Cancer Specific Mortality in Men Diagnosed with Prostate Cancer before Age 50 Years: A Nationwide Population Based Study.

PubMed

Thorstenson, Andreas; Garmo, Hans; Adolfsson, Jan; Bratt, Ola

2017-01-01

We compared clinical characteristics and cancer specific mortality in men diagnosed with prostate cancer before vs after age 50 years. A total of 919 men 35 to 49 years old and 45,098 men 50 to 66 years old who were diagnosed with prostate cancer between 1998 and 2012 were identified in PCBaSe (Prostate Cancer data Base Sweden). Cancer specific mortality was compared among age groups (35 to 49, 50 to 59, 60 to 63 and 64 to 66 years) with and without adjusting for cancer characteristics, comorbidity and education in a multivariable Cox proportional hazards model. Clinical cancer characteristics indicated that most nonmetastatic cancer in men younger than 50 years was detected after prostate specific antigen testing. The proportion of nonmetastatic vs metastatic disease at diagnosis was similar in all age groups. A strong association between younger age and poor prognosis was apparent in men in whom metastatic disease was diagnosed before age 50 to 55 years. The crude and adjusted HRs of cancer specific mortality were 1.41 (95% CI 1.12-1.79) and 1.28 (95% CI 1.01-1.62) in men diagnosed before age 50 and at age 50 to 59 years, respectively. In men with nonmetastatic disease crude cancer specific mortality increased with older age but adjusted cancer specific mortality was similar in all age groups. Our findings suggest that an aggressive form of metastatic prostate cancer is particularly common in men younger than 50 to 55 years. Genetic studies and trials of intensified systemic treatment are warranted in this patient group. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Pre-deployment Year Mental Health Diagnoses and Treatment in Deployed Army Women

PubMed Central

Adams, Rachel Sayko; Mohr, Beth A.; Jeffery, Diana D.; Funk, Wendy; Williams, Thomas V.; Larson, Mary Jo

2016-01-01

We estimated the prevalence of select mental health diagnoses (MHDX) and mental health treatment (MHT), and identified characteristics associated with MHT during the pre-deployment year (365 days before deployment) in active duty Army women (N = 14,633) who returned from Iraq or Afghanistan deployments in FY2010. Pre-deployment year prevalence estimates were: 26.2 % for any select MHDX and 18.1 % for any MHT. Army women who had physical injuries since FY2002 or any behavioral health treatment between FY2002 and the pre-deployment year had increased odds of pre-deployment year MHT. During the pre-deployment year, a substantial percentage of Army women had MHDX and at least one MHT encounter or stay. Future research should determine if pre-deployment MHDX among Army women reflect vulnerability to future MHDX, or if pre-deployment MHT results in protection from chronic symptoms. PMID:27368233

Pre-deployment Year Mental Health Diagnoses and Treatment in Deployed Army Women.

PubMed

Wooten, Nikki R; Adams, Rachel Sayko; Mohr, Beth A; Jeffery, Diana D; Funk, Wendy; Williams, Thomas V; Larson, Mary Jo

2017-07-01

We estimated the prevalence of select mental health diagnoses (MHDX) and mental health treatment (MHT), and identified characteristics associated with MHT during the pre-deployment year (365 days before deployment) in active duty Army women (N = 14,633) who returned from Iraq or Afghanistan deployments in FY2010. Pre-deployment year prevalence estimates were: 26.2 % for any select MHDX and 18.1 % for any MHT. Army women who had physical injuries since FY2002 or any behavioral health treatment between FY2002 and the pre-deployment year had increased odds of pre-deployment year MHT. During the pre-deployment year, a substantial percentage of Army women had MHDX and at least one MHT encounter or stay. Future research should determine if pre-deployment MHDX among Army women reflect vulnerability to future MHDX, or if pre-deployment MHT results in protection from chronic symptoms.

DSM-IV Diagnoses and Obstructive Sleep Apnea in Children Before and 1 Year after Adenotonsillectomy

ERIC Educational Resources Information Center

Dillon, James E.; Blunden, Sarah; Ruzicka, Deborah L.; Guire, Kenneth E.; Champine, Donna; Weatherly, Robert A.; Hodges, Elise K.; Giordani, Bruno J.; Chervin, Ronald D.

2007-01-01

DSM-IV criteria-based psychiatric diagnoses done in children before and one year after adenotonsillectomy are assessed to record any improvement in behavior. It is found that surgery might be associated with reduced behavioral morbidity.

Afghanistan and Iraq War Veterans: Mental Health Diagnoses are Associated with Respiratory Disease Diagnoses.

PubMed

Slatore, Christopher G; Falvo, Michael J; Nugent, Shannon; Carlson, Kathleen

2018-05-01

Many veterans of the wars in Afghanistan and Iraq have concomitant respiratory conditions and mental health conditions. We wanted to evaluate the association of mental health diagnoses with respiratory disease diagnoses among post-deployment veterans. We conducted a retrospective cohort study of all Afghanistan and Iraq War veterans who were discharged from the military or otherwise became eligible to receive Veterans Health Administration services. The primary exposure was receipt of a mental health diagnosis and the primary outcome was receipt of a respiratory diagnosis as recorded in the electronic health record. We used multivariable adjusted logistic regression to measure the associations of mental health diagnoses with respiratory diagnoses and conducted several analyses exploring the timing of the diagnoses. Among 182,338 post-deployment veterans, 14% were diagnosed with a respiratory condition, 77% of whom had a concomitant mental health diagnosis. The incidence rates were 5,363/100,000 person-years (p-y), 587/100,000 p-y, 1,450/100,000 p-y, and 233/100,000 p-y for any respiratory disease diagnosis, bronchitis, asthma, and chronic obstructive lung disease diagnoses, respectively, after the date of first Veterans Health Administration utilization. Any mental health diagnosis was associated with increased odds for any respiratory diagnosis (adjusted odds ratio 1.41, 95% confidence interval 1.37-1.46). The association of mental health diagnoses and subsequent respiratory disease diagnoses was stronger and more consistent than the converse. Many Afghanistan and Iraq War veterans are diagnosed with both respiratory and mental illnesses. Comprehensive plans that include care coordination with mental health professionals and treatments for mental illnesses may be important for many veterans with respiratory diseases.

Sigmoid-vaginal fistula during bevacizumab treatment diagnosed by fistulography.

PubMed

Hayashi, C; Takada, S; Kasuga, A; Shinya, K; Watanabe, M; Kano, H; Takayama, T

2016-12-01

There have been several reports describing rectovaginal fistula development after bevacizumab treatment, and these fistulas were diagnosed by CT scan or colonoscopy. We report a case of sigmoid-vaginal fistula diagnosed by fistulography. The case is a 53-year-old woman who was treated for chronic myelogenous leukaemia and gynaecological cancers 8 years previously. At 52 years of age, she was diagnosed with colon cancer and had a partial colectomy performed. One year after surgery, colon cancer recurred, and she was treated with anticancer agents, including bevacizumab. During chemotherapy, she complained of a foul smelling discharge from the vagina. Fistulography revealed a sigmoid-vaginal fistula. This is the first report of vaginal fistulography performed on a patient who was treated with bevacizumab. Fistulography may be useful for detecting sigmoid-vaginal fistula. © 2016 John Wiley & Sons Ltd.

Predictive factors for disability pension--an 11-year follow up of young persons on sick leave due to neck, shoulder, or back diagnoses.

PubMed

Borg, K; Hensing, G; Alexanderson, K

2001-06-01

Although back diagnoses are recurrent and the main diagnoses behind sickness absence and disability pension surprisingly few longitudinal studies have been performed. This study identifies predictive factors for disability pension among young persons initially sick-listed with back diagnoses. An 11-year prospective cohort study was conducted, including all individuals in a Swedish city who, in 1985, were aged 25-34 and sick-listed > or =28 days owing to neck, shoulder, or back diagnoses (n = 213). The following data was obtained: disability pension, emigration, and death for 1985-96, sickness absence for 1982-84, and demographics in 1985 regarding sex, income, occupation, marital status, diagnosis, socioeconomic group, and citizenship. Cox regression and life tables were used in the analyses. In 1996, i.e. within 11 years, 22% of the individuals (27% of the women and 14% of the men) had been granted disability pension. The relative risk for disability pension was higher for women (2.4; p = 0.010), persons with foreign citizenship (3.6; p=0.009), and those who had had >14 sick-leave days per spell during the three years before inclusion, compared to those with <7 days/spell (3.1; p=0.003). This cohort of young persons proved to be a high-risk group for disability pension. Some of the factors known to predict long-time sickness absence also predict disability pension in a cohort of already sick-listed persons.

Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States.

PubMed

Biggs, M Antonia; Neuhaus, John M; Foster, Diana G

2015-12-01

We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion. We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility's gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals. The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits. Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term.

Diagnosing cystic fibrosis in newborn screening in Poland - 15 years of experience.

PubMed

Sands, Dorota; Zybert, Katarzyna; Mierzejewska, Ewa; Ołtarzewski, Mariusz

2015-01-01

Early diagnosis of cystic fibrosis (CF) made by the introduction of CF NBS (Cystic Fibrosis Newborn Screening) provides the opportunity to undertake preventive measures and provide treatment before the development of irreversible changes in the respiratory tract and other complications. CF NBS was conducted as a pilot programme in four Polish districts in the period 1999-2003. In 2006 CF NBS started again and was gradually extended across the country. The aim of this study was to show the evolution of the Polish CF NBS strategies and assess the diagnostic consequences of this programme. The study involved children diagnosed and treated only in the IMiD Centre. The strategy in Polish CF NBS was modified over time. Firstly, the model IRT/IRT and IRT/IRT/DNA with one mutation was implemented, which was followed by IRT/DNA with a gradually expanding number of CFTR mutations (tab. I). Newborns with positive results of CF NBS were called to the CF IMiD Centre, and sweat tests were performed. The children diagnosed and children with mutations in both alleles of the CFTR gene even if at least one of them had undefined pathogenicity) were taken under IMiD Centre care. Sensitivity, specificity and positive predictive values during subsequent stages of CF NBS were calculated (tab. III). During the 1999-2003 pilot study 444 063 newborns underwent CF NBS and in 74 cases CF was diagnosed. 582 693 newborns were screened from September 2006 to December 2011 in four regions and 100 children were diagnosed with CF. The frequencies of CF in the Polish population in both screening periods were 1:5767 and 1:5712 respectively. Firstly, the IRT/IRT model was implemented, but the number of newborns called to the CF Centre was high - the PPV was 7.6%. In the next step CF NBS DNA analysis was used. Here sensitivity and specificity were high - nearly 100%. In the following years the number of mutations detected was expanded (including 16 most common ones in the Polish population). Due to the

Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States

PubMed Central

Neuhaus, John M.; Foster, Diana G.

2015-01-01

Objectives. We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion. Methods. We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility’s gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals. Results. The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits. Conclusions. Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term. PMID:26469674

Diagnoses during follow-up of patients presenting with fatigue in primary care.

PubMed

Nijrolder, Iris; van der Windt, Daniëlle; de Vries, Henk; van der Horst, Henriëtte

2009-11-10

Little is known about the distribution of diagnoses that account for fatigue in patients in primary care. We evaluated the diagnoses established within 1 year after presentation with fatigue in primary care that were possibly associated with the fatigue. We conducted a prospective observational cohort study with 1-year follow-up. We included adult patients who presented with a new episode of fatigue between June 2004 and January 2006. We extracted data on diagnoses during the follow-up period from the patients' medical records as well as data on pre-existing chronic diseases. Of the 571 patients for whom diagnostic data were available, 268 (46.9%) had received one or more diagnoses that could be associated with fatigue. The diagnoses were diverse and mostly included symptom diagnoses, with main categories being musculoskeletal (19.4%) and psychological problems (16.5%). Clear somatic pathology was diagnosed in 47 (8.2%) of the patients. Most diagnoses were not made during the consultation when fatigue was presented. Only a minority of patients were diagnosed with serious pathology. Half of the patients did not receive any diagnosis that could explain their fatigue. Nevertheless, because of the wide range of conditions and symptoms that may explain or co-occur with the fatigue, fatigue is a complex problem that deserves attention not only as a symptom of underlying specific disease.

Diagnosing pediatric functional abdominal pain in children (4-15 years old) according to the Rome III Criteria: results from a Norwegian prospective study.

PubMed

Helgeland, Helene; Flagstad, Gro; Grøtta, Jon; Vandvik, Per Olav; Kristensen, Hanne; Markestad, Trond

2009-09-01

To determine the proportion of referred children with nonorganic abdominal pain who meet the criteria for 1 or more diagnoses of functional gastrointestinal disorders (FGID), explore the distribution of diagnoses according to the revised pediatric Rome III criteria (PRC-III), and to investigate reasons for failure to meet these criteria. We recruited children (4-15 years) consecutively referred by general practitioners to 4 general pediatric outpatient clinics for the evaluation of recurrent abdominal pain. FGID diagnoses were based on the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version, completed by parents. To exclude organic disease, all patients underwent medical investigations and were reevaluated at follow-up after 6 to 9 months. Of the 152 patients included, 142 (93%) had functional abdominal pain. Of these, 124 (87%) met the criteria for 1 or more diagnoses according to the PRC-III: 66% met the criteria for 1, 29% for 2, and 5% for 3 diagnoses. Irritable bowel syndrome was the most common diagnosis (43%) and overlapped with aerophagia in 16 children (38% of the children with overlapping diagnoses) and with abdominal migraine in 14 (33%). In the 18 patients (13%) not fulfilling the PRC-III for any FGID diagnosis, the main reason was insufficient pain frequency (83%). Of the referred children with functional abdominal pain, 87% met the PRC-III for specific diagnoses. This supports the use of these criteria as a diagnostic tool. The significant overlap between different FGIDs, however, makes it unclear whether some of the diagnoses represent distinct disorders or artificial categories.

Newly diagnosed thyrotoxicosis in hospitalized patients: clinical characteristics.

PubMed

Rotman-Pikielny, P; Borodin, O; Zissin, R; Ness-Abramof, R; Levy, Y

2008-11-01

Thyrotoxicosis is often diagnosed in an outpatient setting. The most common symptoms include irritability, heat intolerance, palpitations and weakness. Sometimes, however, thyrotoxicosis is first diagnosed in the hospital setting. The prevalent symptoms in hospitalized patients with newly diagnosed thyrotoxicosis have not been fully characterized. To determine the clinical characteristics of patients with thyrotoxicosis newly diagnosed during hospitalization. A retrospective computer-based search was undertaken to detect patients that were hospitalized in our medical centre during 1999-2006, and discharged with thyrotoxicosis or thyroiditis as the primary diagnosis. Fifty-eight patients (36F/22M; mean age 52.1 +/- 17.5 years) were identified. Weakness, weight loss and palpitations were the most common manifestations (50, 40 and 35%, respectively) and were predominantly present in patients with hyperthyroidism. Sore throat was present in 41% of patients with thyroiditis. Sinus tachycardia and atrial fibrillation occurred in 65.5 and 15.5% of the patients, more common in those with hyperthyroidism. The diagnoses on discharge were Graves' disease, subacute thyroiditis and multinodular goiter in 39.7, 34.5 and 8.9%, respectively. Weakness, weight loss and palpitations were the main symptoms in patients diagnosed with thyrotoxicosis during hospitalization. Thyrotoxicosis should be included in the differential diagnosis when patients are admitted to the hospital with those symptoms.

Ameloblastomas: Clinicopathological features from 70 cases diagnosed in a single Oral Pathology service in an 8-year period

PubMed Central

Filizzola, Andressa-Incerte; Bartholomeu-dos-Santos, Teresa-Cristina-Ribeiro

2014-01-01

Ameloblastomas are odontogenic tumors that can present some distinct clinicopathological profiles when comparing different populations and studies. Objectives: The aim of the present study was to analyze the clinicopathological features from a series of ameloblastomas diagnosed in a single Oral Pathology service in Brazil in an 8-year period. Study Design: The files were revised and all cases diagnosed as ameloblastomas in the period were retrieved. All hematoxylin and eosin stained histological slides were reviewed and all clinical and radiological information were obtained through a review of the laboratory forms. Data were descriptively analyzed and a comparison was performed with the different ameloblastomas subtypes. Results: Seventy ameloblastomas composed the final sample, including 57 (81%) solid/multicystic, 9 (13%) unicystic, 2 (3%) desmoplastic and 2 (3%) peripheral ameloblastomas. Mean age of the affected patients was in the forth decade of life and there was a slight male predominance. Most tumors presented as multilocular radiolucencies, were located in the posterior mandible and showed the follicular and plexiform histological patterns. There was no difference on the mean age of the patients affected by solid and unicystic ameloblastomas. Conclusions: The present results showed that the clinicopathological features of the ameloblastomas included in this Brazilian sample were similar to the features described in most other worldwide populations. Key words:Ameloblastoma, solid, unicystic, review, epidemiology, histology. PMID:25129244

HIV Diagnoses Among Persons Aged 13-29 Years - United States, 2010-2014.

PubMed

Ocfemia, M Cheryl Bañez; Dunville, Richard; Zhang, Tianchi; Barrios, Lisa C; Oster, Alexandra M

2018-02-23

In 2014, persons aged 13-29 years represented 23% of the U.S. population, yet accounted for 40% of diagnoses of human immunodeficiency virus (HIV) infection during the same year (1). During 2010-2014, the rates of diagnosis of HIV infection decreased among persons aged 15-19 years, were stable among persons aged 20-24 years, and increased among persons aged 25-29 years (1). However, these 5-year age groups encompass multiple developmental stages and potentially mask trends associated with the rapid psychosocial changes during adolescence through young adulthood. To better understand HIV infection among adolescents aged 13-17 years and young adults aged 18-29 years in the United States and identify ideal ages to target primary HIV prevention efforts, CDC analyzed data from the National HIV Surveillance System (NHSS)* using narrow age groups. During 2010-2014, rates of diagnosis of HIV infection per 100,000 population varied substantially among persons aged 13-15 years (0.7), 16-17 years (4.5), 18-19 years (16.5), and 20-21 years (28.6), and were higher, but less variable, among persons aged 22-23 years (34.0), 24-25 years (33.8), 26-27 years (31.3), and 28-29 years (28.7). In light of the remarkable increase in rates between ages 16-17, 18-19, and 20-21 years, and a recent study revealing that infection precedes diagnosis for young persons by an average of 2.7 years (2), these findings demonstrate the importance of targeting primary prevention efforts to persons aged <18 years and continuing through the period of elevated risk in their mid-twenties.

Patterns of Somatic Diagnoses in Older People with Intellectual Disability: A Swedish Eleven Year Case-Control Study of Inpatient Data

ERIC Educational Resources Information Center

Sandberg, Magnus; Ahlström, Gerd; Kristensson, Jimmie

2017-01-01

Background: Knowledge about diagnoses patterns in older people with intellectual disabilities is limited. Methods: The case group (n = 7936) comprised people with intellectual disabilities aged 55 years and older. The control group (n = 7936) was age matched and sex matched. Somatic inpatient diagnoses (2002-2012) were collected retrospectively.…

Work-loss years among people diagnosed with diabetes: a reappraisal from a life course perspective.

PubMed

von Bonsdorff, Mikaela B; von Bonsdorff, Monika E; Haanpää, Maija; Salonen, Minna; Mikkola, Tuija M; Kautiainen, Hannu; Eriksson, Johan G

2018-05-01

Early exit from the workforce has been proposed to be one of the unfavorable consequences of diabetes. We examined whether early exit from the workforce differed between persons who were and were not diagnosed with diabetes during their work career. The cohort included 12,726 individuals of the Helsinki Birth Cohort Study, born between 1934 and 1944. Using data from nationwide registers, the cohort was followed up from early adulthood until they transitioned into retirement or died. Work-loss years were estimated using the restricted mean work years method. During a follow-up of 382,328 person-years for men and 349 894 for women, 36.8% transitioned into old age pension and 63.2% exited workforce early. Among men, 40.5% of those with and 32.8% of those without diabetes transitioned into old age pension (p=0.003). The corresponding numbers for women were 48.6% and 40.4% (p = 0.013), respectively. Mean age at exit from the workforce was 60.1 (95% confidence interval [CI], 59.6 to 60.7) years among men with diabetes and 57.6 (95% CI, 57.2 to 58.0) years among men without diabetes (p = 0.016). Among women, corresponding ages were 61.4 (95% CI, 60.8 to 61.9) years for those with diabetes and 59.5 (95% CI, 59.3 to 59.7) years for those without diabetes (p < 0.001). The difference in mean restricted work-loss years according to diabetes was 2.5 (95% CI 0.5 to 4.6) for men and 1.9 (95% CI 1.0 to 2.8) for women. Among individuals followed up throughout their work career, those with a diabetes diagnosis exited the workforce approximately two years later compared to those without diabetes.

No 'cure' within 12 years of diagnosis among breast cancer patients who are diagnosed via mammographic screening: women diagnosed in the West Midlands region of England 1989-2011.

PubMed

Woods, L M; Morris, M; Rachet, B

2016-11-01

We have previously reported that there is little evidence of population 'cure' among two populations of women diagnosed with invasive breast cancer. 'Cure' has not yet been examined in the context of screen-detection. We examined cancer registry data on 19 800 women aged 50-70, diagnosed with a primary, invasive, non-metastatic breast cancer between 1 April 1989 and 31 March 2011 in the West Midlands region of England, linked to Hospital Episode Statistics (HES) and the National Breast Screening Service (NBSS). Follow-up was complete on all women up to 31 July 2012. Analyses were stratified by screening status, age, tumour stage, deprivation and ethnicity. We estimated net survival for the whole cohort and each subgroup. Population 'cure' was evaluated by fitting flexible parametric log-cumulative excess hazard regression models in which the excess hazard of breast cancer death was assumed to be equal to zero after a given follow-up time. There was an overall lack of evidence for 'cure'. Across all subgroups examined, the general pattern was that of a continuous decrease in net survival over time, with no obvious asymptotic tendency within 12 years of follow-up. Model-based analyses confirmed this observation. Despite dramatic improvements in survival over past decades, diagnosis with breast cancer remains associated with a small but persistent increased risk of death for all groups of women, including those whose cancer is detected asymptomatically. These findings are unlikely to be due to methodological inadequacies. Communication of these long-term consequences of breast cancer among women recently diagnosed and to those considering undergoing screening should take due consideration of these patterns. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology.

HIV Trends in the United States: Diagnoses and Estimated Incidence

PubMed Central

Song, Ruiguang; Tang, Tian; An, Qian; Prejean, Joseph; Dietz, Patricia; Hernandez, Angela L; Green, Timothy; Harris, Norma; McCray, Eugene; Mermin, Jonathan

2017-01-01

Background The best indicator of the impact of human immunodeficiency virus (HIV) prevention programs is the incidence of infection; however, HIV is a chronic infection and HIV diagnoses may include infections that occurred years before diagnosis. Alternative methods to estimate incidence use diagnoses, stage of disease, and laboratory assays of infection recency. Using a consistent, accurate method would allow for timely interpretation of HIV trends. Objective The objective of our study was to assess the recent progress toward reducing HIV infections in the United States overall and among selected population segments with available incidence estimation methods. Methods Data on cases of HIV infection reported to national surveillance for 2008-2013 were used to compare trends in HIV diagnoses, unadjusted and adjusted for reporting delay, and model-based incidence for the US population aged ≥13 years. Incidence was estimated using a biomarker for recency of infection (stratified extrapolation approach) and 2 back-calculation models (CD4 and Bayesian hierarchical models). HIV testing trends were determined from behavioral surveys for persons aged ≥18 years. Analyses were stratified by sex, race or ethnicity (black, Hispanic or Latino, and white), and transmission category (men who have sex with men, MSM). Results On average, HIV diagnoses decreased 4.0% per year from 48,309 in 2008 to 39,270 in 2013 (P<.001). Adjusting for reporting delays, diagnoses decreased 3.1% per year (P<.001). The CD4 model estimated an annual decrease in incidence of 4.6% (P<.001) and the Bayesian hierarchical model 2.6% (P<.001); the stratified extrapolation approach estimated a stable incidence. During these years, overall, the percentage of persons who ever had received an HIV test or had had a test within the past year remained stable; among MSM testing increased. For women, all 3 incidence models corroborated the decreasing trend in HIV diagnoses, and HIV diagnoses and 2 incidence

Outcome of intrahepatic portosystemic shunt diagnosed prenatally.

PubMed

Francois, Bérengère; Gottrand, Fréderic; Lachaux, Alain; Boyer, Corinne; Benoit, Bernard; De Smet, Stéphanie

2017-12-01

We analyzed the characteristics of the population with congenital portosystemic shunt diagnosed during the antenatal period and the organization of their perinatal care. This multicentric retrospective study included all the patients with a prenatal diagnosis of congenital portosystemic shunt. Between 1999 and 2015, 12 patients were included. Prenatal diagnosis was done at a median 26.5 weeks of gestation (21-34). All the patients presented intrahepatic CPSS, three of them had associated congenital cardiopathy, and one a Bannayan-Zonana syndrome. Ten patients had simple outcome on conservative treatment, eight of them having a spontaneous closure of their portosystemic shunt within the first 2 years of life. One patient had surgical treatment which failed and he developed a focal nodular hyperplasia. Another patient had radiological interventional closure of his shunt which was complicated by a venal portal thrombosis. Outcome of intrahepatic portosystemic shunt diagnosed prenatally is good in the majority of cases. What is known: • Multiples studies exist on congenital porto systemic shunt but when the diagnosis is done after birth. • The evolution, management, and complication are well known. What is new: • There is very few studies with only patients diagnosed in antenatal and it is a large series of cases. • Outcome of intrahepatic portosystemic shunt diagnosed prenatally is good in the majority of cases.

Sociodemographic and behavioral characteristics associated with self-reported diagnosed diabetes mellitus in adults aged 50+ years in Ghana and South Africa: results from the WHO-SAGE wave 1

PubMed Central

Padyab, Mojgan; Schröders, Julia; Stewart Williams, Jennifer

2018-01-01

Objective The objective is to identify and describe the sociodemographic and behavioral characteristics of adults, aged 50 years and over, who self-reported having been diagnosed and treated for diabetes mellitus (DM) in Ghana and South Africa. Research design and methods This is a cross-sectional study based on the WHO Study on global AGEing and adult health (SAGE) wave 1. Information on sociodemographic factors, health states, risk factors and chronic conditions is captured from questionnaires administered in face-to-face interviews. Self-reported diagnosed and treated DM is confirmed through a ‘yes’ response to questions regarding 1 having previously been diagnosed with DM, and 2 having taken insulin or other blood sugar lowering medicines. Crude and adjusted logistic regressions test associations between candidate variables and DM status. Analyses include survey sampling weights. The variance inflation factor statistic tested for multicollinearity. Results In this nationally representative sample of adults aged 50 years and over in Ghana, after adjusting for the effects of sex, residence, work status, body mass index, waist-hip and waist-height ratios, smoking, alcohol, fruit and vegetable intake and household wealth, WHO-SAGE survey respondents who were older, married, had higher education, very high-risk waist circumference measurements and did not undertake high physical activity, were significantly more likely to report diagnosed and treated DM. In South Africa, respondents who were older, lived in urban areas and had high-risk waist circumference measurements were significantly more likely to report diagnosed and treated DM. Conclusions Countries in sub-Saharan Africa are challenged by unprecedented ageing populations and transition from communicable to non-communicable diseases such as DM. Information on those who are already diagnosed and treated needs to be combined with estimates of those who are prediabetic or, as yet, undiagnosed. Multisectoral

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

PubMed Central

Madden-Fuentes, Ramiro J.; McNamara, Erin R.; Nseyo, Unwanaobong; Wiener, John S.; Routh, Jonathan C.; Ross, Sherry S.

2015-01-01

Objective Diagnosis of low-grade hydronephrosis often occurs prenatally, during evaluation after urinary tract infection (UTI), or imaging for non-urologic reasons within the first year of life. Its significance in terms of resolution, need for antibiotic prophylaxis, or progression to surgery remains uncertain. We hypothesized that isolated low-grade hydronephrosis in this population frequently resolves, UTIs are infrequent, and progression to surgical intervention is minimal. Patients and methods Children <12 months old diagnosed hydronephrosis (Society for Fetal Urology [SFU] grade 1 or 2) between January 2004 and December 2009 were identified by ICD9 code. Patients with other urological abnormalities were excluded. Stability of hydronephrosis, UTI (≥100,000 CFU/mL bacterial growth) or need for surgical intervention was noted. Results Of 1496 infants with hydronephrosis, 416 (623 renal units) met inclusion criteria. Of 398 renal units with grade 1 hydronephrosis, 385 (96.7%) resolved or remained stable. Only 13 (3.3%) worsened, of which one underwent ureteroneocystostomy. Of 225 renal units with grade 2 hydro-nephrosis, 222 (98.7%) resolved, improved or remained stable, three (1.3%) worsened, of which one required pyeloplasty. Only 0.7% of patients in the ambulatory setting had a febrile UTI. Conclusions Low-grade hydronephrosis diagnosed within the first year of life remains stable or improves in 97.4% of renal units. Given the low rate of recurrent UTI in the ambulatory setting, antibiotic prophylaxis has a limited role in management. PMID:25185821

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life.

PubMed

Madden-Fuentes, Ramiro J; McNamara, Erin R; Nseyo, Unwanaobong; Wiener, John S; Routh, Jonathan C; Ross, Sherry S

2014-08-01

Diagnosis of low-grade hydronephrosis often occurs prenatally, during evaluation after urinary tract infection (UTI), or imaging for non-urologic reasons within the first year of life. Its significance in terms of resolution, need for antibiotic prophylaxis, or progression to surgery remains uncertain. We hypothesized that isolated low-grade hydronephrosis in this population frequently resolves, UTIs are infrequent, and progression to surgical intervention is minimal. Children < 12 months old diagnosed hydronephrosis (Society for Fetal Urology [SFU] grade 1 or 2) between January 2004 and December 2009 were identified by ICD9 code. Patients with other urological abnormalities were excluded. Stability of hydronephrosis, UTI (≥ 100,000 CFU/mL bacterial growth) or need for surgical intervention was noted. Of 1496 infants with hydronephrosis, 416 (623 renal units) met inclusion criteria. Of 398 renal units with grade 1 hydronephrosis, 385 (96.7%) resolved or remained stable. Only 13 (3.3%) worsened, of which one underwent ureteroneocystostomy. Of 225 renal units with grade 2 hydronephrosis, 222 (98.7%) resolved, improved or remained stable, three (1.3%) worsened, of which one required pyeloplasty. Only 0.7% of patients in the ambulatory setting had a febrile UTI. Low-grade hydronephrosis diagnosed within the first year of life remains stable or improves in 97.4% of renal units. Given the low rate of recurrent UTI in the ambulatory setting, antibiotic prophylaxis has a limited role in management. Copyright © 2014. Published by Elsevier Ltd.

Associations of physician-diagnosed asthma with country of residence in the first year of life and other immigration-related factors: Chicago asthma school study.

PubMed

Eldeirawi, Kamal M; Persky, Victoria W

2007-09-01

Among Mexican Americans in the United States, US-born children have higher rates of asthma than their Mexico-born peers. To evaluate the associations of immigration-related variables with physician-diagnosed asthma in a sample of Mexican American children. We analyzed data from the ongoing Chicago Asthma School Study, a population-based cross-sectional study, for 10,106 Mexican American schoolchildren in Chicago, Illinois. Mexican American children who lived in the United States in the first year of life were more likely to have physician-diagnosed asthma than their peers who lived in Mexico in the first year of life, independent of age, sex, income, language, and country of birth (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.09-2.94). The risk of asthma in US-born children was higher (but not significantly) than that observed in Mexico-born children after accounting for covariates, including country of residence in the first year of life (OR, 1.37; 95% CI, 0.86-2.18). Long-term immigrants (lived in the United States for 10 years) had an increased risk of asthma compared with short-term immigrants (lived in the United States for <10 years), independent of country of residence in the first year of life (OR, 1.93; 95% CI, 1.00-3.73). These findings confirm the importance of early childhood exposures and environmental factors that are modified with migration and acculturation in asthma development.

Five cases of neurocysticercosis diagnosed in Sydney.

PubMed

Walker, J; Chen, S; Packham, D; McIntyre, P

1991-12-01

Cysticercosis, once rare in Australia, is now more frequently diagnosed. This change reflects the countries of origin of new immigrants and the destinations of Australians travelling. Five cases of neurocysticercosis diagnosed at Westmead Hospital in Sydney are described. Two involved Australians, a father and son who had visited eastern and southeastern Asia 10 years before presentation. The other three included immigrants from Chile and India and a visitor from Timor. Ages ranged from 5 to 57 years. Three individuals presented after focal seizures involving the upper limb, one had a long standing history of neurological dysfunction and one suffered from persistent headaches. In all cases computed tomographic scanning (CT) or magnetic resonance imaging (MRI) revealed cystic brain lesions and three of the five were seropositive as well. Four were treated with praziquantel and in one the lesions regressed significantly following treatment. However, the lesion in one case had decreased in size prior to treatment and that in the untreated individual also became smaller.

Trends on epidemiological, virological, and clinical features among newly diagnosed HIV-1 persons in Northwest Spain over the last 10 years.

PubMed

Pernas, B; Mena, A; Cañizares, A; Grandal, M; Castro-Iglesias, A; Pértega, S; Pedreira, J D; Poveda, E

2015-08-01

To describe temporal trend and characteristics of newly HIV-diagnosed patients in a medical care area in Northwest Spain over the last 10 years. All newly diagnosed patients for HIV-infection from 2004 to 2013 at a reference medical care area in Northwest of Spain were identified. Epidemiological, virological, immunological, and clinical data, as well as HIV genotype and drug resistance information were recorded. A total of 565 newly HIV-diagnosed patients were identified. The number of new cases increased in the last 5 years (66 cases/year). Overall, 53.1% had a median CD4 counts < 350 cells/µl and 33.6% had an AIDS defining criteria. Non-B variants were found in 34.4% of patients being subtype F (25.8%) the most common non-B subtype. The rate of transmitted drug resistance (TDR) over the study period was 3.7%, but a decreased to 2.6% was observed in the last 5 years. The most prevalent TDR mutations were: T215 revertants (1.5%), K219QENR (1.2%), for NRTIs; K103N (1.9%), for NNRTIs; L90M (0.3%), for PIs. Overall, 73.2% of patients started antiretroviral treatment and 9.9% of patients died during follow-up. The number of newly HIV diagnosed patients increased since year 2009. There is a high prevalence of late diagnosis (53%) and 33% had an AIDS defining criteria. Interestingly, the most prevalent non-B subtype in our population was F (25.8%). These findings support the need to facilitate the access for HIV testing to reduce the rate of late HIV diagnosis, improve the clinical outcome and prevent HIV transmission. © 2015 Wiley Periodicals, Inc.

Functional performance of school children diagnosed with developmental delay up to two years of age

PubMed Central

Dornelas, Lílian de Fátima; Magalhães, Lívia de Castro

2016-01-01

Abstract Objective: To compare the functional performance of students diagnosed with developmental delay (DD) up to two years of age with peers exhibiting typical development. Methods: Cross-sectional study with functional performance assessment of children diagnosed with DD up to two years of age compared to those with typical development at seven to eight years of age. Each group consisted of 45 children, selected by non-random sampling, evaluated for motor skills, quality of home environment, school participation and performance. ANOVA and the Binomial test for two proportions were used to assess differences between groups. Results: The group with DD had lower motor skills when compared to the typical group. While 66.7% of children in the typical group showed adequate school participation, receiving aid in cognitive and behavioral tasks similar to that offered to other children at the same level, only 22.2% of children with DD showed the same performance. Although 53.3% of the children with DD achieved an academic performance expected for the school level, there were limitations in some activities. Only two indicators of family environment, diversity and activities with parents at home, showed statistically significant difference between the groups, with advantage being shown for the typical group. Conclusions: Children with DD have persistent difficulties at school age, with motor deficit, restrictions in school activity performance and low participation in the school context, as well as significantly lower functional performance when compared to children without DD. A systematic monitoring of this population is recommended to identify needs and minimize future problems. PMID:26553573

HIV Trends in the United States: Diagnoses and Estimated Incidence.

PubMed

Hall, H Irene; Song, Ruiguang; Tang, Tian; An, Qian; Prejean, Joseph; Dietz, Patricia; Hernandez, Angela L; Green, Timothy; Harris, Norma; McCray, Eugene; Mermin, Jonathan

2017-02-03

The best indicator of the impact of human immunodeficiency virus (HIV) prevention programs is the incidence of infection; however, HIV is a chronic infection and HIV diagnoses may include infections that occurred years before diagnosis. Alternative methods to estimate incidence use diagnoses, stage of disease, and laboratory assays of infection recency. Using a consistent, accurate method would allow for timely interpretation of HIV trends. The objective of our study was to assess the recent progress toward reducing HIV infections in the United States overall and among selected population segments with available incidence estimation methods. Data on cases of HIV infection reported to national surveillance for 2008-2013 were used to compare trends in HIV diagnoses, unadjusted and adjusted for reporting delay, and model-based incidence for the US population aged ≥13 years. Incidence was estimated using a biomarker for recency of infection (stratified extrapolation approach) and 2 back-calculation models (CD4 and Bayesian hierarchical models). HIV testing trends were determined from behavioral surveys for persons aged ≥18 years. Analyses were stratified by sex, race or ethnicity (black, Hispanic or Latino, and white), and transmission category (men who have sex with men, MSM). On average, HIV diagnoses decreased 4.0% per year from 48,309 in 2008 to 39,270 in 2013 (P<.001). Adjusting for reporting delays, diagnoses decreased 3.1% per year (P<.001). The CD4 model estimated an annual decrease in incidence of 4.6% (P<.001) and the Bayesian hierarchical model 2.6% (P<.001); the stratified extrapolation approach estimated a stable incidence. During these years, overall, the percentage of persons who ever had received an HIV test or had had a test within the past year remained stable; among MSM testing increased. For women, all 3 incidence models corroborated the decreasing trend in HIV diagnoses, and HIV diagnoses and 2 incidence models indicated decreases among blacks

A 27-year-old woman diagnosed as polycystic ovary syndrome associated with Graves' disease.

PubMed

Jung, Jung Hwa; Hahm, Jong Ryeal; Jung, Tae Sik; Kim, Hee Jin; Kim, Ho Soo; Kim, Sungsu; Kim, Soo Kyoung; Lee, Sang Min; Kim, Deok Ryong; Choi, Won Jun; Seo, Yeong Mi; Chung, Soon Il

2011-01-01

Polycystic ovary syndrome (PCOS) and Graves' disease are the common causes of menstrual irregularity leading to infertility in women of child-bearing age. A 21-year-old female patient visited us with complaints of oligomenorrhea and hand tremor. She was diagnosed as having PCOS and hyperthyroid Graves' disease, simultaneously. She had low body weight (BMI: 16.4 kg/m(2)), mild hirsutism, and thyrotoxicosis. The patient was treated with anti-thyroid drug and beta-blocker for about two years, and then recovered to normal thyroid function. Although some studies have suggested a connection between PCOS and autoimmune thyroiditis, no study indicated that PCOS is associated with Graves' disease until now. Here, we describe the first case report of a lean woman with normal insulin sensitivity presenting PCOS and Graves' disease simultaneously.

No ‘cure’ within 12 years of diagnosis among breast cancer patients who are diagnosed via mammographic screening: women diagnosed in the West Midlands region of England 1989–2011

PubMed Central

Woods, L. M.; Morris, M.; Rachet, B.

2016-01-01

Background We have previously reported that there is little evidence of population ‘cure’ among two populations of women diagnosed with invasive breast cancer. ‘Cure’ has not yet been examined in the context of screen-detection. Patients and methods We examined cancer registry data on 19 800 women aged 50–70, diagnosed with a primary, invasive, non-metastatic breast cancer between 1 April 1989 and 31 March 2011 in the West Midlands region of England, linked to Hospital Episode Statistics (HES) and the National Breast Screening Service (NBSS). Follow-up was complete on all women up to 31 July 2012. Analyses were stratified by screening status, age, tumour stage, deprivation and ethnicity. We estimated net survival for the whole cohort and each subgroup. Population ‘cure’ was evaluated by fitting flexible parametric log-cumulative excess hazard regression models in which the excess hazard of breast cancer death was assumed to be equal to zero after a given follow-up time. Results There was an overall lack of evidence for ‘cure’. Across all subgroups examined, the general pattern was that of a continuous decrease in net survival over time, with no obvious asymptotic tendency within 12 years of follow-up. Model-based analyses confirmed this observation. Conclusions Despite dramatic improvements in survival over past decades, diagnosis with breast cancer remains associated with a small but persistent increased risk of death for all groups of women, including those whose cancer is detected asymptomatically. These findings are unlikely to be due to methodological inadequacies. Communication of these long-term consequences of breast cancer among women recently diagnosed and to those considering undergoing screening should take due consideration of these patterns. PMID:27573567

[Functional performance of school children diagnosed with developmental delay up to two years of age].

PubMed

Dornelas, Lílian de Fátima; Magalhães, Lívia de Castro

2016-01-01

To compare the functional performance of students diagnosed with developmental delay (DD) up to two years of age with peers exhibiting typical development. Cross-sectional study with functional performance assessment of children diagnosed with DD up to two years of age compared to those with typical development at seven to eight years of age. Each group consisted of 45 children, selected by non-random sampling, evaluated for motor skills, quality of home environment, school participation and performance. ANOVA and the Binomial test for two proportions were used to assess differences between groups. The group with DD had lower motor skills when compared to the typical group. While 66.7% of children in the typical group showed adequate school participation, receiving aid in cognitive and behavioral tasks similar to that offered to other children at the same level, only 22.2% of children with DD showed the same performance. Although 53.3% of the children with DD achieved an academic performance expected for the school level, there were limitations in some activities. Only two indicators of family environment, diversity and activities with parents at home, showed statistically significant difference between the groups, with advantage being shown for the typical group. Children with DD have persistent difficulties at school age, with motor deficit, restrictions in school activity performance and low participation in the school context, as well as significantly lower functional performance when compared to children without DD. A systematic monitoring of this population is recommended to identify needs and minimize future problems. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

One-year renal and cardiac effects of bisoprolol versus losartan in recently diagnosed hypertensive patients: a randomized, double-blind study.

PubMed

Parrinello, Gaspare; Paterna, Salvatore; Torres, Daniele; Di Pasquale, Pietro; Mezzero, Manuela; La Rocca, Gabriella; Cardillo, Mauro; Trapanese, Caterina; Caradonna, Mario; Licata, Giuseppe

2009-01-01

Hypertension is a significant cause of chronic renal injury and its effective treatment is capable of reducing the rate of renal failure. beta-Adrenoceptor antagonists (beta-blockers) have been reported to induce a deterioration in renal function, while several data have indicated a renoprotective effect of treatment with the angiotensin II type 1 receptor antagonist losartan. Previous studies of the interaction between the selective beta(1)-blocker bisoprolol and kidney function were performed only for short- and medium-term periods. The aim of this study was to compare the antihypertensive efficacy and renal and cardiac haemodynamic effects of bisoprolol with those of losartan over a 1-year time period in patients with essential hypertension. Seventy-two patients (40 males) with recently diagnosed uncomplicated (European Society of Hypertension [ESH] criteria stage 1-2) hypertension (mean +/- SD age 52 +/- 12 years) were enrolled in the study. After a run-in period of 14 days on placebo, the patients were randomized in a double-blind, prospective study to receive either bisoprolol 5 mg or losartan 50 mg, administered once daily for 1 year. At recruitment and 12 months after treatment, cardiac output and renal haemodynamics and function were evaluated by echocardiography and radionuclide studies, respectively. There were no significant differences in baseline clinical data, including glomerular filtration rate and blood pressure, between the two treatment groups. At 1 year, blood pressure had decreased significantly (p < 0.001) with both treatments, and heart rate was reduced only in the group taking bisoprolol. The long-term effects on renal haemodynamics and cardiac function were similar with both drugs, the only change being a significant reduction in the filtration fraction for each group. These data suggest that both bisoprolol and losartan are effective agents for the treatment of patients with recently diagnosed ESH stage 1-2 hypertension. Over a 1-year

Changed terms for drug payment influenced GPs' diagnoses and prescribing practice for inhaled corticosteroids.

PubMed

Dalbak, Lene G; Rognstad, Sture; Melbye, Hasse; Straand, Jørund

2013-06-01

Inhaled glucocorticosteroids (ICS) are first-line anti-inflammatory treatment in asthma, but not in chronic obstructive pulmonary disease (COPD). To restrict ICS use in COPD to cases of severe disease, new terms for reimbursement of drug costs were introduced in Norway in 2006, requiring a diagnosis of COPD to be verified by spirometry. To describe how GPs' diagnoses and treatment of patients who used ICS before 2006 changed after a reassessment of the patients that included spirometry. From the shared electronic patient record system in one group practice, patients ≥ 50 years prescribed ICS (including in combination with long-acting beta2-agonists) during the previous year were identified and invited to a tailored consultation including spirometry to assure the quality of diagnosis and treatment. GPs' diagnoses and ICS prescribing patterns after this reassessment were recorded, retrospectively. Of 164 patients identified, 112 were included. Post-bronchodilator spirometry showed airflow limitation indicating COPD in 55 patients. Of the 57 remaining patients, five had a positive reversibility test. The number of patients diagnosed with asthma increased (from 25 to 62) after the reassessment. A diagnosis of COPD was also more frequently used, whereas fewer patients had other pulmonary diagnoses. ICS was discontinued in 31 patients; 20 with mild to moderate COPD and 11 with normal spirometry. Altered reimbursement terms for ICS changed GPs' diagnostic practice in a way that made the diagnoses better fit with the treatment given, but over-diagnosis of asthma could not be excluded. Spirometry was useful for identifying ICS overuse.

Time trends in lifetime incidence rates of first-time diagnosed anorexia nervosa and bulimia nervosa across 16 years in a Danish nationwide psychiatric registry study.

PubMed

Steinhausen, Hans-Christoph; Jensen, Christina Mohr

2015-11-01

To study recent time trends in the incidence of diagnosed anorexia nervosa (AN) and bulimia nervosa (BN) based on nationwide psychiatric register data. The Danish Psychiatric Central Research Registry was used to identify the incidence of diagnosed cases with AN and BN at the ages of 4-65 years from 1995 to 2010. Age- and sex-adjusted incidence rates per 100,000 person-years were calculated and were adjusted for time trends in the total number of people diagnosed in psychiatry. Time trends were analyzed using JoinPoint regression analysis. A total of N = 5,902 persons had a first-time incidence of AN, and a total of N = 5,113 had first-time incidence of BN. Incidence rates increased for AN from 6.4 to 12.6 per 100,000 person-years, and for BN from 6.3 to 7.2 per 100,000 person-years. In 2010, the male-to-female ratio was 1:8 for AN, and 1:20 for BN. There was an earlier onset for AN than for BN, and age at incidence decreased during the observation period for AN but not for BN. A sizeable part of the increasing incidence rates for AN and in particular, the younger AN age groups, could be attributed to an increase in the total number of N = 249,607 persons with first-time diagnoses in psychiatry. Incidence rates had increased slightly for AN, but were stable for BN across 16 years in this nationwide study and to a large extent were reflective of a general increase in diagnosed mental disorders. © 2015 Wiley Periodicals, Inc.

Otological diagnoses and probable age-related auditory neuropathy in "younger" and "older" elderly persons.

PubMed

Rosenhall, Ulf; Hederstierna, Christina; Idrizbegovic, Esma

2011-09-01

Audiological data from a population based epidemiological investigation were studied on elderly persons. Specific diagnoses of otological and audiological disorders, which can result in hearing loss, were searched for. A retrospective register study. Three age cohorts, 474 70- and 75-year olds ("younger"), and 252 85-year olds ("older"), were studied. Clinical pure tone and speech audiometry was used. Data from medical files were included. Conductive hearing loss was diagnosed in 6.1% of the "younger" elderly persons, and in 10.3% of the "older" ones. Specific diagnoses (chronic otitis media and otosclerosis) were established in about half of the cases. Sensorineural hearing loss, other than age-related hearing loss and noise induced hearing loss, was diagnosed in 3.4 % and 5.2% respectively. Severely impaired speech recognition, possibly reflecting age-related auditory neuropathy, was found in 0.4% in the "younger" group, and in 10% in the "older" group. Bilateral functional deafness was present in 3.2% of the 85-year-old persons, but was not present in the 70-75-year group. The incidence of probable age-related auditory neuropathy increases considerably from 70-75 to 85 years. There are marked differences between "younger" and "older" elderly persons regarding hearing loss that severely affects oral communication.

Serial analysis of 3D H-1 MRSI for patients with newly diagnosed GBM treated with combination therapy that includes bevacizumab.

PubMed

Nelson, Sarah J; Li, Yan; Lupo, Janine M; Olson, Marram; Crane, Jason C; Molinaro, Annette; Roy, Ritu; Clarke, Jennifer; Butowski, Nicholas; Prados, Michael; Cha, Soonmee; Chang, Susan M

2016-10-01

Interpretation of changes in the T1- and T2-weighted MR images from patients with newly diagnosed glioblastoma (GBM) treated with standard of care in conjunction with anti-angiogenic agents is complicated by pseudoprogression and pseudoresponse. The hypothesis being tested in this study was that 3D H-1 magnetic resonance spectroscopic imaging (MRSI) provides estimates of levels of choline, creatine, N-acetylaspartate (NAA), lactate and lipid that change in response to treatment and that metrics describing these characteristics are associated with survival. Thirty-one patients with newly diagnosed GBM and being treated with radiation therapy (RT), temozolomide, erlotinib and bevacizumab were recruited to receive serial MR scans that included 3-D lactate edited MRSI at baseline, mid-RT, post-RT and at specific follow-up time points. The data were processed to provide estimates of metrics representing changes in metabolite levels relative to normal appearing brain. Cox proportional hazards analysis was applied to examine the relationship of these parameters with progression free survival (PFS) and overall survival (OS). There were significant reductions in parameters that describe relative levels of choline to NAA and creatine, indicating that the treatment caused a decrease in tumor cellularity. Changes in the levels of lactate and lipid relative to the NAA from contralateral brain were consistent with vascular normalization. Metabolic parameters from the first serial follow-up scan were associated with PFS and OS, when accounting for age and extent of resection. Integrating metabolic parameters into the assessment of patients with newly diagnosed GBM receiving therapies that include anti-angiogenic agents may be helpful for tracking changes in tumor burden, resolving ambiguities in anatomic images caused by non-specific treatment effects and for predicting outcome.

Newly Diagnosed Meniere's Disease: Clinical Course With Initiation of Noninvasive Treatment Including an Accounting of Vestibular Migraine.

PubMed

Sbeih, Firas; Christov, Florian; Gluth, Michael B

2018-05-01

To describe the course of Meniere's disease with noninvasive treatment during the first few years after initial diagnosis. A retrospective review of consecutive patients with newly diagnosed definite Meniere's disease between 2013 and 2016 and a minimum follow-up of 1 year. Patients received a written plan for low sodium, water therapy, and treatment with a diuretic and/or betahistine. Subjects were screened and treated for vestibular migraine as needed. Vertigo control and hearing status at most recent follow-up were assessed. Forty-four subjects had an average follow up of 24.3 months. Thirty-four percent had Meniere's disease and vestibular migraine, and 84% had unilateral Meniere's disease. Seventy-five percent had vertigo well controlled at most recent follow-up, with only noninvasive treatments. Age, gender, body mass index, presence of vestibular migraine, bilateral disease, and duration of follow-up did not predict noninvasive treatment failure. Worse hearing threshold at 250 Hz and lower pure tone average (PTA) at the time of diagnosis did predict failure. Fifty-two percent of ears had improved PTA at most recent visit, 20% had no change, and 28% were worse Conclusions: Encountering excellent vertigo control and stable hearing after a new diagnosis of Meniere's disease is possible with noninvasive treatments. Worse hearing status at diagnosis predicted treatment failure.

