these agents. The small number of cases and lack of unified reporting measures makes it difficult to draw generalizations and underline the heterogeneity of psoriasis as a disease entity. Though not yet licensed for the treatment of psoriasis in humans, experimental data supports the potential of VEGF inhibitors to influence relevant aspects of human cell biology (such as endothelial cell differentiation) and to improve animal models of skin disease. Given the multi-factorial nature of psoriasis it is unlikely that VEGF inhibitors will be effective in all patients, however they have the potential to be a valuable addition to the therapeutic arsenal in selected cases. Current VEGF inhibitors in clinical use are associated with a number of potentially serious side effects including hypertension, left ventricular dysfunction, and gastrointestinal perforation. Such risks require careful consideration in psoriasis populations particularly in light of growing concerns linking psoriasis to increased cardiovascular risk. PMID:24101875

  16. Vascular endothelial growth factor inhibitors: investigational therapies for the treatment of psoriasis.

    PubMed

    Weidemann, Anja K; Crawshaw, Ania A; Byrne, Emily; Young, Helen S

    2013-01-01

    Psoriasis is a common inflammatory autoimmune condition in which environmental factors and genetic predisposition contribute to the development of disease in susceptible individuals. Angiogenesis is known to be a key pathogenic feature of psoriasis. Local and systemic elevation of vascular endothelial growth factor (VEGF)-A has been demonstrated in the skin and plasma of patients with psoriasis and is known to correlate with improvement following some traditional psoriasis treatments. A number of VEGF inhibitors are licensed for the treatment of malignancies and eye disease and isolated case reports suggest that some individuals with psoriasis may improve when exposed to these agents. The small number of cases and lack of unified reporting measures makes it difficult to draw generalizations and underline the heterogeneity of psoriasis as a disease entity. Though not yet licensed for the treatment of psoriasis in humans, experimental data supports the potential of VEGF inhibitors to influence relevant aspects of human cell biology (such as endothelial cell differentiation) and to improve animal models of skin disease. Given the multi-factorial nature of psoriasis it is unlikely that VEGF inhibitors will be effective in all patients, however they have the potential to be a valuable addition to the therapeutic arsenal in selected cases. Current VEGF inhibitors in clinical use are associated with a number of potentially serious side effects including hypertension, left ventricular dysfunction, and gastrointestinal perforation. Such risks require careful consideration in psoriasis populations particularly in light of growing concerns linking psoriasis to increased cardiovascular risk. PMID:24101875

  17. The role of nerve growth factor in the prophylaxis and treatment of diabetic foot ulcers

    PubMed Central

    Tiaka, Elisavet K; Papanas, Nikolaos; Manolakis, Anastassios C; Maltezos, Efstratios

    2011-01-01

    Diabetic foot ulcers are still particularly difficult to heal. Therefore, preventing and therapeutic adjuncts are increasingly being explored. Nerve growth factor (NGF) is a promising agent exhibiting beneficial actions on both diabetic peripheral neuropathy, one of the main causes of foot ulcers, and on ulcer healing. Indeed, preclinical research in animal models of diabetes has revealed the trophic effect of NGF on small C-fibres, while phase 2 human trials have provided evidence for a favourable effect on sensory neuropathy. However, the results of a phase 3 trial were moderate and, therefore, not enough to encourage widespread use of NGF in the treatment of diabetic neuropathy. Available literature on the role of NGF on diabetic wound healing is sparse but encouraging. Exogenous supplementation of NGF or the use of alternative techniques to increase its endogenous expression could emerge as a protective and therapeutic modality for diabetic foot ulcers in addition to standard treatment and other growth factors. The present review provides an outlook on the role of NGF in the prophylaxis and treatment of diabetic foot ulcers. PMID:22928161

  18. Controlling factors for water residence time and flow patterns in Ekeby treatment wetland, Sweden

    NASA Astrophysics Data System (ADS)

    Kjellin, Johan; Wörman, Anders; Johansson, Håkan; Lindahl, Anna

    2007-04-01

    Treatment wetlands play an important role in reducing nutrient content and heavy metals in wastewater and run-off water. The treatment efficiency strongly depends on flow pattern and residence times of the water. Here, we study the impact of different factors on water flow patterns based on a tracer experiment with tritiated water in a 2.6 ha constructed wetland pond. A 2D flow and inert transport model was used to evaluate the relative importance of bottom topography, vegetation distribution, water exchange with stagnant zones and dispersion. Results from computer simulations and independent measurements of friction losses as well as wetland geometry showed that variations in bottom topography, formed by several deep zones, decreased the variance in water residence times to a minor extent. Heterogeneity in vegetation, on the other hand, significantly contributed to the spread in water residence times and explained the multiple peaks observed in the breakthrough curves. Analyses showed that in the Ekeby treatment wetland, basin shape explained about 10% of the variance in the observed residence times, whereas vegetation explained about 60-80%. To explain all variance secondary factors were needed, such as dispersion and water exchange with stagnant zones. These were shown to contribute to the spread of residence times and primarily to the long tail of the observed breakthrough curves.

  19. Non-communicable disease risk factors and treatment preference of obese patients in Cape Town

    PubMed Central

    Manning, Kathryn; Senekal, Marjanne

    2016-01-01

    Background Insights into the characteristics of treatment seekers for lifestyle changes and treatment preferences are necessary for intervention planning. Aim To compile a profile of treatment-seeking obese patients with non-communicable diseases (NCDs) or NCD risk factors and to compare patients who choose group-based (facility-based therapeutic group [FBTG]) versus usual care (individual consultations) treatment. Setting A primary healthcare facility in Cape Town, South Africa. Methods One hundred and ninety-three patients were recruited in this cross-sectional study. Ninety six chose FBTG while 97 chose usual care. A questionnaire, the hospital database and patients’ folders were used to collect data. Weight, height and waist circumference were measured. STATA 11.0 was used for descriptive statistics and to compare the two groups. Results The subjects’ mean age was 50.4 years, 78% were women and of low education levels and income, and 41.5% had type 2 diabetes, 83.4% hypertension and 69.5% high cholesterol. Mean (s.d.) HbA1c was 9.1 (2.0)%, systolic BP 145.6 (21.0) mmHg, diastolic BP 84.5 (12.0) mmHg, cholesterol 5.4 (1.2) mmol/L), body mass indicator (BMI) 39.3 (7.3) kg/m2 and waist circumference 117 (12.6) cm). These figures were undesirable although pharmacological treatment for diabetes and hypertension was in place. Only 14% were physically active, while TV viewing was > 2h/day. Mean daily intake of fruit and vegetables (2.2 portions/day) was low while added sugar (5 teaspoons) and sugar-sweetened beverages (1.3 glasses) were high. Usual care patients had a higher smoking prevalence, HbA1c, number of NCD risk factors and refined carbohydrate intake, and a lower fruit and vegetable intake. Conclusion Treatment seekers were typically middle-aged, low income women with various modifiable and intermediate risk factors for NCDs. Patients choosing usual care could have more NCD risks. PMID:27380784

  20. FacPad: Bayesian sparse factor modeling for the inference of pathways responsive to drug treatment

    PubMed Central

    Ma, Haisu; Zhao, Hongyu

    2012-01-01

    Motivation: It is well recognized that the effects of drugs are far beyond targeting individual proteins, but rather influencing the complex interactions among many relevant biological pathways. Genome-wide expression profiling before and after drug treatment has become a powerful approach for capturing a global snapshot of cellular response to drugs, as well as to understand drugs’ mechanism of action. Therefore, it is of great interest to analyze this type of transcriptomic profiling data for the identification of pathways responsive to different drugs. However, few computational tools exist for this task. Results: We have developed FacPad, a Bayesian sparse factor model, for the inference of pathways responsive to drug treatments. This model represents biological pathways as latent factors and aims to describe the variation among drug-induced gene expression alternations in terms of a much smaller number of latent factors. We applied this model to the Connectivity Map data set (build 02) and demonstrated that FacPad is able to identify many drug–pathway associations, some of which have been validated in the literature. Although this method was originally designed for the analysis of drug-induced transcriptional alternation data, it can be naturally applied to many other settings beyond polypharmacology. Availability and implementation: The R package ‘FacPad’ is publically available at: http://cran.open-source-solution.org/web/packages/FacPad/ Contact: hongyu.zhao@yale.edu Supplementary Information: Supplementary data are available at Bioinformatics online. PMID:22923307

  1. Impact of identifying factors which trigger bothersome tinnitus on the treatment outcome in tinnitus retraining therapy.

    PubMed

    Molini, Egisto; Faralli, Mario; Calzolaro, Lucia; Ricci, Giampietro

    2014-01-01

    The aim of this work was to ascertain any differences in the effectiveness of rehabilitation therapy in relation to the presence or absence of a known negative reinforcement responsible for the tinnitus-related pathology. Between 1 January 2001 and 31 December 2008, we recruited 294 subjects suffering from incapacitating tinnitus and/or hyperacusis. The patients underwent tinnitus retraining therapy (TRT) according to the methods described by Jastreboff and Hazell [Tinnitus Retraining Therapy: Implementing the Neurophysiological Model. Cambridge, Cambridge University Press, 2004, pp 121-133]. We clinically assessed the presence or absence of known phenomena of associative learning, regarding the presence of adverse events temporally correlated with tinnitus and the treatment outcome. The separate analysis of the 2 subgroups shows a statistically significant difference in the improvement rate between the group with a known triggering factor and the group without a triggering factor, with a preponderance of the former with a 91% improvement rate versus approximately 56% for the latter. In our study, the inability to identify factors triggering bothersome tinnitus negatively affected the treatment outcome in TRT. PMID:24777173

  2. Dry-heat treatment process for enhancing viral safety of an antihemophilic factor VIII concentrate prepared from human plasma.

    PubMed

    Kim, In Seop; Choi, Yong Woon; Kang, Yong; Sung, Hark Mo; Shin, Jeong Sup

    2008-05-01

    Viral safety is a prerequisite for manufacturing clinical antihemophilic factor VIII concentrates from human plasma. With particular regard to the hepatitis A virus (HAV), a terminal dry-heat treatment (100 degrees for 30 min) process, following lyophilization, was developed to improve the virus safety of a solvent/detergent-treated antihemophilic factor VIII concentrate. The loss of factor VIII activity during dry-heat treatment was of about 5%. No substantial changes were observed in the physical and biochemical characteristics of the dry-heat-treated factor VIII compared with those of the factor VIII before dry-heat treatment. The dry-heat-treated factor VIII was stable for up to 24 months at 4oC. The dry-heat treatment after lyophilization was an effective process for inactivating viruses. The HAV, murine encephalomyocarditis virus (EMCV), and human immunodeficiency virus (HIV) were completely inactivated to below detectable levels within 10 min of the dry-heat treatment. Bovine herpes virus (BHV) and bovine viral diarrhea virus (BVDV) were potentially sensitive to the treatment. However porcine parvovirus (PPV) was slightly resistant to the treatment. The log reduction factors achieved during lyophilization and dry-heat treatment were > or =5.55 for HAV, > or =5.87 for EMCV, > or =5.15 for HIV, 6.13 for BHV, 4.46 for BVDV, and 1.90 for PPV. These results indicate that dry-heat treatment improves the virus safety of factor VIII concentrates, without destroying the activity. Moreover, the treatment represents an effective measure for the inactivation of non-lipid-enveloped viruses, in particular HAV, which is resistant to solvent/detergent treatment. PMID:18633304

  3. Vascular endothelial growth factor as a predictive marker for POEMS syndrome treatment response: retrospective cohort study

    PubMed Central

    Misawa, S; Sato, Y; Katayama, K; Hanaoka, H; Sawai, S; Beppu, M; Nomura, F; Shibuya, K; Sekiguchi, Y; Iwai, Y; Watanabe, K; Amino, H; Ohwada, C; Takeuchi, M; Sakaida, E; Nakaseko, C; Kuwabara, S

    2015-01-01

    Objective POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes) syndrome is a rare multisystem disease characterised by plasma cell dyscrasia and overproduction of vascular endothelial growth factor (VEGF). VEGF is assumed to be useful in monitoring disease activity, because VEGF levels usually decrease after treatment. However, there is no study to investigate whether the extent of decrease in VEGF correlates with clinical outcome. We tested the predictive efficacy of serum VEGF levels in POEMS syndrome. Method This was an institutional review board approved retrospective observational cohort study of 20 patients with POEMS monitored regularly for more than 12 months (median follow-up, 87 months) after treatment onset using our prospectively accumulated database of POEMS from 1999 to 2015. Patients were treated by autologous peripheral blood stem cell transplantation or thalidomide administration. Serum VEGF was measured by ELISA. Outcome measures included clinical and laboratory findings and relapse-free survival. Results Serum VEGF levels decreased rapidly after treatment, and stabilised by 6 months post treatment. Patients with normalised serum VEGF levels (<1040 pg/mL) at 6 months showed prolonged relapse-free survival (HR=12.81, 95% CI 2.691 to 90.96; p=0.0001) and greater later clinical improvement. The rate of serum VEGF reduction over the first 6 months post treatment correlated with increased grip strength, serum albumin levels, and compound muscle action potential amplitudes at 12 months. Conclusions Serum VEGF level at 6 months post treatment is a predicative biomarker for disease activity and prognosis in POEMS syndrome. Serum VEGF could be used as a surrogate endpoint for relapse-free survival or clinical or laboratory improvement of POEMS syndrome for clinical trials. PMID:26560063

  4. Prediction factors for failure to seek treatment following traumatic dental injuries to primary teeth.

    PubMed

    Firmino, Ramon Targino; Siqueira, Maria Betânia Lins Dantas; Vieira-Andrade, Raquel Gonçalves; Gomes, Genara Brum; Martins, Carolina Castro; Paiva, Saul Martins; Granville-Garcia, Ana Flávia

    2014-01-01

    The objective of this study was to evaluate prediction factors for failure to seek treatment following a traumatic dental injury (TDI) to primary teeth among preschool children in the city of Campina Grande, Brazil. A cross-sectional study was carried out involving 277 children 3 to 5 years of age, with TDI, enrolled in public and private preschools. Parents filled out a form addressing demographic data and whether or not they had sought treatment. Clinical examinations were performed by three dentists who had undergone a calibration exercise (Kappa: 0.85 to 0.90) for the evaluation of TDI. Bivariate and multivariate Poisson regression models were constructed (α=5%). Enamel fracture was the most prevalent type of TDI (48.7%) and the upper central incisors were the most affected teeth (88.4%). The frequency of seeking dental treatment was low (9.7%). The following variables were associated with failure to seek treatment following TDI: a household income greater than one minimum wage (PR=1.170; 95%CI 1.018-1.341), parents/caregivers' perception of a child's oral health as poor (PR=1.100; 95%CI 1.026-1.176), and the non-perception of TDI by parents/caregivers (PR=1.250; 95%CI 1.142-1.360). In the present study, the frequency of seeking treatment following TDI was low, and parents/caregivers with a higher income, a poor perception of their child's oral health and a lack of awareness regarding the trauma were more likely to fail to seek treatment following TDI to primary teeth. PMID:24918361

  5. Factors predicting treatment adherence in patients with adult attention-deficit/hyperactivity disorder: a preliminary study.

    PubMed

    Semerci, Bengi; Taskıran, Sarper; Tufan, Evren; Şanlı, Işın

    2016-09-01

    This study aimed to elicit patient- and treatment-related factors that can potentially predict treatment adherence in adult ADHD. Subjects who were over 18 and received a diagnosis of ADHD were included in the study. Chart review data of 102 subjects regarding demographics, medications, comorbidities, concomitant medications and domains of functional impairment were collected, and predictors were assessed using a binominal logistical regression model. One hundred and two patients (78.4 % male) with a mean age of 28.8 (SD = 9.8, range = 18-55) years were enrolled in the study. Childhood diagnosis of ADHD, agents used for treatment (MPH or atomoxetine), individual domains of dysfunction and use of additional psychotropic drugs were not found to be related to treatment adherence. Patients with a university education and those referred for family history of ADHD were more likely to adhere to treatment (p = 0.05 and 0.03, respectively). On the other hand, reasons for referral other than ADHD were significantly more frequently related to non-adherence (p = 0.02). Treatment noncompliance remains a significant problem despite therapeutic effects of medications. Identification of predictors of non-adherence can lead to heightened awareness of special populations at risk. We have found that prior awareness on ADHD (via past history/media/friends) leading to self/clinician referral to rule out ADHD and pervasiveness of symptoms across functional domains led to better compliance in our sample. Future research with prospective design utilizing objective tools for adherence is required. PMID:27056071

  6. Contextual and Individual Factors Influencing Periodontal Treatment Needs by Elderly Brazilians: A Multilevel Analysis

    PubMed Central

    Dalazen, Chaiane Emilia; De Carli, Alessandro Diogo; Bomfim, Rafael Aiello; dos Santos, Mara Lisiane Moraes

    2016-01-01

    Objective To assess the relationship between periodontal treatment needs by elderly Brazilians and contextual as well as individual variables. Methods A cross-sectional study was carried out to assess the need for clinical periodontal treatment, based on National Oral Health Survey (SB Brasil 2010) data on the presence of dental calculus, shallow (3–5 mm) and deep (≥ 6 mm) periodontal pockets, and gingival bleeding in elderly people (n = 7,619). The contextual variables included the Municipal Human Development Index (MHDI), income inequality (Gini Index) and coverage of the municipal population by the Family Health Strategy (FHS) program oral health teams.<0} The individual variables were sex, income, education level and self-reported skin color. Multilevel logistic regression models were used to calculate the odds ratio (OR) and 95% confidence intervals (CI95%) between periodontal treatment needs and the contextual as well as individual variables. Results Gingival bleeding was found in 20.7% of the elderly analyzed (n = 1,577), dental calculus in 34% (n = 2,590), shallow periodontal pockets in 15.6% (n = 1,189), and deep periodontal pockets in 4.2% (n = 320). Individual factors were correlated with all the outcomes assessed. Sex was a protective factor in regard to gingival bleeding (OR = 0.87; CI95% 0.76–1.00), dental calculus (OR = 0.86; CI95% 0.75–0.99), shallow periodontal pockets (OR = 0.69; CI95% 0.60–0.80) and deep periodontal pockets (OR = 0.58; CI95% 0.45–0.74). It was found that fewer women needed treatment. Elderly people who self-reported having nonwhite skin had higher chances of needing periodontal treatment. Skin color was a risk factor for gingival bleeding (OR = 1.32; CI95% 1.14–1.53), dental calculus (OR = 1.32; CI95%1.14–1.54) and shallow periodontal pockets (OR = 1.27; CI95% 1.09–1.49). Education level was associated with the presence of dental calculus (OR = 0.77; CI95% 0.66–0.89), shallow periodontal pockets (OR = 0.86; CI

  7. Psoriasis in the U.S. Medicare population: prevalence, treatment, and factors associated with biologic use

    PubMed Central

    Takeshita, Junko; Gelfand, Joel M.; Li, Penxiang; Pinto, Lionel; Yu, Xinyan; Rao, Preethi; Viswanathan, Hema N.; Doshi, Jalpa A.

    2015-01-01

    Psoriasis is a common chronic inflammatory disorder, primarily of the skin. Despite an aging population, knowledge of the epidemiology of psoriasis and its treatments among the elderly is limited. We examined the prevalence of psoriasis and its treatments, with a focus on biologics and identification of factors associated with biologic use, using a nationally representative sample of Medicare beneficiaries in 2011. Based on several psoriasis identification algorithms, the claims-based prevalence for psoriasis in the United States ranged from 0.51% to 1.23%. Treatments employed for moderate to severe psoriasis (phototherapy, oral systemic, or biologic therapies) were received by 27.3% of the total psoriasis sample, of whom 37.2% used biologics. Patients without Medicare Part D low-income subsidies had 70% lower odds of having received biologics than those with low-income subsidies (odds ratio 0.30; 95% confidence interval, 0.19– 0.46). Similarly, the odds of having received biologics was 69% lower among black patients than white patients (0.31; 0.16–0.60). This analysis identified potential financial and racial barriers to receipt of biologic therapies and underscores the need for additional studies to further define the epidemiology and treatment of psoriasis among the elderly. PMID:26214380

  8. Impact of socio-psychological factors on treatment adherence of TB patients in Russia.

    PubMed

    Jakubowiak, W M; Bogorodskaya, E M; Borisov, S E; Danilova, I D; Lomakina, O B; Kourbatova, E V

    2008-09-01

    The aim of this study was to assess the impact of social and psychological factors on treatment adherence of patients with tuberculosis (TB). To this end a cross-sectional questionnaire-based study was conducted among TB patients in four Russian regions (Orel, Vladimir, Belgorod oblasts, and Republic of Mari-El) from 01/04/2004 to 31/03/2005. A total of 87 non-adherent and 1302 adherent patients were interviewed. Compared to adherents, non-adherents were significantly more likely to be male, unemployed, have a technical college education, have a history of imprisonment, have a negative emotional status, consider themselves "not sick", not know the treatment period, have negative feelings and distrust for medical staff, not believe they will fully recover, and not want to continue treatment. Patients at highest risk for non-adherence should be identified at the start of treatment, and offered the services of a psychologist. A case management and patient-centered approach should be applied. PMID:18501675

  9. Factors preventing African Americans from seeking early intervention in the treatment of ischemic strokes.

    PubMed Central

    King, D. F.; Trouth, A. J.; Adams, A. O.

    2001-01-01

    The most widely advocated drug that has been developed to decrease and possibly reverse the crippling effect of stroke is recombinant tissue plasminogen activator (rt-PA). In the treatment of ischemic stroke, rt-PA must be administered within the first 3 hr after the onset of symptoms for optimal efficacy and avoidance of life-threatening cerebral hemorrhage. This study sought to determine whether African-American stroke victims presented for treatment within the first 3 hr. In the study, we identified some of the more common reasons for the lack of prompt presentation. A prospective survey of 103 randomly selected acute stroke patients was performed. We found that less than half of this population sought assistance in the emergency department in time to take advantage of rt-PA therapy. When confronted with symptoms that were consistent with acute stroke, many patients either chose to ignore them or thought that they were experiencing transient phenomena. Three factors were identified as possible reasons for the lack of prompt response: (a) a lack of information about available treatment options; (b) the inability to recognize the early warning signs of an impending stroke; and (c) denial of illness. This study may help to evolve strategies that must be instituted to better educate the community about the early recognition of stroke and available treatment alternatives. PMID:12653381

  10. Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use.

    PubMed

    Takeshita, Junko; Gelfand, Joel M; Li, Penxiang; Pinto, Lionel; Yu, Xinyan; Rao, Preethi; Viswanathan, Hema N; Doshi, Jalpa A

    2015-12-01

    Psoriasis is a common chronic inflammatory disorder, primarily of the skin. Despite an aging population, knowledge of the epidemiology of psoriasis and its treatments among the elderly is limited. We examined the prevalence of psoriasis and its treatments, with a focus on biologics and identification of factors associated with biologic use, using a nationally representative sample of Medicare beneficiaries in 2011. On the basis of several psoriasis identification algorithms, the claims-based prevalence for psoriasis in the United States ranged from 0.51 to 1.23%. Treatments used for moderate-to-severe psoriasis (phototherapy, oral systemic, or biologic therapies) were received by 27.3% of the total psoriasis sample, of whom 37.2% used biologics. Patients without a Medicare Part D low-income subsidy (LIS) had 70% lower odds of having received biologics than those with LIS (odds ratio 0.30; 95% confidence interval, 0.19-0.46). Similarly, the odds of having received biologics were 69% lower among black patients compared with white patients (0.31; 0.16-0.60). This analysis identified potential financial and racial barriers to receipt of biologic therapies and underscores the need for additional studies to further define the epidemiology and treatment of psoriasis among the elderly. PMID:26214380

  11. Potential therapeutic effects of pigment epithelium-derived factor for treatment of diabetic retinopathy.

    PubMed

    Liu, Xiao; Chen, Hui-Hui; Zhang, Li-Wei

    2013-01-01

    Diabetic retinopathy (DR), a major micro-vascular complication of diabetes, has emerged as a leading cause of visual impairment and blindness among working adults in the worldwide. The pathobiology of DR involves multiple molecular pathways and is characterized chronic neurovascular degeneration. Current approaches to prevent or to treat DR are still far from satisfactory. Therefore, it is important to develop new therapeutic strategies for the prevention and treatment to DR. Pigment epithelium-derived factor (PEDF), a 50-kDa secreted glycoprotein, has been described as a multi-functional protein. Some emerging evidences indicate that PEDF are able to target multiple pathways exerting neurotropic, neuroprotective, anti-angiogenic, antivasopermeability, anti-inflammation, anti-thrombogenic and anti-oxidative effects in DR. In this review, we addressed the functions of PEDF in different pathways, which could lead to potential therapeutics on the treatment to DR. PMID:23638428

  12. Treatment of ulcerative colitis in the cottontop tamarin using antibody to tumour necrosis factor alpha.

    PubMed Central

    Watkins, P E; Warren, B F; Stephens, S; Ward, P; Foulkes, R

    1997-01-01

    BACKGROUND: The aetiology and pathophysiology of ulcerative colitis remains unclear; however, there is increasing recognition of the critical role of inflammatory cytokines in the pathogenesis of this disease. Among these, tumour necrosis factor alpha (TNF alpha) seems to play an important role. AIM: To study the effects of an engineered human monoclonal antibody to TNF alpha (CDP571) in the treatment of idiopathic ulcerative colitis in the cottontop tamarin. METHODS: Six cottontop tamarins with confirmed ulcerative colitis received repeated doses of CDP571. Progression of disease was assessed by measuring both body weight and rectal biopsy pathology. RESULTS: All animals showed a rapid improvement in clinical condition and rectal biopsy pathology that was maintained following completion of the therapy. CONCLUSION: These studies indicate the efficacy of selective antibody therapy to TNF alpha for the treatment of ulcerative colitis in a primate and suggest that similar therapy in human could be of value. Images PMID:9203942

  13. Analysis of related factor of pigment alteration after Q-switched laser treatment

    NASA Astrophysics Data System (ADS)

    Zhang, Wei; Xu, Cai Xia; Ding, Yang Feng; Tan, Yi Wen

    2005-07-01

    To explore the related factors of pigment alteration after the Q-switched laser treatment. After the Q-switched laser treatment, the side effects in patients were observed, recorded and analyzed. The results showed that the incidence of pigment alteration is directly related to age (OR1=2.519, confidence interval 0.996-6.366; OR2=2.519, confidence interval 0.978-6.488; OR3=8.311, confidence interval 3.312-29.695). Besides, the pigment alteration is also correlated to the skin types, but not to gender, kind of diseases, parts of body, intensity of ultraviolet radiation, character of work, wavelength of laser and the energy of laser. Older patient is easier to have pigment alteration than younger patient. Pigment alteration may be obvious in a pigmented individual than a lightly pigmented individual.

  14. Monoamine Oxidase Inhibitors Extracted from Tobacco Smoke as Neuroprotective Factors for Potential Treatment of Parkinson's Disease.

    PubMed

    Sari, Youssef; Khalil, Ashraf

    2015-01-01

    Parkinson's disease (PD) is a neurodegenerative disease characterized by the loss of mainly the nigrostriatal dopaminergic neurons, which leads to motor dysfunction. Although, most of the drugs are currently used for symptomatic treatment, there are at least three FDA-approved drugs for the treatment of PD that have been suggested preclinically to have neuroprotective effects. Among these drugs are monoamine oxidase (MAO) type B inhibitors such as selegiline and rasagiline, and non-ergot derivative dopamine agonist, pramipexole. In this review article, we focused on the potential uses of non-selective reversible MAO inhibitor, 2,3,6-trimethyl-1,4-naphthoquinone, from flue-cured tobacco leaves extract and two β- carboline alkaloids (harman and norharman) as potent, reversible and non-selective MAO inhibitors for the treatment of PD. In addition, we discussed the potential uses of farnesol as a potent inhibitor of MAO-B and farnesylacetone as a less potent selective MAO-B inhibitor. Furthermore, adducts of 1,2,3,4-tetrahydroisoquinoline have shown to have competitive inhibitory effects for both MAO-A and MAO-B. These inhibitors have potential neuroprotective effects, which might be mediated at least through nerve growth factor, neurotrophin 3, brain derived neurotrophic factor, and glial-cell-line-derived neurotrophic factor. We suggest here the neuroprotective implication of extracted MAO inhibitors from smoke tobacco; however, it is important to note that there are several existing compounds in tobacco smoke that have toxic effects in the brain, these include and not limited to the induction of neuropathological features observed in individuals suffering from Alzheimer's disease and dementia. PMID:25808895

  15. NDMA formation during drinking water treatment: A multivariate analysis of factors influencing formation.

    PubMed

    Leavey-Roback, Shannon L; Sugar, Catherine A; Krasner, Stuart W; Suffet, Irwin H Mel

    2016-05-15

    The formation of the carcinogen N-nitrosodimethylamine (NDMA) during drinking water treatment has raised concerns in the drinking water industry. Many bench-scale laboratory tests and pilot plant studies have been completed to try to determine which factors during water treatment increase or decrease the amount of NDMA formed in drinking water. This study used data from over 20 drinking water treatment plants in the United States and Canada to determine which factors are most highly correlated with the NDMA concentration in delivered water using a mixed effects model with a random intercept. This type of analysis has not been used previously with trihalomethane (THM) models due to the fact that those studies did not sample such a large number and range of plants as was done in this NDMA study. Ultraviolet absorbance at 254 nm (UV254) in the plant influent and pre-chlorination time used at the plant were highly correlated in all models with NDMA concentration in finished water as well as the percentage change between NDMA formation potential in the plant influent and actual formation in the finished water. Specifically, an increase in UV254 absorbance in a model was associated with an increase in NDMA and an increase in pre-chlorination time in a model was associated with a decrease in NDMA. Other water quality parameters including sucralose concentration in the plant influent, polyDADMAC polymer dose, pH, and chlorine-to-ammonia weight ratio used in the plant were also correlated with NDMA concentration in the distribution system. Lastly, NDMA precursor loading was correlated with the use of polyDADMAC (where precursors were added) and the use of ozone and granular activated carbon (GAC) treatment (where precursors were removed). PMID:27015632

  16. Prognostic factors identified three risk groups in the LRF CLL4 trial, independent of treatment allocation

    PubMed Central

    Oscier, David; Wade, Rachel; Davis, Zadie; Morilla, Alison; Best, Giles; Richards, Sue; Else, Monica; Matutes, Estella; Catovsky, Daniel

    2010-01-01

    Background Many prognostic markers have been identified in chronic lymphocytic leukemia, but there have been few opportunities to assess their relative importance in a large randomized trial. The aim of this study was to determine which of the available markers independently predicted outcome in patients requiring treatment and to use these to define new risk groups. Design and Methods A broad panel of clinical and laboratory markers, measured at randomization in patients entering the LRF CLL4 trial, was assessed with respect to treatment response, progression-free and overall survival, at a median follow-up of 68 months. Results Using the factors identified as independent predictors for progression-free survival, patients were subdivided into three risk groups: 6% had poor risk with known TP53 loss of greater than 10%; 72% had an intermediate risk without TP53 loss (≤10%) and with at least one of: unmutated IGHV genes and/or IGHV3-21 usage, 11q deletion, β-2 microglobulin greater than 4 mg/L; 22% had a good risk (with none of the above and mutated IGHV genes). The 5-year progression-free survival rates for these three groups were 0%, 12% and 34%, respectively, and the corresponding 5-year overall survival rates were 9%, 53% and 79% (both P<0.00005 independent of treatment allocation). In the intermediate risk group 250 patients, with data for all three risk factors, were further subdivided into intermediate-low (one risk factor) or intermediate-high (2 or 3 risk factors). The 5-year progression-free survival rates were 18% and 7% (P=0.0001) and the 5-year overall survival rates were 68% and 40% (P<0.00005), respectively. Conclusions This study demonstrates the role of biomarkers in prognosis and shows that, in patients requiring treatment, disease stage may no longer be an independent predictor of outcome. If validated independently, the risk groups defined here may inform the design of future trials in chronic lymphocytic leukemia. (Clinicaltrials

  17. Imported Flood-Related Leptospirosis From Palau: Awareness of Risk Factors Leads to Early Treatment.

    PubMed

    Matono, Takashi; Kutsuna, Satoshi; Koizumi, Nobuo; Fujiya, Yoshihiro; Takeshita, Nozomi; Hayakawa, Kayoko; Kanagawa, Shuzo; Kato, Yasuyuki; Ohmagari, Norio

    2015-01-01

    We describe two Japanese travelers with leptospirosis who visited Palau. Both travelers swam in Ngardmau Falls, which was flooded for two days after typhoon Phanfone. The diagnoses were confirmed by microscopic agglutination test or polymerase chain reaction. This is the first report of leptospirosis in travelers who returned from Palau. It should be noted that choosing the appropriate test to biologically confirm leptospirosis was highly time-dependent. Awareness of the risk factors for leptospirosis, mainly that of the exposure to contaminated fresh water after a flooding, would lead to an early and appropriate treatment before the confirmed diagnosis. PMID:26503094

  18. Prevalence of and Factors Related to Tobacco Ban Implementation in Substance Use Disorder Treatment Programs.

    PubMed

    Muilenburg, Jessica L; Laschober, Tanja C; Eby, Lillian T; Moore, Nancy D

    2016-03-01

    This study examined the prevalence of and factors (psychological climate for change and staff attributes) related to indoor and outdoor tobacco bans for patients, employees, and visitors in U.S. substance use disorder treatment programs. Data were collected from a random sample of 1,026 program administrators. Almost all programs banned tobacco use indoors and around one third banned tobacco use outdoors. When there was no tobacco ban, the majority of programs restricted smoking to designated indoor and/or outdoor areas. Further, all psychological climate for change factors (perceived program support, perceived tobacco culture, and tobacco ban beliefs) but none of the staff attributes (percentage licensed/certified clinicians, percentage clinicians with master's degrees, total staff with education in health-related field) were significantly related to the implementation of comprehensive tobacco bans (both indoors and outdoors). PMID:25677250

  19. Sleep disturbances in caregivers of persons with dementia: Contributing factors and treatment implications

    PubMed Central

    McCurry, Susan M.; Logsdon, Rebecca G.; Teri, Linda; Vitiello, Michael V.

    2007-01-01

    Estimates suggest that there are more than 10 million adult caregivers of persons with dementia, two-thirds of who experience some form of sleep disturbance during the course of their caregiving career. Health care professionals are in the best position to detect and address this significant public health problem. Three major contributors to caregiver sleep disturbance are discussed in this paper: 1) the presence of caregiver disrupted sleep routines; 2) caregiver burden and depression; and, 3) the caregiver’s physical health status. Successful treatment of a caregiver’s sleep disturbance requires careful consideration of each of these contributors. We review and analyze the scientific literature concerning the multiple complex factors associated with the development and maintenance of sleep disturbances in caregivers. We provide a clinical vignette that illustrates the interplay of these contributing factors, and close by providing recommendations for clinicians and researchers treating and investigating the development and maintenance of sleep problems in family caregivers. PMID:17287134

  20. Antiretroviral treatment adherence as a mediating factor between psychosocial variables and HIV viral load.

    PubMed

    Attonito, Jennifer; Dévieux, Jessy G; Lerner, Brenda D G; Hospital, Michelle M; Rosenberg, Rhonda

    2014-01-01

    Psychosocial factors may directly impact HIV health measures such as viral load (VL) whether or not patients are taking antiretroviral treatment (ART) consistently. Structural equation modeling plus Baron and Kenny's (1986) four-step approach were used to test a mediated model predicting VL among 246 HIV-infected adults who were on ART. Exogenous variables were social support, barriers to adherence, and stress. Moderators were alcohol use, marijuana use, and neurocognitive impairment. A small positive association between marijuana use and ART adherence approached significance. Only barriers to adherence predicted a decrease in adherence rates and an increase in VL. No other factors were significantly associated with either VL or adherence, and no interaction effects between exogenous variables and moderators were identified. The association between barriers to adherence and VL was partially mediated by ART adherence. Findings provide modest support for a direct link between psychosocial variables and a virologic response to ART. PMID:25305029

  1. Antiretroviral treatment adherence as a mediating factor between psychosocial variables and HIV viral load

    PubMed Central

    Attonito, Jennifer; Dévieux, Jessy G.; Lerner, Brenda D. G.; Hospital, Michelle M.; Rosenberg, Rhonda

    2014-01-01

    Psychosocial factors may directly impact HIV health measures such as viral load (VL), whether or not patients are taking antiretroviral treatment (ART) consistently. Structural equation modeling plus Baron and Kenny’s (1986) four-step approach were used to test a mediated model predicting VL among 246 HIV-infected adults who were on ART. Exogenous variables were social support, barriers to adherence, and stress. Moderators were alcohol use, marijuana use, and neurocognitive impairment. A small positive association between marijuana use and ART adherence approached significance. Only barriers to adherence predicted a decrease in adherence rates and an increase in VL. No other factors were significantly associated with either VL or adherence and no interaction effects between exogenous variables and moderators were identified. The association between barriers to adherence and VL was partially mediated by ART adherence. Findings provide modest support for a direct link between psychosocial variables and a virologic response to ART. PMID:25305029

  2. Posttraumatic Stress Disorder in Adults: Impact, Comorbidity, Risk Factors, and Treatment

    PubMed Central

    Sareen, Jitender

    2014-01-01

    During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the wars in Afghanistan and Iraq, and the terrorist attacks of September 11 on the World Trade Center, have led to a greater public interest in the risk and protective factors for PTSD. In this In Review paper, I discuss some of the important advances in PTSD. The paper provides a concise review of the evolution of PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, impact of PTSD in the community, an overview of the established risk factors for developing PTSD, and assessment and treatment. Throughout the paper, controversies and clinical implications are discussed. PMID:25565692

  3. Treatment of psychological factors in a child with difficult asthma: a case report.

    PubMed

    Anbar, Ran D; Sachdeva, Shagun

    2011-07-01

    Difficult asthma is defined as the persistence of asthma symptoms, abnormal pulmonary function showing airway obstruction, and continued requirement for short-acting bronchodilator therapy, despite adequate treatment with inhaled corticosteroids. It calls for a thorough evaluation of the patient to look into alternate and complicating diagnoses. The authors report a case of a 9-year-old patient with difficult asthma who failed to respond to conventional therapy. Although it was recognized that he had a number of potential medical complicating factors including allergies, chronic sinusitis, and gastroesophageal reflux, a psychological intervention using hypnosis ultimately appeared to help alleviate his symptoms completely. Thus, psychological evaluation and intervention should be considered early in the course of management of a patient with difficult asthma, because it may help avoid time-consuming and expensive investigations of potential complicating factors, and it may yield rapid improvement in the patient's clinical condition. PMID:21922711

  4. Fibroblast growth factor receptor inhibitors as a cancer treatment: from a biologic rationale to medical perspectives.

    PubMed

    Dieci, Maria Vittoria; Arnedos, Monica; Andre, Fabrice; Soria, Jean Charles

    2013-03-01

    The fibroblast growth factor/fibroblast growth factor receptor (FGF/FGFR) signaling pathway plays a fundamental role in many physiologic processes, including embryogenesis, adult tissue homeostasis, and wound healing, by orchestrating angiogenesis. Ligand-independent and ligand-dependent activation have been implicated in a broad range of human malignancies and promote cancer progression in tumors driven by FGF/FGFR oncogenic mutations or amplifications, tumor neoangiogenesis, and targeted treatment resistance, thereby supporting a strong rationale for anti-FGF/FGFR agent development. Efforts are being pursued to develop selective approaches for use against this pathway by optimizing the management of emerging, class-specific toxicity profiles and correctly designing clinical trials to address these different issues. PMID:23418312

  5. [Anticoagulant treatment of patients with atrial fibrillations: dependent on age and other risk factors for thromboembolism].

    PubMed

    Vink, R; van den Brink, R B A; Levi, M

    2002-11-30

    Atrial fibrillation is a common arrhythmic disorder which is becoming increasingly prevalent among the elderly. Atrial fibrillation is an independent risk factor for ischaemic stroke. Patients with hypertension, heart failure, diabetes, age older than 65 years, previous thromboembolisms, left atrial enlargement and left ventricular dysfunction have an increased risk. Coumarins (with a target international normalised ratio (INR) of 2.0 to 3.0) are the treatment of first choice in patients with atrial fibrillation. In young patients without additional risk factors, acetyl salicylic acid provides sufficient protection. The management of anticoagulant therapy during electric cardioversion in the acute phase of an ischaemic stroke and during elective surgical interventions, is still a subject of clinical research. PMID:12497755

  6. Advances in the use of growth factors for treatment of disorders of soft tissues.

    PubMed

    Halper, Jaroslava

    2014-01-01

    Repair and healing of injured and diseased tendons have been traditionally fraught with apprehension and difficulties, and often lead to rather unsatisfactory results. The burgeoning research field of growth factors has opened new venues for treatment of tendon disorders and injuries, and possibly for treatment of disorders of the aorta and major arteries as well. Several chapters in this volume elucidate the role of transforming growth factor β in pathogenesis of several heritable disorders affecting soft tissues, such as aorta, cardiac valves, and tendons and ligaments. Several members of the bone morphogenetic group either have been approved by the FDA for treatment of non-healing fractures or have been undergoing intensive clinical and experimental testing for use in healing of bone fractures and tendon injuries. Because FGFs are involved in embryonic development of tendons and muscles among other tissues and organs the hope is that their testing would lead to the development of some new treatment strategies providing that we can control angiogenicity of these growth factors. The problem, or rather question regarding practical use of IGF-I in tendon repair is whether IGF-I acts independently or under the guidance of growth hormone. FGF2 or PDGF alone or in combination with IGF-I stimulated regeneration of periodontal ligament, a matter of importance in Marfan patients with periodontitis. In contrast, VEGF appears to have rather deleterious effect on experimental tendon healing, perhaps because of its angiogenic activity and stimulation of matrix metalloproteinases, proteases whose increased expression has been documented in a variety of ruptured tendons. Other modalities, such as local administration of platelet-rich plasma (PRP) and/or of mesenchymal stem cells have been explored extensively in tendon healing. Though treatment with PRP and mesenchymal stem cells has met with some success in horses (who experience a lot of tendon injuries and other tendon

  7. Factors related to compliance with oral analgesic treatment of inpatients with chronic pain.

    PubMed

    Zhu, Hong; Zheng, Yuzhu; Gao, Hui; Liu, Li; Yang, Lie

    2015-09-01

    This study aimed to determine the relationship between the different factors of analgesic therapy and the compliance of chronic pain inpatients. We prospectively investigated 100 consecutive inpatients with noncancer chronic pain who were hospitalized to receive oral analgesic treatment in the Pain Department of West China Hospital from May 2013 to October 2013. Patients who completed the treatment plan were recorded as good compliance, whereas patients who partly completed or even refused the treatment were recorded as moderate or non-compliance, respectively. A total of 73 (73.7%), 17 (17.1%), and 9 (9.2%) patients showed good, moderate, and non-compliance, respectively. Univariate analyses showed significantly better compliance among farmers, patients educated in college or above, with family income of < 3000 CNY, and with severe or moderate pain than those employed and unemployed (P = 0.02), patients educated below college (P = 0.013), with family income of ≥ 3000 CNY (P = 0.025), and with mild pain (P < 0.001), respectively. Logistic regression analysis showed that the family income of ≥ 3000 CNY (OR: 2.50, 95%CI: 1.65-4.51, P = 0.021) and mild pain (OR: 1.27, 95%CI: 1.03-3.31, P = 0.016) were associated with moderate or non-compliance with oral analgesic treatment. In conclusion, the low compliance with oral treatment of analgesics was found in Chinese inpatients with chronic pain and compliance was negatively associated with family income and degree of pain of patients. PMID:26290285

  8. Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya.