Treatment-related mortality in newly diagnosed pediatric cancer: a population-based analysis.

PubMed

Gibson, Paul; Pole, Jason D; Lazor, Tanya; Johnston, Donna; Portwine, Carol; Silva, Mariana; Alexander, Sarah; Sung, Lillian

2018-03-01

Using a previously developed reliable and valid treatment-related mortality (TRM) definition, our objective was to describe the proportion of children newly diagnosed with cancer experiencing TRM and to identify risk factors for TRM in a population-based cohort. We included children with cancer <19 years diagnosed and treated in Ontario who were diagnosed between 2003 and 2012. Children with cancer were identified using data in a provincial registry. Cumulative incidence of TRM was calculated where progressive disease death was considered a competing event. Among the 5179 children included, 179 had TRM, 478 died of progressive disease, and 4522 were still alive. At 5 years, the cumulative incidence of TRM among the entire cohort was 3.9% (95% confidence interval (CI) 3.3-4.5%). When compared to brain tumor patients, leukemia and lymphoma patients had a significantly higher risk of TRM (hazard ratio (HR) 2.5, 95% CI: 1.6-4.0; P < 0.0001). Infants were at significantly higher risk of TRM across diagnostic groups. Other factors associated with higher risks of TRM were metastatic disease (P < 0.0001), diagnosis prior to 1 January 2008 (P = 0.001), hematopoietic stem cell transplantation (HSCT) (P < 0.0001), and relapse (P < 0.0001). The 5-year cumulative incidence of TRM was 3.9% among newly diagnosed children with cancer. Infants were at higher risk of TRM across diagnostic groups. Other risk factors for TRM were leukemia or lymphoma, metastatic disease, earlier diagnosis year, HSCT, and relapse. Future work should further refine prognostic factors by specific cancer diagnosis to best understand when and how to intervene to improve outcomes. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Clinical presentation and epidemiology of brain tumors firstly diagnosed in adults in the Emergency Department: a 10-year, single center retrospective study.

PubMed

Comelli, Ivan; Lippi, Giuseppe; Campana, Valentina; Servadei, Franco; Cervellin, Gianfranco

2017-07-01

Several patients with new onset brain tumors present to the Emergency Department (ED) complaining for new symptoms. Although information exists on symptom prevalence in the entire population of patients with brain tumors, little is known about the clinical presentation in ED. This retrospective study was planned to investigate clinical presentation and epidemiology of brain tumors firstly diagnosed in a large urban ED throughout a 10-year period. All medical records of patients aged ≥18 years, discharged from our ED with a diagnosis of brain tumor were retrieved from the electronic hospital database during a 10-year period (2006 to 2015). The records were reassessed for selecting only brain tumors firstly diagnosed in the ED. The symptoms at presentation were divided in six categories: (I) headache; (II) seizures; (III) focal signs; (IV) altered mental status; (V) nausea/vomiting/dizziness; (VI) trauma. For all cases, the hospital record was retrieved, to obtain histologic classification of tumors. Patients with inflammatory neoformations were excluded from the study. Overall, 205 patients with firstly diagnosed brain tumor were identified among 870,135 ED visits (i.e., <1%). Glial tumors were the most frequent (50% of the entire sample). No significant differences were found between mean age of patients in the different histologically based groups (meningiomas 66±14; glioblastomas 65±16 years; metastases 66±13 years; other miscellaneous 66±19 years). Focal signs accounted for more than 50% of all presentation signs/symptoms. First presentation of brain tumor in the ED is not a rare occurrence, so that the emergency physicians should be aware of this possibility.

Once-monthly injection of paliperidone palmitate in patients with recently diagnosed and chronic schizophrenia: a post-hoc comparison of efficacy and safety.

PubMed

Si, Tianmei; Zhuo, Jianmin; Turkoz, Ibrahim; Mathews, Maju; Tan, Wilson; Feng, Yu

2017-12-01

The use of long-acting injectable antipsychotics in recently diagnosed schizophrenia remains less explored. We evaluated the efficacy and safety of paliperidone palmitate once-monthly (PP1M) treatment in adult patients with recently diagnosed vs. chronic schizophrenia. These post-hoc analyses included two multicenter studies. Study 1 (NCT01527305) enrolled recently diagnosed (≤5 years) and chronic (>5 years) patients; Study 2 (NCT01051531) enrolled recently diagnosed patients only. Recently diagnosed patients were further sub-grouped into ≤2 years or 2-5 years. The primary efficacy endpoint was the change from baseline in Positive and Negative Syndrome Scale (PANSS) total score. In Study 1, 41.5% patients had recent diagnosis (≤2 years: 56.8%; 2-5 years: 43.2%); 58.5% had chronic schizophrenia. In Study 2, 52.8% and 47.2% patients were grouped into ≤2 years and 2-5 years, respectively. PANSS total score showed significantly greater improvement in patients with recently diagnosed vs. chronic schizophrenia. Similar results were obtained for PANSS responder rate, improvements in PANSS, and CGI-S scores. PP1M was efficacious in both recently diagnosed and chronic schizophrenia, with the benefits being more pronounced in patients with recently diagnosed schizophrenia. This adds to growing evidence recommending long-acting antipsychotic interventions at early stages of schizophrenia.

Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia.

PubMed

Rakha, Emad A; Ho, Bernard C; Naik, Veena; Sen, Soumadri; Hamilton, Lisa J; Hodi, Zsolt; Ellis, Ian O; Lee, Andrew H S

2011-03-01

To provide updated evidence of the outcome of breast lesions of uncertain malignant potential (B3) and suspicious of malignancy (B4) diagnosed on needle core biopsy (NCB) and analyse the outcome of the different types of intraductal epithelial atypia. One-hundred and forty-nine B3 and 26 B4 NCBs diagnosed over a 2-year period (2007-2008) were compared with those diagnosed over a previous 2-year period (1998-2000). The proportion of B3 diagnoses increased from 3.1% to 4.5%, and the positive predictive value (PPV) of malignancy of a B3 core decreased from 25% to 10%. Increased diagnosis of radial scar and reductions in the PPV of lobular neoplasia and of atypical intraductal proliferation may explain the reduction in the PPV of the B3 group as a whole. There were no significant changes in the proportion of B4 diagnosis (1.1% and 0.8%) or the PPV of B4 (83% and 88%). Review of cores with intraductal atypia showed a wide range of PPVs, from 100% for suspicious of ductal carcinoma in situ, to 40% for atypical ductal hyperplasia categorized as B3, and 14% for isolated flat epithelial atypia. The study has found a decrease in the PPV for a B3 diagnosis and suggests possible explanations. © 2011 Blackwell Publishing Limited.

Airway hyperresponsiveness to methacholine in 7-year-old children: sensitivity and specificity for pediatric allergist-diagnosed asthma.

PubMed

Carlsten, Chris; Dimich-Ward, Helen; Ferguson, Alexander; Becker, Allan; Dybuncio, Anne; Chan-Yeung, Moira

2011-02-01

The operating characteristics of PC(20) values used as cut-offs to define airway hyperresponsiveness, as it informs the diagnosis of asthma in children, are poorly understood. We examine data from a unique cohort to inform this concern. Determine the sensitivity and specificity of incremental PC(20) cut-offs for allergist-diagnosed asthma. Airway reactivity at age 7 was assessed in children within a birth cohort at high risk for asthma; PC(20) for methacholine was determined by standard technique including interpolation. The diagnosis of asthma was considered by the pediatric allergist without knowledge of the methacholine challenge results. Sensitivity and specificity were calculated using a cross-tabulation of asthma diagnosis with incremental PC(20) cut-off values, from 1.0 to 8.0 mg/ml, and plotted as receiver operator characteristic (ROC) curves. The "optimal" cut-off was defined as that PC(20) conferring maximal value for sensitivity plus specificity while the "balanced" cut-off was defined as that PC(20) at which sensitivity and specificity were most equal. 70/348 children (20.1%) were diagnosed with asthma. The optimal and balanced PC(20) cut-offs, both for all children and for females alone, were respectively 3 mg/ml (sensitivity 80.0%, specificity 49.1%) and 2 mg/ml (sensitivity 63.1%, specificity 64.7%). For males alone, the "optimal" and "balanced" PC(20) cut-offs were both 2 mg/ml. For this cohort of 7-year olds at high risk for asthma, methacholine challenge testing using a cut-off value of PC(20) 3 mg/ml conferred the maximal sum of specificity plus sensitivity. For contexts in which higher sensitivity or specificity is desired, other cut-offs may be preferred. Copyright © 2011 Wiley-Liss, Inc.

Newly Diagnosed Hepatitis C in the US Commercially Insured Population Before and After the 2012 Implementation of Expanded Screening Guidelines

PubMed Central

Pyenson, Bruce S.; Dieguez, Gabriela; Ferro, Christine; Mavinkurve, Maushumi; Gonzalez, Yuri Sanchez

2018-01-01

Background In the United States in 2014, more than 3 million individuals were estimated to have chronic hepatitis C virus (HCV) infection, including many undiagnosed individuals. In 2012, the Centers for Disease Control and Prevention expanded its HCV testing recommendations to target all adults born between 1945 and 1965, in addition to at-risk individuals, which has led to an increase in newly diagnosed patients. Few studies have explored the medical cost or clinical status of patients who are newly diagnosed with HCV. Objective To compare the demographics, comorbidities, and medical costs of patients who are newly diagnosed and those who were previously diagnosed with HCV infection. Method We conducted a retrospective study using 2013 claims data from the Truven Health MarketScan Commercial database to compare patients newly diagnosed with HCV infection in 2013 and patients who were diagnosed before 2013. The patients were divided into 2 cohorts based on the time of diagnosis before and after 2013. All patients were classified by disease stage and by comorbidities, and were required to have continuous health plan enrollment between January 2010 and December 2013. The full-year costs were tabulated for every patient, regardless of the date of diagnosis. Results Of the 9193 patients with an HCV diagnosis in 2013 in the database, approximately 26% (N = 2428) were newly diagnosed in 2013, of whom 12% (N = 299) had advanced-stage HCV. The average age of the newly diagnosed patients was 49.5 years versus 54.1 years for previously diagnosed patients. Patients who were previously diagnosed had a higher prevalence of HIV, diabetes, and more severe cancers than patients who were newly diagnosed with HCV. Patients who were newly diagnosed with HCV had a higher prevalence of acute liver failure and drug-induced psychosis. The average annual per-patient per-month (PPPM) medical costs for both groups was approximately $2200 in 2013. The annual medical cost for a patient who

Newly Diagnosed Hepatitis C in the US Commercially Insured Population Before and After the 2012 Implementation of Expanded Screening Guidelines.

PubMed

Pyenson, Bruce S; Dieguez, Gabriela; Ferro, Christine; Mavinkurve, Maushumi; Gonzalez, Yuri Sanchez

2018-02-01

In the United States in 2014, more than 3 million individuals were estimated to have chronic hepatitis C virus (HCV) infection, including many undiagnosed individuals. In 2012, the Centers for Disease Control and Prevention expanded its HCV testing recommendations to target all adults born between 1945 and 1965, in addition to at-risk individuals, which has led to an increase in newly diagnosed patients. Few studies have explored the medical cost or clinical status of patients who are newly diagnosed with HCV. To compare the demographics, comorbidities, and medical costs of patients who are newly diagnosed and those who were previously diagnosed with HCV infection. We conducted a retrospective study using 2013 claims data from the Truven Health MarketScan Commercial database to compare patients newly diagnosed with HCV infection in 2013 and patients who were diagnosed before 2013. The patients were divided into 2 cohorts based on the time of diagnosis before and after 2013. All patients were classified by disease stage and by comorbidities, and were required to have continuous health plan enrollment between January 2010 and December 2013. The full-year costs were tabulated for every patient, regardless of the date of diagnosis. Of the 9193 patients with an HCV diagnosis in 2013 in the database, approximately 26% (N = 2428) were newly diagnosed in 2013, of whom 12% (N = 299) had advanced-stage HCV. The average age of the newly diagnosed patients was 49.5 years versus 54.1 years for previously diagnosed patients. Patients who were previously diagnosed had a higher prevalence of HIV, diabetes, and more severe cancers than patients who were newly diagnosed with HCV. Patients who were newly diagnosed with HCV had a higher prevalence of acute liver failure and drug-induced psychosis. The average annual per-patient per-month (PPPM) medical costs for both groups was approximately $2200 in 2013. The annual medical cost for a patient who was newly diagnosed increased sharply

Sleep Patterns as Predictors for Disability Pension Due to Low Back Diagnoses: A 23-Year Longitudinal Study of Finnish Twins

PubMed Central

Ropponen, Annina; Silventoinen, Karri; Hublin, Christer; Svedberg, Pia; Koskenvuo, Markku; Kaprio, Jaakko

2013-01-01

Study Objectives: Impaired sleep patterns are known to be associated with many chronic conditions and ultimately they may lead to permanent work incapacity. Less is known about the associations between sleep patterns and cause-specific disability pensions, such as low back diagnoses, or whether familial factors (genetics and family environment) can affect the associations. The objective of this study was to investigate sleep patterns as predictors of disability pension due to low back diagnoses with a 23-year follow-up. Design and Setting: A prospective cohort study with comprehensive mailed questionnaires about sleep patterns, e.g., quality and length of sleep in 1975 and 1981. Follow-up from the national disability pension register data until 2004. Interventions: Not applicable. Participants: There were 18,979 individuals (7,722 complete twin pairs) born before 1958. Measurements and Results: Cox proportional hazards regression was used to calculate hazard ratios (HR) with 95% confidence intervals (95% CI). Disability pension due to low back diagnoses had been granted to 467 individuals during the follow-up. Sleeping moderately well (HR 1.25; 95% CI 1.02, 1.53), or fairly poorly/poorly (HR 2.05; 95% CI 1.53, 2.73) at baseline predicted a significantly higher risk for disability pension. Stable patterns of sleeping either fairly well (HR 1.29; 95% CI 1.01, 1.64), or stably fairly poorly/poorly (HR 2.29; 95% CI 1.49, 3.52) between 1975 and 1981 were associated with a higher risk as compared to a stable pattern of sleeping well. Furthermore, a decrease in quality of sleep from 1975 to 1981 was associated (HR 1.34; 95% CI 1.03, 1.76) with an increased risk of disability pension. Conclusions: Sleep quality and changes in sleep quality appear to be early predictors for disability pension due to low back diagnoses independently from other confounding factors. Citation: Ropponen A; Silventoinen K; Hublin C; Svedberg P; Koskenvuo M; Kaprio J. Sleep patterns as predictors

Mortality in Mild Cognitive Impairment Diagnosed with DSM-5 Criteria and with Petersen's Criteria: A 17-Year Follow-Up in a Community Study.

PubMed

Santabárbara, Javier; Gracia-García, Patricia; Pírez, Guillermo; López-Antón, Raúl; De La Cámara, Concepcion; Ventura, Tirso; Pérez-Sastre, Marina; Lobo, Elena; Saz, Pedro; Marcos, Guillermo; Lobo, Antonio

2016-11-01

To explore the possibility that the mortality risk of mild cognitive impairment (MCI) as diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria (DSM-5-MCI) will be higher than using Petersen's criteria (P-MCI) and to report the population-attributable fraction (PAF) of mortality due to MCI. A representative community sample of 4,803 individuals aged 55 or more years was interviewed and then followed for 17 years. Standardized instruments were used in the assessment, including the Geriatric Mental State-AGECAT, and research psychiatrists diagnosed P-MCI and DSM-5-MCI cases following operationalized criteria. Mortality information was obtained from the official population registry. Kaplan-Meier age-adjusted survival curves were built for the MCI diagnostic groups, and Cox proportional hazards regression models were used to calculate the hazard ratio of death in participants with MCI relative to those without. We also estimated the PAF of mortality due to specific MCI diagnostic groups. Compared with noncases, the mortality rate ratio was approximately double in DSM-5-MCI individuals (2.3) than in P-MCI individuals (1.2). In the multivariate statistical analysis, a significant association between each diagnostic category and mortality was observed but was only maintained in the final model in DSM-5-MCI cases (hazard ratio: 1.24). The PAF of mortality due to MCI was approximately 1% in both MCI categories. The mortality risk in comparison with noncases was higher in DSM-5-MCI than in P-MCI. The PAF of mortality in DSM-5-MCI individuals was ~ 1% over a 17-year period. Copyright © 2016. Published by Elsevier Inc.

Organization of care and diagnosed depression among women veterans.

PubMed

Sambamoorthi, Usha; Bean-Mayberry, Bevanne; Findley, Patricia A; Yano, Elizabeth M; Banerjea, Ranjana

2010-09-01

To analyze the association between the organizational features of integration of physical and mental healthcare in womens health clinics and the diagnosis of depression among women veterans with or at risk for cardiovascular conditions (ie, diabetes mellitus, heart disease, or hypertension). Retrospective and observational secondary data analyses. We studied 27,972 women veterans from 118 facilities with diagnosed cardiovascular conditions in fiscal year 2001 (FY2001) using merged Medicare claims and Veterans Health Administration (VHA) data merged with the 1999 VHA Survey of Primary Care Practices and the 2001 VHA Survey of Women Veterans Health Programs and Practices. The dependent variable was a binary indicator for diagnosed depression during FY2001 at the individual level. We used a multilevel logistic regression model to control for clustering of women veterans within facilities. Individual-level independent variables included demographics, socioeconomic characteristics, and chronic physical conditions. Overall, 27% of women veterans using the VHA were diagnosed as having depression in FY2001. Across facilities, rates of diagnosed depression varied from 13% to 41%. After controlling for individual-level and facility-level independent variables, women veterans who were served in separate women's health clinics with integrated physical and mental healthcare were more likely to have diagnosed depression. The adjusted odds ratio was 1.12 (95% confidence interval, 1.01-1.25). Existing women-specific VHA organizational features with integration of primary care and mental health seem effective in diagnosing depression. Emerging patient-centered medical home models may facilitate diagnosis and treatment of mental health issues among women with complex chronic conditions.

Stroke mimic diagnoses presenting to a hyperacute stroke unit.

PubMed

Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

2016-10-01

Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

Diagnosing comorbidity in psychiatric hospital: challenging the validity of administrative registers.

PubMed

Oiesvold, Terje; Nivison, Mary; Hansen, Vidje; Skre, Ingunn; Ostensen, Line; Sørgaard, Knut W

2013-01-08

This study will explore the validity of psychiatric diagnoses in administrative registers with special emphasis on comorbid anxiety and substance use disorders. All new patients admitted to psychiatric hospital in northern Norway during one year were asked to participate. Of 477 patients found eligible, 272 gave their informed consent. 250 patients (52%) with hospital diagnoses comprised the study sample. Expert diagnoses were given on the basis of a structured diagnostic interview (M.I.N.I.PLUS) together with retrospective checking of the records. The hospital diagnoses were blind to the expert. The agreement between the expert's and the clinicians' diagnoses was estimated using Cohen's kappa statistics. The expert gave a mean of 3.4 diagnoses per patient, the clinicians gave 1.4. The agreement ranged from poor to good (schizophrenia). For anxiety disorders (F40-41) the agreement is poor (kappa = 0.12). While the expert gave an anxiety disorder diagnosis to 122 patients, the clinicians only gave it to 17. The agreement is fair concerning substance use disorders (F10-19) (kappa = 0.27). Only two out of 76 patients with concurrent anxiety and substance use disorders were identified by the clinicians. The validity of administrative registers in psychiatry seems dubious for research purposes and even for administrative and clinical purposes. The diagnostic process in the clinic should be more structured and treatment guidelines should include comorbidity.

Surgical procedures and their cost estimates among women with newly diagnosed endometriosis: a US database study.

PubMed

Fuldeore, M; Chwalisz, K; Marx, S; Wu, N; Boulanger, L; Ma, L; Lamothe, K

2011-01-01

This descriptive study assessed the rate and costs of surgical procedures among newly diagnosed endometriosis patients. Utilizing the Medstat MarketScan database, commercially insured women aged 18-45 with endometriosis newly diagnosed during 2006-2007 were identified. Each endometriosis patient was matched to four women without endometriosis (population controls) based on age and region of residence. Surgical procedures received during the 12 months post-diagnosis were assessed. Costs of surgical procedures were the amount paid by the insurance companies. This study identified 15,891 women with newly diagnosed endometriosis and 63,564 population controls. More than 65% of endometriosis patients received an endometriosis-related surgical procedure within 1 year of the initial diagnosis. The most common procedure was therapeutic laparoscopy (31.6%), followed by abdominal hysterectomy (22.1%) and vaginal hysterectomy (6.8%). Prevalence and type of surgery performed varied by patient age, including a hysterectomy rate of approximately 16% in patients younger than 35 and 37% among patients aged 35-45 years. Average costs ranged from $4,289 (standard deviation [SD]: $3,313) for diagnostic laparoscopy to $11,397 (SD: $8,749) for abdominal hysterectomy. Diagnosis of endometriosis cannot be validated against medical records, and information on the severity of endometriosis-related symptoms is not available in administrative claims data. Over 65% of patients had endometriosis-related surgical procedures, including hysterectomy, within 1 year of being diagnosed with endometriosis. The cost of surgical procedures related to endometriosis places a significant financial burden on the healthcare system.

Intraabdominal actinomycosis resulting in a difficult to diagnose intraperitoneal mass: A case report.

PubMed

Tsujimura, Naoto; Takemoto, Hiroyoshi; Nakahara, Yujiro; Wakasugi, Masaki; Matsumoto, Takashi; Nishioka, Kiyonori; Takachi, Kou; Oshima, Satoshi; Yoshida, Kyotaro

2018-01-01

Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces israelii. Preoperative confirmed diagnosis is very difficult, so most cases are diagnosed preoperatively as malignant tumors. We report a case of intraabdominal actinomycosis which was difficult to diagnose preoperatively. A woman, 60 years old, experienced discomfort in her lower right abdomen. She complained of nausea and anorexia and visited our hospital. Laboratory blood tests, abdominal CT, and abdominal MRI led to a diagnosis of a uterine sarcoma or primary intestinal mass, and she underwent surgery. Her histopathological diagnosis was intraabdominal actinomycosis. Actinomycosis is a chronic purulent granulomatous inflammation caused by Actinomyces israelii. No clinical symptoms or laboratory findings are characteristic of abdominal actinomycosis, so this disorder is very difficult to diagnose preoperatively. Therefore, many cases are diagnosed as malignant tumors and undergo surgery. After surgery, long-term antibiotic treatment (penicillin) is usually administered. We reported a case of intraabdominal actinomycosis that resulted in a difficult to diagnose intraperitoneal mass. When a large intraperitoneal mass is found, actinomycosis needs to be included as one of differential diagnoses. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Acute lymphoblastic leukemia in a 2-year-old girl whose mother was previously diagnosed with antiphospholipid syndrome: a case report.

PubMed

Castro-Jiménez, Miguel Ángel; Cortés-Sánchez, Carlos Efraín; Rueda-Arenas, Ernesto; Tibaduiza-Buitrago, Lucy Adela

2015-04-15

The role of maternal exposures and conditions in the origin of childhood cancer has been a subject of growing interest, but current evidence is inconclusive. We present a case detected in a multicenter case-control study evaluating the association between parental risk factors and childhood acute lymphoblastic leukemia (ALL). The patient is a Colombian girl who was diagnosed with ALL-L1 when she was 2 years old. Her mother had been diagnosed with antiphospholipid syndrome before pregnancy and had also been treated with subcutaneous injections of heparin. Other potentially relevant maternal and patient exposures are also reported in this paper. We hypothesize that the maternal autoimmune disease could be a contributor in the causality network of the daughter's leukemia. However, the role of other exposures cannot be excluded.

Trends in incidence of end-stage renal disease among persons with diagnosed diabetes--Puerto Rico, 1996-2010.

PubMed

Burrows, Nilka Rios; Hora, Israel; Williams, Desmond E; Geiss, Linda S

2014-03-07

During 2010, approximately 6,091 persons aged ≥18 years in Puerto Rico were living with end-stage renal disease (ESRD) (i.e., kidney failure that requires regular dialysis or kidney transplantation for survival). This included 1,462 persons who began treatment for ESRD in 2010. Diabetes is the leading cause of ESRD in Puerto Rico, accounting for 66% of new cases in adults, followed by hypertension, which accounts for 15% of the cases. Although the number of adults initiating ESRD treatment (i.e., dialysis or kidney transplantation) in Puerto Rico each year who have diabetes listed as a primary cause (ESRD-D) has increased since 1996, ESRD-D incidence among adults with diagnosed diabetes has not shown a consistent trend. To assess recent trends in ESRD-D incidence among adults aged ≥18 years in Puerto Rico with diagnosed diabetes and to further examine trends by age group and sex, CDC analyzed 1996-2010 data from the U.S. Renal Data System (USRDS) and the Behavioral Risk Factor Surveillance System (BRFSS). After increasing in the late 1990s, ESRD-D incidence decreased during the 2000s among adult men and among persons aged 18-44 years with diagnosed diabetes in Puerto Rico. Throughout the period, ESRD-D incidence among adult women and among persons aged 45-64 and ≥75 years with diagnosed diabetes did not show a consistent trend, and ESRD-D incidence among persons aged 65-74 years with diagnosed diabetes increased. Increased awareness of the risk factors for kidney disease and implementation of effective interventions to prevent or delay kidney disease among persons with diagnosed diabetes might decrease ESRD incidence in Puerto Rico, particularly among women and older persons.

Psychiatric diagnoses in a group of astronaut applicants

NASA Technical Reports Server (NTRS)

Santy, Patricia A.; Faulk, Dean M.; Holland, Al W.

1991-01-01

Between 1959 and 1987, the psychiatric evaluation of astronaut candidates evolved from a 30-h intensive examination evaluating applicants for psychopathology, and studying their performance under stress, to a 2-h clinical interview whose structure and contents were determined by the individual examiner. Evaluations done during these years applied both psychiatric (or, 'select-out') criteria and psychological (or, 'select-in') criteria. In an attempt to more rigorously define the psychiatric, 'select-out' component, a standardized, semistructured clinical interview was developed to identify the presence or history of psychiatric disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 3rd Ed. ('DSM-III'). A total of 117 astronaut applicants underwent this clinical interview as part of a comprehensive medical evaluation during a recent astronaut selection. Of the 117 applicants, 9 (7.7 percent) met DSM-III criteria for a variety of Axis I and Axis II diagnoses, including V-code diagnoses.

Acromegaly diagnosed in a young woman presenting with headache and arthritis.

PubMed

Nachtigall, Lisa B

2006-10-01

A 38-year-old woman presented with severe headaches to her primary-care physician. The patient had been diagnosed with rheumatoid arthritis and had begun having headache 4 years previously. An MRI scan revealed an 11-12 mm pituitary tumor. Her physical examination was unremarkable for the classic acral or facial changes characteristic of acromegaly, and she was referred for neuroendocrine consultation for a presumed nonfunctioning adenoma. MRI of the pituitary, and laboratory investigations that included measurement of serum insulin-like growth factor 1 (IGF1) and prolactin levels. In view of the elevated level of IGF1 and presence of a pituitary adenoma, the patient was diagnosed with acromegaly caused by a pituitary adenoma that secretes growth hormone. The patient underwent trans-sphenoidal surgery, which resulted in resolution of joint pain and headache, eradication of the tumor mass, normal IGF1 levels, and appropriate suppression of growth hormone (confirmed by oral glucose tolerance test postoperatively).

Low Vocational Outcome Among People Diagnosed With Borderline Personality Disorder During First Admission to Mental Health Services in Denmark: A Nationwide 9-Year Register-Based Study.

PubMed

Hastrup, Lene Halling; Kongerslev, Mickey T; Simonsen, Erik

2018-03-05

Earlier studies report that although people with borderline personality disorder (BPD) experience symptom reduction in the long term, they continue to have difficulties in work recovery. This nationwide 9-year register-based study (N = 67,075) investigated the long-term labor-market attachment of all individuals diagnosed with BPD during first admission to Danish mental health services in comparison with other psychiatric disorders. Controlling for baseline characteristics and co-occurring secondary psychiatric diagnoses, the BPD group had 32% lower odds (OR = 0.68; 95% CI [0.61, 0.76]) of being in work/under education after 9 years. Individuals diagnosed with BPD also showed more impairment in long-term vocational outcome than other personality disorders, and lower labor-market attachment than other psychiatric disorders except for schizophrenia, schizotypal and delusional disorders, and mental and behavioral disorders due to psychoactive substance use. Intervention programs addressing social psychiatric aspects of BPD in terms of work functioning is henceforth an important area for future research.

Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis.

PubMed

Ruggeri, Annalisa; Volt, Fernanda; Locatelli, Franco; Michel, Gerard; Diaz de Heredia, Cristina; Abecasis, Manuel; Zecca, Marco; Vora, Ajay; Yakouben, Karima; O'Brien, Tracey A; Giardino, Stefano; Cornish, Jacqueline; Rocha, Vanderson; Peters, Christina; Bader, Peter; Gluckman, Eliane; Dalle, Jean Hugues

2017-01-01

Infant acute leukemia still has a poor prognosis, and allogeneic hematopoietic stem cell transplantation is indicated in selected patients. Umbilical cord blood (UCB) is an attractive cell source for this population because of the low risk of chronic graft-versus-host disease (GVHD), the strong graft-versus-leukemia effect, and prompt donor availability. This retrospective, registry-based study reported UCB transplantation (UCBT) outcomes in 252 children with acute lymphoblastic leukemia (ALL; n = 157) or acute myelogenous leukemia (AML; n = 95) diagnosed before 1 year of age who received a single-unit UCBT after myeloablative conditioning between 1996 and 2012 in European Society for Blood and Marrow Transplantation centers. Median age at UCBT was 1.1 years, and median follow-up was 42 months. Most patients (57%) received a graft with 1 HLA disparity and were transplanted in first complete remission (CR; 55%). Cumulative incidence function (CIF) of day 100 acute GVHD (grades II to IV) was 40% ± 3% and of 4-year chronic GVHD was 13% ± 2%. CIF of 1-year transplant-related mortality was 23% ± 3% and of 4-year relapse was 27% ± 3%. Leukemia-free-survival (LFS) at 4 years was 50% ± 3%; it was 40% and 66% for those transplanted for ALL and AML, respectively (P = .001). LFS was better for patients transplanted in first CR, regardless of diagnosis. In multivariate model, diagnosis of ALL (P = .001), advanced disease status at UCBT (<.001), age at diagnosis younger than 3 months (P = .012), and date of transplant before 2004 were independently associated with worse LFS. UCBT is a suitable option for patients diagnosed with infant acute leukemia who achieve CR. In this cohort, patients with AML had better survival than those with ALL. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Transient ischaemic attack clinic: an evaluation of diagnoses and clinical decision making.

PubMed

Lee, Will; Frayne, Judith

2015-04-01

The diagnosis of transient ischaemic attack (TIA) is based largely on the patient's symptom recall and clinical judgement. This decision-making process is highly subjective and the inter-observer reliability of TIA diagnosis is at best moderate, even among neurologists. The aim of this study is to examine the presenting features and final diagnoses of referrals to a TIA clinic and to evaluate characteristics that favoured the diagnosis of TIA over other TIA "mimics". Consecutive new referrals to a tertiary metropolitan hospital TIA clinic over a 9month period were examined. Characteristics between TIA and non-TIA diagnoses were compared and analysed. Eighty-two patients were recruited. Eighteen (22%) were given a final diagnosis of TIA or stroke. Major alternative diagnoses included migraine (n=17, 21%), presyncope/syncope (n=13, 16%) and anxiety (n=7, 9%). Four (5%) patients had unclassifiable symptoms with no clear final diagnosis. Mean age was 67±a standard deviation of 17years and patients diagnosed with TIA/stroke were on average older than those with non-TIA diagnoses (77±10 versus 64±17years, p=0.003). A diagnosis of TIA/stroke was favoured in the presence of moderate to severe weakness (p=0.032), dysphasia (p=0.037) or dysarthria (p=0.005). Unclassifiable symptoms (for example, palpitations, confusion, headache) were reported in 27 patients (33%) and their presence favoured non-TIA diagnoses (p=0.0003). TIA constituted a minority of the referrals to our clinic. Accurate clinical diagnosis of TIA facilitates early stroke prevention and avoids unnecessary investigations and prescriptions. Attempts to improve diagnostic accuracy of TIA should target improving the education and awareness of frontline medical practitioners. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mortality in adults with newly diagnosed and chronic epilepsy: a retrospective comparative study.

PubMed

Mohanraj, Rajiv; Norrie, John; Stephen, Linda J; Kelly, Kevin; Hitiris, Nikolas; Brodie, Martin J

2006-06-01

People with epilepsy are at increased risk of premature death compared with the general population. Many clinicians are unsure whether and when this issue should be broached with their patients. We analysed mortality in patients with newly diagnosed and chronic epilepsy over a 20-year period. Patients who attended the epilepsy service at the Western Infirmary in Glasgow, UK between 1981 and 2001, with newly diagnosed epilepsy (n=890) or referred after receiving unsuccessful treatment elsewhere (n=2689) were included in the study. Mortality data were obtained from the General Registrar Office for Scotland. Causes of death were ascertained from death certificates and primary care and health authority records. The two patient cohorts were compared with age-matched and sex-matched Scottish comparison groups. Standardised mortality ratios (SMR) were calculated for each epilepsy type, 10-year age band, and cause of death category. Newly diagnosed patients had a 42% increase in mortality (SMR 1.42, 95% CI 1.16-1.72) compared with the comparison group. Increased mortality was recorded in those who had not responded to treatment, with no increase in risk observed in patients who were seizure free. In the chronic epilepsy cohort, there was more than double the expected number of deaths (2.05, 1.83-2.26). The incidence of sudden unexpected death in epilepsy was 1.08 and 2.46 per 1000 patient-years in patients with newly diagnosed and chronic epilepsy, respectively. The greatest excess in mortality was reported in patients younger than 30 years. Mortality risks and preventive strategies should be discussed with patients with epilepsy when treatment fails or is refused despite recurrent seizures.

Bipolar Disorder in Nursing Homes: Impact on Antipsychotic Use, Diagnosis Patterns, and New Diagnoses in People with Dementia.

PubMed

Carnahan, Ryan M; Letuchy, Elena M

2018-01-01

Nursing home quality measures include the proportion of residents who receive antipsychotics. Residents with bipolar disorder are included even though antipsychotics are FDA-approved for this indication. We evaluated how including residents with bipolar disorder impacted the antipsychotic use quality measure for long-stay residents. We evaluated the agreement of minimum data set (MDS) bipolar disorder diagnoses with Medicare data, whether dementia was diagnosed before bipolar disorder, and how less-specific bipolar disorder diagnoses impacted findings. Cross-sectional study. Nursing homes in Iowa. 21,955 long-stay nursing home residents in the first quarter of 2014. We identified antipsychotic use and bipolar disorder using MDS data. We compared MDS bipolar disorder diagnoses with Chronic Conditions Warehouse (CCW) "ever" bipolar disorder indicators, and prior year claims. We compared CCW condition onset dates to identify bipolar disorder diagnosed after dementia. The mean (SD) proportion receiving antipsychotics was 19.6% (11.1%) with bipolar disorder and 18.3% (10.8%) without. The positive predictive value (PPV) of MDS bipolar disorder diagnoses was 80.2% versus CCW lifetime indicators, and 74.6% versus claims. PPV decreased by 27.1% when "bipolar disorder, unspecified" and "other bipolar disorders" diagnoses were excluded. Nearly three-quarters of residents with bipolar disorder had dementia. Over half of those with dementia had dementia first per CCW records. This proportion was lower among those with more specific bipolar disorder diagnoses or MDS bipolar disorder indicators. Bipolar disorder in nursing home residents is often first diagnosed after dementia using nonspecific diagnoses. This practice deserves further evaluation. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Drug treatment in patients with newly diagnosed unprovoked seizures/epilepsy.

PubMed

Karlsson, Linnéa; Wettermark, Björn; Tomson, Torbjörn

2014-07-01

The objective of this study was to analyze drug treatment in patients with newly diagnosed unprovoked seizures/epilepsy in a population-based cohort in Stockholm, Sweden. Clinical data from the Stockholm Incidence Registry of Epilepsy was cross-linked with drug dispensing data from the Swedish Prescribed Drug Register to analyze drug treatment in patients diagnosed with unprovoked seizures between 2006 and 2008. Specific questions addressed were the use of other medications at seizures onset, the proportion of patients initiated on different antiepileptic drugs (AEDs) within one year after inclusion, and the extent of switching between different AEDs during the first year. In total 367 patients were included. More than 50% had other medications prescribed at date of first seizure. All together, 262 patients received an AED within one year and 257 patients (98%) were initiated on monotherapy. One year after first prescription, 147 patients (56%) remained on the initially prescribed AED and 48 patients (18%) had switched to another AED. Among the remaining patients, 29 (11%) had died and 38 patients (15%) had discontinued AED treatment. A majority of all patients with epilepsy receive treatment within one year. Many patients use other medications and several of them are related to known comorbidities and can also be involved in drug-drug interactions. Nevertheless, most patients remained on the same AED at the end of the first year. Copyright © 2014 Elsevier B.V. All rights reserved.

Psychiatric diagnoses in older people with intellectual disability in comparison with the general population: a register study.

PubMed

Axmon, A; Björne, P; Nylander, L; Ahlström, G

2017-02-23

To describe the occurrence of psychiatric diagnoses in a specialist care setting in older people with intellectual disability (ID) in relation to those found in the same age group in the general population. A cohort of people with ID (n = 7936), aged 55 years or more in 2012, was identified, as was an age and sex-matched cohort from the general population (n = 7936). Information regarding psychiatric diagnoses during 2002-2012 was collected from the National Patient Register, which contains records from all inpatient care episodes and outpatient specialist visits in Sweden. The mean age at the start of data collection (i.e. January 1st, 2002) was 53 years (range 44-85 years). Seventeen per cent (n = 1382) of the people in the ID cohort had at least one psychiatric diagnosis recorded during the study period. The corresponding number in the general population cohort was 10% (n = 817), which translates to an odds ratio (OR) of 1.84. The diagnoses recorded for the largest number of people in the ID cohort were 'other' (i.e. not included in any of the diagnostic groups) psychiatric diagnoses (10% of the cohort had at least one such diagnosis recorded) and affective disorders (7%). In the general population cohort, the most common diagnoses were affective disorders (4%) and alcohol/substance-abuse-related disorders (4%). An increased odds of having at least one diagnosis was found for all investigated diagnoses except for alcohol/substance-abuse-related disorders (OR = 0.56). The highest odds for the ID cohort was found for diagnosis of psychotic disorder (OR = 10.4) followed by attention deficit/hyperactive disorder (OR = 3.81), dementia (OR = 2.71), personality disorder (OR = 2.67), affective disorder (OR = 1.74) and anxiety disorder (OR = 1.36). People with ID also had an increased odds of psychiatric diagnoses not included in any of these groups (OR = 8.02). The percentage of people with ID who had at least one diagnosis recorded during the study period decreased

Patterns of treatment response in newly diagnosed epilepsy

PubMed Central

Brodie, M.J.; Barry, S.J.E.; Bamagous, G.A.; Norrie, J.D.

2012-01-01

Objective: To delineate the temporal patterns of outcome and to determine the probability of seizure freedom with successive antiepileptic drug regimens in newly diagnosed epilepsy. Methods: Patients in whom epilepsy was diagnosed and the first antiepileptic drug prescribed between July 1, 1982, and April 1, 2006, were followed up until March 31, 2008. Outcomes were categorized into 4 patterns: A) early and sustained seizure freedom; B) delayed but sustained seizure freedom; C) fluctuation between periods of seizure freedom and relapse; and D) seizure freedom never attained. Probability of seizure freedom with successive drug regimens was compared. Seizure freedom was defined as no seizures for ≥1 year. Results: A total of 1,098 patients were included (median age 32 years, range 9–93). At the last clinic visit, 749 (68%) patients were seizure-free, 678 (62%) on monotherapy. Outcome pattern A was observed in 408 (37%), pattern B in 246 (22%), pattern C in 172 (16%), and pattern D in 272 (25%) patients. There was a higher probability of seizure freedom in patients receiving 1 compared to 2 drug regimens, and 2 compared to 3 regimens (p < 0.001). The difference was greater among patients with symptomatic or cryptogenic than with idiopathic epilepsy. Less than 2% of patients became seizure-free on subsequent regimens but a few did so on their sixth or seventh regimen. Conclusions: Most patients with newly diagnosed epilepsy had a constant course which could usually be predicted early. The chance of seizure freedom declined with successive drug regimens, most markedly from the first to the third and among patients with localization-related epilepsies. PMID:22573629

Conservative management of antenatally diagnosed cystic lung malformations.

PubMed

Ng, Christabella; Stanwell, Joanna; Burge, David M; Stanton, Michael P

2014-05-01

To review the outcome of all antenatally diagnosed conservatively managed congenital lung malformations (CLMs) managed at our centre. All patients diagnosed antenatally with cystic lung malformations from 2001 to 2011, at a tertiary referral paediatric surgical centre practising a policy of conservative management of asymptomatic cases, were retrospectively reviewed. Data were collected from medical case notes and radiology reports. Ethical approval was obtained from our institutional research and development department. The complete records of 74 fetuses antenatally diagnosed with CLM were reviewed. There were 72 live births, at a median gestation of 39.6 weeks. Emergency lobectomy was performed in one symptomatic neonate. Elective lobectomies were performed at parental request in three asymptomatic infants, one of whom had a family history of synovial sarcoma. Two patients developed pneumonia in the affected lobe during early childhood and proceeded to lobectomy at the age of 3 years. One patient with a bronchopulmonary sequestration required embolisation for cyanotic episodes. The remaining 65 patients have been conservatively managed to date, and none have required hospital admission. Less than a quarter report mild respiratory symptoms such as cough or wheeze. Median follow-up is 5 years. This retrospective cohort study of 74 consecutive CLMs diagnosed antenatally over a 10-year period demonstrates that most of these lesions will remain asymptomatic throughout childhood. Although the natural history of CLMs in later years remains to be elucidated, we hope that this report on medium-term outcomes will be useful to clinicians who undertake antenatal counselling and may inform the discussion on how best to manage these children.

Do psychopathic traits assessed in mid-adolescence predict mental health, psychosocial, and antisocial, including criminal outcomes, over the subsequent 5 years?

PubMed

Hemphälä, Malin; Hodgins, Sheilagh

2014-01-01

To determine whether psychopathic traits assessed in mid-adolescence predicted mental health, psychosocial, and antisocial (including criminal) outcomes 5 years later and would thereby provide advantages over diagnosing conduct disorder (CD). Eighty-six women and 61 men were assessed in mid-adolescence when they first contacted a clinic for substance misuse and were reassessed 5 years later. Assessments in adolescence include the Psychopathy Checklist-Youth Version (PCL-YV), and depending on their age, either the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Aged Children or the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). Assessments in early adulthood included the SCID, self-reports of psychosocial functioning, aggressive behaviour, and criminality and official criminal records. The antisocial facet score positively predicted the number of anxiety symptoms and likelihood of receiving treatment for substance use disorders (SUDs). Lifestyle and antisocial facet scores negatively predicted Global Assessment of Functioning scores. By contrast, the interpersonal score and male sex independently and positively predicted the number of months worked or studied, as did the interaction of Lifestyle × Sex indicating that among men, but not women, an increase in lifestyle facet score was associated with less time worked or studied. Interpersonal and antisocial scores positively predicted school drop-out. Antisocial facet scores predicted the number of symptoms of antisocial personality disorder, alcohol and SUDs, and violent and nonviolent criminality but much more strongly among males than females. Predictions from numbers of CD symptoms were similar. Psychopathic traits among adolescents who misuse substances predict an array of outcomes over the subsequent 5 years. Information on the levels of these traits may be useful for planning treatment.

Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji.

PubMed

Engelman, Daniel; Mataika, Reapi L; Ah Kee, Maureen; Donath, Susan; Parks, Tom; Colquhoun, Samantha M; Carapetis, Jonathan R; Kado, Joseph H; Steer, Andrew C

2017-08-01

Echocardiographic screening is under consideration as a disease control strategy for rheumatic heart disease (RHD). However, clinical outcomes of young people with screening-detected RHD are unknown. We aimed to describe the outcomes for a cohort with screening-detected RHD, in comparison to patients with clinically-diagnosed RHD. A retrospective cohort study included all young people with screening-detected RHD in the Central Division of Fiji in the primary cohort. Screen-negative and clinically-diagnosed comparison groups were matched 1:1 to the primary cohort. Data were collected on mortality, clinical complications and healthcare utilisation from the electronic and paper health records and existing databases. Seventy participants were included in each group. Demographic characteristics of the groups were similar (median age 11years, 69% female, median follow-up 7years). There were nine (12.9%) RHD-related deaths in the clinically-diagnosed group and one (1.4%) in the screening-detected group (Incident Rate Ratio: 9.6, 95% CI 1.3-420.6). Complications of RHD were observed in 39 (55.7%) clinically-diagnosed cases, four (20%) screening-detected cases and one (1.4%) screen-negative case. There were significant differences in the cumulative complication curves of the groups (p<0.001). Rates of admission and surgery were highest in the clinically-diagnosed group, and higher in the screening-detected than screen-negative group. Young people with screening-detected RHD have worse health outcomes than screen-negative cases in Fiji. The prognosis of clinically-diagnosed RHD remains poor, with very high mortality and complication rates. Further studies in other settings will inform RHD screening policy. Comprehensive control strategies are required for disease prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

High validity of cardiomyopathy diagnoses in western Sweden (1989-2009).

PubMed

Basic, Carmen; Rosengren, Annika; Lindström, Sandra; Schaufelberger, Maria

2018-04-01

Hospital discharges with a diagnosis of cardiomyopathy have more than doubled in Sweden since 1987. We validated the cardiomyopathy diagnoses over this time period to investigate that the increase was real and not a result of improved recognition of the diagnosis and better diagnostic methods. Every fifth year from 1989 to 2009, records for all patients with a cardiomyopathy diagnosis were identified by searching the local registers in three hospitals in Västra Götaland, Sweden. The diagnoses were validated according to criteria defined by the European Society of Cardiology from 2008. The population comprised 611 cases with cardiomyopathy diagnoses [mean age 58.9 (SD 15.5) years, 68.2% male], divided into three major groups: dilated, hypertrophic, and other cardiomyopathies. Hypertrophic cardiomyopathy and hypertrophic obstructive cardiomyopathy were analysed as a group. Cardiomyopathies for which there were few cases, such as restrictive, arrhythmogenic right ventricular, left ventricular non-compaction, takotsubo, and peripartum cardiomyopathies, were analysed together and defined as 'other cardiomyopathies'. Relevant co-morbidities were registered. The use of echocardiography was 99.7%, of which 94.6% was complete echocardiography reports. The accuracy rates of the diagnoses dilated cardiomyopathy, hypertrophic cardiomyopathy, and other cardiomyopathies were 85.5%, 87.5%, and 100%, respectively, with no differences between the three hospitals or years studied; nor did the prevalence of co-morbidities differ. The accuracy rate of the cardiomyopathy diagnoses from in-hospital records from >600 patients in western Sweden during a 20 year period was 86.6%, with no significant trend over time, strengthening epidemiological findings that this is likely due to an actual increase in cardiomyopathy diagnoses rather than changes in coding practices. The use of echocardiography was high, and there was no significant difference in co-morbidities during the study period

Long term (>1 year) postpartum glucose tolerance status among Indian women with history of Gestational Diabetes Mellitus (GDM) diagnosed by IADPSG criteria.

PubMed

Goyal, Alpesh; Gupta, Yashdeep; Kalaivani, Mani; Sankar, M Jeeva; Kachhawa, Garima; Bhatla, Neerja; Gupta, Nandita; Tandon, Nikhil

2018-05-24

To determine prevalence of long term dysglycemia and its risk factors among women with history of GDM diagnosed using IADPSG criteria at a tertiary care hospital in North India. Women with GDM diagnosed between 2012 and 2016 were invited. Socio-demographic, anthropometric, medical data were collected and 75 gm OGTT with serum insulin estimation, HbA1c and fasting lipid profile were done at the hospital visit. Women (N = 267) were tested at 32.5 (±4.6) years of age and at a median (q 25- q 75 ) of 20 (12-44) months following the index delivery. Dysglycemia was found in 57.7% by ADA criteria [Diabetes in 10.5% and prediabetes in 47.2%]. Risk factors for cardiovascular disease were significantly more prevalent among these women. On multivariable analysis, HOMA-IR correlated positively, while insulinogenic index correlated negatively with postpartum dysglycemia. This is possibly the first long term (>1 year) glucose tolerance outcome study in South Asian women with history of GDM diagnosed by IADPSG criteria, which demonstrates significantly elevated risk of postpartum dysglycemia. While the IADPSG criteria identify women with a lower future conversion to diabetes compared with previous criteria, prediabetes conversion remains high, thereby offering an opportunity to intervene early and prevent progression to future diabetes. Copyright © 2018 Elsevier B.V. All rights reserved.

Incidence of depression and anxiety among women newly diagnosed with breast or genital organ cancer in Germany.

PubMed

Jacob, Louis; Kalder, Matthias; Kostev, Karel

2017-10-01

To analyze the incidence of depression and anxiety among women newly diagnosed with breast or genital organ cancer (BC or GOC) in Germany. A total of 29 366 women initially diagnosed with BC or GOC between 2005 and 2014 were available for analysis. The main outcome measure was the incidence of depression and anxiety among women newly diagnosed with BC or GOC within 5 years after the first cancer diagnosis in German gynecologist practices. Demographic and clinical data included age, type of cancer, and presence of metastases at diagnosis. The incidence rate of depression and anxiety per 100 person-years was calculated. We performed a multivariate regression model to analyze the association between depression and the variables of interest. In total, 7994 women were diagnosed with depression/anxiety (81.3% had BC and 18.7% had GOC). The incidence of depression and anxiety was 8.8 per 100 person-years in women with BC. In individuals with GOC, the incidence of depression/anxiety was 5.9 per 100 person-years. Breast cancer was associated with a 1.41-fold increase in the risk of developing depression or anxiety as compared with GOC. Patients with metastases also had a higher risk of being depressed and anxious than others (odds ratio = 1.40). Finally, women in the age groups of 41 to 50, 51 to 60, and 61 to 70 years were at a higher risk of depression/anxiety than women in the age group of 71 to 80 years (odds ratios equal to 1.50, 1.38, and 1.22). Women diagnosed with BC were at a higher risk of developing depression or anxiety than women with GOC. Copyright © 2016 John Wiley & Sons, Ltd.

Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort.

PubMed

Levenstein, Susan; Jacobsen, Rikke Kart; Rosenstock, Steffen; Jørgensen, Torben

2017-09-01

To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades. A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30-60, in 1982-3. Mental vulnerability, Helicobacter pylori IgG antibodies, socioeconomic status, and sleep duration were determined at baseline; non-steroidal antiinflammatory drug use, smoking, leisure time physical activity, and alcohol consumption both at baseline and in 1993-4. Hospital diagnoses of incident ulcer through 2011 were detected using the Danish National Patient Registry. Ulcers were diagnosed in 166 subjects, including 83 complicated by bleeding or perforation. Age-, gender-, and socioeconomic status-adjusted associations were significant for mental vulnerability (Hazard Ratio (HR) 2.0, 95% Confidence Interval 1.4-2.8), Helicobacter pylori (HR 1.7, CI 1.2-2.3), smoking (HR 2.0, CI 1.3-3.1), heavy drinking (HR 1.6, CI 1.1-2.4), abstinence (HR 1.6, CI 1.1-2.5), non-steroidal antiinflammatory drugs (HR 2.1, CI 1.5-3.0), and sedentary lifestyle (HR 1.9, CI 1.4-2.7). Adjusted for all behavioral mediators, the HR for mental vulnerability was 1.5 (CI 1.0-2.2, p = .04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers. A vulnerable personality raises risk for hospital-diagnosed peptic ulcer, in part because of an association with health risk behaviors. Its impact is seen in 'idiopathic' and Helicobacter pylori-associated ulcers, and in acute surgical cases.

Durable recovery of the macular architecture and functionality of a diagnosed age-related macular degeneration 1 year after a single intravitreal injection of dobesilate

PubMed Central

Cuevas, P; Outeiriño, L A; Azanza, C; Giménez-Gallego, G

2013-01-01

Among the age-related diseases that affect vision, age-related macular degeneration is the most frequent cause of blindness in patients older than 60 years. In this communication, we report the full anatomical and functional recovery of a patient diagnosed with wet age-related macular degeneration 1 year after a single intravitreal injection of dobesilate. PMID:24225910

Analysis of Diagnoses Associated with Multiple Sclerosis-Related In-Hospital Mortality Using the Premier Hospital Database.

PubMed

Ernst, Frank R; Pocoski, Jennifer; Cutter, Gary; Kaufman, David W; Pleimes, Dirk

2016-01-01

We sought to compare mortality rates and related diagnoses in hospitalized patients with multiple sclerosis (MS), those with diabetes mellitus (DM), and the general hospitalized population (GHP). Patients who died between 2007 and 2011 were identified in the US hospital-based Premier Healthcare Database. Demographic information was collected, mortality rates calculated, and principal diagnoses categorized. Of 55,152 unique patients with MS identified, 1518 died. Mean age at death was 10 years younger for the MS group (63.4 years) than for the DM (73.3 years) and GHP (73.1 years) groups. Age-adjusted mortality rates, based on the 2000 US Standard Million Population, were 1077, 1248, and 1133 per 100,000, respectively. Infection was the most common principal diagnosis at the hospital stay during which the patient died in the MS cohort (43.1% vs. 26.3% and 24.0% in the DM and GHP groups, respectively). Other common principal diagnoses in the MS group included pulmonary (17.5%) and cardiovascular (12.1%) disease. Septicemia/sepsis/septic shock was a secondary diagnosis for 50.7% of patients with MS versus 36.0% and 31.0% of patients in the DM and GHP cohorts, respectively. Patients with MS had a shorter life span than patients with DM or the GHP and were more likely to have a principal diagnosis of infection at their final hospital stay. However, the database was limited to codes recorded in the hospital; diagnoses received outside the hospital were not captured.

High validity of cardiomyopathy diagnoses in western Sweden (1989–2009)

PubMed Central

Rosengren, Annika; Lindström, Sandra; Schaufelberger, Maria

2017-01-01

Abstract Aim Hospital discharges with a diagnosis of cardiomyopathy have more than doubled in Sweden since 1987. We validated the cardiomyopathy diagnoses over this time period to investigate that the increase was real and not a result of improved recognition of the diagnosis and better diagnostic methods. Methods and results Every fifth year from 1989 to 2009, records for all patients with a cardiomyopathy diagnosis were identified by searching the local registers in three hospitals in Västra Götaland, Sweden. The diagnoses were validated according to criteria defined by the European Society of Cardiology from 2008. The population comprised 611 cases with cardiomyopathy diagnoses [mean age 58.9 (SD 15.5) years, 68.2% male], divided into three major groups: dilated, hypertrophic, and other cardiomyopathies. Hypertrophic cardiomyopathy and hypertrophic obstructive cardiomyopathy were analysed as a group. Cardiomyopathies for which there were few cases, such as restrictive, arrhythmogenic right ventricular, left ventricular non‐compaction, takotsubo, and peripartum cardiomyopathies, were analysed together and defined as ‘other cardiomyopathies’. Relevant co‐morbidities were registered. The use of echocardiography was 99.7%, of which 94.6% was complete echocardiography reports. The accuracy rates of the diagnoses dilated cardiomyopathy, hypertrophic cardiomyopathy, and other cardiomyopathies were 85.5%, 87.5%, and 100%, respectively, with no differences between the three hospitals or years studied; nor did the prevalence of co‐morbidities differ. Conclusions The accuracy rate of the cardiomyopathy diagnoses from in‐hospital records from >600 patients in western Sweden during a 20 year period was 86.6%, with no significant trend over time, strengthening epidemiological findings that this is likely due to an actual increase in cardiomyopathy diagnoses rather than changes in coding practices. The use of echocardiography was high, and there was no

[The Frequency of Depression Diagnoses in Different Groups of Insured Persons - A Routine Data Analysis of the Years 2006 to 2015].

PubMed

Stahmeyer, Jona Theodor; Kuhlmann, Kristina; Eberhard, Sveja

2018-04-03

Depressive disorders are one of the most common type of mental disorders and are associated with a significant loss of social functioning and decrease in quality of life. While survey data from the Robert Koch-Institute show no increase in the prevalence of depression during recent years, data from social insurance agencies demonstrate an increasing social significance. Many people argue that changes in working conditions are a major reason for increasing depression diagnoses. Aim of the current study was to analyze the prevalence of depression diagnoses in health insurance data (administrative prevalence) for different types of insured persons and to examine the development over time with particular regard to working and non-working insured people. We conducted a cross-sectional analysis of administrative depression prevalence for the years 2006 to 2015 using F32 and F33 diagnoses. Analyses were stratified by sex and insured persons were grouped in (1.) employees, (2.) self-employed, (3.) spouses with insurance coverage as family member, (4.) pensioners, (5.) unemployed people receiving unemployment benefit I, (6.) people receiving unemployment benefit II and (7.) students and trainees. During the 10-year period, we found an increase in administrative prevalence from 12.0% in 2006 (women: 16.3%; men: 6.8%) to 16.3% in 2015 (women: 21.3%; men: 10.9%). In 2015, highest administrative prevalence rates were observed in people receiving unemployment benefit I or II and in pensioners. The lowest rates were found in students and trainees as well as self-employed. Employees had significantly lower administrative prevalence rates than people receiving unemployment benefit. We observed large increases in administrative prevalence over time in all groups of insured persons. The results highlight the increasing social significance of depressive disorders. A comparatively greater increase in the working population was not observed. A long-term health objective should be to

Mistakes in diagnosing non-accidental injury: 10 years' experience

PubMed Central

Wheeler, David M; Hobbs, Christopher J

1988-01-01

Fifty children who were referred to the child abuse team in Leeds over the 10 years 1976-86 with suspected non-accidental injury were found to have conditions which mimicked non-accidental injury. These included impetigo (nine children) and blue spots (five children). Five children who presented with multiple bruising had haemostatic disorders. Eight children had disorders of the bone. Five children had been previously abused physically. Four showed evidence of neglect. One had evidence of non-accidental injury as well as the condition mimicking abuse. It is emphasised that when child abuse is suspected a sensitive and thorough assessment should be carried out by a paediatrician who is experienced in this. ImagesFIG 1 PMID:3133026

Exercise recommendations in patients with newly diagnosed fibromyalgia.

PubMed

Wilson, Brad; Spencer, Horace; Kortebein, Patrick

2012-04-01

To evaluate exercise recommendations in patients newly diagnosed with fibromyalgia. A retrospective chart review. A public university rheumatology clinic. Patients newly diagnosed with fibromyalgia (N = 122). Frequency and type of exercise recommendations. The mean (standard deviation) age of these patients with fibromyalgia was 45 ± 12 years; 91% were women. Exercise was recommended as part of the documented treatment plan in 47% of these patients (57/122); only 3 patients had a documented contraindication for exercise. Aquatic exercise was most frequently recommended (56% [32/57]), followed by combined aquatic-aerobic exercise (26% [15/57]), and, infrequently, aerobic exercise only (5% [3/57]); only 7% of these patients (4/57) were referred for physical therapy. The primary method of communication was verbal discussion (94% [54/57]). Although there is well-documented evidence that exercise is beneficial for patients with fibromyalgia, we found that less than half of patients with newly diagnosed fibromyalgia in our study were provided recommendations to initiate an exercise program as part of their treatment plan. Further investigation of these findings are warranted, including evaluation of other university and community rheumatology practices as well as that of other physicians caring for patients with fibromyalgia. However, our findings indicate that there appears to be an opportunity to provide more specific and practical education regarding the implementation of an exercise regimen for patients with newly diagnosed fibromyalgia. Physiatrists may be particularly well suited to manage the exercise component of patients with fibromyalgia because of their specialized training in exercise prescription. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Ultrasound for diagnosing radiographically occult scaphoid fracture.

PubMed

Kwee, Robert M; Kwee, Thomas C

2018-04-04

To systematically review the literature on the performance of ultrasound in diagnosing radiographically occult scaphoid fracture. A systematic search was performed in the MEDLINE and Embase databases. Original studies investigating the performance of ultrasound in diagnosing radiographically occult scaphoid fracture in more than 10 patients were eligible for inclusion. Studies that included both radiographically apparent and occult scaphoid fractures (at initial radiography) were only included if independent data on radiographically occult fractures were reported. Methodological quality of the studies included was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Accuracy data were extracted. Sensitivity and specificity were pooled with a bivariate random-effects model. The inclusion criteria were met by 7 studies; total sample size comprised 314 patients. All studies, except 1, included cortical disruption of the scaphoid in their diagnostic criteria. The sensitivity and specificity of ultrasound in diagnosing radiographically occult scaphoid fracture ranged from 77.8% to 100% and from 71.4% to 100% respectively, with pooled estimates of 85.6% (95% CI: 73.9%, 92.6%) and 83.3% % (95% CI: 72.0%, 90.6%) respectively. Exclusion of two studies with a high risk of bias in any QUADAS-2 domain did not affect the pooled results. Ultrasound can diagnose radiographically occult scaphoid fracture with a fairly high degree of accuracy. Because of its relatively low costs and fairly high sensitivity, ultrasound seems more cost-effective than empiric cast immobilization and may be used when CT and MRI are not readily available.

High Rate of Alternative Diagnoses in Patients Referred for Presumed Clostridium difficile Infection

PubMed Central

Jackson, Melissa; Olefson, Sidney; Machan, Jason T.; Kelly, Colleen R.

2015-01-01

Goals We evaluated a cohort of patients referred to our center for presumed recurrent Clostridium difficile infection (CDI) to determine final diagnoses and outcomes. Background As rates of CDI have increased, more patients are diagnosed with recurrent CDI and other sequelae of the infection. Distinguishing symptomatic patients with CDI from those who are colonized with an alternative etiology of diarrheal symptoms may be challenging. Methods We performed a retrospective review of 117 patients referred to our center for recurrent CDI between January 2013 and June 2014. Data collected included demographics, referring provider, previous anti-CDI treatment, and significant medical conditions. Additionally we gathered data on atypical features of CDI and investigations obtained to investigate etiology of symptoms. Outcomes included rates of alternative diagnoses and the accuracy of CDI diagnosis by referral source. Results The mean age was 61 years and 70% were female. 29 patients (25%) were determined to have a non-CDI diagnosis. Most common alternative diagnoses included irritable bowel syndrome (18 patients: 62%) and inflammatory bowel disease (3:10 %). Age was inversely correlated with rate of non-CDI diagnosis (p=0.016). Of the remaining 88 (75%) patients with a confirmed diagnosis of CDI, 25 (28%) received medical therapy alone and 63 (72%) underwent fecal microbiota transplantation (FMT). Conclusion Among patients referred to our center for recurrent CDI, a considerable percentage did not have CDI, but rather an alternative diagnosis, most commonly IBS. The rate of alternative diagnosis correlated inversely with age. Providers should consider other etiologies of diarrhea in patients presenting with features atypical of recurrent CDI. PMID:26565971

Twenty-year trends in the incidence and prevalence of diagnosed anogenital warts in Canada.

PubMed

Kliewer, Erich V; Demers, Alain A; Elliott, Lawrence; Lotocki, Robert; Butler, James R G; Brisson, Marc

2009-06-01

A vaccine has recently been licensed in many countries that protects against the human papillomavirus types 6, 11, 16, and 18. Types 6 and 11 account for approximately 90% of anogenital warts (AGWs). We describe the 20-year trends in the incidence and prevalence of AGWs in Manitoba, Canada. We used linked population-based hospital and physician databases for Manitoba for 1984 to 2004. Cases were identified using tariff (billing) and ICD codes. A case was considered to be incident if it was preceded by a 12-month interval free period of AGWs care. Otherwise, it was deemed to be prevalent. An episode was considered over once a 12-month interval had elapsed without an AGW claim. Approximately 25,000 Manitobans were diagnosed with AGWs between 1985 and 2004. The annual age-standardized incidence rates peaked in 1992 (men, 149.9/100,000; women 170.8/100,000). In recent years, the rates have been increasing again, particularly for men. The male:female incidence rate ratio increased from 0.76 in 1985 to 1.25 in 2004. The highest incidence rate tended to be in those aged 20 to 24 years. Trends in prevalence were similar. Prevalence in 2004 was 165.2/100,000 for men and 128.4/100,000 for women. These population-based findings suggest that AGWs are a substantial burden to Manitobans and that their pattern has changed over time, with incidence and prevalence becoming higher in men than women. Monitoring the future trends in AGWs will provide an early marker of the effectiveness and duration of protection of human papillomavirus vaccination at a population level.

[Factors associated with marital status among spouse after diagnosed in newly reported HIV cases in China, 2014].

PubMed

Li, J; Xu, J; Tang, H L; Han, J; Mao, Y R

2017-02-10

Objective: To analyze the factors associated with divorce or separation when one of the spouse diagnosed and newly reported as HIV positive, in China. Methods: Data from the Chinese HIV/AIDS Comprehensive Response Information Management System, by December 31, 2015 were used for collection on newly reported HIV cases regarding their baseline information in 2014 and follow-up within one year, among couples and above 18 year olds. HIV cases were divided into divorce/separation group and married group according to their marriage dynamics in one year after being diagnosed as HIV positive. Multivariate logistic regressions were used to analyze potential factors associated with divorce or separation after the diagnoses made. Results: A total of 31 708 HIV cases were included in this study. 22.5% (7 134/31 708) of them got divorced or separated in one year after diagnose being made. 81.6% (25 864/31 708) of them had couples tested in one year after diagnose made and 10.0% (2 599/25 864) of them got divorced or separated. Among 18.4% (5 844/31 708) of the HIV cases who did not have their couples tested in one year after the diagnoses, 77.6% (4 535/5 844) got divorced or separated. For those who did not have their couples tested in one year after the diagnose. Data from the multivariate logistic regression analysis showed that factors as those who were older than 45 (46-60 yr.: OR =1.28, 95 %CI : 1.03-1.58; ≥61 yr.: OR =1.83, 95 %CI : 1.41-2.37), with Han ethnicity ( OR =1.56, 95 %CI : 1.34-1.83), with high school education or above ( OR =1.55, 95 %CI : 1.27-1.90), non-farmers or non-rural laborers ( OR =1.34, 95 %CI : 1.17-1.54), infected through injecting drug use ( OR =1.33, 95 % CI : 1.03-1.71), men who had sex with men ( OR =1.49, 95 % CI : 1.20-1.86), or with childless ( OR =2.35, 95 %CI : 1.78-3.09) etc . were more likely to be divorced or separated after the diagnoses being made, among those who had their couples tested in one year after the diagnoses. Results

Postpartum Human Immunodeficiency Virus Care Among Women Diagnosed During Pregnancy

PubMed Central

Swain, Carol-Ann; Smith, Lou C.; Nash, Denis; Pulver, Wendy P.; Gordon, Daniel; Bian, Fuqin; Miranda, Wilson; Anderson, Bridget J.; Chicoine, Joyce; Birkhead, Guthrie S.; McNutt, Louise-Anne

2017-01-01

OBJECTIVE To identify factors associated with continuity of care and human immunodeficiency virus (HIV) virologic suppression among postpartum women diagnosed with HIV during pregnancy in New York State. METHODS This retrospective cohort study was conducted among 228 HIV-infected women diagnosed during pregnancy between 2008 and 2010. Initial receipt of HIV-related medical care (first CD4 or viral load test after diagnosis) was evaluated at 30 days after diagnosis and before delivery. Retention in care (2 or more CD4 or viral load tests, 90 days or greater apart) and virologic suppression (viral load 200 copies/mL or less) were evaluated in the 12 months after hospital discharge. RESULTS Most women had their initial HIV-related care encounter within 30 days of diagnosis (74%) and before delivery (87%). Of these women, 70% were retained in the first year postpartum. Women waiting more than 30 days for their initial HIV-related care encounter were more likely diagnosed in the first (29%) compared with the third (11%) trimester and were of younger (younger than 25 years, 32%) compared with older (35 years or older, 13%) age. Loss to follow-up within the first year was significantly greater among women diagnosed in the third compared with the first trimester (adjusted relative risk 2.21, 95% confidence interval [CI] 1.41–3.45) and among women who had a cesarean compared with vaginal delivery (adjusted relative risk 1.76, 95% CI 1.07– 2.91). Of the 178 women with one or more HIV viral load test in the first year postpartum, 58% had an unsuppressed viral load. CONCLUSION Despite the high proportion retained in care, many women had poor postpartum virologic control. Robust strategies are needed to increase virologic suppression among newly diagnosed postpartum HIV-infected women. PMID:27275796

Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD.

PubMed

Drescher, Jack

2015-01-01

The American Psychiatric Association (APA) recently completed a several year process of revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During that time, there were objections raised to retaining DSM's gender identity disorder diagnoses and calls to remove them, just as homosexuality had been removed from DSM-II in 1973. At the conclusion of the DSM-5 revision process, the gender diagnoses were retained, albeit in altered form and bearing the new name of 'gender dysphoria'. The author of this paper was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders and presently serves on the WHO Working Group on Sexual Disorders and Sexual Health. Both groups faced similar tasks: reconciling patients' needs for access to care with the stigma of being given a psychiatric diagnosis. The differing nature of the two diagnostic manuals led to two different outcomes. As background, this paper updates the history of homosexuality and the gender diagnoses in the DSM and in the International Statistical Classification of Diseases and Related Health Problems (ICD) as well as what is expected to happen to the homosexuality and gender diagnoses following the current ICD-11 revision process.

Getting Diagnosed

MedlinePlus

... also for those with related disorders. How is Marfan syndrome diagnosed? getting_diagnosed.jpg A Marfan diagnosis can ... spinal column). Is there a genetic test for Marfan syndrome? Genetic testing can provide helpful information in some ...

Trends in genital warts diagnoses in New Zealand five years following the quadrivalent human papillomavirus vaccine introduction.

PubMed

Oliphant, Jeannie; Stewart, Joanna; Saxton, Peter; Lo, Min; Perkins, Nicky; Ward, Daniel

2017-03-24

To investigate whether changes in rates of genital warts diagnosis at Auckland Sexual Health Service (ASHS), pre and post the quadrivalent human papillomavirus (4vHPV) vaccine introduction in late 2008, differed between clients vaccine-eligible and not eligible. All new clients attending ASHS from 2007 to 2013 were categorised as having genital warts or not. Generalised linear mixed models were used to compare differences in rates of change in diagnoses. Overall, 43,480 were seen with genital warts diagnosed in 13.1%. The difference in rate of change over time in diagnosis pre- to post-vaccine differed in females vaccine-eligible to not (p=0.004). The relative risk of diagnosis per year pre-vaccine was 0.98 (0.84, 1.13) and post-vaccine 0.77 (0.74, 0.81) in those eligible compared to 0.87 (0.80, 0.95) and 0.95 (0.91, 0.98), respectively, in those not eligible. This difference in change, between vaccine eligible or not, differed between males and females (p=0.02), with males considered eligible if the same aged female would have been. In males, no difference in rate change pre- to post-vaccine could be shown in those eligible or not (p=0.53). In this study a population effect for women of the 4vHPV vaccine was demonstrated.

Sleep patterns as predictors for disability pension due to low back diagnoses: a 23-year longitudinal study of Finnish twins.

PubMed

Ropponen, Annina; Silventoinen, Karri; Hublin, Christer; Svedberg, Pia; Koskenvuo, Markku; Kaprio, Jaakko

2013-06-01

Impaired sleep patterns are known to be associated with many chronic conditions and ultimately they may lead to permanent work incapacity. Less is known about the associations between sleep patterns and cause-specific disability pensions, such as low back diagnoses, or whether familial factors (genetics and family environment) can affect the associations. The objective of this study was to investigate sleep patterns as predictors of disability pension due to low back diagnoses with a 23-year follow-up. A prospective cohort study with comprehensive mailed questionnaires about sleep patterns, e.g., quality and length of sleep in 1975 and 1981. Follow-up from the national disability pension register data until 2004. Not applicable. There were 18,979 individuals (7,722 complete twin pairs) born before 1958. Cox proportional hazards regression was used to calculate hazard ratios (HR) with 95% confidence intervals (95% CI). Disability pension due to low back diagnoses had been granted to 467 individuals during the follow-up. Sleeping moderately well (HR 1.25; 95% CI 1.02, 1.53), or fairly poorly/poorly (HR 2.05; 95% CI 1.53, 2.73) at baseline predicted a significantly higher risk for disability pension. Stable patterns of sleeping either fairly well (HR 1.29; 95% CI 1.01, 1.64), or stably fairly poorly/poorly (HR 2.29; 95% CI 1.49, 3.52) between 1975 and 1981 were associated with a higher risk as compared to a stable pattern of sleeping well. Furthermore, a decrease in quality of sleep from 1975 to 1981 was associated (HR 1.34; 95% CI 1.03, 1.76) with an increased risk of disability pension. Sleep quality and changes in sleep quality appear to be early predictors for disability pension due to low back diagnoses independently from other confounding factors.

Diagnosing Lupus

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... Lupus.org Sign Up for Our Newsletter Donate Diagnosing Lupus Learn about lab tests, lupus symptoms, and how ... doctor's appointment article Reducing time to diagnosis blog Diagnosing lupus Getting a lupus diagnosis is challenging. Here’s what ...

Autism Spectrum Disorder Diagnoses in Stockholm Preschoolers

ERIC Educational Resources Information Center

Fernell, Elisabeth; Gillberg, Christopher

2010-01-01

The aims of this study were to estimate prevalence rates of children with autism spectrum disorder (ASD) diagnoses in a cohort of 6-year-old children with birth year 2002, referred to the Autism Centre for Young Children, serving the whole of Stockholm county and on the basis of the available data discuss clinical aspects of assessment,…

Epidemiology of otologic diagnoses in United States emergency departments.

PubMed

Kozin, Elliott D; Sethi, Rosh K V; Remenschneider, Aaron K; Kaplan, Alyson B; Del Portal, Daniel A; Gray, Stacey T; Shrime, Mark G; Lee, Daniel J

2015-08-01

Otologic complaints may place a significant burden on emergency departments (EDs) in the United States; however, few studies have comprehensively examined this discrete patient population. We aimed to identify utilization of EDs by patients with primary otologic complaints. Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011. The NEDS database was queried for patient encounters with a primary otologic diagnosis based on International Classification of Diseases, Ninth Revision codes (380-389). Weighted estimates for demographics, diagnostic characteristics, socioeconomic status, and trends over time were extracted. Predictors of mortality and admission were determined by multivariable logistic regression. A weighted total of 8,611,282 visits between 2009 and 2011 were attributed to otologic diagnoses, representing 2.21% of all ED visits. Stratified by patient age, otologic diagnoses encompassed 1.01% and 6.79% of all adult and pediatric ED visits, respectively. The majority of patients were treated and released (98.17%). The average age of patients presenting with an otologic complaint was 17.9 years (standard error = 0.23). Overall, 62.7% of patients who presented with an otologic complaint were 0 to 17 years old. The most common diagnoses among all age groups included otitis media not otherwise specified (NOS) (60.6%), infected otitis externa NOS (11.8%), and otalgia NOS (6.8%). We provide a comprehensive overview of otologic complaints that are an overlooked diagnostic category in public health research. NEDS data demonstrate a significant number of visits related to otologic complaints, especially in the pediatric population, that are nonemergent. 4 © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Does early paternal involvement predict offspring developmental diagnoses?

PubMed

Jackson, Dylan B; Newsome, Jamie; Beaver, Kevin M

2016-12-01

A long line of research has illustrated that fathers play an important role in the development of their children. Few studies, however, have examined the impact of paternal involvement at the earliest stages of life on developmental diagnoses in childhood. The present study extends this line of research by exploring the possibility that paternal involvement prenatally, postnatally, and at the time of birth may influence offspring risk for various diagnoses in childhood. A quasi-experimental, propensity score matching design was used to create treatment and control groups to assess the relationship between paternal involvement at each stage of development and developmental diagnoses. Approximately 6000 children, and a subsample of fathers, who participated in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). Activity, attention and learning, speech or language, and other diagnoses in early childhood, and overall number of diagnoses at 4years of age. We find no consistent evidence that low paternal involvement prenatally or postnatally increases the risk of various developmental diagnoses by age 4. However, children whose fathers were absent at the time of their birth were at significantly greater risk of incurring various developmental diagnoses, as well as a significantly greater number of developmental diagnoses. The findings expand our understanding of exactly how early paternal influence begins and the specific dimensions of early father behaviors that are related to the risk of various developmental diagnoses. Ultimately, these results have important implications concerning father involvement during the earliest stages of the life course. Copyright © 2016. Published by Elsevier Ireland Ltd.

[Delirium in Patients Over 60 Years of Age in a Tertiary Level Public Hospital in the City of Pereira (Colombia): Under-Diagnosed and Under-Recorded].

PubMed

César Sánchez, Julio; Isabel González, Martha; César Gutiérrez, Julio

2013-06-01

Delirium is a common disorder in the hospitalized geriatric population and it has a great importance on the clinical outcome of inpatients; however, delirium is not diagnosed properly. To clarify the state of delirium diagnosis and records in a tertiary level public hospital in the city of Pereira. A cross-sectional descriptive study was performed by searching the clinical records of hospitalized patients older than 60 years 2010 and 2011, using the ICD-10 classification as a filter, and verifying the diagnostic criteria of DSM-IV in the clinical records. In the years 2010 and 2011, 5325 patients older than 60 years were hospitalized (19.3%). According to the official statistical records; 0.08% of them were reported with an unspecified diagnosis of delirium (F059). In the clinical records search 455 additional delirium patients were found using the same criteria (40.2%), of which 90.1% had delirium, and only 29.5% were classified with the code F059. The diagnoses and recording of delirium patients over 60 years old patients are underestimated, which is demonstrated by the incongruence of the data obtained from the official records and those obtained from the clinical records. This fact increases the risk and vulnerability of patients with undetected delirium or diagnosed but not reported delirium in hospital statistical sources. Liaison psychiatry is a necessity in third level health institutions, as well as a program of continued education for the health staff about prevention, diagnosis criteria and treatment of delirium. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

A Retrospective, Longitudinal, Claims-Based Comparison of Concomitant Diagnoses Between Individuals with and Without Down Syndrome.

PubMed

Kong, Amanda M; Hurley, Dana; Evans, Kristin A; Brixner, Diana; Csoboth, Csilla; Visootsak, Jeannie

2017-07-01

Individuals with Down syndrome (DS) experience various comorbidities in excess of the prevalence seen among the non-DS population. However, the extent of the excess burden of comorbidities specifically within commercially and publicly insured DS populations aged < 21 years is not currently known. To (a) describe the most common diagnoses among individuals with DS who have either commercial or Medicaid insurance and (b) compare the prevalence of those diagnoses between DS cases and non-DS controls. This was a longitudinal, retrospective study using health care claims of commercially insured and Medicaid-insured individuals in the Truven Health MarketScan Databases from 2008 to 2015. Individuals aged < 2, 2-5, 6-11, and 12-20 years with a DS diagnosis (cases; commercial: n = 15,948; Medicaid: n = 11,958) were matched to individuals without DS (controls; commercial: n = 47,844; Medicaid: n = 35,874) using a 1:3 ratio. The annual number of diagnoses was compared between cases and controls within age groups using t-tests, and the prevalence of the most common diagnoses was compared using chi-square tests. Cases in all age groups in both databases had more diagnoses annually than controls (mean =9-17 per year vs. 4-10 per year, P < 0.001), and the number of diagnoses decreased with age for cases and controls. Among the most common case diagnoses were upper respiratory infections (28.9%-59.1% vs. 19.5%-52.9%); suppurative otitis media (25.1%-56.8% vs. 8.7%-51.2%); nutrition/metabolic/developmental symptoms (37.9%-50.4% vs. 7.7%-10.6%); delays in development (22.8%-52.8% vs. 4.1%-10.9%); and general symptoms (35.1%-47.2% vs. 22.1%-37.2%), and the prevalence of each was greater among cases versus controls in all age groups in both databases (P < 0.001). The most common diagnoses among controls included some of the same as among cases, as well as acute pharyngitis (18.7%-31.8% vs. 19.2%-30.5%); allergic rhinitis (19.9%-24.3% vs. 15.3%-20.7%); viral/chlamydial infections (24

Analysis of Diagnoses Associated with Multiple Sclerosis–Related In-Hospital Mortality Using the Premier Hospital Database

PubMed Central

Pocoski, Jennifer; Cutter, Gary; Kaufman, David W.; Pleimes, Dirk

2016-01-01

Background: We sought to compare mortality rates and related diagnoses in hospitalized patients with multiple sclerosis (MS), those with diabetes mellitus (DM), and the general hospitalized population (GHP). Methods: Patients who died between 2007 and 2011 were identified in the US hospital–based Premier Healthcare Database. Demographic information was collected, mortality rates calculated, and principal diagnoses categorized. Results: Of 55,152 unique patients with MS identified, 1518 died. Mean age at death was 10 years younger for the MS group (63.4 years) than for the DM (73.3 years) and GHP (73.1 years) groups. Age-adjusted mortality rates, based on the 2000 US Standard Million Population, were 1077, 1248, and 1133 per 100,000, respectively. Infection was the most common principal diagnosis at the hospital stay during which the patient died in the MS cohort (43.1% vs. 26.3% and 24.0% in the DM and GHP groups, respectively). Other common principal diagnoses in the MS group included pulmonary (17.5%) and cardiovascular (12.1%) disease. Septicemia/sepsis/septic shock was a secondary diagnosis for 50.7% of patients with MS versus 36.0% and 31.0% of patients in the DM and GHP cohorts, respectively. Conclusions: Patients with MS had a shorter life span than patients with DM or the GHP and were more likely to have a principal diagnosis of infection at their final hospital stay. However, the database was limited to codes recorded in the hospital; diagnoses received outside the hospital were not captured. PMID:27252603

Neonatal factors among subjects diagnosed with a pervasive developmental disorder in the US.

PubMed

Geier, David; Kern, Janet; Geier, Mark

2018-07-01

Contradictory studies suggest that some neonatal factors may be associated with a pervasive developmental disorder (PDD) diagnosis, but limited data is available from longitudinal, prospective medical record assessments. The present hypothesis-testing longitudinal, case-control study evaluated birth characteristics among cases diagnosed with a PDD in comparison to controls by examining prospectively collected automated medical records within the Vaccine Safety Datalink (VSD) database. Cases were Health Maintenance Organization (HMO)-enrolled from birth until diagnosed with International Classification of Disease, 9th revision (ICD-9) PDD (299.xx) and controls were HMO-enrolled from birth for at least 4.75 years without a PDD diagnosis. The birth characteristics examined included: gender, gestational age in weeks at birth, mean birth weight in grams, Appearance-Pulse-Grimace-Activity-Respiration (APGAR) scores at 1 minute and 5 minutes, and maternal age in years at birth. Cases had a significantly increased male/female ratio relative to controls. By contrast, mean gestational age at birth, mean birth weight, mean maternal age at birth, and mean APGAR scores at 1 minute and 5 minutes were not statistically different among cases compared to controls. This study indicates that cases diagnosed with a PDD as compared to controls do not have significant differences in neonatal factors.

A French multicenter study of over 700 patients with 22q11 deletions diagnosed using FISH or aCGH.

PubMed

Poirsier, Céline; Besseau-Ayasse, Justine; Schluth-Bolard, Caroline; Toutain, Jérôme; Missirian, Chantal; Le Caignec, Cédric; Bazin, Anne; de Blois, Marie Christine; Kuentz, Paul; Catty, Marie; Choiset, Agnès; Plessis, Ghislaine; Basinko, Audrey; Letard, Pascaline; Flori, Elisabeth; Jimenez, Mélanie; Valduga, Mylène; Landais, Emilie; Lallaoui, Hakima; Cartault, François; Lespinasse, James; Martin-Coignard, Dominique; Callier, Patrick; Pebrel-Richard, Céline; Portnoi, Marie-France; Busa, Tiffany; Receveur, Aline; Amblard, Florence; Yardin, Catherine; Harbuz, Radu; Prieur, Fabienne; Le Meur, Nathalie; Pipiras, Eva; Kleinfinger, Pascale; Vialard, François; Doco-Fenzy, Martine

2016-06-01

Although 22q11.2 deletion syndrome (22q11.2DS) is the most recurrent human microdeletion syndrome associated with a highly variable phenotype, little is known about the condition's true incidence and the phenotype at diagnosis. We performed a multicenter, retrospective analysis of postnatally diagnosed patients recruited by members of the Association des Cytogénéticiens de Langue Française (the French-Speaking Cytogeneticists Association). Clinical and cytogenetic data on 749 cases diagnosed between 1995 and 2013 were collected by 31 French cytogenetics laboratories. The most frequent reasons for referral of postnatally diagnosed cases were a congenital heart defect (CHD, 48.6%), facial dysmorphism (49.7%) and developmental delay (40.7%). Since 2007 (the year in which array comparative genomic hybridization (aCGH) was introduced for the routine screening of patients with intellectual disability), almost all cases have been diagnosed using FISH (96.1%). Only 15 cases (all with an atypical phenotype) were diagnosed with aCGH; the deletion size ranged from 745 to 2904 kb. The deletion was inherited in 15.0% of cases and was of maternal origin in 85.5% of the latter. This is the largest yet documented cohort of patients with 22q11.2DS (the most commonly diagnosed microdeletion) from the same population. French cytogenetics laboratories diagnosed at least 108 affected patients (including fetuses) per year from among a national population of ∼66 million. As observed for prenatal diagnoses, CHDs were the most frequently detected malformation in postnatal diagnoses. The most common CHD in postnatal diagnoses was an isolated septal defect.

Two rare diagnoses during chronic lymphocytic leukaemia follow-up: Kaposi's sarcoma and Merkel cell carcinoma.

PubMed

Dogu, Mehmet H; Sari, Ismail; Hacioglu, Sibel; Degirmencioglu, Serkan; Şen, Nilay; Keskin, Ali

2016-02-01

Chronic lymphocytic leukaemia often has a clinical presentation characterised by increased neoplastic lymphocytes which are mostly mature looking due to B lymphocytes. Increased secondary cancer prevalence has been detected among patients with chronic lymphocytic leukaemia diagnosis. In this report, we present three chronic lymphocytic leukaemia patients who developed secondary rare cancers during their follow-up at our clinic. Case 1: A 54-year-old female patient was diagnosed with stage I chronic lymphocytic leukaemia in 2003 and was diagnosed with Merkel cell carcinoma in February 2013. Case 2: A 66-year-old male patient was diagnosed with stage II chronic lymphocytic leukaemia in 2009 and was diagnosed with Kaposi's sarcoma in March 2013. Case 3: A 77-year-old male patient was diagnosed with stage I chronic lymphocytic leukaemia in 2006 and was diagnosed with Kaposi's sarcoma in 2011. In conclusion, secondary cancers are observed in patients diagnosed with chronic lymphocytic leukaemia. Therefore, follow-up of chronic lymphocytic leukaemia requires additional attention in this context. © The Author(s) 2016.

Clinical Prediction Model for Time in Therapeutic Range While on Warfarin in Newly Diagnosed Atrial Fibrillation.

PubMed

Williams, Brent A; Evans, Michael A; Honushefsky, Ashley M; Berger, Peter B

2017-10-12

Though warfarin has historically been the primary oral anticoagulant for stroke prevention in newly diagnosed atrial fibrillation (AF), several new direct oral anticoagulants may be preferred when anticoagulation control with warfarin is expected to be poor. This study developed a prediction model for time in therapeutic range (TTR) among newly diagnosed AF patients on newly initiated warfarin as a tool to assist decision making between warfarin and direct oral anticoagulants. This electronic medical record-based, retrospective study included newly diagnosed, nonvalvular AF patients with no recent warfarin exposure receiving primary care services through a large healthcare system in rural Pennsylvania. TTR was estimated as the percentage of time international normalized ratio measurements were between 2.0 and 3.0 during the first year following warfarin initiation. Candidate predictors of TTR were chosen from data elements collected during usual clinical care. A TTR prediction model was developed and temporally validated and its predictive performance was compared with the SAMe-TT 2 R 2 score (sex, age, medical history, treatment, tobacco, race) using R 2 and c-statistics. A total of 7877 newly diagnosed AF patients met study inclusion criteria. Median (interquartile range) TTR within the first year of starting warfarin was 51% (32, 67). Of 85 candidate predictors evaluated, 15 were included in the final validated model with an R 2 of 15.4%. The proposed model showed better predictive performance than the SAMe-TT 2 R 2 score ( R 2 =3.0%). The proposed prediction model may assist decision making on the proper mode of oral anticoagulant among newly diagnosed AF patients. However, predicting TTR on warfarin remains challenging. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Syphilis epidemics: a descriptive study of patients diagnosed in a tertiary hospital between 2011 and 2015.

PubMed

Fustà, Xavier; Fuertes, Irene; Lugo-Colón, Rossie; Blanco, José Luís; Baras, Núria; Alsina-Gibert, Mercè

2017-12-20

In the last decade, the incidence of syphilis has increased in our health area. Our objective is to describe the epidemiological and clinical characteristics of patients diagnosed with syphilis at our centre and their relationship with HIV. The clinical and epidemiological variables of patients diagnosed with syphilis in a third-level hospital over a period of 4.5 years, as well as their HIV status, were analysed through a descriptive study. There was a significant increase in the incidence of syphilis in the period 2011-2015. We included 220 patients, 98% men (94% MSM). 62% were HIV+ and 89% came in early/infectious stages of the disease. 7% were concomitantly diagnosed with HIV. There was a high number of sexual partners and frequent use of drugs associated with sexual activity (46%). The incidence of syphilis has increased in our centre in the last 2 years. The most affected group is MSM, with high HIV prevalence and risk behaviours for STI acquisition. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

ICD-10 classification in Danish child and adolescent psychiatry--have diagnoses changed after the introduction of ICD-10?

PubMed

Møller, Lene Ruge; Sørensen, Merete Juul; Thomsen, Per Hove

2007-01-01

The aim was to test this in a nationwide register study of diagnoses used in child and adolescents psychiatry in Denmark. A larger number of different diagnoses were expected to be applied after the introduction of the 10th version of the International Classification of Diseases (ICD-10). Reflecting the time trend, we particularly expected an increase in the number of neuropsychiatric diagnoses. From the Danish Psychiatric Central Register data were drawn on clinical discharge diagnoses. All patients aged 0-15 years examined at psychiatric hospitals from 1995-2002 were included; 22,469 children and adolescents with a first contact were registered. The most frequent discharge diagnoses were pervasive development disorders (PDD; 11.9%), adjustment disorders (10.6%), conduct disorder (9.5%), emotional and anxiety disorders (7.6%), hyperkinetic disorders (7.3%), and specific developmental disorders (7.3%). We found a significant increase in the number of neuropsychiatric and affective diagnoses and a significant decrease in the number of adjustment, conduct and anxiety diagnoses during the study period. Of the 22,469 diagnoses, 45% were only partly specified according to ICD-10. Thirty-four per cent had diagnoses unspecified on the four-character level (Fxx.9) and 11% had Z-diagnoses. A larger number of different diagnoses and an increase in the use of neuropsychiatric diagnoses were seen after the introduction of ICD-10. Many diagnoses were only partly specified; consequently, a more detailed specification of the ICD-10 is still required.

Diagnosing malaria in pregnancy: an update

PubMed Central

Fried, Michal; Muehlenbachs, Atis; Duffy, Patrick E

2013-01-01

Pregnancy malaria (PM) due to Plasmodium falciparum is a major cause of morbidity and mortality for women and their offspring, but is difficult to recognize and diagnose. During PM, parasites typically sequester in the placenta, whereas peripheral blood smears often appear negative. In addition, many infected women remain asymptomatic, especially in areas of high transmission where systemic immunity is high, although sequelae including maternal anemia and intrauterine growth retardation develop insidiously and increase mortality. New rapid diagnostic tests (RDTs) have shown promise for malaria diagnosis in nonpregnant individuals, including a product recently approved by the US FDA for use in the USA. However, the sensitivity and specificity of RDTs for diagnosis of PM may be suboptimal. Here, we review the methods that are used to detect or diagnose PM, including blood smear microscopy, RDTs, PCR-based methods, and finally placental histology, which is often cited as the gold standard for use in research studies and clinical trials. PMID:23199403

Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care.

PubMed

Khunti, Kamlesh; Gray, Laura J; Skinner, Timothy; Carey, Marian E; Realf, Kathryn; Dallosso, Helen; Fisher, Harriet; Campbell, Michael; Heller, Simon; Davies, Melanie J

2012-04-26

To measure whether the benefits of a single education and self management structured programme for people with newly diagnosed type 2 diabetes mellitus are sustained at three years. Three year follow-up of a multicentre cluster randomised controlled trial in primary care, with randomisation at practice level. 207 general practices in 13 primary care sites in the United Kingdom. 731 of the 824 participants included in the original trial were eligible for follow-up. Biomedical data were collected on 604 (82.6%) and questionnaire data on 513 (70.1%) participants. A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care. The primary outcome was glycated haemoglobin (HbA(1c)) levels. The secondary outcomes were blood pressure, weight, blood lipid levels, smoking status, physical activity, quality of life, beliefs about illness, depression, emotional impact of diabetes, and drug use at three years. HbA(1c) levels at three years had decreased in both groups. After adjusting for baseline and cluster the difference was not significant (difference -0.02, 95% confidence interval -0.22 to 0.17). The groups did not differ for the other biomedical and lifestyle outcomes and drug use. The significant benefits in the intervention group across four out of five health beliefs seen at 12 months were sustained at three years (P<0.01). Depression scores and quality of life did not differ at three years. A single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs. Current Controlled Trials ISRCTN17844016.

Healthcare cost attributable to recently-diagnosed breast cancer in a privately-insured population in the United States.

PubMed

Fu, Alex Z; Jhaveri, Mehul

2012-01-01

To evaluate breast cancer-associated healthcare cost from the payer perspective for the initial year after diagnoses of invasive breast cancer. Breast cancer is the second most common malignancy in American women. While lifetime burden-of-care studies have reported spending between $20,000 and $100,000 per patient, previous studies have not outlined first year cost in managing this disease in recently diagnosed patients. This study was a retrospective, matched cohort study of privately-insured patients. Data were from a large US employers' health claims database (January 2003-September 2008). Breast cancer cases were identified by ICD-9-CM diagnostic codes on index and confirmatory claims. A control group was identified with a ratio of 3:1, matched by demographic and health plan characteristics. Comorbidities were analyzed using the Charlson comorbidity index and AHRQ Comorbidity Software. A multivariate, log-linked, generalized linear model evaluated cost contributions of breast cancer in relation to demographic factors, comorbidities, and plan type. The study included 35,057 cases and 105,171 matched controls (mean age 52 years). Common comorbidities included hypertension, diabetes, hypothyroidism, chronic pulmonary disease, and deficiency anemia. In the generalized linear model, the adjusted difference in total healthcare cost was $42,401 per patient within a year, with outpatient services responsible for most of this sum. Breast cancer-associated incremental annual costs per patient in inpatient, outpatient, and prescription categories were $5100, $37,231, and $1037, respectively. These results may not be representative of the entire US, as data were derived from breast cancer patients with private, employer-based health insurance, and lacked covariates including race/ethnicity, education, income, and disease stage. Recently diagnosed breast cancer represents a substantial economic burden for US healthcare payers.

Iodine-131-meta-iodobenzylguanidine therapy for patients with newly diagnosed high-risk neuroblastoma.

PubMed

Kraal, Kathelijne Cjm; van Dalen, Elvira C; Tytgat, Godelieve Am; Van Eck-Smit, Berthe Lf

2017-04-21

); five-year overall survival was 14.6%; median event-free survival was 10 months (95% CI 7 to 13); and five-year event-free survival was 12.2%. In the other study, the ORR was 56% after myeloablative therapy and autologous stem cell transplantation; 10-year overall survival was 6.25%; and event-free survival was not reported. With regard to short-term adverse effects, one study showed a prevalence of 2% (95% CI 0% to 13%; best-case scenario) for death due to myelosuppression. After the first cycle of 131 I-MIBG therapy in one study, platelet toxicity occurred in 38% (95% CI 18% to 61%), neutrophil toxicity in 50% (95% CI 28% to 72%) and haemoglobin toxicity in 69% (95% CI 44% to 86%); after the second cycle this was 60% (95% CI 36% to 80%) for platelets and neutrophils and 53% (95% CI 30% to 75%) for haemoglobin. In one study, the prevalence of hepatic toxicity during or within four weeks after last the MIBG treatment was 0% (95% CI 0% to 9%; best-case scenario). Neither study reported cardiovascular toxicity and sialoadenitis. One study assessed long-term adverse events in some of the children: there was elevated plasma thyroid-stimulating hormone in 45% (95% CI 27% to 65%) of children; in all children, free T4 was within the age-related normal range (0%, 95% CI 0% to 15%). There were no secondary malignancies observed (0%, 95% CI 0% to 9%), but only five children survived more than four years. We identified no RCTs or CCTs comparing the effectiveness of treatment including 131 I-MIBG therapy versus treatment not including 131 I-MIBG therapy in patients with newly diagnosed HR NBL. We found two small observational studies including chilren. They had high risk of bias, and not all relevant outcome results were available. Based on the currently available evidence, we cannot make recommendations for the use of 131 I-MIBG therapy in patients with newly diagnosed HR NBL in clinical practice. More high-quality research is needed.

Nursing diagnoses related to psychiatric adult inpatient care.

PubMed

Frauenfelder, Fritz; van Achterberg, Theo; Müller Staub, Maria

2018-02-01

To detect the prevalence of NANDA-I diagnoses and possible relationships between those and patient characteristics such as gender, age, medical diagnoses and psychiatric specialty/setting. There is a lack on studies about psychiatric inpatient characteristics and possible relationships among these characteristics with nursing diagnoses. A quantitative-descriptive, cross-sectional, completed data sampling study was performed. The data were collected from the electronic patient record system. Frequencies for the social-demographic data, the prevalence of the NANDA-I diagnoses and the explanatory variables were calculated. In total, 410 nursing phenomena were found representing 85 different NANDA-I diagnoses in 312 patients. The NANDA-I diagnosis "Ineffective Coping" was the most frequently stated diagnosis followed by "Ineffective Health Maintenance," "Hopelessness" and "Risk for Other-Directed Violence". Men were more frequently affected by the diagnoses "Ineffective Coping," "Hopelessness," "Risk for Self-Directed Violence," "Defensive Coping" and "Risk for Suicide," whereas the diagnoses "Insomnia," "Chronic Confusion," "Chronic Low Self-Esteem" and "Anxiety" were more common in women. Patients under the age of 45 years were more frequently affected by "Chronic Low Self-Esteem" and "Anxiety" than older patients. "Ineffective Coping" was the most prevalent diagnosis by patients with mental disorders due to psychoactive substance use. Patients with schizophrenia were primarily affected by the diagnoses "Ineffective Coping," "Impaired Social Interaction" and "Chronic Low Self-Esteem." This study demonstrates the complexity and diversity of nursing care in inpatient psychiatric settings. Patients' gender, age and psychiatric diagnoses and settings are a key factor for specific nursing diagnosis. There are tendencies for relationships between certain nursing diagnosis and patient characteristics in psychiatric adult inpatients. This enhances the specific, extended

Age-related differences in temporomandibular disorder diagnoses.

PubMed

Guarda-Nardini, Luca; Piccotti, Fabio; Mogno, Giorgia; Favero, Lorenzo; Manfredini, Daniele

2012-04-01

The purpose of the current study was to evaluate the pattern of age distribution of temporomandibular disorders (TMD) and to identify prevalence peaks for the different diagnoses. The study sample (N = 383; F:M ratio = 3.9; mean age range 41.7 +/- 17 years) consisted of patients seeking treatment for TMD and who were assessed in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) version 1.0 guidelines. The sample was divided into four age groups on the basis of percentile-derived intervals to compare prevalence of different diagnoses in relation to age. The pattern of clinical diagnoses changed with increasing age. The peculiar distribution of RDC/TMD axis I diagnoses, with relation to age, mainly affected the disorders trend of groups II and III, with the former decreasing with age from about 62% to 40% and the latter increasing from 75% to almost 95%. Two distinct age peaks were identified for the prevalence of the main clinical marker of group III diagnosis of arthrosis/arthritis, viz., joint crepitus sounds (N = 104, mean age range 51.9 +/- 14.5), and for the prevalence of all other diagnoses in patients without joint crepitus (N = 279, mean age range 37.9 +/- 16.4). The hypothesis that TMD patient populations may be composed of at least two diagnostic subgroups in relation to age, and that the presence of clinically diagnosed degenerative joint disorders may be a key discriminating factor, was supported. The external validity of the results from this investigation needs to be confirmed by multicenter and cross-cultural studies.

Low prevalence of neurocognitive impairment in early diagnosed and managed HIV-infected persons

PubMed Central

Moore, David J.; Letendre, Scott; Poehlman Roediger, Mollie; Eberly, Lynn; Weintrob, Amy; Ganesan, Anuradha; Johnson, Erica; Del Rosario, Raechel; Agan, Brian K.; Hale, Braden R.

2013-01-01

Objective: To describe the prevalence of neurocognitive impairment (NCI) among early diagnosed and managed HIV-infected persons (HIV+) compared to HIV-negative controls. Methods: We performed a cross-sectional study among 200 HIV+ and 50 matched HIV-uninfected (HIV−) military beneficiaries. HIV+ patients were categorized as earlier (<6 years of HIV, no AIDS-defining conditions, and CD4 nadir >200 cells/mm3) or later stage patients (n = 100 in each group); both groups were diagnosed early and had access to care. NCI was diagnosed using a comprehensive battery of standardized neuropsychological tests. Results: HIV+ patients had a median age of 36 years, 91% were seroconverters (median window of 1.2 years), had a median duration of HIV of 5 years, had a CD4 nadir of 319, had current CD4 of 546 cells/mm3, and 64% were on highly active antiretroviral therapy (initiated 1.3 years after diagnosis at a median CD4 of 333 cells/mm3). NCI was diagnosed among 38 (19%, 95% confidence interval 14%–25%) HIV+ patients, with a similar prevalence of NCI among earlier and later stage patients (18% vs 20%, p = 0.72). The prevalence of NCI among HIV+ patients was similar to HIV− patients. Conclusions: HIV+ patients diagnosed and managed early during the course of HIV infection had a low prevalence of NCI, comparable to matched HIV-uninfected persons. Early recognition and management of HIV infection may be important in limiting neurocognitive impairment. PMID:23303852

Diagnosed hematological malignancies in Bangladesh - a retrospective analysis of over 5000 cases from 10 specialized hospitals.