    PubMed

    Njuguna, F; Martijn, H; Langat, S; Musimbi, J; Muliro, H; Skiles, J; Vik, T; Sitaresmi, M N; van de Ven, P M; Kaspers, G J L; Mostert, S

    2016-04-01

    Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment. Study participants were parents of childhood cancer patients diagnosed between August 2013 and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9-1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days; P < .001). Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media. PMID:27184775

  9. Platelet-Derived Growth Factor: A Key Factor in the Pathogenesis of Graves' Ophthalmopathy and Potential Target for Treatment

    PubMed Central

    Virakul, Sita; van Steensel, Leendert; Dalm, Virgil A.S.H.; Paridaens, Dion; van Hagen, P. Martin; Dik, Willem A.

    2014-01-01

    Activation of orbital fibroblasts resulting in excessive proliferation, cytokine and hyaluronan production and differentiation into adipocytes, is a main determinant of orbital tissue inflammation and tissue expansion in Graves' ophthalmopathy (GO). During the last years we have shown that the platelet-derived growth factor (PDGF) isoforms PDGF-AA, PDGF-AB and PDGF-BB are increased in orbital tissue from GO patients with active and inactive disease. These PDGF isoforms exhibit the capacity to stimulate proliferation, hyaluronan and cytokine/chemokine production by orbital fibroblasts. Moreover, PDGF-AB and PDGF-BB increase thyroid stimulating hormone receptor (TSHR) expression by orbital fibroblasts, which enhances the orbital fibroblast activating capacity of the THSR stimulatory autoantibodies present in Graves' disease (GD) patients. Of these PDGF isoforms PDGF-BB exhibits the strongest orbital fibroblast activating effects, which is likely related to its ability to bind both the PDGF-receptor (PDGF-R)α and PDGF-Rβ chains. Thus the PDGF-system fulfills important roles in orbital fibroblast activation in both active and inactive GO, which supports a therapeutic rationale for blocking PDGF signaling in GO. Tyrosine kinase inhibitors (TKIs) may be candidates to target PDGF signaling. Of several TKIs tested dasatinib exhibited the highest potency to block PDGF-R signaling in orbital fibroblasts and may represent a promising compound for the treatment of GO as it was effective at low dosage and is associated with less side effects compared to imatinib mesylate and nilotinib. In this review the contribution of PDGF to the pathophysiology of GO as well as therapeutic approaches to target this PDGF-system will be addressed. PMID:25759797

  10. Prevalence, Risk Factors, Awareness, and Treatment and Control of Hypertension in Mafia Island, Tanzania

    PubMed Central

    Nagri, Z. I.; Manji, K. P.

    2016-01-01

    Introduction. The prevalence of hypertension in Africa ranges from 29.7% in Cameroon to 47% in South Africa. Only 10% receive treatment in Cameroon while 32% are on medications in Ghana. Control rates vary from 0.4% to 16.8%. This study was done to assess prevalence, risk factors, awareness, treatment, and control of hypertension in Mafia Island, Tanzania, which has never been documented before, so that necessary interventions can be undertaken accordingly. Methodology. Data was collected through questionnaires and anthropometric measurements were taken. Descriptive statistics were done and potential correlations were analyzed. Results. Out of 570 adults who were included in the study, 154 (27%) were aged 41–50 and the male-to-female ratio was 1 : 1.05. Almost half (49.5%) of the participants fit into the criteria of hypertension. Out of the 118 participants who were aware of having hypertension, 68 (57.6%) were currently taking medication. From those taking medication, only 14 (20.6%) had controlled hypertension. Conclusion. This study tried to show the extent of hypertension and find out risk factors which could explain the high prevalence of hypertension. This is very alarming and a dire need to raise awareness through health education, availability of screening, and treating and follow-up should be given priority. PMID:27525113

  11. Influence of dimensional factors and heat treatment on permanent deformation of wrought wire clasps.

    PubMed

    Ikebe, K; Nokubi, T; Kibi, M; Ono, T; Okuno, Y

    1992-12-01

    The purpose of this study is to examine the fatigue profiles of wrought wire clasps during the clinical use. Cobalt-chromium-nickel alloy wires were bent into circular beams, which dimensions and fabrication methods were similar to the clinical cases. Deflections of 0.5 mm in a normal direction were applied 10,000 times to the tips of clasp arm and permanent deformations were measured. The following results were obtained. 1) The clasp arms with larger cross sectional diameter, shorter length and smaller radius of curvature showed larger amounts of permanent deformation. 2) The amounts of permanent deformation of the clasp arm remarkably decreased by electric resistance soldering and decreased further more by heat treatment at 500 degrees C for 10 minutes after soldering regardless of the number of deflection. From the results of this study, it was concluded that dimensional factors and heat treatment influenced the permanent deformation of the wrought wire clasps remarkably. Therefore, considering these factors, wrought wire clasps could be designed to reduce permanent deformation. PMID:1364131

  12. Granulocyte-colony stimulating factor as a treatment for diabetic neuropathy in rat.

    PubMed

    Kim, Kyung-Soo; Song, Yi-Sun; Jin, Jiyong; Joe, Jun-Ho; So, Byung-Im; Park, Jun-Young; Fang, Cheng-Hu; Kim, Mi Jung; Cho, Youl-Hee; Hwang, Sejin; Ro, Young-Suck; Kim, Hyuck; Ahn, You-Hern; Sung, Hak-Joon; Sung, Jung-Joon; Park, Sung-Hye; Lipton, Stuart A

    2015-10-15

    Effective treatment of diabetic neuropathy (DN) remains unsolved. We serendipitously observed dramatic relief of pain in several patients with painful DN receiving granulocyte-colony stimulating factor (G-CSF). The aim of this study was to determine if G-CSF could treat DN in an animal model and to ascertain its mechanism of action. In a rodent model of DN, G-CSF dramatically recovered nerve function, retarded histological nerve changes and increased the expression of neurotrophic factors within nerve. A sex-mismatched bone marrow transplantation (BMT) study revealed that G-CSF treatment increased the abundance of bone marrow (BM)-derived cells in nerves damaged by DN. However, we did not observe evidence of transdifferentiation or cell fusion of BM-derived cells. The beneficial effects of G-CSF were dependent on the integrity of BM. In conclusion, G-CSF produced a therapeutic effect in a rodent model of DN, which was attributed, at least in part, to the actions of BM-derived cells. PMID:26190836

  13. Opioid treatment of experimental pain activates nuclear factor-κB

    PubMed Central

    Compton, Peggy; Griffis, Charles; Breen, Elizabeth Crabb; Torrington, Matthew; Sadakane, Ryan; Tefera, Eshetu; Irwin, Michael R.

    2015-01-01

    Objective To determine the independent and combined effects of pain and opioids on the activation of an early marker of inflammation, nuclear factor-κB (NF-κB). Design NF-κB activation was compared within-subjects following four randomly ordered experimental sessions of opioid-only (intravenous fentanyl 1 μg/kg), pain-only (cold-pressor), opioid + pain, and a resting condition. Setting University General Clinical Research Center. Participants Twenty-one (11 female) healthy controls. Interventions Following exposure to treatment (fentanyl administration and/or cold-pressor pain), blood samples for NF-kB analysis were obtained. Main outcome measures Intracellular levels of activated NF-κB, in unstimulated and stimulated peripheral blood mononuclear cells at 15 and 30 minutes. Results Neither pain nor opioid administration alone effected NF-κB levels in cell populations; however, the combination of treatments induced significant increases of NF-κB in stimulated peripheral blood mononuclear cell, lymphocytes, and monocytes. Conclusions The combination of acute pain with opioids, as occurs in clinical situations, activates a key transcription factor involved in proinflammatory responses. PMID:25901477

  14. Prevalence, Risk Factors, Awareness, and Treatment and Control of Hypertension in Mafia Island, Tanzania.

    PubMed

    Muhamedhussein, M S; Nagri, Z I; Manji, K P

    2016-01-01

    Introduction. The prevalence of hypertension in Africa ranges from 29.7% in Cameroon to 47% in South Africa. Only 10% receive treatment in Cameroon while 32% are on medications in Ghana. Control rates vary from 0.4% to 16.8%. This study was done to assess prevalence, risk factors, awareness, treatment, and control of hypertension in Mafia Island, Tanzania, which has never been documented before, so that necessary interventions can be undertaken accordingly. Methodology. Data was collected through questionnaires and anthropometric measurements were taken. Descriptive statistics were done and potential correlations were analyzed. Results. Out of 570 adults who were included in the study, 154 (27%) were aged 41-50 and the male-to-female ratio was 1 : 1.05. Almost half (49.5%) of the participants fit into the criteria of hypertension. Out of the 118 participants who were aware of having hypertension, 68 (57.6%) were currently taking medication. From those taking medication, only 14 (20.6%) had controlled hypertension. Conclusion. This study tried to show the extent of hypertension and find out risk factors which could explain the high prevalence of hypertension. This is very alarming and a dire need to raise awareness through health education, availability of screening, and treating and follow-up should be given priority. PMID:27525113

  15. Factors associated with hypertension prevalence, unawareness and treatment among Costa Rican elderly

    PubMed Central

    Méndez-Chacón, Ericka; Santamaría-Ulloa, Carolina; Rosero-Bixby, Luis

    2008-01-01

    Background Reliable information on the prevalence of hypertension is crucial in the development of health policies for prevention, control, and early diagnosis of this condition. This study describes the prevalence of hypertension among Costa Rican elderly, and identifies co-factors associated with its prevalence, unawareness and treatment. Methods The prevalence of hypertension is estimated for the Costa Rican elderly. Measurement error is assessed, and factors associated with high blood pressure are explored. Data for this study came from a nationally representative sample of about 2,800 individuals from CRELES (Costa Rica: Longevity and Healthy Aging Study). Two blood pressure measures were collected using digital monitors. Self reports of previous diagnosis, and medications taken were also recorded as part of the study. Results No evidence of information bias was found among interviewers, or over time. Hypertension prevalence in elderly Costa Ricans was found to be 65% (Males = 60%, Females = 69%). Twenty-five percent of the studied population did not report previous diagnoses of hypertension, but according to our measurement they had high blood pressure. The proportion of unaware men is higher than the proportion of unaware women (32% vs. 20%). The main factors associated with hypertension are: age, being overweight or obese, and family history of hypertension. For men, current smokers are 3 times more likely to be unaware of their condition than non smokers. Both men and women are less likely to be unaware of their condition if they have a family history of hypertension. Those women who are obese, diabetic, have suffered heart disease or stroke, or have been home visited by community health workers are less likely to be unaware of their hypertension. The odds of being treated are higher in educated individuals, those with a family history of hypertension, elderly with diabetes or those who have had heart disease. Conclusion Sex differences in terms of

  16. Hypertension in Northern Angola: prevalence, associated factors, awareness, treatment and control

    PubMed Central

    2013-01-01

    Background Seventy-five million people are estimated to be hypertensive in sub-Saharan Africa. This translates in high morbidity and mortality, as hypertension is now considered to be the number one single risk factor for death worldwide. Accurate data from countries lacking national disease surveillance is needed to guide future evidence-driven health policies. The authors aimed to estimate the prevalence, awareness, management and control of hypertension and associated factors in an adult population of Angola. Methods A community-based survey of 1,464 adults, following the World Health Organization's Stepwise Approach to Chronic Disease Risk Factor Surveillance, was conducted to estimate the prevalence of hypertension, awareness, treatment and control in Dande, Northern Angola. Using a demographic surveillance system database, a representative sample of subjects, stratified by sex and age (18–40 and 41–64 years old), was selected. Results Prevalence of hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or hypertensive therapy) was of 23% (95% CI: 21% to 25.2%). A follow-up consultation confirmed the hypertensive status in 82% of the subjects who had a second measurement on average 23 days after the first. Amongst hypertensive individuals, 21.6% (95% CI: 17.0% to 26.9%) were aware of their status. Only 13.9% (95% CI: 5.9% to 29.1%) of the subjects aware of their condition were under pharmacological treatment, of which approximately one-third were controlled. Older age, lower level of education, higher body mass index and abdominal obesity were found to be significantly (p<0.01) associated with hypertension. Conclusions Our survey is the first to provide insightful data on hypertension prevalence in Angola. There is an urgent need for strategies to improve prevention, diagnosis and access to adequate treatment in this country, where a massive economic growth and consequent potential impact on lifestyle risk factors

  17. Late rectal and bladder toxicity following radiation therapy for prostate cancer: Predictive factors and treatment results

    PubMed Central

    Fuentes-Raspall, Rafael; Inoriza, José Maria; Rosello-Serrano, Alvaro; Auñón-Sanz, Carmen; Garcia-Martin, Pilar; Oliu-Isern, Gemma

    2013-01-01

    Aim This study aimed at investigating factors associated to late rectal and bladder toxicity following radiation therapy and the effectiveness of Hyperbaric Oxygen Therapy (HBOT) when toxicity is grade ≥2. Background Radiation is frequently used for prostate cancer, but a 5–20% incidence of late radiation proctitis and cystitis exists. Some clinical and dosimetric factors have been defined without a full agreement. For patients diagnosed of late chronic proctitis and/or cystitis grade ≥2 treatment is not well defined. Hyperbaric Oxygen Therapy (HBOT) has been used, but its effectiveness is not well known. Materials and methods 257 patients were treated with radiation therapy for prostate cancer. Clinical, pharmacological and dosimetric parameters were collected. Patients having a grade ≥2 toxicity were treated with HBOT. Results of the intervention were measured by monitoring toxicity by Common Toxicity Criteria v3 (CTCv3). Results Late rectal toxicity was related to the volume irradiated, i.e. V50 > 53.64 (p = 0.013); V60 > 38.59% (p = 0.005); V65 > 31.09% (p = 0.002) and V70 > 22.81% (p = 0.012). We could not correlate the volume for bladder. A total of 24 (9.3%) patients experienced a grade ≥2. Only the use of dicumarinic treatment was significant for late rectal toxicity (p = 0.014). A total of 14 patients needed HBOT. Final percentage of patients with a persistent toxicity grade ≥2 was 4.5%. Conclusion Rectal volume irradiated and dicumarinic treatment were associated to late rectal/bladder toxicity. When toxicity grade ≥2 is diagnosed, HBOT significantly ameliorate symptoms. PMID:24416567

  18. Opioid growth factor (OGF) for hepatoblastoma: a novel non-toxic treatment.

    PubMed

    Rogosnitzky, Moshe; Finegold, Milton J; McLaughlin, Patricia J; Zagon, Ian S

    2013-08-01

    Hepatoblastoma is the most common liver malignancy in children, typically diagnosed before age 2. The survival rate for hepatoblastoma has increased dramatically in the last 30 years, but the typical chemotherapeutic agents used for treatment are associated with significant toxicity. In this report, the authors present two cases of hepatoblastoma treated with surgical resection and a novel biotherapeutic regimen that included opioid growth factor (OGF). Case #1 is an infant diagnosed with a large mass on prenatal ultrasound. After subsequent diagnosis of hepatoblastoma, she was treated with one course of neoadjuvant chemotherapy at approximately 1 week of age. Following significant complications from the chemotherapy (neutropenic fever, pneumonia and sepsis), the patient's parents declined further chemotherapy, and the infant was treated with surgical resection and opioid growth factor (OGF)/low dose naltrexone (LDN). She is currently at close to 10 years disease-free survival. Case #2 is a child diagnosed with a liver mass on ultrasound at 20 months of age, later biopsy-proven to represent hepatoblastoma. Due to existing co-morbidities including autosomal recessive polycystic kidney disease and hypertension, and indications from the biopsy that the tumor might be insensitive to chemotherapy, the parents elected not to proceed with neoadjuvant chemotherapy. The patient was treated with surgical resection and OGF/LDN, and is currently at more than 5 years disease-free survival. This case series highlights the need for less toxic treatment options than conventional chemotherapy. Modulation of the OGF-OGF receptor axis represents a promising safe and therapeutic avenue for effective treatment of hepatoblastoma. PMID:23275062

  19. Breast Cancer After Treatment of Hodgkin's Lymphoma: Risk Factors That Really Matter

    SciTech Connect

    Alm El-Din, Mohamed A.; Hughes, Kevin S.; Finkelstein, Dianne M.; Betts, Keith A.; Yock, Torunn I.; Tarbell, Nancy J.; Aisenberg, Alan C.; Taghian, Alphonse G.

    2009-01-01

    Purpose: To evaluate the risk of breast cancer (BC) and the contributing risk factors in women after supradiaphragmatic irradiation (SDI) for Hodgkin's lymphoma (HL). Subjects and Methods: Medical records of 248 women 60 years of age or less who received SDI for stage I/II HL between 1964 and 2001 at Massachusetts General Hospital were retrospectively reviewed. Results: The median age at SDI was 26 years (range, 5.7-59.3). The median follow-up was 15.2 years (range, 0.1-41.3). In 36 patients, BC developed (bilaterally in 11 patients) at a median interval of 18.4 years (range, 4.3-33.8) after SDI. Based on data from the National Cancer Institute Surveillance, Epidemiology, and End Results program, the standardized morbidity ratio (SMR) for the first BC after SDI was 9.78 (95% confidence interval [CI], 4.64-18.11, p < 0.0001). The SMR of patients who received radiation before age of 30 years was 19.05 (95% CI, 12.33-28.13) compared with 4.64 (95% CI, 2.31-8.30) for patients aged 30 years or more at the time of treatment (p < 0.00003). Risk for BC was significantly higher 15 years or more after SDI compared with the risk during the first 15 years (p = 0.0026). None of HL characteristics or treatment details was associated with higher risk of BC after adjusting for age and calendar time. Conclusions: Age at irradiation and time since therapy appear to be the only significant risk factors for development of BC after treatment of HL. The risk is significantly higher 15 years or more after radiation and for women treated before age 30 years. Long-term surveillance strategies are indicated for women at risk.

  20. Factors Affecting Distribution of Estrogenicity in the Influents, Effluents, and Biosolids of Canadian Wastewater Treatment Plants.

    PubMed

    Shieh, Ben H H; Louie, Alvin; Law, Francis C P

    2016-05-01

    Canadian wastewater treatment plants (WWTPs) release significant amounts of estrogenic chemicals to nearby surface waters. Environmental estrogens have been implicated as the causative agents of many developmental and reproductive problems in animals, including fish. The goals of this study were to assess the estrogenic activity in the influents, effluents, and biosolids of thirteen Canadian WWTPs using the yeast estrogen screen (YES) bioassay and to investigate whether factors, such as wastewater treatment method, sample storage, extraction efficiency, population, and summer/winter temperature had any effects on the distribution of estrogenicity in the WWTPs. Results of the study showed that estrogenicity from the influent to the effluent decreased in seven WWTPs, increased in two WWTPs, and did not change in four WWTPs during the winter. Estrogenic concentrations generally decreased in the order of biosolids > influents > effluents and ranged from 1.57 to 24.6, 1.25E-02 to 3.84E-01, and 9.46E-03 to 3.90E-01 ng estradiol equivalents/g or ml, respectively. The estrogenicity in the final effluents, but not those in the influents and biosolids, was significantly higher in the summer than the winter. Among the WWTP treatment methods, advanced, biological nutrient removal appeared to be the most effective method to remove estrogenic chemicals from wastewaters in Canada. Our studies help to identify factors or mechanisms that affect the distribution of estrogenicity in WWTPs, providing a better understanding on the discharges of estrogenic chemicals from WWTPs. PMID:26433808

  1. Challenging factors for enuresis treatment: Psychological problems and non-adherence.

    PubMed

    Van Herzeele, Charlotte; De Bruyne, Pauline; De Bruyne, Elke; Walle, Johan Vande

    2015-12-01

    The evidence for organic pathogenetic factors in enuresis and the discovery of effective therapies targeting the bladder and/or nocturnal diuresis have overwhelmed every potential role of psychological factors in pathogenesis and treatment. However, psychopathology is still important in enuresis because according to the document of the International Children's Continence Society (ICCS) 20-30% of the children with enuresis have at least one psychological/psychiatric disorder at rates two times higher than non-wetting children. The most common comorbid disorder with enuresis is attention deficit hyperactivity disorder. The aim of this review is to translate the existing evidence on the importance of a psychological screening into daily clinical practice of the medical practitioner. The use of the minimal psychological screening tool should be considered mandatory in each primary setting. If psychological problems are indicated, referral of the patient to a multidisciplinary setting should be considered, not only to allow psychological assessment to screen for a possible psychopathology, but also since therapy resistance might be expected. This review concentrates on two items from psychopathology/psychotherapy that might predict insufficient treatment response: the psychological comorbidities as described according to the DSM-5 criteria and the underestimated importance of therapy adherence. Adherence is a cornerstone of effective therapy in enuresis. It is a problem involving the doctor, the patient, and the parents. Increasing adherence takes effort and is time-consuming. But it is worthwhile knowing that several studies have demonstrated that high adherence is associated with high therapy success of enuresis. Eventually, this is the ultimate goal of treatment. PMID:26182849

  2. [Performance and Factors Analysis of Sludge Dewatering in Different Wastewater Treatment Processes].

    PubMed

    Liu, Ji-bao; Li, Ya-ming; Lü, Jian; Wei, Yuan-song; Yang, Min; Yu, Da-wei

    2015-10-01

    Sludge dewatering is one of the keys for sludge disposal and treatment of municipal wastewater treatment plants. In this study, the sludge dewaterability, flocculant consumption and costs of sludge dewatering for different wastewater treatment processes including A2/O and A2/O-MBR processes were analyzed, as well as the factors of sludge dewatering were analyzed by redundancy analysis (RDA) method, based on the data of one municipal wastewater treatment plant of Beijing in 2013. Results showed that both sludge dewaterability and flocculant consumption presented the seasonal variation, which means sludge dewatering was harder and coupled with higher flocculant consumption in the winter. Although the lower moisture content of dewatered sludge was obtained in the A2/O-MBR process (81.92% ± 1.64% ) compared with that in the A2/O process (82.56% ± 1.35%), the consumptions of flocculant [ (8.70 ± 7.25) kg x t(-1) DS] and electric energy (331.82 kW x h x t(-1) DS) in the A2/O-MBR process were higher than those in the A2/O process [(7.42 ± 2.96) kg x t(-1) DS, 121.57 kW x h x t(-1) DS for flocculant consumption and electric energy respectively], resulting in higher operation costs (RMB 204.76 yuan x t(-1) DS of flocculant consumption and RMB 231.61 yuan x t(-1) DS of energy consumption for the A2/O-MBR, RMB 175.00 yuan x t(-1) DS of flocculant consumption and RMB 84.86 yuan x t(-1) DS of energy consumption for the A2/O, respectively). Results of RDA showed that the seasonal variation of sludge dewaterability mainly depended on the content of organic matter in sludge which was related to the seasonal factors such as temperature, and was also impacted by the operating parameters such as SRT in wastewater treatment. PMID:26841614

  3. Intracerebral hemorrhage during treatment with oral anticoagulants. Risk factors, therapy and prognosis.

    PubMed

    Ernestus, R I; Speder, B; Pakos, P; Hildebrandt, G; Klug, N

    1994-01-01

    Intracerebral hemorrhage (ICH) during oral anticoagulation is a serious complication, which is mostly fatal for the multimorbid patient. In the present retrospective study of 53 patients with ICH during treatment with a cumarin derivative (Phenoprocoumon, Marcumar), we investigated the relationship between therapy and preexisting parameters such as age, location, level of consciousness, additional bleeding risks, and the degree of anticoagulation, which were assumed to be of prognostic relevance. The therapeutic management of ICH during treatment with anticoagulants was determined predominantly by location of the hematoma, patient's age, and additional bleeding risks, but less by level of consciousness and initial thromboplastin time (Quick's test). As a consequence of the individual analysis of these 5 parameters, age over 60 years, location of hematoma in the midline or ventricles, coma, additional bleeding risks such as arterial hypertension and trauma, and Quick's test below 15% at the time of bleeding were supposed to be responsible for poor prognosis. Mortality increased with a rising number of poor prognostic factors, independently of surgical or conservative treatment. In consequence, prognosis of ICH during oral anticoagulation is predominantly influenced by the number of such disadvantageous indicators and only little by therapy. PMID:8053274

  4. Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review.

    PubMed

    Lin, Stephanie; Ramulu, Pradeep; Lamoureux, Ecosse L; Sabanayagam, Charumathi

    2016-05-01

    The number of people with diabetic retinopathy (DR) has increased with the increasing prevalence of diabetes mellitus worldwide, especially in developing countries. In recent years, the successful implementation of public health programs in developed countries has been thought to contribute to decreases in blindness from DR. Developing countries, however, have not seen the same improvements, and their public health interventions still face significant challenges. In this review we describe the current state of public health approaches including risk factor control, screening and treatment techniques for DR in developing countries, and suggest recommendations. While the awareness of DR is variable, specific knowledge about DR is low, such that many patients have already experienced vision loss by the time they are screened. Attempts to improve rates of screening, in particular through non-mydriatic cameras and tele-screening, are ongoing and promising, although challenges include collaboration with healthcare systems and technology failures. Laser treatment is the most readily available, with anti-VEGF therapy and vitreo-retinal surgery increasingly sought after and provided. Recommendations include the use of 'targeted mydriasis' for fundus imaging to address high rates of ungradable images, increased communication with diabetes management services to improve patient retention and mobilization of access to DR treatments. PMID:26991970

  5. Empirical risk factors for delinquency and best treatments: where do we go from here?

    PubMed

    Zagar, Robert John; Busch, Kenneth G; Hughes, John Russell

    2009-02-01

    Youth development and prevention of violence are two sides of the same public policy issue. A great deal of theoretical and empirical effort has focused on identification of risk factors for delinquency and development of interventions for general risks. Recent calls for changes in public policy are evaluated here--and challenged--in light of new comprehensive, longitudinal empirical data on urban violent delinquency. Treatments such as prenatal care, home visitation, prevention of bullying, prevention of alcohol and/or drug abuse, promotion of alternative thinking, mentoring, life skills training, rewards for graduation and employment, functional family therapy, and multidimensional foster care are effective because they prevent or ameliorate risks for delinquency occurring during development. At present, the best treatments yield 10 to 40% reductions in delinquent recidivism. Better controlled application of developmentally appropriate treatments in higher doses, with narrow targeting of the highest-risk youth based on actuarial testing--rather than less accurate clinical judgment--should result in higher effectiveness. Such a focused approach in a geographical area with high homicide rates should be cost-effective. A prediction of cost-benefit outcomes for a carefully constructed example of a large-scale program is presented. PMID:19480217

  6. Evaluating Persistent Postoperative Pain in One Tertiary Hospital: Incidence, Quality of Life, Associated Factors, and Treatment

    PubMed Central

    Guimaraes-Pereira, Luis; Valdoleiros, Ines; Reis, Pedro; Abelha, Fernando

    2016-01-01

    Background Persistent postoperative pain (PPP) is defined as persistent pain after surgery of greater than three months’ duration. Objectives Identify the incidence of PPP in our hospital and its associated factors; evaluate quality of life (QoL) and treatment of patients. Patients and Methods We conducted an observational prospective study in adults proposed to various types of surgery using the brief pain inventory short form preoperatively (T0), one day after surgery, and three months later (T3). If the patient had pain at T3 and other causes of pain were excluded, they were considered to have PPP, and the McGill Pain Questionnaire Short Form was applied. QoL was measured with the EuroQol 5-dimension questionnaire (EQ-5D). Results One hundred seventy-five patients completed the study. The incidence of PPP was 28%, and the affected patients presented lower QoL. The majority referred to a moderate to severe level of interference in their general activity. Cholecystectomies were less associated with PPP, and total knee/hip replacements were more associated with it. Preoperative pain, preoperative benzodiazepines or antidepressants, and more severe acute postoperative pain were associated with the development of PPP. Half of the patients with PPP were under treatment, and they refer a mean symptomatic relief of 69%. Conclusions This study, apart from attempting to better characterize the problem of PPP, emphasizes the lack of its treatment. PMID:27252908

  7. Risk factors for treatment delay in pulmonary tuberculosis in Recife, Brazil

    PubMed Central

    dos Santos, Martinho APS; Albuquerque, Maria FPM; Ximenes, Ricardo AA; Lucena-Silva, Norma LCL; Braga, Cynthia; Campelo, Antônio RL; Dantas, Odimariles MS; Montarroyos, Ulisses R; Souza, Wayner V; Kawasaki, Alexandre M; Rodrigues, Laura C

    2005-01-01

    Background Tuberculosis is still a great challenge to public health in Brazil and worldwide. Early detection followed by effective therapy is extremely important in controlling the disease. Recent studies have investigated reasons for delays in treatment, but there is no agreed definition of what constitutes an "acceptable" delay. This study investigates factors associated with total delay in treatment of tuberculosis. Methods A cohort of adult cases of pulmonary tuberculosis diagnosed over a two-year period was studied. Patients were interviewed on entry, reporting the duration of symptoms before the start of treatment, and sputum and blood samples were collected. It was decided that sixty days was an acceptable total delay. Associations were investigated using univariable and multivariable analysis and the population attributable fraction was estimated. Results Of 1105 patients, 62% had a delay of longer than 60 days. Age, sex, alcoholism and difficulty of access were not associated with delays, but associations were found in the case of unemployment, having given up smoking, having lost weight and being treated in two of the six health districts. The proportion attributable to: not being an ex-smoker was 31%; unemployment, 18%; weight loss, 12%, and going to the two worst health districts, 25%. Conclusion In this urban area, delays seem to be related to unemployment and general attitudes towards health. Although they reflect the way health services are organized, delays are not associated with access to care. PMID:15777473

  8. Diabetic nephropathy--a review of the natural history, burden, risk factors and treatment.

    PubMed Central

    Ayodele, Olugbenga E.; Alebiosu, C. Olutayo; Salako, Babatunde L.

    2004-01-01

    The earliest clinical evidence of diabetic nephropathy is microalbuminuria. Progression from microalbuminuria to overt nephropathy occurs in 20-40% within a 10-year period with approximately 20% of these patients progressing to end-stage renal disease. End-stage renal disease develops in 50% of type-1 diabetes patients with overt nephropathy within 10 years and in more than 75% by 20 years in the absence of treatment. In type-2 diabetes, a greater proportion of patients have microalbuminuria and overt nephropathy at or shortly after diagnosis of diabetes. The incidence of diabetes is increasing worldwide, with subsequent increase in the incidence of diabetic nephropathy. The risk factors identified in the development of DN from longitudinal and cross-sectional studies include race, genetic susceptibility, hypertension, hyperglycemia, hyperfiltration, smoking, advanced age, male sex, and high-protein diet. Treatment interventions in diabetic nephropathy include glycemic control, treatment of hypertension, hyperlipidemia, cessation of smoking, protein restriction, and renal replacement therapy. Multifactorial approach includes combined therapy targeting hyperglycemia, hypertension, microalbuminuria, and dyslipidemia. PMID:15586648

  9. Treatment results and prognostic factors of pediatric neuroblastoma: a retrospective study

    PubMed Central

    2010-01-01

    Background We conducted a retrospective analysis to investigate treatment results and prognostic factors of pediatric neuroblastoma patients. Methods This retrospective study was carried out analyzing the medical records of patients with the pathological diagnosis of neuroblastoma seen at South Egypt Cancer Institute, Assiut University during the period from January 2001 and January 2010. After induction chemotherapy, response according to international neuoblastoma response criteria was assessed. Radiotherapy to patients with residual primary tumor was applied. Overall and event free survival (OAS and EFS) rates were estimated using Graphed prism program. The Log-rank test was used to examine differences in OAS and EFS rates. Cox-regression multivariate analysis was done to determine the independent prognostic factors affecting survival rates. Results Fifty three cases were analyzed. The median follow-up duration was 32 months and ranged from 2 to 84 months. The 3-year OAS and EFS rates were 39.4% and 29.3% respectively. Poor prognostic factors included age >1 year of age, N-MYC amplification, and high risk group. The majority of patients (68%) presented in high risk group, where treatment outcome was poor, as only 21% of patients survived for 3 year. Conclusion Multivariate analysis confirmed only the association between survival and risk group. However, in univariate analysis, local radiation therapy resulted in significant survival improvement. Therefore, radiotherapy should be given to patients with residual tumor evident after induction chemotherapy and surgery. Future attempts to improve OAS in high risk group patients with aggressive chemotherapy and bone marrow transplantation should be considered. PMID:21182799

  10. Risk Factors Contributing to Type 2 Diabetes and Recent Advances in the Treatment and Prevention

    PubMed Central

    Wu, Yanling; Ding, Yanping; Tanaka, Yoshimasa; Zhang, Wen

    2014-01-01

    Type 2 diabetes is a serious and common chronic disease resulting from a complex inheritance-environment interaction along with other risk factors such as obesity and sedentary lifestyle. Type 2 diabetes and its complications constitute a major worldwide public health problem, affecting almost all populations in both developed and developing countries with high rates of diabetes-related morbidity and mortality. The prevalence of type 2 diabetes has been increasing exponentially, and a high prevalence rate has been observed in developing countries and in populations undergoing “westernization” or modernization. Multiple risk factors of diabetes, delayed diagnosis until micro- and macro-vascular complications arise, life-threatening complications, failure of the current therapies, and financial costs for the treatment of this disease, make it necessary to develop new efficient therapy strategies and appropriate prevention measures for the control of type 2 diabetes. Herein, we summarize our current understanding about the epidemiology of type 2 diabetes, the roles of genes, lifestyle and other factors contributing to rapid increase in the incidence of type 2 diabetes. The core aims are to bring forward the new therapy strategies and cost-effective intervention trials of type 2 diabetes. PMID:25249787

  11. Role of enhanced half-life factor VIII and IX in the treatment of haemophilia.

    PubMed

    Mahdi, Ali J; Obaji, Samya G; Collins, Peter W

    2015-06-01

    Treatment of congenital haemophilia with factor VIII and IX concentrates often requires frequent infusions. This has obvious implications in establishing effective administration strategies and, in turn, adherence. To overcome these issues, three main technologies--polyethylene-glycol, Fc-neonatal IgG1 and albumin fusion products--have emerged into various stages of clinical development. Published data indicates an approximately 1·5- and fivefold increase in half-life of factor VIII and IX, respectively, compared to standard recombinant concentrates. Studies into efficacy and safety are starting to be published. Monitoring and optimal use of these new concentrates remains unknown. Weekly factor IX prophylaxis appears to be a feasible prophylactic regimen in haemophilia B patients. Weekly longer-acting FVIII is unlikely to provide adequate prophylaxis in most patients with haemophilia A but may reduce the frequency of infusions. Ongoing clinical trials and real life experience will help shape how these products can be used in practice and their cost effectiveness. The drive for convenience however should not overshadow the ultimate goal of prophylaxis, namely, preventing bleeding and arthropathy. PMID:25754016

  12. Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention.

    PubMed

    Wu, Yanling; Ding, Yanping; Tanaka, Yoshimasa; Zhang, Wen

    2014-01-01

    Type 2 diabetes is a serious and common chronic disease resulting from a complex inheritance-environment interaction along with other risk factors such as obesity and sedentary lifestyle. Type 2 diabetes and its complications constitute a major worldwide public health problem, affecting almost all populations in both developed and developing countries with high rates of diabetes-related morbidity and mortality. The prevalence of type 2 diabetes has been increasing exponentially, and a high prevalence rate has been observed in developing countries and in populations undergoing "westernization" or modernization. Multiple risk factors of diabetes, delayed diagnosis until micro- and macro-vascular complications arise, life-threatening complications, failure of the current therapies, and financial costs for the treatment of this disease, make it necessary to develop new efficient therapy strategies and appropriate prevention measures for the control of type 2 diabetes. Herein, we summarize our current understanding about the epidemiology of type 2 diabetes, the roles of genes, lifestyle and other factors contributing to rapid increase in the incidence of type 2 diabetes. The core aims are to bring forward the new therapy strategies and cost-effective intervention trials of type 2 diabetes. PMID:25249787

  13. Factors Influencing Compliance to Radical Treatment of Middle Thoracic Esophageal Cancer: An Audit from a Regional Cancer Centre

    PubMed Central

    Kapoor, Rakesh; Bansal, Anshuma; Kumar, Shikhar; Miriyala, Ravi Teja

    2016-01-01

    Background: The aim of this study is to identify the factors responsible for interruption of planned treatment in patients of carcinoma mid-thoracic esophagus and also discuss the strategies for improving treatment completion rates. Materials and Methods: Patients with nonmetastatic mid-thoracic esophageal cancer who received treatment by multimodality approach using chemotherapy, radiation, and/or surgery were retrospectively analyzed. Factors influencing compliance with planned treatment completion were evaluated, and their significance was determined using multivariate Cox regression analysis. Results: Ninety-one patients were reviewed. Median follow-up period was 11 months. Of 15 patients planned with neoadjuvant chemoradiation followed by surgery (Group 1), only 6 (40%) could complete the treatment. Similarly, only 19 out of 36 patients (52.8%) completed the planned definitive chemoradiation (Group 2). Furthermore, of forty patients planned with definitive radiotherapy (Group 3), 29 patients only (72.5%) completed this schedule. The rate of completion of therapy was worst in Group 1. The most common reason for noncompletion of planned treatment was nutritional inadequacy and excessive weight loss in all groups. In addition, chemotherapy-induced myelosuppression (P = 0.05) was the factor leading to treatment interruption in Group 2 and radiation-induced acute mucositis (P = 0.02) and lost to follow-up (P = 0.02) were the factors in Group 3. Conclusions: Rate of treatment completion significantly impacts survival rates. Nutritional inadequacy was the most common factor for noncompletion of planned treatment. A well-trained management team consisting of oncologist, dietitian, and psychotherapist can help overcome these factors and thereby improve the treatment completion rates. PMID:27559257

  14. Greenhouse gas production in wastewater treatment: process selection is the major factor.

    PubMed

    Keller, J; Hartley, K

    2003-01-01

    Many practical design and operating decisions on wastewater treatment plants can have significant impacts on the overall environmental performance, in particular the greenhouse gas (GHG) emissions. The main factor in this regard is the use of aerobic or anaerobic treatment technology. This paper compares the GHG production of a number of case studies with aerobic or anaerobic main and sludge treatment of domestic wastewater and also looks at the energy balances and economics. This comparison demonstrates that major advantages can be gained by using primarily anaerobic processes as it is possible to largely eliminate any net energy input to the process, and therefore the production of GHG from fossil fuels. This is achieved by converting the energy of the incoming wastewater pollutants to methane which is then used to generate electricity. This is sufficient to power the aerobic processes as well as the mixing etc. of the anaerobic stages. In terms of GHG production, the total output (in CO2 equivalents) can be reduced from 2.4 kg CO2/kg COD(removed) for fully aerobic treatment to 1.0 kg CO2/kg COD(removed) for primarily anaerobic processes. All of the CO2 produced in the anaerobic processes comes from the wastewater pollutants and is therefore greenhouse gas neutral, whereas up to 1.4 kg CO2/kg COD(removed) originates from power generation for the fully aerobic process. This means that considerably more CO2 is produced in power generation than in the actual treatment process, and all of this is typically from fossil fuels, whereas the energy from the wastewater pollutants comes primarily from renewable energy sources, namely agricultural products. Even a change from anaerobic to aerobic sludge treatment processes (for the same aerobic main process) has a massive impact on the CO2 production from fossil fuels. An additional 0.8 kg CO2/kg COD(removed) is produced by changing to aerobic sludge digestion, which equates for a typical 100,000 EP plant to an additional

  15. Granulocyte-colony stimulating factor as treatment option in patients with recurrent miscarriage.

    PubMed

    Santjohanser, Claudia; Knieper, Catherine; Franz, Cordula; Hirv, Kaino; Meri, Osama; Schleyer, Manfred; Würfel, Wolfgang; Toth, Bettina

    2013-04-01

    In 1-5% of patients during childbearing years recurrent miscarriages (RM) occur. There are established risk factors like anatomical, endocrine and hemostatic disorders as well as immunological changes in the maternal immune system. Nevertheless, further elucidation of the pathogenesis remains a matter of debate. In addition, there are no standardized immunological treatment strategies. Recent studies indicate possible effects of tumor necrosis factor α blocker and granulocyte-colony stimulating factor (G-CSF) concerning live birth rate (LBR) in RM patients. Therefore, we performed a retrospective cohort study in patients undergoing assisted reproductive treatment (ART) with known RM analysing the possible benefits of G-CSF application. From January 2002 to December 2010, 127 patients (199 cylces) with RM (at least 2 early miscarriages) 49 (72 cycles) receiving G-CSF and 78 (127 cycles) controls receiving either no medication (subgroup 1) or Cortisone, intravenous immunoglobulins or low molecular weight heparin (subgroup 2) undergoing ART for in vitro fertilisation/intracytoplasmic sperm injection were analysed. G-CSF was administered weekly once (34 Mill) in 11 patients, 38 patients received 2 × 13 Mill G-CSF per week until the 12th week of gestation. Statistical analysis was performed with SPSS for Windows (19.0), p < 0.05 significant. The mean age of the study population was 37.3 ± 4.4 years (mean ± standard deviation) and differed not significantly between patients and subgroups. However, the number of early miscarriages was significantly higher in the G-CSF group as compared to the subgroups (G-CSF 2.67 ± 1.27, subgroup 1 0.85 ± 0.91, subgroup 2 0.64 ± 0.74) and RM patients receiving G-CSF had significantly more often a late embryo transfer (day 5) (G-CSF 36.7%, subgroup 1 12.1%, subgroup 2 8.9%). The LBR of patients and the subgroups differed significantly (G-CSF 32%, subgroup 1 13%, subgroup 2 14%). Side effects were present in less than 10% of

  16. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...), you must avail yourself of appropriate treatment for your drug addiction or alcoholism at...