PubMed

Hossain, Mohammad Sorowar; Iqbal, Mohd S; Khan, Mohiuddin Ahmed; Rabbani, Mohammad Golam; Khatun, Hazera; Munira, Sirajam; Miah, M Morshed Zaman; Kabir, Amin Lutful; Islam, Naima; Dipta, Tashmim Farhana; Rahman, Farzana; Mottalib, Abdul; Afrose, Salma; Ara, Tasneem; Biswas, Akhil Ranjan; Rahman, Mizanur; Abedin, Akm Mustafa; Rahman, Mahbubur; Yunus, A B M; Niessen, Louis W; Sultana, Tanvira Afroze

2014-06-14

The global burden from cancer is rising, especially as low-income countries like Bangladesh observe rapid aging. So far, there are no comprehensive descriptions reporting diagnosed cancer group that include hematological malignancies in Bangladesh. This was a multi-center hospital-based retrospective descriptive study of over 5000 confirmed hematological cancer cases in between January 2008 to December 2012. Morphological typing was carried out using the "French American British" classification system. A total of 5013 patients aged between 2 to 90 years had been diagnosed with malignant hematological disorders. A 69.2% were males (n=3468) and 30.8% females (n=1545), with a male to female ratio of 2.2:1. The overall median age at diagnosis was 42 years. Acute myeloid leukemia was most frequent (28.3%) with a median age of 35 years, followed by chronic myeloid leukemia with 18.2% (median age 40 years), non-Hodgkin lymphoma (16.9%; median age 48 years), acute lymphoblastic leukemia (14.1%; median age 27 years), multiple myeloma (10.5%; median age 55 years), myelodysplastic syndromes (4.5%; median age 57 years) and Hodgkin's lymphoma (3.9%; median age 36 years). The least common was chronic lymphocytic leukemia (3.7%; median age 60 years). Below the age of 20 years, acute lymphoblastic leukemia was predominant (37.3%), followed by acute myeloid leukemia (34%). Chronic lymphocytic leukemia and multiple myeloma had mostly occurred among older patients, aged 50-over. For the first time, our study presents the pattern and distribution of diagnosed hematological cancers in Bangladesh. It shows differences in population distributions as compared to other settings with possibly a lower presence of non-Hodgkin lymphoma. There might be under-reporting of affected women. Further studies are necessary on the epidemiology, genetics and potential environmental risk factors within this rapidly aging country.

Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood.

PubMed

Cain, Nicole; Irving, Claire; Webber, Steven; Beerman, Lee; Arora, Gaurav

2013-10-01

Wolff-Parkinson-White (WPW) syndrome carries a risk for symptomatic arrhythmias and sudden death. The aim of this study was to examine the natural history of patients with Wolff-Parkinson-White syndrome diagnosed in childhood followed longitudinally at a single institution. The study population consisted of 446 patients. The median age of diagnosis was 7 years, and 61% were male. Associated heart disease was present in 40 patients (9%). Modes of presentation included supraventricular tachycardia (38%), palpitations (22%), chest pain (5%), syncope (4%), atrial fibrillation (0.4%), sudden death (0.2%), and incidental findings (26%); data were unavailable in 4%. During the study period, a total of 243 patients (54%) had supraventricular tachycardia, and 7 patients (1.6%) had atrial fibrillation. Of patients who presented at ≤3 months of age, 35% had resolution of manifest preexcitation compared with 5.8% who presented at >3 months of age (p <0.0001). There were 6 sudden deaths (1.3%), with an incidence of 2.8 per 1,000 patient-years. Two of these patients had structurally normal hearts (incidence 1.1 per 1,000 patient-years). Four of these patients had associated heart disease (incidence 27 per 1,000 patient-years) (p <0.01). In conclusion, in a large population of patients with Wolff-Parkinson-White syndrome diagnosed in childhood, 64% had symptoms at presentation, and an additional 20% developed symptoms during follow-up. There were 6 sudden deaths (1.3%), with an overall incidence of 1.1 per 1,000 patient-years in patients with structurally normal hearts and 27 per 1,000 patient-years in patients with associated heart disease. Copyright © 2013 Elsevier Inc. All rights reserved.

Aberrations in carbohydrate metabolism in patients with diagnosed acromegaly, hospitalized in the Endocrinology and Diabetology Department of Collegium Medicum University of Nicolaus Copernicus in Bydgoszcz in the years 2001-2009.

PubMed

Gierach, Marcin; Gierach, Joanna; Pujanek, Małgorzata; Skowrońska, Agnieszka; Rutkowska, Emilia; Junik, Roman

2010-01-01

The incidence rate of acromegaly is 50 to70 persons per one million people. It occurs twice as often in women than in men, especially in middle age. In the course of the disease, insulin resistance develops, which is connected with the hypersecretion of somatotropin. Type 2 diabetes mellitus occurs more frequently in patients with acromegaly than in the rest of the population. It is diagnosed in 13-56% of acromegaly sufferers; impaired glucose tolerance occurs in 16-46% of examined patients with acromegaly. The aim of this study is to estimate disturbances of glycaemia in patients with diagnosed acromegaly, hospitalized in the Endocrinology and Diabetology Department of Collegium Medicum University of Nicolaus Copernicus in Bydgoszcz in the years 2001-2009. The participants were a group of 70 patients with acromegaly diagnosed on the basis of clinical symptoms, high levels of somatotropin, and MRI imaging of the pituitary gland. Type 2 diabetes was diagnosed in 19 patients (27%); there were 11 cases (15%) of diagnosis of impaired fasting glycaemia (IFG) and imapired glucose tolerance (IGT) combined. Normoglycaemia was recognized in 57% of participants (40 patients). The average age of participants with concomitant type 2 diabetes was 56.1 years, whereas the average age of those without carbohydrate metabolism disturbances was 47.1 years. In patients with acromegaly, the incidence rate of type 2 diabetes is 3-4-times higher than in the rest of the population and increases with age, especially after the age of 60.

Assessing the economic burden of Alzheimer's disease patients first diagnosed by specialists.

PubMed

Kirson, Noam Y; Desai, Urvi; Ristovska, Ljubica; Cummings, Alice Kate G; Birnbaum, Howard G; Ye, Wenyu; Andrews, J Scott; Ball, Daniel; Kahle-Wrobleski, Kristin

2016-07-11

It is not known if there is a differential impact on Alzheimer's disease (AD) diagnosis and outcomes if/when patients are diagnosed with cognitive decline by specialists versus non-specialists. This study examined the cost trajectories of Medicare beneficiaries initially diagnosed by specialists compared to similar patients who received their diagnosis in primary care settings. Patients with ≥2 claims for AD were selected from de-identified administrative claims data for US Medicare beneficiaries (5 % random sample). The earliest observed diagnosis of cognitive decline served as the index date. Patients were required to have continuous Medicare coverage for ≥12 months pre-index (baseline) and ≥12 months following the first AD diagnosis, allowing for up to 3 years from index to AD diagnosis. Time from index date to AD diagnosis was compared between those diagnosed by specialists (i.e., neurologist, psychiatrist, or geriatrician) versus non-specialists using Kaplan-Meier analyses with log-rank tests. Patient demographics, Charlson Comorbidity Index (CCI) during baseline, and annual all-cause medical costs (reimbursed by Medicare) in baseline and follow-up periods were compared across propensity-score matched cohorts. Patients first diagnosed with cognitive decline by specialists (n = 2593) were younger (78.8 versus 80.8 years old), more likely to be male (40 % versus 34 %), and had higher CCI scores and higher medical costs at baseline than those diagnosed by non-specialists (n = 13,961). However, patients diagnosed by specialists had a significantly shorter time to AD diagnosis, both before and after matching (mean [after matching]: 3.5 versus 4.6 months, p < 0.0001). In addition, patients diagnosed by specialists had significantly lower average total all-cause medical costs in the first 12 months after their index date, a finding that persisted after matching ($19,824 versus $25,863, p < 0.0001). Total per-patient annual medical costs

The recognition of diagnosable psychiatric disorders in suicide cases' last medical contacts.

PubMed

Pan, Yi-Ju; Lee, Ming-Been; Chiang, Hung-Chi; Liao, Shih-Cheng

2009-01-01

The objective of this study is to examine physicians' awareness of diagnosable psychiatric disorders in suicide cases' last medical contacts (MCs). The contact rates and proportions of both psychiatric and somatic diagnoses in a national cohort of suicide subjects (N=3468) in Taiwan seeking psychiatric or nonpsychiatric medical services within 1 month and 1 year preceding death were examined. The overall rates of MCs were 72.6% within 1 month and 89.2% within 1 year preceding suicide. While around 99.9% of the suicide subjects who contacted psychiatrists within 1 month preceding death were diagnosed as having psychiatric disorders, only 19.7% of those visiting nonpsychiatric physicians had psychiatric diagnoses. Suicide subjects, however, frequently complained of somatic symptoms, for example, gastrointestinal discomfort, headache/dizziness and back problem during their contacts with nonpsychiatric physicians within 1 month preceding death. Despite the high rates of MCs preceding suicide, the majority of suicide subjects were not diagnosed. Emphasizing psychosomatic manifestations of psychiatric disorders in physician education programs may help enhance the awareness of psychiatric disorders/suicide risk in clinical settings.

Complex sacral abscess 8 years after abdominal sacral colpopexy.

PubMed

Collins, Sarah A; Tulikangas, Paul K; LaSala, Christine A; Lind, Lawrence R

2011-08-01

Sacral colpopexy is an effective, durable repair for women with apical vaginal or uterovaginal prolapse. There are few reports of serious complications diagnosed in the remote postoperative period. A 74-year-old woman presented 8 years after undergoing posthysterectomy abdominal sacral colpopexy using polypropylene mesh. Posterior vaginal mesh erosion had been diagnosed several months before presentation. She suffered severe infectious complications including an infected thrombus in the inferior vena cava, sacral osteomyelitis, and a complex abscess with presacral and epidural components. Surgical exploration revealed an abscess cavity surrounding the mesh. Although minor complications commonly occur after sacral colpopexy using abdominal mesh, serious and rare postoperative infectious complications may occur years postoperatively.

Characteristics and Outcome of Patients Diagnosed With HIV at Older Age.

PubMed

Asher, Ilan; Guri, Keren Mahlab; Elbirt, Daniel; Bezalel, Shira Rosenberg; Maldarelli, Frank; Mor, Orna; Grossman, Zehava; Sthoeger, Zev M

2016-01-01

To characterize the clinical, virological, and immunological status at presentation as well as the outcome of patients diagnosed with HIV above the age of 50. A retrospective study of 418 patients newly diagnosed with HIV in 1 Israeli center, between the years 2004 and 2013. Patients with new HIV diagnosis ≥ 50 years of age defined as "older' and < 50 defined as "younger.' Patients were evaluated every 1 to 3 months (mean follow-up 53 ± 33 months). Patients with < 2 CD4/viral-load measurements or with < 1 year of follow-up were excluded. Time of HIV infection was estimated by HIV sequence ambiguity assay. Ambiguity index ≤ 0.43 indicated recent (≤ 1 year) HIV infection. Eighty nine (21%) patients were diagnosed with HIV at an older age. Those older patients presented with significant lower CD4 cell counts and higher viral-load compared with the younger patients. At the end of the study, the older patients had higher mortality rate (21% vs 3.5%; P < 0.001) and lower CD4 cell counts (381 ± 228 vs 483 ± 26 cells/μL; P < 0.001) compared with the younger patients. This difference was also observed between older and younger patients with similar CD4 cell counts and viral load at the time of HIV diagnosis and among patients with a recent (≤ 1 year) HIV infection. One-fifth of HIV patients are diagnosed at older age (≥ 50 years). Those older patients have less favorable outcome compared with the younger patients. This point to the need of educational and screening programs within older populations and for a closer follow-up of older HIV patients.

Attention Deficit Hyperactivity Disorder Erroneously Diagnosed and Treated as Bipolar Disorder

ERIC Educational Resources Information Center

Atmaca, Murad; Ozler, Sinan; Topuz, Mehtap; Goldstein, Sam

2009-01-01

Objective: There is a dearth of literature on patients erroneously diagnosed and treated for bipolar disorder. Method: The authors report a case of an adult with attention deficit hyperactivity disorder erroneously diagnosed and treated for bipolar disorder for 6 years. At that point, methylphenidate was initiated. The patient was judged to be a…

Cost-effectiveness of finding new HIV diagnoses using rapid HIV testing in community-based organizations.

PubMed

Shrestha, Ram K; Clark, Hollie A; Sansom, Stephanie L; Song, Binwei; Buckendahl, Holly; Calhoun, Cindy B; Hutchinson, Angela B; Heffelfinger, James D

2008-01-01

We assessed the cost-effectiveness of determining new human immunodeficiency virus (HIV) diagnoses using rapid HIV testing performed by community-based organizations (CBOs) in Kansas City, Missouri, and Detroit, Michigan. The CBOs performed rapid HIV testing during April 2004 through March 2006. In Kansas City, testing was performed in a clinic and in outreach settings. In Detroit, testing was performed in outreach settings only. Both CBOs used mobile testing vans. Measures of effectiveness were the number of HIV tests performed and the number of people notified of new HIV diagnoses, based on rapid tests. We retrospectively collected program costs, including those for personnel, test kits, mobile vans, and facility space. The CBO in Kansas City tested a mean of 855 people a year in its clinic and 703 people a year in outreach settings. The number of people notified of new HIV diagnoses was 19 (2.2%) in the clinic and five (0.7%) in outreach settings. The CBO in Detroit tested 976 people a year in outreach settings, and the number notified of new HIV diagnoses was 15 (1.5%). In Kansas City, the cost per person notified of a new HIV diagnosis was $3,637 in the clinic and $16,985 in outreach settings. In the Detroit outreach settings, the cost per notification was $13,448. The cost of providing a new HIV diagnosis was considerably higher in the outreach settings than in the clinic. The variation can be largely explained by differences in the number of undiagnosed infections among the people tested and by the costs of purchasing and operating a mobile van.

Examining perceived stigma of children with newly-diagnosed epilepsy and their caregivers over a two-year period.

PubMed

Rood, Jennifer E; Schultz, Janet R; Rausch, Joseph R; Modi, Avani C

2014-10-01

The purpose of this study was to examine the following: 1) the course of perceived epilepsy-related stigma among children newly diagnosed with epilepsy (n=39) and their caregivers (n=97) over a two-year period, 2) the influence of seizure absence/presence on children and caregivers' perception of epilepsy-related stigma, and 3) the congruence of child and caregiver perception of child epilepsy-related stigma. Participants completed a measure of perceived epilepsy-related stigma at three time points, and seizure status was collected at the final time point. Results indicated that both caregivers (t(1,76)=-2.57, p<.01) and children with epilepsy (t(1,29)=-3.37, p<.01) reported decreasing epilepsy-related stigma from diagnosis to two years postdiagnosis. No significant differences were found in caregiver and child reports of perceived stigma for children experiencing seizures compared with children who have been seizure-free for the past year. Results revealed poor caregiver-child agreement of perceived epilepsy-related stigma at all three time points. These data suggest that while children with epilepsy initially perceive epilepsy-related stigma at diagnosis, their perception of stigma decreases over time. Having a better understanding of the course of epilepsy-related stigma provides clinicians with information regarding critical times to support families with stigma reduction interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

Examining Perceived Stigma of Children with Newly-Diagnosed Epilepsy and Their Caregivers Over a Two Year Period

PubMed Central

Rood, Jennifer E.; Schultz, Janet R.; Rausch, Joseph R.; Modi, Avani C.

2014-01-01

The purpose of this study was to examine: 1) the course of perceived epilepsy-related stigma among children newly-diagnosed with epilepsy (n=39) and their caregivers (n=97) over a two year period, 2) the influence of seizure absence/presence on children and caregivers’ perception of epilepsy-related stigma, and 3) congruence of child and caregiver perception of child epilepsy-related stigma. Participants completed a measure of perceived epilepsy-related stigma at three time points, and seizure status was collected at the final time point. Results indicated both caregivers (t1,76 = − 2.57 p< .01) and children with epilepsy (t1,29=−3.37, p< .01) reported decreasing epilepsy-related stigma from diagnosis to two years post-diagnosis. No significant differences were found in caregiver and child report of perceived stigma for children experiencing seizures as compared to children who have been seizure-free for the past year. Results revealed poor caregiver-child agreement of perceived epilepsy-related stigma at all three time points. These data suggest that while children with epilepsy initially perceive epilepsy-related stigma at diagnosis, their perception of stigma decreases over time. Having a better understanding of the course of epilepsy-related stigma provides clinicians with information regarding critical times to support families with stigma reduction interventions. PMID:25173098

Pregnancy outcomes in prenatally diagnosed 47, XXX and 47, XYY syndromes: a 30-year French, retrospective, multicentre study.

PubMed

Gruchy, Nicolas; Blondeel, Eleonore; Le Meur, Nathalie; Joly-Hélas, Géraldine; Chambon, Pascal; Till, Marianne; Herbaux, Martine; Vigouroux-Castera, Adeline; Coussement, Aurélie; Lespinasse, James; Amblard, Florence; Jimenez Pocquet, Mélanie; Lebel-Roy, Camille; Carré-Pigeon, Frédérique; Flori, Elisabeth; Mugneret, Francine; Jaillard, Sylvie; Yardin, Catherine; Harbuz, Radu; Collonge-Rame, Marie-Agnès; Vago, Philippe; Valduga, Mylène; Leporrier, Nathalie; Vialard, François

2016-06-01

Sex chromosome aneuploidies are frequently detected fortuitously in a prenatal diagnosis. Most cases of 47, XXX and 47, XYY syndromes are diagnosed in this context, and parents are thus faced with an unexpected situation. The objective of the present study was to characterize a French cohort of prenatally diagnosed cases of 47, XXX and 47, XYY and to evaluate the termination of pregnancy (TOP) rate before and after France's implementation of multidisciplinary centres for prenatal diagnosis in 1997. This retrospective study identified respectively 291 and 175 cases of prenatally diagnosed 47, XXX and 47, XYY between 1976 and 2012. For each case, the indication, maternal age, karyotype and outcome were recorded. Most diagnoses of the two conditions were fortuitous. The occurrence of 47, XXX was associated with advanced maternal age. The overall TOP rate was higher for 47, XXX (22.9%) than for 47, XYY (14.6%), although this difference was not statistically significant. However, the TOP rates fell significantly after 1997 (from 41.1% to 11.8% for 47, XXX and from 25.8% to 6.7% for 47, XYY). The TOP rates after prenatal diagnoses of 47, XXX and 47, XYY fell significantly after 1997, following France's implementation of multidisciplinary centres for prenatal diagnosis. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

Cost and quality implications of discrepancies between admitting and discharge diagnoses.

PubMed

McNutt, Robert; Johnson, Tricia; Kane, Jason; Ackerman, Mariel; Odwazny, Richard; Bardhan, Jaydeep

2012-01-01

Presenting and discharge diagnoses of hospitalized patients may differ as a result of patient complexity, diagnostic dilemmas, or errors in clinical judgment at the time of primary assessment. When diagnoses at admission and discharge are not in agreement, this discrepancy may indicate more complex processes of care and resultant costs. It is unclear whether surrogate measures reflecting quality of care are impacted by discrepant diagnoses. To assess whether an association exists between admitting and discharge International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes and other quality markers including hospital length of stay, total cost of care, and 30-day readmission rate. This was a retrospective, cross-sectional analysis of general internal medicine patients aged 18 years and older. Diagnosis discrepancy was defined as a difference between the 3-digit ICD-9 diagnosis code at admission and the principal 3-digit ICD-9 diagnosis code at discharge. Sixty-eight percent of patients had a diagnosis discrepancy. Diagnosis discrepancy was associated with a 0.41-day increase in length of stay (P < .001), $663 increase in direct costs (P < .001), and a 1.55 times greater odds of readmission within 30 days (P < .001). Diagnosis discrepancy was associated with hospital quality outcome measures. This finding likely reflects variations in patients' diagnostic complexity.

[Linkage to care among new human immunodeficiency virus diagnoses in Spain].

PubMed

Oliva, Jesús; Malo, Carmen; Fernández, Ana; Izquierdo, Ana; Marcos, Henar; Cevallos, Carlos; Castilla, Jesús; García, Rocio; Díez, Mercedes

2014-03-01

To describe linkage to care among new HIV diagnoses in Spain; and to estimate factors associated to linkage to care within three months after diagnosis. The distribution of the time elapsing between the date of HIV diagnosis and the date of first determination of CD4 (considered to be the date of linkage to care) was calculated among new HIV diagnoses in 2010 in the seven Autonomous Regions participating, where data on date of CD4 count was available. Linkage to care was considered «correct» if done within three months after diagnosis. Factors associated to correct linkage to care were estimated using logistic regression. A total of 1769 new HIV diagnoses were included. Of them, 83.1% had evidence of linkage to care within a year, and 75.7% were linked within three months after diagnosis. Being an injectable drug user (IDU) was the only factor inversely associated with linkage to care within 3 months (OR = 0.3; 95% CI: 0.2-0.6). In Spain linkage to care after HIV diagnosis is good, but there is still room for improvement, especially among IDUs. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Deep learning aided decision support for pulmonary nodules diagnosing: a review.

PubMed

Yang, Yixin; Feng, Xiaoyi; Chi, Wenhao; Li, Zhengyang; Duan, Wenzhe; Liu, Haiping; Liang, Wenhua; Wang, Wei; Chen, Ping; He, Jianxing; Liu, Bo

2018-04-01

Deep learning techniques have recently emerged as promising decision supporting approaches to automatically analyze medical images for different clinical diagnosing purposes. Diagnosing of pulmonary nodules by using computer-assisted diagnosing has received considerable theoretical, computational, and empirical research work, and considerable methods have been developed for detection and classification of pulmonary nodules on different formats of images including chest radiographs, computed tomography (CT), and positron emission tomography in the past five decades. The recent remarkable and significant progress in deep learning for pulmonary nodules achieved in both academia and the industry has demonstrated that deep learning techniques seem to be promising alternative decision support schemes to effectively tackle the central issues in pulmonary nodules diagnosing, including feature extraction, nodule detection, false-positive reduction, and benign-malignant classification for the huge volume of chest scan data. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the deep learning aided decision support for pulmonary nodules diagnosing. As far as the authors know, this is the first time that a review is devoted exclusively to deep learning techniques for pulmonary nodules diagnosing.

Deep learning aided decision support for pulmonary nodules diagnosing: a review

PubMed Central

Yang, Yixin; Feng, Xiaoyi; Chi, Wenhao; Li, Zhengyang; Duan, Wenzhe; Liu, Haiping; Liang, Wenhua; Wang, Wei; Chen, Ping

2018-01-01

Deep learning techniques have recently emerged as promising decision supporting approaches to automatically analyze medical images for different clinical diagnosing purposes. Diagnosing of pulmonary nodules by using computer-assisted diagnosing has received considerable theoretical, computational, and empirical research work, and considerable methods have been developed for detection and classification of pulmonary nodules on different formats of images including chest radiographs, computed tomography (CT), and positron emission tomography in the past five decades. The recent remarkable and significant progress in deep learning for pulmonary nodules achieved in both academia and the industry has demonstrated that deep learning techniques seem to be promising alternative decision support schemes to effectively tackle the central issues in pulmonary nodules diagnosing, including feature extraction, nodule detection, false-positive reduction, and benign-malignant classification for the huge volume of chest scan data. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the deep learning aided decision support for pulmonary nodules diagnosing. As far as the authors know, this is the first time that a review is devoted exclusively to deep learning techniques for pulmonary nodules diagnosing. PMID:29780633

Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip: 864 hips followed for 3.2 to 8.9 years.

PubMed

Ning, Bo; Yuan, Yi; Yao, Jie; Zhang, Sichng; Sun, Jun

2014-11-28

The one-stage procedure for treatment of older developmental dislocation of the hip (DDH) is used widely. However, the best age group for this operation is still unknown. The aims of our study were to evaluate middle-term outcomes of one-stage surgical treatment of a large number of patients with late-diagnosed DDH, and to explore the best age group for treatment. We retrospectively reviewed 652 patients with a total of 864 hip joints with DDH, all aged >18 months. All the hip joints were treated with one-stage procedures including open reduction, pelvic osteotomy, and femoral shortening. The patients were divided into three groups according to age at surgery: Group I: 1.5-2.5 years; Group II: 2.5-8 years; and Group III: >8 years. The latest clinical and radiographic outcomes, complications and avascular necrosis (AVN) of the femoral head were evaluated and compared among the three groups. The mean age at surgery was 5.8 years (range: 1.5-13.2 years). The average time of follow-up was 6.2 years (range: 3.2-8.9 years). A total of 79.4% of good or excellent outcomes were obtained for clinical functional evaluation according to the McKay classification. For radiographic outcomes, 732 hips (84.7%) were classified as good or excellent according to the Severin classification. A total of 27.4% of all hips had a poor outcome according to the Kalamchi and MacEwen classification for AVN. The poorest outcomes were observed for clinical, radiographic and AVN results in Group III (p < 0.001). Compared with Group I, the better results for clinical and AVN outcomes were found in Group II (p < 0.001). However, similar clinical outcomes were observed between Groups I and II (p > 0.05). A significantly higher incidence of redislocation and residual acetabular dysplasia was observed in Tonnis grade II and III hip dislocation (p < 0.001). One-stage treatment of late-diagnosed DDH had a good outcome in young and middle group. Younger patients achieved better results

Performance-based measures and behavioral ratings of executive function in diagnosing attention-deficit/hyperactivity disorder in children.

PubMed

Tan, Alexander; Delgaty, Lauren; Steward, Kayla; Bunner, Melissa

2018-04-16

Deficits in real-world executive functioning (EF) are a frequent characteristic of attention-deficit/hyperactivity disorder (ADHD). However, the predictive value of using performance-based and behavioral rating measures of EF when diagnosing ADHD remains unclear. The current study investigates the use of performance-based EF measures and a parent-report questionnaire with established ecological validity and clinical utility when diagnosing ADHD. Participants included 21 healthy controls, 21 ADHD-primary inattentive, and 21 ADHD-combined type subjects aged 6-15 years. A brief neuropsychological battery was administered to each subject including common EF assessment measures. Significant differences were not found between groups on most performance-based EF measures, whereas significant differences (p < 0.05) were found on most parent-report behavioral rating scales. Furthermore, performance-based measures did not predict group membership above chance levels. Results further support differences in predictive value of EF performance-based measures compared to parent-report questionnaires when diagnosing ADHD. Further research must investigate the relationship between performance-based and behavioral rating measures when assessing EF in ADHD.

Validation of Autism Spectrum Disorder Diagnoses in Large Healthcare Systems with Electronic Medical Records

ERIC Educational Resources Information Center

Coleman, Karen J.; Lutsky, Marta A.; Yau, Vincent; Qian, Yinge; Pomichowski, Magdalena E.; Crawford, Phillip M.; Lynch, Frances L.; Madden, Jeanne M.; Owen-Smith, Ashli; Pearson, John A.; Pearson, Kathryn A.; Rusinak, Donna; Quinn, Virginia P.; Croen, Lisa A.

2015-01-01

To identify factors associated with valid Autism Spectrum Disorder (ASD) diagnoses from electronic sources in large healthcare systems. We examined 1,272 charts from ASD diagnosed youth <18 years old. Expert reviewers classified diagnoses as confirmed, probable, possible, ruled out, or not enough information. A total of 845 were classified with…

Osteogenesis Imperfecta Diagnosed from Mandibular and Lower Limb Fractures: A Case Report.

PubMed

Kobayashi, Yoshikazu; Satoh, Koji; Mizutani, Hideki

2016-06-01

Osteogenesis imperfecta (OI) is a congenital disease characterized by bone fragility and low bone mass. Despite the variety of its manifestation and severity, facial fractures occur very infrequently. Here, we report a case of an infant diagnosed with OI after mandibular and lower limb fractures. A boy aged 1 year and 3 months was brought to his neighboring hospital with a complaint of facial injury. He was transferred to our hospital to undergo operation 3 days later. Computed tomography images revealed multiple mandibular fractures including complete fracture in the symphysis and dislocated condylar fracture on the right side. Open reduction and internal fixation with absorbable implants was performed 7 days after injury. He fractured his right lower limb 2 months later. He was diagnosed with OI type IA by an orthopedist. He will be administered bone-modifying agents if he suffers from frequent fractures.

Characteristics and Outcome of Patients Diagnosed With HIV at Older Age

PubMed Central

Asher, Ilan; Guri, Keren Mahlab; Elbirt, Daniel; Bezalel, Shira Rosenberg; Maldarelli, Frank; Mor, Orna; Grossman, Zehava; Sthoeger, Zev M.

2016-01-01

Abstract To characterize the clinical, virological, and immunological status at presentation as well as the outcome of patients diagnosed with HIV above the age of 50. A retrospective study of 418 patients newly diagnosed with HIV in 1 Israeli center, between the years 2004 and 2013. Patients with new HIV diagnosis ≥50 years of age defined as “older" and <50 defined as “younger." Patients were evaluated every 1 to 3 months (mean follow-up 53 ± 33 months). Patients with <2 CD4/viral-load measurements or with <1 year of follow-up were excluded. Time of HIV infection was estimated by HIV sequence ambiguity assay. Ambiguity index ≤0.43 indicated recent (≤1 year) HIV infection. Eighty nine (21%) patients were diagnosed with HIV at an older age. Those older patients presented with significant lower CD4 cell counts and higher viral-load compared with the younger patients. At the end of the study, the older patients had higher mortality rate (21% vs 3.5%; P < 0.001) and lower CD4 cell counts (381 ± 228 vs 483 ± 261cells/μL; P < 0.001) compared with the younger patients. This difference was also observed between older and younger patients with similar CD4 cell counts and viral load at the time of HIV diagnosis and among patients with a recent (≤1 year) HIV infection. One-fifth of HIV patients are diagnosed at older age (≥50 years). Those older patients have less favorable outcome compared with the younger patients. This point to the need of educational and screening programs within older populations and for a closer follow-up of older HIV patients. PMID:26735534

"Testing-only" visits: an assessment of missed diagnoses in clients attending sexually transmitted disease clinics.

PubMed

Xu, Fujie; Stoner, Bradley P; Taylor, Stephanie N; Mena, Leandro; Martin, David H; Powell, Suzanne; Markowitz, Lauri E

2013-01-01

At sexually transmitted disease (STD) clinics, advances in testing technology coupled with increasing demands and diminishing resources have promoted the use of testing-only visits (clinic visits with testing for STDs but no full examination) to meet increasing demands for STD services. The aims of the present study were to estimate the prevalence of STD diagnoses that could become "missed diagnoses" if patients would use testing-only visits and to examine patient characteristics associated with these potential missed diagnoses. We conducted a self-administered survey of STD-related symptoms and sexual risk behaviors in patients seeking routine clinical care at 3 STD clinics. Medical charts were abstracted to estimate the prevalence of viral STDs, trichomoniasis, and other diagnoses from standard clinical services that could become missed diagnoses. Of 2582 patients included, the median age was 24 years and 50% were women. In women, overall, 3.2% were diagnosed as having a viral STD; 9.6%, trichomoniasis; and 41.0%, vulvovaginal candidiasis or symptomatic bacterial vaginosis. The prevalence of these potential missed diagnoses varied by patient characteristics, but in women who reported no symptoms, the prevalence of trichomoniasis was still 6.3%. In men, 19.3% received a diagnosis of urethritis but tested negative for both gonorrhea and chlamydia; this prevalence varied from 15.7% in those who reported no symptoms to 32.6% in those who reported malodor. A high proportion of STD clients received diagnoses from standard care visits that would be missed by testing-only visits. When patients, even those asymptomatic, use testing-only visits, missed diagnoses of STDs or related genital tract conditions can be substantial. The potential disadvantages of testing-only visits should be weighed against the advantages of such visits.

The impact of transmission clusters on primary drug resistance in newly diagnosed HIV-1 infection.

PubMed

Yerly, Sabine; Junier, Thomas; Gayet-Ageron, Angèle; Amari, Emmanuelle Boffi El; von Wyl, Viktor; Günthard, Huldrych F; Hirschel, Bernard; Zdobnov, Evgeny; Kaiser, Laurent

2009-07-17

To monitor HIV-1 transmitted drug resistance (TDR) in a well defined urban area with large access to antiretroviral therapy and to assess the potential source of infection of newly diagnosed HIV individuals. All individuals resident in Geneva, Switzerland, with a newly diagnosed HIV infection between 2000 and 2008 were screened for HIV resistance. An infection was considered as recent when the positive test followed a negative screening test within less than 1 year. Phylogenetic analyses were performed by using the maximum likelihood method on pol sequences including 1058 individuals with chronic infection living in Geneva. Of 637 individuals with newly diagnosed HIV infection, 20% had a recent infection. Mutations associated with resistance to at least one drug class were detected in 8.5% [nucleoside reverse transcriptase inhibitors (NRTIs), 6.3%; non-nucleoside reverse transcriptase inhibitors (NNRTIs), 3.5%; protease inhibitors, 1.9%]. TDR (P-trend = 0.015) and, in particular, NNRTI resistance (P = 0.002) increased from 2000 to 2008. Phylogenetic analyses revealed that 34.9% of newly diagnosed individuals, and 52.7% of those with recent infection were linked to transmission clusters. Clusters were more frequent in individuals with TDR than in those with sensitive strains (59.3 vs. 32.6%, respectively; P < 0.0001). Moreover, 84% of newly diagnosed individuals with TDR were part of clusters composed of only newly diagnosed individuals. Reconstruction of the HIV transmission networks using phylogenetic analysis shows that newly diagnosed HIV infections are a significant source of onward transmission, particularly of resistant strains, thus suggesting an important self-fueling mechanism for TDR.

Divorce and risk of hospital-diagnosed infectious diseases.

PubMed

Nielsen, Nete Munk; Davidsen, Rie B; Hviid, Anders; Wohlfahrt, Jan

2014-11-01

Although, divorce is considered to have a negative impact on morbidity, very little is known concerning exposure to divorce and risk of infectious diseases. We aimed to investigate the association between divorce and subsequent hospital contacts with infectious diseases. We performed a nation-wide cohort study, including all Danish men and women (n≈5.6 million) alive on the 1 January 1982 or later, and followed them for infectious disease diagnosed in hospital settings from 1982 to 2010. The association between divorce and risk of infectious diseases was evaluated through rate ratios (RRs) comparing incidence rates of infectious diseases between divorced and married pesons. Compared with married persons, divorced persons were overall at a 1.48 fold (RR=1.48 (95% CI: 1.47-1.50)) increased risk of hospital-diagnosed infectious diseases (RR adjusted for sex, age, period, income and education). The risk of infectious diseases was slightly more pronounced for divorced women (RR=1.54 (1.52-1.56)) than divorced men ((RR=1.42 (1.41-1.44)). The increased risk remained almost unchanged even more than 15 years after the divorce. Young age at divorce, short duration of marriage and number of divorces further increased the risk of infectious diseases, whereas number of children at time of divorce had no impact on risk of hospital-diagnosed infectious diseases following the divorce. Divorce appears to have a moderate but long lasting impact on the risk of infectious diseases the underlying mechanism is unknown but shared risk factors predicting divorce and infectious diseases could contribute to our findings. © 2014 the Nordic Societies of Public Health.

Retinal arteriole-to-venule ratio changes and target organ disease evolution in newly diagnosed hypertensive patients at 1-year follow-up.

PubMed

Coll-de-Tuero, Gabriel; González-Vázquez, Sonia; Rodríguez-Poncelas, Antonio; Barceló, María Antònia; Barrot-de-la Puente, Joan; Penedo, Manuel G; Pose-Reino, Antonio; Pena-Seijo, Marta; Saez, Marc

2014-02-01

There is no agreement on the systematic exploration of the fundus oculi (FO) in hypertensive patients, and it is unknown whether the evolution of retinal microcirculatory alterations has prognostic value or not. The aim of this study was to investigate whether the evolution of the arteriole-to-venule ratio (AVR) in newly-diagnosed hypertensive patients is associated with better or worse evolution of target organ damage (TOD) during 1 year. A cohort of 133 patients with newly-diagnosed untreated hypertension was followed for 1 year. At baseline and follow-up, all patients underwent a physical examination, self-blood pressure measurement, ambulatory blood pressure monitoring, blood and urine analysis, electrocardiogram, and retinography. The endpoint was the favourable evolution of TOD and the total amount of TOD, according to the baseline AVR and the baseline and final difference of the AVR. A total of 133 patients were analyzed (mean age, 57 ± 10.7 years; 59% men). No differences were found in the decrease in blood pressure or antihypertensive treatment between quartiles of baseline AVR or baseline-final AVR difference. Patients with a difference between baseline and final AVR in the highest quartile (>0.0817) had a favorable evolution of left ventricular hypertrophy (odds ratio, 14.9; 95% confidence interval, 1.08-206.8) and the amount of TOD (odds ratio, 2.22; 95% confidence interval, 1.03-6.05). No favorable evolution was found of glomerular filtration rate. There is an association between the evolution of the AVR and the favorable evolution of TOD. Patients with greater increase of AVR have significantly better evolution of left ventricular hypertrophy and amount of TOD. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Content validity of the PedsQL™ 3.2 Diabetes Module in newly diagnosed patients with Type 1 diabetes mellitus ages 8-45.

PubMed

Varni, James W; Curtis, Bradley H; Abetz, Linda N; Lasch, Kathryn E; Piault, Elisabeth C; Zeytoonjian, Andrea A

2013-10-01

The content validity of the 28-item PedsQL™ 3.0 Diabetes Module has not been established in research on pediatric and adult patients with newly diagnosed Type 1 diabetes across a broad age range. This study aimed to document the content validity of three age-specific versions (8-12 years, 13-18 years, and 18-45 years) of the PedsQL™ Diabetes Module in a population of newly diagnosed patients with Type 1 diabetes. The study included in-depth interviews with 31 newly diagnosed patients with Type 1 diabetes between the ages of 8 and 45 years, as well as 14 parents and/or caregivers of child and teenage patients between the ages of 8 and 18 years of age; grounded theory data collection and analysis methods; and review by clinical and measurement experts. Following the initial round of interviews, revisions reflecting patient feedback were made to the Child and Teen versions of the Diabetes Module, and an Adult version of the Diabetes Module was drafted. Cognitive interviews of the modified versions of the Diabetes Module were conducted with an additional sample of 11 patients. The results of these interviews support the content validity of the modified 33-item PedsQL™ 3.2 Diabetes Module for pediatric and adult patients, including interpretability, comprehensiveness, and relevance suitable for all patients with Type 1 Diabetes. Qualitative methods support the content validity of the modified PedsQL™ 3.2 Diabetes Module in pediatric and adult patients. It is recommended that the PedsQL™ 3.2 Diabetes Module replaces version 3.0 and is suitable for measuring patient-reported outcomes in all patients with newly diagnosed, stable, or long-standing diabetes in clinical research and practice.

Diagnoses of HIV-1 and HIV-2 in England, Wales, and Northern Ireland associated with west Africa.

PubMed

Dougan, S; Patel, B; Tosswill, J H; Sinka, K

2005-08-01

To describe HIV diagnoses, including those of HIV-2 infection, made in England, Wales, and Northern Ireland (E,W&NI) among those probably infected in west Africa, and to consider whether there is evidence for ongoing heterosexual transmission within the United Kingdom. Reports of new HIV diagnoses received at the Communicable Disease Surveillance Centre were analysed. Individuals probably infected in west Africa and those infected through heterosexual intercourse within the United Kingdom by a heterosexual partner infected in west Africa were included. Between 1985 and 2003 inclusive, 1324 individuals diagnosed and reported with HIV had probably been infected in west Africa, with 222 diagnoses made in 2003. 917 (69%) were HIV-1 infected and 52 (6%) HIV-2 or HIV-1/HIV-2 co-infected. For 355 (27%) the HIV type was not reported. The proportion of HIV-2 and HIV-1/HIV-2 infections varied by country of infection (p<0.001): ranging from the Gambia (11.7%-15.2%) to Nigeria (0.7%-1.0%). A further 130 individuals were probably infected through heterosexual intercourse within the United Kingdom by a heterosexual partner infected in west Africa. 89 (68%) were HIV-1 infected and three (2%) HIV-2 infected or HIV-1/HIV-2 co-infected. For 38 (29%) HIV type was not reported. The number of people infected with HIV in west Africa and diagnosed in E,W&NI has increased in recent years, and there is evidence of heterosexual transmission within the United Kingdom from people infected in west Africa. While numbers of HIV-2 diagnoses remain relatively low, an appreciable proportion of people infected in some west African countries and diagnosed in the United Kingdom may be HIV-2 positive, with implications for prognosis and treatment.

Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison.

PubMed

Carlson, Kathleen F; Taylor, Brent C; Hagel, Emily M; Cutting, Andrea; Kerns, Robert; Sayer, Nina A

2013-01-01

To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care. Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample. We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses. In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back

Costs of newly diagnosed neovascular age-related macular degeneration among medicare beneficiaries, 2004-2008.

PubMed

Qualls, Laura G; Hammill, Bradley G; Wang, Fang; Lad, Eleonora M; Schulman, Kevin A; Cousins, Scott W; Curtis, Lesley H

2013-04-01

To examine associations between newly diagnosed neovascular age-related macular degeneration and direct medical costs. This retrospective observational study matched 23,133 Medicare beneficiaries diagnosed with neovascular age-related macular degeneration between 2004 and 2008 with a control group of 92,532 beneficiaries on the basis of age, sex, and race. The index date for each case-control set corresponded to the first diagnosis for the case. Main outcome measures were total costs per patient and age-related macular degeneration-related costs per case 1 year before and after the index date. Mean cost per case in the year after diagnosis was $12,422, $4,884 higher than the year before diagnosis. Postindex costs were 41% higher for cases than controls after adjustment for preindex costs and comorbid conditions. Age-related macular degeneration-related costs represented 27% of total costs among cases in the postindex period and were 50% higher for patients diagnosed in 2008 than in 2004. This increase was attributable primarily to the introduction of intravitreous injections of vascular endothelial growth factor antagonists. Intravitreous injections averaged $203 for patients diagnosed in 2004 and $2,749 for patients diagnosed in 2008. Newly diagnosed neovascular age-related macular degeneration was associated with a substantial increase in total medical costs. Costs increased over time, reflecting growing use of anti-vascular endothelial growth factor therapies.

An under-diagnosed geriatric syndrome: sleep disorders among older adults.

PubMed

Tufan, Asli; Ilhan, Birkan; Bahat, Gulistan; Karan, Mehmet Akif

2017-06-01

Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered 'yes' to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment.

Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses.

PubMed

Blom, Kerstin; Jernelöv, Susanna; Rück, Christian; Lindefors, Nils; Kaldo, Viktor

2017-08-01

This 3-year follow-up compared insomnia treatment to depression treatment for patients with both diagnoses. Forty-three participants were randomized to either treatment, in the form of Internet-delivered therapist-guided cognitive behavior therapy (CBT), and 37 (86%) participants provided primary outcome data at the 3-year follow-up. After 3 years, reductions on depression severity were similar in both groups (between-group effect size, d = 0.33, p = .45), while the insomnia treatment had superior effects on insomnia severity (d = 0.66, p < .05). Overall, insomnia treatment was thus more beneficial than depression treatment. The implication for practitioners, supported by previous research, is that patients with co-occurring depression and insomnia should be offered CBT for insomnia, in addition to medication or psychological treatment for depression. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Comorbid psychiatric diagnoses in suicide attempt by charcoal burning: a 10-year study in a general hospital in Taiwan.

PubMed

Lin, Chemin; Yen, Tzung-Hai; Juang, Yeong-Yuh; Leong, Wa Cheong; Hung, Huei-Min; Ku, Chung-Hsuan; Lin, Ja-Liang; Lee, Shwu-Hua

2012-01-01

Over the last decade, charcoal burning has become a common method of suicide in Taiwan; however, the underlying psychiatric diagnoses and gender differences have yet to be examined. We conducted a retrospective chart review on inpatients after suicide attempt by charcoal burning during 2000-2010. The patients were referred to the psychiatric consultation team and diagnoses were made according to DSM-IV. We chose those who were admitted to the nephrology ward in the same period due to accidental carbon monoxide intoxication as controls. Demographic and laboratory data, psychiatric diagnoses and reasons for suicide were obtained and analyzed. Among seventy-three patients, major depressive disorder (49.3%) and adjustment disorder (41.1%) were most frequently diagnosed. Breaking-up, financial debt and physical/mental illnesses were the top three reasons for suicide (17.8% each). The male-to-female gender ratio was 1.5:1. Female patients had higher rates of major depressive disorders, while male patients presented more adjustment disorders comorbid with alcohol use disorders. There were gender differences in patients of suicide attempt by charcoal burning, in terms of demographic profiles and psychiatric diagnoses. Suicide risk assessment and prevention should be tailored by gender. Copyright © 2012 Elsevier Inc. All rights reserved.

A human case of Echinostoma hortense (Trematoda: Echinostomatidae) infection diagnosed by gastroduodenal endoscopy in Korea

PubMed Central

Cho, Chang-Min; Tak, Won-Young; Kweon, Young-Oh; Kim, Sung-Kook; Choi, Yong-Hwan; Kong, Hyun-Hee

2003-01-01

A human Echinostoma hortense infection was diagnosed by gastroduodenoscopy. An 81-year-old Korean male, living in Yeongcheon-shi, Gyeongsangbuk-do and with epigastric discomfort of several days duration, was subjected to upper gastrointestinal endoscopy. He was in the habit of eating fresh water fish. Two live worms were found in the duodenal bulb area and were removed using an endoscopic forcep. Based on their morphological characteristics, the worms were identified as E. hortense. The patient was treated with praziquantel 10 mg/kg as a single dose. The source of the infection in this case remains unclear, but the fresh water fish consumed, including the loach, may have been the source. This is the second case of E. hortense infection diagnosed by endoscopy in Korea. PMID:12815324

Clinical and genetic characterization of the autoinflammatory diseases diagnosed in an adult reference center.

PubMed

Hernández-Rodríguez, José; Ruíz-Ortiz, Estíbaliz; Tomé, Adrià; Espinosa, Gerard; González-Roca, Eva; Mensa-Vilaró, Anna; Prieto-González, Sergio; Espígol-Frigolé, Georgina; Mensa, Josep; Cardellach, Francesc; Grau, Josep M; Cid, Maria C; Yagüe, Jordi; Aróstegui, Juan I; Cervera, Ricard

2016-01-01

Autoinflammatory diseases (AID) are usually diagnosed during the pediatric age. However, adult-onset disease or diagnosis during adulthood has been occasionally described. To assess the clinical and genetic characteristics of adult patients diagnosed with an AID in an adult referral center for AID. We retrospectively evaluated clinical and genetic features of adult patients (≥16 years) diagnosed with an AID or referred after AID diagnosis to the Clinical Unit of AID, at the Department of Autoimmune Diseases, Hospital Clínic of Barcelona, from 2008 to 2014. During the study period, a genetic study for suspected AID was requested to 90 patients at the Department of Autoimmune Diseases. A final diagnosis of monogenic AID was achieved in 17 patients (19% of patients tested). Five additional cases were diagnosed with periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome and 10 patients with AID were referred from other adult departments. Finally, a total of 32 patients with AID were finally diagnosed or monitored in our Clinical Unit. These included 12 (37.5%) familial Mediterranean fever, 6 (18.8%) tumour necrosis factor-receptor associated periodic syndrome, 8 (25%) cryopirin-associated periodic syndromes (Muckle-Wells syndrome [MWS] or overlap familial cold-associated periodic syndrome/MWS), 1 (3.1%) mevalonate kinase deficiency, and 5 (15.6%) PFAPA. Clinical evidence of disease-onset during childhood and adulthood was observed in 15 (47%) and 17 (53%) patients, respectively. Overall, the final diagnosis was obtained after a delay of a mean of 12 years (range 0-47 years). Compared to children, adult patients with AID in our series presented more frequently with non-severe manifestations and none of them developed amyloidosis during follow-up. Adult patients also carried higher proportion of low-penetrance mutations or polymorphisms and all genetic variants were presented in heterozygosis or as heterozygous compounds. Adult disease

Diagnosed hematological malignancies in Bangladesh - a retrospective analysis of over 5000 cases from 10 specialized hospitals

PubMed Central

2014-01-01

Background The global burden from cancer is rising, especially as low-income countries like Bangladesh observe rapid aging. So far, there are no comprehensive descriptions reporting diagnosed cancer group that include hematological malignancies in Bangladesh. Methods This was a multi-center hospital-based retrospective descriptive study of over 5000 confirmed hematological cancer cases in between January 2008 to December 2012. Morphological typing was carried out using the “French American British” classification system. Results A total of 5013 patients aged between 2 to 90 years had been diagnosed with malignant hematological disorders. A 69.2% were males (n = 3468) and 30.8% females (n = 1545), with a male to female ratio of 2.2:1. The overall median age at diagnosis was 42 years. Acute myeloid leukemia was most frequent (28.3%) with a median age of 35 years, followed by chronic myeloid leukemia with 18.2% (median age 40 years), non-Hodgkin lymphoma (16.9%; median age 48 years), acute lymphoblastic leukemia (14.1%; median age 27 years), multiple myeloma (10.5%; median age 55 years), myelodysplastic syndromes (4.5%; median age 57 years) and Hodgkin’s lymphoma (3.9%; median age 36 years). The least common was chronic lymphocytic leukemia (3.7%; median age 60 years). Below the age of 20 years, acute lymphoblastic leukemia was predominant (37.3%), followed by acute myeloid leukemia (34%). Chronic lymphocytic leukemia and multiple myeloma had mostly occurred among older patients, aged 50-over. Conclusions For the first time, our study presents the pattern and distribution of diagnosed hematological cancers in Bangladesh. It shows differences in population distributions as compared to other settings with possibly a lower presence of non-Hodgkin lymphoma. There might be under-reporting of affected women. Further studies are necessary on the epidemiology, genetics and potential environmental risk factors within this rapidly aging country. PMID

Cytomegalovirus peritonitis after kidney transplantation diagnosed through histopathological examination.

PubMed

Hotta, Kiyohiko; Fukasawa, Yuichiro; Wada, Yoshiki; Fukuzawa, Nobuyuki; Seki, Toshimori; Harada, Hiroshi

2017-08-01

Among organ transplant recipients, cytomegalovirus (CMV) commonly results in various types of infection such as pneumonitis, hepatitis, and enterocolitis. However, CMV peritonitis is very rare and difficult to diagnose owing to lack of visible clinical signs. We present a case of a 35-year-old female kidney recipient who developed abdominal pain and urinary retention caused by CMV peritonitis. To our knowledge, this is the first case report of CMV peritonitis after organ transplantation to be diagnosed through histopathological examination. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Incidence of Mental Health Diagnoses in Veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn, 2001-2014.

PubMed

Ramsey, Christine; Dziura, James; Justice, Amy C; Altalib, Hamada Hamid; Bathulapalli, Harini; Burg, Matthew; Decker, Suzanne; Driscoll, Mary; Goulet, Joseph; Haskell, Sally; Kulas, Joseph; Wang, Karen H; Mattocks, Kristen; Brandt, Cynthia

2017-02-01

To evaluate gender, age, and race/ethnicity as predictors of incident mental health diagnoses among Operations Iraqi Freedom, Enduring Freedom, and New Dawn veterans. We used US Veterans Health Administration (VHA) electronic health records from 2001 to 2014 to examine incidence rates and sociodemographic risk factors for mental health diagnoses among 888 142 veterans. Posttraumatic stress disorder (PTSD) was the most frequently diagnosed mental health condition across gender and age groups. Incidence rates for all mental health diagnoses were highest at ages 18 to 29 years and declined thereafter, with the exceptions of major depressive disorder (MDD) in both genders, and PTSD among women. Risk of incident bipolar disorder and MDD diagnoses were greater among women; risk of incident schizophrenia, and alcohol- and drug-use disorders diagnoses were greater in men. Compared with Whites, risk incident PTSD, MDD, and alcohol-use disorder diagnoses were lower at ages 18 to 29 years and higher at ages 45 to 64 years for both Hispanics and African Americans. Differentiating high-risk demographic and gender groups can lead to improved diagnosis and treatment of mental health diagnoses among veterans and other high-risk groups.

[The causes of symptomatic epilepsy in children aged 3-18 years hospitalized in the year 2006-2007].

PubMed

Gergont, Aleksandra; Kroczka, Sławomir; Kaciński, Marek

2008-01-01

Epilepsy can be one of symptoms of the damage to CNS in children with neurodevelopmental deficits, it is more difficult however to diagnose seizures if they are the first symptom of severe brain damage. This retrospective research was conducted to study causes of symptomatic epilepsy in children aged 3-18 year hospitalized between 2006 and 2007 year in the Department of Pediatric Neurology. 156 children with symptomatic epilepsy occurred after 2 years of life were included. The diagnosis of symptomatic epilepsy was established including clinical picture, neuro-radiological tests and EEG. The information from parents was helpful to analyze the type of seizures. The clinical state of children was analyzed, especially psychomotor development, focal deficits, as well as results of CT and/or MRI, in some children psychological testing was performed, molecular or serological. 156 children with epilepsy were hospitalized, within encephalopathy was diagnosed in 61 children. In 42 children static encephalopathy was associated with birth trauma, in 7 progressive encephalopathy was diagnosed, in 1 child CO intoxication caused encephalopathy, and in 11 cases the cause was not identified. Malformations of nervous system were associated with epilepsy in 37 children, geneticaly determined syndromes in 6, and the head trauma in other 6 children. Disorders of vascular origin caused epilepsy in 16 children, and neuroinfections in 9 children. In 2 children epilepsy was associated with ADEM, and in 11 children nonspecific de/dysmyelination was detected. The brain tumor was detected in 6 children with symptomatic epilepsy. The most common disorder leading to epilepsy in children aged 3-18 years was encephalopathy, within hypoxic-ischemic encephalopathy. The other in sequence were malformations of nervous system and vascular diseases.

Water Resources Data for Illinois - Water Year 2005 (Includes Historical Data)

USGS Publications Warehouse

LaTour, J.K.; Weldon, E.A.; Dupre, D.H.; Halfar, T.M.

2006-01-01

This annual Water-Data Report for Illinois contains current water year (Oct. 1, 2004, to Sept. 30, 2005) and historical data of discharge, stage, water quality and biology of streams; stage of lakes and reservoirs; levels and quality of ground water; and records of precipitation, air temperature, dew point, solar radiation, and wind speed. The current year's (2005) data provided in this report include (1) discharge for 182 surface-water gaging stations and for 9 crest-stage partial-record stations; (2) stage for 33 surface-water gaging stations; (3) water-quality records for 10 surface-water stations; (4) sediment-discharge records for 14 surface-water stations; (5) water-level records for 98 ground-water wells; (6) water-quality records for 17 ground-water wells; (7) precipitation records for 48 rain gages; (8) records of air temperature, dew point, solar radiation and wind speed for 1 meteorological station; and (9) biological records for 6 sample sites. Also included are miscellaneous data collected at various sites not in the systematic data-collection network. Data were collected and compiled as a part of the National Water Information System (NWIS) maintained by the U.S. Geological Survey in cooperation with Federal, State, and local agencies.

Incidence, demographics and surgical outcomes of cutaneous squamous cell carcinoma diagnosed in Northland, New Zealand.

PubMed

Elliott, Brodie M; Douglass, Benjamin R; McConnell, Daniel; Johnson, Blair; Harmston, Christopher

2018-05-18

Non-melanoma skin cancer (NMSC) is the most commonly diagnosed and most costly cancer in Australasia. Cutaneous squamous cell carcinoma (cSCC) accounts for approximately 25% of NMSC. Despite this, reporting of cSCC is not mandatory in Australasia. This creates difficulties in planning, resourcing and improving outcomes in cSCC. Previous studies in New Zealand have lacked data on ethnicity. The aim of this study was to define the incidence and demographics of cSCC diagnosed in Northland, New Zealand, including data on ethnicity. A 12-month retrospective study was carried out of all primary cSCC histologically diagnosed in Northland for one year. The cohort was identified by searching the Northland District Health Board pathology database. Data on outcomes and ethnicity were obtained from the hospital results system. Primary outcome of interest was the incidence of cSCC in Northland. Secondary outcomes of interest were lesion characteristics and positive margin rate. 1,040 cSCC were identified in 890 patients. Mean age of patients was 75. Crude incidence of primary cSCC was 668/100,000 patient years. Age standardised incidence was 305/100,000 patient years. An estimate of New Zealand incidence adjusted for age and ethnicity is 580/100,000 patient years. Overall positive margin rate in excised lesions was 9.5%. This study has defined the rate of cSCC in a large, well defined New Zealand population, and estimated age and ethnicity adjusted incidence in New Zealand. It has demonstrated the highest incidence of cSCC in the world outside Australia. Overall positive margin rate of excised lesions was acceptable.

The developmental processes for NANDA International Nursing Diagnoses.

PubMed

Scroggins, Leann M

2008-01-01

This study aims to provide a step-by-step procedural guideline for the development of a nursing diagnosis that meets the necessary criteria for inclusion in the NANDA International and NNN classification systems. The guideline is based on the processes developed by the Diagnosis Development Committee of NANDA International and includes the necessary processes for development of Actual, Wellness, Health Promotion, and Risk nursing diagnoses. Definitions of Actual, Wellness, Health Promotion, and Risk nursing diagnoses along with inclusion criteria and taxonomy rules have been incorporated into the guideline to streamline the development and review processes for submitted diagnoses. A step-by-step procedural guideline will assist the submitter to move efficiently and effectively through the submission process, resulting in increased submissions and enhancement of the NANDA International and NNN classification systems.

The Polish National Registry for Fetal Cardiac Pathology: organization, diagnoses, management, educational aspects and telemedicine endeavors.

PubMed

Slodki, Maciej; Szymkiewicz-Dangel, Joanna; Tobota, Zdzislaw; Seligman, Neil S; Weiner, Stuart; Respondek-Liberska, Maria

2012-05-01

We describe the National Registry for Fetal Cardiac Pathology, a program under the Polish Ministry of Health aimed at improving the prenatal diagnosis, care, and management of congenital heart disease (CHD). An online database was created to prospectively record diagnosis, prenatal care, delivery, follow-up, and still images and video for fetuses with CHD. A certification program in fetal cardiac ultrasound was also implemented. Optimal screening and referral centers were identified by number of fetuses entered in the Registry yearly by each center. From 2004 to 2009, 2910 fetuses with CHD were registered (2473 structural, 437 functional anomalies). The most common reasons for referral for fetal echocardiography were abnormal four-chamber view (56.0%) and extra-cardiac anomalies (8.2% ), while the most common diagnoses were atrioventricular septal defects (10.2%) and hypoplastic left heart syndrome (9.7%). Prenatal diagnosis increased yearly, from 10.0% of neonatal diagnoses in 2003 to 38.0% in 2008. From inception of the registry up to 2009 there has been a fourfold increase in the number of neonates referred for cardiac surgery in whom the condition was prenatally diagnosed. Equally important achievements include the establishment of a certification program for fetal echocardiography and the organization of prenatal and neonatal management. © 2012 John Wiley & Sons, Ltd.

Voice Outcomes of Adults Diagnosed with Pediatric Vocal Fold Nodules and Impact of Speech Therapy.

PubMed

Song, Brian H; Merchant, Maqdooda; Schloegel, Luke

2017-11-01

Objective To evaluate the voice outcomes of adults diagnosed with vocal fold nodules (VFNs) as children and to assess the impact of speech therapy on long-term voice outcomes. Study Design Prospective cohort study. Setting Large health care system. Subjects and Methods Subjects diagnosed with VFNs as children between the years 1996 and 2008 were identified within a medical record database of a large health care system. Included subjects were 3 to 12 years old at the time of diagnosis, had a documented laryngeal examination within 90 days of diagnosis, and were ≥18 years as of December 31, 2014. Qualified subjects were contacted by telephone and administered the Vocal Handicap Index-10 (VHI-10) and a 15-item questionnaire inquiring for confounding factors. Results A total of 155 subjects were included, with a mean age of 21.4 years (range, 18-29). The male:female ratio was 2.3:1. Mean VHI-10 score for the entire cohort was 5.4. Mean VHI-10 scores did not differ between those who received speech therapy (6.1) and those who did not (4.5; P = .08). Both groups were similar with respect to confounding risk factors that can contribute to dysphonia, although the no-therapy group had a disproportionately higher number of subjects who consumed >10 alcoholic drinks per week ( P = .01). Conclusion The majority of adults with VFNs as children will achieve a close-to-normal voice quality when they reach adulthood. In our cohort, speech therapy did not appear to have an impact on the long-term voice outcomes.

A Case of Echinostoma cinetorchis (Trematoda: Echinostomatidae) Infection Diagnosed by Colonoscopy

PubMed Central

Jung, Woon Tae; Lee, Kyeong Ju; Kim, Hong Jun; Kim, Tae Hyo; Na, Byoung-Kuk

2014-01-01

Human cases of echinostomiasis have been sporadically diagnosed by extracting worms in the endoscopy in Korea and Japan. Most of these were caused by Echinostoma hortense infection. However, in the present study, we detected 2 live worms of Echinostoma cinetorchis in the ascending colon of a Korean man (68-year old) admitted to the Gyeongsang National University Hospital with complaint of intermittent right lower quadrant abdominal pain for 5 days. Under colonoscopy, 1 worm was found attached on the edematous and hyperemic mucosal surface of the proximal ascending colon and the other was detected on the mid-ascending colon. Both worms were removed from the mucosal surface with a grasping forceps, and morphologically identified as E. cinetorchis by the characteristic head crown with total 37 collar spines including 5 end-group ones on both sides, disappearance of testes, and eggs of 108×60 µm with abopercular wrinkles. The infection source of this case seems to be the raw frogs eaten 2 months ago. This is the first case of endoscopy-diagnosed E. cinetorchis infection in Korea. PMID:25031469

A case of Echinostoma cinetorchis (Trematoda: Echinostomatidae) infection diagnosed by colonoscopy.

PubMed

Jung, Woon Tae; Lee, Kyeong Ju; Kim, Hong Jun; Kim, Tae Hyo; Na, Byoung-Kuk; Sohn, Woon-Mok

2014-06-01

Human cases of echinostomiasis have been sporadically diagnosed by extracting worms in the endoscopy in Korea and Japan. Most of these were caused by Echinostoma hortense infection. However, in the present study, we detected 2 live worms of Echinostoma cinetorchis in the ascending colon of a Korean man (68-year old) admitted to the Gyeongsang National University Hospital with complaint of intermittent right lower quadrant abdominal pain for 5 days. Under colonoscopy, 1 worm was found attached on the edematous and hyperemic mucosal surface of the proximal ascending colon and the other was detected on the mid-ascending colon. Both worms were removed from the mucosal surface with a grasping forceps, and morphologically identified as E. cinetorchis by the characteristic head crown with total 37 collar spines including 5 end-group ones on both sides, disappearance of testes, and eggs of 108×60 µm with abopercular wrinkles. The infection source of this case seems to be the raw frogs eaten 2 months ago. This is the first case of endoscopy-diagnosed E. cinetorchis infection in Korea.

Nursing diagnoses in patients having mechanical ventilation support in a respiratory intensive care unit in Turkey.

PubMed

Yücel, Şebnem Çinar; Eşer, Ismet; Güler, Elem Kocaçal; Khorshid, Leyla

2011-10-01

This research was carried out to find out the nursing diagnoses in patients who have mechanical ventilation support in a respiratory intensive care unit. The study was conducted with 51 evaluations of critically ill adult patients who underwent invasive and non-invasive mechanical ventilation therapy in 2008. Data collection was based on Gordon's 11 Functional Health Patterns, and nursing diagnoses were determined according to North American Nursing Diagnosis Association-International (NANDA-I) Taxonomy II. The nursing diagnoses were determined by two researchers separately. The consistency between the nursing diagnoses defined by the two researchers was evaluated by using Cohen's kappa (κ). Forty men (78.4%) and 11 women (21.6%) whose mean ages were 70.19 (SD = 8.96) years were included in the study. Nineteen subgroups of nursing diagnoses about safety/protection domain, and 15 subgroups about activity/rest domain were seen at different rates in the patients. There was a statistically significant difference between mechanical ventilation via tracheostomy or endotracheal tube and decreased cardiac output (d.f. = 1, χ(2) = 4.760, P = 0.029). The relationship between the length of time under mechanical ventilation and impaired physical mobility was considerably significant (d.f. = 3, χ(2) = 24.459, P = 0.000). It was found out that there was a high degree of agreement (96.8%) between the nursing diagnoses defined by the two researchers separately (κ = 0.936, SE = 0.08). © 2011 Blackwell Publishing Asia Pty Ltd.

How Are Genetic Conditions Diagnosed?

MedlinePlus

... Consultation How are genetic conditions diagnosed? How are genetic conditions diagnosed? A doctor may suspect a diagnosis ... and advocacy resources. For more information about diagnosing genetic conditions: Genetics Home Reference provides information about genetic ...

Atypical presentation of West Nile virus in a newly diagnosed human immunodeficiency virus patient in New York City.

PubMed

Josekutty, Joby; Yeh, Richard; Mathew, Sheena; Ene, Ada; Ramessar, Nina; Trinidad, Jennilee

2013-04-01

Central nervous system manifestations of West Nile virus (WNV) infection include meningitis, encephalitis, and poliomyelitis-like syndrome. We describe a 44-year-old man with no past medical history who presented with a meningoencephalitic syndrome and spastic paralysis bilaterally in the upper and lower extremities, hyperreflexia, and myoclonus and was ultimately diagnosed as being infected with HIV and WNV.

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

PubMed Central

Preyra, Colin

2004-01-01

Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

Coding response to a case-mix measurement system based on multiple diagnoses.

PubMed

Preyra, Colin

2004-08-01

To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia

PubMed Central

Rogoveanu, OC; Tuțescu, NC; Kamal, D; Alexandru, DO; Kamal, C; Streba, CT; Trăistaru, MR

2016-01-01

Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability. PMID:27974931

The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia.

PubMed

Rogoveanu, O C; Tuțescu, N C; Kamal, D; Alexandru, D O; Kamal, C; Streba, C T; Trăistaru, M R

2016-01-01

Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.

[Evaluation of eating habits and nutritional behaviors of women in the perimenopausal period with the diagnosed celiac disease].

PubMed

Friedrich, Mariola; Podlaszewska, Grazyna; Kuchlewska, Magdalena

2012-01-01

The aim of this study was to evaluate eating habits and nutritional behaviors of women in the perimenopausal period with celiac disease diagnosed within the last 4 years. The study covered a group of 26 women, at the age of 51-54 years, with celiac disease diagnosed in the last 4 years and staying on a gluten-free diet for 6 months to 4 years and agreed to participate in this studies. Information of nutrition were collected from the women, who, after an appropriate instruction, recorded the timing, type and amount of food consumed in the three days a week, selected at random. The amount of consumed portions was defined on the basis of the "Book of portions, products and dishes". The menus (78) were recorded in April and May. Collected data were prepared, based on a computer program Dietetyk 2009 Prof. The analysis of results achieved in this study enabled concluding that--from the viewpoint of the diagnosed disease--the nutritional patterns of the women were very appropriate. However, it failed to meet basic nutritional guidelines, which was reflected in, among other things, unsatisfactory intake of vegetables, fruits, oils and water, and in excessive intake of protein of animal origin. In addition, it did not cover demands resulting from the perimenopausal period the surveyed women were in, which is likely to facilitate, e.g. disorders in lipid metabolism and water-mineral balance, as well as development of osteoporosis. The general picture of behaviors, including the nutritional ones, pointed to a strong predominance of the diagnosed disease but also to the need of compensating for the resultant restrictions, with the latter being perceived by the surveyed women as health-promoting actions.

Inhalant-Abuse Myocarditis Diagnosed by Cardiac Magnetic Resonance.

PubMed

Dinsfriend, William; Rao, Krishnasree; Matulevicius, Susan

2016-06-01

Multiple reports of toxic myocarditis from inhalant abuse have been reported. We now report the case of a 23-year-old man found to have toxic myocarditis from inhalation of a hydrocarbon. The diagnosis was made by means of cardiac magnetic resonance imaging with delayed enhancement. The use of cardiac magnetic resonance to diagnose myocarditis has become increasingly common in clinical medicine, although there is not a universally accepted criterion for diagnosis. We appear to be the first to document a case of toxic myocarditis diagnosed by cardiac magnetic resonance. In patients with a history of drug abuse who present with clinical findings that suggest myocarditis or pericarditis, cardiac magnetic resonance can be considered to support the diagnosis.

Association between Diagnosed ADHD and Selected Characteristics among Children Aged 4-17 Years: United States, 2011-2013. NCHS Data Brief. Number 201

ERIC Educational Resources Information Center

Pastor, Patricia N.; Reuben, Cynthia A.; Duran, Catherine R.; Hawkins, LaJeana D.

2015-01-01

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder diagnosed in U.S. children (1). While this disorder is most often diagnosed in children when they are in elementary school, it is increasingly being identified in preschool children (2-5). This report describes the prevalence of diagnosed ADHD among…

An adverse event screening tool based on routinely collected hospital-acquired diagnoses.

PubMed

Brand, Caroline; Tropea, Joanne; Gorelik, Alexandra; Jolley, Damien; Scott, Ian; Sundararajan, Vijaya

2012-06-01

The aim was to develop an electronic adverse event (AE) screening tool applicable to acute care hospital episodes for patients admitted with chronic heart failure (CHF) and pneumonia. Consensus building using a modified Delphi method and descriptive analysis of hospital discharge data. Consultant physicians in general medicine (n = 38). In-hospital acquired (C-prefix) diagnoses associated with CHF and pneumonia admissions to 230 hospitals in Victoria, Australia, were extracted from the Victorian Admitted Episodes Data Set between July 2004 and June 2007. A 9-point rating scale was used to prioritize diagnoses acquired during hospitalization (routinely coded as a 'C-prefix' diagnosis to distinguish from diagnoses present on admission) for inclusion within an AE screening tool. Diagnoses rated a group median score between 7 and 9 by the physician panel were included. Selection of C-prefix diagnoses with a group median rating of 7-9 in a screening tool, and the level of physician agreement, as assessed using the Interpercentile Range Adjusted for Symmetry. Of 697 initial C-prefix diagnoses, there were high levels of agreement to include 113 (16.2%) in the AE screening tool. Using these selected diagnoses, a potential AE was flagged in 14% of all admissions for the two index conditions. Intra-rater reliability for each clinician ranged from kappa 0.482 to 1.0. A high level of physician agreement was obtained in selecting in-hospital diagnoses for inclusion in an AE screening tool based on routinely collected data. These results support further tool validation.

Objectively assessed physical activity and lower limb function and prospective associations with mortality and newly diagnosed disease in UK older adults: an OPAL four-year follow-up study

PubMed Central

Fox, Kenneth R.; Ku, Po-Wen; Hillsdon, Melvyn; Davis, Mark G.; Simmonds, Bethany A. J.; Thompson, Janice L.; Stathi, Afroditi; Gray, Selena F.; Sharp, Deborah J.; Coulson, Joanne C.

2015-01-01

Background: objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period. Participants: two hundred and forty older adults were randomly recruited from 12 general practices in urban and suburban areas of a city in the United Kingdom. Follow-up included 213 of the baseline sample. Methods: socio-demographic variables, height and weight, and self-reported diagnosed diseases were recorded at baseline. Seven-day accelerometry was used to assess total physical activity, moderate-to-vigorous activity and sedentary time. A log recorded trips from home. Lower limb function was assessed using the Short Physical Performance Battery. Medical records were accessed on average 50 months post baseline, when new diseases and deaths were recorded. Analyses: ANOVAs were used to assess socio-demographic, physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up. Regression models were constructed to assess the prospective associations between physical activity and function with mortality and new disease. Results: for every 1,000 steps walked per day, the risk of mortality was 36% lower (hazard ratios 0.64, 95% confidence interval (CI) 0.44–0.91, P = 0.013). Low levels of moderate-to-vigorous physical activity (incident rate ratio (IRR) 1.67, 95% CI 1.04–2.68, P = 0.030) and low frequency of trips from home (IRR 1.41, 95% CI 0.98–2.05, P = 0.045) were associated with diagnoses of more new diseases. Conclusion: physical activity should be supported for adults in their 70s and 80s, as it is associated with reduced risk of mortality and new disease development. PMID:25377744

Objectively assessed physical activity and lower limb function and prospective associations with mortality and newly diagnosed disease in UK older adults: an OPAL four-year follow-up study.

PubMed

Fox, Kenneth R; Ku, Po-Wen; Hillsdon, Melvyn; Davis, Mark G; Simmonds, Bethany A J; Thompson, Janice L; Stathi, Afroditi; Gray, Selena F; Sharp, Deborah J; Coulson, Joanne C

2015-03-01

Objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period. Two hundred and forty older adults were randomly recruited from 12 general practices in urban and suburban areas of a city in the United Kingdom. Follow-up included 213 of the baseline sample. Socio-demographic variables, height and weight, and self-reported diagnosed diseases were recorded at baseline. Seven-day accelerometry was used to assess total physical activity, moderate-to-vigorous activity and sedentary time. A log recorded trips from home. Lower limb function was assessed using the Short Physical Performance Battery. Medical records were accessed on average 50 months post baseline, when new diseases and deaths were recorded. ANOVAs were used to assess socio-demographic, physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up. Regression models were constructed to assess the prospective associations between physical activity and function with mortality and new disease. For every 1,000 steps walked per day, the risk of mortality was 36% lower (hazard ratios 0.64, 95% confidence interval (CI) 0.44-0.91, P=0.013). Low levels of moderate-to-vigorous physical activity (incident rate ratio (IRR) 1.67, 95% CI 1.04-2.68, P=0.030) and low frequency of trips from home (IRR 1.41, 95% CI 0.98-2.05, P=0.045) were associated with diagnoses of more new diseases. Physical activity should be supported for adults in their 70s and 80s, as it is associated with reduced risk of mortality and new disease development. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society.

Incidence and outcome of acquired aplastic anemia: real-world data from patients diagnosed in Sweden from 2000-2011.

PubMed

Vaht, Krista; Göransson, Magnus; Carlson, Kristina; Isaksson, Cecilia; Lenhoff, Stig; Sandstedt, Anna; Uggla, Bertil; Winiarski, Jacek; Ljungman, Per; Brune, Mats; Andersson, Per-Ola

2017-10-01

A plastic anemia is a rare life-threatening disease. However, since the introduction of immunosuppressive therapy and allogeneic stem cell transplantation, the outcome has improved considerably, and the 5-year survival is reported to be 70-80% in selected patient cohorts. Yet, contemporary population-based data on incidence and survival are lacking. We performed a national retrospective study to determine the incidence, treatment, and survival of patients with aplastic anemia diagnosed in Sweden from 2000-2011. Patients were included via the National Patient Registry, and diagnosed according to the Camitta criteria. In total, 257 confirmed cases were identified, with an overall incidence of 2.35 (95% CI: 2.06-2.64) cases per million inhabitants per year. Median age was 60 years (range: 2-92), and median follow up was 76 (0-193) months. Primary treatments included immunosuppressive therapy (63%), allogenic stem cell transplantation (10%), or single-agent cyclosporine/no specific therapy (27%). The 5-year survival was 90.7% in patients aged 0-18 years, 90.5% in patients aged 19-39 years, 70.7% in patients aged 40-59 years, and 38.1% in patients aged ≥60 years. Multivariate analysis showed that age (both 40-59 and ≥60 age groups), very severe aplastic anemia and single-agent cyclosporine/no specific therapy were independent risk factors for inferior survival. In conclusion, younger aplastic anemia patients experience a very good long-term survival, while that of patients ≥60 years in particular remains poor. Apparently, the challenge today is to improve the management of older aplastic anemia patients, and prospective studies to address this medical need are warranted. Copyright© 2017 Ferrata Storti Foundation.

Pulmonary symptoms and diagnoses are associated with HIV in the MACS and WIHS cohorts.

PubMed

Gingo, Matthew R; Balasubramani, Goundappa K; Rice, Thomas B; Kingsley, Lawrence; Kleerup, Eric C; Detels, Roger; Seaberg, Eric C; Greenblatt, Ruth M; Holman, Susan; Huang, Laurence; Sutton, Sarah H; Bertolet, Marnie; Morris, Alison

2014-04-30

Several lung diseases are increasingly recognized as comorbidities with HIV; however, few data exist related to the spectrum of respiratory symptoms, diagnostic testing, and diagnoses in the current HIV era. The objective of the study is to determine the impact of HIV on prevalence and incidence of respiratory disease in the current era of effective antiretroviral treatment. A pulmonary-specific questionnaire was administered yearly for three years to participants in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). Adjusted prevalence ratios for respiratory symptoms, testing, or diagnoses and adjusted incidence rate ratios for diagnoses in HIV-infected compared to HIV-uninfected participants were determined. Risk factors for outcomes in HIV-infected individuals were modeled. Baseline pulmonary questionnaires were completed by 907 HIV-infected and 989 HIV-uninfected participants in the MACS cohort and by 1405 HIV-infected and 571 HIV-uninfected participants in the WIHS cohort. In MACS, dyspnea, cough, wheezing, sleep apnea, and incident chronic obstructive pulmonary disease (COPD) were more common in HIV-infected participants. In WIHS, wheezing and sleep apnea were more common in HIV-infected participants. Smoking (MACS and WIHS) and greater body mass index (WIHS) were associated with more respiratory symptoms and diagnoses. While sputum studies, bronchoscopies, and chest computed tomography scans were more likely to be performed in HIV-infected participants, pulmonary function tests were no more common in HIV-infected individuals. Respiratory symptoms in HIV-infected individuals were associated with history of pneumonia, cardiovascular disease, or use of HAART. A diagnosis of asthma or COPD was associated with previous pneumonia. In these two cohorts, HIV is an independent risk factor for several respiratory symptoms and pulmonary diseases including COPD and sleep apnea. Despite a higher prevalence of chronic respiratory symptoms

School Age Outcomes of Children Diagnosed Early and Later with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Clark, Megan Louise Erin; Vinen, Zoe; Barbaro, Josephine; Dissanayake, Cheryl

2018-01-01

Early diagnosis of Autism Spectrum Disorder is considered best practice, increasing access to early intervention. Yet, many children are diagnosed after 3-years. The current study investigated the school age outcomes of children who received an early and later diagnosis of ASD. The cognitive and behavioural outcomes of children diagnosed early (n…

Surgical treatment of late-diagnosed bronchial foreign body aspiration: a report of 23 cases.

PubMed

Duan, Liang; Chen, Xiaofeng; Wang, Hao; Hu, Xuefei; Jiang, Gening

2014-07-01

Late-diagnosed bronchial foreign bodies can lead to irreversible changes in the bronchi and the lungs. To date, few reports are available concerning surgical treatment for this condition. The present report summarizes clinicopathological features and surgical treatment options for late-diagnosed bronchial foreign body aspiration. Clinical data of 23 patients who underwent surgical treatment for late-diagnosed bronchial foreign body aspiration in our hospital from 1980 to 2010 were reviewed. The patients included 17 male and six female patients, aged 6 to 66 years. To remove the foreign body, bronchotomy was performed in six patients and pulmonary resection in 17 patients. Foreign bodies were located on the right side in 17 cases and on the left side in six cases. The majority of the foreign bodies were of food origin. Postoperative bronchopleural fistula occurred in two patients. One patient died of renal failure subsequent to lung infections. Detailed history, awareness of potential foreign body aspiration and thorough bronchoscopic examination are helpful to avoid pulmonary resection. However, the latter is necessary in patients with the associated substantial lung lesions to prevent these from progressing into serious lung infections such as pulmonary suppuration or empyema. © 2013 John Wiley & Sons Ltd.

The challenge of diagnosing focal hand dystonia in musicians.

PubMed

Rosset-Llobet, J; Candia, V; Fàbregas i Molas, S; Dolors Rosinés i Cubells, D; Pascual-Leone, A

2009-07-01

To most clinicians, medical problems in musicians, particularly those concerning focal hand dystonia, constitute an unfamiliar domain difficult to manage. The latter can importantly influence diagnostics and the course of treatment. The purpose of this study was to enlighten the issue and to identify possible problems in diagnosing musicians' cramp within the Spanish medical community. We used a brief questions' catalog and clinical histories of 665 musicians seen at our clinic for performing artists. We analyzed patients' diagnosis records in 87 cases of focal hand dystonia (13.1%). In so doing, we surveyed previous diagnoses and diverse treatments prescriptions prior to referral to our clinic. Referrals came primarily from orthopaedists and neurologists. The 52.9% arrived at our clinic without a diagnosis or a suspicion of suffering from focal dystonia. The most frequently attempted diagnoses other than musicians' dystonia included nerve compression, tendonitis and trigger fingers. Commonly prescribed treatments included rest, various surgical procedures, physiotherapy and oral anti-inflammatory medication. This data depicts the diagnostic challenges of medical professionals may encounter when confronted with musician's focal dystonia.

Acute admissions to medical departments in Denmark: diagnoses and patient characteristics.

PubMed

Vest-Hansen, Betina; Riis, Anders Hammerich; Sørensen, Henrik Toft; Christiansen, Christian Fynbo

2014-09-01

Despite extensive research on individual diseases, population-based knowledge about reasons for acute medical admissions remains limited. Our aim was to examine primary diagnoses, Charlson Comorbidity Index (CCI) score, age, and gender among patients admitted acutely to medical departments in Denmark. In this population-based observational study, 264,265 acute medical patients admitted during 2010 were identified in the Danish National Registry of Patients (DNRP), covering all hospitals in Denmark. Reasons for acute admissions were assessed by primary diagnoses, grouped according to the International Classification of Diseases 10th edition. Additionally, the CCI score, age and gender were presented according to each diagnostic group. Two-thirds of the patients had one of the four following reasons for admission: cardiovascular diseases (19.3%), non-specific Z-diagnoses ("Factors influencing health status and contact with health services") (16.9%), infectious diseases (15.5%), and non-specific R-diagnoses ("Symptoms and abnormal findings, not elsewhere classified") (11.8%). In total, 45% of the patients had a CCI score of one or more and there was a considerable overlap between the patients' chronic diseases and the reason for admission. The median age of the study population was 64 years (IQR 47-77 years), ranging from 46 years (IQR 27-66) for injury and poisoning to 74 years (IQR 60-83) for hematological diseases. Gender representation varied considerably within the diagnostic groups, for example with male predominance in mental disorders (59.0%) and female predominance in diseases of the musculoskeletal system (57.8%). Our study identifies that acute medical patients often present with non-specific symptoms or complications related to their chronic diseases. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

[A Case of Subcortical Intracerebral Hemorrhage Caused by Underlying Oligodendroglioma Diagnosed through Long-Term Follow-Up].

PubMed

Kidoguchi, Masamune; Isozaki, Makoto; Hirose, Satoshi; Kitai, Ryuhei; Kikuta, Ken-Ichiro

2017-03-01

We report on a case of an oligodendroglioma that caused intracerebral hemorrhage, which was diagnosed by long-term follow-up. An 82-year-old man with underlying hypertrophic cardiomyopathy presented with weakness in the right upper extremity. Computed tomography and magnetic resonance imaging(MRI)showed intracerebral hemorrhage and focal brain edema. Since there was a discrepancy between hematoma and focal brain edema, we first diagnosed cardiogenic cerebral embolism. Six months later, MRI results showed an improvement of the brain edema; however, the lesion developed after a year. We suspected that this lesion included a brain tumor and performed an open surgical biopsy. Pathological examination revealed that the tumor was an oligodendroglioma(World Health Organization grade 2). Because brain tumors that are complicated with intratumoral bleeding are often highly malignant and the lesions gradually increase in size, it is relatively easy to make a precise diagnosis. However, in low-grade gliomas, the intracerebral hemorrhage and brain edema may occasionally improve in the short term. We show that a case with a discrepancy between hematoma and brain edema should be followed up for at least more than a year, even when initial MRI does not reveal a brain tumor .

BORDERLINE PERSONALITY DISORDER IN THE MEDICAL SETTING: Suggestive Behaviors, Syndromes, and Diagnoses.

PubMed

Sansone, Randy A; Sansone, Lori A

2015-01-01

Borderline personality disorder is a personality dysfunction that is characterized by disinhibition and impulsivity, which oftentimes manifest as self-regulation difficulties. Patients with this disorder have always been present in medical settings, but have been described as "difficult patients" rather than patients with borderline personality disorder. According to empirical findings, a number of behaviors and medical syndromes/diagnoses are suggestive of borderline personality disorder. Suggestive behaviors in the medical setting may include aggressive or disruptive behaviors, the intentional sabotage of medical care, and excessive healthcare utilization. Suggestive medical syndromes and diagnoses in the medical setting may include alcohol and substance misuse (including the abuse of prescription medications), multiple somatic complaints, chronic pain, obesity, sexual impulsivity, and hair pulling. While not all-inclusive or diagnostic, these behaviors and syndromes/diagnoses may invite further clinical evaluation of the patient for borderline personality disorder.

Can We Confidently Diagnose Pilomatricoma with Fine Needle Aspiration Cytology?

PubMed Central

WONG, Yin-Ping; MASIR, Noraidah; SHARIFAH, Noor Akmal

2015-01-01

Pilomatricomas can be confidently diagnosed cytologically due to their characteristic cytomorphological features. However, these lesions are rarely encountered by cytopathologists and thus pose a diagnostic dilemma to even experienced individuals, especially when the lesions are focally sampled. We describe two cases of histologically confirmed pilomatricoma. The first case is of a 13-year-old boy with posterior cervical ‘lymphadenopathy’, and the second one is of a 12-year-old girl with a lower cheek swelling. Both aspirates comprised predominantly atypical basal-like cells, with prominent nucleoli. ‘Ghost cells’ were readily identified by cell block in case two, but cell block in case one yielded no diagnostic material. In case two, pilomatricoma was accurately diagnosed pre-operatively. A cytological suspicion of a neoplastic process was raised in case one. Despite being diagnostically challenging, pilomatricoma can be diagnosed with careful observation of two unique cytological features of the lesions: (1) pathognomonic ‘ghost cells’ and (2) irregular, saw-toothed, loosely cohesive basaloid cells, with prominent nucleoli. The role of thorough sampling of the lesion, with multiple passes of various sites, cannot be overemphasized. PMID:25892955

Risk factors for disability pension over 11 years in a cohort of young persons initially sick-listed with low back, neck, or shoulder diagnoses.

PubMed

Borg, Karin; Hensing, Gunnel; Alexanderson, Kristina

2004-01-01

A study was undertaken to ascertain whether the differences in risk in relation to gender and citizenship observed in a previous study of the same cohort would remain if more recent data on sickness absence were used. This was an 11-year prospective population-based cohort study. The dataset includes all individuals in a Swedish city who, in 1985, were aged 25-34 and had a sick-leave spell > or = 28 days with neck, shoulder, or back diagnoses (n=213). The data covered the following: for 1985-96, disability pension, emigration, and death; for 1982-96, sickness absence; for 1985, sex and citizenship. The data were subjected to Cox regression analyses with a time-dependent covariate. Disability pension was granted to 22% (n=46) of the cohort. The relative risk for disability pension increased by 9.3 with each sick-leave spell > or = 90 days during the two previous years. The risk was higher for women than men, and also higher for foreign citizens than Swedes. Many studies have revealed a gender difference in the risk of being on disability pension, and it was found that this difference was still apparent when sick leave during the follow-up period is taken into account. Thus, the reason for the gender differences ought to be found among other factors than prior levels of sickness absence. Copyright 2004 Taylor & Francis

[Causes of symptomatic epilepsy in two first years of life children hospitalized in 2006-2007 years].

PubMed

Kroczka, Sławomir; Skowronek-Bała, Barbara; Zajac, Anna

2008-01-01

Epilepsy in two first years of life needs constant attention due to diagnostic and therapeutic difficulties. The aim of the study was to identify cause of symptomatic epilepsy in two first years of life children from miopolskie and podkarpackie provinces hospitalized in Pediatric Neurology Clinic of Children and Adolescents Neurology Cathedra UJ in Cracow. 102 children with epilepsy aged from 1 week to 24 months hospitalized between 1st of January 2006 and 31st of December 2007. The group included 47 girls and 55 boys. On the basis of clinical characteristics and results of additional examinations idiopathic epilepsy was diagnosed in 16/102 (13.3%) children and in remaining 86 (87.7%) symtopmatic epilepsy was established. Perinatal burdening was cause of epilepsy in 31/86 (33.72%) children. Other causes were identified in 32/54 children (59.3%) and in remaining 231 54 (40.7%) children the cause was not established. In 3/32 epilepsy occured in the course of hydrocephalus and in 3/32 children as one of CNS inflammation complications. Epilepsy as a result of vascular lesions and bleeding to CNS occured in 4 children. Multiple developmental deffects syndrome was diagnosed in 4 children and in 11 specific neurodevelopmental disorders were the cause of epilepsy. In 6 children epilepsy occured in the course of neurometabolic diseases, neurocutaneous syndromes and neoplasms. In children in two first years of life polimorphic seizures were diagnosed the most often (32/86 that is 37.2%) and tonic, tonic-clonic seizures were less often (21/86 that is 24.43%). Focal seizures occured in 20/86 (23.26%) patients, in 4/86 (4.65%) mioclonic jerks were observed and infantile spasms in 9/86 (10.46%). (1) In most hospitalized children in two first years of life symptomatic epilepsy was diagnosed. (2) Epilepsy in two first years of life was more often in boys. (3) The most often cause of symptomatic epilepsy was pathology of perinatal period. (4) Polymorphic seizures were the most

The quality of severe mental disorder diagnoses in a national health registry as compared to research diagnoses based on structured interview.

PubMed

Nesvåg, Ragnar; Jönsson, Erik G; Bakken, Inger Johanne; Knudsen, Gun Peggy; Bjella, Thomas D; Reichborn-Kjennerud, Ted; Melle, Ingrid; Andreassen, Ole A

2017-03-14

Utilization of diagnostic information from national patient registries rests on the quality of the registered diagnoses. We aimed to investigate the agreement and consistency of diagnoses of psychotic and bipolar disorders in the Norwegian Patient Registry (NPR) compared to structured interview-based diagnoses given as part of a clinical research project. Diagnostic data from NPR were obtained for the period 01.01.2008-31.12.2013 for all patients who had been included in the Thematically Organized Psychosis (TOP) study between 18.10.2002 and 01.09.2014 with a Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnosis of schizophrenia (n = 537), delusional disorder (n = 48), schizoaffective disorder (n = 118) or bipolar disorder (n = 408). Diagnostic agreement between the primary DSM-IV diagnosis in TOP and the International Classification of Diseases, 10th revision (ICD-10) diagnoses in NPR was evaluated using Cohen's unweighted nominal kappa (κ). Diagnostic consistency was calculated as the proportion of all registered severe mental disorder diagnoses in NPR that were equivalent to the primary diagnosis given in the TOP study. The proportion of patients registered with the equivalent ICD-10 diagnosis as the primary DSM-IV diagnosis given in TOP was 84.2% for the schizophrenia group, 68.8% for the delusional disorder group, 76.3% for the schizoaffective disorder group, and 78.4% for the bipolar disorder group. Diagnostic agreement was good for schizophrenia (κ = 0.74) and bipolar disorder (κ = 0.72), fair for schizoaffective disorder (κ = 0.63), and poor for delusional disorder (κ = 0.39). Among patients with DSM-IV schizophrenia, 4.7% were diagnosed with ICD-10 bipolar disorder, and among patients with DSM-IV bipolar disorder, 2.5% were diagnosed with ICD-10 schizophrenia. Diagnostic consistency was 84.9% for schizophrenia, 59.1% for delusional disorder, 65.9% for schizoaffective disorder, and 91

Measurement properties of gait-related outcomes in youth with neuromuscular diagnoses: a systematic review.

PubMed

Ammann-Reiffer, Corinne; Bastiaenen, Caroline H G; de Bie, Rob A; van Hedel, Hubertus J A

2014-08-01

Sound measurement properties of outcome tools are essential when evaluating outcomes of an intervention, in clinical practice and in research. The purpose of this study was to review the evidence on reliability, measurement error, and responsiveness of measures of gait function in children with neuromuscular diagnoses. The MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched up to June 15, 2012. Studies evaluating reliability, measurement error, or responsiveness of measures of gait function in 1- to 18-year-old children and youth with neuromuscular diagnoses were included. Quality of the studies was independently rated by 2 raters using a modified COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. Studies with a fair quality rating or better were considered for best evidence synthesis. Regarding the methodological quality, 32 out of 35 reliability studies, all of the 13 measurement error studies, and 5 out of 10 responsiveness studies were of fair or good quality. Best evidence synthesis revealed moderate to strong evidence for reliability for several measures in children and youth with cerebral palsy (CP) but was limited or unknown in other diagnoses. The Functional Mobility Scale (FMS) and the Gross Motor Function Measure (GMFM) dimension E showed limited positive evidence for responsiveness in children with CP, but it was unknown or controversial in other diagnoses. No information was reported on the minimal important change; thus, evidence on measurement error remained undetermined. As studies on validity were not included in the review, a comprehensive appraisal of the best available gait-related outcome measure per diagnosis is not possible. There is moderate to strong evidence on reliability for several measures of gait function in children and youth with CP, whereas evidence on responsiveness exists only for the FMS and the GMFM dimension E. © 2014 American Physical Therapy Association.

Using the Childhood Autism Rating Scale to Diagnose Autism Spectrum Disorders

ERIC Educational Resources Information Center

Chlebowski, Colby; Green, James A.; Barton, Marianne L.; Fein, Deborah

2010-01-01

This study investigated the childhood autism rating scale (CARS) as a tool for ASD diagnoses for 2-year-old (n = 376) and 4-year-old (n = 230) children referred for possible autism. The cut-off score to distinguish autistic disorder from PDD-NOS was 32 in the 2-year-old sample (consistent with Lord in "J Child Psychol Psychiatry Allied…

Myositis with antimitochondrial antibodies diagnosed by rectus abdominis muscle biopsy.

PubMed

Uenaka, Takeshi; Kowa, Hisatomo; Sekiguchi, Kenji; Nagata, Kakuya; Ohtsuka, Yoshihisa; Kanda, Fumio; Toda, Tatsushi

2013-05-01

Antimitochondrial antibodies are autoantibodies detected in 90% of primary biliary cirrhosis (PBC) patients. Some PBC cases are complicated by myositis, which is difficult to confirm due to minimal histological evidence of inflammation in limb muscles. Our aim was to determine the extent of inflammatory changes in a truncal muscle biopsy specimen from a PBC patient. A 48-year-old woman with a 5-year history of atrial fibrillation and chronic heart failure was evaluated for elevated serum creatine kinase level. Antimitochondrial M2 antibodies were detected, and PBC was diagnosed. A biceps brachii biopsy specimen showed mild, non-specific myogenic changes; a second biopsy was performed on the rectus abdominis muscle, which showed typical inflammatory changes. Myositis with antimitochondrial M2 antibodies was confirmed. In myositis patients with antimitochondrial M2 antibodies, muscles of the extremities are involved to a lesser extent. Radiological and histological examination focusing on truncal muscles, including a biopsy, is important. Copyright © 2012 Wiley Periodicals, Inc.

Inhalant-Abuse Myocarditis Diagnosed by Cardiac Magnetic Resonance

PubMed Central

Rao, Krishnasree; Matulevicius, Susan

2016-01-01

Multiple reports of toxic myocarditis from inhalant abuse have been reported. We now report the case of a 23-year-old man found to have toxic myocarditis from inhalation of a hydrocarbon. The diagnosis was made by means of cardiac magnetic resonance imaging with delayed enhancement. The use of cardiac magnetic resonance to diagnose myocarditis has become increasingly common in clinical medicine, although there is not a universally accepted criterion for diagnosis. We appear to be the first to document a case of toxic myocarditis diagnosed by cardiac magnetic resonance. In patients with a history of drug abuse who present with clinical findings that suggest myocarditis or pericarditis, cardiac magnetic resonance can be considered to support the diagnosis. PMID:27303242

The impact of patients' involvement in cooking on their mortality and morbidity: a 19-year follow-up of patients diagnosed with type 2 diabetes mellitus.

PubMed

Jandorf, Sofie; Siersma, Volkert; Køster-Rasmussen, Rasmus; de Fine Olivarius, Niels; Waldorff, Frans Boch

2015-03-01

This study explored the impact of involvement in cooking on long-term morbidity and mortality among patients newly diagnosed with type 2 diabetes mellitus (T2DM). Data are from the population-based study Diabetes Care in General Practice. In baseline questionnaires, 1348 patients newly diagnosed with T2DM gave information on how frequently they consumed a warm main meal and how often they cooked it themselves. The selected patients were followed up for 19 years in the Danish National Patient Registry and the Danish Register of Causes of Death. This study analysed the association between involvement in cooking and each of seven pre-specified outcomes was analysed in Cox regression models with stepwise adjustment for possible confounders and mediators. 92% of the patients with T2DM consumed a warm main meal ≥ five times per week. Among these, women who cooked for themselves less than once a week had a higher risk of diabetes-related deaths (HR 1.86 [95% CI 1.03-3.35], p = 0.039) and stroke (HR 2.47 [95% CI 1.08-5.65], p = 0.033), after adjustment for confounders. For men, infrequent cooking was not related to increased risk for the outcomes investigated. In patients newly diagnosed with T2DM and with a regular intake of warm main meals, infrequent involvement in cooking was associated with an increased risk of diabetes-related death and stroke for women, but not for men. General practitioners should pay special attention to managing diabetes treatment in female patients newly diagnosed with T2DM who report infrequent involvement in cooking.

[The use of diagnoses related to tobacco use in the Czech Republic].

PubMed

Zvolský, Miroslav; Nechanská, Blanka; Králíková, Eva

2012-01-01

According to the International Statistical Classification of Diseases and Related Health Problems 10th Revision, tobacco dependence is coded by group F17 - Mental and behavioral disorders due to use of tobacco. There are other codes for diagnoses and conditions associated with tobacco use. The aim of our analysis was to determine how often these codes are reported in clinical practice. We observed the incidence of diagnoses F17, P04.2, Z72.0 or T65.2 in years 2002-2011 in hospitalized patients and the F17 diagnosis in patients of psychiatric health facilities. According to data from the Institute of Health Information and Statistics of the Czech Republic diagnoses indicating smoking patients were reported in 1.5% of hospitalized patients in 2011, although the prevalence of smoking in the population is around 30% in last 15 years. Smoking-related diagnoses were reported in 2.1% of cases in Internal medicine departments. Codes F17, T65.2 and Z72.0 occurred as an accessory diagnose in vascular brain disease in 1.8% of hospitalizations and for respiratory tract neoplasms (dg. C32-C34) it was 7.1% of hospitalizations. These results demonstrate the underestimation of the importance of smoking and its relationship to clinical disciplines. Although it is one of the most common diseases in the population with a direct relation to fatal diseases of civilization, the information on its incidence is not used in clinical practice.

Diagnosing subtle palatal anomalies: Validation of video-analysis and assessment protocol for diagnosing occult submucous cleft palate.

PubMed

Rourke, Ryan; Weinberg, Seth M; Marazita, Mary L; Jabbour, Noel

2017-09-01

Submucous cleft palate (SMCP) classically involves bifid uvula, zona pellucida, and notched hard palate. However, patients may present with more subtle anatomic abnormalities. The ability to detect these abnormalities is important for surgeons managing velopharyngeal dysfunction (VPD) or considering adenoidectomy. Validate an assessment protocol for diagnosis of occult submucous cleft palate (OSMCP) and identify physical examination features present in patients with OSMCP in the relaxed and activated palate positions. Study participants included patients referred to a pediatric VPD clinic with concern for hypernasality or SMCP. Using an appropriately encrypted iPod touch, transoral video was obtained for each patient with the palate in the relaxed and activated positions. The videos were reviewed by two otolaryngologists in normal speed and slow-motion, as needed, and a questionnaire was completed by each reviewer pertaining to the anatomy and function of the palate. 47 patients, with an average age of 4.6 years, were included in the study over a one-year period. Four videos were unusable due to incomplete view of the palate. The most common palatal abnormality noted was OSMCP, diagnosed by each reviewer in 26/43 and 30/43 patients respectively. Using the assessment protocol, agreement on palatal diagnosis was 83.7% (kappa = 0.68), indicating substantial agreement, with the most prevalent anatomic features being vaulted palate elevation (96%) and visible notching of hard palate (75%). The diagnosis of subtle palatal anomalies is difficult and can be subjective. Using the proposed video-analysis method and assessment protocol may improve reliability of diagnosis of OSMCP. Copyright © 2017 Elsevier B.V. All rights reserved.

Identification of nursing management diagnoses.

PubMed

Morrison, R S

1997-02-01

Theories from nursing and management provide frameworks for enhancing effectiveness of nursing management practice. The concept nursing management diagnosis has been developed by integrating nursing diagnosis and organizational diagnosis as a basis for nurse manager decision-making. Method triangulation was used to identify problems of managing nursing units, to validate those problems for relevancy to practice, to generate nursing management diagnoses, and to validate the diagnoses. Diagnoses were validated according to a definition of nursing management diagnosis provided. Of the 72 nursing management diagnoses identified, 66 were validated at a 70% level of agreement by nurse managers participating in the study.

Diagnostic shift in patients diagnosed with schizoaffective disorder: a systematic review and meta-analysis of rediagnosis studies.