  17. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...), you must avail yourself of appropriate treatment for your drug addiction or alcoholism at...

  18. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...), you must avail yourself of appropriate treatment for your drug addiction or alcoholism at...

  19. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...), you must avail yourself of appropriate treatment for your drug addiction or alcoholism at...

  20. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...), you must avail yourself of appropriate treatment for your drug addiction or alcoholism at...

  1. Brain-Derived Neurotrophic Factor Gene Expression in Pediatric Bipolar Disorder: Effects of Treatment and Clinical Response

    ERIC Educational Resources Information Center

    Pandey, Ghanshyam N.; Rizavi, Hooriyah S.; Dwivedi, Yogesh; Pavuluri, Mani N.

    2008-01-01

    The study determines the gene expression of brain-derived neurotrophic factor (BDNF) in the lymphocytes of subjects with pediatric bipolar disorder (PBD) before and during treatment with mood stabilizers and in drug-free normal control subjects. Results indicate the potential of BDNF levels as a biomarker for PBD and as a treatment predictor and…

  2. Early Systemic Granulocyte-Colony Stimulating Factor Treatment Attenuates Neuropathic Pain after Peripheral Nerve Injury

    PubMed Central

    Lee, Yun-Lin; Chen, Jin-Chung; Wang, Hung-Li; Yang, Yi-Ling; Cheng, Mei-Yun; Liao, Ming-Feng; Ro, Long-Sun

    2012-01-01

    Recent studies have shown that opioid treatment can reduce pro-inflammatory cytokine production and counteract various neuropathic pain syndromes. Granulocyte colony-stimulating factor (G-CSF) can promote immune cell differentiation by increasing leukocytes (mainly opioid-containing polymorphonuclear (PMN) cells), suggesting a potential beneficial role in treating chronic pain. This study shows the effectiveness of exogenous G-CSF treatment (200 µg/kg) for alleviating thermal hyperalgesia and mechanical allodynia in rats with chronic constriction injury (CCI), during post-operative days 1–25, compared to that of vehicle treatment. G-CSF also increases the recruitment of opioid-containing PMN cells into the injured nerve. After CCI, single administration of G-CSF on days 0, 1, and 2, but not on day 3, relieved thermal hyperalgesia, which indicated that its effect on neuropathic pain had a therapeutic window of 0–48 h after nerve injury. CCI led to an increase in the levels of interleukin-6 (IL-6) mRNA and tumor necrosis factor-α (TNF-α) protein in the dorsal root ganglia (DRG). These high levels of IL-6 mRNA and TNF-α were suppressed by a single administration of G-CSF 48–144 h and 72–144 h after CCI, respectively. Furthermore, G-CSF administered 72–144 h after CCI suppressed the CCI-induced upregulation of microglial activation in the ipsilateral spinal dorsal horn, which is essential for sensing neuropathic pain. Moreover, the opioid receptor antagonist naloxone methiodide (NLXM) reversed G-CSF-induced antinociception 3 days after CCI, suggesting that G-CSF alleviates hyperalgesia via opioid/opioid receptor interactions. These results suggest that an early single systemic injection of G-CSF alleviates neuropathic pain via activation of PMN cell-derived endogenous opioid secretion to activate opioid receptors in the injured nerve, downregulate IL-6 and TNF-α inflammatory cytokines, and attenuate microglial activation in the spinal dorsal horn. This

  3. Parental Factors that Detract from the Effectiveness of Cognitive-Behavioral Treatment for Childhood Anxiety: Recommendations for Practitioners

    ERIC Educational Resources Information Center

    Walker, Jerry V., III

    2012-01-01

    This article reviews the recent empirical literature on the various parental factors that detract from the effectiveness of cognitive-behavioral treatment for children with anxiety. Interventions such as treating parental anxiety and increasing parental involvement in the therapeutic process may combat these factors. Newer strategies such as…

  4. Chitosan gel formulations containing egg yolk oil and epidermal growth factor for dermal burn treatment.

    PubMed

    Yenilmez, E; Başaran, E; Arslan, R; Berkman, M S; Güven, U M; Bayçu, C; Yazan, Y

    2015-02-01

    In the present study chitosan based gel formulations containing Egg Yolk Oil (EYO) and Epidermal Growth Factor (EGF) were formulated successfully aiming at enhanced topical treatment of dermal burns the combination of traditional approaches with modern drug delivery systems. Physicochemical properties of the formulations were analyzed and efficacy of the formulations prepared were evaluated versus a commercial product; Silverdin (1% silver sulfadiazine) in vivo on Wistar rats. Burns were generated on the back of the rats and at predetermined time intervals tissue samples were collected and evaluated histologically. The analyses showed that chitosan based gel formulations containing Egg Yolk Oil (E1) and chitosan based gel formulations containing EYO and EGF (M1) formulations seem to be better alternatives for Silverdin with a significant difference (p < 0.05) considering healing ranks of tissue samples. PMID:25997244

  5. Gefitinib in the treatment of nonsmall cell lung cancer with activating epidermal growth factor receptor mutation

    PubMed Central

    Nurwidya, Fariz; Takahashi, Fumiyuki; Takahashi, Kazuhisa

    2016-01-01

    Lung cancer is still the main cause of cancer-related deaths worldwide, with most patients present with advanced disease and poor long-term prognosis. The aim of lung cancer treatment is to slow down the progression of the disease, to relieve the patients from the lung cancer symptoms and whenever possible, to increase the overall survival. The discovery of small molecule targeting tyrosine kinase of epidermal growth factor receptor opens a new way in the management of advanced nonsmall cell lung cancer (NSCLC). This review will discuss several Phase II and III trials evaluated the clinical efficacy of gefitinib as monotherapy in pretreated patients with advanced NSCLC, as well as both monotherapy and combined with chemotherapy in chemotherapy-naive patients. PMID:27433059

  6. Surgical treatment for a paraplegic patient induced by congenital factor X deficiency

    PubMed Central

    Lin, Weicheng; Zhou, Jing; Wang, Tianbing; Zhang, Peixun

    2015-01-01

    Congenital factor X (FX) deficiency is a rare disease which usually leads to coagulation disorders. We reported a case of paraplegic patient induced by traumatic spinal epidural hematoma which was associated with congenital FX deficiency. The treatments of this patient included elevating FX activity (FX: C) by adding fresh-frozen plasma (FFP) or prothrombin complex concentration (PCC) to improve his coagulation function, and doing operation to remove his spinal hematoma. Symptoms started to resolve after operation. Besides, we found one of his elder brother had the same disease as the patient himself via family follow-up. They can survive because their FX: C are relatively high enough to keep them away from fatal bleeding. PMID:26550274

  7. Personality disorders among Spanish prisoners starting hepatitis C treatment: Prevalence and associated factors.

    PubMed

    Marco, Andrés; Antón, José J; Saiz de la Hoya, Pablo; de Juan, José; Faraco, Inmaculada; Caylà, Joan A; Trujols, Joan

    2015-12-30

    The purpose of this study was to assess the prevalence of personality disorders (PDs) and their associated factors in prisoners who initiate chronic hepatitis C (CHC) treatment in 25 Spanish prisons. The Personality Diagnostic Questionnaire-4 was used to diagnose PDs according to DSM-IV criteria. Factors potentially associated with a PD diagnosis were evaluated by logistic regression analysis. Two hundred and fifty-five patients were initially assessed and 62 (24.3%) were excluded due to an incomplete or invalid self-report screening questionnaire. PD prevalence was 70.5%, with antisocial PD being the most prevalent (46.1%). In terms of PD clusters, the most prevalent was cluster-B (55.4%). PD diagnosis was associated with HCV genotypes 1, 2, or 3 (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.02-4.49). Patients with a cluster-B PD were more likely to be infected with HCV genotypes 1, 2, or 3 (OR 2.37, 95% CI 1.08-5.23) and be HIV-infected (OR 2.20, 95% CI 1.10-4.39), to report past-year injection drug use (OR 7.17, 95% CI 1.49-34.58), and to have stage 3 or 4 fibrosis (OR 2.16, 95% CI 1.06-4.49). The prevalence of PDs in Spanish prisoners who initiate CHC treatment is very high. PD management issues should be considered in treating CHC patients in prisons. PMID:26602229

  8. Treatment outcome and prognostic factor of CO2 laser cordectomy for early glottic cancer

    NASA Astrophysics Data System (ADS)

    Chung, Phil-Sang; Lee, Sang Joon

    2012-02-01

    Objectives: Laser cordectomy is very popular nowadays and become one of the treatments of choice for early glottis carcinoma. Transoral laser microsurgery has many advantages comparing conventional open surgery or radiation therapy. In this study, we examined the oncologic results of laser cordectomy for early glottic cancer and analyzed the prognostic impact on the survival of the several tumor-related and treatment-related factors. Methods: Patients who were diagnosed as early glottic squamous cell carcinoma, treated by laser cordectomy with curative intent were analyzed. Patients with preivous radiation therapy were included. From June 1988 to March 2005, 202 patients from five hospitals were analyzed (174 T1, 28 T2). Results: Five-year overall survival and disease-free survival were 98.4% and 84.9%. Twenty two patients developed local recurrence. Total laryngectomy was done in 6 patients and laryngeal preservation rate was 97%. Recurrence was higher in the patients with anterior commissure involvement (9/39) than without anterior commissure involvement (13/163). Recurrence was higher in T1b (4/15) than T1a (13/159). Previous radiation was also highly related to the recurrence (7/20 vs 15/182). Twenty patients with local recurrence after radiation therapy were treated by salvage laser cordectomy. Of them, 7 patients developed local recurrence and 5 year disease-free survival was 57%. Complication was rare with one case of hemorrhage. Tracheotomy was not necessary in all patients. Conclusions: Laser cordectomy for early glottic carcinoma showed high survival, laryngeal preservation rate and low complication rate. The prognostic factors were anterior commissure involvement, both vocal fold involvement and previous radiotherapy.

  9. Influencing Factors of Limestone Sorption and its Usage in Advanced Wastewater Treatment for Phosphorus Removal

    NASA Astrophysics Data System (ADS)

    Li, Linyong; Zhang, Hua; Wang, Dunqiu

    2012-01-01

    Phosphorus (P) is one of the main triggering nutrients responsible for eutrophication which troubles many waters in China. This study was to investigate the influencing factors of limestone (LS) adsorption and establish the parameter of constructed wetland (CW) using LS as the main substrate when treating effluent from a municipal wastewater treatment plant (MWTP) for P removal. First, a series of batch experiments were conducted to study the influencing factors of LS adsorption. Consequently, the P removal efficiency increased with the temperature and was high during the initial 3 h; the efficiency was over 75% even at initial P content 50 mg/L; under 2 mm small LS particle size enhanced the adsorption but the difference was not significant; the efficiency was over 90% when initial pH was below 6.37 and decreased sharply at pH above 8.15; sodium chloride as background electrolyte decreased the adsorption; organic acids including tartaric acid, oxalic acid and citric acid all suppressed the adsorption, and citric acid demonstrated the strongest effect. Then column experiment was conducted to evaluate the effect of the continuous vertical-flow LS bed treating effluent from a MWTP with varying hydraulic retention time (HRT). Over 80 days, the effluent pH was between 7 and 9, and effective running time increased with HRT during which the effluent total P content was below 0.5 mg/L. Short HRT such as 1 h or 1.5 h was recommended for dynamic LS adsorption. It showed that LS was suitable for the substrate in CW for P removal in wastewater advanced treatment.

  10. Risk factors associated with short-term post-treatment outcomes of clinical mastitis.

    PubMed

    Pinzón-Sánchez, C; Ruegg, P L

    2011-07-01

    The objectives of this study were to characterize 60-d outcomes after treatment of mild (abnormal milk) and moderate (abnormal milk and abnormal udder) cases of clinical mastitis (CM) occurring in a single quarter of cows on Wisconsin farms (n=4) and to determine risk factors associated with those outcomes. Duplicate milk samples were collected from the affected quarter of each cow for microbiological analysis at the onset of CM (PRE) and 21 d later (POST). Cows were treated only in the affected quarter using an intramammary product containing 125 mg of ceftiofur. Bacteriological cure was defined as absence of pathogens in the POST sample obtained from the enrolled quarter. Recurrence was defined for the cow when CM occurred after the milk-withholding period for the enrolled case of CM. Retention in the herd was defined when a cow was retained within the herd for the 60-d follow-up period. Somatic cell count reduction (SCCR) was defined at the cow level as somatic cell count (SCC) below 200,000 cells/mL at the Dairy Herd Improvement Association test day occurring between 21 to 55 d post-treatment. The effects of farm, days in milk, parity, severity, microbiological diagnosis at PRE, previous milk yield, previous SCC, previous occurrence of CM and treatment duration on selected post-treatment outcomes were assessed using Chi-squared analysis and logistic regression. Microbiological results at PRE were distributed as: Escherichia coli (n=14), Klebsiella spp. (n=11), Enterobacter spp. (n=8), Serratia spp. (n=7), other gram-negative species (n=3), Streptococcus spp. (n=25), coagulase-negative staphylococci (n=4); Staphylococcus aureus (n=1); Streptococcus agalactiae (n=1), other gram-positive species (n=9), and culture negative (n=60). Treated quarters were more likely to experience bacteriological cure when the cow experienced CM for the first time in the lactation and when no pathogen was recovered from PRE milk samples obtained from the enrolled quarter. Parity and

  11. Prognostic factors determining the outcome of treatment in chronic hepatitis C.

    PubMed

    Hadziyannis, S J

    2000-01-01

    After a brief introduction in terminology and a distinction between predictors and determinants or response to therapy in chronic hepatitis C, a review of the wide literature on this topic is presented. None of the pretreatment variables or combination of them can be used as an absolute predictor of response in individual patients. Prognostic factors can help in clinical practice for informing and counseling patients of the likelihood of response. Information on pretreatment HCV RNA levels and HCV genotype can improve the cost benefit of therapy. Predictors of response should be properly evaluated in terms of positive predictive value, negative predictive value and accuracy. The strongest hitherto predictor of sustained response to any therapeutic regimen in chronic hepatitis is the clearance of HCV RNA during treatment. Recent data suggest that sequencing of several regions of the HCV genome may provide important prognostic information on the outcome of therapy. In complex and difficult to treat subsets of patients with chronic HCV infection, available data on predictors and determinants of the outcome of treatment are limited. PMID:10925467

  12. Corticorelin, a synthetic human corticotropin-releasing factor analog, for the treatment of peritumoral brain edema.

    PubMed

    Panickar, Kiran S

    2010-12-01

    Corticorelin is a synthetic analog of the naturally occurring human peptide corticotropin-releasing factor (CRF). Several studies have indicated the ability of CRF to reduce the brain edema caused by brain tumors. Peritumoral brain edema (PBE), caused by an intracerebral tumor, manifests several features of vasogenic edema, which is a type of edema characterized by disruption of the blood-brain barrier. Traditionally, PBE has been treated using corticosteroids, primarily dexamethasone. Introduced more than four decades ago, dexamethasone revolutionized the treatment of PBE, but the side effects and withdrawal symptoms associated with corticosteroids propelled the investigation of other drugs. Clinical trials with the synthetic human CRF (hCRF) corticorelin (Xerecept, NEU-3002; Celtic Pharmaceutical Holdings) have indicated that this drug has a distinct advantage over classical corticosteroids in the treatment of PBE. Fewer and/or milder side effects have been reported for corticorelin compared with dexamethasone, although at higher doses of corticorelin several side effects, including hypotension and transient flushing, have been reported. Nevertheless, corticorelin was reasonably well tolerated in patients and healthy volunteers, and may be a good candidate for reducing PBE and associated neural damage, as well as improving neurological symptoms. PMID:21154169

  13. Targeted delivery of brain-derived neurotrophic factor for the treatment of blindness and deafness

    PubMed Central

    Khalin, Igor; Alyautdin, Renad; Kocherga, Ganna; Bakar, Muhamad Abu

    2015-01-01

    Neurodegenerative causes of blindness and deafness possess a major challenge in their clinical management as proper treatment guidelines have not yet been found. Brain-derived neurotrophic factor (BDNF) has been established as a promising therapy against neurodegenerative disorders including hearing and visual loss. Unfortunately, the blood–retinal barrier and blood–cochlear barrier, which have a comparable structure to the blood–brain barrier prevent molecules of larger sizes (such as BDNF) from exiting the circulation and reaching the targeted cells. Anatomical features of the eye and ear allow use of local administration, bypassing histo-hematic barriers. This paper focuses on highlighting a variety of strategies proposed for the local administration of the BDNF, like direct delivery, viral gene therapy, and cell-based therapy, which have been shown to successfully improve development, survival, and function of spiral and retinal ganglion cells. The similarities and controversies for BDNF treatment of posterior eye diseases and inner ear diseases have been analyzed and compared. In this review, we also focus on the possibility of translation of this knowledge into clinical practice. And finally, we suggest that using nanoparticulate drug-delivery systems may substantially contribute to the development of clinically viable techniques for BDNF delivery into the cochlea or posterior eye segment, which, ultimately, can lead to a long-term or permanent rescue of auditory and optic neurons from degeneration. PMID:25995632

  14. Bisphosphonate Associated Osteonecrosis of the Jaw: An Update on Pathophysiology, Risk Factors, and Treatment

    PubMed Central

    Rasmusson, Lars

    2014-01-01

    Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly. PMID:25254048

  15. Demyelinizing Neurological Disease after Treatment with Tumor Necrosis Factor-α Antagonists

    PubMed Central

    Bruè, Claudia; Mariotti, Cesare; Rossiello, Ilaria; Saitta, Andrea; Giovannini, Alfonso

    2016-01-01

    Purpose Demyelinizing neurological disease is a rare complication after treatment with tumor necrosis factor (TNF)α antagonists. We report on a case of multiple sclerosis after TNFα antagonist treatment and discuss its differential diagnosis. Methods This is an observational case study. Results A 48-year-old male was referred to Ophthalmology in January 2015 for an absolute scotoma in the superior quadrant of the visual field in his right eye. Visual acuity was 20/50 in the right eye and 20/20 in the left. Fundus examination was unremarkable bilaterally. Spectral domain optical coherence tomography revealed a normal macular retina structure. Visual field examination revealed a superior hemianopsia in the right eye. Head magnetic resonance imaging showed findings compatible with optic neuritis. The visual evoked potentials confirmed the presence of optic neuritis. The patient had been under therapy with adalimumab since January 2014, for Crohn's disease. Suspension of adalimumab was recommended, and it was substituted with tapered deltacortene, from 1 mg/kg/day. After 1 month, the scotoma was resolved completely. Conclusions TNFα antagonists can provide benefit to patients with inflammatory autoimmune diseases. However, they can also be associated with severe adverse effects. Therefore, adequate attention should be paid to neurological abnormalities in patients treated with TNFα antagonists. PMID:27504093

  16. Heat shock protein 90: a pathophysiological factor and novel treatment target in autoimmune bullous skin diseases.

    PubMed

    Tukaj, Stefan; Zillikens, Detlef; Kasperkiewicz, Michael

    2015-08-01

    The chaperone heat shock protein 90 (Hsp90), a cell stress-inducible molecule that regulates activity of many client proteins responsible for cellular growth, differentiation and apoptosis, has been proposed as an important therapeutic target in patients with malignancies. More recently, its active participation in (auto)immune processes has been recognized as evidenced by amelioration of inflammatory disease pathways through pharmacological inhibition of Hsp90 in rodent models of autoimmune encephalomyelitis, rheumatoid arthritis and systemic lupus erythematosus. Based on own current research results, this viewpoint essay provides important insights that Hsp90 is also involved as a notable pathophysiological factor in autoimmune blistering dermatoses including epidermolysis bullosa acquisita, bullous pemphigoid and possibly dermatitis herpetiformis. The observed in vitro, ex vivo and in vivo efficacy of anti-Hsp90 treatment in experimental models of autoimmune bullous diseases and its underlying multimodal anti-inflammatory mechanisms of interference with key contributors to autoimmune-mediated blister formation supports the introduction of selective non-toxic Hsp90 inhibitors into the clinical setting for the treatment of patients with these disorders. PMID:25980533

  17. Implementing physician orders for life-sustaining treatment in California hospitals: factors associated with adoption.

    PubMed

    Sugiyama, Takehiro; Zingmond, David; Lorenz, Karl A; Diamant, Allison; O'Malley, Kate; Citko, Judy; Gonzalez, Victor; Wenger, Neil S

    2013-08-01

    Physician Orders for Life-Sustaining Treatment (POLST) is a tool to document and ensure continuity of end-of-life treatment decisions across healthcare settings that became a legal document in California in January 2009. Hospitals were surveyed to evaluate factors associated with uptake of this intervention and whether a grassroots community coalition intervention facilitated dissemination. A mail and telephone survey of all acute care hospitals in California was conducted between August 2011 and January 2012, and community coalition reports of interaction with hospitals and hospital characteristics from the California Office of Statewide Planning and Development and Census ZIP Code Tabulation Areas were analyzed. Of 349 hospitals, 286 (81.9%) responded to the survey. Sixty-five percent of hospitals had a policy about POLST, 87% had available blank POLST forms, 84% had educated staff, and 94% reported handling POLST properly in the emergency department and on admission. In multivariable analyses, hospitals in poor areas and for-profit (vs nonprofit) hospitals were less likely to stock blank POLST forms and to have educated staff, and hospitals with community coalition interaction and in wealthier areas were more likely to handle POLST forms correctly. Although POLST is widely used in California, a significant minority of hospitals remain unprepared 3 years after implementation. Efforts to improve implementation should emphasize dissemination in poorer areas and in for-profit hospitals. PMID:23865958

  18. Spirituality factors in the prediction of outcomes of PTSD treatment for U.S. military veterans.

    PubMed

    Currier, Joseph M; Holland, Jason M; Drescher, Kent D

    2015-02-01

    Spirituality is a multifaceted construct that might affect veterans' recovery from posttraumatic stress disorder (PTSD) in adaptive and maladaptive ways. Using a cross-lagged panel design, this study examined longitudinal associations between spirituality and PTSD symptom severity among 532 U.S. veterans in a residential treatment program for combat-related PTSD. Results indicated that spirituality factors at the start of treatment were uniquely predictive of PTSD symptom severity at discharge, when accounting for combat exposure and both synchronous and autoregressive associations between the study variables, βs = .10 to .16. Specifically, veterans who scored higher on adaptive dimensions of spirituality (daily spiritual experiences, forgiveness, spiritual practices, positive religious coping, and organizational religiousness) at intake fared significantly better in this program. In addition, possible spiritual struggles (operationalized as negative religious coping) at baseline were predictive of poorer PTSD outcomes, β = .11. In contrast to these results, PTSD symptomatology at baseline did not predict any of the spirituality variables at posttreatment. In keeping with a spiritually integrative approach to treating combat-related PTSD, these results suggest that understanding the possible spiritual context of veterans' trauma-related concerns might add prognostic value and equip clinicians to alleviate PTSD symptomatology among those veterans who possess spiritual resources or are somehow struggling in this domain. PMID:25624135

  19. Brain metastasis in human epidermal growth factor receptor 2-positive breast cancer: from biology to treatment

    PubMed Central

    Koo, Taeryool

    2016-01-01

    Overexpression of human epidermal growth factor receptor 2 (HER2) is found in about 20% of breast cancer patients. With treatment using trastuzumab, an anti-HER2 monoclonal antibody, systemic control is improved. Nonetheless, the incidence of brain metastasis does not be improved, rather seems to be increased in HER2-positive breast cancer. The mainstay treatment for brain metastases is radiotherapy. According to the number of metastatic lesions and performance status of patients, radiosurgery or whole brain radiotherapy can be performed. The concurrent use of a radiosensitizer further improves intracranial control. Due to its large molecular weight, trastuzumab has a limited ability to cross the blood-brain barrier. However, small tyrosine kinase inhibitors such as lapatinib, has been noted to be a promising agent that can be used as a radiosensitizer to affect HER2-positive breast cancer. This review will outline general management of brain metastases and will focus on preclinical findings regarding the radiosensitizing effect of small molecule HER2 targeting agents. PMID:27104161

  20. Clinical factors correlated with the success rate of miniscrews in orthodontic treatment

    PubMed Central

    Topouzelis, Nikolaos; Tsaousoglou, Phoebus

    2012-01-01

    Miniscrews offer a reliable alternative for anchorage during orthodontic treatment, particularly for non-cooperative patients or periodontal patients with alveolar bone loss. The study aims at assessing the correlation of various clinical indicators with the success or failure of miniscrews used for anchorage during orthodontic treatment. Thirty-four consecutive patients with a cumulative total of 82 miniscrews implanted participated in the study. Generalized Estimating Equations were used to assess the correlation of various factors with success rates. The miniscrew was considered the unit of analysis clustered within site and within patient. The overall success rate of miniscrews was 90.2%. For every additional miniscrew used in a patient's oral cavity, the success rate was reduced by 67%. Retromandibular triangle and palatal placement and in movable mucosa resulted in lower success rate. The miniscrew length and diameter were found to correlate with success rates. Orthodontic force applied on miniscrews for uprighting purposes showed a lower success rate than that used for retraction. This study revealed that miniscrews present high success rates. The number of miniscrews used per patient, the miniscrew site placement, the soft tissue type of placement, the miniscrew length and diameter as well as the orthodontic force applied on the miniscrew showed significant correlation with success rates. PMID:22241373

  1. Factors related to the process of seeking and completing treatment for drug abuse (qualitative methods in drug abuse research).

    PubMed

    Otiashvili, D; Djordjevic, A; Morales, D; Parsons, A; Platt, E; Stempliuk, V

    2005-05-01

    Numerous studies have demonstrated the effectiveness of drug abuse treatment. Yet many drug abusers do not enter treatment, many who do enter leave prematurely, and relapse following treatment is common. Understanding motivation for change and treatment readiness is key to understanding how to induct and engage drug users in treatment. To the extent that treatment programs focus initially on reducing drug use, rather than psychosocial problems that motivate individuals to seek treatment, treatment programs may fail to meet the primary needs of users and thus fail to attract or engage them. Outcomes of substance abuse treatment programs historically have been measured by successful program completion, reduced drug use and illegal activity, and improved social functioning (employment, education etc). There is minimal reference to client expectations of treatment and factors that influenced treatment-seeking behavior. Studies that have assessed client dropout from substance abuse treatment have generally focused upon quantitative measures that attempt to determine what types of clients drop out or stay, or what types of characteristics best predict client dropout. Qualitative methods are the most appropriate to fill these gaps in substance abuse treatment research. PMID:15988078

  2. Use of Hydrocoil in small aneurysms: procedural safety, treatment efficacy and factors predicting complete occlusion.

    PubMed

    Williams, Amanda; Millar, John; Ditchfield, Adam; Vundavalli, Sriram; Barker, Simon

    2014-01-01

    Coil technology has been directed to reduce recurrence rates and we have seen the introduction of trials comparing the efficacy of surface modified versus bare platinum coils (BPC). This article reports on one treatment strategy in the treatment of small aneurysms by the placement of Hydrocoil across the neck of the aneurysm. Procedural safety, treatment efficacy and factors which predict complete occlusion are evaluated. We retrospectively identified a subgroup of small aneurysms treated over a four-year period. Analysis comparing aneurysms treated with Hydrocoil and BPC versus Hydrocoil alone was undertaken. Eighty-five aneurysms were coiled; 62% with Hydrocoil alone, 38% in combination with BPC. At six-month follow-up, overall 50% were completely occluded, 39.5% had a neck remnant and 10.5% had a residual aneurysm. Complete occlusion was identified in 39% in the Hydrocoil and BPC group compared to 56% in the Hydrocoil alone group. In 56/76 (74%) cases analysed, Hydrocoil loop successfully bridged the neck of the aneurysm in which 38/76 (68%) of these were completely occluded at six-month follow-up. Thirteen procedure-related complications occurred. Aneurysms treated with Hydrocoil alone resulted in fewer recurrences compared with a combination of Hydrocoil and BPC. These data suggest that the technique of positioning Hydrocoil at the neck of the aneurysm increases the probability of complete occlusion and is therefore a strong predictor of aneurysm occlusion. In our experience, this technique did not demonstrate an increased risk of intra-procedural rupture or thrombo-embolic complications compared to conventional embolization with BPC. PMID:24556298

  3. Report: risk factors associated with treatment of mixed municipal solid waste in the Indian context.

    PubMed

    Nema, Asit

    2009-12-01

    Across India, all small and large urban local bodies (ULB) alike are grappling with the problem of municipal solid waste (MSW), which has reached critical dimensions because of, among others, rapidly increasing quantities and complex characteristics, inadequate regulation, lack of awareness, concern and cooperation on the part of the urban residents, limited resources for collection, transport and safe disposal, and limited expertise on the part of the ULBs. A number of ULBs have attempted to address the two-fold constraint of resources and land by setting up treatment plants under the premise of generating revenue and reducing liability of safe disposal. Over the last three decades, under the paradigms of converting 'waste to energy' and 'waste to wealth' various technologies have been tried out, however time and again it is seen that irrespective of the technology, MSW treatment plants run in to difficulties and/or close down. The issues do not pertain just to technology but are systemic and encompass project development, feedstock delivery system including quality and quantity, climate, high life-cycle costs, low value realization on outputs and adverse environmental and social impacts. With such a wide range of risk factors, experience has shown that the probability of manifestation of any one of them or a combination thereof at one or the other stages of the project is quite high. Investment in a mixed MSW treatment plant therefore can not deliver positive financial returns, rather it can become a non-performing asset without even guaranteeing the desired environmental and public health benefits. This paper therefore argues for the adoption of a robust, elastic and most forgiving option of sanitary landfill as a dependable and safe disposal system for MSW. PMID:19423584

  4. Outcome and prognostic factors of desmoplastic medulloblastoma treated within a multidisciplinary treatment concept

    PubMed Central

    2010-01-01

    Background Desmoplasia in medulloblastoma is often diagnosed in adult patients and was repeatedly associated with improved results. Today, all medulloblastoma patients receive intensive multimodal treatment including surgery, radiotherapy and chemotherapy. This study was set up to investigate treatment outcome and prognostic factors after radiation therapy in patients with desmoplastic medulloblastomas. Methods Twenty patients treated for desmoplastic medulloblastoma in the Department of Radiation Oncology at the University of Heidelberg between 1984 and 2007 were included. Data were collected retrospectively. Tumor resection was performed in all patients. All patients underwent postsurgical radiotherapy (RT). Two patients underwent whole brain radiotherapy (WBRT), and 18 patients received craniospinal irradiation (CSI). In all patients, an additional boost was delivered to the posterior fossa. The median dose to the whole brain and the craniospinal axis was 35.2 Gray (Gy), and 54.4 Gy to the posterior fossa. Fourteen patients received chemotherapy, including seven who were treated with combined radiochemotherapy and twelve who received adjuvant chemotherapy. Statistical analysis was performed using the log-rank test and the Kaplan-Meier method. Results Median follow-up was 59 months. Overall (OS), local (LPFS) and distant progression-free survival (DPFS) was 80%, 71.2%, and 83.3% at 60 months. Patients who suffered from local or distant relapses had significantly worse outcome. Five patients died from recurrent medulloblastoma. Treatment-associated toxicity was acceptable. Conclusions Multimodal approaches with surgical resection followed by chemoirradiation achieved high response rates with long OS in desmoplastic medulloblastoma patients. Staging parameters expected to predict for poor prognosis did not significantly influence outcome. However, success of any first line regimen had strong impact on disease control, and remission was achieved in no patient with

  5. Clinical and Pharmacogenetic Factors Affecting Neonatal Bilirubinemia Following Atazanavir Treatment of Mothers During Pregnancy

    PubMed Central

    Huang, Shu-Pang; Conradie, Francesca; Zorrilla, Carmen D.; Josipovic, Deirdre; Botes, Mariëtte; Osiyemi, Olayemi; Hardy, Hélène; Bertz, Richard; McGrath, Donnie

    2013-01-01

    Abstract A theoretical concern exists that atazanavir (ATV) use during pregnancy may exacerbate physiologic neonatal hyperbilirubinemia. The aim of this substudy was to evaluate patterns of neonatal bilirubin following ATV/ritonavir (RTV) treatment of pregnant mothers and clinical and pharmacogenetic factors that may correlate. The design involved a subanalysis of study AI424182, a multicenter, open-label, prospective, single-arm Phase I study. The study had two treatment arms: (1) ATV/RTV 300/100 mg once daily or (2) ATV/RTV 400/100 mg once daily, both in combination with zidovudine/lamivudine 300/150 mg twice daily. Total bilirubin was assessed at baseline, each visit, and delivery day for mothers and on days 1 (delivery day), 3, 5, and 7 and weeks 2 and 6 for neonates. Blood samples were obtained for UGT1A1 genotyping and ATV cord blood concentration. Bilirubin elevation of any grade occurred in 14/40 neonates (35%). All Grade 3 to 4 bilirubin abnormalities (n=7) occurred after day 14. The pattern of neonatal bilirubin levels reported was consistent with neonatal physiologic elevations of bilirubin. Little correlation was observed between either maternal bilirubin levels over the last 4 weeks of pregnancy (including delivery) or ATV cord concentration and neonatal bilirubin. There was a significant association between UGT1A1 genotype and bilirubin grade in the maternal population (p=0.0006) but not neonates (p=0.49). Neither neonatal UGT1A1 genotype nor cord blood ATV concentration is a good predictor of neonatal hyperbilirubinemia. ATV/RTV treatment of mothers does not appear to exacerbate neonatal physiologic hyperbilirubinemia. PMID:23782005

  6. Clinical and pharmacogenetic factors affecting neonatal bilirubinemia following atazanavir treatment of mothers during pregnancy.

    PubMed

    Eley, Timothy; Huang, Shu-Pang; Conradie, Francesca; Zorrilla, Carmen D; Josipovic, Deirdre; Botes, Mariëtte; Osiyemi, Olayemi; Hardy, Hélène; Bertz, Richard; McGrath, Donnie

    2013-10-01

    A theoretical concern exists that atazanavir (ATV) use during pregnancy may exacerbate physiologic neonatal hyperbilirubinemia. The aim of this substudy was to evaluate patterns of neonatal bilirubin following ATV/ritonavir (RTV) treatment of pregnant mothers and clinical and pharmacogenetic factors that may correlate. The design involved a subanalysis of study AI424182, a multicenter, open-label, prospective, single-arm Phase I study. The study had two treatment arms: (1) ATV/RTV 300/100 mg once daily or (2) ATV/RTV 400/100 mg once daily, both in combination with zidovudine/lamivudine 300/150 mg twice daily. Total bilirubin was assessed at baseline, each visit, and delivery day for mothers and on days 1 (delivery day), 3, 5, and 7 and weeks 2 and 6 for neonates. Blood samples were obtained for UGT1A1 genotyping and ATV cord blood concentration. Bilirubin elevation of any grade occurred in 14/40 neonates (35%). All Grade 3 to 4 bilirubin abnormalities (n=7) occurred after day 14. The pattern of neonatal bilirubin levels reported was consistent with neonatal physiologic elevations of bilirubin. Little correlation was observed between either maternal bilirubin levels over the last 4 weeks of pregnancy (including delivery) or ATV cord concentration and neonatal bilirubin. There was a significant association between UGT1A1 genotype and bilirubin grade in the maternal population (p=0.0006) but not neonates (p=0.49). Neither neonatal UGT1A1 genotype nor cord blood ATV concentration is a good predictor of neonatal hyperbilirubinemia. ATV/RTV treatment of mothers does not appear to exacerbate neonatal physiologic hyperbilirubinemia. PMID:23782005

  7. Factors Associated with Loss to Follow-up during Treatment for Multidrug-Resistant Tuberculosis, the Philippines, 2012–2014

    PubMed Central

    Garfin, Anna Marie Celina G.; Kurbatova, Ekaterina V.; Mangan, Joan M.; Orillaza-Chi, Ruth; Naval, Leilani C.; Balane, Glenn I.; Basilio, Ramon; Golubkov, Alexander; Joson, Evelyn S.; Lew, Woo-jin; Lofranco, Vivian; Mantala, Mariquita; Pancho, Stuart; Sarol, Jesus N.

    2016-01-01

    To identify factors associated with loss to follow-up during treatment for multidrug-resistant (MDR) tuberculosis (TB) in the Philippines, we conducted a case–control study of adult patients who began receiving treatment for rifampin-resistant TB during July 1–December 31, 2012. Among 91 case-patients (those lost to follow-up) and 182 control-patients (those who adhered to treatment), independent factors associated with loss to follow-up included patients’ higher self-rating of the severity of vomiting as an adverse drug reaction and alcohol abuse. Protective factors included receiving any type of assistance from the TB program, better TB knowledge, and higher levels of trust in and support from physicians and nurses. These results provide insights for designing interventions aimed at reducing patient loss to follow-up during treatment for MDR TB. PMID:26889786

  8. The use of microbial-earthworm ecofilters for wastewater treatment with special attention to influencing factors in performance: A review.

    PubMed

    Jiang, Luhua; Liu, Yunguo; Hu, Xinjiang; Zeng, Guangming; Wang, Hui; Zhou, Lu; Tan, Xiaofei; Huang, Binyan; Liu, Shaobo; Liu, Simian

    2016-01-01

    With the unique advantages of lower operational and maintenance cost, the use of microbial-earthworm ecofilters (MEEs) for the wastewater treatment has been increasing rapidly in the recent years. This paper provided an overview of the research activities on the use of MEEs for removing pollutants from various wastewater throughout the world. However, the long-term effective treatment performance and sustainable operation of this system still remain a challenge since the treatment performance would be affected by design parameters, operational conditions, and environmental factors. In order to promote the treatment performance, therefore, this paper also provided and summarized the influencing factors of pollutants removal in MEEs. The design parameters and operational conditions of MEEs include earthworm species and load, filter media type, hydraulic loading rate, nutrient load, packing bed height, chemical factors and temperature. Lastly, this review highlighted the further research on these issues to improve performance and sustainability of MEEs. PMID:26611806

  9. Risk Factors and Treatment Strategies in Patients With Retinal Vascular Occlusions.

    PubMed

    Chapin, John; Carlson, Karen; Christos, Paul J; DeSancho, Maria Teresa

    2015-10-01

    Retinal vein occlusion (RVO) and retinal artery occlusion (RAO) cause significant visual impairment. The role of thrombophilia and cardiovascular testing is uncertain, and optimal treatment strategies have not been determined. We reviewed medical records of 39 patients with RVO and RAO (23 women and 16 men). Thrombophilia and cardiovascular evaluations were performed and outcomes were reviewed. In all, 24 (61.5%) patients had at least 1 thrombophilia. Elevated factor VIII levels were found in RVO (n = 5) but not in RAO. There are no other significant differences in thrombophilias in RVO compared to those in RAO. Most patients had hypertension(41.2% RAO and 55% RVO) and hyperlipidemia (35.5% RAO and 81.8% RVO). In all, 4 women were using oral contraceptives, 2 were pregnant or postpartum. Follow-up data was available for 28 patients (13 RAO, 15 RVO). Nineteen were treated with aspirin, four with warfarin, and one with low molecular weight heparin. Eight patients reported improvement in vision at time of follow-up (5 RAO, 3 RVO). Multiple risk factors are associated with RVO and RAO, and a complete assessment should include thrombophilia and cardiovascular studies. PMID:24335246

  10. Quality-Shaping Factors and Endodontic Treatment amongst General Dental Practitioners with a Focus on Denmark

    PubMed Central

    Demant, Sune; Markvart, Merete; Bjørndal, Lars

    2012-01-01

    There is a gap between the endodontic outcome that can be achieved and the outcome observed on the basis of worldwide general dental practitioner data. The quality of root canal treatment (RCT) is shaped by the dentist's knowledge, attitude, and skills, but it may also be influenced by the patient's demands and degree of satisfaction. The topic has only been sparsely investigated. Although dental health has increased over the years in Denmark, the number of performed root fillings has also increased, probably because the number of tooth extractions have declined and more molar teeth have been treated. Caries appears to be the main cause for performing RCT and a preventive approach by employing stepwise excavation may reduce RCT, but this strategy does not remove the gap. Factors influencing RCT quality could be the status on adoption of nickel-titanium rotary technology, more focus on infection control (rubber dam use, knowledge of factors important for prognosis), as dentists often think that they are good at doing RCT, but often perform inadequately, an alteration of clinician's awareness of their performance in the context of dental practices, seems warranted. Finally, the development of new preventive modalities for pulp and apical inflammation are crucial. PMID:22536241

  11. Factors Affecting Adherence to Antiretroviral Treatment in Harari National Regional State, Eastern Ethiopia

    PubMed Central

    Mitiku, Habtamu; Abdosh, Tekabe; Teklemariam, Zelalem

    2013-01-01

    Background. The efficacy of antiretroviral treatment (ART) depends on strict adherence to the regimen, but many factors have been identified for nonadherence. Method. To identify the factors for non-adherence to ART, a cross-sectional study was conducted on people living with human immunodeficiency virus (HIV) and attending the ART service at Hiwot Fana and Jugal hospitals; it was done from October to December, 2010. Adherence was defined as taking 95% of the prescribed doses in the week before the survey. Data were collected using a standard interview questionnaire and were analyzed using SPSS Version 16. Result. Among the 239 study participants, the magnitude of adherence to ART in the week before interview was 87%. The main reasons for nonadherence were forgetting (47.2%), traveling (18.9%), and being busy doing other things (15.1%). There was not any independent predicator identified for adherence to ART. Conclusion. Compared to other similar studies in Ethiopia, in this study a high adherence rate was found. Forgetfulness was the most common reason for the nonadherence. Therefore, the ART counseling needs to give emphasis to using memory aids. In addition, a further study on adherence rate and its determinants with multiple adherence measurements is recommended. PMID:24052892

  12. [Risk factors for the oral use of antibiotics and animal treatment incidence of weaners in Switzerland].

    PubMed

    Hirsiger, P; Malik, J; Kommerlen, D; Vidondo, B; Arnold, C; Harisberger, M; Spring, P; Sidler, X

    2015-12-01

    In the present study, risk factors for the use of oral antibiotics in weaned piglets were collected on 112 pig farms by a personal questionaire. The most common indication for an antibiotic group therapy was diarrhoea, and the most frequently used antibiotic was Colistin. On average, 27.33 daily doses in the control farms and 387.21 daily doses in the problem farms per 1000 weaners were administered on a given day. The significant risk factors in the multivariate model were poor hygiene in the water supply of suckling piglets, less than two doses ofprestarter feed daily, lack of an all-in-and-all-out production system in weaners, no herd book performance data analysis, and less than two of the legally prescribed veterinary visits per year. Furthermore, the treatment incidence of weaners for oral antibiotics was calculated on the basis of the drug inventory. This study provides evidence that the use of oral antibiotics in weaners can be reduced by interventions in hygiene and management. PMID:26891574

  13. Oral, direct factor Xa inhibitors in development for the prevention and treatment of thromboembolic diseases.

    PubMed

    Turpie, Alexander G G

    2007-06-01

    Anticoagulants are recommended for the prevention and treatment of a wide variety of thromboembolic events. Although existing anticoagulants are effective, their use is limited by parenteral administration or the requirement for frequent monitoring and subsequent dose adjustment. Therefore, there is an urgent need for novel, oral agents with a predictable anticoagulant action. Because of its key position in the coagulation cascade and its limited roles outside of coagulation, Factor Xa has emerged as an attractive target for novel anticoagulants. As a result, the past decade has witnessed an explosion of research into small-molecule, oral, direct Factor Xa inhibitors, and several are now in clinical development. Rivaroxaban, LY517717, YM150, apixaban, PRT054021, and DU-176b, among others, have shown considerable promise; rivaroxaban is currently furthest ahead in its developmental program, having entered phase III in 3 indications. It is hoped that, before long, these anticoagulants will allow us to enter an era of convenient, oral anticoagulation, without the need for regular monitoring or dose adjustment. PMID:17379841

  14. Factor V Deficiency in Korean Patients: Clinical and Laboratory Features, Treatment, and Outcome

    PubMed Central

    2016-01-01

    Due to rarity of factor V (FV) deficiency, there have been only a few case reports in Korea. We retrospectively analysed the clinical-laboratory features of FV deficiency in 10 Korean patients. Between January 1987 and December 2013, 10 case reports published in a Korean journal or proceedings of Korea Society on Thrombosis and Hemostasis were reviewed. Severity is defined as mild (> 5% of factor activity), moderate (1%–5%), and severe (< 1%). The median age at diagnosis, six males and four females, was 26 years (range, 1 month-73 years). Six of 10 patients were classified as moderate, three as mild, and one as severe disease. Eight patients were diagnosed as inherited FV deficiency. The most frequent symptoms were mucosal tract bleedings (40%) such as epistaxis, and menorrhagia in female. Hemarthroses and postoperative bleeding occurred in one and four patients, respectively. Life-threatening bleeding episodes occurred in the peritoneal cavity (n = 2), central nerve system (n = 1), and retroperitoneal space (n = 1). No lethal haemorrhages happened to patients with mild disease. The majority of bleeding episodes were controlled with local measures and fresh-frozen plasma replacement. Two acquired FV deficient-patients showing life-threatening haemorrhages received the immunosuppressive therapy, but one of them died from postoperative bleeding complications. Despite the small sample size of this study due to rarity of the disease, we found that Korean patients with FV deficiency had similar clinical manifestations and treatment outcomes shown in previous studies. PMID:26839474

  15. Psychiatric Morbidity and Other Factors Affecting Treatment Adherence in Pulmonary Tuberculosis Patients

    PubMed Central

    Pachi, Argiro; Bratis, Dionisios; Moussas, Georgios; Tselebis, Athanasios

    2013-01-01

    As the overall prevalence of TB remains high among certain population groups, there is growing awareness of psychiatric comorbidity, especially depression and its role in the outcome of the disease. The paper attempts a holistic approach to the effects of psychiatric comorbidity to the natural history of tuberculosis. In order to investigate factors associated with medication nonadherence among patients suffering from tuberculosis, with emphasis on psychopathology as a major barrier to treatment adherence, we performed a systematic review of the literature on epidemiological data and past medical reviews from an historical perspective, followed by theoretical considerations upon the relationship between psychiatric disorders and tuberculosis. Studies reporting high prevalence rates of psychiatric comorbidity, especially depression, as well as specific psychological reactions and disease perceptions and reviews indicating psychiatric complications as adverse effects of anti-TB medication were included. In sum, data concerning factors affecting medication nonadherence among TB patients suggested that better management of comorbid conditions, especially depression, could improve the adherence rates, serving as a framework for the effective control of tuberculosis, but further studies are necessary to identify the optimal way to address such issues among these patients. PMID:23691305

  16. Factors associated with chronic diseases among the elderly receiving treatment under the Family Health Strategy.

    PubMed

    Pimenta, Fernanda Batista; Pinho, Lucinéia; Silveira, Marise Fagundes; Botelho, Ana Cristina de Carvalho

    2015-08-01

    The profile of a sample population of elderly receiving treatment under the Family Health Strategy in the municipality of Teófilo Otoni, State of Minas Gerais, Brazil, is described, and the factors associated with diseases prevalence examined. Using simple random sampling, 385 elderly were interviewed using Form A and Elderly Form from the Primary Health Care Information System. The majority of the sample (83.1%) self-reported at least one disease, 69.9% had hypertension, and 17.7% had diabetes. Poisson regression analysis showed that the main factors associated with hypertension and other diseases were being non-white, having a low level of education, medication use, dental prosthesis use, and lack of a private health plan. The prevalence of diabetes was greater among women and individuals who depended on other people to live. It can be concluded that this sample population of elderly has a generally low socioeconomic status and are more susceptible to developing diseases, particularly hypertension. Diabetes should be controlled although had relatively low prevalence. It is suggested investments in structuring the health system network to provide adequate care for the elderly and in training health professionals to play an effective role in improving the quality of life of the elderly in Brazil. PMID:26221814

  17. Risk Factors and Prevention of Guiding Catheter-induced Vasospasm in Neuroendovascular Treatment

    PubMed Central

    ISHIHARA, Hideaki; ISHIHARA, Shoichiro; NIIMI, Jun; NEKI, Hiroaki; KAKEHI, Yoshiaki; UEMIYA, Nahoko; KOHYAMA, Shinya; YAMANE, Fumitaka; KATO, Hiroshi

    2015-01-01

    Mechanically-induced vasospasm often occurs during guiding catheter insertion, occasionally preventing catheter advancement to the desired location. Delicate manipulation would be impossible without the proper positioning of guiding catheters, and vasospasm-induced cerebral hypoperfusion may cause thrombotic complications. From June 2012 to December 2013, we prospectively analyzed 150 endovascular treatment cases, excluding acute cases, for the frequency of vasospasm, risk factors, and countermeasures. The associated risk factors such as the Japanese-style State-Trait Anxiety Inventory (STAI) score; anatomy and devices; and the efficacies of warm compresses, intra-arterial lidocaine/nicardipine, and tranquilizers were analyzed. Groups 1, 2, and 3 comprised 50 patients each with controls, tranquilizer administration, and prophylactic warm compresses/intra-arterial drug injection, respectively. Moderate or severe vasospasm was seen in approximately 40% patients in each group; however, severe vasospasm was absent in Group 3. Mild vasospasm-induced cerebral infarction occurred in one patient each in Groups 1 and 2. Vasospasm during diagnostic angiography [odds ratio (OR) = 10.63; P = 0.01], many ≥ 30° vessel curves [OR = 4.21; P = 0.01], and the high STAI score [OR = 1.84; P = 0.01] were risk factors for severe vasospasm. Although the relationship between anxiety and sympathetic tone remained unclear, tranquilizer administration relieved vasospasm. Warm compresses and the intra-arterial drug infusion were also useful for relieving vasospasm. Prophylactic measures such as a tranquilizer and warm compresses are expected to alleviate vasospasm; in addition, countermeasures such as the intra-arterial injection of lidocaine/nicardipine are effective. PMID:25739431

  18. A Prospective Surveillance Study of Candidaemia: Epidemiology, Risk Factors, Antifungal Treatment and Outcome in Hospitalized Patients

    PubMed Central

    Rajendran, Ranjith; Sherry, Leighann; Deshpande, Ashutosh; Johnson, Elizabeth M.; Hanson, Mary F.; Williams, Craig; Munro, Carol A.; Jones, Brian L.; Ramage, Gordon

    2016-01-01

    This study provide an up-to-date overview of the epidemiology and risk factors for Candida bloodstream infection in Scotland in 2012/2013, and the antifungal susceptibility of isolates from blood cultures from 11 National Health Service boards within Scotland. Candida isolates were identified by chromogenic agar and confirmed by MALDI–TOF methods. Survival and associated risk factors for patients stratified as albicans and non-albicans cases were assessed. Information on the spectrum of antifungals used was collected and summarized. The isolates sensitivity to different antifungals was tested by broth microdilution method and interpreted according to CLSI/EUCAST guidelines. Forty one percent of candidaemia cases were associated with Candida albicans, followed by C. glabrata (35%), C. parapsilosis (11.5%), and remainder with other Candida spp. C. albicans and C. glabrata infections were associated with 20.9 and 16.3% mortality, respectively. Survival of patients with C. albicans was significantly lower compared to non-C. albicans and catheter line removal in C. albicans patients significantly increases the survival days. Predisposing factors such as total parenteral nutrition, and number of days on mechanical ventilation or in intensive care, were significantly associated with C. albicans infections. Fluconazole was used extensively (64.5%) for treating candidaemia cases followed by echinocandins (33.8%). Based on CLSI breakpoints, MIC test found no resistance to any antifungals tested except 5.26% fluconazole resistance among C. glabrata isolates. Moreover, by comparing to EUCAST breakpoints we found 3.95% of C. glabrata isolates were resistant to anidulafungin. We have observed a shift in Candida spp. with an increasing isolation of C. glabrata. Delay and choice of antifungal treatment are associated with poor clinical outcomes. PMID:27379047

  19. Factors associated with pretreatment and treatment dropouts: comparisons between Aboriginal and non-Aboriginal clients admitted to medical withdrawal management

    PubMed Central

    2013-01-01

    Background Addiction treatment faces high pretreatment and treatment dropout rates, especially among Aboriginals. In this study we examined characteristic differences between Aboriginal and non-Aboriginal clients accessing an inpatient medical withdrawal management program, and identified risk factors associated with the probabilities of pretreatment and treatment dropouts, respectively. Methods 2231 unique clients (Aboriginal = 451; 20%) referred to Vancouver Detox over a two-year period were assessed. For both Aboriginal and non-Aboriginal groups, multivariate logistic regression analyses were conducted with pretreatment dropout and treatment dropout as dependent variables, respectively. Results Aboriginal clients had higher pretreatment and treatment dropout rates compared to non-Aboriginal clients (41.0% vs. 32.7% and 25.9% vs. 20.0%, respectively). For Aboriginal people, no fixed address (NFA) was the only predictor of pretreatment dropout. For treatment dropout, significant predictors were: being female, having HCV infection, and being discharged on welfare check issue days or weekends. For non-Aboriginal clients, being male, NFA, alcohol as a preferred substance, and being on methadone maintenance treatment (MMT) at referral were associated with pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on weekends. Conclusions Our results highlight the importance of social factors for the Aboriginal population compared to substance-specific factors for the non-Aboriginal population. These findings should help clinicians and decision-makers to recognize the importance of social supports especially housing and initiate appropriate services to improve treatment intake and subsequent retention, physical and mental health outcomes and the cost-effectiveness of treatment. PMID:24325629

  20. Factors Associated With Adherence to Methylphenidate Treatment in Adult Patients With Attention-Deficit/Hyperactivity Disorder and Substance Use Disorders.

    PubMed

    Skoglund, Charlotte; Brandt, Lena; Almqvist, Catarina; DʼOnofrio, Brian M; Konstenius, Maija; Franck, Johan; Larsson, Henrik

    2016-06-01

    Adherence to treatment is one of the most consistent factors associated with a favorable addiction treatment outcome. Little is known about factors associated with treatment adherence in individuals affected with comorbid attention-deficit/hyperactivity disorder and substance use disorders (SUD). This study aimed to explore whether treatment-associated factors, such as the prescribing physician's (sub)specialty and methylphenidate (MPH) dose, or patient-related factors, such as sex, age, SUD subtype, and psychiatric comorbidity, were associated with adherence to MPH treatment. Swedish national registers were used to identify adult individuals with prescriptions of MPH and medications specifically used in the treatment of SUD or a diagnosis of SUD and/or coexisting psychiatric diagnoses. Primary outcome measure was days in active MPH treatment in stratified dose groups (≤36 mg, ≥37 mg to ≤54 mg, ≥55 mg to ≤72 mg, ≥73 mg to ≤90 mg, ≥91 mg to ≤108 mg, and ≥109 mg). Lower MPH doses (ie, ≤36 mg day 100) were associated with treatment discontinuation between days 101 and 830 (HR≤36 mg, 1.67; HR37-54mg, 1.37; HR55-72mg, 1.36; HR73-90mg, 1.19; HR≥108mg, 1.09). The results showed a linear trend (P < 0.0001) toward decreased risk of treatment discontinuation along with increase of MPH doses. In conclusion, this study shows that higher MPH doses were associated with long-term treatment adherence in individuals with attention-deficit/hyperactivity disorder and SUD. PMID:27043119

  1. Treatment patterns and risk factor control in patients with and without metabolic syndrome in cardiac rehabilitation

    PubMed Central

    Gitt, Anselm; Jannowitz, Christina; Karoff, Marthin; Karmann, Barbara; Horack, Martin; Völler, Heinz

    2012-01-01

    Aim Metabolic syndrome (MetS) is a clustering of factors that are associated with increased cardiovascular risk. We aimed to investigate the proportion of patients with MetS in patients undergoing cardiac rehabilitation (CR), and to describe differences between patients with MetS compared to those without MetS with regard to (1) patient characteristics including demographics, risk factors, and comorbidities, (2) risk factor management including drug treatment, and (3) control status of risk factors at entry to CR and discharge from CR. Methods Post-hoc analysis of data from 27,904 inpatients (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management registry) that underwent a CR period of about 3 weeks were analyzed descriptively in total and compared by their MetS status. Results In the total cohort, mean age was 64.3 years, (71.7% male), with no major differences between groups. Patients had been referred after a ST elevation of myocardial infarction event in 41.1% of cases, non-ST elevation of myocardial infarction in 21.8%, or angina pectoris in 16.7%. They had received a percutaneous coronary intervention in 55.1% and bypass surgery (coronary artery bypass graft) in 39.5%. Patients with MetS (n = 15,819) compared to those without MetS (n = 12,085) were less frequently males, and in terms of cardiac interventions, more often received coronary artery bypass surgery. Overall, statin use increased from 79.9% at entry to 95.0% at discharge (MetS: 79.7% to 95.2%). Patients with MetS compared to those without MetS received angiotensin converting enzyme inhibitors, angiotensin receptor blockers, oral antidiabetics, and insulin at entry and discharge more frequently, and less frequently clopidogrel and aspirin/clopidogrel combinations. Mean blood pressure was within the normal range at discharge, and did not differ substantially between groups (124/73 versus 120/72 mmHg). Overall, between entry and discharge, levels of total cholesterol, low density

  2. Predictive Factors for Subjective Improvement in Lumbar Spinal Stenosis Patients with Nonsurgical Treatment: A 3-Year Prospective Cohort Study

    PubMed Central

    Matsudaira, Ko; Hara, Nobuhiro; Oka, Hiroyuki; Kunogi, Junichi; Yamazaki, Takashi; Takeshita, Katsushi; Atsushi, Seichi; Tanaka, Sakae

    2016-01-01

    Objective To assess the predictive factors for subjective improvement with nonsurgical treatment in consecutive patients with lumbar spinal stenosis (LSS). Materials and Methods Patients with LSS were enrolled from 17 medical centres in Japan. We followed up 274 patients (151 men; mean age, 71 ± 7.4 years) for 3 years. A multivariable logistic regression model was used to assess the predictive factors for subjective symptom improvement with nonsurgical treatment. Results In 30% of patients, conservative treatment led to a subjective improvement in the symptoms; in 70% of patients, the symptoms remained unchanged, worsened, or required surgical treatment. The multivariable analysis of predictive factors for subjective improvement with nonsurgical treatment showed that the absence of cauda equina symptoms (only radicular symptoms) had an odds ratio (OR) of 3.31 (95% confidence interval [CI]: 1.50–7.31); absence of degenerative spondylolisthesis/scoliosis had an OR of 2.53 (95% CI: 1.13–5.65); <1-year duration of illness had an OR of 3.81 (95% CI: 1.46–9.98); and hypertension had an OR of 2.09 (95% CI: 0.92–4.78). Conclusions The predictive factors for subjective symptom improvement with nonsurgical treatment in LSS patients were the presence of only radicular symptoms, absence of degenerative spondylolisthesis/scoliosis, and an illness duration of <1 year. PMID:26863214

  3. Risk Factors for Problematic Behaviors among Forensic Outpatients under the Medical Treatment and Supervision Act in Japan

    PubMed Central

    Ando, Kumiko; Soshi, Takahiro; Nakazawa, Kanako; Noda, Takamasa; Okada, Takayuki

    2016-01-01

    The Medical Treatment and Supervision Act (MTSA) was enacted in 2005 in Japan to promote the reintegration of clinical offenders with mental disorders into society. Under the MTSA, individuals who committed serious crimes in a state of insanity or diminished responsibility are diverted from the criminal justice system to the mental health system. Based on court decisions about MTSA-based treatment, clinical offenders have an obligation to engage in rehabilitation within their local community under the guidance of mental health professionals. However, patients under MTSA-based clinical treatments have faced various problems in the course of treatment, because of psychiatric as well as other static or dynamic factors, and sometimes have committed problematic behaviors, such as violence and medical non-compliance. Hence, this study aimed to clarify factors related to patients’ inclusion in MTSA-based outpatient treatment and additionally, their commitment of problematic behaviors, based on confidential data acquired during a four-year government survey period (National Center of Neurology and Psychiatry) from MTSA enactment (July 15, 2005) to December 31, 2009. In total, we recruited 441 clinical offenders receiving MTSA-based outpatient treatment from 158 nationwide facilities. To evaluate related factors, we collected demographic, psychiatric, forensic, clinical treatment, and social service information. Statistical analyses demonstrated that predominant profiles of patients included male gender, younger age, low school history, psychiatric diagnoses (F1, F2, and F3), and no correctional or outpatient history before MTSA-based treatment. F1 or substance use diagnosis, in particular, was increasingly correlated with other factors, such as male gender, older age, and correctional history before MTSA treatment. Among the 441 patients, 189 (43%) committed problematic behaviors in the course of the MTSA-based outpatient treatment. Risk factors for patients

  4. Risk Factors for Problematic Behaviors among Forensic Outpatients under the Medical Treatment and Supervision Act in Japan.

    PubMed

    Ando, Kumiko; Soshi, Takahiro; Nakazawa, Kanako; Noda, Takamasa; Okada, Takayuki

    2016-01-01

    The Medical Treatment and Supervision Act (MTSA) was enacted in 2005 in Japan to promote the reintegration of clinical offenders with mental disorders into society. Under the MTSA, individuals who committed serious crimes in a state of insanity or diminished responsibility are diverted from the criminal justice system to the mental health system. Based on court decisions about MTSA-based treatment, clinical offenders have an obligation to engage in rehabilitation within their local community under the guidance of mental health professionals. However, patients under MTSA-based clinical treatments have faced various problems in the course of treatment, because of psychiatric as well as other static or dynamic factors, and sometimes have committed problematic behaviors, such as violence and medical non-compliance. Hence, this study aimed to clarify factors related to patients' inclusion in MTSA-based outpatient treatment and additionally, their commitment of problematic behaviors, based on confidential data acquired during a four-year government survey period (National Center of Neurology and Psychiatry) from MTSA enactment (July 15, 2005) to December 31, 2009. In total, we recruited 441 clinical offenders receiving MTSA-based outpatient treatment from 158 nationwide facilities. To evaluate related factors, we collected demographic, psychiatric, forensic, clinical treatment, and social service information. Statistical analyses demonstrated that predominant profiles of patients included male gender, younger age, low school history, psychiatric diagnoses (F1, F2, and F3), and no correctional or outpatient history before MTSA-based treatment. F1 or substance use diagnosis, in particular, was increasingly correlated with other factors, such as male gender, older age, and correctional history before MTSA treatment. Among the 441 patients, 189 (43%) committed problematic behaviors in the course of the MTSA-based outpatient treatment. Risk factors for patients' commitment of

  5. Nonacog gamma, a novel recombinant factor IX with low factor IXa content for treatment and prophylaxis of bleeding episodes.

    PubMed

    Turecek, Peter L; Abbühl, Brigitt; Tangada, Srilatha D; Chapman, Miranda; Gritsch, Herbert; Rottensteiner, Hanspeter; Schrenk, Gerald; Mitterer, Artur; Dietrich, Barbara; Höllriegl, Werner; Schiviz, Alexandra; Horling, Frank; Reipert, Birgit M; Muchitsch, Eva-Maria; Pavlova, Borislava G; Scheiflinger, Friedrich

    2015-03-01

    Nonacog gamma is a new recombinant factor IX to treat factor IX deficiency. It is indicated for control of bleeding episodes, perioperative management and routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adults and children with hemophilia B. Nonacog gamma was first approved in the USA in June 2013 under the trade name RIXUBIS followed by market approvals in Australia and the EU in 2014, and marketing authorization decision is pending in Japan. Nonacog gamma is derived from a recombinant Chinese hamster ovary cell line using a state of the art biotechnological manufacturing process. Recombinant factor IX is produced by Baxter's protein-free fermentation technology, which was first developed for ADVATE. The product is purified and formulated in the absence of any human or animal-derived protein. Nonacog gamma was characterized both in comprehensive in vitro and in vivo non-clinical studies as well as in an extensive clinical trial program. PMID:25660348

  6. The exposure of urologists and the treatment for male factor infertility on the Web sites of ART centers in Taiwan.

    PubMed

    Hsiao, Fu-Yin; Huang, William J; Chen, Kuang-Kuo

    2011-01-01

    Couples with male factor disorders can have their own biologic offspring nowadays via in vitro fertilization or intracytoplasmic sperm injection technologies. Because infertile couples commonly seek treatment options through public Web sites on the Internet, an appropriate exposure of urologic opinions on male factor infertility is important. It was therefore of interest to survey the extent of urologists' exposure on the official Web sites of the assisted reproductive technology (ART) centers. We surveyed the official Web sites of all 74 qualified ART centers in Taiwan. Web sites of these centers were evaluated for their information on male factor infertility and varicoceles, especially treatment suggestions for varicocele and attitudes toward urologist referral. Among the 74 centers, only 69 had established official Web sites. Forty-eight Web sites (69.6%) provided information regarding infertility, whereas only 42 Web sites (60.9%) mentioned male factor infertility and 23 (33.3%) had descriptions of varicoceles. The quantity and quality of disclosed information varied, 11 (15.9%) sites provided treatment opinions for varicocele, and only 4 (5.8%) supported surgical intervention. Most Web sites of ART centers in Taiwan had content on male factor infertility, but the vast majority did not mention urologist referral or varicocele treatment. Urologists' opinions are relatively less exposed on the Web sites of fertility services. Further efforts should be made by urologists to provide comprehensive information to the public and to reinforce the importance of urologist referral in male factor infertility. PMID:20829520

  7. Predicting the In-Hospital Responsiveness to Treatment of Alcoholics. Social Factors as Predictors of Outcome. Brain Damage as a Factor in Treatment Outcome of Chronic Alcoholic Patients.

    ERIC Educational Resources Information Center

    Mascia, George V.; And Others

    The authors attempt to locate predictor variables associated with the outcome of alcoholic treatment programs. Muscia's study focuses on the predictive potential of: (1) response to a GSR conditioning procedure; (2) several personality variables; and (3) age and IQ measures. Nine variables, reflecting diverse perspectives, were selected as a basis…

  8. An integrative analysis of treatment, outcomes and prognostic factors for primary spinal anaplastic ependymomas.

    PubMed

    Chen, Peiqin; Sui, Mingxing; Ye, Jingliang; Wan, Zhiping; Chen, Feng; Luo, Chun

    2015-06-01

    The aim of this study was to elucidate the role of treatment modalities in primary spinal anaplastic ependymomas (PSAE) and identify promising prognostic factors. PSAE are rare tumors of the central nervous system with poorly understood clinical characteristics and treatment outcomes. We reviewed the literature in PubMed, Web of Science and Scopus databases to identify patients with PSAE. Multivariate Cox proportional hazards analysis and univariate Kaplan-Meier analysis were performed on the PSAE patients and overall survival (OS) and progression-free survival (PFS) were assessed to evaluate the clinical outcomes. Of the 40 patients with PSAE, the tumors were mostly intramedullary (n=19; 47.5%) and frequently involved the thoracic cord (n=25; 62.5%). Eighteen patients suffered recurrence during the follow-up with a median PFS of 24 months. The 1, 2, and 5year OS rates of the PSAE patients were 91.5%, 82.1%, and 63.1%, respectively. Gross total resection (GTR) was independently associated with prolonged PFS (hazard ratio [HR] 0.11; p=0.004) and OS (HR 0.11; p=0.003) in the multivariate analysis. Adjuvant radiotherapy also conferred improved PFS (HR 0.15; p=0.008) and OS (HR 0.16; p=0.022). Age, sex, tumor location and chemotherapy did not influence the outcomes in this group. The results of our study suggest that GTR and adjuvant radiotherapy are strong prognostic indicators in patients with PSAE and the role of chemotherapy is yet to be defined. PMID:25769252

  9. Breast sarcomas and malignant phyllodes tumours: comparison of clinicopathological features, treatment strategies, prognostic factors and outcomes.

    PubMed

    Lim, Sue Zann; Selvarajan, Sathiyamoorthy; Thike, Aye Aye; Nasir, Nur Diyana Binte Md; Tan, Benita Kiat Tee; Ong, Kong Wee; Tan, Puay Hoon

    2016-09-01

    We aimed to compare the clinicopathological features, treatment strategies and clinical outcomes of breast sarcomas (BS) and malignant phyllodes tumours (MPT), and determine their prognostic factors. Cases of BS and MPT diagnosed at the Department of Pathology, Singapore General Hospital from January 1991 to December 2014 were derived from department files. Clinicopathological features, treatment strategies and survivals of patients with BS and MPT were compared. Prognostic indicators for BS and MPT were identified. BS and MPT were comparable in all except one of their clinicopathological features. A significantly higher proportion of BS patients had a history of previous breast carcinoma and thus radiation to the chest as compared to the MPT group (17.6 vs 0 %, P = 0.018). There was no significant difference in survival outcomes between BS and MPT. The 5-year disease-free survivals (DFS) for BS and MPT were 59.1 and 57.4 % respectively (P = 0.816), while the 5-year overall survivals (OS) for BS and MPT were 86.5 and 78.5 % respectively (P = 0.792). Combining both groups of tumours, univariate analysis showed that DFS was significantly affected by multifocality (P = 0.019), histological subtype (P = 0.014), presence of malignant heterologous elements (P < 0.001) and margin status (P = 0.023). Margin status was the only parameter which had a significant impact on OS (P = 0.040). Multivariate analysis confirmed the above findings. BS and MPT are rare entities with remarkable heterogeneity. They share similar clinicopathological features and outcomes, provoking thoughts on their biological relationship and clinical significance of pathologic distinction. PMID:27541020

  10. Depression, suicidal ideation, and related factors of methadone maintenance treatment users in Guangzhou, China.

    PubMed

    Zhang, Xiao; Xu, Huifang; Gu, Jing; Lau, Joseph T F; Hao, Chun; Zhao, Yuteng; Davis, Alissa; Hao, Yuantao

    2016-07-01

    Mental health problems are prevalent among drug users. Methadone maintenance treatment (MMT) is an evidence-based effective treatment for drug addiction; however, there are few studies investigating depression, suicidal ideation, and their related factors among MMT users. In this cross-sectional study, 648 MMT users were recruited from six MMT clinics in Guangzhou, China. Data were collected through face-to-face interviews by trained interviewers. Of all participants, 270 (42.7%) exhibited probable depression (Depression Subscale of the Chinese short version of Depression, Anxiety, and Stress Scale (DASS-D), score ≥ 10) and 99 (15.3%) reported having suicidal ideation in the last six months. After adjusting for significant socio-demographic characteristics, all studied variables, including drug use history, social support, family support for MMT use, and satisfaction toward MMT services were significantly associated with both probable depression and suicidal ideation in the last six months. Furthermore, depression fully mediated the associations between drug use history, satisfaction toward MMT services, and suicidal ideation. In the final multivariate models, probable depression was associated with social support (OR = 0.88, 95% CI = 0.83-0.93) and satisfaction toward MMT services provided by doctors (OR = 0.59, 95% CI = 0.40-0.86), while for suicidal ideation, social support (OR = 0.85, 95% CI = 0.78-0.92) and probable depression (OR = 5.94, 95% CI = 3.39-10.42) were significant. The findings suggest that there are unmet mental health needs among MMT users. For countries with limited resources of psychological services, mental health care toward MMT users should be implanted into current health care settings and incorporate components such as social support, family's understanding of MMT, and service satisfaction. PMID:26839180

  11. Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap

    PubMed Central

    Bora, Béatrice Koba; Lez, Didier Malamba; Luwa, Daniel Okitundu; Baguma, Marcellin Bugeme; Katumbay, Désiré Tshala; Kalula, Tharcisse Kayembe; Mesu'a Kabwa, Pierre Luabeya

    2015-01-01

    Introduction Epilepsy is the most common of serious neurological disorders, yet despite considerable efforts, good access to medication, appropriate social and societal acceptance and acceptable quality of life (QoL) are difficult to achieve especially in developing countries. It is estimated that over 500,000 people suffer from epilepsy in the DRC. There is no report, in our knowledge on the epilepsy in Lubumbashi. Methods A descriptive study was undertaken in individuals with a clinical diagnosis of epilepsy who presented at the CNPJG outpatient clinic in Lubumbashi over a 12 months period. A 64-item questionnaire was used to collect information from the patients. Case records were reviewed and relevant demographic, social, professional, medical history, medical condition data were extracted. Results Among 3,540 patients who presented to a neuropsychiatric clinic run by the Fracarita charity over a 1-year period, 423 (11.9%) were identified as having epilepsy, and 179 were subsequently included in the survey after they (or their parent/guardian) provided informed consent and completed an EEG investigation. Data were collected using a standardized, 64-item questionnaire. Epilepsy had negative impact on the lives of individuals with the condition; 40.8% had either no education or had completed primary education only, 38.0% were unemployed and the majority (64.6%; n = 113) were unmarried or divorced. Family history of epilepsy (first or second degree) was present in 23.5% of cases. Other reported factors that could potentially precipitate epilepsy included obstetric and perinatal factors (15.1%) and central nervous system infections during infancy (8.4%). Consumption of alcohol or recreational drugs accounted for 10.6%. The treatment gap was above 67% and the delay between first seizure and first consultation was 15 months. When asked to describe their condition, or its cause, 55.3% of participants (or their families) considered epilepsy to be of spiritual

  12. Factors that Influence Adherence to Antiretroviral Treatment in an Urban Population, Jakarta, Indonesia

    PubMed Central

    Weaver, Emma Rosamond Nony; Pane, Masdalina; Wandra, Toni; Windiyaningsih, Cicilia; Herlina; Samaan, Gina

    2014-01-01

    Introduction Although the number of people receiving antiretroviral therapy (ART) in Indonesia has increased in recent years, little is known about the specific characteristics affecting adherence in this population. Indonesia is different from most of its neighbors given that it is a geographically and culturally diverse country, with a large Muslim population. We aimed to identify the current rate of adherence and explore factors that influence ART adherence. Methods Data were collected from ART-prescribed outpatients on an HIV registry at a North Jakarta hospital in 2012. Socio-demographic and behavioral characteristics were explored as factors associated with adherence using logistics regression analyses. Chi squared test was used to compare the difference between proportions. Reasons for missing medication were analyzed descriptively. Results Two hundred and sixty-one patients participated, of whom 77% reported ART adherence in the last 3 months. The level of social support experienced was independently associated with adherence where some social support (p = 0.018) and good social support (p = 0.039) improved adherence compared to poor social support. Frequently cited reasons for not taking ART medication included forgetting to take medication (67%), busy with something else (63%) and asleep at medication time (60%). Discussion This study identified that an increase in the level of social support experienced by ART-prescribed patients was positively associated with adherence. Social support may minimize the impact of stigma among ART prescribed patients. Based on these findings, if social support is not available, alternative support through community-based organizations is recommended to maximize treatment success. PMID:25229671

  13. Factors in reliable treatment plant operation for the production of safe water.

    PubMed

    Hendry, Bruce A

    2010-08-01

    This contribution to the International Congress on Production of Safe Water, Izmir, Turkey, 20-24 January, 2009, relates to general aspects of a water supply undertaking rather than to particular technologies or chemistries for water treatment. The paper offers a "creative problem solving" approach following Fogler and LeBlanc (Strategies for creative problem solving. Prentice Hall, NJ, 1995) as a model for generating sustainable solutions when water quality and safety problems arise. Such a structured approach presents a systematic methodology that can promote communication and goal-sharing across the inter-related, but often isolated and dispersed, functions of water scientists and researchers, engineers, operations managers, government departments and communities. A problem-solving strategy, or "heuristic", invokes five main steps (define; generate; decide; implement; evaluate). Associated with each step are various creative and enabling techniques, many of which are quite familiar to us in one form or another, but which we can use more effectively in combination and through our increased awareness and practice. For example, taking a fresh view of a problem can be promoted by a variety of "lateral thinking" tools. First-hand investigation of a problem can trigger new thinking about the real problem and its origins. A good strategy implementation will always address each and every step (though not necessarily every possible technique) and will use them at various stages in the search for and implementation of solutions. The creative nature of our experience with a problem-solving heuristic develops our facility to cope better with complex formal situations, as well as with less formal or everyday problem situations. A few anecdotes are presented that illustrate some of the author's experiences relating to factors involved in safe water supply. Here, the term "factors" may signify people and organisations as agents, as well as meaning those aspects of a problem

  14. Race/Ethnicity and Multiple Cancer Risk Factors among Individuals Seeking Smoking Cessation Treatment

    PubMed Central

    Kendzor, Darla E.; Costello, Tracy J.; Li, Yisheng; Vidrine, Jennifer Irvin; Mazas, Carlos A.; Reitzel, Lorraine R.; Cinciripini, Paul M.; Cofta-Woerpel, Ludmila M.; Businelle, Michael S.; Wetter, David W.

    2016-01-01

    Smoking in combination with other behavioral risk factors is known to have a negative influence on health, and individuals who smoke typically engage in multiple risk behaviors. However, little is known about the clustering of risk behaviors among smokers of varying race/ethnicity. The purpose of this study was to examine patterns of cancer risk behaviors and to identify predictors of multiple risk behaviors in a racially/ethnically diverse sample of individuals seeking smoking cessation treatment. Overweight/obesity, at-risk alcohol consumption, and insufficient physical activity were measured in 424 smokers (African American, n = 144; Latino, n = 141; Caucasian, n = 139). Results indicated that 90% of participants reported behavioral cancer risk factors in addition to smoking. Approximately 70% of participants were overweight or obese, 48% engaged in at-risk drinking, and 27% were insufficiently physically active. Univariate analyses indicated that race/ethnicity, p < .001, smoking level, p = .03, and marital status, p = .04, were significant predictors of multiple risk behaviors, although only race/ethnicity remained a significant predictor, p < .001, when gender, smoking level, age, education, household income, marital status, and health insurance status were included in a multivariate model. Multivariate analysis indicated that the odds of engaging in multiple risk behaviors were significantly higher among Latinos, OR = 2.85, and African Americans, OR = 1.86, than Caucasians. Our findings highlight the need for research aimed at identifiying determinants of racial/ethnic differences in multiple risk behaviors, and indicate the importance of developing culturally sensitive interventions that target multiple risk behaviors. PMID:18990734

  15. Intracranial meningiomas: Prognostic factors and treatment outcome in patients undergoing postoperative radiation therapy

    PubMed Central

    Anvari, Kazem; Hosseini, Sare; Rahighi, Saeid; Toussi, Mehdi Seilanian; Roshani, Nasrin; Torabi-Nami, Mohammad

    2016-01-01

    Background: Meningioma constitutes 20% of the intracranial neoplasms. Followed by surgery as the primary treatment for most patients, radiotherapy becomes indicated in high-grade tumors with incomplete surgical removal. We evaluated the prognostic factors and overall outcome in meningioma patients who underwent radiotherapy. Materials and Methods: In this retrospective analysis, data from all patients with documented diagnosis of meningioma who referred to the Omid and Ghaem Oncology Centers (Mashhad, Iran) from 2002 to 2013 were included. We calculated the overall survival rates using the Kaplan–Meier method and compared the survival curves between groups by the log-rank test. Results: Eighty-three patients with a median age of 50 years (ranging: 16–84) were included. Grade I, II, and III meningiomas were seen in 40 (48%), 31 (37%), and 12 (15%) patients, respectively. Radiation therapy was indicated due to tumor recurrence, incomplete excision, or tumor grade in 32, 8, and 43 patients, respectively. Tumor grade had a significant effect on the overall survival with a 3-year overall survival of 76.7%, 43.5%, and 13.3% in Grade I, II, and III, respectively (P < 0.001). Gender, age, and tumor location were not correlated with the overall survival. Moreover, patients with Grade II and III who underwent total resection had a significantly higher overall survival than those with subtotal resection or biopsy alone (5-year survival rates of 82% vs. 17.1%, respectively; P = 0.008). Conclusion: Tumor grade was the most important prognostic factor in meningioma patients undergoing radiation therapy. In patients with Grade II and III tumors, the extent of surgical resection is significantly correlated with the overall survival. PMID:27274498

  16. Treatment Outcome of Tuberculosis Patients under Directly Observed Treatment Short Course and Factors Affecting Outcome in Southern Ethiopia: A Five-Year Retrospective Study.

    PubMed

    Gebrezgabiher, Gebremedhin; Romha, Gebremedhin; Ejeta, Eyasu; Asebe, Getahun; Zemene, Endalew; Ameni, Gobena

    2016-01-01

    Tuberculosis (TB) is one of the major public health and socio-economic issues in the 21st century globally. Assessment of TB treatment outcomes, and monitoring and evaluation of its risk factors in Directly Observed Treatment Short Course (DOTS) are among the major indicators of the performance of a national TB control program. Hence, this institution-based retrospective study was conducted to determine the treatment outcome of TB patients and investigate factors associated with unsuccessful outcome at Dilla University Referral Hospital, southern Ethiopia. Five years (2008 to 2013) TB record of TB clinic of the hospital was reviewed. A total 1537 registered TB patients with complete information were included. Of these, 942 (61.3%) were male, 1015 (66%) were from rural areas, 544 (35.4%) were smear positive pulmonary TB (PTB+), 816 (53.1%) were smear negative pulmonary TB (PTB-) and 177(11.5%) were extra pulmonary TB (EPTB) patients. Records of the 1537 TB patients showed that 181 (11.8%) were cured, 1129(73.5%) completed treatment, 171 (11.1%) defaulted, 52 (3.4%) died and 4 (0.3%) had treatment failure. The overall mean treatment success rate of the TB patients was 85.2%. The treatment success rate of the TB patients increased from 80.5% in September 2008-August 2009 to 84.8% in September 2012-May 2013. Tuberculosis type, age, residence and year of treatment were significantly associated with unsuccessful treatment outcome. The risk of unsuccessful outcome was significantly higher among TB patients from rural areas (AOR = 1.63, 95% CI: 1.21-2.20) compared to their urban counterparts. Unsuccessful treatment outcome was also observed in PTB- patients (AOR = 1.77, 95% CI: 1.26-2.50) and EPTB (AOR = 2.07, 95% CI: 1.28-3.37) compared to the PTB+ patients. In conclusion, it appears that DOTS have improved treatment success in the hospital during five years. Regular follow-up of patients with poor treatment outcome and provision of health information on TB treatment to

  17. Organizational factors influencing implementation of evidence-based practices for integrated treatment in behavioral health agencies.