PubMed

Santelmann, Hanno; Franklin, Jeremy; Bußhoff, Jana; Baethge, Christopher

2016-05-01

The diagnosis of schizoaffective disorder (SAD) is well established in clinical practice but is heavily disputed on theoretical grounds. We analyzed the extent and direction of diagnostic shift in SAD patients. We searched Medline, Embase, and PsycINFO systematically for all studies documenting two diagnostic assessments at different points in time (rediagnosis studies) and used meta-analytic methods to quantify diagnostic shift. Multiple prespecified and post-hoc subgroup analyses (e.g., rater blinding) and meta-regressions (e.g., year of publication) were carried out. We included 31 studies out of 4,415 articles screened: 27 studies on the shift from and 23 studies on the shift to SAD (median time span was two years). A total of 36% of patients with a diagnosis of SAD at first assessment switch, many to schizophrenia (19%), 14% to affective disorders, and 6% to other disorders. Among patients diagnosed with SAD at second assessment, 55% had received a different diagnosis at first assessment, a large portion of whom had been initially diagnosed with affective disorder (24%), schizophrenia (18%), and other disorders (12%). Diagnostic shift in SAD patients is substantial. Psychiatrists need to reassess the diagnosis during the course of the illness and to adjust treatment. Slightly more diagnoses of SAD are changed to schizophrenia than to affective disorders, and among patients rediagnosed with SAD, fewer have been diagnosed with schizophrenia than with affective disorders. Thus, at the diagnostic level, there seems to be a slight trend toward schizophrenia during the course of functional psychoses. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The role of invasive and non-invasive procedures in diagnosing fever of unknown origin.

PubMed

Mete, Bilgul; Vanli, Ersin; Yemisen, Mucahit; Balkan, Ilker Inanc; Dagtekin, Hilal; Ozaras, Resat; Saltoglu, Nese; Mert, Ali; Ozturk, Recep; Tabak, Fehmi

2012-01-01

The etiology of fever of unknown origin has changed because of the recent advances in and widespread use of invasive and non-invasive diagnostic tools. However, undiagnosed patients still constitute a significant number. To determine the etiological distribution and role of non-invasive and invasive diagnostic tools in the diagnosis of fever of unknown origin. One hundred patients who were hospitalized between June 2001 and 2009 with a fever of unknown origin were included in this study. Clinical and laboratory data were collected from the patients' medical records retrospectively. Fifty three percent of the patients were male, with a mean age of 45 years. The etiology of fever was determined to be infectious diseases in 26, collagen vascular diseases in 38, neoplastic diseases in 14, miscellaneous in 2 and undiagnosed in 20 patients. When the etiologic distribution was analyzed over time, it was noted that the rate of infectious diseases decreased, whereas the rate of rheumatological and undiagnosed diseases relatively increased because of the advances in imaging and microbiological studies. Seventy patients had a definitive diagnosis, whereas 10 patients had a possible diagnosis. The diagnoses were established based on clinical features and non-invasive tests for 61% of the patients and diagnostic benefit was obtained for 49% of the patients undergoing invasive tests. Biopsy procedures contributed a rate of 42% to diagnoses in patients who received biopsies. Clinical features (such as detailed medical history-taking and physical examination) may contribute to diagnoses, particularly in cases of collagen vascular diseases. Imaging studies exhibit certain pathologies that guide invasive studies. Biopsy procedures contribute greatly to diagnoses, particularly for malignancies and infectious diseases that are not diagnosed by non-invasive procedures.

Clinical efficacy of dim light melatonin onset testing in diagnosing delayed sleep phase syndrome.

PubMed

Rahman, Shadab A; Kayumov, Leonid; Tchmoutina, Ekaterina A; Shapiro, Colin M

2009-05-01

Delayed Sleep Phase Syndrome (DSPS) arises from biological clock desynchrony and accounts for 10% of chronic insomnia patients. Currently DSPS is diagnosed based on sleep/wake cycle disruptions rather than examining the underlying biological clock alterations. The objective of the study was to determine the sensitivity and specificity of the Dim Light Melatonin Onset (DLMO) Test in diagnosing DSPS in a clinical setting. Fifty-six patients (mean age 28 years) symptomatic of DSPS participated in the study. Following an initial assessment of DSPS using sleep diaries, participants underwent two consecutive nights of polysomnography (PSG), with an imposed sleep period on the second night to demonstrate the delay in the timing of habitual sleep period and to thereby confirm DSPS. Circadian phase delays were also measured using melatonin secretion profiles, and the efficacy of diagnosing DSPS using DLMO was compared to using sleep diaries and PSG. Melatonin secretion was assayed for each individual by ELISA using saliva samples. Main outcome measures included the time of melatonin secretion onset, clinical sensitivity and specificity of the DLMO test. The time of melatonin secretion onset was significantly delayed in DSPS patients. Clinical sensitivity and specificity of the DLMO test in diagnosing DSPS were 90.3% and 84.0%, respectively. The DLMO test is an accurate tool for differentiating between sleep disorder patients with or without underlying circadian rhythm disruption. It is effective for phase typing DSPS patients in a clinical setting.

Profile of nursing diagnoses in patients with respiratory disorders.

PubMed

Alves dos Santos, Naftale; Frota Cavalcante, Tahissa; de Oliveira Lopes, Marcos Venícios; Bezerra Gomes, Emiliana; de Oliveira, Célida Juliana

2015-01-01

Identify the profile of nursing diagnoses in patients with respiratory disorders. A descriptive and cross-sectional study involving 38 patients with respiratory problems, of referral hospitals, in a city in northeastern Brazil, in the period from August to October, 2012. Data collection was performed using a form and diagnostic inference was made according with the Taxonomy II of NANDA I. The average age of the patients was 46 years and males predominated (60.5%). The most frequent nursing diagnoses were: Risk for infection (97.3%), Acute pain (68.4%), Poor knowledge (68.4%), Sedentary lifestyle (65.7%), Ineffective airway clearance (65.7%), Risk-prone health behavior (63.1%), Activity intolerance (52.6%) and Disturbed sleep pattern (33.3%). Evaluated patients exhibited an average of 8.6 nursing diagnoses (SD = 2.8). With respect to the defining characteristics and related factors the average per person was 7.2 and 9.3, respectively. In this group of patients the most frequent diagnoses were the domain activity/rest. Knowledge of nursing diagnoses profile presented by people with respiratory disorders is important, because it is part of the Nursing Process and nurses who take care of such patients should exercise them in their care practice. Knowledge of the mains nursing diagnosis presented by patients with respiratory disorders are important for the practice of nurses who care for these patients, because it allows the choice of responses to problems of their clientele.

Handwriting capacity in children newly diagnosed with Attention Deficit Hyperactivity Disorder.

PubMed

Brossard-Racine, Marie; Majnemer, Annette; Shevell, Michael; Snider, Laurie; Bélanger, Stacey Ageranioti

2011-01-01

Preliminary evidence suggests that children with Attention Deficit Hyperactivity Disorder (ADHD) may exhibit handwriting difficulties. However, the exact nature of these difficulties and the extent to which they may relate to motor or behavioural difficulties remains unclear. The aim of this study was to describe handwriting capacity in children newly diagnosed with ADHD and identify predictors of performance. Forty medication-naïve children with ADHD (mean age 8.1 years) were evaluated with the Evaluation Tool of Children's Handwriting-Manuscript, the Movement Assessment Battery for Children (M-ABC), the Developmental Test of Visual Motor Integration (VMI) and the Conner Global Index. An important subset (85.0%) exhibited manual dexterity difficulties. Handwriting performance was extremely variable in terms of speed and legibility. VMI was the most important predictor of legibility. Upper extremity coordination, as measured by the M-ABC ball skills subtest, was also a good predictor of word legibility. Poor handwriting legibility and slow writing speed were common in children newly diagnosed with ADHD and were associated with motor abilities. Future studies are needed to determine whether interventions, including stimulant medications, can improve handwriting performance and related motor functioning. Copyright © 2011 Elsevier Ltd. All rights reserved.

Hypogammaglobulinemia in newly diagnosed chronic lymphocytic leukemia: Natural history, clinical correlates, and outcomes.

PubMed

Parikh, Sameer A; Leis, Jose F; Chaffee, Kari G; Call, Timothy G; Hanson, Curtis A; Ding, Wei; Chanan-Khan, Asher A; Bowen, Deborah; Conte, Michael; Schwager, Susan; Slager, Susan L; Van Dyke, Daniel L; Jelinek, Diane F; Kay, Neil E; Shanafelt, Tait D

2015-09-01

Although hypogammaglobulinemia is a well recognized complication in patients with chronic lymphocytic leukemia (CLL), its prevalence at the time of CLL diagnosis, and association with novel prognostic markers and clinical outcome is not well understood. All patients at the Mayo Clinic between January 1999 and July 2013 who had newly diagnosed CLL and had a baseline assessment of serum immunoglobulin G (IgG) were included. The relation between hypogammaglobulinemia at diagnosis and the novel prognostic parameters time to first treatment (TFT) and overall survival (OS) were evaluated. Of 1485 patients who met the eligibility criteria, 382 (26%) had hypogammaglobulinemia (median IgG, 624 mg/dL), whereas the remaining 1103 patients (74%) had normal serum IgG levels (median IgG, 1040 mg/dL). Patients who had hypogammaglobulinemia at diagnosis were more likely to have advanced Rai stage (III-IV; P = .001) and higher expression of CD49d (P < .001) compared with patients who had normal IgG levels. Although the median TFT for patients who had hypogammaglobulinemia was shorter compared with that for patients who had normal IgG levels (3.8 years vs 7.4 years; P < .001), on multivariable analysis, there was no difference in OS between these 2 groups (12.8 years vs 11.3 years, respectively; P = .73). Of 1103 patients who had CLL with normal IgG levels at diagnosis and who did not receive CLL therapy, the risk of acquired hypogammaglobulinemia was 11% at 5 years and 23% at 10 years. Hypogammaglobulinemia is present in 25% of patients with newly diagnosed CLL. Approximately 25% of patients who have CLL with normal IgG levels at diagnosis will subsequently develop hypogammaglobulinemia on long-term follow-up. The presence of hypogammaglobulinemia does not appear to impact overall survival. © 2015 American Cancer Society.

The challenge of diagnosing focal hand dystonia in musicians

PubMed Central

Rosset-Llobet, J.; Candia, V.; Molas, S. Fàbregas i; Dolors Rosinés i Cubells, D.; Pascual-Leone, A.

2012-01-01

Background and purpose To most clinicians, medical problems in musicians, particularly those concerning focal hand dystonia, constitute an unfamiliar domain difficult to manage. The latter can importantly influence diagnostics and the course of treatment. The purpose of this study was to enlighten the issue and to identify possible problems in diagnosing musicians’ cramp within the Spanish medical community. Methods We used a brief questions’ catalog and clinical histories of 665 musicians seen at our clinic for performing artists. We analyzed patients’ diagnosis records in 87 cases of focal hand dystonia (13.1%). In so doing, we surveyed previous diagnoses and diverse treatments prescriptions prior to referral to our clinic. Results Referrals came primarily from orthopaedists and neurologists. The 52.9% arrived at our clinic without a diagnosis or a suspicion of suffering from focal dystonia. The most frequently attempted diagnoses other than musicians’ dystonia included nerve compression, tendonitis and trigger fingers. Commonly prescribed treatments included rest, various surgical procedures, physiotherapy and oral anti-inflammatory medication. Conclusions This data depicts the diagnostic challenges of medical professionals may encounter when confronted with musician’s focal dystonia. PMID:19473363

Discharge diagnoses in infants with apparent life-threatening event.

PubMed

Okada, Kazuko; Miyako, Motoko; Honma, Satoshi; Wakabayashi, Yasuko; Sugihara, Shigetaka; Osawa, Makiko

2003-10-01

There are various identifiable diseases or conditions that can be associated with an apparent life-threatening event (ALTE) in infancy. The present study was carried out to investigate the etiology of ALTE based on the discharge diagnoses. A protocol for the complete work-up used to examine the cause of ALTE was designed, and was carried out for 69 infants with ALTE. Gastroesophageal reflux disease (GERD) was demonstrated in 38 cases, and chronic gastric volvulus (CGV) was diagnosed in 21 (associated with GERD in 13 infants). Four cases of pertussis and two cases each of sepsis, laryngomalacia, respiratory immaturity, and premature ventricular contractions were found. Others cases presented with pneumonia, meningitis, intussuception, food allergy, epilepsy, and adenoid vegetations. In 12 of the 69 infants with ALTE, no abnormalities were found in any of the studies performed, including two patients with breath-holding spells. In 17 cases, two or more possibly contributing findings were diagnosed. It is important to recognize that gastroesophageal impairments such as GERD or CGV could be responsible for many incidences of ALTE in infancy. The authors recommend a trial be established to investigate the causes of ALTE, including gastroesophageal evaluations in all infants with ALTE.

Validation of nursing management diagnoses.

PubMed

Morrison, R S

1995-01-01

Nursing management diagnosis based on nursing and management science, merges "nursing diagnosis" and "organizational diagnosis". Nursing management diagnosis is a judgment about nursing organizational problems. The diagnoses provide a basis for nurse manager interventions to achieve outcomes for which a nurse manager is accountable. A nursing organizational problem is a discrepancy between what should be happening and what is actually happening that prevents the goals of nursing from being accomplished. The purpose of this study was to validate 73 nursing management diagnoses identified previously in 1992: 71 of the 72 diagnoses were considered valid by at least 70% of 136 participants. Diagnoses considered to have high priority for future research and development were identified by summing the mean scores for perceived frequency of occurrence and level of disruption. Further development of nursing management diagnoses and testing of their effectiveness in enhancing decision making is recommended.

Peritoneal Lipomatosis: A Case Report of a 12-Year-Old Boy

PubMed Central

Fotis, L.; Koglmeier, J.; Shah, N.

2013-01-01

Peritoneal lipomatosis is a rare disease in childhood with only two cases previously described in children. We report a further case of a 12-year-old boy diagnosed with peritoneal lipomatosis. His main symptoms were abdominal pain, alternating bowel habit, abdominal distension, and melaena. His diagnostic work up included an abdominal MRI, wireless capsule endoscopy and single-balloon enteroscopy. Peritoneal lipomatosis although rare can be diagnosed in childhood. It is a benign clinical entity with variable manifestations. PMID:23762668

Debunking Occam's razor: Diagnosing multiple genetic diseases in families by whole-exome sequencing.

PubMed

Balci, T B; Hartley, T; Xi, Y; Dyment, D A; Beaulieu, C L; Bernier, F P; Dupuis, L; Horvath, G A; Mendoza-Londono, R; Prasad, C; Richer, J; Yang, X-R; Armour, C M; Bareke, E; Fernandez, B A; McMillan, H J; Lamont, R E; Majewski, J; Parboosingh, J S; Prasad, A N; Rupar, C A; Schwartzentruber, J; Smith, A C; Tétreault, M; Innes, A M; Boycott, K M

2017-09-01

Recent clinical whole exome sequencing (WES) cohorts have identified unanticipated multiple genetic diagnoses in single patients. However, the frequency of multiple genetic diagnoses in families is largely unknown. We set out to identify the rate of multiple genetic diagnoses in probands and their families referred for analysis in two national research programs in Canada. We retrospectively analyzed WES results for 802 undiagnosed probands referred over the past 5 years in either the FORGE or Care4Rare Canada WES initiatives. Of the 802 probands, 226 (28.2%) were diagnosed based on mutations in known disease genes. Eight (3.5%) had two or more genetic diagnoses explaining their clinical phenotype, a rate in keeping with the large published studies (average 4.3%; 1.4 - 7.2%). Seven of the 8 probands had family members with one or more of the molecularly diagnosed diseases. Consanguinity and multisystem disease appeared to increase the likelihood of multiple genetic diagnoses in a family. Our findings highlight the importance of comprehensive clinical phenotyping of family members to ultimately provide accurate genetic counseling. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm.

PubMed

Rajan, Gita; Ljunggren, Gunnar; Wändell, Per; Wahlström, Lars; Svedin, Carl-Göran; Carlsson, Axel C

2017-06-01

Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions. Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated. Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 0-17 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic

Estimates of CDC-Funded and National HIV Diagnoses: A Comparison by Demographic and HIV-related Factors.

PubMed

Krueger, Amy; Dietz, Patricia; Van Handel, Michelle; Belcher, Lisa; Johnson, Anna Satcher

2016-12-01

To determine whether CDC-funded HIV testing programs are reaching persons disproportionately affected by HIV infection. The percentage distribution for HIV testing and diagnoses by demographics and transmission risk group (diagnoses only) were calculated using 2013 data from CDC's National HIV Surveillance System and CDC's national HIV testing program data. In 2013, nearly 3.2 million CDC-funded tests were provided to persons aged 13 years and older. Among persons who received a CDC-funded test, 41.1 % were aged 20-29 years; 49.2 % were male, 46.2 % were black/African American, and 56.2 % of the tests were conducted in the South. Compared with the characteristics of all persons diagnosed with HIV in the United States in 2013, among persons diagnosed as a result of CDC-funded tests, a higher percentage were aged 20-29 years (40.3 vs 33.7 %) and black/African American (55.3 vs 46.0 %). CDC-funded HIV testing programs are reaching young people and blacks/African Americans.

Research Diagnostic Criteria for Temporomandibular Disorders: Validity of Axis I Diagnoses

PubMed Central

Truelove, Edmond; Pan, Wei; Look, John O.; Mancl, Lloyd A.; Ohrbach, Richard K.; Velly, Ana; Huggins, Kimberly; Lenton, Patricia; Schiffman, Eric L.

2011-01-01

AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. METHODS A combined total of 614 TMD community and clinic cases and 91 controls were examined at 3 study sites. RDC/TMD Axis I diagnoses were algorithmically derived from an examination performed by calibrated dental hygienists. Reference standards (Gold Standards) were established by means of consensus diagnoses rendered by 2 TMD experts using all available clinical data, including imaging studies. Validity of the RDC/TMD Axis I TMD diagnoses was estimated relative to reference-standard diagnoses (gold standard diagnoses). Target sensitivity and specificity were set a priori at ≥ 0.70 and ≥ 0.95, respectively. RESULTS Target sensitivity and specificity were not observed for any of the 8 RDC/TMD diagnoses. The highest validity was achieved for Group Ia myofascial pain (sensitivity 0.65, specificity 0.92) and Group Ib myofascial pain with limited opening (sensitivity 0.79, specificity 0.92). Target sensitivity and specificity were observed only when both Group I diagnoses were combined (0.87 and 0.98, respectively). For Group II (disc displacements) and Group III (arthralgia, arthritis, arthrosis) diagnoses, all estimates for sensitivity were below target (0.03 to 0.53), and specificity ranged from below to on target (0.86 to 0.99). CONCLUSION The RDC/TMD Axis I TMD diagnoses did not reach the targets set at sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Target validity was obtained only for myofascial pain without differentiation between normal and limited opening. Revision of the current Axis I TMD diagnostic algorithms is warranted to improve their validity. PMID:20213030

A programmatic approach to address increasing HIV diagnoses among Hispanic/Latino MSM, 2010-2014.

PubMed

McCree, Donna Hubbard; Walker, Tanja; DiNenno, Elizabeth; Hoots, Brooke; Valverde, Eduardo; Cheryl Bañez Ocfemia, M; Heitgerd, Janet; Stallworth, JoAna; Ferro, Benny; Santana, Alberto; German, Emilio; Harris, Norma

2018-06-14

From 2010 to 2015, young (13-24 years) Hispanic/Latino gay, bisexual and other men who have sex with men (MSM) experienced the largest increase (18%) in numbers of HIV diagnoses among all racial/ethnic groups. In 2016, the Centers for Disease Control and Prevention (CDC) assembled a team of scientists and public health analysts to develop a programmatic approach for addressing the increasing HIV diagnosis among Hispanic/Latino MSM. The team used a data driven review process, i.e., comprehensive review of surveillance, epidemiologic, and programmatic data, to explore key questions from the literature on factors associated with HIV diagnoses among Hispanic/Latino MSM and to inform the approach. This paper describes key findings from the review and discusses the approach. The approach includes the following activities: increase awareness and support testing by expanding existing campaigns targeting Hispanic/Latino MSM to jurisdictions where diagnoses are increasing; strengthen existing efforts that support treatment as prevention and increase engagement in care and viral suppression among Hispanic/Latino MSM living with HIV and promote prevention, e.g., PrEP uptake and condom use, among Hispanic/Latino MSM who are at high-risk for HIV infection. Copyright © 2018. Published by Elsevier Inc.

Outcomes and genotype-phenotype correlations in 52 individuals with VLCAD deficiency diagnosed by NBS and enrolled in the IBEM-IS database

PubMed Central

Pena, Loren D.M.; van Calcar, Sandra C.; Hansen, Joyanna; Edick, Mathew J.; Vockley, Cate Walsh; Leslie, Nancy; Cameron, Cynthia; Mohsen, Al-Walid; Berry, Susan A; Arnold, Georgianne L; Vockley, Jerry

2016-01-01

Very long chain acyl-CoA dehydrogenase (VLCAD) deficiency can present at various ages from the neonatal period to adulthood, and poses the greatest risk of complications during intercurrent illness or after prolonged fasting. Early diagnosis, treatment, and surveillance can reduce mortality; hence, the disorder is included in the newborn Recommended Uniform Screening Panel (RUSP) in the United States. The Inborn Errors of Metabolism Information System (IBEM-IS) was established in 2007 to collect longitudinal information on individuals with inborn errors of metabolism included in newborn screening (NBS) programs, including VLCAD deficiency. We retrospectively analyzed early outcomes for individuals who were diagnosed with VLCAD deficiency by NBS and describe initial presentations, diagnosis, clinical outcomes and treatment in a cohort of 52 individuals ages 1–18 years. Maternal prenatal symptoms were not reported, and most newborns remained asymptomatic. Cardiomyopathy was uncommon in the cohort, diagnosed in 2/52 cases. Elevations in creatine kinase were a common finding, and usually first occurred during the toddler period (1–3 years of age). Diagnostic evaluations required several testing modalities, most commonly plasma acylcarnitine profiles and molecular testing. Functional testing, including fibroblast acylcarnitine profiling and white blood cell or fibroblast enzyme assay, is a useful diagnostic adjunct if uncharacterized mutations are identified. PMID:27209629

[Intravesical active prostate bleeding diagnosed in B-mode ultrasound].

PubMed

Kirchgesner, T; Danse, E; Tombal, B

2013-09-01

Hematuria is one of the most frequent minor complications after prostatic biopsy. We would like to report the case of a 68-year-old patient with massive hematuria after prostatic biopsy and intravesical active prostate bleeding diagnosed in B-mode ultrasonography. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The impact of patients’ involvement in cooking on their mortality and morbidity: A 19-year follow-up of patients diagnosed with type 2 diabetes mellitus

PubMed Central

Siersma, Volkert; Køster-Rasmussen, Rasmus; Olivarius, Niels De Fine; Waldorff, Frans Boch

2015-01-01

Abstract Objective. This study explored the impact of involvement in cooking on long-term morbidity and mortality among patients newly diagnosed with type 2 diabetes mellitus (T2DM). Design and subjects. Data are from the population-based study Diabetes Care in General Practice. In baseline questionnaires, 1348 patients newly diagnosed with T2DM gave information on how frequently they consumed a warm main meal and how often they cooked it themselves. The selected patients were followed up for 19 years in the Danish National Patient Registry and the Danish Register of Causes of Death. Main outcome measures. This study analysed the association between involvement in cooking and each of seven pre-specified outcomes was analysed in Cox regression models with stepwise adjustment for possible confounders and mediators. Results. 92% of the patients with T2DM consumed a warm main meal = five times per week. Among these, women who cooked for themselves less than once a week had a higher risk of diabetes-related deaths (HR 1.86 [95% CI 1.03–3.35], p = 0.039) and stroke (HR 2.47 [95% CI 1.08–5.65], p = 0.033), after adjustment for confounders. For men, infrequent cooking was not related to increased risk for the outcomes investigated. Conclusions. In patients newly diagnosed with T2DM and with a regular intake of warm main meals, infrequent involvement in cooking was associated with an increased risk of diabetes-related death and stroke for women, but not for men. General practitioners should pay special attention to managing diabetes treatment in female patients newly diagnosed with T2DM who report infrequent involvement in cooking. PMID:25592166

Incident diagnoses of cancers and cancer-related deaths, active component, U.S. Armed Forces, 2000-2011.

PubMed

2012-06-01

In the United States, cancer is one of the five leading causes of death in all age groups among both men and women; overall, approximately one in four deaths is attributable to cancer. Compared to the general U.S. population, military members have been estimated to have lower incidence rates of several cancers including colorectal, lung, and cervical cancers and higher rates of prostate, breast, and thyroid cancer. Between 2000 and 2011 in active component members of the U.S. military, crude incidence rates of most cancer diagnoses have remained stable. 9,368 active component service members were diagnosed with one of the cancers of interest and no specific increasing or decreasing trends were observed. Cancer is an uncommon cause of death among service members on active duty and accounted for a total of 1,185 deaths during the 12-year surveillance period.

[The Clinical Significance of Serum Alpha-fetoprotein in Diagnosing Hepatocellular Carcinoma in a Health Screening Population].

PubMed

Ko, Young Sun; Bae, Joo Hwan; Sinn, Dong Hyun; Gwak, Geum Youn; Kang, Wonseok; Paik, Yong Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon

2017-04-25

Serum alpha-fetoprotein (AFP) measurement is commonly included in a health check-up program in Korea. However, its benefits remain uncertain. We analyzed whether AFP measurement should be included in a general health check-up program to screen for hepatocellular carcinoma (HCC). A total of 36,552 adults aged 18 years or older-who participated in a routine health examination including AFP determination between January 2009 and December 2009 at the Health Promotion Center, Samsung Medical Center, South Korea-were analyzed. High risk of HCC was defined as positivity for hepatitis B surface antigen, anti-hepatitis C virus antibody or having liver cirrhosis. AFP level >10 ng/mL was observed in 27 participants (0.1%) and primary liver cancer was diagnosed in 9 patients (6 HCC and 3 cholangiocarcinoma). Among 1,619 participants with high risk factors of HCC, AFP level >10 ng/mL was observed in 16 participants, of which, 4 diagnoses were made. Sensitivity, specificity, positive predictive value, and negative predictive value of AFP for HCC was 0.66, 0.99, 0.25 and 0.99, respectively, for high risk participants. Among 34,933 participants without risk factors for HCC, 11 patients (<0.1%) showed elevated AFP levels above 10 ng/mL, and no case was diagnosed with primary liver cancer during a median follow-up period of 36 months (range: 0-48 months). AFP elevation was rare in participants without risk factors for HCC, and was unable to screen for HCC in this population. We discourage routine AFP measurements for asymptomatic adults without risk factors of HCC.

Clinical usefulness of fine needle aspiration cytology in patients less than 20 years old: a 10-year experience at a single institution.

PubMed

Kim, Sunzoo; Jang, Eun Jeong; Jeong, Ji Yun; Park, Ji Young

2013-01-01

The purpose of this study was to identify the spectrum of cytological diagnoses and evaluate the diagnostic effectiveness of fine needle aspiration cytology (FNA) in patients less than 20 years old. The subjects were selected by retrospectively reviewing records from 1999 to 2009. Selected patients less than 20 years old underwent FNA. Cytological and histological slides of samples from the subjects were reviewed. Our study included a total of 909 subjects with a mean age of 14.6 years. The majority of the FNA samples were taken from lymph nodes (n = 448, 49.3%), with the remaining aspirates obtained from the thyroid gland (n = 247, 27.2%), soft tissues of head and neck masses (n = 106, 11.7%), salivary glands (n = 75, 8.3%), breasts (n = 18, 1.9%), skins (n = 9, 1.0%) and soft tissues of extremity (n = 6, 0.7%). The majority (87.6%, n = 796) of the FNA samples were categorized as 'benign', with the remaining designated as 'atypical lesion' (n = 18, 2.0%), 'malignant' (n = 24, 2.6%), or 'inadequate specimen' (n = 71, 7.8%). FNA accuracy was 92% for diagnosing cancer. Specificity and sensitivity were 99% and 63%, respectively. Our study first revealed that FNA has a high specificity for diagnosing cancer in various anatomical locations in young patients and can be confidently used as an effective tool for diagnosing malignancies in young individuals with a clinically suspicious lesion.

Heterotopic pancreas in excluded stomach diagnosed after gastric bypass surgery

PubMed Central

2013-01-01

Background Heterotopic pancreas is defined as finding of pancreatic tissue without anatomic and vascular continuity with the normal pancreas. Heterotopic pancreas is a rare condition difficult to diagnose and with controversial clinical management. Case presentation We describe a 43 year old female patient previously submitted to laparoscopic gastric bypass for primary treatment of morbid obesity; 5 years later, the patient was discovered to have a mass in the antrum of the excluded stomach that was found to be heterotopic pancreatic tissue. Before gastric bypass surgery, the presence of the pancreatic mass in the gastric wall was unnoticed in the imagiologic records. Conclusion This is the first reported case of pancreatic heterotopy diagnosed in the excluded stomach after gastric bypass. A putative role of incretin hormones in mediating pancreatic cell hyperplasia of heterotopic pancreatic remnants should be considered an additional hypothesis that requires further research. PMID:24267291

Correlates of incident bipolar disorder in children and adolescents diagnosed with attention-deficit/hyperactivity disorder.

PubMed

Jerrell, Jeanette M; McIntyre, Roger S; Park, Yong-Moon Mark

2014-11-01

The greater severity and chronicity of illness in youths with co-occurring attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder deserve further investigation as to the risk imparted by comorbid conditions and the pharmacotherapies employed. A retrospective cohort design was employed, using South Carolina's Medicaid claims dataset covering outpatient and inpatient medical and psychiatric service claims with International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses and medication prescriptions between January 1996 and December 2006 for patients ≤ 17 years of age. The cohort included 22,797 cases diagnosed with ADHD at a mean age of 7.8 years; 1,604 (7.0%) were diagnosed with bipolar disorder at a mean age of 12.2 years. The bipolar disorder group developed conduct disorder (CD)/oppositional defiant disorder (ODD), anxiety disorder, and a substance use disorder later than the ADHD-only group. The odds of a child with ADHD developing bipolar disorder were significantly and positively associated with a comorbid diagnosis of CD/ODD (adjusted odds ratio [aOR] = 4.01), anxiety disorder (aOR = 2.39), or substance use disorder (aOR = 1.88); longer treatment with methylphenidate, mixed amphetamine salts, or atomoxetine (aOR = 1.01); not being African American (aOR = 1.61); and being treated with certain antidepressant medications, most notably fluoxetine (aOR = 2.00), sertraline (aOR = 2.29), bupropion (aOR = 2.22), trazodone (aOR = 2.15), or venlafaxine (aOR = 2.37) prior to the first diagnosis of mania. Controlling for pharmacotherapy differences, incident bipolar disorder was more likely in individuals clustering specific patterns of comorbid psychiatric disorders, suggesting that there are different pathways to bipolarity and providing a clinical impetus for prioritizing prevention and preemptive strategies to reduce their hazardous influence. © Copyright 2014 Physicians Postgraduate Press, Inc.

Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation.

PubMed

Wunsch, Hannah; Christiansen, Christian F; Johansen, Martin B; Olsen, Morten; Ali, Naeem; Angus, Derek C; Sørensen, Henrik Toft

2014-03-19

The relationship between critical illness and psychiatric illness is unclear. To assess psychiatric diagnoses and medication prescriptions before and after critical illness. Population-based cohort study in Denmark of critically ill patients in 2006-2008 with follow-up through 2009, and 2 matched comparison cohorts from hospitalized patients and from the general population. Critical illness defined as intensive care unit admission with mechanical ventilation. Adjusted prevalence ratios (PRs) of psychiatrist-diagnosed psychiatric illnesses and prescriptions for psychoactive medications in the 5 years before critical illness. For patients with no psychiatric history, quarterly cumulative incidence (risk) and adjusted hazard ratios (HRs) for diagnoses and medications in the following year, using Cox regression. Among 24,179 critically ill patients, 6.2% had 1 or more psychiatric diagnoses in the prior 5 years vs 5.4% for hospitalized patients (adjusted PR, 1.31; 95% CI, 1.22-1.42; P<.001) and 2.4% for the general population (adjusted PR, 2.57; 95% CI, 2.41-2.73; P<.001). Five-year preadmission psychoactive prescription rates were similar to hospitalized patients: 48.7% vs 48.8% (adjusted PR, 0.97; 95% CI, 0.95-0.99; P<.001) but were higher than the general population (33.2%; adjusted PR, 1.40; 95% CI, 1.38-1.42; P<.001). Among the 9912 critical illness survivors with no psychiatric history, the absolute risk of new psychiatric diagnoses was low but higher than hospitalized patients: 0.5% vs 0.2% over the first 3 months (adjusted HR, 3.42; 95% CI, 1.96-5.99; P <.001), and the general population cohort (0.02%; adjusted HR, 21.77; 95% CI, 9.23-51.36; P<.001). Risk of new psychoactive medication prescriptions was also increased in the first 3 months: 12.7% vs 5.0% for the hospital cohort (adjusted HR, 2.45; 95% CI, 2.19-2.74; P<.001) and 0.7% for the general population (adjusted HR, 21.09; 95% CI, 17.92-24.82; P<.001). These differences had largely resolved by 9 to 12

Incidence and outcome of acquired aplastic anemia: real-world data from patients diagnosed in Sweden from 2000–2011

PubMed Central

Vaht, Krista; Göransson, Magnus; Carlson, Kristina; Isaksson, Cecilia; Lenhoff, Stig; Sandstedt, Anna; Uggla, Bertil; Winiarski, Jacek; Ljungman, Per; Brune, Mats; Andersson, Per-Ola

2017-01-01

A plastic anemia is a rare life-threatening disease. However, since the introduction of immunosuppressive therapy and allogeneic stem cell transplantation, the outcome has improved considerably, and the 5-year survival is reported to be 70–80% in selected patient cohorts. Yet, contemporary population-based data on incidence and survival are lacking. We performed a national retrospective study to determine the incidence, treatment, and survival of patients with aplastic anemia diagnosed in Sweden from 2000–2011. Patients were included via the National Patient Registry, and diagnosed according to the Camitta criteria. In total, 257 confirmed cases were identified, with an overall incidence of 2.35 (95% CI: 2.06–2.64) cases per million inhabitants per year. Median age was 60 years (range: 2–92), and median follow up was 76 (0–193) months. Primary treatments included immunosuppressive therapy (63%), allogenic stem cell transplantation (10%), or single-agent cyclosporine/no specific therapy (27%). The 5-year survival was 90.7% in patients aged 0–18 years, 90.5% in patients aged 19–39 years, 70.7% in patients aged 40–59 years, and 38.1% in patients aged ≥60 years. Multivariate analysis showed that age (both 40–59 and ≥60 age groups), very severe aplastic anemia and single-agent cyclosporine/no specific therapy were independent risk factors for inferior survival. In conclusion, younger aplastic anemia patients experience a very good long-term survival, while that of patients ≥60 years in particular remains poor. Apparently, the challenge today is to improve the management of older aplastic anemia patients, and prospective studies to address this medical need are warranted. PMID:28751565

Long-term mortality in children diagnosed with Haemophilus influenzae meningitis: a Danish nationwide cohort study.

PubMed

Roed, Casper; Engsig, Frederik Neess; Omland, Lars Haukali; Skinhoj, Peter; Obel, Niels

2011-08-01

The long-term mortality in children diagnosed with Haemophilus influenzae meningitis is poorly documented. We performed a nationwide, population-based cohort study including all Danish children diagnosed at the age between 0 and <5 years with H. influenzae meningitis from 1977 through 1996 and who were alive 1 year after diagnosis. Data were retrieved from medical databases in Denmark. For each H. influenzae meningitis patient, 6 age- and gender-matched population controls were indentified. We constructed Kaplan-Meier survival curves and used Cox regression analysis to estimate mortality rate ratios (MRR) and analyze causes of death. The risk of inpatient admission and of requiring hospital outpatient services during follow-up was calculated. We identified 1242 H. influenzae meningitis patients and 7452 population controls, with a median follow-up time of 21.3 years. The MRR for patients with H. influenzae meningitis was 1.08 (95% confidence interval, 0.57-2.05), adjusted MRR was 0.97 (95% confidence interval, 0.50-1.89). No increased mortality due to infections, respiratory diseases, or cancer was observed. The overall risk of inpatient admission and of requiring hospital outpatient services for the H. influenzae meningitis patients was increased the first 15 years of follow-up, mainly due to the nervous system diseases and ear diseases, thereafter the risk decreased to that of the population controls. In a developed country, children younger than 5 years surviving the acute phase of H. influenzae meningitis have no increased long-term mortality and only moderately increased morbidity.

Variability and accuracy in interpretation of consolidation on chest radiography for diagnosing pneumonia in children under 5 years of age.

PubMed

Williams, Gabrielle J; Macaskill, Petra; Kerr, Marianne; Fitzgerald, Dominic A; Isaacs, David; Codarini, Miriam; McCaskill, Mary; Prelog, Kristina; Craig, Jonathan C

2013-12-01

Consolidation on chest radiography is widely used as the reference standard for defining pneumonia and variability in interpretation is well known but not well explored or explained. Three pediatric sub-specialists (infectious diseases, radiology and respiratory medicine) viewed 3,033 chest radiographs in children aged under 5 years of age who presented to one Emergency Department (ED) with a febrile illness. Radiographs were viewed blind to clinical information about the child and blind to findings of other readers. Each chest radiograph was identified as positive or negative for consolidation. Percentage agreement and kappa scores were calculated for pairs of readers. Prevalence of consolidation and reader sensitivity/specificity was estimated using latent class analysis. Using the majority rule, 456 (15%) chest radiographs were positive for consolidation while the latent class estimate was 17%. The radiologist was most likely (21.3%) and respiratory physician least likely (13.7%) to diagnose consolidation. Overall percentage agreement for pairs of readers was 85-90%. However, chance corrected agreement between the readers was moderate, with kappa scores 0.4-0.6 and did not vary with patient characteristics (age, gender, and presence of chronic illness). Estimated sensitivity ranged from 0.71 to 0.81 across readers, and specificity 0.91 to 0.98. Overall agreement for identification of consolidation on chest radiographs was good, but agreement adjusted for chance was only moderate and did not vary with patient characteristics. Clinicians need to be aware that chest radiography is an imperfect test for diagnosing pneumonia and has considerable variability in its interpretation. © 2013 Wiley Periodicals, Inc.

Neuropsychological and psychological interventions for people with newly diagnosed epilepsy.

PubMed

Jackson, Cerian F; Makin, Selina M; Baker, Gus A

2015-07-22

Many people with epilepsy report experiencing psychological difficulties such as anxiety, depression and neuropsychological deficits including memory problems. Research has shown that these difficulties are often present not only for people with chronic epilepsy but also for people with newly diagnosed epilepsy. Despite this, there are very few published interventions that detail means to help people with newly diagnosed epilepsy manage these problems. To identify and assess possible psychological and neuropsychological interventions for adults with newly diagnosed epilepsy. We searched the following databases on 30 June 2015: the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), SCOPUS, PsycINFO, CINAHL, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). This review includes all randomised controlled trials, quasi-randomised controlled trials, prospective cohort controlled studies, and prospective before and after studies which include psychological or neuropsychological interventions for people with newly diagnosed epilepsy. We excluded studies that included people with epilepsy and any other psychological disorder or neurological condition. We excluded studies carried out which recruited only children. We used the standard methodological procedure expected by The Cochrane Collaboration. Two authors independently completed data extraction and risk of bias analysis. The results of this were cross-checked and third author resolved any discrepancies. In the event of missing data, we contacted the study authors. Meta-analysis was not completed due to differences in the intervention and outcomes reported in the two studies. We included two randomised controlled trials assessing psychological interventions for people with newly diagnosed epilepsy. One study assessed a cognitive behavioural intervention (CBI) in an adolescent

ULTRASONOGRAPHY, AN EFFECTIVE TOOL IN DIAGNOSING PLANTAR FASCIITIS: A SYSTEMATIC REVIEW OF DIAGNOSTIC TRIALS

PubMed Central

Wyland, Matthew; Applequist, Lee; Bolowsky, Erin; Klingensmith, Heather; Virag, Isaac

2016-01-01

Background Plantar fasciitis (PF) is the most common cause of heel pain that affects 10% of the general population, whether living an athletic or sedentary lifestyle. The most frequent mechanism of injury is an inflammatory response that is caused by repetitive micro trauma. Many techniques are available to diagnose PF, including the use of ultrasonography (US). Purpose The purpose of this study is to systematically review and appraise previously published articles published between the years 2000 and 2015 that evaluated the effectiveness of using US in the process of diagnosing PF, as compared to alternative diagnostic methods. Methods A total of eight databases were searched to systematically review scholarly (peer reviewed) diagnostic and intervention articles pertaining to the ability of US to diagnose PF. Results Using specific key words the preliminary search yielded 264 articles, 10 of which were deemed relevant for inclusion in the study. Two raters independently scored each article using the 15 point modified QUADAS scale. Discussion Six studies compared the diagnostic efficacy of US to another diagnostic technique to diagnose PF, and four studies focused on comparing baseline assessment of plantar fascia before subsequent intervention. The most notable US outcomes measured were plantar fascia thickness, enthesopathy, and hypoechogenicity. Conclusion US was found to be accurate and reliable compared to alternative reference standards like MRI in the diagnosis of PF. The general advantages of US (e.g. cost efficient, ease of administration, non-invasive, limited contraindications) make it a superior diagnostic modality in the diagnosis of PF. US should be considered in rehabilitation clinics to effectively diagnose PF and to accurately monitor improvement in the disease process following rehabilitation interventions. Level of Evidence 1A PMID:27757279

Pulmonary symptoms and diagnoses are associated with HIV in the MACS and WIHS cohorts

PubMed Central

2014-01-01

Background Several lung diseases are increasingly recognized as comorbidities with HIV; however, few data exist related to the spectrum of respiratory symptoms, diagnostic testing, and diagnoses in the current HIV era. The objective of the study is to determine the impact of HIV on prevalence and incidence of respiratory disease in the current era of effective antiretroviral treatment. Methods A pulmonary-specific questionnaire was administered yearly for three years to participants in the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS). Adjusted prevalence ratios for respiratory symptoms, testing, or diagnoses and adjusted incidence rate ratios for diagnoses in HIV-infected compared to HIV-uninfected participants were determined. Risk factors for outcomes in HIV-infected individuals were modeled. Results Baseline pulmonary questionnaires were completed by 907 HIV-infected and 989 HIV-uninfected participants in the MACS cohort and by 1405 HIV-infected and 571 HIV-uninfected participants in the WIHS cohort. In MACS, dyspnea, cough, wheezing, sleep apnea, and incident chronic obstructive pulmonary disease (COPD) were more common in HIV-infected participants. In WIHS, wheezing and sleep apnea were more common in HIV-infected participants. Smoking (MACS and WIHS) and greater body mass index (WIHS) were associated with more respiratory symptoms and diagnoses. While sputum studies, bronchoscopies, and chest computed tomography scans were more likely to be performed in HIV-infected participants, pulmonary function tests were no more common in HIV-infected individuals. Respiratory symptoms in HIV-infected individuals were associated with history of pneumonia, cardiovascular disease, or use of HAART. A diagnosis of asthma or COPD was associated with previous pneumonia. Conclusions In these two cohorts, HIV is an independent risk factor for several respiratory symptoms and pulmonary diseases including COPD and sleep apnea. Despite a higher

[Clinical analysis of 138 multiple primary cancers diagnosed of digestive system malignant tumor initially].

PubMed

Lyu, J M; Xiong, H C; Wu, B; Zhou, X Q; Hu, J

2018-02-23

Objective: To study the clinical characteristics, strategy of treatment and prognosis of multiple primary cancers(MPC) diagnosed of digestive system malignant tumor firstly. Methods: From January, 2000 to December, 2015, the clinical, follow-up and prognostic data of 138 MPC patients diagnosed of digestive system malignant tumor firstly were retrospectively analyzed. Results: 138 cases were found in 10 580 cases with malignant tumors, and the incidence was 1.30%. There were 129 cases of duplex primary cancers, 8 cases of triple primary cancers and 1 case of quintuple primary cancers. The repetitive primary cancer was occurred in digestive system (61cases, 44.2%) most frequently, with the next in respiratory system (46 cases, 33.3%). 52.2% (72 cases) suffered second primary cancer in 2 years after first primary cancer diagnosed, and 75.4% (104 cases) in 5 years. The median overall survival in patients with all cancer lesions radically treated was 168 months, better than any other treatment (68 months, P <0.05). Conclusions: The second primary cancers of MPC cases initially diagnosed of digestive system malignant tumor most frequently occurred in the digestive system and respiratory system. More concern should be attracted in follow-up, especially in the first 5 years. The key to improve patient' prognosis was radical treatment to every primary cancer.

Lung adenocarcinoma with intraoperatively diagnosed pleural seeding: Is main tumor resection beneficial for prognosis?

PubMed

Li, Chi; Kuo, Shuenn-Wen; Hsu, Hsao-Hsun; Lin, Mong-Wei; Chen, Jin-Shing

2018-03-01

To evaluate whether main tumor resection improves survival compared with pleural biopsy alone in patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. Forty-three patients with lung adenocarcinoma with pleural seeding diagnosed unexpectedly during surgery performed between January 2006 and December 2014 were included in this retrospective study using a prospectively collected lung cancer database. Each surgeon decided whether to perform main tumor resection or pleural biopsy alone. Main tumor and visible pleural nodule resection was performed in 30 patients (tumor resection group). The remaining 13 patients underwent pleural nodule biopsy alone (open-close group). The clinical T stage was higher in the open-close group than in the tumor resection group (P = .02). The tumor resection group had longer operative times compared with the open-close group (mean, 141.8 vs 80.3 minutes). There were no other statistically significant differences in perioperative parameters. The surgical method was the sole statistically significant prognostic factor. Patients in the tumor resection group had better progression-free survival (3-year survival: 44.5% vs 0%; P = .009) and overall survival (3-year survival: 82.9% vs 38.5%; P = .013) than did the open-close group. There was no significant survival difference between sublobar resection and lobectomy for the main tumor resection. Our study demonstrated improved progression-free and overall survival after main tumor and visible pleural nodule resection in patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. Further randomized trials are needed to define the role of main tumor resection in these patients. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Trends in HIV diagnoses and testing among U.S. adolescents and young adults.

PubMed

Hall, H Irene; Walker, Frances; Shah, Daxa; Belle, Eboni

2012-01-01

The Centers for Disease Control and Prevention recommends routine HIV screening in health care settings. Using national surveillance data, we assessed trends in HIV diagnoses and testing frequency in youth aged 13-24 diagnosed with HIV in 2005-2008. Diagnosis rates increased among black (17.0% per year), Hispanic (13.5%), and white males (8.8%), with increases driven by men who have sex with men (MSM). A higher percentage of white males and MSM had previously been tested than their counterparts. No increases in diagnoses or differences in testing were observed among females. Intensified interventions are needed to reduce HIV infections and racial/ethnic disparities.

Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction.

PubMed

Arshad, Q; Roberts, R E; Ahmad, H; Lobo, R; Patel, M; Ham, T; Sharp, D J; Seemungal, B M

2017-04-01

We hypothesised that chronic vestibular symptoms (CVS) of imbalance and dizziness post-traumatic head injury (THI) may relate to: (i) the occurrence of multiple simultaneous vestibular diagnoses including both peripheral and central vestibular dysfunction in individual patients increasing the chance of missed diagnoses and suboptimal treatment; (ii) an impaired response to vestibular rehabilitation since the central mechanisms that mediate rehabilitation related brain plasticity may themselves be disrupted. We report the results of a retrospective analysis of both the comprehensive clinical and vestibular laboratory testing of 20 consecutive THI patients with prominent and persisting vestibular symptoms still present at least 6months post THI. Individual THI patients typically had multiple vestibular diagnoses and unique to this group of vestibular patients, often displayed both peripheral and central vestibular dysfunction. Despite expert neuro-otological management, at two years 20% of patients still had persisting vestibular symptoms. In summary, chronic vestibular dysfunction in THI could relate to: (i) the presence of multiple vestibular diagnoses, increasing the risk of 'missed' vestibular diagnoses leading to persisting symptoms; (ii) the impact of brain trauma which may impair brain plasticity mediated repair mechanisms. Apart from alerting physicians to the potential for multiple vestibular diagnoses in THI, future work to identify the specific deficits in brain function mediating poor recovery from post-THI vestibular dysfunction could provide the rationale for developing new therapy for head injury patients whose vestibular symptoms are resistant to treatment. Copyright © 2017. Published by Elsevier B.V.

PET/CT in a Patient Diagnosed With Dandy-Walker Syndrome.

PubMed

Infante, Jose R; Garcia, Lucia; Rayo, Juan I; Serrano, Justo; Dominguez, Maria L; Moreno, Manuel

2016-01-01

The Dandy-Walker syndrome (DWS) is a rare congenital posterior fossa malformation characterized by aplasia or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and enlargement of the posterior fossa. We present a 52-year-old Caucasian man diagnosed with gastrointestinal stromal tumor and submitted to 18F-FDG PET/CT as a staging procedure. The patient was previously diagnosed with DWS in brain CT scan. PET/CT images revealed an ametabolic large cyst in the posterior fossa and hypoplasia of cerebellar vermis. The case is presented with the aim to show the appearance of this syndrome on PET/CT study.

Mortality Among Veterans with Transgender-Related Diagnoses in the Veterans Health Administration, FY2000-2009.

PubMed

Blosnich, John R; Brown, George R; Wojcio, Sybil; Jones, Kenneth T; Bossarte, Robert M

2014-12-01

The aims of this project were to document all-cause and suicide mortality among Veteran Healthcare Administration (VHA) utilizers with The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis consistent with transgender status. The study population consisted of VHA patients identified as having any one of four diagnosis codes indicating transgender status (n=5,117) gathered from the VA National Patient Care Database. Mortality data were gathered from the National Death Index from 2000-2009 for 1,277 veterans with transgender-related ICD-9-CM diagnoses. The remaining 3,840 were not searched because they had VHA utilization after 2009 (indicating they were alive). Person-time at risk (person-years) for crude rates were calculated based on the time from an individual's index diagnosis to either death or the end of FY 2009. Causes of death were categorized using ICD-10 code groups. Approximately 9.3% (n=309) veterans with transgender-related ICD-9-CM diagnoses died across the study period. Although diseases of the circulatory system and neoplasms were the first and second leading causes of death, respectively, the other ranked causes of mortality differed somewhat from patterns for the US during the same time span. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses across the 10-year period was approximately 82/100,000 person-years, which approximated the crude suicide death rates for other serious mental illness in VHA (e.g., depression, schizophrenia). The average age of suicide decedents was 49.4 years. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses is higher than in the general population, and they may be dying by suicide at younger ages than their veteran peers without transgender-related ICD-9-CM diagnoses. Future research, such as age-adjusted rates or accounting for psychiatric co-morbidities, will help to better clarify if the all-cause and suicide

[Prevalence of previously diagnosed diabetes mellitus in Mexico.

PubMed

Rojas-Martínez, Rosalba; Basto-Abreu, Ana; Aguilar-Salinas, Carlos A; Zárate-Rojas, Emiliano; Villalpando, Salvador; Barrientos-Gutiérrez, Tonatiuh

2018-01-01

To compare the prevalence of previously diagnosed diabetes in 2016 with previous national surveys and to describe treatment and its complications. Mexico's national surveys Ensa 2000, Ensanut 2006, 2012 and 2016 were used. For 2016, logistic regression models and measures of central tendency and dispersion were obtained. The prevalence of previously diagnosed diabetes in 2016 was 9.4%. The increase of 2.2% relative to 2012 was not significant and only observed in patients older than 60 years. While preventive measures have increased, the access to medical treatment and lifestyle has not changed. The treatment has been modified, with an increase in insulin and decrease in hypoglycaemic agents. Population aging, lack of screening actions and the increase in diabetes complications will lead to an increase on the burden of disease. Policy measures targeting primary and secondary prevention of diabetes are crucial.