    PubMed

    Bonham, Caroline A; Sommerfeld, David; Willging, Cathleen; Aarons, Gregory A

    2014-01-01

    Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities. PMID:24772411

  18. Anti-Vascular Endothelial Growth Factor Treatment for Proliferative Macular Telangiectasia Type 2.

    PubMed

    Alkin, Zeynep; Yilmaz, Ihsan; Ozkaya, Abdullah; Yazici, Ahmet Taylan

    2016-01-01

    Idiopathic macular telangiectasia type 2 (IMT 2), is the most common type of a heterogeneous group of disorders, characterized by telangiectatic alterations of the juxtafoveolar capillary network. Vision loss is due to retinal atrophy and subretinal neovascularization (SRN). Here, we report the outcomes of intravitreal anti-vascular endothelial growth factor injections, bevacizumab or ranibizumab, in four cases with proliferative IMT 2. Baseline best corrected visual acuity (VA) ranged from 20/50 to 20/100. Follow-up time ranged from 12 months to 24 months. One of four patients received one injection, two patients received three injections, and one patient received seven injections. VA improved in three eyes (≥1 line improvement) and decreased in one eye (≥1 line decrease) over time. Final acuity ranged from 20/30 to 20/100. There were no cases of leakage after the cessation of treatment. SRN, which is a complication of IMT 2, should be recognized and treated accordingly. PMID:27162458

  19. Anti-Vascular Endothelial Growth Factor Treatment for Proliferative Macular Telangiectasia Type 2

    PubMed Central

    Alkin, Zeynep; Yilmaz, Ihsan; Ozkaya, Abdullah; Yazici, Ahmet Taylan

    2016-01-01

    Idiopathic macular telangiectasia type 2 (IMT 2), is the most common type of a heterogeneous group of disorders, characterized by telangiectatic alterations of the juxtafoveolar capillary network. Vision loss is due to retinal atrophy and subretinal neovascularization (SRN). Here, we report the outcomes of intravitreal anti-vascular endothelial growth factor injections, bevacizumab or ranibizumab, in four cases with proliferative IMT 2. Baseline best corrected visual acuity (VA) ranged from 20/50 to 20/100. Follow-up time ranged from 12 months to 24 months. One of four patients received one injection, two patients received three injections, and one patient received seven injections. VA improved in three eyes (≥1 line improvement) and decreased in one eye (≥1 line decrease) over time. Final acuity ranged from 20/30 to 20/100. There were no cases of leakage after the cessation of treatment. SRN, which is a complication of IMT 2, should be recognized and treated accordingly. PMID:27162458

  20. Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries

    PubMed Central

    Domper Arnal, María José; Ferrández Arenas, Ángel; Lanas Arbeloa, Ángel

    2015-01-01

    Esophageal cancer is one of the most unknown and deadliest cancers worldwide, mainly because of its extremely aggressive nature and poor survival rate. Esophageal cancer is the 6th leading cause of death from cancer and the 8th most common cancer in the world. The 5-year survival is around 15%-25%. There are clear differences between the risk factors of both histological types that affect their incidence and distribution worldwide. There are areas of high incidence of squamous cell carcinoma (some areas in China) that meet the requirements for cost-effectiveness of endoscopy for early diagnosis in the general population of those areas. In Europe and United States the predominant histologic subtype is adenocarcinoma. The role of early diagnosis of adenocarcinoma in Barrett’s esophagus remains controversial. The differences in the therapeutic management of early esophageal carcinoma (high-grade dysplasia, T1a, T1b, N0) between different parts of the world may be explained by the number of cancers diagnosed at an early stage. In areas where the incidence is high (China and Japan among others) early diagnoses is more frequent and has led to the development of endoscopic techniques for definitive treatment that achieve very effective results with a minimum number of complications and preserving the functionality of the esophagus. PMID:26185366

  1. Predictive Factors for Delivery within 7 Days after Successful 48-Hour Treatment of Threatened Preterm Labor

    PubMed Central

    Roos, Carolien; Schuit, Ewoud; Scheepers, Hubertina C. J.; Bloemenkamp, Kitty W. M.; Bolte, Antoinette C.; Duvekot, Hans J. J.; van Eyck, Jim; Kok, Joke H.; Kwee, Anneke; Merién, Ashley E. R.; Opmeer, Brent C.; Oudijk, Martijn A.; van Pampus, Mariëlle G.; Papatsonis, Dimitri N. M.; Porath, Martina M.; Sollie, Krystyna M.; Spaanderman, Marc E. A.; Vijgen, Sylvia M. C.; Willekes, Christine; Lotgering, Fred K.; van der Post, Joris A. M.; Mol, Ben Willem J.

    2015-01-01

    Objective The aim of this study was to assess which characteristics and results of vaginal examination are predictive for delivery within 7 days, in women with threatened preterm labor after initial treatment. Study Design A secondary analysis of a randomized controlled trial on maintenance nifedipine includes women who remained undelivered after threatened preterm labor for 48 hours. We developed one model for women with premature prelabor rupture of membranes (PPROM) and one without PPROM. The predictors were identified by backward selection. We assessed calibration and discrimination and used bootstrapping techniques to correct for potential overfitting. Results For women with PPROM (model 1), nulliparity, history of preterm birth, and vaginal bleeding were included in the multivariable analysis. For women without PPROM (model 2), maternal age, vaginal bleeding, cervical length, and fetal fibronectin (fFN) status were in the multivariable analysis. Discriminative capability was moderate to good (c-statistic 0.68; 95% confidence interval [CI] 0.60–0.77 for model 1 and 0.89; 95% CI, 0.84–0.93 for model 2). Conclusion PPROM and vaginal bleeding in the current pregnancy are relevant predictive factors in all women, as are maternal age, cervical length, and fFN in women without PPROM and nulliparity, history of preterm birth in women with PPROM. PMID:26495173

  2. [Source emission characteristics and impact factors of volatile halogenated organic compounds from wastewater treatment plant].

    PubMed

    He, Jie; Wang, Bo-Guang; Liu, Shu-Le; Zhao, De-Jun; Tang, Xiao-Dong; Zou, Yu

    2011-12-01

    A low enrichment method of using Tenax as absorbent and liquid nitrogen as refrigerant has been established to sample the volatile halogenated organic compounds in Guangzhou Liede municipal wastewater treatment plant as well as its ambient air. The composition and concentration of target halogenated hydrocarbons were analyzed by combined thermal desorption/GC-MS to explore its sources profile and impact factors. The result showed that 19 halogenated organic compounds were detected, including 11 halogenated alkanets, 3 halogenated alkenes, 3 halogenated aromatic hydrocarbons and 2 haloesters, with their total concentrations ranged from 34.91 microg x m(-3) to 127.74 microg x m(-3) and mean concentrations ranged from n.d. to 33.39 microg x m(-3). Main pollutants of the studied plant were CH2Cl2, CHCl3, CFC-12, C2H4Cl2, CFC-11, C2HCl3 and C2Cl4, they came from the wastewater by volatilization. Among the six processing units, the dehydration room showed the highest level of halogenated organic compounds, followed by pumping station, while the sludge thickener was the lowest. The emissions from pumping station, aeration tank and biochemical pool were significantly affected by temperature and humidity of environment. PMID:22468521

  3. Factors associated with suicidal risk among a French cohort of problem gamblers seeking treatment.

    PubMed

    Guillou-Landreat, Morgane; Guilleux, Alice; Sauvaget, Anne; Brisson, Lucille; Leboucher, Juliette; Remaud, Manon; Challet-Bouju, Gaëlle; Grall-Bronnec, Marie

    2016-06-30

    Compared to general population, pathological gamblers are 3.4 times more likely to attempt suicide. Our objective was to identify specific profiles of problem gamblers (PGs) with suicidal risk according to sociodemographic, clinical and gambling characteristics. The PGs cohort, called "EVALJEU" , consists in the inclusion of any new PG seeking treatment in our Department. Patients underwent a semi-structured clinical interview and completed self-report questionnaires. The "suicidal risk module" of the Mini International Psychiatric interview (MINI) allowed to constitute two groups of patients that were compared, according to the presence of a suicidal risk. A logistic regression was performed to identify factors related to suicidal risk in PGs. In our sample (N=194), 40.21% presented a suicidal risk. A history of major depression and anxiety disorders were predictors of suicidal risk as well as the perceived inability to stop gambling. Suicidality is a significant clinical concern in PGs. Therefore, three specific predictors, identified by our study, must be assessed. PMID:27078754

  4. Organizational Factors Influencing Implementation of Evidence-Based Practices for Integrated Treatment in Behavioral Health Agencies

    PubMed Central

    Bonham, Caroline A.; Sommerfeld, David; Willging, Cathleen; Aarons, Gregory A.

    2014-01-01

    Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities. PMID:24772411

  5. Factors associated with residential placement in an assertive community treatment program.

    PubMed

    Hampton, Michelle DeCoux; Chafetz, Linda

    2002-01-01

    Assertive community treatment (ACT) programs originated to meet the needs of the severely mentally ill (SMI) for multiple psychosocial supports necessary for community living. Housing has been prominent among these needs and research to date on ACT programs has addressed residential outcomes, principally reduced homelessness and maintenance in some form of stable housing. However, limited studies have examined variables that might predict particular types of residential placements, which range from unsupervised to highly structured environments. The purpose of this study was to identify factors related to residential placement for the subjects in a model ACT program. Of multiple variables assessed, two were significantly related to residential placement. Chronic respiratory illness was strongly associated with placement in supervised group homes. Team assignment was associated with placement, with clients in one of three teams significantly more likely to live more independently. Clients assigned to this team showed higher psychosocial functioning than others in terms of functional ratings on the Multnomah Community Ability Scale. However, higher function alone was not significantly associated with placement, suggesting a role for clinical judgement and a need for future research in this area. PMID:12349837

  6. Retinopathy of Prematurity among Very-Low-Birth-Weight Infants in Korea: Incidence, Treatment, and Risk Factors.

    PubMed

    Hwang, Jong Hee; Lee, Eun Hee; Kim, Ellen Ai-Rhan

    2015-10-01

    This study was conducted to describe the incidence, risk factors, and current treatment status of retinopathy of prematurity (ROP) in very-low-birth-weight (VLBW) infants registered in the Korean Neonatal Network database. Medical records of 2,009 VLBW infants born between January 2013 and June 2014 who underwent examination by an ophthalmologist were reviewed. The total incidence of ROP was 34.1%. Of the patients, 11.6% showed ROP stage ≥ 3 and 11.5% received treatment of VLBW. Among all infants who received treatment of ROP, 63.6% underwent operation only; 16.9%, anti-vascular endothelial growth factor (anti-VEGF) treatment only; and 19.5%, both operation and anti-VEGF treatment. The mean gestational age (GA) and birth weight (BW) were significantly lower and the prevalence rates of respiratory distress syndrome, patent ductus arteriosus (PDA), invasive ventilator duration, and sepsis were significantly higher in the VLBW infants with ROP than in those without ROP. In the multivariable logistic regression analysis, PDA (odd ratio [OR], 2.1; 95% confidence interval [CI], 1.11-3.79) and invasive ventilator duration (OR, 1.0; 95% CI, 1.00-1.02) were significant risk factors of ROP and ROP stage ≥ 3. In conclusion, the high incidence of ROP is associated with low GA and BW, and attempt to reduce the aforementioned risk factors could reduce the incidence of ROP stage ≥ 3 in VLBW infants. PMID:26566363

  7. Retinopathy of Prematurity among Very-Low-Birth-Weight Infants in Korea: Incidence, Treatment, and Risk Factors

    PubMed Central

    Hwang, Jong Hee; Lee, Eun Hee

    2015-01-01

    This study was conducted to describe the incidence, risk factors, and current treatment status of retinopathy of prematurity (ROP) in very-low-birth-weight (VLBW) infants registered in the Korean Neonatal Network database. Medical records of 2,009 VLBW infants born between January 2013 and June 2014 who underwent examination by an ophthalmologist were reviewed. The total incidence of ROP was 34.1%. Of the patients, 11.6% showed ROP stage ≥ 3 and 11.5% received treatment of VLBW. Among all infants who received treatment of ROP, 63.6% underwent operation only; 16.9%, anti-vascular endothelial growth factor (anti-VEGF) treatment only; and 19.5%, both operation and anti-VEGF treatment. The mean gestational age (GA) and birth weight (BW) were significantly lower and the prevalence rates of respiratory distress syndrome, patent ductus arteriosus (PDA), invasive ventilator duration, and sepsis were significantly higher in the VLBW infants with ROP than in those without ROP. In the multivariable logistic regression analysis, PDA (odd ratio [OR], 2.1; 95% confidence interval [CI], 1.11-3.79) and invasive ventilator duration (OR, 1.0; 95% CI, 1.00-1.02) were significant risk factors of ROP and ROP stage ≥ 3. In conclusion, the high incidence of ROP is associated with low GA and BW, and attempt to reduce the aforementioned risk factors could reduce the incidence of ROP stage ≥ 3 in VLBW infants. PMID:26566363

  8. [Successful treatment of venous thromboembolism with a Factor Xa inhibitor, edoxaban, in patients with lenalidomide-treated multiple myeloma].

    PubMed

    Kawaguchi, Masato; Uchimura, Norio; Okuda, Yuko; Konuma, Satomi; Nehashi, Yoshio

    2015-08-01

    Two multiple myeloma (MM) patients developed venous thromboembolism (VTE) while being treated with lenalidomide and low-dose dexamethasone. Aspirin is recommended for VTE prophylaxis when using lenalidomide/dexamethasone for MM patients with a standard risk of VTE. Despite aspirin administration, however, these two patients experienced VTE. Following VTE development, warfarin and then a Factor Xa inhibitor, edoxaban, were administered. The edoxaban treatment, especially, resulted in favorable and effective control of VTE. Considering these observations, Factor Xa inhibitors may in future become a preferred option for prevention and treatment of VTE when managing MM patients. PMID:26345573

  9. Determining factors of observance of antiretroviral treatments in Cameroon during the start-up period (2000-2002)

    PubMed Central

    Commeyras, Christophe; Rey, Jean Loup; Badre-Sentenac, Stéphanie; Essomba-Ntsama, Claudine

    Objective: highlight the socioeconomic and environmental determining factors of long-term observance to antiretroviral treatments in developing countries. Method: The regularity of antiretroviral prescriptions renewal at the central pharmacy of the Yaounde Central Hospital (Cameroon) was measured through analysing the medical and pharmaceutical files of 230 patients over the 21 month start-up period. 99 patients were also interviewed during the last six months. The determining factors were analysed according to various socio-economic criteria, linked with the longitudinal study of treatment observance. Results: The huge price decrease of HIV treatments during the start-up period was conducive to an increase in new treatments by a factor 5.76. In this context of an exploding demand, the paper shows that observance is firstly dependent on quality information about illness and treatment protocols, while longer term adherence is partly dependent on financial capability, and includes the strong influence of living conditions and behaviours. Conclusion: The paper recommends the introduction of free treatment as an objective in national sector policies and the organisation of a long term following-up of patients. In the African context of poverty and actual decentralisation of healthcare, the question of the availability of human resources is profoundly enhanced. PMID:25214897

  10. Hospital and patient influencing factors of treatment schemes given to type 2 diabetes mellitus inpatients in Inner Mongolia, China

    PubMed Central

    Zhang, Nan; McNeil, Edward; Assanangkornchai, Sawitri; Fan, Yancun

    2016-01-01

    Background: In clinical practice, the physician’s treatment decision making is influenced by many factors besides the patient’s clinical conditions and is the fundamental cause of healthcare inequity and discrimination in healthcare settings. Type 2 diabetes mellitus (T2DM) is a chronic disease with high prevalence, long average length of stay and high hospitalization rate. Although the treatment of T2DM is well guideline driven, there is a large body of evidence showing the existence of treatment disparities. More empirical studies from the provider side are needed to determine if non-clinical factors influence physician’s treatment choices. Objective: To determine the hospital and patient influencing factors of treatment schemes given to T2DM inpatients in Inner Mongolia, China. Methods: A cross-sectional, hospital-based survey using a cluster sampling technique was conducted in three tertiary hospitals and three county hospitals in Inner Mongolia, China. Treatment schemes were categorized as lifestyle management, oral therapy or insulin therapy according to the national guideline. Socio-demographic characteristics and variables related to severity of disease at the individual level and hospital level were collected. Weighted multinomial logistic regression models were used to determine influencing factors of treatment schemes. Results: Regardless of patients’ clinical conditions and health insurance types, both hospital and patient level variables were associated with treatment schemes. Males were more likely to be given oral therapy (RRR=1.72, 95% CI=1.06-2.81) and insulin therapy (RRR=1.94, 95% CI=1.29-2.91) compared to females who were given lifestyle management more frequently. Compared to the western region, hospitals in the central regions of Inner Mongolia were less likely to prescribe T2DM patients oral therapy (RRR = 0.18, 95% CI=0.05-0.61) and insulin therapy (RRR = 0.20, 95% CI=0.06-0.67) than lifestyle management. Compared with non

  11. Dyslipidemia awareness, treatment, control and influence factors among adults in the Jilin province in China: a cross-sectional study

    PubMed Central

    2014-01-01

    Background In China, even though the prevalence of dyslipidemia among adults increased yearly and dyslipidemia being an important risk factor for cardiovascular diseases among the Chinese population, however, the awareness, treatment and control of dyslipidemia are at low levels, and only limited studies on the influence factors associated with the awareness, treatment and control dyslipidemia in China have been carried out. Methods The analysis was based on a representative sample of 7138 adult subjects aged 18 ~ 79 years recruited from a cross-sectional study of chronic disease and risk factors among adults in the Jilin province in 2012. Chi-square test was used to compare the rates of dyslipidemia awareness, treatment and control between different characteristics of participants. Multiple logistic regression analyses were performed separately for each group to explore the associations between participants’ characteristics and dyslipidemia awareness, treatment and control. Results Among participants with dyslipidemia, 11.6% were aware of the diagnosis, 8.4% were receiving treatment, and 34.8% had dyslipidemia controlled. Increase in age and BMI ≥ 24 kg/m2 were by far the strongest risk factors associated with better awareness and treatment of dyslipidemia. Retirees were more likely to be aware of their dyslipidemia condition (OR = 1.255; 95% CI: 1.046, 1.506) and to be receiving treatment (OR = 1.367; 95% CI: 1.114, 1.676) than manual workers. A family history of dyslipidemia increased the likelihood of awareness (OR = 3.620; 95% CI: 2.816, 4.653) and treatment (OR = 3.298; 95% CI: 2.488, 4.371) of dyslipidemia. Alcohol drinking and physical activity were associated with a lower level of awareness and treatment. Cigarette smokers (OR = 0.501; 95% CI: 0.349, 0.719) and those with BMI ≥ 24 kg/m2 (OR = 0.480; 95% CI: 0.326, 0.706) who received treatment were also associated with poor dyslipidemia control. Conclusion Our

  12. Risk Factors Associated with Default from Multi- and Extensively Drug-Resistant Tuberculosis Treatment, Uzbekistan: A Retrospective Cohort Analysis

    PubMed Central

    Lalor, Maeve K.; Greig, Jane; Allamuratova, Sholpan; Althomsons, Sandy; Tigay, Zinaida; Khaemraev, Atadjan; Braker, Kai; Telnov, Oleksander; du Cros, Philipp

    2013-01-01

    Background The Médecins Sans Frontières project of Uzbekistan has provided multidrug-resistant tuberculosis treatment in the Karakalpakstan region since 2003. Rates of default from treatment have been high, despite psychosocial support, increasing particularly since programme scale-up in 2007. We aimed to determine factors associated with default in multi- and extensively drug-resistant tuberculosis patients who started treatment between 2003 and 2008 and thus had finished approximately 2 years of treatment by the end of 2010. Methods A retrospective cohort analysis of multi- and extensively drug-resistant tuberculosis patients enrolled in treatment between 2003 and 2008 compared baseline demographic characteristics and possible risk factors for default. Default was defined as missing ≥60 consecutive days of treatment (all drugs). Data were routinely collected during treatment and entered in a database. Potential risk factors for default were assessed in univariate analysis using chi-square test and in multivariate analysis with logistic regression. Results 20% (142/710) of patients defaulted after a median of 6 months treatment (IQR 2.6–9.9). Factors associated with default included severity of resistance patterns (pre-extensively drug-resistant/extensively drug-resistant tuberculosis adjusted odds ratio 0.52, 95%CI: 0.31–0.86), previous default (2.38, 1.09–5.24) and age >45 years (1.77, 1.10–2.87). The default rate was 14% (42/294) for patients enrolled 2003–2006 and 24% (100/416) for 2007–2008 enrolments (p = 0.001). Conclusions Default from treatment was high and increased with programme scale-up. It is essential to ensure scale-up of treatment is accompanied with scale-up of staff and patient support. A successful first course of tuberculosis treatment is important; patients who had previously defaulted were at increased risk of default and death. The protective effect of severe resistance profiles suggests that understanding disease

  13. Factors influencing the decision about orthodontic treatment. A longitudinal study among 11- and 15-year-olds and their parents.

    PubMed

    Birkeland, K; Katle, A; Løvgreen, S; Bøe, O E; Wisth, P J

    1999-01-01

    The aims of the study were to evaluate the attitude towards orthodontic treatment among 11-(T1) and 15-year-old children (T2) and their parents, to present the distribution of referral rate and treatment uptake by a treatment need index assessed at T1 and to elucidate factors influencing the decision about orthodontic treatment in the period from T1 to T2. A group of 359 children and their parents answered separate questionnaires at T1, and 293 families responded to a follow-up study 4 years later. For the clinical examination, 224 children participated after exclusion of children in active treatment. The dental study casts were assessed by the Index of Orthodontic Treatment Need (IOTN). The mean referral rate was 56%, with a variation from 40% to 71% among different dental clinics. About 44% of the children had completed or were undergoing orthodontic treatment at T2. No significant sex differences among referred and treated children were discovered. Aesthetic motives were the most frequently reported subjective reason for orthodontic care. The untreated group expressed diminishing treatment desire in the follow-up period. The logistic regression analysis selected Dental Health Component (DHC) grades as a strong predictor for treatment uptake, followed by parents' concern and attitude to braces, while the 11-year-olds' own orthodontic concern was less significant. Children in the untreated group with late treatment decisions (T2) were best predicted by Aesthetic Component (AC) changes from T1 to T2. The results indicate that dentists play a key role in determining orthodontic treatment levels. High referral rates secured low risk of denying care to some patients. Treatment decision may be guided by the orthodontist. However, individual variation in attitude and desire influence treatment uptake even among children with great need. PMID:10546413

  14. Systematic Literature Review of Risk Factors and Treatments for Ulcerative Dermatitis in C57BL/6 Mice

    PubMed Central

    Sargent, Jennifer L; Koewler, Nathan J; Diggs, Helen E

    2015-01-01

    Ulcerative dermatitis (UD) in C57BL/6 mice is poorly understood and challenging to treat. We sought to evaluate the evidence regarding commonly cited risk factors for UD and reported UD treatments. The terms ‘ulcerative dermatitis’ and ‘C57BL/6’ were used to search 3 electronic databases. The resulting 347 articles were screened to identify publications that compared the risk of spontaneous UD in wild-type C57BL/6 mice according to sex, season, diet, or age and those that compared the degree of healing or rate of lesion resolution according to the intervention used. Articles were evaluated by using published criteria for assessing methodologic quality, including study design, number of animals per study group, case definition, method of diagnosis, randomization, enrollment criteria, exclusion criteria, and outcomes. The search identified 11 publications on risk factors that met the inclusion criteria, and no publication on UD treatment met all of the criteria. Relaxing the inclusion criteria for reporting of risk factors and treatment outcomes to include both wild-type C57BL/6 mice and genetically engineered mice on a B6 background yielded 12 publications on risk factors and 3 publications on treatment. Dietary factors, particularly caloric restriction, appear to influence UD risk. Female sex was inconsistently associated with a higher risk of UD, which most often occurred in 13- to 24-mo-old mice in the studies that were reviewed. Only 1 of the 3 publications that evaluated UD treatments included an untreated group or alternative therapy control. Further research is needed to explore epidemiologic aspects of UD and to compare treatment options. PMID:26678363

  15. Referral and Receipt of Treatment for Hepatocellular Carcinoma in United States Veterans: Effect of Patient and Non-Patient Factors

    PubMed Central

    Davila, Jessica A.; Kramer, Jennifer R.; Duan, Zhigang; Richardson, Peter A.; Tyson, Gia L.; Sada, Yvonne H.; Kanwal, Fasiha; El-Serag, Hashem B.

    2014-01-01

    Background The delivery of treatment for hepatocellular carcinoma (HCC) could be influenced by place of HCC diagnosis (hospitalization vs. outpatient), subspecialty referral following diagnosis, as well as physician and facility factors. We conducted a study to examine the effect of patient and non-patient factors on the place of HCC diagnosis, referral, and treatment in Veterans Administration (VA) hospitals in the United States. Methods Using the VA Hepatitis C Clinical Case Registry, we identified HCV-infected patients who developed HCC during 1998–2006. All cases were verified and staged according to Barcelona Clinic Liver Cancer (BCLC) criteria. The main outcomes were place of HCC diagnosis, being seen by a surgeon or oncologist, and treatment. We examined factors related to these outcomes using hierarchical logistic regression. These factors included HCC stage, HCC surveillance, physician specialty, and facility factors, in addition to risk factors, co-morbidity, and liver disease indicators. Results Approximately 37.2% of the 1,296 patients with HCC were diagnosed during hospitalization, 31.0% were seen by a surgeon or oncologist, and 34.3% received treatment. Being seen by a surgeon or oncologist was associated with surveillance (adjusted odds ratio (aOR)=1.47;95%CI:1.20–1.80) and varied by geography (1.74;1.09–2.77). Seeing a surgeon or oncologist was predictive of treatment (aOR=1.43;95%CI:1.24–1.66). There was a significant increase in treatment among patients who received surveillance (aOR=1.37; 95%CI:1.02–1.71), were seen by gastroenterology (1.65;1.21–2.24) or were diagnosed at a transplant facility (1.48;1.15–1.90). Conclusions Approximately 40% of patients were diagnosed during hospitalization. Most patients were not seen by a surgeon or oncologist for treatment evaluation and only 34% received treatment. Only receipt of HCC surveillance was associated with increased likelihood of outpatient diagnosis, being seen by a surgeon or

  16. Diagnosis, Treatment and Risk Factors of Strongyloides stercoralis in Schoolchildren in Cambodia

    PubMed Central

    Khieu, Virak; Schär, Fabian; Marti, Hanspeter; Sayasone, Somphou; Duong, Socheat; Muth, Sinuon; Odermatt, Peter

    2013-01-01

    Background Worldwide, an estimated 30 to 100 million people are infected with Strongyloides stercoralis, a soil-transmitted helminth. Information on the parasite is scarce in most settings. In semi-rural Cambodia, we determined infection rates and risk factors; compared two diagnostic methods (Koga agar plate [KAP] culture and Baermann technique) for detecting S. stercoralis infections, using a multiple stool examination approach; and assessed efficacy of ivermectin treatment. Methods/Principal Findings We performed a cross-sectional study in 458 children from four primary schools in semi-rural villages in Kandal province, using three diagnostic procedures (Kato-Katz, KAP culture and Baermann technique) on three stool samples. Infected children were treated with ivermectin (100 µg/kg/day for two days) and re-examined three weeks after treatment. Hookworm, S. stercoralis, Trichuris trichiura, and small trematode eggs were most prevalent, with 24.4% of children being infected with S. stercoralis. The sensitivity of KAP culture and Baermann technique was 88.4% and 75.0%, respectively and their negative predictive values were 96.4% and 92.5%, respectively. The cumulative prevalence of S. stercoralis increased from 18.6% to 24.4%, after analyzing three stool samples, which was close to the modeled ‘true’ prevalence of 24.8%. Children who reported defecating in latrines were significantly less infected with S. stercoralis than those who did not use latrines (p<0.001). Itchy skin and diarrhea were significantly associated with S. stercoralis infection. The cure rate of ivermectin was 98.3%. Conclusions/Significance S. stercoralis infection is highly prevalent among semi-rural Cambodian schoolchildren. The sensitivity of KAP culture is higher than that of the Baermann technique. In the absence of a “gold standard”, analysis of multiple stool samples by different diagnostic methods is required to achieve a satisfactory level of sensitivity. Almost three-quarters of

  17. Treatment of metastatic colorectal carcinomas by systemic inhibition of vascular endothelial growth factor signaling in mice

    PubMed Central

    Schmitz, Volker; Kornek, Miroslaw; Hilbert, Tobias; Dzienisowicz, Christian; Raskopf, Esther; Rabe, Christian; Sauerbruch, Tilman; Qian, Cheng; Caselmann, Wolfgang H

    2005-01-01

    AIM: Tumor angiogenesis has been shown to be promoted by vascular endothelial growth factor (VEGF) via stimulating endothelial cell proliferation, migration, and survival. Blockade of VEGF signaling by different means has been demonstrated to result in reduced tumor growth and suppression of tumor angiogenesis in distinct tumor entities. Here, we tested a recombinant adenovirus, AdsFlt1-3, that encodes an antagonistically acting fragment of the VEGF receptor 1 (Flt-1), for systemic antitumor effects in pre-established subcutaneous CRC tumors in mice. METHODS: Murine colorectal carcinoma cells (CT26) were inoculated subcutaneously into Balb/c mice for in vivo studies. Tumor size and survival were determined. 293 cell line was used for propagation of the adenoviral vectors. Human lung cancer line A549 and human umbilical vein endothelial cells were transfected for in vitro experiments. RESULTS: Infection of tumor cells with AdsFlt1-3 resulted in protein secretion into cell supernatant, demonstrating correct vector function. As expected, the secreted sFlt1-3 protein had no direct effect on CT26 tumor cell proliferation in vitro, but endothelial cell function was inhibited by about 46% as compared to the AdLacZ control in a tube formation assay. When AdsFlt1-3 (5×109 PFU/animal) was applied to tumor bearing mice, we found a tumor inhibition by 72% at d 12 after treatment initiation. In spite of these antitumoral effects, the survival time was not improved. According to reduced intratumoral microvessel density in AdsFlt1-3-treated mice, the antitumor mechanism can be attributed to angiostatic vector effects. We did not detect increased systemic VEGF levels after AdsFlt1-3 treatment and liver toxicity was low as judged by serum alanine aminotransferase determination. CONCLUSION: In this study we confirmed the value of a systemic administration of AdsFlt1-3 to block VEGF signaling as antitumor therapy in an experimental metastatic colorectal carcinoma model in mice. PMID

  18. Psychological and psychophysiological factors in prevention and treatment of cold injuries.

    PubMed

    Kappes, B; Mills, W; O'Malley, J

    1993-01-01

    Cold injured patients in Alaska come from many sources. Although sport and work continues to provide large numbers of cold injured, most severe repeat injuries tend to reflect other biopsychosocial consequences. Certain behaviors can increase the probability of injury, however all persons living in cold climates are potential candidates. One can decrease risk by education, knowledge and intelligent behavior. Proper respect for adequate protection and hydration seem to be critical factors. Understanding the psychological, physiological and psychophysiological aspects of the cold environment performer helps refine the prevention and treatment strategies for cold injury. Skill training with bio-behavioral methods, such as thermal biofeedback, and the value of medical psychotherapy appear to offer continued promise by facilitating physiologic recovery from injury, as well as assisting in long term rehabilitation. Both approaches increase the likelihood of a favorable healing response by soliciting active patient participation. Medical Psychotherapy for traumatic injuries can also help identify and manage cognitive emotional issues for families and patients faced with the permanent consequences of severe thermal injuries. Thermal biofeedback therapy has the potential benefit of encouraging greater self-reliance and responsibility for self-regulating overall health by integrating self-management skills regarding physiology, diet and lifestyle. Inpatient and outpatient biofeedback training offers specific influence over vascular responses for healing, as well as providing an effective tool for pain management. Interest in cold region habitation has continued to expand our study of human tolerance to harsh, extreme environments. Biological, psychological, sociological, and anthropological views on adaptation, habituation, acclimatization, and injury in cold environments acknowledges the role of development, learning and educated responses to cold environments. The study of

  19. Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma

    PubMed Central

    Valero-Elizondo, Javier; Kim, Yuhree; Prescott, Jason D.; Margonis, Georgios A.; Tran, Thuy B.; Postlewait, Lauren M.; Maithel, Shishir K.; Wang, Tracy S.; Glenn, Jason A.; Hatzaras, Ioannis; Shenoy, Rivfka; Phay, John E.; Keplinger, Kara; Fields, Ryan C.; Jin, Linda X.; Weber, Sharon M.; Salem, Ahmed; Sicklick, Jason K.; Gad, Shady; Yopp, Adam C.; Mansour, John C.; Duh, Quan-Yang; Seiser, Natalie; Solorzano, Carmen C.; Kiernan, Colleen M.; Votanopoulos, Konstantinos I.; Levine, Edward A.; Poultsides, George A.

    2016-01-01

    Background Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. Given the lack of data on readmission after resection of ACC, the objective of the current study was to define the incidence of readmission, as well as identify risk factors associated with readmission among patients with ACC who underwent surgical resection. Methods Two hundred nine patients who underwent resection of ACC between January 1993 and December 2014 at 1 of 13 major centers in the USA were identified. Demographic and clinicopathological data were collected and analyzed relative to readmission. Results Median patient age was 52 years, and 62 % of the patients were female. Median tumor size was 12 cm, and the majority of patients had an American Society of Anesthesiologists (ASA) class of 3–4 (n=85, 56 %). The overall incidence of readmission within 90 days from surgery was 18 % (n=38). Factors associated with readmission included high ASA class (odds ratio (OR), 4.88 (95 % confidence interval (CI), 1.75–13.61); P=0.002), metastatic disease on presentation (OR, 2.98 (95 % CI, 1.37–6.46); P=0.006), EBL (>700 mL: OR, 2.75 (95 % CI, 1.16–6.51); P=0.02), complication (OR, 1.91 (95 % CI, 1.20–3.05); P=0.007), and prolonged length of stay (LOS; ≥9 days: OR, 4.12 (95 % CI, 1.88–9.01); P<0.001). On multivariate logistic regression, a high ASA class (OR, 4.01 (95 % CI, 1.44–11.17); P=0.008) and metastatic disease on presentation (OR, 3.44 (95 % CI, 1.34–8.84); P=0.01) remained independently associated with higher odds of readmission. Conclusion Readmission following surgery for ACC was common as one in five patients experienced a readmission. Patients with a high ASA class and metastatic disease on presentation were over four and three times more likely to be readmitted after surgical treatment for ACC, respectively. PMID:26286367

  20. Sexual behaviors and associated factors among antiretroviral treatment attendees in Ethiopia

    PubMed Central

    Demissie, Kassahun; Asfaw, Shifera; Abebe, Lakew; Kiros, Getachew

    2015-01-01

    Background Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome is one of the major public health problems throughout the world. Nowadays, antiretroviral treatment (ART) is available in health institutions and HIV-positive individuals who are eligible for ART are taking it. But studies show reinfection of HIV is occurring in them for unknown reasons. Purpose This study aimed to assess risky sexual practice and associated factors among HIV-positive ART attendees. Methods An institution-based cross-sectional study was employed in ten randomly selected health centers in Addis Ababa, between October 05 and November 05, 2013. Simple random sampling technique was employed to select 376 respondents for face-to-face interviews from ART registration book. After the data collection process, data were entered and analyzed using the SPSS version 20 statistical package. Then the effect of each variable was observed by regression analysis to identify the predictors for risky sexual practice at a significant level of P<0.05. Results A total of 376 respondents were included in the study, with 100% response rate. The mean age of the total respondents was 35.28±8.94 (standard deviation). Of the 376 respondents, 30.4% had a history of risky sexual practice, which was inconsistent condom use in the last 3 months prior to the study period. Factors associated with risky sexual practice included alcohol consumption (adjusted odds ratio [AOR] =2.01, 95% CI: 1.07, 3.77), being single (AOR =0.29, 95% CI: 0.15, 0.59) and widowed (AOR =0.32, 95% CI: 0.13, 0.77) respondents, and the gender of the respondents, with an AOR of 1.55 (95% CI: 1.01, 2.33), shows a significant relationship with risky sexual behavior. Conclusion Generally, a significant number (30%) of the respondents engaged in risky sexual behavior; so health providers should encourage, support, and allow clients to effectively use condoms during their sexual practice. PMID:26082664

  1. Treatment Integrity in Psychotherapy Research: Analysis of the Studies and Examination of the Associated Factors

    ERIC Educational Resources Information Center

    Perepletchikova, Francheska; Treat, Teresa A.; Kazdin, Alan E.

    2007-01-01

    Treatment integrity refers to the degree to which an intervention is delivered as intended. Two studies evaluated the adequacy of treatment integrity procedures (including establishing, assessing, evaluating, and reporting integrity; therapist treatment adherence; and therapist competence) implemented in psychotherapy research, as well as…

  2. Sexual Dysfunction in Women Undergoing Fertility Treatment in Iran: Prevalence and Associated Risk Factors

    PubMed Central

    Bakhtiari, Afsaneh; Basirat, Zahra; Nasiri-Amiri, Fatemeh

    2016-01-01

    Background: Sexual dysfunctions are one of the most fundamental difficulties for infertile women, which can be as the cause of infertility. This study investigated the prevalence of this disorder and associated factors in order to improve infertility treatment process and the quality of life of women referring to infertility center. Methods: A cross sectional study was performed on 236 women who referred to Fatima Zahra infertility center of Babol, Iran. Data collection tool was a questionnaire contained two parts; demographic characteristics and infertility information. Also, data for sexual dysfunction was obtained through diagnostic interview based on the international classification DSM-IV. For data analysis, logistic and linear regression analysis were used. The p<0.05 was considered significant. Results: Most of women (84.9%) suffered from primary infertility and the mean duration of infertility was 60.2±8.4 months. The prevalence of sexual dysfunction was 55.5% (n=131); including dyspareunia in 28% (n=66), impaired sexual desire and lack of orgasm in 26.3% (n=62 patients), vaginismus in 15.2% (n=36) and lack of sexual stimulation in 13.6% (n=32). Binary logistic regression analysis showed that age, sexual satisfaction and history of mental illness had a significant effect on the probability of experiencing the sexual dysfunction. Conclusion: There is a high prevalence of sexual dysfunction among infertile women. Considering the interaction between sexual dysfunction and infertility, professional health care centers should be sensitive to this effect. Also, more attention must be paid on marital relationships, economic and social situation and infertility characteristics in order to prevent sexual dysfunction development through early screening and psychological interference. PMID:26962480

  3. Treatment with didemnin B, an elongation factor 1A inhibitor, improves hepatic lipotoxicity in obese mice.

    PubMed

    Hetherington, Alexandra M; Sawyez, Cynthia G; Sutherland, Brian G; Robson, Debra L; Arya, Rigya; Kelly, Karen; Jacobs, René L; Borradaile, Nica M

    2016-09-01

    Eukaryotic elongation factor EEF1A1 is induced by oxidative and ER stress, and contributes to subsequent cell death in many cell types, including hepatocytes. We recently showed that blocking the protein synthesis activity of EEF1A1 with the peptide inhibitor, didemnin B, decreases saturated fatty acid overload-induced cell death in HepG2 cells. In light of this and other recent work suggesting that limiting protein synthesis may be beneficial in treating ER stress-related disease, we hypothesized that acute intervention with didemnin B would decrease hepatic ER stress and lipotoxicity in obese mice with nonalcoholic fatty liver disease (NAFLD). Hyperphagic male ob/ob mice were fed semipurified diet for 4 weeks, and during week 5 received i.p. injections of didemnin B or vehicle on days 1, 4, and 7. Interestingly, we observed that administration of this compound modestly decreased food intake without evidence of illness or distress, and thus included an additional control group matched for food consumption with didemnin B-treated animals. Treatment with didemnin B improved several characteristics of hepatic lipotoxicity to a greater extent than the effects of caloric restriction alone, including hepatic steatosis, and some hepatic markers of ER stress and inflammation (GRP78, Xbp1s, and Mcp1). Plasma lipid and lipoprotein profiles and histopathological measures of NAFLD, including lobular inflammation, and total NAFLD activity score were also improved by didemnin B. These data indicate that acute intervention with the EEF1A inhibitor, didemnin B, improves hepatic lipotoxicity in obese mice with NAFLD through mechanisms not entirely dependent on decreased food intake, suggesting a potential therapeutic strategy for this ER stress-related disease. PMID:27613825

  4. A systematic review on prevalence and risk factors associated with treatment- emergent central sleep apnea

    PubMed Central

    Nigam, Gaurav; Pathak, Charu; Riaz, Muhammad

    2016-01-01

    INTRODUCTION: Treatment-emergent central sleep apnea (TECSA) is the appearance of central apneas and hypopneas after significant resolution of the obstructive events has been attained using positive airway pressure (PAP) therapy. The aim of the study was to determine the prevalence of TECSA and to understand what factors are associated with its development. METHODS: PubMed, MEDLINE, Scopus, Web of Science and Cochran Library databases were searched with Mesh headings to locate studies linking TECSA and obstructive sleep apnea (OSA). RESULTS: Nine studies were identified that reported the prevalence of TECSA ranging from 5.0% to 20.3%. Prevalence of TECSA for studies using only full night titration was between 5.0% and 12.1% where as it was between 6.5% and 20.3% for studies using split-night polysomnogram. The mean effective continuous PAP (CPAP) setting varied between 7.5 cm and 15.2 cm of water for patients in TECSA group and between 7.4 cm and 13.6 cm of water for the group without TECSA. CONCLUSIONS: The aggregate point prevalence of TECSA is about 8% with the estimated range varying from 5% to 20% in patients with untreated OSA. The prevalence tends to be higher for split-night studies compared to full night titration studies. TECSA can occur at any CPAP setting although extremely high CPAP settings could increase the likelihood. Male gender, higher baseline apnea-hypopnea index, and central apnea index at the time of diagnostic study could be associated with the development of TECSA at a subsequent titration study. PMID:27512510

  5. Factors associated with increased incidence of severe toxicities following yttrium-90 resin microspheres in the treatment of hepatic malignancies

    PubMed Central

    Roberson II, John D; McDonald, Andrew M; Baden, Craig J; Lin, Chee Paul; Jacob, Rojymon; Burnett III, Omer L

    2016-01-01

    AIM: To further define variables associated with increased incidences of severe toxicities following administration of yttrium-90 (90Y) microspheres. METHODS: Fifty-eight patients undergoing 79 treatments were retrospectively assessed for development of clinical and laboratory toxicity incidence following 90Y administration. Severe toxicity events were defined using Common Terminology Criteria for Adverse Events version 4.03 and defined as grade ≥ 3. Univariate logistic regression analyses were used to evaluate the effect of different factors on the incidence of severe toxicity events. Multicollinearity was assessed for all factors with P < 0.1 using Pearson correlation matrices. All factors not excluded due to multicollinearity were included in a multivariate logistic regression model for each measurement of severe toxicity. RESULTS: Severe (grade ≥ 3) toxicities occurred following 21.5% of the 79 treatments included in our analysis. The most common severe laboratory toxicities were severe alkaline phosphatase (17.7%), albumin (12.7%), and total bilirubin (10.1%) toxicities. Decreased pre-treatment albumin (OR = 26.2, P = 0.010) and increased pre-treatment international normalized ratio (INR) (OR = 17.7, P = 0.048) were associated with development of severe hepatic toxicity. Increased pre-treatment aspartate aminotransferase (AST; OR = 7.4, P = 0.025) and decreased pre-treatment hemoglobin (OR = 12.5, P = 0.025) were associated with severe albumin toxicity. Increasing pre-treatment model for end-stage liver disease (MELD) score (OR = 1.8, P = 0.033) was associated with severe total bilirubin toxicity. Colorectal adenocarcinoma histology was associated with severe alkaline phosphatase toxicity (OR = 5.4, P = 0.043). CONCLUSION: Clinicians should carefully consider pre-treatment albumin, INR, AST, hemoglobin, MELD, and colorectal histology when choosing appropriate candidates for 90Y microsphere therapy. PMID:26973396

  6. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction...

  7. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction...

  8. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction...

  9. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction...

  10. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction...

  11. Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context

    PubMed Central

    Cruz, Maria Letícia Santos; Cardoso, Claudete A. Araújo; Darmont, Mariana Q.; Dickstein, Paulo; Bastos, Francisco I.; Souza, Edvaldo; Andrade, Solange D.; Fabbro, Marcia D’All; Fonseca, Rosana; Monteiro, Simone

    2016-01-01

    Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers’ role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors. PMID:27338431

  12. Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context.

    PubMed

    Cruz, Maria Letícia Santos; Cardoso, Claudete A Araújo; Darmont, Mariana Q; Dickstein, Paulo; Bastos, Francisco I; Souza, Edvaldo; Andrade, Solange D; Fabbro, Marcia D'All; Fonseca, Rosana; Monteiro, Simone

    2016-01-01

    Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers' role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors. PMID:27338431

  13. Definitive chemoradiotherapy of limited-disease small cell lung cancer: Retrospective analysis of new predictive factors affecting treatment results

    PubMed Central

    Komatsu, Tetsuya; Oizumi, Yukio; Kunieda, Etsuo; Tamai, Yoshifumi; Akiba, Takeshi; Kogawa, Asuka

    2011-01-01

    The aim of this study was to evaluate potential predictive factors in the treatment of limited-disease small cell lung cancer (LD-SCLC). A total of 33 patients with LD-SCLC who underwent definitive chemoradiotherapy at our institute between April 1996 and May 2007 were enrolled in our retrospective study. The relationship between a range of potential predictive factors and the initial response, time to progression and pattern of failure was analyzed. The factors evaluated included the tumor markers Pro-gastrin-releasing peptide (Pro-GRP) and neuron-specific enolase; net tumor size (sum of each lesion mass on computed tomography at 1-cm intervals); total radiation dose; biological effective dose (BED); overall treatment time (OTT); time between the start of any type of treatment and the end of radiation therapy (SER). In addition, the novel factors of radiation dose-intensity (RDI = BED/OTT) and RDI/NTS (= RDI/net tumor size) were defined. Of the 33 patients evaluated in our study, 22 (67%) achieved a complete response (CR) and 27 (82%) experienced treatment failure or recurrence. High RDI/NTS values showed a significant correlation with CR (P=0.043). Prolonged OTT and lower values of RDI and RDI/NTS showed a significant correlation with recurrence within 12 months (P=0.022, 0.033 and 0.015, respectively). The lower values of RDI and RDI/NTS showed a significant correlation with distant metastasis as a first failure site (P=0.038 and 0.044, respectively). Patients with RDI/NTS ≥0.08 had a more favorable prognosis (P=0.045). Thus, RDI and RDI/NTS may become beneficial predictive factors in the treatment of LD-SCLC. However, further studies are required to confirm our preliminary results. PMID:22866140

  14. Factors involved in the delay of treatment initiation for cervical cancer patients: A nationwide population-based study.

    PubMed

    Shen, Szu-Ching; Hung, Yao-Ching; Kung, Pei-Tseng; Yang, Wen-Hui; Wang, Yueh-Hsin; Tsai, Wen-Chen

    2016-08-01

    Cervical cancer ranks as the fourth leading cause of cancer death in women worldwide. In Taiwan, although the universal health insurance system has achieved 99.9% coverage and ensured easy access to medical care, some cervical cancer patients continue to delay initiation of definitive treatment after diagnosis. This study focused on cervical cancer patients who delayed treatment for at least 4 months, and examined the characteristics, related factors, and survival in these patients.Data on patients with a new confirmed diagnosis of cervical cancer by the International Federation of Gynecology and Obstetrics (FIGO) staging system between 2005 and 2010 were obtained from the National Health Insurance Research Database and the Taiwan Cancer Registry. Logistic regression analysis was performed to analyze the association of various factors with treatment delay. The Cox proportional hazards model was used to analyze the effects of various factors on mortality risk.The rate of treatment delay for cervical cancer decreased steadily from 6.46% in 2005 to 2.48% in 2010. Higher rates of treatment delay were observed among patients who were aged ≥75 years (9.91%), had severe comorbidity, had stage IV (9.50%), diagnosing hospital level at nonmedical center, or at public hospital ownership. Factors that correlated with treatment delay were age ≥75 years (odds ratio [OR] = 2.42), higher comorbidity Charlson comorbidity index (CCI) 4-6, or ≥7 (OR = 1.60, 2.00), cancer stage IV (OR = 2.60), the diagnosing hospital being a regional, district hospital, or other (OR = 3.00, 4.01, 4.60), and at public hospital ownership. Those who delayed treatment had 2.31 times the mortality risk of those who underwent timely treatment (P < 0.05).Delayed cervical cancer treatment in Taiwan was associated with age, comorbidity, cancer stage, diagnosing hospital level, and hospital ownership. Delaying treatment for ≥4 months substantially raised mortality risk in cervical cancer patients

  15. Genetic and treatment-related risk factors associated with external apical root resorption (EARR) concurrent with orthodontia

    PubMed Central

    Dempsey, J.; Falcão-Alencar, G.; Mason, A.; Jacobson, E.; Kluemper, G. T.; Macri, J. V.; Hartsfield, J. K.

    2016-01-01

    Objective As genetic variation accounts for two-thirds of the variation in external apical root resorption (EARR) concurrent with orthodontic treatment, we analyzed the association of selected genetic and treatment-related factors with EARR concurrent with orthodontic treatment. Setting and sample population This case–control study of 134 unrelated, orthodontically treated Caucasian individuals was conducted in part at an Indiana Private Practice, Indiana University and the University of Kentucky. Methods Utilizing a research data bank containing information from ~1450 orthodontically treated patients, pre- and post-treatment radiographs from 460 individuals were evaluated for EARR of the four permanent maxillary incisors. Sixty-seven unrelated Caucasians with moderate to severe EARR were identified and were age-/sex-matched with orthodontically treated Caucasian controls yielding 38 females and 29 males per group. Factors tested for an association with EARR included the following: 1) treatment duration, 2) extraction of maxillary premolars, 3) numerous cephalometric measurements, and 4) DNA polymorphisms within/near candidate genes in a pathway previously implicated in EARR such as the purinergic-receptor-P2X, ligand-gated ion channel 7 (P2RX7; rs208294, rs1718119, and rs2230912), caspase-1 (CASP1; rs530537, rs580253, and rs554344), interleukin-1 beta (IL1B; rs1143634), interleukin-1 alpha (IL1A; rs1800587), and interleukin-1 receptor antagonist (IL1RA; rs419598) genes. Stepwise logistic regression was utilized to identify the factors significantly associated (significance taken at or less than the layered Bonferroni correction alpha) with the occurrence of EARR. Results A long length of treatment and the presence of specific genotypes for P2RX7 SNP rs208294 were significantly associated with EARR. Conclusion EARR occurrence was associated with both genetic and treatment-related variables, which together explained 25% of the total variation associated with EARR

  16. Neonatal (+)-methamphetamine increases brain derived neurotrophic factor, but not nerve growth factor, during treatment and results in long-term spatial learning deficits.

    PubMed

    Skelton, Matthew R; Williams, Michael T; Schaefer, Tori L; Vorhees, Charles V

    2007-07-01

    In this study, brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were examined at five time points [postnatal day (P)11, 15, 20, 21, and 68 (the latter with or without behavioral testing)] during and after P11-20 (+)-methamphetamine (MA) (10 mg/kg 4 x day) treatment. BDNF in MA-treated animals was elevated on P15 and P20 in the hippocampus but not in the hypothalamus and was unchanged on P11 and P21. On P68 (1 h after Morris water maze testing) MA-treated offspring showed a trend toward higher levels of BDNF in the hippocampus than saline-treated animals. MA treatment increased NGF levels in the hippocampus but only on P20. No effect of MA treatment was observed in the elevated zero maze. MA-treated offspring had increased latencies, cumulative distances, path lengths, and first bearings in the Morris water maze. The findings indicate that early MA exposure induces hippocampal BDNF increases that precede the later emergence of spatial learning deficits. PMID:17606327

  17. Baseline Factors Predicting Placebo Response to Treatment in Children and Adolescents With Autism Spectrum Disorders

    PubMed Central

    King, Bryan H.; Dukes, Kimberly; Donnelly, Craig L.; Sikich, Linmarie; McCracken, James T.; Scahill, Lawrence; Hollander, Eric; Bregman, Joel D.; Anagnostou, Evdokia; Robinson, Fay; Sullivan, Lisa; Hirtz, Deborah

    2016-01-01

    IMPORTANCE The finding of factors that differentially predict the likelihood of response to placebo over that of an active drug could have a significant impact on study design in this population. OBJECTIVE To identify possible nonspecific, baseline predictors of response to intervention in a large randomized clinical trial of children and adolescents with autism spectrum disorders. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of citalopram hydrobromide for children and adolescents with autism spectrum disorders and prominent repetitive behavior. Baseline data at study entry were examined with respect to final outcome to determine if response predictors could be identified. A total of 149 children and adolescents 5 to 17 years of age (mean [SD] age, 9.4 [3.1] years) from 6 academic centers were randomly assigned to citalopram (n = 73) or placebo (n = 76). Participants had autistic disorder, Asperger syndrome, or pervasive developmental disorder, not otherwise specified; had illness severity ratings that were moderate or more than moderate on the Clinical Global Impression–Severity scale; and scored moderate or more than moderate on compulsive behaviors measured with the modified Children’s Yale-Brown Obsessive-Compulsive Scale. INTERVENTIONS Twelve weeks of treatment with citalopram (10 mg/5 mL) or placebo. The mean (SD) maximum dose of citalopram was 16.5 (6.5) mg by mouth daily (maximum dose, 20 mg/d). MAIN OUTCOMES AND MEASURES A positive response was defined as having a score of at least much improved on the Clinical Global Impression–Improvement scale at week 12. Baseline measures included demographic (sex, age, weight, and pubertal status), clinical, and family measures. Clinical variables included baseline illness severity ratings (the Aberrant Behavior Checklist, the Child and Adolescent Symptom Inventory, the Vineland Adaptive Behavior Scales, the Repetitive Behavior Scale–Revised, and the Children’s Yale-Brown Obsessive

  18. A multilevel analysis of factors affecting pocket probing depth in patients responding differently to periodontal treatment.

    PubMed

    Axtelius, B; Söderfeldt, B; Attström, R

    1999-02-01

    3 distinct levels are involved in the periodontal inflammatory process: site, tooth, and individual. By focusing attention on the levels in the population, multilevel or hierarchical modelling (MLM) enables the researcher to understand where and how the effects at the levels involved are occurring. The aim of this paper is therefore to analyse the progression of periodontal disease using analytical models that consider the level hierarchy. 22 patients with periodontitis, in previous reports described as either non-responsive or responsive to periodontal treatment, were investigated. In the multilevel modelling method (MLM), the site pocket probing depth (PPD) is summarised in 3 parameters: the overall mean, the between-individual variance, and the within-individual, between-site variance. The model can readily be extended to include independent variables for sites, teeth and individuals. If these variables are important determinants of PPD, their inclusion in the model will lead to a reduction in residual variances between sites, teeth and individuals. The PPDs were used for construction of a PPD change variable (cPPD). This variable, together with the final registrations of PPD (fPPD) alone, were used as dependent variables in the MLM. Independent predictor variables, 12 on site-level, 3 on tooth-level, and 19 on individual-level, were constructed. The total number of sites assessed was 2236 distributed on 559 teeth in 22 subjects. Initially, a fixed, fully unconditional model (models A and E) was assessed, where no predictor variables were specified at any level. Different random-intercept models (B-D, F-H) were then calculated where the independent variables were inserted in blocks relating to each level. The variance components at all 3 levels were significantly larger than zero. This indicates that MLM is recommended for analysing the present data. The inserted predictors showed 100% sensitivity relating to the subject-level variance. Subsequent testing of the

  19. Predicting Residential Treatment Outcomes for Emotionally and Behaviorally Disordered Youth: The Role of Pretreatment Factors

    ERIC Educational Resources Information Center

    den Dunnen, Wendy; St. Pierre, Jeff; Stewart, Shannon L.; Johnson, Andrew; Cook, Steven; Leschied, Alan W.

    2012-01-01

    This study examined outcomes with 170 children and youth admitted to residential treatment with complex mental health problems. Overall, outcomes at 2 years post-treatment was predicted by children and youth's behavioral pretreatment status reflected in lower internalizing and externalizing behavior at admission. These findings recognize a cluster…

  20. Factors Related to Parents' Choices of Treatments for Their Children with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Miller, Victoria A.; Schreck, Kimberly A.; Mulick, James A.; Butter, Eric

    2012-01-01

    The history of autism treatment has been plagued with fad therapies which waste parents' and children's time, energy, and money. To determine if referral sources, such as professionals' recommendations, media, or scholarly sources, have influenced parents' treatment decisions, parents of at least one child with an autism spectrum disorder (N =…

  1. The role of treatment delivery factors in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia.

    PubMed

    Weck, Florian; Grikscheit, Florian; Höfling, Volkmar; Kordt, Anne; Hamm, Alfons O; Gerlach, Alexander L; Alpers, Georg W; Arolt, Volker; Kircher, Tilo; Pauli, Paul; Rief, Winfried; Lang, Thomas

    2016-08-01

    Treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) are considered to be important for cognitive behavioral therapy (CBT) for panic disorder and agoraphobia (PD/AG). In the current study, four independent raters conducted process evaluations based on 168 two-hour videotapes of 84 patients with PD/AG treated with exposure-based CBT. Two raters evaluated patients' interpersonal behavior in Session 1. Two raters evaluated treatment delivery factors in Session 6, in which therapists provided the rationale for conducting exposure exercises. At the 6-month follow-up, therapists' adherence (r=0.54) and therapeutic alliance (r=0.31) were significant predictors of changes in agoraphobic avoidance behavior; therapist competence was not associated with treatment outcomes. Patients' interpersonal behavior in Session 1 was a significant predictor of the therapeutic alliance in Session 6 (r=0.17). The findings demonstrate that treatment delivery factors, particularly therapist adherence, are relevant to the long-term success of CBT for PD/AG. PMID:27235836

  2. Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use

    PubMed Central

    Kitchen, Katherine A.; McKibbin, Christine L.; Wykes, Thomas L.; Lee, Aaron A.; Carrico, Catherine P.; McConnell, Katelynn A.

    2013-01-01

    The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician. PMID:24409008

  3. Messenger RNA delivery of a cartilage-anabolic transcription factor as a disease-modifying strategy for osteoarthritis treatment

    PubMed Central

    Aini, Hailati; Itaka, Keiji; Fujisawa, Ayano; Uchida, Hirokuni; Uchida, Satoshi; Fukushima, Shigeto; Kataoka, Kazunori; Saito, Taku; Chung, Ung-il; Ohba, Shinsuke

    2016-01-01

    Osteoarthritis (OA) is a chronic degenerative joint disease and a major health problem in the elderly population. No disease-modifying osteoarthritis drug (DMOAD) has been made available for clinical use. Here we present a disease-modifying strategy for OA, focusing on messenger RNA (mRNA) delivery of a therapeutic transcription factor using polyethylene glycol (PEG)-polyamino acid block copolymer-based polyplex nanomicelles. When polyplex nanomicelles carrying the cartilage-anabolic, runt-related transcription factor (RUNX) 1 mRNA were injected into mouse OA knee joints, OA progression was significantly suppressed compared with the non-treatment control. Expressions of cartilage-anabolic markers and proliferation were augmented in articular chondrocytes of the RUNX1-injected knees. Thus, this study provides a proof of concept of the treatment of degenerative diseases such as OA by the in situ mRNA delivery of therapeutic transcription factors; the presented approach will directly connect basic findings on disease-protective or tissue-regenerating factors to disease treatment. PMID:26728350

  4. Increasing and decreasing factors of hope in infertile women with failure in infertility treatment: A phenomenology study

    PubMed Central

    Mosalanejad, Leili; Parandavar, Nehle; Gholami, Morteza; Abdollahifard, Sareh

    2014-01-01

    Background: Assisted reproductive technology (ART) provide the hope of pregnancy for infertile women, but do not always turn this hope into reality. Objective: The purpose of this study was to explore the lived experience of infertile women from increasing and decreasing factors of hope in infertile women with failure in infertility treatment. Materials and Methods: Using a qualitative research design (Phenomenology study), 23 subjects were selected who had experienced infertility failure visited by gynecologist (Rasekh Infertility center) in 2012. The data were collected through semi structured interviews and analyzed using interpretive research strategies of phenomenology by Collizi's seven-stage method. Results: Totally 96 codes were identified. The data arranged in two categories. The factors decreasing and increasing hope in infertility treatments. Totally 5 themes and 20 sub themes were extracted. The increasing factors which emerged from the data contain "spiritual source", "family interaction and support" and "information through the media", and decreasing factors contain "nature of treatments" and "negatively oriented mind". PMID:24799869

  5. Clinical course, costs and predictive factors for response to treatment in carpal tunnel syndrome: the PALMS study protocol

    PubMed Central

    2014-01-01

    Background Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb and a significant contributor to hand functional impairment and disability. Effective treatment options include conservative and surgical interventions, however it is not possible at present to predict the outcome of treatment. The primary aim of this study is to identify which baseline clinical factors predict a good outcome from conservative treatment (by injection) or surgery in patients diagnosed with carpal tunnel syndrome. Secondary aims are to describe the clinical course and progression of CTS, and to describe and predict the UK cost of CTS to the individual, National Health Service (NHS) and society over a two year period. Methods/Design In this prospective observational cohort study patients presenting with clinical signs and symptoms typical of CTS and in whom the diagnosis is confirmed by nerve conduction studies are invited to participate. Data on putative predictive factors are collected at baseline and follow-up through patient questionnaires and include standardised measures of symptom severity, hand function, psychological and physical health, comorbidity and quality of life. Resource use and cost over the 2 year period such as prescribed medications, NHS and private healthcare contacts are also collected through patient self-report at 6, 12, 18 and 24 months. The primary outcome used to classify treatment success or failures will be a 5-point global assessment of change. Secondary outcomes include changes in clinical symptoms, functioning, psychological health, quality of life and resource use. A multivariable model of factors which predict outcome and cost will be developed. Discussion This prospective cohort study will provide important data on the clinical course and UK costs of CTS over a two-year period and begin to identify predictive factors for treatment success from conservative and surgical interventions. PMID:24507749

  6. Evaluating the Stability of Open Bite Treatments and Its Predictive Factors in the Retention Phase during Permanent Dentition

    PubMed Central

    Salehi, Parisa; Pakshir, Hamid Reza; Hoseini, Seyed Ali Reza

    2015-01-01

    Statement of the Problem Orthodontists often find challenges in treating the anterior open bite and maintaining the results. Purpose This retrospective study was aimed to evaluate the stability of corrected open bite in the retention phase during permanent dentition. Materials and Method A total number of 37 patients, including 20 males and 17 females, with the mean age of 18±2.1 years at the beginning of the treatment were studied after correction of the anterior open bite. Overbites of the patients were measured from their lateral cephalograms before (T1), at the end (T2) and at least 3 years after the end of the treatment in the presence of their fixed retainers (T3).The mean overbite changes and the number of patients with open bite, due to treatment relapse, at T3 were calculated. The relationship between the pre-treatment factors and the treatment relapse was assessed at T1 and T2. Also the effects of treatment methods, extraction and adjunctive use of removable appliances on the post-treatment relapse were evaluated. Results The mean overbite change during the post-treatment period was -0.46±0.7 mm and six patients (16.2%) had relapse in the follow-up recall. Cephalometric Jaraback index showed statistically significant, but weak correlation with overbite changes after the treatment (p= 0.035; r= -0.353). No significant difference was found between the extraction and non-extraction groups (p= 0.117) the use and the type of the removable appliances (p= 0.801). Conclusion Fixed retainers alone are insufficient for stabilizing the results of corrected open bite. The change of overbite in the retention phase could not be predicted from cephalometric measurements. Extraction and use of adjunctive removable appliance did not have any effect on the treatment relapse. PMID:25759854

  7. Factors affecting the response to the specific treatment of several forms of clinical anestrus in high producing dairy cows.

    PubMed

    López-Gatius, F; Mirzaei, A; Santolaria, P; Bech-Sàbat, G; Nogareda, C; García-Ispierto, I; Hanzen, Ch; Yániz, J L

    2008-06-01

    This study was designed to examine estrous response rates to the therapeutic treatment of clinical anestrus in high producing dairy cows and to identify the factors that could affect these rates. Cows with silent ovulation (Subestrus group), cystic ovarian disease (Cyst group) or ovarian hypofunction (OH group) were given specific treatment for their disorder. Data were derived from 1764 treatments in cows producing a mean of 45.4 kg of milk upon treatment including: 889 subestrous cows, 367 cystic cows and 508 cows with ovarian hypofunction. Cows showing estrus following treatment exhibited a similar pregnancy rate to cows attaining natural estrus used as reference: 33% (337/1006) and 35% (626/1796), respectively. No significant differences in pregnancy rates were observed among the Subestrus, Cyst and OH groups (34% (196/571), 34% (44/130), 32% (97/305), respectively. Based on the odds ratio, an estrous response for all groups was less likely to occur in cows that had suffered previous anestrus, compared to cows that were anestrous for the first time, whereas the likelihood of an estrous response increased in cows treated after 90 days in milk. Our results indicate that previous anestrus and a late stage of lactation can have a negative and positive effect, respectively, on the estrous response to the specific treatment of clinical anestrus shown by high producing dairy cows. Treatment targeted at each type of clinical anestrus can render similar pregnancy rates to those shown by cows in natural estrus. PMID:18359070

  8. Tricyclic antidepressant treatment evokes regional changes in neurotrophic factors over time within the intact and degenerating nigrostriatal system

    PubMed Central

    Paumier, Katrina L.; Sortwell, Caryl E.; Madhavan, Lalitha; Terpstra, Brian; Daley, Brian F.; Collier, Timothy J.

    2015-01-01

    In addition to alleviating depression, trophic responses produced by antidepressants may regulate neural plasticity in the diseased brain, providing not only symptomatic benefit but potentially slowing the rate of disease progression in Parkinson’s disease (PD). Recent in vitro and in vivo data provide evidence that neurotrophic factors such as brain derived-neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) may be key mediators of the therapeutic response to antidepressants. As such, we conducted a cross-sectional time-course study to determine whether antidepressant-mediated changes in neurotrophic factors occur in relevant brain regions in response to amitriptyline (AMI) treatment before and after intrastriatal 6-hydroxydopamine (6OHDA). Adult male Wistar rats were divided into seven cohorts and given daily injections (i.p.) of AMI (5mg/kg) or saline throughout the duration of the study. In parallel, various cohorts of intact or parkinsonian animals were sacrificed at specific time points to determine the impact of AMI treatment on trophic factor levels in the intact and degenerating nigrostriatal system. The left and right hemispheres of the substantia nigra, striatum, frontal cortex, piriform cortex, hippocampus and anterior cingulate cortex were dissected and BDNF and GDNF levels were measured with ELISA. Results show that chronic AMI treatment elicits effects in multiple brain regions and differentially regulates levels of BDNF and GDNF depending on the region. Additionally, AMI halts the progressive degeneration of dopamine (DA) neurons elicited by an intrastriatal 6-OHDA lesion. Taken together, these results suggest that AMI treatment elicits significant trophic changes important to DA neuron survival within both the intact and degenerating nigrostriatal system. PMID:25681575

  9. Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers.

    PubMed

    Grein, Jonathan D; Kahn, Katherine L; Eells, Samantha J; Choi, Seong K; Go-Wheeler, Marianne; Hossain, Tanzib; Riva, Maya Y; Nguyen, Megan H; Rekha Murthy, A; Miller, Loren G

    2016-03-01

    BACKGROUND Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines. OBJECTIVE To evaluate risk factors for treatment of ASB. DESIGN Retrospective observational study. SETTING A tertiary academic hospital, county hospital, and community hospital. PATIENTS Hospitalized adults with bacteriuria. METHODS Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria. RESULTS Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14-0.80], P =.01), presence of leukocyte esterase (5.48 [2.35-12.79], P<.01), presence of nitrites (2.45 [1.11-5.41], P=.03), and Escherichia coli on culture (2.4 [1.2-4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%. CONCLUSIONS ASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use. Infect. Control Hosp. Epidemiol. 2016;37(3):319-326. PMID:26607408

  10. The Role of Gender in Factors Associated With Addiction Treatment Satisfaction Among Long-Term Opioid Users

    PubMed Central

    Marchand, Kirsten; Palis, Heather; Peng, Defen; Fikowski, Jill; Harrison, Scott; Spittal, Patricia; Schechter, Martin T.; Oviedo-Joekes, Eugenia

    2015-01-01

    Objectives: To identify factors associated with Opioid Agonist Treatment (OAT) satisfaction and to determine whether these relationships are gender specific. Methods: This study was based on data collected in a cross-sectional study among long-term opioid-dependent individuals (n = 160; 46.3% women). Participants completed the Client Satisfaction Questionnaire in reference to OAT episodes. Sociodemographic, illicit substance use, health, and addiction treatment history data were collected. Multivariable linear regression was used to determine the relationship between these variables and treatment satisfaction. To explore the potential role of gender in these identified relationships stratified multivariable models were tested. Additional open-ended questions regarding positive and negative perceptions of treatment were collected, and a thematic analysis was conducted. Results: In the multivariable linear regression model, participants who were older, of Aboriginal ancestry, and currently receiving OAT had higher OAT satisfaction scores, whereas participants who had methadone dose preferences of 30 mg or less had lower OAT satisfaction. In stratified analyses among women, the relationship between preferred methadone dose and current OAT remained significantly associated with satisfaction. Open-ended positive and negative perceptions complemented and provided further valuable data to interpret these identified relationships. Conclusions: To our knowledge, this is the first study to explore the potential role of gender in factors associated with OAT satisfaction. These findings provide valuable information to health care providers working in OAT settings regarding how to address women and men's OAT needs and improve treatment satisfaction. PMID:26335006

  11. Risk factors for the development of non-response to first-line treatment for tuberculosis in southern Vietnam.

    PubMed

    Keane, V P; de Klerk, N; Krieng, T; Hammond, G; Musk, A W

    1997-10-01

    Since 1979, the International Organization for Migration has provided tuberculosis screening and treatment for those who intend to migrate from Viet Nam--a country with one of the highest tuberculosis incidence rates. The factors associated with non-response to first-line tuberculosis treatment were investigated in a comparative study of 130 non-responders (cases) and 673 responders (controls). Cases had worse radiologic signs and greater numbers of acid-fast bacilli on their sputum smears than controls. When these two factors were used as a diagnostic test to predict non-response, the model had a sensitivity of 70% and a specificity of 80%. Sensitivity increased to 80% when variables measured in the first 3 months of treatment were used. Failure to respond to treatment can be a result of infection with other mycobacteria, infection with a multi-drug resistant tuberculosis strain, or acquisition of resistance after the initiation of therapy. Further analysis of the same database is underway to determine the natural history and success of second-line treatment. PMID:9363535

  12. Configuration of biological wastewater treatment line and influent composition as the main factors driving bacterial community structure of activated sludge.

    PubMed

    Jaranowska, Paulina; Cydzik-Kwiatkowska, Agnieszka; Zielińska, Magdalena

    2013-07-01

    The structure of microbial consortia in wastewater treatment facilities is a resultant of environmental conditions created by the operational parameters of the purification process. In the research, activated sludge from nine Polish wastewater treatment plants (WWTPs) was investigated at a molecular level to determine the impact of the complexity of biological treatment line and the influent composition on the species structure and the diversity of bacterial consortia. The community fingerprints and technological data were subjected to the canonical correspondence and correlation analyses. The number of separated biological processes realized in the treatment line and the presence of industrial wastewater in the influent were the key factors determining the species structure of total and ammonia-oxidizing bacteria in biomass. The N2O-reducers community composition depended significantly on the design of the facility; the highest species richness of denitrifiers was noted in the WWTPs with separated denitrification tanks. The contribution of industrial streams to the inflow affected the diversity of total and denitrifying bacterial consortia and diminished the diversity of ammonia oxidizers. The obtained data are valuable for engineers since they revealed the main factors, including the design of wastewater treatment plant, influencing the microbial groups critical for the stability of purification processes. PMID:23397107

  13. Evaluation of factors associated with failure of tuberculosis treatment under DOTS in northern Islamic Republic of Iran.

    PubMed

    Mohammadzadeh, Kh Ali; Ghayoomi, A; Maghsoudloo, D

    2016-02-01

    Tuberculosis treatment failure remains a major health problem in many parts of the Islamic Republic of Iran. This study was conducted to identify the risk factors associated with failure of tuberculosis treatment under the DOTS strategy in two cities of Golestan province. A retrospective cohort study in 2012-2013 was conducted on 167 smearpositive tuberculosis patients monitored under DOTS. Demographic, clinical and treatment outcome factors and social determinants of health were recorded for each patient. Multivariate regression analysis found that the strongest predictors of tuberculosis treatment failure were: being infected with other diseases (OR 9.35; 95% CI: 3.01-29.1), male sex (OR 5.03; 95% CI: 1.58-16.1), Turkoman ethnicity (OR 11.0; 95% CI: 2.00-60.1), family history of tuberculosis (OR 0.21; 95% CI: 0.05-0.96) and household size (OR 1.21; 95% CI: 0.99-1.48). Recommendations include better follow-up for patients with other diseases and facilitating access to treatment, especially for Turkoman patients. PMID:27180736

  14. Recurrent Stage I endometrial carcinoma: results of treatment and prognostic factors

    SciTech Connect

    Mandell, L.R.; Nori, D.; Hilaris, B.

    1985-06-01

    Recurrences of clinical Stage I endometrial carcinoma after initial treatment are rare. They are nonetheless a serious complication, uniformly associated with poor outcome. Between 1969-1980, 20 patients with clinical Stage I endometrial carcinoma were treated for recurrent tumor at the time of first relapse. Nonpapillary adenocarcinoma represented 70% of the primary tumors and papillary adenocarcinoma, 30%. The median time to recurrence after completion of primary treatment was 9.5 mo. The vagina was the site of relapse in 65% of patients, the abdomen in 20%, the pelvis in 10% and the lung in 5%. Ninety-five percent of recurrences were treated with curative intent. Complications were seen in three patients, small bowel obstruction (2 pts) and vaginal vault necrosis (1 pt); however, these patients responded effectively to conservative treatment. The review suggests that: (1) Histology and site of relapse are important prognosticators of treatment outcome; (2) Long term survival may be achieved in vaginal recurrences with aggressive local treatment; and (3) There may be a role for multimodality ovarian type treatment in overall management of recurrent papillary adenocarcinoma, a cell type that appears to exhibit a tendency towards extrapelvic spread refractory to definitive loco-regional treatment.

  15. Post-Traumatic Stress Disorder among Cardiac Patients: Prevalence, Risk Factors, and Considerations for Assessment and Treatment

    PubMed Central

    Tulloch, Heather; Greenman, Paul S.; Tassé, Vanessa

    2014-01-01

    There is increasing awareness of the impact of post-traumatic stress disorder (PTSD) on physical health, particularly cardiovascular disease. We review the literature on the role of trauma in the development of cardiovascular risk factors and disease, aftermath of a cardiac event, and risk for recurrence in cardiac patients. We explore possible mechanisms to explain these relationships, as well as appropriate assessment and treatment strategies for this population. Our main conclusion is that screening and referral for appropriate treatments are important given the high prevalence rates of PTSD in cardiac populations and the associated impact on morbidity and mortality. PMID:25545708

  16. Personal Factors Determining Patient Satisfaction with All-Ceramic Crown Treatment for Single Anterior Teeth.

    PubMed

    Zou, Yun; Zhan, DeSong

    2016-01-01

    The Eysenck Personality Questionnaire's (EPQ) N value (neuroticism) was used to evaluate information from 158 patients before ceramic crown treatment. Patient satisfaction was also evaluated using a satisfaction questionnaire 2 weeks post treatment. Patient expectations were not correlated with sex, age, or N value, and sex was not correlated with patient satisfaction other than in relation to crown shape. Total esthetic satisfaction and feature improvement were positively correlated with age, while satisfaction for five specific criteria was negatively correlated with N value and overall expectation. These observations underscore the importance of considering the physical and psychologic aspects of patient care when planning dental treatment. PMID:27611752

  17. Treatment

    MedlinePlus

    ... Prevention Treatment 2003 U.S. Outbreak African Rodent Importation Ban For Clinicians Clinical Recognition Specimen Collection Treatment Smallpox ... Examining Animals with Suspected Monkeypox African Rodent Importation Ban Resources Related Links Poxvirus Molluscum Contagiosum Orf Virus ( ...

  18. Variation in access to outpatient substance abuse treatment: organizational factors and conceptual issues.

    PubMed

    McCaughrin, W C; Howard, D L

    1996-01-01

    Access is a multidimensional concept representing the ease with which health services are initiated and sustained. In this study, conceptual domains of access--affordability, acceptability, accommodation, availability, service diversity, and competitive stance--are hypothesized to predict the time clients wait to receive services. A large, recently surveyed, nationally representative sample of outpatient substance abuse treatment organizations provided the data. Multivariate regression analysis of 326 organizations was conducted with the conceptual domains sequentially predicting the time clients waited to receive service. Results show that increased waiting time was positively associated with treatment staff case overload and the average number of months clients spent in treatment and negatively associated with the percent of a treatment organization's client base on public assistance. Implications for policy makers and clinicians concerning client selection strategies by organizations and problems with the organizational capacity to treat clients are discussed. Areas for future research also are highlighted. PMID:9058353

  19. EVALUATION OF BIOAEROSOL COMPONENTS, GENERATION FACTORS, AND AIRBORNE TRANSPORT ASSOCIATED WITH LIME TREATMENT OF CONTAMINATED SEDIMENT

    EPA Science Inventory

    Lime treatment has been used in contaminated sediment management activities for many purposes such as dewatering, improvement of physical properties, and reducing contaminant mobility. Exothermic volatilization of volatile organic compounds from lime-treated sediment is well kno...

  20. Prognostic factors of long-term CD4+count-guided interruption of antiretroviral treatment.

    PubMed

    Sarmati, L; Andreoni, C; Nicastri, E; Tommasi, C; Buonomini, A; D'Ettorre, G; Corpolongo, A; Dori, L; Montano, M; Volpi, A; Narciso, P; Vullo, V; Andreoni, M

    2009-03-01

    Aim of the study was to determine predictors of the duration of antiretroviral treatment interruption in patients infected with HIV. This pilot prospective, open-label, multicenter trial comprised 62 HIV-seropositive subjects who decided voluntarily to interrupt therapy after two or more years of successful HAART. The primary end-point was the time to patients being free of therapy before reaching a CD4+ cell count < or =350/microl. Fifteen of 62 patients remained in treatment interruption for more than 180 days. Patients restarting therapy had higher HIV-DNA levels (P = 0.05), were treated more frequently with NNRTI-drugs (P = 0.02), had a shorter period of HAART (P = 0.046), and lower CD4+ cell counts after day 14 of interruption of treatment (P = 0.04). Multivariate regression analysis showed that less than 323 baseline proviral HIV-DNA cp/10(6) PBMCs and more than 564 CD4 cells/microl at day 14 after interruption were associated independently with a reduced risk of restarting treatment (P = 0.041 and P = 0.012, respectively). A score based on CD4+ cell counts at nadir, at baseline, at week 2 of treatment interruption, and on baseline HIV-DNA values can identify patients with a prolonged period free safely of treatment. PMID:19152399

  1. Endoscopic laser treatment for rectosigmoid villous adenoma: factors effecting the results

    NASA Astrophysics Data System (ADS)

    Brunetaud, Jean Marc; Maunoury, Vincent; Cochelard, Dominique; Boniface, Brigitte

    1994-12-01

    This present work reports the long term results after endoscopic laser treatment in 474 patients with benign rectosigmoid villous adenomas revealed by biopsy. Two types of wavelength were used: The 1.06 micrometers infrared light from the Nd:YAG laser and the green light from the argon laser or the Nd:YAG frequency doubled laser. In some patients, both wavelengths were used. Treatment was completed in 415 patients. Total tumor destruction was obtained in 92.8% of them, a carcinoma was detected in 6.5% on biopsy specimens obtained during laser treatment, and benign villous tissue persisted in 0.7%. During the average 30 mo. follow up period of the patients with total tumor destruction, 18% had a tumor recurrence. Treatment was well tolerated with a 1.8% complication rate (one perforation, one hemorrhage, and 7 stenosis requiring dilatation). Because treatment is long and difficult and cancer rate is high, endoscopic laser should be limited in patients with a circumferential villous adenoma to nonsurgical candidates. The risk of complication after surgery (some being fatal) has to be balanced against the risk of undetected carcinoma in the other patients and the indication for endoscopic laser treatment should be discussed case by case.

  2. Cross-sex hormone treatment in male-to-female transsexual persons reduces serum brain-derived neurotrophic factor (BDNF).

    PubMed

    Fuss, Johannes; Hellweg, Rainer; Van Caenegem, Eva; Briken, Peer; Stalla, Günter K; T'Sjoen, Guy; Auer, Matthias K

    2015-01-01

    Serum levels of brain-derived neurotrophic factor (BDNF) are reduced in male-to-female transsexual persons (MtF) compared to male controls. It was hypothesized before that this might reflect either an involvement of BDNF in a biomechanism of transsexualism or to be the result of persistent social stress due to the condition. Here, we demonstrate that 12 month of cross-sex hormone treatment reduces serum BDNF levels in male-to-female transsexual persons independent of anthropometric measures. Participants were acquired through the European Network for the Investigation of Gender Incongruence (ENIGI). Reduced serum BDNF in MtF thus seems to be a result of hormonal treatment rather than a consequence or risk factor of transsexualism. PMID:25498415

  3. Recombinant B domain deleted porcine factor VIII for the treatment of bleeding episodes in adults with acquired hemophilia A.

    PubMed

    Gomperts, Edward

    2015-08-01

    Hemophilia A is an inherited deficiency of clotting factor VIII (FVIII) often complicated by inhibitor development (CHAWI) in which neutralizing antibodies block the therapeutic benefit of replacement therapy. Inhibitors to FVIII can also be seen in an auto-immune disease known as acquired hemophilia A (AHA). 'Bypassing' therapies have been shown to provide hemostasis but dosing must be done empirically because current assays cannot measure objective markers of treatment efficacy and safety. A recombinant porcine sequence factor VIII (r-pFVIII) has been developed for the management of AHA. Preclinical, Phase I and Phase II clinical research studies in CHAWI subjects showed therapeutic potential and safety of this agent. A Phase II/III study in AHA with serious bleeding episodes shows a positive response in all subjects after administration. Based on current preclinical and clinical trial data, r-pFVIII should become the first line of treatment in the management of hemorrhage in patients with AHA. PMID:25927594

  4. Vascular endothelial growth factor: an attractive target in the treatment of hypoxic/ischemic brain injury

    PubMed Central

    Guo, Hui; Zhou, Hui; Lu, Jie; Qu, Yi; Yu, Dan; Tong, Yu

    2016-01-01

    Cerebral hypoxia or ischemia results in cell death and cerebral edema, as well as other cellular reactions such as angiogenesis and the reestablishment of functional microvasculature to promote recovery from brain injury. Vascular endothelial growth factor is expressed in the central nervous system after hypoxic/ischemic brain injury, and is involved in the process of brain repair via the regulation of angiogenesis, neurogenesis, neurite outgrowth, and cerebral edema, which all require vascular endothelial growth factor signaling. In this review, we focus on the role of the vascular endothelial growth factor signaling pathway in the response to hypoxic/ischemic brain injury, and discuss potential therapeutic interventions. PMID:26981109

  5. Vascular endothelial growth factor: an attractive target in the treatment of hypoxic/ischemic brain injury.

    PubMed

    Guo, Hui; Zhou, Hui; Lu, Jie; Qu, Yi; Yu, Dan; Tong, Yu

    2016-01-01

    Cerebral hypoxia or ischemia results in cell death and cerebral edema, as well as other cellular reactions such as angiogenesis and the reestablishment of functional microvasculature to promote recovery from brain injury. Vascular endothelial growth factor is expressed in the central nervous system after hypoxic/ischemic brain injury, and is involved in the process of brain repair via the regulation of angiogenesis, neurogenesis, neurite outgrowth, and cerebral edema, which all require vascular endothelial growth factor signaling. In this review, we focus on the role of the vascular endothelial growth factor signaling pathway in the response to hypoxic/ischemic brain injury, and discuss potential therapeutic interventions. PMID:26981109

  6. Extracorporeal membrane oxygenation support in refractory cardiogenic shock: treatment strategies and analysis of risk factors.