Newly Diagnosed Breast Cancer: Comparison of Contrast-enhanced Spectral Mammography and Breast MR Imaging in the Evaluation of Extent of Disease.

PubMed

Lee-Felker, Stephanie A; Tekchandani, Leena; Thomas, Mariam; Gupta, Esha; Andrews-Tang, Denise; Roth, Antoinette; Sayre, James; Rahbar, Guita

2017-11-01

Purpose To compare the diagnostic performances of contrast material-enhanced spectral mammography and breast magnetic resonance (MR) imaging in the detection of index and secondary cancers in women with newly diagnosed breast cancer by using histologic or imaging follow-up as the standard of reference. Materials and Methods This institutional review board-approved, HIPAA-compliant, retrospective study included 52 women who underwent breast MR imaging and contrast-enhanced spectral mammography for newly diagnosed unilateral breast cancer between March 2014 and October 2015. Of those 52 patients, 46 were referred for contrast-enhanced spectral mammography and targeted ultrasonography because they had additional suspicious lesions at MR imaging. In six of the 52 patients, breast cancer had been diagnosed at an outside institution. These patients were referred for contrast-enhanced spectral mammography and targeted US as part of diagnostic imaging. Images from contrast-enhanced spectral mammography were analyzed by two fellowship-trained breast imagers with 2.5 years of experience with contrast-enhanced spectral mammography. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated for both imaging modalities and compared by using the Bennett statistic. Results Fifty-two women with 120 breast lesions were included for analysis (mean age, 50 years; range, 29-73 years). Contrast-enhanced spectral mammography had similar sensitivity to MR imaging (94% [66 of 70 lesions] vs 99% [69 of 70 lesions]), a significantly higher PPV than MR imaging (93% [66 of 71 lesions] vs 60% [69 of 115 lesions]), and fewer false-positive findings than MR imaging (five vs 45) (P < .001 for all results). In addition, contrast-enhanced spectral mammography depicted 11 of the 11 secondary cancers (100%) and MR imaging depicted 10 (91%). Conclusion Contrast-enhanced spectral mammography is potentially as sensitive as MR imaging in the evaluation of

Quadruple cancer including Bowen's disease after arsenic injections 40 years earlier: report of a case.

PubMed

Murata, K; Iwazawa, T; Takayama, T; Yamashita, K; Okagawa, K

1994-01-01

This report describes the successful treatment of quadruple cancer including Bowen's disease in a 71-year-old man who had been given injections of salvarsan, an arsenic compound, for syphilis more than 40 years earlier. Resection of a skin lesion on his chest subsequently confirmed a diagnosis of Bowen's disease, 3 years after which he was operated on for concurrent gastric cancer and sigmoid colon cancer. A fourth cancer was discovered on his left vocal cord 2 weeks after this operation; it was resected 2 years later. A discussion of multiple malignant neoplasms and the possible relationship between arsenic and cancer is presented following this case report.

Training clinicians treating HIV to diagnose cytomegalovirus retinitis.

PubMed

Heiden, David; Tun, NiNi; Maningding, Ernest; Heiden, Matthew; Rose-Nussbaumer, Jennifer; Chan, Khin Nyein; Khizniak, Tamara; Yakubenko, Alexandra; Lewallen, Susan; Keenan, Jeremy D; Saranchuk, Peter

2014-12-01

Acquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed. We developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation. Workshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease. Clinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data. Skills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries.

[Gnathostomiasis caused by Gnathostoma spinigerum etiologically diagnosed upon extraction of the worm from the skin].

PubMed

Sakamoto, Mitsuo; Sato, Fumiya; Mizuno, Yasutaka; Komatsuzaki, Makoto; Yoshikawa, Koji; Yoshida, Masaki; Shiba, Kohya; Onodera, Shoichi; Hosoya, Tatsuo; Kumagai, Masahiro

2004-05-01

We report a patient with gnathostomiasis in whom a specific diagnosis of Gnathostoma spinigerum infestation was made morphologically upon removal of the worm. A 47-Year-old Japanese male on a business trip to Vietnam ate fried frog with a Vietnamese friend in January 2002, the friend was diagnosed with gnathostomiasis in June 2002. The patient noted swelling of the right leg with migration to the right arm, prompting him to our hospital in February 2003. Hematologic examination showed eosinophilia, and specific anti-gnathostome antibody was detected by a dot enzyme-linked immunosorbent assay (Dot ELISA) in the serum. He was diagnosed as gnathostomiasis, and was given albendazole 400 mg b.i.d. On day 11 of therapy the patient removed a larval worm from the right palmar lesion by pinching with his nails. The worm was identified as G. spinigerum based on morphologic characteristics including number of hooklets on its head-bulb. When gnathostomiasis is suspected, albendazole should be administered before incision of the skin lesion.

Coping strategies among patients with newly diagnosed amyotrophic lateral sclerosis.

PubMed

Jakobsson Larsson, Birgitta; Nordin, Karin; Askmark, Håkan; Nygren, Ingela

2014-11-01

To prospectively identify different coping strategies among newly diagnosed amyotrophic lateral sclerosis patients and whether they change over time and to determine whether physical function, psychological well-being, age and gender correlated with the use of different coping strategies. Amyotrophic lateral sclerosis is a fatal disease with impact on both physical function and psychological well-being. Different coping strategies are used to manage symptoms and disease progression, but knowledge about coping in newly diagnosed amyotrophic lateral sclerosis patients is scarce. This was a prospective study with a longitudinal and descriptive design. A total of 33 patients were included and evaluation was made at two time points, one to three months and six months after diagnosis. Patients were asked to complete the Motor Neuron Disease Coping Scale and the Hospital Anxiety and Depression Scale. Physical function was estimated using the revised Amyotrophic Lateral Sclerosis Functional Rating Scale. The most commonly used strategies were support and independence. Avoidance/venting and information seeking were seldom used at both time points. The use of information seeking decreased between the two time points. Men did not differ from women, but patients ≤64 years used positive action more often than older patients. Amyotrophic Lateral Sclerosis Functional Rating Scale was positively correlated with positive action at time point 1, but not at time point 2. Patients' psychological well-being was correlated with the use of different coping strategies. Support and independence were the most used coping strategies, and the use of different strategies changed over time. Psychological well-being was correlated with different coping strategies in newly diagnosed amyotrophic lateral sclerosis patients. The knowledge about coping strategies in early stage of the disease may help the nurses to improve and develop the care and support for these patients. © 2014 John Wiley

Nursing diagnoses of newborns with sepsis in a Neonatal Intensive Care Unit

PubMed Central

Santos, Ana Paula de Souza; da Silva, Maria de Lourdes Costa; de Souza, Nilba Lima; Mota, Gabriela Miranda; de França, Débora Feitosa

2014-01-01

Objectives to elaborate the Nursing Diagnoses of newborns with sepsis in a neonatal intensive care unit and characterize the profile of the neonates and their mothers. Method a cross-sectional and quantitative study, with a sample of 41 neonates. A physical examination and consultation of the hospital records were undertaken, using an instrument. The elaboration of the Nursing Diagnoses followed a process of diagnostic inference and was based on the North American Nursing Diagnosis Association 2012-2014. Results the mothers were around 25 years old, had a low average number of pre-natal consultations, and various complications during the pregnancy; and the newborns were predominantly premature and with very low birth weights. Five Nursing Diagnoses predominated, and all the neonates presented Risk of Shock and Risk of fluid volume imbalance. Conclusion the Nursing Diagnoses of the neonates with sepsis can guide the formulating of specific assistential plans. The study contributes to the generation of new knowledge and found various relationships between the Nursing Diagnoses and the variables selected in the characterization of the neonates, which deserve to be elucidated in greater detail based on further research on the issue. PMID:26107833

Cytomegalovirus retinitis diagnosed after completion of chemotherapy for acute lymphoblastic leukemia in an adolescent.

PubMed

Han, Seung Beom; Lee, Jin Hee; Lee, Jae Wook; Chung, Nack-Gyun; Cho, Bin; Kang, Jin Han; Kim, Hack-Ki; Lee, Jin Hae; Lee, Won Ki

2015-03-01

Although cytomegalovirus (CMV) retinitis is usually diagnosed in allogeneic hematopoietic cell transplantation recipients among patients with hematologic and oncologic disease, it can also occur in acute leukemia patients who have not received hematopoietic cell transplantation. However, CMV retinitis diagnosed after completion of chemotherapy for acute leukemia has not previously been reported. A 17-year-old boy was diagnosed with CMV retinitis 3 months after completion of chemotherapy for acute lymphoblastic leukemia, and his retinitis was assumed to be caused by a delayed immune reconstitution after chemotherapy. The patient was treated with intravenous and intravitreous ganciclovir therapy, and subsequently underwent surgery for retinal detachment.

A nationwide epidemiological study of newly diagnosed spine metastasis in the adult Korean population.

PubMed

Sohn, Seil; Kim, Jinhee; Chung, Chun Kee; Lee, Na Rae; Park, Eunjung; Chang, Ung-Kyu; Sohn, Moon Jun; Kim, Sung Hwan

2016-08-01

Metastatic spine tumor has become clinically important because of the availability of improved diagnostic tools and increases in survival periods in cancer patients. In spite of this interest, the burden of metastatic spine tumor on the general population has not been extensively reported. The aim of this 2009-2011 nationwide study of adult Koreans was to describe characteristics, medical use, and survival rate of patients with newly diagnosed metastatic spine tumors according to the primary tumor. This is a retrospective cohort study. A national health insurance database was used to identify a cohort of patients with newly diagnosed metastatic spine tumors. This study aimed to analyze characteristics, medical use, and survival rate of patients with newly diagnosed metastatic spine tumors according to the primary tumor. Data for patients with metastatic spine tumors were extracted from the Korean Health Insurance Review and Assessment Service database. Data included patient age, sex, health insurance type, comorbidities, medical cost, and hospital stay duration. Hospital stay duration and medical costs per person during 1 calendar year were evaluated. In addition, survival rates of patients with metastatic spine tumor according to primary tumor sites were evaluated. The incidence rate of spine metastasis increased with age, year of diagnosis, and the number of comorbidities (p≤.0001). The 6 most prevalent primary tumor sites were lung, liver and biliary tract, breast, colon, stomach, and prostate. Of patients with the 6 most prevalent primary tumors, total average annual medical costs, including inpatient and outpatient services, ranged from 12,734USD (prostate origin) to 15,556 USD (lung origin). Of patients with the 6 most prevalent primary tumors, total average annual hospital stay duration, including inpatient and outpatient services, ranged from 70.8 days (stomach origin) to 78.7 days (colon origin). Median overall survival duration in patients with

Esophageal achalasia compressing left atrium diagnosed by echocardiography using a liquid containing carbon dioxide in a 21-year-old woman with Turner syndrome.

PubMed

Park, Man Je; Song, Bong Gun; Lee, Hyoun Soo; Kim, Ki Hoon; Ok, Hea Sung; Kim, Byeong Ki; Park, Yong Hwan; Kang, Gu Hyun; Chun, Woo Jung; Oh, Ju Hyeon

2012-01-01

Extrinsic compression of the left atrium by the esophagus, the stomach, or both is an uncommon but important cause of hemodynamic compromise. Achalasia is a motility disorder characterized by impaired relaxation of the lower esophageal sphincter and dilatation of the distal two thirds of the esophagus. Echocardiographic imaging after oral ingestion of liquid containing carbon dioxide allowed for differentiation between a compressive vascular structure and the esophagus. We report a rare case of esophageal achalasia compressing the left atrium diagnosed by echocardiography using a liquid containing carbon dioxide in a 21-year-old woman with Turner syndrome. Copyright © 2012 Elsevier Inc. All rights reserved.

A Characterization of t/s-Diagnosability and Sequential t-Diagnosability in Designs

DTIC Science & Technology

1990-10-01

41 151 161 171 181 r91 1101 REFERENCES K.-Y. Chwa and S. L. Hakimi, “On fault identification in diagnosable systems,” ZEEE Tmns. Comput...1975, pp. 167-170. S. L. Hakimi and A. T. Amin, “Characterization of the connection assignment problem of diagnosable systems,” ZEEE Trans. Comput...S. Karunanithi and A. D. Friedman, “Analysis of digital systems using a new measure of system diagnosis,” ZEEE Trans. Cornput., vol. C- A

Preceding diagnoses to young adult bipolar disorder and schizophrenia in a nationwide study

PubMed Central

2013-01-01

Background The aim of this comparative study was to investigate the type and frequency of diagnoses preceding adult bipolar disorder (BD) and schizophrenia (SZ). Methods A follow-back study of all preceding diagnoses in all patients aged 21–34 years with a primary, first time diagnosis of BD (N = 784) or SZ (N = 1667) in 2008 to 2010. Data were taken from the Danish Psychiatric Central Research Register (DPCRR) including ICD-10 and ICD-8 diagnoses. Results The numbers of patients with any preceding diagnoses amounted to 69.3% in BD and 76.6% in SZ with affective disorders (excluding BD) being the most frequent preceding diagnosis (46.6 vs. 28.0%), followed by psychoses (PSY) other than SZ (14.2 vs. 41.5%, p < .001), and substance use disorders (SUD) (16.1 vs. 26.9%, p < .001). Reactions to severe stress were equally frequent in both samples (26.3 vs. 26.6%) as were personality disorders (21.8 vs. 22.4%) and ADHD (4.2 vs. 3.5%), whereas rates of conduct disorders (1.7 vs. 3.1%) were rather low in both samples. Very few of the preceding diagnoses had their onset in childhood and adolescence. Overall patients with SZ had a minor but statistically significant earlier onset of any psychiatric disorder compared to BD (mean age: 23.3 vs. 22.5, p < .001). Regression analyses indicated that BD was associated with an increased risk of having experienced preceding affective disorders and ADHD, while SZ was associated with an increased risk of preceding substance use disorders, psychosis, anxiety disorders, and personality disorders. Conclusions Specific developmental trajectories of preceding disorders were delineated for BD and SZ with affective disorders being more specific for BD and both SUD and PSY more specific to SZ. There are different patterns of vulnerability in terms of preceding diagnosis in young adults with BD and SZ. PMID:24359146

Sexuality Among Middle-Aged and Older Adults With Diagnosed and Undiagnosed Diabetes

PubMed Central

Lindau, Stacy Tessler; Tang, Hui; Gomero, Ada; Vable, Anusha; Huang, Elbert S.; Drum, Melinda L.; Qato, Dima M.; Chin, Marshall H.

2010-01-01

OBJECTIVE To describe sexual activity, behavior, and problems among middle-age and older adults by diabetes status. RESEARCH DESIGN AND METHODS This was a substudy of 1,993 community-residing adults, aged 57–85 years, from a cross-sectional, nationally representative sample (N = 3,005). In-home interviews, observed medications, and A1C were used to stratify by diagnosed diabetes, undiagnosed diabetes, or no diabetes. Logistic regression was used to model associations between diabetes conditions and sexual characteristics, separately by gender. RESULTS The survey response rate was 75.5%. More than 60% of partnered individuals with diagnosed diabetes were sexually active. Women with diagnosed diabetes were less likely than men with diagnosed diabetes (adjusted odds ratio 0.28 [95% CI 0.16–0.49]) and other women (0.63 [0.45–0.87]) to be sexually active. Partnered sexual behaviors did not differ by gender or diabetes status. The prevalence of orgasm problems was similarly elevated among men with diagnosed and undiagnosed diabetes compared with that for other men, but erectile difficulties were elevated only among men with diagnosed diabetes (2.51 [1.53 to 4.14]). Women with undiagnosed diabetes were less likely to have discussed sex with a physician (11%) than women with diagnosed diabetes (19%) and men with undiagnosed (28%) or diagnosed (47%) diabetes. CONCLUSIONS Many middle-age and older adults with diabetes are sexually active and engage in sexual behaviors similarly to individuals without diabetes. Women with diabetes were more likely than men to cease all sexual activity. Older women with diabetes are as likely to have sexual problems but are significantly less likely than men to discuss them. PMID:20802158

[Microalbuminuria in pediatric patients diagnosed with hemolytic uremic syndrome].

PubMed

Cubillos C, María Paz; Del Salas, Paulina; Zambrano, Pedro O

2015-01-01

Hemolytic uremic syndrome (HUS) is characterized by the presence of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney failure. It is the leading cause of acute kidney failure in children under 3 years of age. A variable number of patients develop proteinuria, hypertension, and chronic renal failure. To evaluate the renal involvement in pediatric patients diagnosed with HUS using the microalbumin/creatinine ratio. Descriptive concurrent cohort study that analyzed the presence of microalbuminuria in patients diagnosed with HUS between January 2001 and March 2012, who evolved without hypertension and normal renal function (clearance greater than 90ml/min using Schwartz formula). Demographic factors (age, sex), clinical presentation at time of diagnosis, use of antibiotics prior to admission, and need for renal replacement therapy were evaluated. Of the 24 patients studied, 54% were male. The mean age at diagnosis was two years. Peritoneal dialysis was required in 45%, and 33% developed persistent microalbuminuria. Antiproteinuric treatment was introduce in 4 patients, with good response. The mean follow-up was 6 years (range 6 months to 11 years). The serum creatinine returned to normal in all patients during follow up. The percentage of persistent microalbuminuria found in patients with a previous diagnosis of HUS was similar in our group to that described in the literature. Antiproteinuric treatment could delay kidney damage, but further multicenter prospective studies are necessary. Copyright © 2015. Publicado por Elsevier España, S.L.U.

[Psychometric properties of Q-DIO, an instrument to measure the quality of documented nursing diagnoses, interventions and outcomes].

PubMed

Müller-Staub, Maria; Lunney, Margaret; Lavin, Mary Ann; Needham, Ian; Odenbreit, Matthias; van Achterberg, Theo

2010-04-01

The instrument Q-DIO was developed in the years 2005 till 2006 to measure the quality of documented nursing diagnoses, interventions, and nursing sensitive patient outcomes. Testing psychometric properties of the Q-DIO (Quality of nursing Diagnoses, Interventions and Outcomes.) was the study aim. Instrument testing included internal consistency, test-retest reliability, interrater reliability, item analyses, and an assessment of the objectivity. To render variation in scores, a random strata sample of 60 nursing documentations was drawn. The strata represented 30 nursing documentations with and 30 without application of theory based, standardised nursing language. Internal consistency of the subscale nursing diagnoses as process showed Cronbach's Alpha 0.83 [0.78, 0.88]; nursing diagnoses as product 0.98 [0.94, 0.99]; nursing interventions 0.90 [0.85, 0.94]; and nursing-sensitive patient outcomes 0.99 [0.95, 0.99]. With Cohen's Kappa of 0.95, the intrarater reliability was good. The interrater reliability showed a Kappa of 0.94 [0.90, 0.96]. Item analyses confirmed the fulfilment of criteria for degree of difficulty and discriminative validity of the items. In this study, Q-DIO has shown to be a reliable instrument. It allows measuring the documented quality of nursing diagnoses, interventions and outcomes with and without implementation of theory based, standardised nursing languages. Studies for further testing of Q-DIO in other settings are recommended. The results implicitly support the use of nursing classifications such as NANDA, NIC and NOC.

A Competition between Care Teams Improved Recording of Diagnoses in Primary Dental Care: A Longitudinal Follow-Up Study.

PubMed

Kallio, Jouko; Kauppila, Timo; Suominen, Lasse; Heikkinen, Anna Maria

2017-01-01

A playful competition was launched in a primary dental health care system to improve the recording of diagnoses into an electronic patient chart system and to study what diagnoses were used in primary dental care. This was a longitudinal follow-up study with public sector primary dental care practices in a Finnish city. A one-year-lasting playful competition between the dental care teams was launched and the monthly percentage of dentists' visits with recorded diagnosis before, during, and after the intervention was recorded. The assessed diagnoses were recorded with the International Classification of Diseases (ICD-10). Before the competition, the level of diagnosis recordings was practically zero. At the end of this intervention, about 25% of the visits had a recorded diagnosis. Two years after the competition, this percentage was 35% without any additional measures. The most frequent diagnoses were dental caries (K02, 38.6%), other diseases of hard tissues of teeth (K03, 14.8%), and diseases of pulp and periapical tissues (K04, 11.4%). Commitment to the idea that recording of diagnoses was beneficial improved the recording of dental diagnoses. However, the diagnoses obtained did not accurately reflect the reputed prevalence of oral diseases in the Finnish population.

Blood component use in a sub-Saharan African country: results of a 4-year evaluation of diagnoses associated with transfusion orders in Namibia.

PubMed

Pitman, John P; Wilkinson, Robert; Liu, Yang; von Finckenstein, Bjorn; Smit Sibinga, Cees Th; Lowrance, David W; Marfin, Anthony A; Postma, Maarten J; Mataranyika, Mary; Basavaraju, Sridhar V

2015-01-01

National blood use patterns in sub-Saharan Africa are poorly described. Although malaria and maternal hemorrhage remain important drivers of blood demand across Africa, economic growth and changes in malaria, HIV/AIDS, and noncommunicable disease epidemiology may contribute to changes in blood demand. We evaluated indications for blood use in Namibia, a country in southern Africa, using a nationally representative sample and discuss implications for the region. Clinical and demographic data related to the issuance of blood component units in Namibia were reviewed for a 4-year period (August 1, 2007-July 31, 2011). Variables included blood component type, recipient age and sex, and diagnosis. Diagnoses reported by clinicians were reclassified into International Statistical Classification of Diseases, 10th Revision categories. Multiple imputation methods were used to complete a data set missing age, sex or diagnosis data. Descriptive analyses were conducted to describe indications for transfusions and use of red blood cells (RBCs), platelets, and plasma. A total of 39,313 records accounting for 91,207 blood component units were analyzed. The median age of Namibian transfusion recipients was 45 years (SD, ±19). A total of 78,660 RBC units were issued in Namibia during the study period. Red blood cells transfused for "unspecified anemia" accounted for the single largest category of blood issued (24,798 units). Of the overall total, 38.9% were for diseases of the blood and blood-forming organs (D50-D89). Infectious disease (A00-B99), pregnancy (O00-O99), and gastrointestinal (K20-K93) accounted for 14.8%, 11.1%, and 6.1% of RBC units issued, respectively. Although a specific diagnosis of malaria accounted for only 2.7% of pediatric transfusions, an unknown number of additional transfusions for malaria may have been categorized by requesting physicians as unspecified anemia and counted under diseases of blood forming organs. During the study period, 9751 units of fresh

The health diagnoses of homeless adolescents: a systematic review of the literature.

PubMed

Medlow, Sharon; Klineberg, Emily; Steinbeck, Kate

2014-07-01

Homelessness during adolescence impacts negatively upon young people's physical and mental wellbeing. To be effective, programs aimed at addressing the health needs of this population must include knowledge of both the presenting and underlying acute and chronic conditions that characterise this high risk group of youth. We undertook a systematic review of the international literature for studies that used validated instruments and techniques to diagnose prevalence rates of physical and mental health disorders in homeless adolescents. Twenty-one studies fulfilled the selection criteria. Of these, nine studies examined mental health diagnoses including depression, post-traumatic stress disorder, anxiety and substance abuse disorders. With one exception, the remaining twelve studies all related to sexually transmitted infections. Homeless adolescents are diagnosed with widely varying rates of mental health disorders and high rates of sexually transmitted infection. Other likely chronic and acute physical conditions appear to be neglected in the published research. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Mental disorder diagnoses among children and adolescents who use antipsychotic drugs.

PubMed

Nesvåg, Ragnar; Hartz, Ingeborg; Bramness, Jørgen G; Hjellvik, Vidar; Handal, Marte; Skurtveit, Svetlana

2016-09-01

Antipsychotic drugs are used increasingly by children and adolescents and there is concern about off-label use. We aimed to study which substances, and for which mental disorder diagnoses, antipsychotic drugs were prescribed to 0-18-year-old boys and girls in Norway. Linked data from the national health registry for prescription drugs in 2010 and mental disorder diagnoses in 2008-2012 were used to study the prevalence of antipsychotic drug use, the type of antipsychotic drug substances used, mental disorder diagnoses in users and distribution of drugs per diagnostic category across gender. In total, 0.18% of Norwegian children and adolescents were prescribed antipsychotic drugs during 2010, of which there were more boys (0.23%) than girls (0.13%). Risperidone was the most frequently used substance among boys (57.4%) and girls (32.3%), followed by aripiprazole (19.4%) in boys and quetiapine (27.4%) in girls. The most common mental disorder diagnoses among male users were hyperkinetic (49.9%) and autism spectrum disorder (27.1%), while anxiety disorders (41.5%) and depressive illness (33.6%) were most common among female users. A schizophrenia-like psychosis diagnosis was given to 11.1% of the male and 18.2% of the female users. A hyperkinetic disorder was diagnosed among 56.9% and 52.4% of the male risperidone and aripiprazole users, respectively. Among female quetiapine users, 57.1% were diagnosed with anxiety disorders and 52.4% with depressive illness. These results demonstrate that children and adolescents who use antipsychotic drugs are predominantly diagnosed with non-psychotic mental disorders such as hyperkinetic disorder among boys and anxiety disorder or depressive illness among girls. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer.

PubMed

Wolf, Michael S; Knight, Sara J; Lyons, E Allison; Durazo-Arvizu, Ramón; Pickard, Simon A; Arseven, Adnan; Arozullah, Ahsan; Colella, Kathleen; Ray, Paul; Bennett, Charles L

2006-07-01

Among men with newly diagnosed prostate cancer, prostate-specific antigen (PSA) levels are higher and the cancer stage more advanced for African Americans than for whites. An earlier study found that after adjustment for literacy, race was no longer a significant predictor of advanced stage at presentation. We investigated whether, after adjusting for literacy, race was a significant independent predictor of greater PSA levels among men with newly diagnosed prostate cancer. Consecutive patients with newly diagnosed prostate cancer from four outpatient care facilities in Chicago were interviewed and given a literacy assessment (n = 308). The PSA level at diagnosis was obtained from the medical charts. Logistic regression models were used to identify predictors of high PSA levels (greater than 20 ng/mL) at presentation. African-American men were three times more likely to have low literacy skills (sixth grade or less: 22.9% versus 7.1%; P <0.001) than were white men. In turn, men with low literacy skills were more than twice as likely to have a PSA level greater than 20 ng/mL at diagnosis (33.3% versus 13.5%; P = 0.009). On multivariate analyses, significant predictors of high PSA levels included low literacy (adjusted odds ratio 2.5, 95% confidence interval 1.5 to 4.2) and older age (age 65 to 74 years, adjusted odds ratio 2.6, 95% confidence interval 2.1 to 3.1 versus older than 74 years, adjusted odds ratio 3.4, 95% confidence interval 1.8 to 6.6), but not African-American race. In the current era in which PSA testing is common, low literacy may be an important and potentially overlooked factor associated with higher PSA levels at prostate cancer diagnosis among African-American and white men.

Urine flow acceleration is superior to Qmax in diagnosing BOO in patients with BPH.

PubMed

Wen, Jian-guo; Cui, Lin-gang; Li, Yi-dong; Shang, Xiao-ping; Zhu, Wen; Zhang, Rui-li; Meng, Qing-jun; Zhang, Sheng-jun

2013-08-01

We performed a retrospective, case-control study to evaluate whether the urine flow acceleration (UFA, mL/s(2)) is superior to maximum uroflow (Qmax, mL/s) in diagnosing bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH). In this study, a total of 50 men with BPH (age: 58±12.5 years) and 50 controls (age: 59±13.0 years) were included. A pressure-flow study was used to determine the presence of BOO according to the recommendations of Incontinence Control Society (ICS). The results showed that the UFA and Qmax in BPH group were much lower than those in the control group [(2.05±0.85) vs. (4.60±1.25) mL/s(2) and (8.50±1.05) vs. (13.00±3.35) mL/s] (P<0.001). According to the criteria (UFA<2.05 mL/s(2), Qmax<10 mL/s), the sensitivity and specificity of UFA vs. Qmax in diagnosing BOO were 88%, 75% vs. 81%, 63%. UFA vs. Omax, when compared with the results of P-Q chart (the kappa values in corresponding analysis), was 0.55 vs. 0.35. The prostate volume, post void residual and detrusor pressure at Qmax between the two groups were 28.6±9.8 vs. 24.2±7.6 mL, 60.4±1.4 vs. 21.3±2.5 mL and 56.6±8.3 vs. 21.7±6.1 cmH2O, respectively (P<0.05). It was concluded that the UFA is a useful urodynamic parameter, and is superior to Qmax in diagnosing BOO in patients with BPH.

Training clinicians treating HIV to diagnose cytomegalovirus retinitis

PubMed Central

Tun, NiNi; Maningding, Ernest; Heiden, Matthew; Rose-Nussbaumer, Jennifer; Chan, Khin Nyein; Khizniak, Tamara; Yakubenko, Alexandra; Lewallen, Susan; Keenan, Jeremy D; Saranchuk, Peter

2014-01-01

Abstract Problem Acquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed. Approach We developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation. Local setting Workshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease. Relevant changes Clinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data. Lessons learnt Skills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries. PMID:25552774

Pathologically Diagnosed Placenta Accreta and Hemorrhagic Morbidity in a Subsequent Pregnancy.

PubMed

Roeca, Cassandra; Little, Sarah E; Carusi, Daniela A

2017-02-01

To identify the relationship between pathologically diagnosed placenta accreta and risk of major morbidity in a subsequent pregnancy. We conducted a retrospective cohort study of patients with pathologically diagnosed placenta accreta in an index pregnancy who returned with a subsequent pregnancy at our academic center from 2007 to 2015. Subsequent delivery outcomes included minor, major, or no morbidity. Minor morbidity included estimated blood loss 500-1,500 cc for vaginal and 1,000-1,500 cc for cesarean delivery, transfusion of one to three units of red cells, and minor surgical procedures. Major morbidity included estimated blood loss greater than 1,500 cc, transfusion of greater than three units of red cells, uterine artery embolization, unplanned laparotomy, or hysterectomy. Three hundred thirty-nine patients with pathologically diagnosed accreta did not undergo hysterectomy, and 39 (11.5%) of these returned for subsequent delivery. Of these, 14 (36%) had accretas that had been identified clinically in the index pregnancy. Twenty-one (54%) experienced morbidity in the index pregnancy, 16 of these (76%) minor and five (24%) major. Of patients without morbidity in the first pregnancy, none experienced major morbidity in a subsequent pregnancy, whereas 6 of 21 (29%) with any index morbidity had a subsequent major morbid outcome (P=.02). Of those with a morbid index delivery, 25% had either a clinical or pathologic accreta diagnosis at follow-up compared with none of those who index accreta was nonmorbid (P=.05). Risk for major hemorrhagic morbidity after a prior pathologically diagnosed accreta depends on the clinical context. Preparation for major blood loss is indicated after any prior pregnancy complicated by hemorrhage or treatment of retained placenta with a pathologic accreta.

Sociodemographic Study of Danish Individuals Diagnosed with Transsexualism

PubMed Central

Simonsen, Rikke; Hald, Gert Martin; Giraldi, Annamaria; Kristensen, Ellids

2015-01-01

Introduction Male-to-female (MtF) and female-to-male (FtM) individuals with transsexualism (International Classification of Diseases-10) may differ in core clinical and sociodemographic variables such as age, sexual orientation, marriage and parenthood, school, educational level, and employment. Assessing and understanding the implication of such differences may be a key to developing appropriate and effective treatment and intervention strategies for this group. However, research in the area remains sparse and is often on small populations, making the generalization of results from current studies on individuals diagnosed with transsexualism difficult. Aims (i) To describe and assess key sociodemographic and treatment-related differences between MtF and FtM individuals in a Danish population of individuals diagnosed with transsexualism; (ii) to assess possible implications of such difference, if any, for clinical treatment initiatives for individuals diagnosed with transsexualism. Methods Follow-up of 108 individuals who had permission to undergo sex reassignment surgery (SRS, meaning castration and genital plastic surgery) over a 30-year period from 1978 to 2008 through the Gender Identity Unit in Copenhagen, Denmark. The individuals were identified through Social Security numbers. Clinical and sociodemographic data from medical records were collected. Results The sex ratio was 1.16:1 (MtF : FtM). Mean age at first referral was 26.9 (standard deviation [SD] 8.8) years for FtM and 30.2 (SD 9.7) for MtF individuals. Compared with MtF, FtM had a significantly lower onset age (before 12 years of age) and lower age when permission for SRS was granted. Further, FtM individuals were significantly more often gynephilic (sexually attracted to females) during research period and less likely to start self-initiated hormonal sex reassignment (SR) (treatment with cross-sex hormones). The MtF and FtM groups did not differ in years of school, educational level, employment

Sociodemographic Study of Danish Individuals Diagnosed with Transsexualism.

PubMed

Simonsen, Rikke; Hald, Gert Martin; Giraldi, Annamaria; Kristensen, Ellids

2015-06-01

Male-to-female (MtF) and female-to-male (FtM) individuals with transsexualism (International Classification of Diseases-10) may differ in core clinical and sociodemographic variables such as age, sexual orientation, marriage and parenthood, school, educational level, and employment. Assessing and understanding the implication of such differences may be a key to developing appropriate and effective treatment and intervention strategies for this group. However, research in the area remains sparse and is often on small populations, making the generalization of results from current studies on individuals diagnosed with transsexualism difficult. (i) To describe and assess key sociodemographic and treatment-related differences between MtF and FtM individuals in a Danish population of individuals diagnosed with transsexualism; (ii) to assess possible implications of such difference, if any, for clinical treatment initiatives for individuals diagnosed with transsexualism. Follow-up of 108 individuals who had permission to undergo sex reassignment surgery (SRS, meaning castration and genital plastic surgery) over a 30-year period from 1978 to 2008 through the Gender Identity Unit in Copenhagen, Denmark. The individuals were identified through Social Security numbers. Clinical and sociodemographic data from medical records were collected. The sex ratio was 1.16:1 (MtF : FtM). Mean age at first referral was 26.9 (standard deviation [SD] 8.8) years for FtM and 30.2 (SD 9.7) for MtF individuals. Compared with MtF, FtM had a significantly lower onset age (before 12 years of age) and lower age when permission for SRS was granted. Further, FtM individuals were significantly more often gynephilic (sexually attracted to females) during research period and less likely to start self-initiated hormonal sex reassignment (SR) (treatment with cross-sex hormones). The MtF and FtM groups did not differ in years of school, educational level, employment, or engagement in marriage and

[Prevalence of osteoporosis and osteopenia among women over fifty years of age, from the city of Durango, Mexico, diagnosed by forearm-DEXA].

PubMed

González-Arellano, J Andrés; Milla-Villeda, Reynaldo H; Hernández-Vera, Gloria E; Cisneros-Pérez, Vicente; Lazalde, Brissia; Reyes, Miguel R

2007-01-01

To estimate the prevalence of osteopenia and osteporosis using distal forearm dual-energy X-ray absorptiometry among a random sample of women of 50 years or older living in the city of Durango, Mexico. 258 women participated in a cross-sectional study fielded at the Osteoporosis Clinic of Durango. Bone mineral density was determined by dual-energy X-ray absorptiometry. Scanning was performed on the distal third of the dominant forearm. Diagnosis of osteopenia and osteoporosis was based on the WHO criteria. Osteoporosis was diagnosed in 13.65% (95%CI: 9.6-18.5) and osteopenia in 30.12% (95% CI: 24.5-36.2) of participants. Mean age, weight, height and body mass index were 65 years, 60.5 kg, 147.8 cm and 28.3 kg/m2 respectively. Osteoporosis and osteopenia were a common diagnosis given the mean age of our sample. These results can be extrapolated to the general population thereby suggesting the need for preventive measures to decrease disease prevalence, especially considering the increase in life expectancy.

The Prevalence of Barrett Esophagus Diagnosed in the Second Endoscopy

PubMed Central

Suna, Nuretdin; Parlak, Erkan; Kuzu, Ufuk Baris; Yildiz, Hakan; Koksal, Aydin Seref; Oztas, Erkin; Sirtas, Zeliha; Yuksel, Mahmut; Aydinli, Onur; Bilge, Zulfikar; Taskiran, Ismail; Sasmaz, Nurgul

2016-01-01

Abstract At present, we do not know the exact prevalence of Barrett esophagus (BE) developing later in patients without BE in their first endoscopic screening. The purpose of this study was to determine the prevalence of BE on the second endoscopic examination of patients who had no BE in their first endoscopic examination. The data of the patients older than 18 years who had undergone upper gastrointestinal system endoscopy more than once at the endoscopy unit of our clinic during the last 6 years were retrospectively analyzed. During the last 6 years, 44,936 patients had undergone at least one endoscopic examination. Among these patients, 2701 patients who had more than one endoscopic screening were included in the study. Of the patients, 1276 (47.3%) were females and 1425 (52.7%) were males, with an average age of 54.9 (18–94) years. BE was diagnosed in 18 (0.66%) of the patients who had no BE in the initial endoscopic examination. The patients with BE had reflux symptoms in their medical history and in both endoscopies, they revealed a higher prevalence of lower esophageal sphincter laxity, hiatal hernia, and reflux esophagitis when compared to patients without BE (P < 0.001). Our study showed that in patients receiving no diagnosis of BE on their first endoscopic examination performed for any reason, the prevalence of BE on their second endoscopy within 6 years was very low (0.66%). PMID:27057907

Influence of medications and diagnoses on fall risk in psychiatric inpatients.

PubMed

Lavsa, Stacey M; Fabian, Tanya J; Saul, Melissa I; Corman, Shelby L; Coley, Kim C

2010-08-01

The influence of medications and diagnoses on fall risk in psychiatric inpatients was evaluated. In this retrospective case-control study, psychiatric inpatients age 18 years or older with a documented fall that was reported served as study cases. These patients were matched to control patients from the same hospital (1:1) by admission year, sex, and age. Psychiatric diagnoses evaluated included major depressive disorder, schizophrenia or schizoaffective disorder, bipolar disorder, Alzheimer's disease and dementia, anxiety or neurosis, delirium, personality disorder, and obsessive-compulsive disorder. Medications assessed as independent variables were conventional antipsychotics, atypical antipsychotics, selective serotonin-reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, monoamine oxidase inhibitors, lithium, anticonvulsants, benzodiazepines, nonbenzodiazepine sleep aids, Alzheimer's disease medications, antihistamines, antiarrhythmics, antihypertensives, benign prostatic hyperplasia medications, oral hypoglycemic agents, histamine H(2)-receptor blockers, laxatives and stool softeners, muscle relaxants, nonsteroidal antiinflammatory drugs, opioids, Parkinson's disease medications, and overactive bladder medications. Univariate logistic regression models were developed for each risk factor to determine its impact on fall risk. A total of 774 patient cases were matched with controls. Most falls occurred on the second day of hospitalization. Medications associated with a higher risk of falls were alpha-blockers, nonbenzodiazepine sleep aids, benzodiazepines, H(2)-blockers, lithium, antipsychotics, atypical antidepressants, anticonvulsants, and laxatives and stool softeners. Patients with a diagnosis of dementia and Alzheimer's disease also had an increased risk of falling. Alpha-blockers, nonbenzodiazepine sleep aids, benzodiazepines, H(2)-blockers, lithium, atypical antipsychotics, atypical antidepressants, anticonvulsants and mood

Clinicopathological review of immunohistochemically defined Kikuchi-Fujimoto disease-including some interesting cases.

PubMed

Seong, Gil Myeong; Kim, Jo-Heon; Lim, Gil Chai; Kim, Jinseok

2012-10-01

Kikuchi-Fujimoto Disease (KFD) is a benign, self-limited disease characterized by tender regional lymphadenopathy with fever. KFD remains a poorly defined disease, and no clear diagnostic criteria are available. Here, we assess the clinical, laboratory, and histopathologic findings of KFD cases and report two unusual cases. Forty KFD patients that underwent lymph node (LN) biopsy and diagnosed by immunohistochemical staining, from January 2003 to November 2010, were enrolled in this retrospective study. The patients had a mean age of 29.3 years, and 29 (72.5 %) were women. Affected LNs were mainly located unilaterally in the cervical area. Mean LN size was 15.3 mm. Twenty-eight (70 %) patients had LN tenderness, and 25 (62.5 %) patients had fever. Leukopenia was observed in 18 of 35 evaluable patients. C-reactive protein and erythrocyte sedimentation rate were elevated in most patients. Anti-nuclear antibody was positive in four of 19 evaluable patients, but all had been diagnosed with concurrent systemic lupus erythematosus. Histologically, the 40 cases were classified into three types, that is, as proliferative (37.5 %), necrotizing (55.0 %), or xanthomatous (7.5 %). Interesting cases: Case 1 was a 35-year-old female with KFD and uveitis, retinal vasculitis, and superior sagittal sinus thrombosis. Case 2 was a 47-year-old male with KFD and bone marrow involvement and presented with severe bicytopenia. Although KFD is an uncommon self-limited benign disorder, it must be included in the differential diagnosis of lymphadenopathy with fever and cytopenia. It is important that the clinical features of KFD be understood to reach a correct diagnosis.

Outcomes of a 4-year program with higher education and employment goals for individuals diagnosed with mental illness.

PubMed

Schindler, Victoria P; Sauerwald, Camille

2013-01-01

This study examined outcomes of the first four years (2005-2009) of the Bridge Program, an occupational therapy (OT) program that incorporates principles of supported education and supported employment. This program was developed to assist individuals with mental illness to achieve higher education and employment goals. Forty-eight adult participants with various mental health diagnoses. A quantitative one-group pretest-posttest survey design and posttest qualitative focus groups were used. Participants enrolled in higher education increased from 7 to 11 (pretest=15%; posttest=23%), participants employed increased from 5 to 19 (pretest=10%; posttest=40%), and the combined category of higher education/employment increased from 12 to 30 (pretest=25%; posttest=63%) Statistical significance was achieved from pre to posttest in the employment sample (p<0.000), and in the combined sample of higher education/employment (p< 0.000), but was not achieved in the higher education sample from pre to posttest (p=0.125). Quantitative and qualitative results support that an OT program incorporating principles of supported education and employment can assist individuals with mental illness to achieve higher education and employment goals. Results also outlined items participants found to be supports and barriers to achieving goals.

Diagnosing Flu

MedlinePlus

... your symptoms and their clinical judgment. Will my health care provider test me for flu if I have flu-like ... with flu symptoms are not tested because the test results usually do not change how you are treated. Your health care provider may diagnose you with flu based on ...

A prospective cohort study of disability pension due to mental diagnoses: the importance of health factors and behaviors

PubMed Central

2013-01-01

Background Previous studies have found associations between various health factors and behaviors and mental disorders. However, knowledge of such associations with disability pension (DP) due to mental diagnoses is scarce. Moreover, the influence of familial factors (genetics and family background) on the associations are mainly unknown. The aim of the study was to investigate associations between health factors and behaviors and future DP due to mental diagnoses in a twin cohort, accounting for familial confounding. Methods A prospective cohort study of Swedish twins (N=28 613), including survey data and national register data on DP and other background factors was conducted. Cox proportional hazards regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the whole twin cohort, and for discordant twin pairs. Results During follow-up 1998–2008 (median 10 years), 2.2% of the cohort was granted a DP with a mental diagnosis. In the fully adjusted analyses of the whole cohort, the associations of poor or moderate self-rated health (SRH), under- or overweight, former or current tobacco use, or being an abstainer from alcohol were significantly associated with risk of DP due to mental diagnoses. Analyses of discordant twin pairs confirmed all these associations, except for current tobacco use, being independent from familial confounding. Exclusion of individuals with current or previous depression or anxiety at baseline did not influence the associations found. Conclusions Poor or moderate SRH, under- or overweight, former tobacco use or being an abstainer from alcohol seem to be strong direct predictors of DP due to mental diagnoses, independently of several confounders of this study, including familial factors. PMID:23816331

Renal cell carcinoma with inferior vena cava thrombus extending to the right atrium diagnosed during pregnancy.

PubMed

Ghanney, Efe C; Cavallo, Jaime A; Levin, Matthew A; Reddy, Ramachandra; Bander, Jeffrey; Mella, Maria; Stone, Joanne; Schwartz, Myron; Haines, Kenneth; Gidwani, Umesh; Mehrazin, Reza

2017-12-01

Only one case of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus diagnosed and treated during pregnancy has been reported in the literature. In that report, the tumor thrombus extended to the infrahepatic IVC (level II tumor thrombus). In the present case, a 37-year-old woman with lupus anticoagulant antibodies was diagnosed with RCC and IVC tumor thrombus extending to the right atrium (level IV tumor thrombus) at 24 weeks of pregnancy. The fetus was safely delivered by cesarean section at 30 weeks of gestation. At 4 days later, an open right radical nephrectomy and IVC and right atrial thrombectomy were performed on cardiopulmonary bypass (CPB) once the patient's hemodynamic status had been optimized. Fetal and maternal concerns included the risk of a thromboembolic event (due to increased hypercoagulability from pregnancy, active malignancy, and lupus anticoagulant), intraoperative hemorrhage risk (due to extensive venous collaterals and anticoagulation), and fetal morbidity and mortality (due to fetal lung immaturity). Standardized guidelines for treatment of RCC with or without IVC tumor thrombus during pregnancy are unavailable due to the infrequency of such cases. Treatment decisions are therefore individualized and this case report may inform the management of future patients diagnosed with RCC with level IV tumor thrombus during pregnancy.

Hope in newly diagnosed cancer patients.

PubMed

Duggleby, Wendy; Ghosh, Sunita; Cooper, Dan; Dwernychuk, Lynne

2013-11-01

Hope is important to cancer patients as it helps them deal with their diagnosis. Little is known about hope in newly diagnosed cancer patients. Based on the Transcending Possibilities conceptual model of hope, the purpose of this study was to examine the relationship of hope with pain, energy, and psychological and demographic characteristics in newly diagnosed adult oncology outpatients. Data from 310 New Patient Assessment Forms from cancer outpatients' health records were collected. Health records from the first six months of 2009 were reviewed and data were collected on hope, energy, pain, depression, anxiety, feeling overwhelmed, and demographic variables. A generalized linear modeling approach was used to study the relationship of hope scores with these variables. Hypothesized variables and variables that were significant at the P = 0.01 level from the univariate analysis were entered into the multivariate model, with hope scores as the dependent variable. Hope scores were significantly negatively related to age (P = 0.02). More specifically, oncology patients who were 65 years of age or older had significantly less hope than those under the age of 65 years (P = 0.01). Gender (P = 0.009) also was a significant factor, with men having higher hope scores than women. No other variables were significant. Older adults comprise the majority of persons in Canada with cancer. The lower hope scores found in this age group compared with their younger counterparts underscore the importance of further research. This study provides a foundation for future research in this important area for oncology patients. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Evaluation of patients diagnosed with fascioliasis: A six-year experience at a university hospital in Turkey.

PubMed

Boşnak, Vuslat Keçik; Karaoğlan, İlkay; Sahin, Handan Haydaroğlu; Namiduru, Mustafa; Pehlivan, Mustafa; Okan, Vahap; Mete, Ayşe Özlem

2016-04-28

In this study, clinical, laboratory, radiological, and serological examinations of fascioliasis patients were analyzed, and data with a significant impact on differential diagnosis were evaluated. Clinical, radiological, and laboratory findings and treatment responses of a total of 22 fascioliasis patients, treated between October 2009 and September 2014, were evaluated. Nineteen patients were diagnosed with fascioliasis at the invasive phase and three patients at the chronic phase. Patients were followed up for clinical, laboratory, and radiology findings for a period of three months to one year after treatment. The most frequent complaints in both groups were abdominal pain, and the most common physical examination finding was epigastric tenderness. In the performed examination, an eosinophil elevation in whole blood count was detected in 19 patients (100%) in the hepatic phase, and in 2 patients (66.6%) in the biliary phase. The results of the Fasciola hepatica indirect hemagglutination assay (IHA) test ordered in the diagnosis were positive in all patients. Treatment with 10 mg/kg/day triclabendazole for two consecutive days was effective. Live parasites were extracted from patients in the biliary phase with endoscopic retrograde cholangiopancreatography. In the follow-ups, remission in IHA titer and clinical and radiological improvement was achieved in all patients. If hypereosinophilia is detected by peripheral smear in patients who are admitted with complaints such as abdominal pain, weakness, nausea, myalgia, and weight loss, radiological evaluation and serological tests should be performed and fascioliasis should be considered in the differential diagnosis.

One-year persistence of individual gait patterns identified in a follow-up study - A call for individualised diagnose and therapy.

PubMed

Horst, F; Mildner, M; Schöllhorn, W I

2017-10-01

Although a hunch about the individuality of human movements generally exists, differences in gait patterns between individuals are often neglected. To date, only a few studies distinguished individual gait patterns in terms of uniqueness and emphasised the relevance of individualised diagnoses and therapy. However, small sample sizes have been a limitation on identifying subjects based on gait patterns, and little is known about the permanence of subject-specific characteristics over time. The purpose of this study was (1) to prove the uniqueness of individual gait patterns within a larger sample and (2) to prove the long-term permanence of individual gait patterns. A sample of 128 healthy participants each walked a distance of 10m barefoot 10 times. Two force plates recorded the ground reaction forces during a double step at a self-selected walking speed. A subsample of 46 participants repeated this procedure after a period of 7-16 months. The application of support vector machines resulted in classification rates of 99.8% (1278 out of 1280) and 99.4% (914 out of 920) for the initial subject-classification and the subsample follow-up-classification, respectively. The results showed that gait patterns based on time-continuous ground reaction forces were unique to an individual and could be differentiated from those of other individuals. Support vector machines classified gait patterns to the corresponding individual almost error-free. Hence, human gait is not only different between individuals but also exhibits unique individual characteristics that are persistent over years. Our findings provide evidence for the individual nature of human walking and emphasise the need to evaluate individualised clinical approaches for diagnoses and therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

[Seasonal distribution of diagnoses and DRG in trauma surgery].

PubMed

von Dercks, N; Melz, R; Hepp, P; Marquass, B; Theopold, J; Josten, C

2011-11-01

Recording DRGs and diagnoses allows their distribution to be shown over the course of the year. Thus, cumulative seasonal occurrence of diseases can be detected. From 2004 to 2010 we recorded 22,293 main diagnoses and DRGs at the clinic for trauma surgery. Injuries with the same localization and treatment were pooled. The most frequent injuries were concussion, followed by spinal and lower leg fractures. They showed no seasonal accumulation. Proximal fractures of the humerus occurred approx. 25% more often in winter and ankle fractures about 33% more frequently. The diagnosis of osteoarthritis of the knee is twice as high in the winter as in the summer. It has to be verified if logistic conclusions of these results can lead to more efficiency in a hospital. The underlying analysis is applicable for every hospital and poses a valid controlling tool.

Prospective Study of Posttraumatic Stress Disorder in Parents of Children with Newly Diagnosed Type 1 Diabetes.

ERIC Educational Resources Information Center

Landolt, Markus A.; Vollrath, Margarete; Laimbacher, Joseph; Gnehm, Hanspeter E.; Sennhauser, Felix H.