    PubMed

    Loforte, Antonio; Marinelli, Giuseppe; Musumeci, Francesco; Folesani, Gianluca; Pilato, Emanuele; Martin Suarez, Sofia; Montalto, Andrea; Lilla Della Monica, Paola; Grigioni, Francesco; Frascaroli, Guido; Menichetti, Antonio; Di Bartolomeo, Roberto; Arpesella, Giorgio

    2014-07-01

    Two centrifugal pumps, the RotaFlow (Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) and Levitronix CentriMag (Levitronix LCC, Waltham, MA, USA), used in central or peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support systems have been investigated, in terms of double-center experience, as treatment for patients with refractory cardiogenic shock (CS). Between January 2006 and December 2012, 228 consecutive adult patients were supported on RotaFlow (n=213) or CentriMag (n=15) ECMO, at our institutions (155 men; age 58.3±10.5 years, range: 19-84 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n=118) and primary donor graft failure (n=37); postacute myocardial infarction CS (n=27); acute myocarditis (n=6); and CS on chronic heart failure (n=40). A peripheral ECMO setting was established in 126 (55.2%) patients while it was established centrally in 102 (44.7%). Overall mean support time was 10.9±9.7 days (range: 1-43 days). Eighty-four (36.8%) patients died on ECMO. Overall success rate, in terms of survival on ECMO (n=144), weaning from mechanical support (n=107; 46.9%), bridge to mid-long-term ventricular assist device (n=6; 2.6%), and bridge to heart transplantation (n=31; 13.5%), was 63.1%. One hundred twenty-two (53.5%) patients were successfully discharged. Stepwise logistic regression identified blood lactate level and MB isoenzyme of creatine kinase (CK-MB) relative index at 72 h after ECMO initiation, and number of packed red blood cells (PRBCs) transfused on ECMO as significant predictors of mortality on ECMO (P=0.010, odds ratio [OR]=2.94; 95% confidence interval [CI]=1.10-3.14; P=0.010, OR=2.82, 95% CI=1.014-3.721; and P=0.011, OR=2.69; 95% CI=1.06-4.16, respectively). Central ECMO population had significantly higher rate of continuous veno-venous hemofiltration need and bleeding requiring surgery events compared with the peripheral ECMO setting population

  7. Factors associated with antiretroviral treatment uptake and adherence: a review. Perspectives from Australia, Canada, and the United Kingdom.

    PubMed

    Bolsewicz, K; Debattista, J; Vallely, A; Whittaker, A; Fitzgerald, L

    2015-01-01

    International focus on reducing onward HIV transmission emphasizes the need for routine HIV testing and early uptake of antiretroviral treatment (ART). Strategic targets have been set for 2020 to achieve the goal of 90% of people infected with HIV diagnosed, 90% of identified cases on treatment, and 90% of persons on treatment virally suppressed (90-90-90). It is vital to understand the complexity of factors influencing a person's treatment decisions over time and the context which may enable better adherence. In this paper we present findings from the review of published and gray literature (2003-2013) on the documented factors associated with treatment initiation and adherence in the general adult population of Australia, Canada, and the UK. A framework developed by Begley, McLaws, Ross, and Gold [2008. Cognitive and behavioural correlates of non-adherence to HIV anti-retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology. Clinical Psychologist, 12(1), 9-17] in Australia was adapted to summarize the findings. A systematic database search using keywords and a set of inclusion criteria yielded 17 studies (Australia = 6; Canada = 8; UK = 3). In addition 11 reports were included in the review. We found that a person's abilities and motivations (intrapersonal factors, reported in 7 studies) to start and continue ART are influenced by a host of interconnected factors spanning relationship (interpersonal, 3 studies) and broader structural (extrapersonal, 15 studies) factors that are situated within social determinants of health. People therefore evaluate various costs and benefits of starting and staying on treatment, in which biomedical concerns play an important yet often subsidiary role. In this review the economic barriers to care were found to be significant and under-reported, highlighting the persistent health inequities in terms of access to services. Our understanding of the context around people's use of

  8. Establishment of non-native plant species after wildfires: Effects of fuel treatments, abiotic and biotic factors, and post-fire grass seeding treatments

    USGS Publications Warehouse

    Hunter, M.E.; Omi, P.N.; Martinson, E.J.; Chong, G.W.

    2006-01-01

    Establishment and spread of non-native species following wildfires can pose threats to long-term native plant recovery. Factors such as disturbance severity, resource availability, and propagule pressure may influence where non-native species establish in burned areas. In addition, pre- and post-fire management activities may influence the likelihood of non-native species establishment. In the present study we examine the establishment of non-native species after wildfires in relation to native species richness, fire severity, dominant native plant cover, resource availability, and pre- and post-fire management actions (fuel treatments and post-fire rehabilitation treatments). We used an information-theoretic approach to compare alternative hypotheses. We analysed post-fire effects at multiple scales at three wildfires in Colorado and New Mexico. For large and small spatial scales at all fires, fire severity was the most consistent predictor of non-native species cover. Non-native species cover was also correlated with high native species richness, low native dominant species cover, and high seeded grass cover. There was a positive, but non-significant, association of non-native species with fuel-treated areas at one wildfire. While there may be some potential for fuels treatments to promote non-native species establishment, wildfire and post-fire seeding treatments seem to have a larger impact on non-native species. ?? IAWF 2006.

  9. Characteristics of elderly patients with COPD and newly diagnosed lung cancer, and factors associated with treatment decision

    PubMed Central

    Qin, Jianwen; Li, Guangsheng; Zhou, Jingmin

    2016-01-01

    Objective To investigate the clinical features, diagnosis, and treatment status of elderly patients with chronic obstructive pulmonary disease (COPD) complicated with lung cancer. Patients and methods This was a retrospective study of 206 patients aged >60 years with COPD and newly diagnosed lung cancer at the Tianjin Chest Hospital Respiratory Centre between September 2008 and September 2013. Lung function, radiology, and clinical data were retrieved. Results Among all patients, 57% (117/206) were hospitalized due to acute COPD aggravation, 47% (96/206) had COPD grade III or IV, 95% (195/206), showed diffusion dysfunction in pulmonary function examination, 90% (185/206) had a history of smoking, and 26% (54/206) were treated with inhaled corticosteroids for COPD treatment. Ninety-eight patients suffered from squamous carcinoma, 73 from adenocarcinoma, and 35 from small-cell carcinoma. Clinical staging was I in 36 patients, II in 47 patients, III in 78 patients, and IV in 45 patients. Initial treatments were surgery in 59 patients, chemotherapy in 30 patients, and no treatment in 117 patients. Multivariate analysis showed that age (P<0.001), COPD grades (P=0.01), clinical staging (P<0.001), and pulmonary diffusion function (P=0.007) were independent factors associated with patients with COPD being given treatments for lung cancer. Conclusion Younger patients with lower COPD grades, earlier lung cancer stage, and better pulmonary diffusion function are more likely to receive treatments. PMID:27445471

  10. Associated factors for treatment delay in pulmonary tuberculosis in HIV-infected individuals: a nested case-control study

    PubMed Central

    2012-01-01

    Background The delay in initiating treatment for tuberculosis (TB) in HIV-infected individuals may lead to the development of a more severe form of the disease, with higher rates of morbidity, mortality and transmissibility. The aim of the present study was to estimate the time interval between the onset of symptoms and initiating treatment for TB in HIV-infected individuals, and to identify the factors associated to this delay. Methods A nested case-control study was undertaken within a cohort of HIV-infected individuals, attended at two HIV referral centers, in the state of Pernambuco, Brazil. Delay in initiating treatment for TB was defined as the period of time, in days, which was greater than the median value between the onset of cough and initiating treatment for TB. The study analyzed biological, clinical, socioeconomic, and lifestyle factors as well as those related to HIV and TB infection, potentially associated to delay. The odds ratios were estimated with the respective confidence intervals and p-values. Results From a cohort of 2365 HIV-infected adults, 274 presented pulmonary TB and of these, 242 participated in the study. Patients were already attending 2 health services at the time they developed a cough (period range: 1 – 552 days), with a median value of 41 days. Factors associated to delay were: systemic symptoms asthenia, chest pain, use of illicit drugs and sputum smear-negative. Conclusion The present study indirectly showed the difficulty of diagnosing TB in HIV-infected individuals and indicated the need for a better assessment of asthenia and chest pain as factors that may be present in co-infected patients. It is also necessary to discuss the role played by negative sputum smear results in diagnosing TB/HIV co-infection as well as the need to assess the best approach for drug users with TB/HIV. PMID:22958583

  11. Factors Associated with Unfavorable Treatment Outcomes in New and Previously Treated TB Patients in Uzbekistan: A Five Year Countrywide Study

    PubMed Central

    Gadoev, Jamshid; Asadov, Damin; Tillashaykhov, Mirzagolib; Tayler-Smith, Katie; Isaakidis, Petros; Dadu, Andrei; de Colombani, Pierpaolo; Gudmund Hinderaker, Sven; Parpieva, Nargiza; Ulmasova, Dilrabo; Jalolov, Avazbek; Hamraev, Atadjan; Ali, Engy; van den Boom, Martin; Hammerich, Asmus; Gozalov, Ogtay; Dara, Masoud

    2015-01-01

    Background TB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures) and describe their associations with socio-demographic and clinical factors. Method A countrywide retrospective cohort study of all new and previously treated TB patients registered in the National Tuberculosis programme between January 2006 and December 2010. Results Among 107,380 registered patients, 67% were adults, with smaller proportions of children (10%), adolescents (4%) and elderly patients (19%). Sixty per cent were male, 66% lived in rural areas, 1% were HIV-infected and 1% had a history of imprisonment. Pulmonary TB (PTB) was present in 77%, of which 43% were smear-positive and 53% were smear-negative. Overall, 83% of patients were successfully treated, 6% died, 6% were lost-to-follow-up, 3% failed treatment and 2% transferred out. Factors associated with death included being above 55 years of age, HIV-positive, sputum smear positive, previously treated, jobless and living in certain provinces. Factors associated with lost-to-follow-up were being male, previously treated, jobless, living in an urban area, and living in certain provinces. Having smear-positive PTB, being an adolescent, being urban population, being HIV-negative, previously treated, jobless and residing in particular provinces were associated with treatment failure. Conclusion Overall, 83% treatment success rate was achieved. However, our study findings highlight the need to improve TB services for certain vulnerable groups and in specific areas of the country. They also emphasize the need to develop unified monitoring and evaluation tools for drug-susceptible and drug-resistant TB, and

  12. Skin Cancer: Biology, Risk Factors & Treatment | NIH MedlinePlus the Magazine

    MedlinePlus

    ... risk factor for skin cancer is exposure to sunlight (UV radiation), but there are also other risk ... the three most common types of skin cancer: Sunlight: Sunlight is a source of UV radiation. It's ...

  13. Three cases of factor I deficiency: the effect of treatment with plasma.

    PubMed Central

    Møller Rasmussen, J; Teisner, B; Jepsen, H H; Svehag, S E; Knudsen, F; Kirstein, H; Buhl, M

    1988-01-01

    Three patients with congenital factor I deficiency associated with different clinical manifestations are described. Case 1 had one single episode of meningococcal disease, case 2 experienced four episodes of meningococcal disease and several other severe infections, whereas case 3, without known predisposition for infections, died from a subacute immune-complex mediated syndrome, resembling polyarteritis nodosa. Family studies in cases 1 and 2 revealed healthy individuals with factor I concentrations below the lower reference limit, indicating heterozygous carriers. The pedigree analyses were consistent with autosomal codominant inheritance. The estimated minimal frequency of the deficient gene was 0.002. Pedigree analysis was not performed in case 3 but the father and sister was found to be probable heterozygous carriers. Cases 2 and 3 were treated with infusions of freshly frozen plasma (FFP) (40 and 27 ml/kg bodyweight) during acute illness and the immunochemical complement profile was monitored. Following plasma infusion factor I was cleared from the circulation with a half-life of 29-45 h. The plasma infusions induced generation of C3d and C4d, increase in native factor B and C3 concentrations and disappearance of Ba split products. Native C3 and C4 increased to normal concentrations and remained normal till 16 days after the plasma infusions, whereas native factor B decreased to preinfusion levels 8 days after plasma infusion. It is concluded, that congenital factor I deficiency can present with different clinical manifestations and may be more prevalent than hitherto anticipated. Furthermore, infusion of blood products containing small amounts of functional factor I can partly normalize the complement profile, with a more prolonged effect on C3 and C4 than on factor B metabolism. Images Fig. 2 PMID:3219799

  14. [Type 2 diabetes mellitus and cardiovascular risk factors: is comprehensive treatment required?].

    PubMed

    Nadal, Josep Franch; Gutiérrez, Pedro Conthe

    2013-09-01

    Diabetes mellitus, especially type 2, is a metabolic disease involving the coexistence of several cardiovascular risk factors. Affected patients are therefore at high cardiovascular risk (2-3 times higher than that of men in the general population and 2-6 times higher than that of women). Cardiovascular disease is the main cause of death in the diabetic population, followed by cancer. Cardiovascular risk cannot be compared between diabetic patients and persons who have already shown one or more manifestations of cardiovascular disease (such as myocardial infarction). Single risk factors should be evaluated in combination with other risk factors and a person's cardiovascular risk should be individually assessed. Cardiovascular risk assessment in patients with diabetes through current calculations methods is complex because their ability to predict risk in individuals is very low. Studies such as that by Steno have demonstrated the validity of a comprehensive strategy to control all the risk factors present in persons with type 2 diabetes mellitus, which can reduce the development of micro- and macrovascular complications and mortality by almost 50%. The present article reviews each of the classical cardiovascular risk factors (hypertension, dyslipidemia, smoking, obesity, sedentariness) in relation to diabetes, as well as their recommended targets and the benefits of their control. In view of the above, a comprehensive approach is recommended to control the multiple risk factors that can coexist in persons with type 2 diabetes mellitus. PMID:24444518

  15. Voluntary STD testing and treatment program at a metropolitan correctional facility: evaluation of test acceptability and associated risk factors.

    PubMed

    Brown, Christopher K; Earley, Mary; Shaikh, Raees; Fickenscher, Jillian; Ott, Jessica; Person, Austin; Islam, K M Monirul; Simonsen, Kari; Sandkovsky, Uriel; Kaiser, Katherine Laux; Foxall, Mark; Margalit, Ruth

    2014-01-01

    Few studies have addressed challenges of diagnosis and treatment of sexually transmitted diseases (STDs) within correctional facilities. Initiatives that screen all inmates can be cost-prohibitive, while symptom-based screening undoubtedly fails to recognize significant numbers of asymptomatically infected persons. This study discusses a voluntary STD screening and treatment program developed at the Douglas County (Nebraska) Department of Corrections where student volunteers interviewed, screened, and educated 456 inmates. Inmate urine samples and interview responses about risk behaviors and motivators for participation in the screening program were analyzed. The results support the ongoing project method to screen and treat inmates in the community correctional facility. Risk factor analysis suggests that targeted testing and treatment efforts may have a role in providing cost-effective care for STD among the incarcerated population. PMID:24352406

  16. Factors predictive of treatment failure in staphylococcal prosthetic vascular graft infections: a prospective observational cohort study: impact of rifampin

    PubMed Central

    2014-01-01

    Background There exists considerable debate concerning management of prosthetic vascular graft infection (PVGI), especially in terms of antimicrobial treatment. This report studies factors associated with treatment failure in a cohort of patients with staphylococcal PVGI, along with the impact of rifampin (RIF). Methods All data on patients with PVGI between 2006 and 2010 were reviewed. Cure was defined as the absence of evidence of infection during the entire post-treatment follow-up for a minimum of one year. Failure was defined as any other outcome. Results 84 patients (72 M/12 F, median age 64.5 ± 11 y) with diabetes mellitus (n = 25), obesity (n = 48), coronary artery disease (n = 48), renal failure (n = 24) or COPD (n = 22) were treated for PVGI (median follow-up was 470 ± 469 d). PVGI was primarily intracavitary (n = 47). Staphylococcus aureus (n = 65; including 17 methicillin-resistant S. aureus) and coagulase-negative Staphylocococcus (n = 22) were identified. Surgical treatment was performed in 71 patients. In univariate analysis, significant risk factors associated with failure were renal failure (p = 0.04), aortic aneurysm (p = 0.03), fever (p = 0.009), aneurysm disruption (p = 0.02), septic shock in the peri-operative period (p = 0.005) and antibiotic treatment containing RIF (p = 0.03). In multivariate analysis, 2 variables were independently associated with failure:septic shock [OR 4.98: CI 95% 1.45-16.99; p=0.01] and antibiotic containing rifampin [OR: 0.32: CI95% 0.10-0.96; p=0.04]. Conclusion Results of the present study suggest that fever, septic shock and non-use of antibiotic treatment containing RIF are associated with poor outcome. PMID:24775563

  17. Serum Levels of Vascular Endothelial Growth Factor and Insulin-like Growth Factor Binding Protein-3 in Obstructive Sleep Apnea Patients: Effect of Continuous Positive Airway Pressure Treatment

    PubMed Central

    Archontogeorgis, Kostas; Nena, Evangelia; Papanas, Nikolaos; Xanthoudaki, Maria; Hatzizisi, Olga; Kyriazis, Georgios; Tsara, Venetia; Maltezos, Efstratios; Froudarakis, Marios; Steiropoulos, Paschalis

    2015-01-01

    Background and Aim: Hypoxia, a major feature of obstructive sleep apnea (OSA), modifies Vascular Endothelial Growth Factor (VEGF) and Insulin-like Growth Factor Binding Protein-3 (IGFBP-3) levels, which contribute to atherogenesis and occurrence of cardiovascular (CV) events. We assessed and compared serum levels of VEGF and IGFBP-3 in newly diagnosed OSA patients and controls, to explore associations with anthropometric and sleep parameters and to study the effect of continuous positive airway pressure (CPAP) treatment on these levels. Materials and Methods: Serum levels of VEGF and IGFBP-3 were measured in 65 OSA patients and 31 age- and body mass index- matched controls. In OSA patients, measurements were repeated after 6 months of CPAP therapy. All participants were non-smokers, without any comorbidities or systemic medication use. Results: At baseline, serum VEGF levels in OSA patients were higher compared with controls (p<0.001), while IGFBP-3 levels were lower (1.41±0.56 vs. 1.61±0.38 μg/ml, p=0.039). VEGF levels correlated with apnea-hypopnea index (r=0.336, p=0.001) and oxygen desaturation index (r=0.282, p=0.007). After 6 months on CPAP treatment, VEGF levels decreased in OSA patients (p<0.001), while IGFBP-3 levels increased (p<0.001). Conclusion: In newly diagnosed OSA patients, serum levels of VEGF are elevated, while IGFBP-3 levels are low. After 6 months of CPAP treatment these levels change. These results may reflect an increased CV risk in untreated OSA patients, which is ameliorated after CPAP therapy. PMID:27006717

  18. Access to artemisinin-based anti-malarial treatment and its related factors in rural Tanzania

    PubMed Central

    2013-01-01

    Background Artemisinin-based combination treatment (ACT) has been widely adopted as one of the main malaria control strategies. However, its promise to save thousands of lives in sub-Saharan Africa depends on how effective the use of ACT is within the routine health system. The INESS platform evaluated effective coverage of ACT in several African countries. Timely access within 24 hours to an authorized ACT outlet is one of the determinants of effective coverage and was assessed for artemether-lumefantrine (Alu), in two district health systems in rural Tanzania. Methods From October 2009 to June 2011we conducted continuous rolling household surveys in the Kilombero-Ulanga and the Rufiji Health and Demographic Surveillance Sites (HDSS). Surveys were linked to the routine HDSS update rounds. Members of randomly pre-selected households that had experienced a fever episode in the previous two weeks were eligible for a structured interview. Data on individual treatment seeking, access to treatment, timing, source of treatment and household costs per episode were collected. Data are presented on timely access from a total of 2,112 interviews in relation to demographics, seasonality, and socio economic status. Results In Kilombero-Ulanga, 41.8% (CI: 36.6–45.1) and in Rufiji 36.8% (33.7–40.1) of fever cases had access to an authorized ACT provider within 24 hours of fever onset. In neither of the HDSS site was age, sex, socio-economic status or seasonality of malaria found to be significantly correlated with timely access. Conclusion Timely access to authorized ACT providers is below 50% despite interventions intended to improve access such as social marketing and accreditation of private dispensing outlets. To improve prompt diagnosis and treatment, access remains a major bottle neck and new more innovative interventions are needed to raise effective coverage of malaria treatment in Tanzania. PMID:23651521

  19. Differential Risk Factors for HIV Drug and Sex Risk-Taking Among Non-treatment-seeking Hospitalized Injection Drug Users

    PubMed Central

    Crooks, Denise; Tsui, Judith; Anderson, Bradley; Dossabhoy, Shernaz; Herman, Debra; Liebschutz, Jane M.; Stein, Michael D.

    2016-01-01

    Injection drug users (IDUs) are at increased risk of contracting HIV. From a clinical trial assessing an intervention to enhance the linkage of hospitalized patients to opioid treatment after discharge, we conducted multivariate analysis of baseline data from hospitalized IDUs with a history of opioid dependence (n = 104) to identify differences in factors predicting HIV drug and sex risk behaviors. Factors significantly associated with HIV drug risk were being non-Hispanic Caucasian and recent cocaine use. Being female, binge drinking, and poorer mental health were significantly associated with higher sex risk. Because factors predicting HIV sex risk behaviors differ from those predicting HIV drug risk, interventions aimed at specific HIV risks should have different behavioral and substance use targets. PMID:25063229

  20. Effects of School-Based Risk and Protective Factors on Treatment Success Among Youth Adjudicated of a Sexual Crime.

    PubMed

    Yoder, Jamie R; Hansen, Jesse; Ruch, Donna; Hodge, Ashleigh

    2016-04-01

    Youth with sexually problematic behaviors are impacted by the reciprocal interplay between individual characteristics and the key social and ecological systems in which they are embedded. The paucity of research on protective factors mitigating risks within various socioecological systems is of concern, as the school is one such system that has been overlooked. This study retroactively investigated probation files among youth who were adjudicated of a sexual crime (N = 85) to determine how school-level variables are associated with treatment completion. A sequential logistical regression model revealed reduced odds for school-based risk factors and a greater proportion of variance explained when school-based protective factors were included. Implications and research considerations are discussed. PMID:27135384

  1. First-line treatment with FOLFOXIRI for advanced pancreatic cancer in clinical practice: Patients' outcome and analysis of prognostic factors.

    PubMed

    Vivaldi, Caterina; Caparello, Chiara; Musettini, Gianna; Pasquini, Giulia; Catanese, Silvia; Fornaro, Lorenzo; Lencioni, Monica; Falcone, Alfredo; Vasile, Enrico

    2016-08-15

    FOLFIRINOX is a standard first-line treatment for advanced pancreatic cancer (aPC). The Gruppo Oncologico Nord Ovest (GONO) FOLFOXIRI regimen demonstrated efficacy in metastatic colorectal cancer. We aimed to evaluate activity and tolerability of FOLFOXIRI regimen in patients with aPC and to explore putative prognostic factors. One hundred thirty-seven consecutive aPC patients were treated with FOLFOXIRI in our institution between 2008 and 2014. Clinical, laboratory and pathological data were collected and their association with activity, progression free survival (PFS) and overall survival (OS) was investigated. After a median follow up of 30 months, median PFS and OS were 8.0 months (95% CI 6.19-9.81) and 12 months (95% CI 9.75-14.25), respectively. Response rate was 38.6%, while disease-control rate 72.2%. At multivariate analysis liver metastases (p = 0.019; Hazard Ratio, HR, 0.59, 95% Confidence Interval, CI, 0.380.96), Eastern Cooperative Oncology Group (ECOG) performance status (PS) 1 (p = 0.001; HR 2.26, 95%CI 1.42-3.59) and neutrophil-lymphocyte ratio (NLR)> 4 (p= 0.002; HR: 2.42; 95% CI 1.38-4.25) were associated with poorer OS. We categorized 119 pts with complete available data as good-risk (0 factors, 38 pts), intermediate-risk (1 factor, 49 pts) and poor-risk (≥2 factors, 32 pts). Median OS for these three groups were 17.6, 11.1 and 7.4 months, respectively (p < 0.001). FOLFOXIRI is active and feasible in aPC. Prognosis of aPC pts treated with FOLFOXIRI is influenced by easily available factors: our analysis revealed ECOG PS, liver metastases and NLR as the most important predictors of survival. These factors could be helpful for treatment decision and clinical trial design. PMID:27038273

  2. Family Factors in the Development, Treatment, and Prevention of Childhood Anxiety Disorders

    ERIC Educational Resources Information Center

    Drake, Kelly L.; Ginsburg, Golda S.

    2012-01-01

    It is now widely accepted that anxiety disorders run in families, and current etiological models have proposed both genetic and environmental pathways to anxiety development. In this paper, the familial role in the development, treatment, and prevention of anxiety disorders in children is reviewed. We focus on three anxiety disorders in youth,…

  3. Family Factors Predict Treatment Outcome for Pediatric Obsessive-Compulsive Disorder

    ERIC Educational Resources Information Center

    Peris, Tara S.; Sugar, Catherine A.; Bergman, R. Lindsey; Chang, Susanna; Langley, Audra; Piacentini, John

    2012-01-01

    Objective: To examine family conflict, parental blame, and poor family cohesion as predictors of treatment outcome for youths receiving family-focused cognitive behavioral therapy (FCBT) for obsessive-compulsive disorder (OCD). Method: We analyzed data from a sample of youths who were randomized to FCBT (n = 49; 59% male; M age = 12.43 years) as…

  4. FIELD MEASUREMENT OF GREENHOUSE GAS EMISSION RATES AND DEVELOPMENT OF EMISSION FACTORS FOR WASTEWATER TREATMENT

    EPA Science Inventory

    The report gives results of field testing to develop more reliable green house gas (GHG) emission estimates for Wastewater treatment (WWT) lagoons. (NOTE: Estimates are available for the amount of methane (CH4) emitted from certain types of waste facilities, but there is not adeq...

  5. Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

    ERIC Educational Resources Information Center

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-01-01

    Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

  6. EVALUATION OF OPERATION AND MAINTENANCE FACTORS LIMITING MUNICIPAL WASTEWATER TREATMENT PLANT PERFORMANCE. PHASE II

    EPA Science Inventory

    Many of the country's wastewater treatment plants do not meet design expectations and NPDES permit standards. A research project was initiated to identify, quantify and rank the causes of this poor performance by comprehensive evaluations of 50 plants in nine western states. The ...

  7. The influence of clinical and pharmacological factors on enuresis treatment with imipramine.

    PubMed Central

    Fernández de Gatta, M M; Galindo, P; Rey, F; Gutierrez, J; Tamayo, M; García, M J; Domínguez-Gil, A

    1990-01-01

    1. The aim of this study has been to evaluate the response to imipramine treatment in enuretic children through the use of a series of clinical and pharmacological variables and by applying a multivariate (principal components) analysis technique. 2. The study was carried out on 146 children whose ages ranged from 5 to 14 years, and who received variable doses of imipramine (12.5 to 100 mg day-1). 3. The quantitative variables analyzed were: drug dosage, serum levels of imipramine and its metabolite desipramine, the relationship between them both, the duration of treatment, age and weight. 4. The qualitative variables were: compliance, presence of side-effects, enuretic and/or psychiatric antecedents, intelligence quotient (I.Q.), the existence (or absence) of related pathologies, sex, and the type of enuresis. 5. The response to treatment was quantified by means of the percentage of decrease in frequency of enuresis as compared with the initial frequency. 6. The results obtained show that the variables which are most associated with the reduction of enuresis are, in decreasing order: the dosage of imipramine administered, the duration of treatment, compliance and the level/dose ratio for the sum of the drug and metabolite levels. PMID:2271368

  8. The influence of clinical and pharmacological factors on enuresis treatment with imipramine.

    PubMed

    Fernández de Gatta, M M; Galindo, P; Rey, F; Gutierrez, J; Tamayo, M; García, M J; Domínguez-Gil, A

    1990-11-01

    1. The aim of this study has been to evaluate the response to imipramine treatment in enuretic children through the use of a series of clinical and pharmacological variables and by applying a multivariate (principal components) analysis technique. 2. The study was carried out on 146 children whose ages ranged from 5 to 14 years, and who received variable doses of imipramine (12.5 to 100 mg day-1). 3. The quantitative variables analyzed were: drug dosage, serum levels of imipramine and its metabolite desipramine, the relationship between them both, the duration of treatment, age and weight. 4. The qualitative variables were: compliance, presence of side-effects, enuretic and/or psychiatric antecedents, intelligence quotient (I.Q.), the existence (or absence) of related pathologies, sex, and the type of enuresis. 5. The response to treatment was quantified by means of the percentage of decrease in frequency of enuresis as compared with the initial frequency. 6. The results obtained show that the variables which are most associated with the reduction of enuresis are, in decreasing order: the dosage of imipramine administered, the duration of treatment, compliance and the level/dose ratio for the sum of the drug and metabolite levels. PMID:2271368

  9. Using Mindfulness in the Treatment of Adolescent Sexual Abusers: Contributing Common Factor or a Primary Modality?

    ERIC Educational Resources Information Center

    Jennings, Jerry L.; Apsche, Jack A.; Blossom, Paige; Bayles, Corliss

    2013-01-01

    Although mindfulness has become a mainstream methodology in mental health treatment, it is a relatively new approach with adolescents, and perhaps especially youth with sexual behavior problems. Nevertheless, clinical experience and several empirical studies are available to show the effectiveness of a systematic mindfulness- based methodology for…

  10. F/Pilipino American Substance Abuse: Sociocultural Factors and Methods of Treatment.

    ERIC Educational Resources Information Center

    Nadal, Kevin L.

    2000-01-01

    The purpose of this manuscript is to illustrate the unique experiences of Filipino Americans in relation to alcohol and tobacco use. Commentary is offered for potential methods of treatment for this ethnic group. The distinction between Filipino Americans and other Asian Americans is drawn to illustrate a need for ethnocentric therapeutic…

  11. Intolerance of Uncertainty: A Common Factor in the Treatment of Emotional Disorders

    PubMed Central

    Boswell, James F.; Thompson-Hollands, Johanna; Farchione, Todd J.; Barlow, David H.

    2013-01-01

    Intolerance of uncertainty (IU) is a characteristic predominantly associated with generalized anxiety disorder (GAD); however, emerging evidence indicates that IU may be a shared element of emotional disorders. Aims This study aimed to examine IU across diagnostic categories, change in IU during transdiagnostic treatment, and the relationship between change in IU and treatment outcome. Method Patients diagnosed with heterogeneous anxiety and depressive disorders received up to 18 weeks of a transdiagnostic cognitive-behavioral therapy intervention. Patient self-reported IU and self-report and clinician-rated symptom/functioning measures were administered at pretreatment and posttreatment. Results When controlling for negative affectivity, IU correlated with measures of depressive symptoms and worry severity at pretreatment. Patients with GAD and panic disorder exhibited the highest pretreatment IU scores, yet IU scores did not differ significantly based on the presence or absence of a specific diagnosis. A significant decrease in IU was observed, and change in IU was related to reduced anxiety and depressive symptom levels at posttreatment across diagnostic categories. Discussion Change in IU can be observed across problem areas in transdiagnostic treatment and such change is correlated with treatment outcome. PMID:23381685

  12. Focus on the family as a factor in differential treatment outcome.

    PubMed

    Webb, N L; Pratt, T C; Linn, M W; Carmichael, J S

    1978-07-01

    The prognostic relationship between prehospital living arrangements and treatment outcome was explored. Drug (N = 17) and alcohol (N = 19) patients who had lived with parents, wives, nonrelatives, or alone before voluntary admission to an inpatient substance abuse program were compared on changes in social dysfunctioning and symptomatology as a result of treatment. Ratings on each patient's level of dysfunctioning and symptomatology were made following intake into the program and within a 3-day period after receiving a regular discharge. While treatment had a positive effect on all groups, multivariate analysis of covariance showed a significant (P less than .009) differential rate of improvement between the pretreatment residential setting groups. Those who had lived alone or with nonrelatives prior to admission changed the most, becoming significantly less dysfunctional and symptomatic. Those coming from parental families changed the least improvement, while those who had lived with their spouses showed moderate improvement. Findings were consistent for both drug and alcohol patients. Results indicate that the type of home environment from which substance abusers come before engaging in treatment significantly influences their receptivity to rehabilitation. Findings suggest the need for assessment of the family environment and utilization of community resources as a means of enhancing adjustment. PMID:721335

  13. Inhibitors in childhood hemophilia A: genetic and treatment-related risk factors for development and eradication.

    PubMed

    DiMichele, Donna M

    2013-01-01

    The development of neutralizing antibodies remains a serious complication of hemophilia replacement therapy. Factor VIII inhibiting antibodies (inhibitors) occur commonly following replacement therapy in hemophilia A, creating a significant burden of clinical disease. This article will review our current understanding of risk factors and their known impact on inhibitor development in previously untreated or minimally treated children with severe and mild hemophilia A. It will also explore how the most recently elucidated immunology of inhibitor development might hold important clues to more effective inhibitor eradication and prevention in this heavily impacted patient population. PMID:23109404

  14. The main factors influencing canine demodicosis treatment outcome and determination of optimal therapy.

    PubMed

    Arsenović, Milica; Pezo, Lato; Vasić, Nebojša; Ćirić, Rodoljub; Stefanović, Milan

    2015-07-01

    The main idea of this research was to evaluate the efficacy of canine demodicosis conventional treatments using mathematical analyses. All available papers published between 1980 and 2014 were used in this study. One hundred six clinical trials enrolling 3414 cases of generalized demodicosis in dogs are studied. Dogs entered in the analysis were only the ones in which the disease occurred naturally, excluding the studies in which transplantation of Demodex canis mites was done from other animals. In conventional acaricide treatments, sorted according to active substances (moxidectin, amitraz, doramectin, ivermectin, and milbemycin oxime), the way of application (spot-on, dips, orally, or subcutaneous), concentration, and interval of application were used as input parameters in mathematical modeling. Data of interest were the treatment outcome, the number of dogs that went into remission, the number of animals not responding to treatment microscopically, the average duration of therapy, the follow-up period, the number of patients with disease recurrence, the number of adverse effects, and the number of animals with side effects. Dogs lost to follow-up or when the treatment was discontinued, due to various reasons not in connection with the therapy protocol, were not considered. Statistical and mathematical analyses were applied for prediction of the drugs' effectiveness. Developed mathematical models showed satisfactorily r (2), higher than 0.87. Good evidence for recommending the use of milbemycin oxime PO (0.5 mg/kg, daily) and moxidectin spot-on (Advocate®, Bayer) weekly is found. A bit less effective therapies were based on ivermectin PO (0.5 mg/kg, daily), moxidectin PO (0.35 mg/kg, daily), and amitraz dips (0.05 % solution, weekly), respectively. It is important to keep in mind that Advocate® is recommended by the manufacturer for use in milder cases. PMID:26013574

  15. Propionibacterium acnes CAMP Factor and Host Acid Sphingomyelinase Contribute to Bacterial Virulence: Potential Targets for Inflammatory Acne Treatment

    PubMed Central

    Nakatsuji, Teruaki; Tang, De-chu C.; Zhang, Liangfang; Gallo, Richard L.; Huang, Chun-Ming

    2011-01-01

    Background In the progression of acne vulgaris, the disruption of follicular epithelia by an over-growth of Propionibacterium acnes (P. acnes) permits the bacteria to spread and become in contact with various skin and immune cells. Methodology/Principal Findings We have demonstrated in the present study that the Christie, Atkins, Munch-Peterson (CAMP) factor of P. acnes is a secretory protein with co-hemolytic activity with sphingomyelinase that can confer cytotoxicity to HaCaT keratinocytes and RAW264.7 macrophages. The CAMP factor from bacteria and acid sphingomyelinase (ASMase) from the host cells were simultaneously present in the culture supernatant only when the cells were co-cultured with P. acnes. Either anti-CAMP factor serum or desipramine, a selective ASMase inhibitor, significantly abrogated the P. acnes-induced cell death of HaCaT and RAW264.7 cells. Intradermal injection of ICR mouse ears with live P. acnes induced considerable ear inflammation, macrophage infiltration, and an increase in cellular soluble ASMase. Suppression of ASMase by systemic treatment with desipramine significantly reduced inflammatory reaction induced by intradermal injection with P. acnes, suggesting the contribution of host ASMase in P. acnes-induced inflammatory reaction in vivo. Vaccination of mice with CAMP factor elicited a protective immunity against P. acnes-induced ear inflammation, indicating the involvement of CAMP factor in P. acnes-induced inflammation. Most notably, suppression of both bacterial CAMP factor and host ASMase using vaccination and specific antibody injection, respectively, cooperatively alleviated P. acnes-induced inflammation. Conclusions/Significance These findings envision a novel infectious mechanism by which P. acnes CAMP factor may hijack host ASMase to amplify bacterial virulence to degrade and invade host cells. This work has identified both CAMP factor and ASMase as potential molecular targets for the development of drugs and vaccines against

  16. Hypothalamic corticotropin-releasing factor immunoreactivity is reduced during induction of pituitary tumors by chronic estrogen treatment

    SciTech Connect

    Haas, D.A.; Borgundvaag, B.; Sturtridge, W.C.; George, S.R.

    1987-11-02

    The role that estrogen plays in the regulation of corticotropin-releasing factor (CRF) is not known. A radioimmunoassay specific for rat CRF was utilized to measure the CRF-like immunoreactivity (CRF-ir) in the hypothalamus of ovariectomized rats treated with estradiol for periods up to 12 weeks. Compared to ovariectomized controls, estradiol treatment resulted in significantly reduced CRF-ir after 3 and 12 weeks, although no significant change was seen after 8 weeks. Anterior pituitary (AP) weight was greatly increased by estradiol treatment at all time points studied. Bromocriptine treatment for the last 3 weeks of the 12-week period, or removal of estradiol for 3 weeks after 9 weeks of treatment did not reverse the changes in CRF-ir even though significant regressions of tumor size was achieved. There was no correlation between AP weight and CRF-ir in individual animals. These data show that chronic treatment with estrogen reduced hypothalamic CRF-ir content. Neither a direct estrogenic effect or an indirect effect mediated through alterations in the adenohypophysis could be ruled out. 21 references, 3 figures.

  17. Clinical presentation, risk factors and treatment outcomes of first allograft rejection after penetrating keratoplasty in early and late postoperative period

    PubMed Central

    Perera, C; Jhanji, V; Lamoureux, E; Pollock, G; Favilla, I; Vajpayee, R B

    2012-01-01

    Purpose Corneal graft rejection is the most common reason for the failure of an allograft corneal transplant. We undertook this study to identify and compare risk factors and treatment outcomes for early and late corneal graft rejections after optical penetrating keratoplasty. Methods A retrospective case file analysis of 880 primary penetrating keratoplasties was performed at a tertiary ophthalmic care centre. Patients were divided into early rejectors (rejection episode within 6 months postoperatively) and late rejectors (rejection episode after 6 months postoperatively). Main parameters evaluated were demographics, preoperative diagnosis and clinical signs, donor tissue details, surgical technique, details of rejection episode, treatment, and outcome information. Results A total of 156 patients with rejection episodes were identified. Of these, 42 (26.9%) patients experienced early rejection episodes and 114 (73.1%) patients experienced late rejection episodes. Preoperative donor and recipient characteristics, surgical technique, and clinical presentation of graft rejection were found to be similar between both groups after a Bonferroni correction was applied (P>0.005). Treatment outcomes of graft rejections were not significantly different (P=0.46) between early and late rejectors, with 83% of patients responding to rejection treatment (80% early rejectors; 85% late rejectors). Conclusion Patients with early and late graft rejection have similar characteristics and both groups respond to treatment equally. PMID:22344190

  18. Risk Factors for Acquisition of Drug Resistance during Multidrug-Resistant Tuberculosis Treatment, Arkhangelsk Oblast, Russia, 2005–2010

    PubMed Central

    Ershova, Julia; Vlasova, Natalia; Nikishova, Elena; Tarasova, Irina; Eliseev, Platon; Maryandyshev, Andrey O.; Shemyakin, Igor G.; Kurbatova, Ekaterina; Cegielski, J. Peter

    2015-01-01

    Acquired resistance to antituberculosis drugs decreases effective treatment options and the likelihood of treatment success. We identified risk factors for acquisition of drug resistance during treatment for multidrug-resistant tuberculosis (MDR TB) and evaluated the effect on treatment outcomes. Data were collected prospectively from adults from Arkhangelsk Oblast, Russia, who had pulmonary MDR TB during 2005–2008. Acquisition of resistance to capreomycin and of extensively drug-resistant TB were more likely among patients who received <3 effective drugs than among patients who received >3 effective drugs (9.4% vs. 0% and 8.6% vs. 0.8%, respectively). Poor outcomes were more likely among patients with acquired capreomycin resistance (100% vs. 25.9%), acquired ofloxacin resistance (83.6% vs. 22.7%), or acquired extensive drug resistance (100% vs. 24.4%). To prevent acquired drug resistance and poor outcomes, baseline susceptibility to first- and second-line drugs should be determined quickly, and treatment should be adjusted to contain >3 effective drugs. PMID:25988954

  19. Venlafaxine treatment after endothelin-1-induced cortical stroke modulates growth factor expression and reduces tissue damage in rats.

    PubMed

    Zepeda, Rodrigo; Contreras, Valentina; Pissani, Claudia; Stack, Katherine; Vargas, Macarena; Owen, Gareth I; Lazo, Oscar M; Bronfman, Francisca C

    2016-08-01

    Neuromodulators, such as antidepressants, may contribute to neuroprotection by modulating growth factor expression to exert anti-inflammatory effects and to support neuronal plasticity after stroke. Our objective was to study whether early treatment with venlafaxine, a serotonin-norepinephrine reuptake inhibitor, modulates growth factor expression and positively contributes to reducing the volume of infarcted brain tissue resulting in increased functional recovery. We studied the expression of BDNF, FGF2 and TGF-β1 by examining their mRNA and protein levels and cellular distribution using quantitative confocal microscopy at 5 days after venlafaxine treatment in control and infarcted brains. Venlafaxine treatment did not change the expression of these growth factors in sham rats. In infarcted rats, BDNF mRNA and protein levels were reduced, while the mRNA and protein levels of FGF2 and TGF-β1 were increased. Venlafaxine treatment potentiated all of the changes that were induced by cortical stroke alone. In particular, increased levels of FGF2 and TGF-β1 were observed in astrocytes at 5 days after stroke induction, and these increases were correlated with decreased astrogliosis (measured by GFAP) and increased synaptophysin immunostaining at twenty-one days after stroke in venlafaxine-treated rats. Finally, we show that venlafaxine reduced infarct volume after stroke resulting in increased functional recovery, which was measured using ladder rung motor tests, at 21 days after stroke. Our results indicate that the early oral administration of venlafaxine positively contributes to neuroprotection during the acute and late events that follow stroke. PMID:26965219

  20. TGF-β2 treatment enhances cytoprotective factors released from embryonic stem cells and inhibits apoptosis in infarcted myocardium.

    PubMed

    Singla, Dinender K; Singla, Reetu D; Lamm, Stephanie; Glass, Carley

    2011-04-01

    We investigated whether factors released from mouse embryonic stem (ES) cells primed with and without transforming growth factor (TGF)-β2 inhibit iodoacetic acid (IAA)- and H(2)O(2)-induced apoptosis in the cell culture system as well as after transplantation in the infarcted heart. We generated conditioned media (CMs) from ES cells primed with and without TGF-β2 and determined their effects on IAA- and H(2)O(2)-induced apoptosis in H9c2 cells. We also transplanted both ES-CMs in the infarcted heart to determine the effects on apoptosis and cardiac function after myocardial infarction (MI) at day (D)1 and D14. Terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling (TUNEL) staining, apoptotic ELISA, and cell viability data demonstrated significantly (P < 0.05) reduced apoptosis with ES-CM compared with controls in both cell culture models. Moreover, TGF-β2-primed ES-CM (T-ES-CM) demonstrated enhanced beneficial effects, with further reduced (P < 0.05) apoptosis compared with ES-CM, suggesting the a presence of additional cytoprotective released factors after TGF-β2 treatment. Next, our in vivo apoptosis data suggested significant decrease in apoptosis with both ES-CMs compared with MI alone at D1 and D14. Notably, T-ES-CM demonstrated significant (P < 0.05) inhibition of apoptosis and fibrosis with improved cardiac function compared with ES-CM at D14, whereas no such effects were observed at D1. Next, we confirmed that apoptosis is mediated through a prosurvival Akt pathway. Moreover, we determined that after TGF-β2 treatment there was a two- to fivefold increase in cytoprotective released factors (interleukin-10, stem cell factor, tissue inhibitor of matrix metalloproteinase-1, and VEGF) with T-ES-CM compared with ES-CM. In conclusion, we suggest that factors released from ES cells with and without TGF-β2 treatment contain antiapoptotic factors that inhibit apoptosis in vitro and in vivo. We also suggest that T-ES-CM demonstrates additional

  1. The Incidence of Hypothyroidism Following the Radioactive Iodine Treatment of Graves’ Disease and the Predictive Factors Influencing its Development

    PubMed Central

    Husseni, Maha Abd El-Kareem El-Sayed

    2016-01-01

    The purpose of this study is to evaluate and compare the incidence of hypothyroidism following different fixed radioactive iodine-131 (131I) activities in the treatment of Graves’ disease (GD) and to investigate the predictive factors that may influence its occurrence. This retrospective analysis was performed on 272 patients with GD who were treated with 131I, among whom 125 received 370 MBq and 147 received 555 MBq. The outcome was categorized as hypothyroidism, euthyroidism, and persistent hyperthyroidism. Multiple logistic regression analysis was performed to identify significant risk factors that affect the development of hypothyroidism. The incidence of hypothyroidism following the first low activity was 24.8% with a high treatment failure rate of 58.4%, compared with 48.3% and 32% following high activity. The overall cumulative incidence of hypothyroidism following repeated activities was 50.7%, out of which 73.9% occurred after the first activity and 20.3% after the second activity. The higher 131I activity (P < 0.001) and average and mild enlargement of the thyroid gland (P = 0.004) were identified as significant independent factors that increase the rate of incidence of hypothyroidism (Odds ratios were 2.95 and 2.59). No correlation was found between the development of hypothyroidism and the factors such as age, gender, presence of exophthalmos, previous antithyroid medications, and the durations, and Technetium-99m (Tc-99m) pertechnetate thyroid uptake. In view of the high treatment failure rate after first low activity and lower post high activity hypothyroid incidence, high activity is recommended for GD patients, reserving the use of 370MBq for patients with average sized and mildly enlarged goiter; this increases patient convenience by avoiding multiple activities to achieve cure and long-term follow-up. PMID:26912976

  2. The Incidence of Hypothyroidism Following the Radioactive Iodine Treatment of Graves' Disease and the Predictive Factors Influencing its Development.

    PubMed

    Husseni, Maha Abd El-Kareem El-Sayed

    2016-01-01

    The purpose of this study is to evaluate and compare the incidence of hypothyroidism following different fixed radioactive iodine-131 ((131)I) activities in the treatment of Graves' disease (GD) and to investigate the predictive factors that may influence its occurrence. This retrospective analysis was performed on 272 patients with GD who were treated with (131)I, among whom 125 received 370 MBq and 147 received 555 MBq. The outcome was categorized as hypothyroidism, euthyroidism, and persistent hyperthyroidism. Multiple logistic regression analysis was performed to identify significant risk factors that affect the development of hypothyroidism. The incidence of hypothyroidism following the first low activity was 24.8% with a high treatment failure rate of 58.4%, compared with 48.3% and 32% following high activity. The overall cumulative incidence of hypothyroidism following repeated activities was 50.7%, out of which 73.9% occurred after the first activity and 20.3% after the second activity. The higher (131)I activity (P < 0.001) and average and mild enlargement of the thyroid gland (P = 0.004) were identified as significant independent factors that increase the rate of incidence of hypothyroidism (Odds ratios were 2.95 and 2.59). No correlation was found between the development of hypothyroidism and the factors such as age, gender, presence of exophthalmos, previous antithyroid medications, and the durations, and Technetium-99m (Tc-99m) pertechnetate thyroid uptake. In view of the high treatment failure rate after first low activity and lower post high activity hypothyroid incidence, high activity is recommended for GD patients, reserving the use of 370MBq for patients with average sized and mildly enlarged goiter; this increases patient convenience by avoiding multiple activities to achieve cure and long-term follow-up. PMID:26912976

  3. Metabolic Risk Factors of Sporadic Alzheimer’s Disease: Implications in the Pathology, Pathogenesis and Treatment

    PubMed Central

    Chakrabarti, Sasanka; Khemka, Vineet Kumar; Banerjee, Anindita; Chatterjee, Gargi; Ganguly, Anirban; Biswas, Atanu

    2015-01-01

    Alzheimer’s disease (AD), the major cause of dementia among the elderly world-wide, manifests in familial and sporadic forms, and the latter variety accounts for the majority of the patients affected by this disease. The etiopathogenesis of sporadic AD is complex and uncertain. The autopsy studies of AD brain have provided limited understanding of the antemortem pathogenesis of the disease. Experimental AD research with transgenic animal or various cell based models has so far failed to explain the complex and varied spectrum of AD dementia. The review, therefore, emphasizes the importance of AD related risk factors, especially those with metabolic implications, identified from various epidemiological studies, in providing clues to the pathogenesis of this complex disorder. Several metabolic risk factors of AD like hypercholesterolemia, hyperhomocysteinemia and type 2 diabetes have been studied extensively both in epidemiology and experimental research, while much less is known about the role of adipokines, pro-inflammatory cytokines and vitamin D in this context. Moreover, the results from many of these studies have shown a degree of variability which has hindered our understanding of the role of AD related risk factors in the disease progression. The review also encompasses the recent recommendations regarding clinical and neuropathological diagnosis of AD and brings out the inherent uncertainty and ambiguity in this area which may have a distinct impact on the outcome of various population-based studies on AD-related risk factors. PMID:26236550

  4. Temperament as a Potential Factor in the Development and Treatment of Conduct Disorders.

    ERIC Educational Resources Information Center

    Center, David; Kemp, Dawn

    This report examines the development of Conduct Disorder (CD) in children and adolescents from the perspective of Hans Eysenck's bio-social theory of personality. The theory views personality as a product of the interaction of temperament and socialization. Eysenck's three-factor model of personality is comprised of Extroversion (E), Neuroticism…

  5. Metabolic Risk Factors of Sporadic Alzheimer's Disease: Implications in the Pathology, Pathogenesis and Treatment.

    PubMed

    Chakrabarti, Sasanka; Khemka, Vineet Kumar; Banerjee, Anindita; Chatterjee, Gargi; Ganguly, Anirban; Biswas, Atanu

    2015-08-01

    Alzheimer's disease (AD), the major cause of dementia among the elderly world-wide, manifests in familial and sporadic forms, and the latter variety accounts for the majority of the patients affected by this disease. The etiopathogenesis of sporadic AD is complex and uncertain. The autopsy studies of AD brain have provided limited understanding of the antemortem pathogenesis of the disease. Experimental AD research with transgenic animal or various cell based models has so far failed to explain the complex and varied spectrum of AD dementia. The review, therefore, emphasizes the importance of AD related risk factors, especially those with metabolic implications, identified from various epidemiological studies, in providing clues to the pathogenesis of this complex disorder. Several metabolic risk factors of AD like hypercholesterolemia, hyperhomocysteinemia and type 2 diabetes have been studied extensively both in epidemiology and experimental research, while much less is known about the role of adipokines, pro-inflammatory cytokines and vitamin D in this context. Moreover, the results from many of these studies have shown a degree of variability which has hindered our understanding of the role of AD related risk factors in the disease progression. The review also encompasses the recent recommendations regarding clinical and neuropathological diagnosis of AD and brings out the inherent uncertainty and ambiguity in this area which may have a distinct impact on the outcome of various population-based studies on AD-related risk factors. PMID:26236550

  6. Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program

    PubMed Central

    Mengesha, Melkamu Merid; Deyessa, Negussie; Tegegne, Balewgizie Sileshi; Dessie, Yadeta

    2016-01-01

    Background The outpatient therapeutic care program (OTP) of children with severe acute malnutrition (SAM) has been decentralized to health post level in Ethiopia since 2008–2009. However, there is a lack of evidence regarding treatment outcomes and factors related to the duration of stay on treatment after its decentralization to health post level. Objective This study was aimed to assess treatment outcome and factors affecting time to recovery in children with SAM treated at OTP. Design Health facility–based retrospective cohort study was conducted using data from 348 patient cards. The outcome variable was time to recovery. Descriptive analysis was done using percentages for categorical data and mean/median for continuous variables. A robust method of analyzing time to event data, the Cox proportional-hazard regression, was used. All statistical tests in this study are declared significant at p<0.05. Result 89.1% of children with kwashiorkor and 69.4% of children with marasmus were recovered. Of the total children studied, 22% were readmitted cases. The median time of recovery was 35 days for children with kwashiorkor and 49 days for children with marasmus. Children older than 3 years were 33% less likely to achieve nutritional recovery [adjusted hazard ratio, AHR=0.67, 95% confidence interval, CI (0.46, 0.97)]. Similarly, marasmic children stayed longer on treatment [AHR=0.42, 95% CI (0.32, 0.56)]. However, children who gained Mid-Upper Arm Circumference (MUAC) ≥ 0.24 mm/day were 59% more likely to recover faster [AHR=1.59, 95% CI (1.23, 2.06)]. Conclusions Close monitoring of weight and MUAC gain to assess nutritional improvement with due emphasis given to children with lower admission weight, children of age 3 years and above and marasmic children will have a positive effect on treatment duration and outcome. PMID:27396484

  7. Higher levels of soluble Fas ligand and transforming growth factor-β after omalizumab treatment: a case report.

    PubMed

    Kao, Shu-Ling; Yu, Hong-Ren; Kuo, Ho-Chang; Tsui, Ka-Yin; Wu, Chih-Chiang; Chang, Ling-Sai; Liang, Chi-Di; Chung, Yu-Hsiu; Yang, Kuender D

    2012-02-01

    A skewed T-helper (T(h))1/T(h)2 immune response is considered to be the major cause of allergic disorders. Overproduction of T(h)2 cytokines, which promote recruitment and activation of mast cells and eosinophils, plays a key part in the pathogenesis of allergic asthma. The mechanisms by which omalizumab is effective in asthma treatment are not yet fully understood. A 16-year-old girl who was experiencing frequent asthma attacks in spite of daily administration of budesonide (640 μg) and montelukast (10mg) was given omalizumab (375 mg) at intervals of 2 weeks, to prevent a visit to the emergency room. Plasma levels of T(h)1 cytokines [interferon (IFN)-γ and interleukin (IL)-12p70], T(h)2 cytokines (IL-4 and IL-13), other proinflammatory and regulatory cytokines [IL-6, IL-10, IL-17, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β], chemokines [monocyte chemotactic protein (MCP)-1, chemokine ligand (CCL)7, and CCL17], and soluble Fas ligand (sFasL) were measured before treatment and after treatment for 8 weeks. She showed a good clinical response to omalizumab: her lung function parameters improved and the use of β2-agonist decreased. No emergency room visits were required after omalizumab treatment for 8 weeks. Plasma levels of sFasL and TGF-β showed obvious increases after omalizumab therapy. IL-12p70 levels were decreased as compared to the corresponding baseline levels. These findings suggest that the effects of omalizumab in asthma treatment are not restricted to the regulation of the skewed T(h)1/T(h)2 cytokine immune response, and sFasL-mediated apoptosis and regulatory T-cell (Treg)-mediated TGF-β seem to have important roles in the therapeutic effects of omalizumab. PMID:22244736

  8. Hormone resistant prostatic adenocarcinoma. An evaluation of prognostic factors in pre- and post-treatment specimens.

    PubMed Central

    Berner, A.; Nesland, J. M.; Waehre, H.; Silde, J.; Fosså, S. D.

    1993-01-01

    Pre- and post-treatment specimens from 47 patients with hormone resistant prostatic carcinoma were compared with each other regarding histological grade and immunoreactivity for p53 protein, neuron specific enolase and c-erbB-2 protein. Significantly more specimens expressed a high malignancy grade when the tumour had become hormone resistant than at the time of initial diagnosis (Gleason P: < 0.0001, WHO P:0.0003). p53 protein immunoreactivity increased significantly with disease progression (P:0.006), while tissue PSA immunoreactivity was reduced in post-treatment specimens (P:0.011). p53 protein expression did not correlate with histological grade or PSA expression and seems to be an independent parameter which participates late in the neoplastic transformation. Thirty-two percent of the tumours were neuron specific enolase positive, but this parameter did not correlate with development of hormone resistance. c-erbB-2 protein reactivity was not recognised. Images Figure 1 PMID:7688548

  9. [Is the insight a favourable prognostic factor in the treatment of mental disorders?].

    PubMed

    Vender, Simone; Poloni, Nicola

    2006-10-01

    In the history of psychology, psychoanalysis and psychiatry, the concept of insight has had alternate fortunes and has been variously interpreted according to the observation apex from which it has been studied. In psychiatry, particularly, the insight has been considered close to the concept of disease consciouness and, consequently, the presence and the degree of intensity of insight have been put in relation with the adhesion to the treatments (the compliance) and the prognostic development of the mental disorders. With regard to the insight, through the analysis of several interpretative models, the authors emphasize how to draw the history of a possible passage of this concept from the side of individual psychopathology to the bi-personal side of therapeutic relationship, where the insight of the patient meets regarding its desease and that of the therapeutist regarding the objects of the treatment. PMID:17263048

  10. Criminogenic Factors, Psychotic Symptoms, and Incident Arrests Among People With Serious Mental Illnesses Under Intensive Outpatient Treatment

    PubMed Central

    Prins, Seth J.; Skeem, Jennifer L.; Mauro, Christine; Link, Bruce G.

    2015-01-01

    Although research robustly indicates that general or “criminogenic” factors predict various measures of recidivism, there is controversy about the extent to which these factors, versus untreated symptoms, lead to justice involvement for people with mental illnesses. Based on a sample of 183 people in intensive outpatient treatment followed for an average period of 34.5 months, the present study tested whether criminogenic factors (i.e., factor-analytically derived proxies of some of the “Central Eight”; Andrews & Bonta, 2010) and psychotic symptoms were independently associated with arrest. The study also compared the predictive utility of these domains. In the fully adjusted model, the antisocial subscale and male sex were associated with increased arrest rates, whereas psychosis and age were associated with decreased arrest rates. Criminogenic factors and psychotic symptoms had comparable predictive utility. We conclude that criminogenic factors—chiefly arrest history—and psychotic symptoms predict arrest rates. Both sets of variables appear useful for assessing risk of arrest among people with mental illnesses who are not under current correctional supervision. PMID:25133918

  11. Lactobacillus rhamnosus GG treatment potentiates intestinal hypoxia-inducible factor, promotes intestinal integrity and ameliorates alcohol-induced liver injury.

    PubMed

    Wang, Yuhua; Kirpich, Irina; Liu, Yanlong; Ma, Zhenhua; Barve, Shirish; McClain, Craig J; Feng, Wenke

    2011-12-01

    Gut-derived endotoxin is a critical factor in the development and progression of alcoholic liver disease (ALD). Probiotics can treat alcohol-induced liver injury associated with gut leakiness and endotoxemia in animal models, as well as in human ALD; however, the mechanism or mechanisms of their beneficial action are not well defined. We hypothesized that alcohol impairs the adaptive response-induced hypoxia-inducible factor (HIF) and that probiotic supplementation could attenuate this impairment, restoring barrier function in a mouse model of ALD by increasing HIF-responsive proteins (eg, intestinal trefoil factor) and reversing established ALD. C57BJ/6N mice were fed the Lieber DeCarli diet containing 5% alcohol for 8 weeks. Animals received Lactobacillus rhamnosus GG (LGG) supplementation in the last 2 weeks. LGG supplementation significantly reduced alcohol-induced endotoxemia and hepatic steatosis and improved liver function. LGG restored alcohol-induced reduction of HIF-2α and intestinal trefoil factor levels. In vitro studies using the Caco-2 cell culture model showed that the addition of LGG supernatant prevented alcohol-induced epithelial monolayer barrier dysfunction. Furthermore, gene silencing of HIF-1α/2α abolished the LGG effects, indicating that the protective effect of LGG is HIF-dependent. The present study provides a mechanistic insight for utilization of probiotics for the treatment of ALD, and suggests a critical role for intestinal hypoxia and decreased trefoil factor in the development of ALD. PMID:22093263

  12. Medulloblastoma--prognostic factors and outcome of treatment: Review of the Mayo Clinic experience

    SciTech Connect

    Garton, G.R.; Schomberg, P.J.; Scheithauer, B.W.; Shaw, E.G.; Ilstrup, D.M.; Blackwell, C.R.; Laws, E.R. Jr.; Earle, J.D. )

    1990-08-01

    From March 1965 through December 1984, 58 patients (35 male and 23 female patients; median age, 17 years) with posterior fossa (PF) medulloblastoma underwent surgical treatment and postoperative radiation therapy at our institution. Radiation fields were the craniospinal axis in 39 patients, PF plus spinal axis in 12, PF in 6, and whole brain in 1. Median radiation doses were 43 Gy (22 to 60 Gy) to the PF and 34 Gy (6.2 to 50 Gy) to the spinal axis. Overall 5- and 10-year survivals were 50% and 33%, respectively; 5- and 10-year relapse-free survivals were 46% and 32%. Treatment failed in 34 patients (59%): in 18 who had irradiation to the craniospinal axis (13 had received 50 Gy or less to the PF) and in 16 who had a radiation field of less than the craniospinal axis. A statistically significant (P less than 0.05) improvement in 10-year survival was associated with the following prognostic variables: PF dose of 50 Gy or more, whole-brain irradiation, and spinal axis irradiation. In comparison with subtotal resection, total resection was correlated with better 10-year relapse-free survival but not overall survival. All five patients with initial treatment failure only in the spine had received a radiation dose of 30 Gy or less to the spinal axis. The 2-year survival after relapse was 46% with salvage chemotherapy or irradiation in 23 patients and 0% in the 11 patients who received no further treatment (P less than 0.01).

  13. Cancer-related lymphedema risk factors, diagnosis, treatment, and impact: a review.

    PubMed

    Paskett, Electra D; Dean, Julie A; Oliveri, Jill M; Harrop, J Phil

    2012-10-20

    PURPOSE Cancer-related lymphedema (LE) is an incurable condition associated with lymph-involved cancer treatments and is an increasing health, quality of life (QOL), and cost burden on a growing cancer survivor population. This review examines the evidence for causes, risk, prevention, diagnosis, treatment, and impact of this largely unexamined survivorship concern. METHODS PubMed and Medline were searched for cancer-related LE literature published since 1990 in English. The resulting references (N = 726) were evaluated for strength of design, methods, sample size, and recent publication and sorted into categories (ie, causes/prevention, diagnosis, treatment, and QOL). Sixty studies were included. Results Exercise and physical activity and sentinel lymph node biopsy reduce risk, and overweight and obesity increase risk. Evidence that physiotherapy reduces risk and that lymph node status and number of malignant nodes increase risk is less strong. Perometry and bioimpedence emerged as attractive diagnostic technologies, replacing the use of water displacement in clinical practice. Swelling can also be assessed by measuring arm circumference and relying on self-report. Symptoms can be managed, not cured, with complex physical therapy, low-level laser therapy, pharmacotherapy, and surgery. Sequelae of LE negatively affect physical and mental QOL and range in severity. However, the majority of reviewed studies involved patients with breast cancer; therefore, results may not be applicable to all cancers. CONCLUSION Research into causes, prevention, and effect on QOL of LE and information on LE in cancers other than breast is needed. Consensus on definitions and measurement, increased patient and provider awareness of signs and symptoms, and proper and prompt treatment/access, including psychosocial support, are needed to better understand, prevent, and treat LE. PMID:23008299

  14. Contemporary management of fibrolamellar hepatocellular carcinoma: diagnosis, treatment, outcome, prognostic factors, and recent developments.

    PubMed

    Kassahun, Woubet Tefera

    2016-01-01

    Fibrolamellar hepatocellular carcinoma (FL-HCC) is a malignant liver tumor which is thought to be a variant of conventional hepatocellular carcinoma (HCC). It accounts for a small proportion of HCC cases and occurs in a distinctly different group of patients which are young and usually not in the setting of chronic liver disease. The diagnosis of FL-HCC requires the integration of clinical information, imaging studies, and histology. In terms of the treatment options, the only potentially curative treatment option for patients who have resectable disease is surgery either liver resection (LR) or liver transplantation (LT). When performed in a context of aggressive therapy, long-term outcomes after surgery, particularly liver resection for FL-HCC, were favorable. The clinical outcome of patients with unresectable disease is suboptimal with median survival of less than 12 months. The aim of this review is to update the available evidence on diagnosis, treatment options, outcome predictors, and recent developments of patients with this rare disease and to provide a summarized overview of the available literature. PMID:27215576

  15. Cocaine abuse among opioid addicts: demographic and diagnostic factors in treatment.

    PubMed

    Kosten, T R; Gawin, F H; Rounsaville, B J; Kleber, H D

    1986-01-01

    Cocaine is becoming a major drug of abuse among the general population and among opiate addicts. Reports from the early 1970s found that most abusers were older Black males with some antisocial characteristics. Cocaine abuse at that time was reported by about 17% of opiate addicts seeking treatment and by 7 to 11% of ex-addicts on methadone maintenance. However, that rate increased dramatically during the 1970s, and in our 1980 study of 533 addicts we found that 74% of opiate addicts applying for treatment used cocaine. It was the second most abused nonopioid drug after marijuana, surpassing alcohol intoxication. Although the mean number of days of abuse over the previous 30 days was substantially lower among the addicts on our methadone maintenance program (mean = 1.4 days, n = 120) than among the addicts applying for treatment (mean = 9 days, n = 204), the following associations with cocaine abuse were consistent in both subsamples. Cocaine abuse was more frequent among Blacks. It was associated with a variety of antisocial indices including Research Diagnostic Criteria antisocial personality disorder, number of arrests, and legal, family, employment, and drug abuse problems as assessed by the Addiction Severity Index and the Social Adjustment Scale. Several differences emerged between Black and White cocaine-abusing addicts, the most interesting being an increased rate of anxiety disorders among White cocaine abusers. Based on these associations, we offer several guidelines for treating cocaine abuse in opiate addicts. PMID:3788892

  16. Meta-analysis of factors predicting resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease

    PubMed Central

    Baek, Jin-Young

    2016-01-01

    Purpose Studies have been conducted to identify predictive factors of resistance to intravenous immunoglobulin (IVIG) for Kawasaki disease (KD). However, the results are conflicting. This study aimed to identify laboratory factors predictive of resistance to high-dose IVIG for KD by performing meta-analysis of available studies using statistical techniques. Methods All relevant scientific publications from 2006 to 2014 were identified through PubMed searches. For studies in English on KD and IVIG resistance, predictive factors were included. A meta-analysis was performed that calculated the effect size of various laboratory parameters as predictive factors for IVIG-resistant KD. Results Twelve studies comprising 2,745 patients were included. Meta-analysis demonstrated significant effect sizes for several laboratory parameters: polymorphonuclear leukocytes (PMNs) 0.698 (95% confidence interval [CI], 0.469–0.926), C-reactive protein (CRP) 0.375 (95% CI, 0.086–0.663), pro-brain natriuretic peptide (pro-BNP) 0.561 (95% CI, 0.261–0.861), total bilirubin 0.859 (95% CI, 0.582–1.136), alanine aminotransferase (AST) 0.503 (95% CI, 0.313–0.693), aspartate aminotransferase (ALT) 0.436 (95% CI, 0.275–0.597), albumin 0.427 (95% CI, –0.657 to –0.198), and sodium 0.604 (95% CI, –0.839 to –0.370). Particularly, total bilirubin, PMN, sodium, pro-BNP, and AST, in descending numerical order, demonstrated more than a medium effect size. Conclusion Based on the results of this study, laboratory predictive factors for IVIG-resistant KD included higher total bilirubin, PMN, pro-BNP, AST, ALT, and CRP, and lower sodium and albumin. The presence of several of these predictive factors should alert clinicians to the increased likelihood that the patient may not respond adequately to initial IVIG therapy. PMID:26958067

  17. Norethisterone treatment, a major risk-factor for veno-occlusive disease in the liver after allogeneic bone marrow transplantation.

    PubMed

    Hägglund, H; Remberger, M; Klaesson, S; Lönnqvist, B; Ljungman, P; Ringdén, O

    1998-12-15

    In this single-center study, we retrospectively analyzed incidence and risk factors for hepatic veno-occlusive disease (VOD) in 249 consecutive patients who underwent allogeneic hematopoietic stem cell transplantation between January 1990 and June 1995. Twenty-four of the 249 transplanted patients developed VOD. The probabilities of developing VOD were 17% among women and 7% in men (P =.01). In women treated with norethisterone, the incidence was 27% compared with 3% in women without this treatment (P =.007). One-year survival rates were 17% and 73% in patients with (n = 24) or without VOD (n = 225), respectively. The use of heparin prophylaxis (100 IE/kg/24 hours for 1 month) did not alter the incidence or 1-year mortality of VOD. In multivariate analysis, the following risk factors were significant: norethisterone treatment (P <.001), bilirubin >26 micromol/L before bone marrow transplantation (BMT) (P =.002), one HLA-antigen mismatch (P =.003), previous abdominal irradiation (P =.02), and conditioning with busulphan (P =.02). Our conclusion is that norethisterone treatment should not be used in patients undergoing BMT and heparin prophylaxis did not affect the incidence or mortality of VOD. PMID:9845522

  18. Treatment with an activator of hypoxia-inducible factor 1, DMOG provides neuroprotection after traumatic brain injury.

    PubMed

    Sen, Tanusree; Sen, Nilkantha

    2016-08-01

    Traumatic brain injury (TBI) is one of the major cause of morbidity and mortality and it affects more than 1.7 million people in the USA. A couple of regenerative pathways including activation of hypoxia-inducible transcription factor 1 alpha (HIF-1α) are initiated to reduce cellular damage following TBI; however endogenous activation of these pathways is not enough to provide neuroprotection after TBI. Thus we aimed to see whether sustained activation of HIF-1α can provide neuroprotection and neurorepair following TBI. We found that chronic treatment with dimethyloxaloylglycine (DMOG) markedly increases the expression level of HIF-1α and mRNA levels of its downstream proteins such as Vascular endothelial growth factor (VEGF), Phosphoinositide-dependent kinase-1 and 4 (PDK1, PDK4) and Erythropoietin (EPO). Treatment of DMOG activates a major cell survival protein kinase Akt and reduces both cell death and lesion volume following TBI. Moreover, administration of DMOG augments cluster of differentiation 31 (CD31) staining in pericontusional cortex after TBI, which suggests that DMOG stimulates angiogenesis after TBI. Treatment with DMOG also improves both memory and motor functions after TBI. Taken together our results suggest that sustained activation of HIF-1α provides significant neuroprotection following TBI. PMID:26970014

  19. Predictive and prognostic factors in the complex treatment of patients with colorectal cancer.

    PubMed

    László, Landherr

    2010-12-01

    Colon cancer is the second most prevalent lethal cancer. The main cause for high mortality rate is that the prognosis for progressed metastatic colon cancer is most unfavorable. Recent data suggest that disease outcome can be further improved by the addition of targeted biological agents to the first- or second-line treatment. As a result of molecularly targeted anti-EGFR therapies (cetuximab and panitumumab) complementing chemotherapy, liver metastases can reduce in size and become operable in certain patients, which can contribute to the complete recovery of the patient. The main problem, however, is the fact that a positive response only occurs in one third of the patients, even in the case of chemotherapy combined protocol, and the side effects are considerable. For the application of individually tailored treatments, it is an urgent need to develop a system of biomarkers that can predict the effect of treatment and provide information about the optimal selection of both chemotherapy and biological treatment. It should be clarified what the most important requirements of a good and reliable biomarker are. As currently there is no precise predictive molecular diagnostics at our disposal, oncologists have to make one of two choices: they treat a large number of patients with anti-EGFR agents which has negative effects on the quality of life and also reduces the patient's chances of getting appropriate treatment or, if the oncologists refuse to take risks, they omit the use of anti-EGFR treatment in which case those patients for whom this would have been the appropriate treatment are also denied the chance of short-term survival or recovery. Clinical data (response rate, time to progression (TTP) and overall survival (OS)) of 130 colorectal cancer patients have been retrospectively analyzed. Patients have received different chemotherapy protocols in combination with anti-VEGF antibody or with anti-EGFR antibody therapies. EGFR expression was evaluated with

  20. Factors influencing the ablative efficiency of high intensity focused ultrasound (HIFU) treatment for adenomyosis: A retrospective study.

    PubMed

    Gong, Chunmei; Yang, Bin; Shi, Yarong; Liu, Zhongqiong; Wan, Lili; Zhang, Hong; Jiang, Denghua; Zhang, Lian

    2016-08-01

    Objectives The aim of this study was to investigate factors affecting ablative efficiency of high intensity focused ultrasound (HIFU) for adenomyosis. Materials and methods In all, 245 patients with adenomyosis who underwent ultrasound guided HIFU (USgHIFU) were retrospectively reviewed. All patients underwent dynamic contrast-enhanced magnetic resonance imaging (MRI) before and after HIFU treatment. The non-perfused volume (NPV) ratio, energy efficiency factor (EEF) and greyscale change were set as dependent variables, while the factors possibly affecting ablation efficiency were set as independent variables. These variables were used to build multiple regression models. Results A total of 245 patients with adenomyosis successfully completed HIFU treatment. Enhancement type on T1 weighted image (WI), abdominal wall thickness, volume of adenomyotic lesion, the number of hyperintense points, location of the uterus, and location of adenomyosis all had a linear relationship with the NPV ratio. Distance from skin to the adenomyotic lesion's ventral side, enhancement type on T1WI, volume of adenomyotic lesion, abdominal wall thickness, and signal intensity on T2WI all had a linear relationship with EEF. Location of the uterus and abdominal wall thickness also both had a linear relationship with greyscale change. Conclusion The enhancement type on T1WI, signal intensity on T2WI, volume of adenomyosis, location of the uterus and adenomyosis, number of hyperintense points, abdominal wall thickness, and distance from the skin to the adenomyotic lesion's ventral side can all be used as predictors of HIFU for adenomyosis. PMID:27385316

  1. Combined Paracrine and Endocrine AAV9 mediated Expression of Hepatocyte Growth Factor for the Treatment of Renal Fibrosis

    PubMed Central

    Schievenbusch, Stephanie; Strack, Ingo; Scheffler, Melanie; Nischt, Roswitha; Coutelle, Oliver; Hösel, Marianna; Hallek, Michael; Fries, Jochen WU; Dienes, Hans-Peter; Odenthal, Margarete; Büning, Hildegard

    2010-01-01

    In chronic renal disease, tubulointerstitial fibrosis is a leading cause of renal failure. Here, we made use of one of the most promising gene therapy vector platforms, the adeno-associated viral (AAV) vector system, and the COL4A3-deficient mice, a genetic mouse model of renal tubulointerstitial fibrosis, to develop a novel bidirectional treatment strategy to prevent renal fibrosis. By comparing different AAV serotypes in reporter studies, we identified AAV9 as the most suitable delivery vector to simultaneously target liver parenchyma for endocrine and renal tubular epithelium for paracrine therapeutic expression of the antifibrogenic cytokine human hepatocyte growth factor (hHGF). We used transcriptional targeting to drive hHGF expression from the newly developed CMV-enhancer-Ksp-cadherin-promoter (CMV-Ksp) in renal and hepatic tissue following tail vein injection of rAAV9-CMV-Ksp-hHGF into COL4A3-deficient mice. The therapeutic efficiency of our approach was demonstrated by a remarkable attenuation of tubulointerstitial fibrosis and repression of fibrotic markers such as collagen1α1 (Col1A1), platelet-derived growth factor receptor-β (PDGFR-β), and α-smooth muscle actin (SMA). Taken together, our results show the great potential of rAAV9 as an intravenously applicable vector for the combined paracrine and endocrine expression of antifibrogenic factors in the treatment of renal failure caused by tubulointerstitial fibrosis. PMID:20424598

  2. Effective treatment of vascular endothelial growth factor refractory hindlimb ischemia by a mutant endothelial nitric oxide synthase gene.

    PubMed

    Qian, H S; Liu, P; Huw, L-Y; Orme, A; Halks-Miller, M; Hill, S M; Jin, F; Kretschmer, P; Blasko, E; Cashion, L; Szymanski, P; Vergona, R; Harkins, R; Yu, J; Sessa, W C; Dole, W P; Rubanyi, G M; Kauser, K

    2006-09-01

    Gene delivery of angiogenic growth factors is a promising approach for the treatment of ischemic cardiovascular diseases. However, success of this new therapeutic principle is hindered by the lack of critical understanding as to how disease pathology affects the efficiency of gene delivery and/or the downstream signaling pathways of angiogenesis. Critical limb ischemia occurs in patients with advanced atherosclerosis often exhibiting deficiency in endothelial nitric oxide production. Similar to these patients, segmental femoral artery resection progresses into severe ischemic necrosis in mice deficient in endothelial nitric oxide synthase (ecNOS-KO) as well as in balb/c mice. We used these models to evaluate the influence of severe ischemia on transfection efficiency and duration of transgene expression in the skeletal muscle following plasmid injection in combination with electroporation. Subsequently, we also explored the potential therapeutic effect of the phosphomimetic mutant of ecNOS gene (NOS1177D) using optimized delivery parameters, and found significant benefit both in ecNOS-KO and balb/c mice. Our results indicate that NOS1177D gene delivery to the ischemic skeletal muscle can be efficient to reverse critical limb ischemia in pathological settings, which are refractory to treatments with a single growth factor, such as vascular endothelial growth factor. PMID:16642030

  3. Predictive factors for renal failure and a control and treatment algorithm

    PubMed Central

    Cerqueira, Denise de Paula; Tavares, José Roberto; Machado, Regimar Carla

    2014-01-01

    Objectives to evaluate the renal function of patients in an intensive care unit, to identify the predisposing factors for the development of renal failure, and to develop an algorithm to help in the control of the disease. Method exploratory, descriptive, prospective study with a quantitative approach. Results a total of 30 patients (75.0%) were diagnosed with kidney failure and the main factors associated with this disease were: advanced age, systemic arterial hypertension, diabetes mellitus, lung diseases, and antibiotic use. Of these, 23 patients (76.6%) showed a reduction in creatinine clearance in the first 24 hours of hospitalization. Conclusion a decline in renal function was observed in a significant number of subjects, therefore, an algorithm was developed with the aim of helping in the control of renal failure in a practical and functional way. PMID:26107827

  4. The Upper Respiratory Pyramid: Early Factors and Later Treatment Utilization in World Trade Center Exposed Firefighters

    PubMed Central

    Niles, Justin K.; Webber, Mayris P.; Liu, Xiaoxue; Zeig-Owens, Rachel; Hall, Charles B.; Cohen, Hillel W.; Glaser, Michelle S.; Weakley, Jessica; Schwartz, Theresa M.; Weiden, Michael D.; Nolan, Anna; Aldrich, Thomas K.; Glass, Lara; Kelly, Kerry J.; Prezant, David J.

    2015-01-01

    Background We investigated early post 9/11 factors that could predict rhinosinusitis healthcare utilization costs up to 11 years later in 8,079 World Trade Center-exposed rescue/recovery workers. Methods We used bivariate and multivariate analytic techniques to investigate utilization outcomes; we also used a pyramid framework to describe rhinosinusitis healthcare groups at early (by 9/11/2005) and late (by 9/11/2012) time points. Results Multivariate models showed that pre-9/11/2005 chronic rhinosinusitis diagnoses and nasal symptoms predicted final year healthcare utilization outcomes more than a decade after WTC exposure. The relative proportion of workers on each pyramid level changed significantly during the study period. Conclusions Diagnoses of chronic rhinosinusitis within 4 years of a major inhalation event only partially explain future healthcare utilization. Exposure intensity, early symptoms and other factors must also be considered when anticipating future healthcare needs. PMID:24898816

  5. Clinical experiences and current evidence for therapeutic recombinant factor VIIa treatment in nontrauma settings.

    PubMed

    Grounds, R Michael; Bolan, Charles

    2005-01-01

    The hemostatic properties of recombinant activated factor VII (rFVIIa) are established in patients with inherited or acquired hemophilia with inhibitors and in patients with congenital factor VII deficiencies. Emerging clinical evidence suggests that there may be a wider role for rFVIIa in the management of hemorrhage associated with traumatic injury/accident and severe bleeding associated with critical surgery. This article considers recent data from studies in which rFVIIa was used in an attempt to control bleeding in clinical situations as diverse as coagulopathy associated with chronic liver disease, massive perioperative bleeding and bleeding during prostatectomy, organ transplantation and orthopedic surgery, uncontrollable obstetric hemorrhage, and intracerebral hemorrhage. In nontrauma settings involving acute and potentially life threatening bleeding, there may be a place for rFVIIa as adjunctive therapy in the control of hemostasis. PMID:16221317

  6. Factors influencing sustainable efficacy of smoking cessation treatment with varenicline beyond nine months

    PubMed Central

    Shimadu, Satoko; Hamajima, Nobuyuki; Okada, Yu; Oguri, Tomoyo; Murohara, Toyoaki; Ban, Nobutaro; Sato, Mitsuo; Hasegawa, Yoshinori

    2016-01-01

    ABSTRACT Pharmacological therapies play an important role in the success of interventions for smoking cessation; however, long-term follow-up studies with analysis of influencing factors are scarce. We examined the sustainable effects of smoking cessation therapy with varenicline, beyond nine months as well as the factors influencing effectiveness. Our sample consisted of 193 patients (126 men [68.2%], 67 women [31.8%], aged 26 to 85 years) who underwent varenicline therapy at the Nagoya University Hospital between January 2009 and October 2013. We examined their clinical records and also conducted a mail survey and evaluated success rates of smoking cessation therapy beyond nine months. Overall, 95.8% (185/193) of the patients had at least one complication. The response rate of questionnaires at the end of smoking cessation was 61.6% (119/193). The smoking cessation rate continued to decline for one year and leveled off afterwards. Smoking cessation rates tended to correlate with an increasing number of outpatient visits. Logistic regression analysis showed that two factors, young age and high Beck Depression Inventory-II (BDI-II) scores, were inversely correlated with success rates of smoking cessation. From the results of this study, aggressive intervention would needed for younger patients or patients with higher BDI-II scores. PMID:27303107

  7. Factors influencing sustainable efficacy of smoking cessation treatment with varenicline beyond nine months.

    PubMed

    Shimadu, Satoko; Hamajima, Nobuyuki; Okada, Yu; Oguri, Tomoyo; Murohara, Toyoaki; Ban, Nobutaro; Sato, Mitsuo; Hasegawa, Yoshinori

    2016-05-01

    Pharmacological therapies play an important role in the success of interventions for smoking cessation; however, long-term follow-up studies with analysis of influencing factors are scarce. We examined the sustainable effects of smoking cessation therapy with varenicline, beyond nine months as well as the factors influencing effectiveness. Our sample consisted of 193 patients (126 men [68.2%], 67 women [31.8%], aged 26 to 85 years) who underwent varenicline therapy at the Nagoya University Hospital between January 2009 and October 2013. We examined their clinical records and also conducted a mail survey and evaluated success rates of smoking cessation therapy beyond nine months. Overall, 95.8% (185/193) of the patients had at least one complication. The response rate of questionnaires at the end of smoking cessation was 61.6% (119/193). The smoking cessation rate continued to decline for one year and leveled off afterwards. Smoking cessation rates tended to correlate with an increasing number of outpatient visits. Logistic regression analysis showed that two factors, young age and high Beck Depression Inventory-II (BDI-II) scores, were inversely correlated with success rates of smoking cessation. From the results of this study, aggressive intervention would needed for younger patients or patients with higher BDI-II scores. PMID:27303107

  8. Treatment Recommendations for Locally Advanced, Non-Small-Cell Lung Cancer: The Influence of Physician and Patient Factors

    SciTech Connect

    Lee, Irwin H.; Hayman, James A.; Landrum, Mary Beth; Tepper, Joel; Goodman, Karyn A.; Keating, Nancy L.

    <