2005-01-01

Objective: To determine the prevalence, course, and predictors of posttraumatic stress disorder (PTSD) in mothers and fathers of children with newly diagnosed type 1 diabetes. Method: Forty-nine mothers and 48 fathers of 52 children (response rate 65%) with newly diagnosed diabetes (age 6.5-15 years) were assessed at 6 weeks, 6 months, and 12…

Assessment of the Relationship between Diagnoses of ASD and Caregiver Symptom Endorsement in Adults Diagnosed with Intellectual Disability

ERIC Educational Resources Information Center

Matson, Johnny L.; Hess, Julie A.; Mahan, Sara; Fodstad, Jill C.; Neal, Daniene

2013-01-01

Individuals diagnosed with an intellectual disability (ID) share overlapping traits with those diagnosed with both ID and an Autism Spectrum Disorder (ASD). Therefore, the purpose of this study was to determine if caregivers' reports of symptoms of ASD are of value (i.e., when comparing them to clinical diagnoses of ASD) and to determine which…

Results for patients with sarcoma not otherwise specified and other diagnoses than Ewing sarcoma treated according to the Euro-EWING 99 trial.

PubMed

Frank, Judith Amalie; Ranft, Andreas; Paulussen, Michael; Juergens, Heribert; Kruseova, Jarmila; Bauer, Sebastian; Niggli, Felix; Reichardt, Peter; Dirksen, Uta

2017-10-01

Euro-EWING 99 trial of the European Ewing tumor Working Initiative of National Groups (EE99) was an international phase III study in patients with Ewing sarcoma. The German Society of Pediatric Oncology and Hematology (GPOH) data center registered and followed patients with other diagnoses than Ewing sarcoma who were treated according to the EE99 protocol in an additional non-Ewing database. Data of 27 patients with other diagnoses than Ewing sarcoma treated according to the EE99 protocol were analyzed. Patients had miscellaneous histologic diagnoses, the majority were diagnosed with sarcoma not otherwise specified (NOS) arising in bone and soft tissue (63%). The median age at diagnosis was 16.9 years (range 4.5-41.4). Localized disease was diagnosed in 61.5% of the patients and 38.5% had distant metastases at time of primary diagnosis. The median follow-up time was 3.7 years (range 0.5-9.5). Patients with localized disease showed a 3-year event-free survival (EFS) of 68%, compared to 3-year EFS of 20% in patients with metastases (P = 0.042). Three-year EFS for patients with sarcoma NOS was 52%, patients with localized and metastatic disease showed 3-year EFS of 66 and 20%, respectively. EFS in patients with other diagnoses than Ewing sarcoma treated according to EE99 was significantly higher in patients with localized than metastatic disease. Sarcomas of soft tissue and bone that cannot be classified to current diagnostic categories constitute a therapeutic challenge. © 2017 Wiley Periodicals, Inc.

Prostate cancer incidence and newly diagnosed patient profile in Spain in 2010.

PubMed

Cózar, José M; Miñana, Bernardino; Gómez-Veiga, Francisco; Rodríguez-Antolín, Alfredo; Villavicencio, Humberto; Cantalapiedra, Arancha; Pedrosa, Emilio

2012-12-01

What's known on the subject? and What does the study add? Prostate cancer (PCa) accounts for 12% of newly diagnosed cases of cancer in Europe. It is one of the most frequently diagnosed tumours in the developed world. Since the introduction of prostate specific antigen as a test for early detection of PCa, the rate of diagnosis has increased significantly and specific mortality has reduced in most western countries. Most of the data on the incidence of PCa are obtained from population-based cancer registries which frequently do not cover the whole population. This first national hospital-based PCa registry aims not only to estimate the incidence of the disease but to ascertain the clinical profile of newly diagnosed PCa patients, a useful tool for evaluating the impact of the disease and its socio-health management. • To estimate the 2010 incidence of prostate cancer (PCa) in Spain. • To describe the clinical profile of newly diagnosed cases using a nationwide hospital-based registry. • This was a national epidemiological observational study in 25 public hospitals with a specific reference population according to the National Health System. • Sociodemographic and clinical variables of all newly diagnosed, histopathologically confirmed PCa cases were collected in 2010, in the area of influence of each centre. Cases diagnosed in private practice were not collected (estimated nearly 10% in Spain). • Data monitoring was external to guarantee quality and homogeneity. • The age-standardized PCa incidence was determined based on the age distribution of the European standard population. • In all, 4087 new cases of PCa were diagnosed for a reference population of 4933940 men (21.8% of the Spanish male population). • The estimated age-standardized PCa incidence was 70.75 cases per 100000 men. • Mean age at diagnosis was 69 years; 11.6% of patients presented with tumour-related symptoms and 39.5% with LUTS. Median PSA was 8 ng/mL. Gleason score was ≤ 6 in

Some Clinical Diagnoses are More Reliable than Others

DTIC Science & Technology

1989-03-29

a more reliable measure than diagnostic type (e.g., schizophrenia versus personality disor- der). Diagnostic type, in turn, was a more reliable...measure than diagnostic subtype (e.g., chronic catatonic schizophrenic). And, certain diagnostic types aild Suutypes wete consistently more reliable across...diagnoses included thie following diagnostic typesý: 1) organic psychoses, 2) schizophrenia , 3) affective psychoses, 4) pala- 4 noia, 5) other

Office-based treatment and outcomes for febrile infants with clinically diagnosed bronchiolitis.

PubMed

Luginbuhl, Lynn M; Newman, Thomas B; Pantell, Robert H; Finch, Stacia A; Wasserman, Richard C

2008-11-01

The goals were to describe the (1) frequency of sepsis evaluation and empiric antibiotic treatment, (2) clinical predictors of management, and (3) serious bacterial illness frequency for febrile infants with clinically diagnosed bronchiolitis seen in office settings. The Pediatric Research in Office Settings network conducted a prospective cohort study of 3066 febrile infants (<3 months of age with temperatures >or=38 degrees C) in 219 practices in 44 states. We compared the frequency of sepsis evaluation, parenteral antibiotic treatment, and serious bacterial illness in infants with and without clinically diagnosed bronchiolitis. We identified predictors of sepsis evaluation and parenteral antibiotic treatment in infants with bronchiolitis by using logistic regression models. Practitioners were less likely to perform a complete sepsis evaluation, urine testing, and cerebrospinal fluid culture and to administer parenteral antibiotic treatment for infants with bronchiolitis, compared with those without bronchiolitis. Significant predictors of sepsis evaluation in infants with bronchiolitis included younger age, higher maximal temperature, and respiratory syncytial virus testing. Predictors of parenteral antibiotic use included initial ill appearance, age of <30 days, higher maximal temperature, and general signs of infant distress. Among infants with bronchiolitis (N = 218), none had serious bacterial illness and those with respiratory distress signs were less likely to receive parenteral antibiotic treatment. Diagnoses among 2848 febrile infants without bronchiolitis included bacterial meningitis (n = 14), bacteremia (n = 49), and urinary tract infection (n = 167). In office settings, serious bacterial illness in young febrile infants with clinically diagnosed bronchiolitis is uncommon. Limited testing for bacterial infections seems to be an appropriate management strategy.

Mental health among young adult survivors of childhood cancer and their siblings including posttraumatic growth.

PubMed

Kamibeppu, Kiyoko; Sato, Iori; Honda, Misato; Ozono, Shuichi; Sakamoto, Naoko; Iwai, Tsuyako; Okamura, Jun; Asami, Keiko; Maeda, Naoko; Inada, Hiroko; Kakee, Naoko; Horibe, Keizo; Ishida, Yasushi

2010-12-01

Few studies have addressed the mental health status of young adult childhood cancer survivors (CCSs) and their siblings (SIBs). This paper focuses on depression, anxiety, posttraumatic stress symptoms (PTSS), and posttraumatic growth (PTG) among Japanese CCSs and their SIBs. Adolescent and young adult CCSs (n=185), in remission for more than 1 year, their SIBs (n=72), and general controls (CONTs) (n=1,000) completed anonymous self-report questionnaires for depression, anxiety, PTSS, and PTG. The physicians in charge also completed an anonymous disease/treatment data sheet. CCSs were approximately 8 years old at diagnosis and approximately 23 years old at the time of the survey. Their diagnoses included leukemia (57%), lymphoma (12%), and solid tumors (30%). Thirty-eight percent underwent surgery and 25% received stem cell transplantation. No significant differences were found between CCSs and CONTs in terms of depression and anxiety. CCSs had significantly more PTSS and had remarkably greater PTG compared to CONTs. Although no significant differences were found between SIBs and CONTs regarding depression, anxiety, or PTSS, female SIBs exhibited greater PTG compared to female CONTs. To empower CCSs, they should be evaluated periodically regarding PTSS and PTG and should be provided appropriate care and feedback. The fact that the mental health status of young adult SIBs was similar to CONTs at 15 years after their siblings' diagnoses may help reassure parents who worry about mental health among the siblings of an affected child during and after his/her treatment.

Disseminated mucormycosis in an adolescent with newly diagnosed diabetes mellitus.

PubMed

McCrory, Michael C; Moore, Blake A; Nakagawa, Thomas A; Givner, Laurence B; Jason, Donald R; Palavecino, Elizabeth L; Ajizian, Samuel J

2014-10-01

We report a 16-year-old, previously healthy female who presented with disseminated mucormycosis leading to multiorgan failure and death with newly diagnosed type 1 diabetes mellitus and ketoacidosis. We review previous reported cases of mucormycosis in children with diabetes to demonstrate that this uncommon invasive infection may cause significant morbidity and mortality in this population.

Prevalence and factors associated with hyperuricaemia in newly diagnosed and untreated hypertensives in a sub-Saharan African setting.

PubMed

Kamdem, Félicité; Doualla, Marie-Solange; Kemta Lekpa, Fernando; Temfack, Elvis; Ngo Nouga, Yvette; Sontsa Donfack, Olivier; Dzudie, Anastase; Kingue, Samuel

2016-10-01

Few studies have evaluated the link between hyperuricaemia and cardiovascular disease in sub-Saharan Africa. To assess the prevalence of and factors associated with hyperuricaemia among newly diagnosed treatment-naïve hypertensive patients in sub-Saharan Africa. We performed a community-based cross-sectional study from January to December 2012 in Douala, Cameroon (Central Africa). We enrolled newly diagnosed treatment-naïve hypertensive patients, and excluded those with gout or a history of gout. Serum uric acid concentrations were measured by enzymatic colourimetric methods, and hyperuricaemia was defined as a serum uric acid concentration>70IU/mL. Fasting blood sugar concentrations, serum creatinine concentrations and lipid profiles were also measured. Logistic regression was used to study factors associated with hyperuricaemia. We included 839 newly diagnosed treatment-naïve hypertensive patients (427 women and 412 men; mean age 51±11 years; mean serum uric acid concentration 60.5±16.5IU/L). The prevalence of hyperuricaemia was 31.8% (95% confidence interval [CI] 28.7-34.9) and did not differ by sex (132 women vs. 135 men; P=0.56). Multivariable logistic regression identified age>55 years (adjusted odds ratio [AOR] 1.65, 95% CI 1.12-2.29), family history of hypertension (AOR 1.65, 95% CI 1.01-2.67), waist circumference>102cm in men or>88cm in women (AOR 1.60, 95% CI 1.12-2.29), low-density lipoprotein cholesterol>1g/L (AOR 1.33, 95% CI 0.97-1.82) and triglycerides>1.5g/L (AOR 1.63, 95% CI 1.01-2.65) as independently associated with hyperuricaemia. Hyperuricaemia is common among newly diagnosed treatment-naïve hypertensive patients in sub-Saharan Africa and is associated with some components of the metabolic syndrome. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A comprehensive iterative approach is highly effective in diagnosing individuals who are exome negative.

PubMed

Shashi, Vandana; Schoch, Kelly; Spillmann, Rebecca; Cope, Heidi; Tan, Queenie K-G; Walley, Nicole; Pena, Loren; McConkie-Rosell, Allyn; Jiang, Yong-Hui; Stong, Nicholas; Need, Anna C; Goldstein, David B

2018-06-15

Sixty to seventy-five percent of individuals with rare and undiagnosed phenotypes remain undiagnosed after exome sequencing (ES). With standard ES reanalysis resolving 10-15% of the ES negatives, further approaches are necessary to maximize diagnoses in these individuals. In 38 ES negative patients an individualized genomic-phenotypic approach was employed utilizing (1) phenotyping; (2) reanalyses of FASTQ files, with innovative bioinformatics; (3) targeted molecular testing; (4) genome sequencing (GS); and (5) conferring of clinical diagnoses when pathognomonic clinical findings occurred. Certain and highly likely diagnoses were made in 18/38 (47%) individuals, including identifying two new developmental disorders. The majority of diagnoses (>70%) were due to our bioinformatics, phenotyping, and targeted testing identifying variants that were undetected or not prioritized on prior ES. GS diagnosed 3/18 individuals with structural variants not amenable to ES. Additionally, tentative diagnoses were made in 3 (8%), and in 5 individuals (13%) candidate genes were identified. Overall, diagnoses/potential leads were identified in 26/38 (68%). Our comprehensive approach to ES negatives maximizes the ES and clinical data for both diagnoses and candidate gene identification, without GS in the majority. This iterative approach is cost-effective and is pertinent to the current conundrum of ES negatives.

Cognitive vulnerabilities and depression versus other psychopathology symptoms and diagnoses in early adolescence.

PubMed

Alloy, Lauren B; Black, Shimrit K; Young, Mathew E; Goldstein, Kim E; Shapero, Benjamin G; Stange, Jonathan P; Boccia, Angelo S; Matt, Lindsey M; Boland, Elaine M; Moore, Lauren C; Abramson, Lyn Y

2012-01-01

We examined the concurrent associations between multiple cognitive vulnerabilities to depression featured in hopelessness theory, Beck's theory, and response styles theory and depressive symptoms and diagnoses in a sample of early adolescents. We also examined the specificity of these cognitive vulnerabilities to depression versus anxiety and externalizing psychopathology, controlling for co-occurring symptoms and diagnoses. Male and female, Caucasian and African American, 12- to 13-year-old adolescents were assessed in a cross-sectional design. Cognitive vulnerabilities of hopelessness, inferential style, rumination, and self-referent information processing were assessed with self-reports and behavioral tasks. Symptoms and diagnoses of depressive, anxiety, and externalizing disorders were assessed with self-report questionnaires and diagnostic interviews. Hopelessness exhibited the greatest specificity to depressive symptoms and diagnoses, whereas negative inferential styles, rumination, and negative self-referent information processing were associated with both depressive and anxiety symptoms and diagnoses and, in some cases, with externalizing disorders. Consistent with cognitive theories of depression, hopelessness, negative inferential styles, rumination, and negative self-referent information processing were associated with depressive symptoms and diagnoses. However, with the exception of hopelessness, most of the remaining cognitive vulnerabilities were not specific to depression. With further maturation of our sample, these cognitive vulnerabilities may become more specific to depression as cognitive styles further develop and consolidate, the rates of depression increase, and individuals' presentations of psychopathology become more differentiated.

Burden among partner caregivers of patients diagnosed with localized prostate cancer within 1 year after diagnosis: an economic perspective.

PubMed

Li, Chunyu; Zeliadt, Steven B; Hall, Ingrid J; Smith, Judith Lee; Ekwueme, Donatus U; Moinpour, Carol M; Penson, David F; Thompson, Ian M; Keane, Thomas E; Ramsey, Scott D

2013-12-01

Informal care plays an important role in the overall care for people with cancer. This study estimates lost productivity and informal caregiving and associated costs among partner caregivers of localized prostate cancer patients within 1 year after diagnosis. We applied data from the Family and Cancer Therapy Selection study, a three-wave self-administered survey among patients diagnosed with localized prostate cancer and their partner caregivers in multiple clinics in the USA. Time spent was measured by the sum of working hours lost, informal caregiving hours performed, and hours spent on household chores. The national median income for women 55 years or older was used to calculate costs associated with the time spent using the opportunity cost method. Descriptive and bivariate analyses were conducted. The average working hours decreased from 14.0 h/week (SD = 17.6) to 10.9 h/week (SD = 15.9), without a significant change in responsibility/intensity at work. The mean annual time spent on informal caregiving and household chores was 65.9 h/year (SD = 172.4) and 76.2 h/year (SD = 193.3), respectively. The mean annual economic burden among partner caregivers was US$6,063 (range US$571-US$47,105) in 2009 dollars accounted for by a mean of 276.2 h (range 26-2,146) in the study sample. The time spent on informal caregiving and household chores varied by patient and caregiver characteristics. Pilot estimates on non-medical economic burden among partner caregivers (spouses) during the initial phase of the treatment provide important information for comprehensive estimation of disease burden and can be used in cost-effectiveness analyses of prostate cancer interventions.

Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001.

PubMed

Gallagher, Arlene M; Thomas, Janice M; Hamilton, William T; White, Peter D

2004-12-01

Little is known about whether the incidence of symptoms of fatigue presented in primary care, and the consequent diagnoses made, change over time. The UK General Practice Research Database was used to investigate the annual incidence of both fatigue symptoms and diagnoses recorded in UK primary care from 1990 to 2001. The overall incidence of all fatigue diagnoses decreased from 87 per 100 000 patients in 1990 to 49 in 2001, a reduction of 44%, while postviral fatigue syndromes decreased from 81% of all fatigue diagnoses in 1990 to 60% in 2001. Chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) together increased from 9% to 26% of all fatigue diagnoses. The incidence of fibromyalgia increased from less than 1 per 100 000 to 35 per 100 000. In contrast, there was no consistent change in the incidence of all recorded symptoms of fatigue, with an average of 1503 per 100 000, equivalent to 1.5% per year. CFS/ME and fibromyalgia were rarely diagnosed in children and were uncommon in the elderly. All symptoms and diagnoses were more common in females than in males. The overall incidence of fatigue diagnoses in general has fallen, but the incidence rates of the specific diagnoses of CFS/ME and fibromyalgia have risen, against a background of little change in symptom reporting. This is likely to reflect fashions in diagnostic labelling rather than true changes in incidence.

Lung ultrasound in diagnosing pneumonia in childhood: a systematic review and meta-analysis.

PubMed

Orso, Daniele; Ban, Alessio; Guglielmo, Nicola

2018-06-21

Pneumonia is the third leading cause of death in children under 5 years of age worldwide. In pediatrics, both the accuracy and safety of diagnostic tools are important. Lung ultrasound (LUS) could be a safe diagnostic tool for this reason. We searched in the literature for diagnostic studies about LUS to predict pneumonia in pediatric patients using systematic review and meta-analysis. The Medline, CINAHL, Cochrane Library, Embase, SPORTDiscus, ScienceDirect, and Web of Science databases from inception to September 2017 were searched. All studies that evaluated the diagnostic accuracy of LUS in determining the presence of pneumonia in patients under 18 years of age were included. 1042 articles were found by systematic search. 76 articles were assessed for eligibility. Seventeen studies were included in the systematic review. We included 2612 pooled cases. The age of the pooled sample population ranged from 0 to about 21 years old. Summary sensitivity, specificity, and AUC were 0.94 (IQR: 0.89-0.97), 0.93 (IQR: 0.86-0.98), and 0.98 (IQR: 0.94-0.99), respectively. No agreement on reference standard was detected: nine studies used chest X-rays, while four studies considered the clinical diagnosis. Only one study used computed tomography. LUS seems to be a promise tool for diagnosing pneumonia in children. However, the high heterogeneity found across the individual studies, and the absence of a reliable reference standard, make the finding questionable. More methodologically rigorous studies are needed.

Diagnosing night sweats.

PubMed

Viera, Anthon J; Bond, Michael M; Yates, Scott W

2003-03-01

Night sweats are a common outpatient complaint, yet literature on the subject is scarce. Tuberculosis and lymphoma are diseases in which night sweats are a dominant symptom, but these are infrequently found to be the cause of night sweats in modern practice. While these diseases remain important diagnostic considerations in patients with night sweats, other diagnoses to consider include human immunodeficiency virus, gastroesophageal reflux disease, obstructive sleep apnea, hyperthyroidism, hypoglycemia, and several less common diseases. Antihypertensives, antipyretics, other medications, and drugs of abuse such as alcohol and heroin may cause night sweats. Serious causes of night sweats can be excluded with a thorough history, physical examination, and directed laboratory and radiographic studies. If a history and physical do not reveal a possible diagnosis, physicians should consider a purified protein derivative, complete blood count, human immunodeficiency virus test, thyroid-stimulating hormone test, erythrocyte sedimentation rate evaluation, chest radiograph, and possibly chest and abdominal computed tomographic scans and bone marrow biopsy.

Diagnosing somatisation disorder (P75) in routine general practice using the International Classification of Primary Care.

PubMed

Schaefert, Rainer; Laux, Gunter; Kaufmann, Claudia; Schellberg, Dieter; Bölter, Regine; Szecsenyi, Joachim; Sauer, Nina; Herzog, Wolfgang; Kuehlein, Thomas

2010-09-01

(i) To analyze general practitioners' diagnosis of somatisation disorder (P75) using the International Classification of Primary Care (ICPC)-2-E in routine general practice. (ii) To validate the distinctiveness of the ICD-10 to ICPC-2 conversion rule which maps ICD-10 dissociative/conversion disorder (F44) as well as half of the somatoform categories (F45.0-2) to P75 and codes the other half of these disorders (F45.3-9), including autonomic organ dysfunctions and pain syndromes, as symptom diagnoses plus a psychosocial code in a multiaxial manner. Cross-sectional analysis of routine data from a German research database comprising the electronic patient records of 32 general practitioners from 22 practices. For each P75 patient, control subjects matched for age, gender, and practice were selected from the 2007 yearly contact group (YCG) without a P75 diagnosis using a propensity-score algorithm that resulted in eight controls per P75 patient. Of the 49,423 patients in the YCG, P75 was diagnosed in 0.6% (302) and F45.3-9 in 1.8% (883) of cases; overall, somatisation syndromes were diagnosed in 2.4% of patients. The P75 coding pattern coincided with typical characteristics of severe, persistent medically unexplained symptoms (MUS). F45.3-9 was found to indicate moderate MUS that otherwise showed little clinical difference from P75. Pain syndromes exhibited an unspecific coding pattern. Mild and moderate MUS were predominantly recorded as symptom diagnoses. Psychosocial codes were rarely documented. ICPC-2 P75 was mainly diagnosed in cases of severe MUS. Multiaxial coding appears to be too complicated for routine primary care. Instead of splitting P75 and F45.3-9 diagnoses, it is proposed that the whole MUS spectrum should be conceptualized as a continuum model comprising categorizations of uncomplicated (mild) and complicated (moderate and severe) courses. Psychosocial factors require more attention. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Regional and temporal variations in coding of hospital diagnoses referring to upper gastrointestinal and oesophageal bleeding in Germany.

PubMed

Langner, Ingo; Mikolajczyk, Rafael; Garbe, Edeltraut

2011-08-17

Health insurance claims data are increasingly used for health services research in Germany. Hospital diagnoses in these data are coded according to the International Classification of Diseases, German modification (ICD-10-GM). Due to the historical division into West and East Germany, different coding practices might persist in both former parts. Additionally, the introduction of Diagnosis Related Groups (DRGs) in Germany in 2003/2004 might have changed the coding. The aim of this study was to investigate regional and temporal variations in coding of hospitalisation diagnoses in Germany. We analysed hospitalisation diagnoses for oesophageal bleeding (OB) and upper gastrointestinal bleeding (UGIB) from the official German Hospital Statistics provided by the Federal Statistical Office. Bleeding diagnoses were classified as "specific" (origin of bleeding provided) or "unspecific" (origin of bleeding not provided) coding. We studied regional (former East versus West Germany) differences in incidence of hospitalisations with specific or unspecific coding for OB and UGIB and temporal variations between 2000 and 2005. For each year, incidence ratios of hospitalisations for former East versus West Germany were estimated with log-linear regression models adjusting for age, gender and population density. Significant differences in specific and unspecific coding between East and West Germany and over time were found for both, OB and UGIB hospitalisation diagnoses, respectively. For example in 2002, incidence ratios of hospitalisations for East versus West Germany were 1.24 (95% CI 1.16-1.32) for specific and 0.67 (95% CI 0.60-0.74) for unspecific OB diagnoses and 1.43 (95% CI 1.36-1.51) for specific and 0.83 (95% CI 0.80-0.87) for unspecific UGIB. Regional differences nearly disappeared and time trends were less marked when using combined specific and unspecific diagnoses of OB or UGIB, respectively. During the study period, there were substantial regional and temporal

How Are Obesity and Overweight Diagnosed?

MedlinePlus

... Share Facebook Twitter Pinterest Email Print How are obesity & overweight diagnosed? Using Body Mass Index The most ... and Blood Institute. (2012). How are overweight and obesity diagnosed? Retrieved August 8, 2012, from http://www. ...

Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer.

PubMed

Letourneau, Joseph M; Smith, James F; Ebbel, Erin E; Craig, Amaranta; Katz, Patricia P; Cedars, Marcelle I; Rosen, Mitchell P

2012-09-15

This study seeks to examine the relation between sociodemographic characteristics and the utilization of fertility preservation services in reproductive age women diagnosed with cancer. A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on demographic information and reproductive health history. Five cancer types were included: leukemia, Hodgkin disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Nine hundred eighteen women reported treatment with potential to affect fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant). Student t test, linear regression, and multivariate logistic regression were used where appropriate to determine the relation between sociodemographic characteristics and the odds of using fertility preservation services. Sixty-one percent of women were counseled on the risk of cancer treatment to fertility by the oncology team. Overall, 4% of women pursued fertility preservation. In multivariate analysis, women who had not attained a bachelor's degree (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.5-0.9) were less likely to be counseled. Trends also suggested possible disparities in access to fertility preservation with age older than 35 years (OR, 0.1; 95% CI, 0.0-1.4) or previous children (OR, 0.3; 95% CI, 0.1-1.1) at diagnosis. Disparities in access to fertility preservation based on ethnicity and sexual orientation were also observed. Sociodemographic health disparities likely affect access to fertility preservation services. Although awareness of fertility preservation has improved in the past decade, an unmet need remains for reproductive health counseling and fertility preservation in reproductive age women diagnosed with cancer. Copyright © 2012 American Cancer Society.

A classical Ehlers-Danlos syndrome family with incomplete presentation diagnosed by molecular testing.

PubMed

Colombi, Marina; Dordoni, Chiara; Cinquina, Valeria; Venturini, Marina; Ritelli, Marco

2018-01-01

The 2017 EDS revised nosology indicates that minimal criteria suggestive for classical Ehlers-Danlos syndrome (cEDS) are skin hyperextensibility plus atrophic scarring together with either generalized joint hypermobility (gJHM) and/or at least three minor criteria that include cutaneous features and gJHM complications. Confirmatory molecular testing is obligatory to reach a final diagnosis. Although the large majority of the patients presents with these clinical features, some do not and might remain undiagnosed or misdiagnosed. Here we describe a family with 2 affected members, a 23-year-old proposita and her 51-year-old mother, who presented subtle cutaneous signs, including a variable degree of skin hyperextensibility without extensive widened atrophic scars that apparently better fitted with the overlapping hypermobile EDS. The proposita also presented gastrointestinal symptoms secondary to aberrant mast cells mediators release, making the clinical picture even more puzzling. Both patients were diagnosed by molecular testing that revealed a COL5A1 splice mutation. This report highlights the relevance of molecular analysis in patients presenting rather mild signs of EDS, especially in familial cases, and the importance of clinical expertise to make such a diagnosis. Copyright © 2017. Published by Elsevier Masson SAS.

Controversies in Poland Syndrome: Alternative Diagnoses in Patients With Congenital Pectoral Muscle Deficiency.

PubMed

Baas, Martijn; Burger, Elise B; Sneiders, Dimitri; Galjaard, Robert-Jan H; Hovius, Steven E R; van Nieuwenhoven, Christianne A

2018-02-01

Poland syndrome was first described as a deficiency of the pectoral muscle with ipsilateral symbrachydactyly. Currently, numerous case reports describe variations of Poland syndrome in which pectoral muscle deficiency is often used as the only defining criterion. However, more syndromes can present with pectoral muscle deficiency. The aim of this review is to illustrate the diversity of the phenotypic spectrum of Poland syndrome and to create more awareness for alternative diagnoses in pectoral muscle deficiency. A systematic literature search was performed. Articles containing phenotypical descriptions of Poland syndrome were included. Data extraction included number of patients, sex, familial occurrence, and the definition of Poland syndrome used. In addition, hand deformities, thoracic deformities, and other deformities in each patient were recorded. Alternative syndrome diagnoses were identified in patients with a combination of hand, thorax, and other deformities. One hundred-and-thirty-six articles were included, describing 627 patients. Ten different definitions of Poland syndrome were utilized. In 58% of the cases, an upper extremity deformity was found and 43% of the cases had an associated deformity. Classic Poland syndrome was seen in 29%. Fifty-seven percent of the patients with a pectoral malformation, a hand malformation, and another deformity had at least 1feature that matched an alternative syndrome. Pectoral muscle hypoplasia is not distinctive for Poland syndrome alone but is also present in syndromes with other associated anomalies with a recognized genetic cause. Therefore, in patients with an atypical phenotype, we recommend considering other diagnoses and/or syndromes before diagnosing a patient with Poland syndrome. This can prevent diagnostic and prognostic errors. Differentiating Poland syndrome from the alternative diagnoses has serious consequences for the patient and their family in terms of inheritance and possible related anomalies

Diagnosing Diabetes and Learning about Prediabetes

MedlinePlus

... Listen En Español Diagnosing Diabetes and Learning About Prediabetes There are several ways to diagnose diabetes. Each ... or equal to 200 mg/dl What is Prediabetes? Before people develop type 2 diabetes, they almost ...

[Validation of SHI Claims Data Exemplified by Gender-specific Diagnoses].

PubMed

Hartmann, J; Weidmann, C; Biehle, R

2016-10-01

Aim: Use of statutory health insurance (SHI) data in health services research is increasing steadily and questions of validity are gaining importance. Using gender-specific diagnosis as an example, the aim of this study was to estimate the prevalence of implausible diagnosis and demonstrate an internal validation strategy. Method: The analysis is based on the SHI data from Baden-Württemberg for 2012. Subject of validation are gender-specific outpatient diagnoses that mismatch with the gender of the insured. To uncover this implausibility, it is necessary to clarify whether the diagnosis or the gender is wrong. The validation criteria used were the presence of further gender-specific diagnoses, the presence of gender-specific settlement items, the specialization of the physician in charge and the gender assignment of the first name of the insured. To review the quality of the validation, it was verified if the gender was changed during the following year. Results: Around 5.1% of all diagnoses were gender-specific and there was a mismatch between diagnosis and gender in 0.04% of these cases. All validation criteria were useful to sort out implausibility, whereas the last one was the most effective. Only 14% remained unsolved. From the total of 1 145 insured with implausible gender-specific diagnoses, one year later 128 had a new gender (in the data). 119 of these cases were rightly classified as insured with wrong gender and 9 cases were in the unsolved group. This confirms that the validation works well. Conclusion: Implausibility in SHI data is relatively small and can be solved with appropriate validation criteria. When validating SHI data, it is advisable to question all data used critically, to use multiple validation criteria instead of just one and to abandon the idea that reality and the associated data conform to standardized norms. Keeping these aspects in mind, analysis of SHI data is a good starting point for research in health services. © Georg

Nursing diagnoses associated with the national policy for health promotion.

PubMed

Maciel Diniz, Camila; de Lima Ferreira, Gabriele; Cavalcante Martins, Mariana

2017-01-01

To identify the relationships between nursing diagnoses proposed by NANDA-I taxonomy II and the priority themes (PT) of the National Policy for Health Promotion (PNPS in Portuguse). An integrative literature review was carried out in the Scopus, Cinahl and SciELO databases, using the descriptors: health promotion, food habits, traffic accidents, drugs abuse, environment and public health. The search considered scientific articles published between 2000 and 2016. Twelve articles were selected to identify and explore nursing actions related to PT. It was identified that although the said taxonomy offers a Domain called Health promotion, there is a need to relate the diagnoses of other domains to include the health actions described in the aforementioned Policy. It was observed that there is an attention and concern of the nursing professionals to address topics such as the training of managers and the promotion of healthy eating. In relation to the priority themes promotion of safe mobility and sustainable development, no nursing diagnoses were identified due to the scarcity of diagnoses related to them in the mentioned taxonomy. Although the NANDA-I taxonomy presents a specific domain on health promotion, these are not sufficient to meet the needs of the priority themes proposed by PNPS. Copyright© by the Universidad de Antioquia.

Critical thinking and accuracy of nurses' diagnoses.

PubMed

Lunney, Margaret

2003-01-01

Interpretations of patient data are complex and diverse, contributing to a risk of low accuracy nursing diagnoses. This risk is confirmed in research findings that accuracy of nurses' diagnoses varied widely from high to low. Highly accurate diagnoses are essential, however, to guide nursing interventions for the achievement of positive health outcomes. Development of critical thinking abilities is likely to improve accuracy of nurses' diagnoses. New views of critical thinking serve as a basis for critical thinking in nursing. Seven cognitive skills and ten habits of mind are identified as dimensions of critical thinking for use in the diagnostic process. Application of the cognitive skills of critical thinking illustrates the importance of using critical thinking for accuracy of nurses' diagnoses. Ten strategies are proposed for self-development of critical thinking abilities.

Diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT: a clinical follow up study.

PubMed

Menéndez-González, Manuel; Tavares, Francisco; Zeidan, Nahla; Salas-Pacheco, José M; Arias-Carrión, Oscar

2014-01-01

The [(123)I]ioflupane-a dopamine transporter radioligand-SPECT (DaT-SPECT) has proven to be useful in the differential diagnosis of tremor. Here, we investigate the diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT. Therefore, 30 patients with tremor and normal DaT-SPECT were followed up for 2 years. In 18 cases we were able to make a diagnosis. The residual 12 patients underwent a second DaT-SPECT, were then followed for additional 12 months and thereafter the diagnosis was reconsidered again. The final diagnoses included cases of essential tremor, dystonic tremor, multisystem atrophy, vascular parkinsonism, progressive supranuclear palsy, corticobasal degeneration, fragile X-associated tremor ataxia syndrome, psychogenic parkinsonism, iatrogenic parkinsonism and Parkinson's disease. However, for 6 patients the diagnosis remained uncertain. Larger series are needed to better establish the relative frequency of the different conditions behind these cases.

The Effect of Race in Patients with Achalasia Diagnosed With High-Resolution Esophageal Manometry.

PubMed

Chedid, Victor; Rosenblatt, Elizabeth; Gandhi, Kunjal Komal; Dhalla, Sameer; Nandwani, Monica C; Stein, Ellen M; Clarke, John O

2018-02-01

The advent of the Chicago Classification for esophageal motility disorders allowed for clinically reproducible subgrouping of patients with achalasia based on manometric phenotype. However, there are limited data with regards to racial variation using high-resolution esophageal manometry (HREM). The aim of our study was to evaluate the racial differences in patients with achalasia diagnosed with HREM using the Chicago Classification. We evaluated the clinical presentation, treatment decisions and outcomes between blacks and non-blacks with achalasia to identify potential racial disparities. We performed a retrospective review of consecutive patients referred for HREM at a single tertiary referral center from June 2008 through October 2012. All patients diagnosed with achalasia on HREM according to the Chicago Classification were included. Demographic, clinical and manometric data were abstracted. All studies interpreted before the Chicago Classification was in widespread use were reanalyzed. Race was defined as black or non-black. Patients who had missing data were excluded. Proportions were compared using chi-squared analysis and means were compared using the Student's t-test. A total of 1,268 patients underwent HREM during the study period, and 105 (8.3%) were manometrically diagnosed with achalasia (53% female, mean age: 53.8 ± 17.0 years) and also met the aforementioned inclusion and exclusion criteria. A higher percentage of women presented with achalasia in blacks as compared to whites or other races (P < 0.001). Non-blacks were more likely to present with reflux than blacks (P = 0.01), while blacks were more likely to be treated on the inpatient service than non-blacks (P < 0.001). There were no other significant differences noted in clinical presentation, treatment decisions and treatment outcomes among blacks and non-blacks. Our study highlights possible racial differences between blacks and non-blacks, including a higher proportion of black women

20 CFR 1002.100 - Does the five-year service limit include all absences from an employment position that are...

Code of Federal Regulations, 2010 CFR

2010-04-01

... services? No. The five-year period includes only the time the employee spends actually performing service... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Does the five-year service limit include all... Section 1002.100 Employees' Benefits OFFICE OF THE ASSISTANT SECRETARY FOR VETERANS' EMPLOYMENT AND...

Bronchiectasis diagnosed after renal transplantation: a retrospective multicenter study.

PubMed

Dury, Sandra; Colosio, Charlotte; Etienne, Isabelle; Anglicheau, Dany; Merieau, Elodie; Caillard, Sophie; Rivalan, Joseph; Thervet, Eric; Essig, Marie; Babinet, François; Subra, Jean-François; Toubas, Olivier; Rieu, Philippe; Launois, Claire; Perotin-Collard, Jeanne-Marie; Lebargy, François; Deslée, Gaëtan

2015-11-07

Bronchiectasis is characterized by abnormal, permanent and irreversible dilatation of the bronchi, usually responsible for daily symptoms and frequent respiratory complications. Many causes have been identified, but only limited data are available concerning the association between bronchiectasis and renal transplantation. We conducted a retrospective multicenter study of cases of bronchiectasis diagnosed after renal transplantation in 14 renal transplantation departments (French SPIESSER group). Demographic, clinical, laboratory and CT scan data were collected. Forty-six patients were included (mean age 58.2 years, 52.2 % men). Autosomal dominant polycystic kidney disease (32.6 %) was the main underlying renal disease. Chronic cough and sputum (50.0 %) were the major symptoms leading to chest CT scan. Mean duration of symptoms before diagnosis was 1.5 years [0-12.1 years]. Microorganisms were identified in 22 patients, predominantly Haemophilus influenzae. Hypogammaglobulinemia was observed in 46.9 % patients. Bronchiectasis was usually extensive (84.8 %). The total bronchiectasis score was 7.4 ± 5.5 with a significant gradient from apex to bases. Many patients remained symptomatic (43.5 %) and/or presented recurrent respiratory tract infections (37.0 %) during follow-up. Six deaths (13 %) occurred during follow-up, but none were attributable to bronchiectasis. These results highlight that the diagnosis of bronchiectasis should be considered in patients with de novo respiratory symptoms after renal transplantation. Further studies are needed to more clearly understand the mechanisms underlying bronchiectasis in this setting.

Long-term beneficial effects of the phenylalanine-restricted diet in late-diagnosed individuals with phenylketonuria.

PubMed

Koch, R; Moseley, K; Ning, J; Romstad, A; Guldberg, P; Guttler, F

1999-06-01

The potential benefits to society of treating late-diagnosed mentally retarded persons with phenylketonuria were investigated. In order to ascertain the effects of late dietary intervention, the charts of 124 adults with PKU seen in the metabolic service at the Childrens Hospital of Los Angeles were reviewed. Fifty-nine were diagnosed later than 3 months of age and were over the age of 18 years. They were followed up with medical, psychological, and nutritional assessments. Genotyping was also performed. Twenty-eight have remained on a phenylalanine-restricted diet during the intervening years. All but 3 of the 28 late-diagnosed PKU persons who remained on a restricted diet showed significant intellectual improvement. Seven are able to attend college, 9 are employed, and 12 are attending workshops and/or day care programs. The result of treatment with the phenylalanine-restricted diet was that these individuals could participate in society and were able to arrest the neurodegenerative course characteristic of persons with mutations classified as severe in the phenylalanine hydroxylase gene. We conclude that society could benefit substantially by providing a phenylalanine-restricted diet for late-diagnosed mentally retarded persons with phenylketonuria. Eighteen of 28 such persons who otherwise would have required residential care are living independently. Copyright 1999 Academic Press.

Predicting parental distress among children newly diagnosed with craniopharyngioma.

PubMed

Peterson, Rachel K; Ashford, Jason M; Scott, Sarah M; Wang, Fang; Zhang, Hui; Bradley, Julie A; Merchant, Thomas E; Conklin, Heather M

2018-06-22

Childhood brain tumor diagnoses are stressful for families. Children diagnosed with craniopharyngioma (Cp) present with particularly challenging medical and cognitive problems due to tumor location and associated biophysiologic comorbidities. This study examined parental distress in a sample of families of patients with Cp treated with proton beam therapy to identify factors for targeting psychological intervention. Prior to (n = 96) and 1 year after (n = 73) proton therapy, parents of children diagnosed with Cp (9.81 ± 4.42 years at baseline; 49% male) completed a self-report measure of distress, the Brief Symptom Inventory (BSI). Children completed cognitive assessment measures at baseline; medical variables were extracted from the study database. At baseline, t-tests revealed parents reported higher levels of distress than normative expectations on Anxiety, Depression, Global Severity, and Positive Symptom Distress BSI scales (P < 0.05). Linear mixed effects models revealed parent report measures of child executive dysfunction and behavioral issues were more predictive of parental distress than patients' cognitive performance or medical status (P < 0.05). Models also revealed a significant reduction only in Anxiety over time (t = -2.19, P < 0.05). Extensive hypothalamic involvement at baseline predicted this reduction (P < 0.05). Parents experience significant distress before their child begins adjuvant therapy for Cp, though parental distress appears largely unrelated to medical complications and more related to parent perceptions of child cognitive difficulties (vs. child performance). Importantly, this may be explained by a negative parent reporting style among distressed parents. Knowledge of socio-emotional functioning in parents related to patient characteristics is important for optimization of psychological intervention. © 2018 Wiley Periodicals, Inc.

Paracoccidioidomycosis in southern Rio Grande do Sul: a retrospective study of histopathologically diagnosed cases.

PubMed

de Souza, Silvana Pereira; Jorge, Valéria Magalhães; Xavier, Melissa Orzechowski

2014-01-01

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and is endemic to Brazil. The aim of this study was to perform a retrospective analysis of the PCM cases in the countryside south of Rio Grande do Sul, Brazil. The files from four histopathology laboratories located in the city of Pelotas were obtained, and all of the epidemiological and clinical data from the PCM diagnosed cases were collected for analysis. A total of 123 PCM cases diagnosed between 1966 and 2009 were selected. Of these patients, 104 (84.5%) were male, and 17 were female. The patients ranged from 02 to 92 years of age. Fifty-two cases (41.9%) were obtained from the oral pathology laboratory, and the remaining 71 cases (58.1%) were obtained from the three general pathology laboratories. Of all of the patients studied, 65.2% lived in rural zones and worked in agriculture or other related fields. Data on the evolution of this disease was available for 43 cases, and the time frame ranged from 20 to 2920 days (mean = 572.3 days). An accurate diagnosis performed in less than 30 days only occurred in 21% of the cases. PCM is endemic to the countryside of Rio Grande do Sul. Therefore, it is recommended that PCM be included as a differential diagnosis, mainly for individuals between 30 and 60 years of age, living in rural zones and who have respiratory signs and associated-oropharyngeal lesions.

Paracoccidioidomycosis in southern Rio Grande do Sul: A retrospective study of histopathologically diagnosed cases

PubMed Central

de Souza, Silvana Pereira; Jorge, Valéria Magalhães; Xavier, Melissa Orzechowski

2014-01-01

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and is endemic to Brazil. The aim of this study was to perform a retrospective analysis of the PCM cases in the countryside south of Rio Grande do Sul, Brazil. The files from four histopathology laboratories located in the city of Pelotas were obtained, and all of the epidemiological and clinical data from the PCM diagnosed cases were collected for analysis. A total of 123 PCM cases diagnosed between 1966 and 2009 were selected. Of these patients, 104 (84.5%) were male, and 17 were female. The patients ranged from 02 to 92 years of age. Fifty-two cases (41.9%) were obtained from the oral pathology laboratory, and the remaining 71 cases (58.1%) were obtained from the three general pathology laboratories. Of all of the patients studied, 65.2% lived in rural zones and worked in agriculture or other related fields. Data on the evolution of this disease was available for 43 cases, and the time frame ranged from 20 to 2920 days (mean = 572.3 days). An accurate diagnosis performed in less than 30 days only occurred in 21% of the cases. PCM is endemic to the countryside of Rio Grande do Sul. Therefore, it is recommended that PCM be included as a differential diagnosis, mainly for individuals between 30 and 60 years of age, living in rural zones and who have respiratory signs and associated-oropharyngeal lesions. PMID:24948940

Association Between Substance Use Diagnoses and Psychiatric Disorders in an Adolescent and Young Adult Clinic-Based Population.

PubMed

Welsh, Justine Wittenauer; Knight, John R; Hou, Sherry Shu-Yeu; Malowney, Monica; Schram, Patricia; Sherritt, Lon; Boyd, J Wesley

2017-06-01

Adolescents with substance use disorders are more likely to have a current psychiatric disorder. However, when compared with the adult literature, there is relatively limited information regarding the specific co-occurrence of certain mental health diagnoses and substance use disorders in adolescents. The objectives of this study were to build on the previous literature regarding mental health diagnoses and different types of substance use disorders in adolescents, as well as explore the differences, if any, between groupings of mental health diagnosis and type of substance used. Data were extracted from the clinical records of 483 individuals aged 11-24 years referred for an evaluation at the Adolescent Substance Abuse Program at Boston Children's Hospital. According to DSM-IV-Text Revision criteria, individuals received diagnoses of substance abuse or dependence and any additional psychiatric disorders. Problematic use was included within the sample for greater power analysis. A multivariable logistic regression model estimated the association between psychiatric diagnosis and substance use while adjusting for covariates including age and gender. Multiple significant associations were found, including having any anxiety-related diagnosis and opioid use (odds ratio [OR] = 2.23, p < .001), generalized anxiety disorder and opioids (OR = 3.42, p = .008), cocaine and post-traumatic stress disorder (OR = 3.61, p = .01), and marijuana and externalizing behavior disorders (OR = 2.10, p = .024). Our study found multiple significant associations between specific substances and certain co-occurring psychiatric disorders. The use of office screening systems to efficiently identify these youths should be a part of routine medical and psychiatric care. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Refractive errors in patients with newly diagnosed diabetes mellitus.

PubMed

Yarbağ, Abdülhekim; Yazar, Hayrullah; Akdoğan, Mehmet; Pekgör, Ahmet; Kaleli, Suleyman

2015-01-01

Diabetes mellitus is a complex metabolic disorder that involves the small blood vessels, often causing widespread damage to tissues, including the eyes' optic refractive error. In patients with newly diagnosed diabetes mellitus who have unstable blood glucose levels, refraction may be incorrect. We aimed to investigate refraction in patients who were recently diagnosed with diabetes and treated at our centre. This prospective study was performed from February 2013 to January 2014. Patients were diagnosed with diabetes mellitus using laboratory biochemical tests and clinical examination. Venous fasting plasma glucose (fpg) levels were measured along with refractive errors. Two measurements were taken: initially and after four weeks. The last difference between the initial and end refractive measurements were evaluated. Our patients were 100 males and 30 females who had been newly diagnosed with type II DM. The refractive and fpg levels were measured twice in all patients. The average values of the initial measurements were as follows: fpg level, 415 mg/dl; average refractive value, +2.5 D (Dioptres). The average end of period measurements were fpg, 203 mg/dl; average refractive value, +0.75 D. There is a statistically significant difference between after four weeks measurements with initially measurements of fasting plasma glucose (fpg) levels (p<0.05) and there is a statistically significant relationship between changes in fpg changes with glasses ID (p<0.05) and the disappearance of blurred vision (to be greater than 50% success rate) were statistically significant (p<0.05). Also, were detected upon all these results the absence of any age and sex effects (p>0.05). Refractive error is affected in patients with newly diagnosed diabetes mellitus; therefore, plasma glucose levels should be considered in the selection of glasses.

Health-related quality of life in children with newly diagnosed immune thrombocytopenia

PubMed Central

Heitink-Pollé, Katja M.J.; Haverman, Lotte; Annink, Kim V.; Schep, Sarah J.; de Haas, Masja; Bruin, Marrie C.A.

2014-01-01

Despite its generally transient and benign course, childhood immune thrombocytopenia has a large impact on health-related quality of life. Recently published guidelines state that quality of life should be taken into account while making decisions on management in childhood immune thrombocytopenia. We, therefore, assessed health-related quality of life in children with newly diagnosed immune thrombocytopenia in a prospective multicenter study. One hundred and seven children aged 6 months-16 years (mean age 5.57 years) were included. We used Pediatric Quality of Life Inventory™ and Kids’ ITP Tools questionnaires at diagnosis and during standardized follow-up. Scores on the Pediatric Quality of Life Inventory™ Core Scales were compared with those of healthy children. Relationships between health-related quality of life scores and treatment modality, bleeding tendency and course of the disease were examined. Kids’ ITP Tools proxy reports and parent self-reports showed significant higher health-related quality of life scores in children who recovered than in children with persistent immune thrombocytopenia (at 3 months: Kids’ ITP Tools parent self-report score 80.85 for recovered patients (n=69) versus 58.98 for patients with persistent disease (n=21), P<0.001). No significant differences in health-related quality of life were found between children with mild or moderate bleeding or between children who received intravenous immunoglobulin or children who were carefully observed. In conclusion, health-related quality of life of children with newly diagnosed immune thrombocytopenia is not influenced by treatment modality or bleeding severity, but only by clinical course of the disease. (Dutch Trial Register identifier: NTR TC1563) PMID:24951468

The clinical course of asymptomatic esophageal candidiasis incidentally diagnosed in general health inspection.

PubMed

Lee, Sang Pyo; Sung, In-Kyung; Kim, Jeong Hwan; Lee, Sun-Young; Park, Hyung Seok; Shim, Chan Sup

2015-01-01

Esophageal candidiasis mostly occurs in the immunocompromised host. However, it may also affect healthy people and is frequently asymptomatic. The clinical significance of asymptomatic esophageal candidiasis (AEC) is still unclear. The aims of the study were to investigate the prevalence of AEC during health inspection and to identify its predisposing factors and clinical significance. A total of 49,497 subjects who underwent a health inspection that included upper endoscopy were enrolled. We retrospectively reviewed the subject's self-reporting questionnaires, medical records and endoscopic findings. We considered "long-term" follow-up to be >6 months with at least one more follow-up endoscopy. One hundred and seventy (0.4%) subjects were endoscopically diagnosed as esophageal candidiasis and 141 subjects were AEC. Multivariate analysis revealed that old age (≥60 years) was an independent risk factor for AEC (OR, 1.862, p = 0.005). The number of subjects with long-term follow-up was 79 (195.3 person-years). Among these, AEC of 64 subjects (81.0%) had disappeared on the follow-up endoscopy and was not recurrent. The other 15 subjects had AEC diagnosed more than once on the follow-up endoscopy, and 5 of them were spontaneously healed during the follow-up period. The remaining 10 subjects whose candidiasis was sustained up to the last endoscopy did not complain of symptoms during the follow-up period, and their endoscopic findings did not worsen. AEC is rare and old age is the only risk factor. AEC does not require medical care because it is a self-limited disease.

Socio-economic patterning in early mortality of patients aged 0-49 years diagnosed with primary bone cancer in Great Britain, 1985-2008.

PubMed

Blakey, Karen; Feltbower, Richard G; James, Peter W; Libby, Gillian; Stiller, Charles; Norman, Paul; Gerrand, Craig; McNally, Richard J Q

2018-04-01

Studies have shown marked improvements in survival between 1981 and 2000 for Ewing sarcoma patients but not for osteosarcoma. This study aimed to explore socio-economic patterning in early mortality rates for both tumours. The study analysed all 2432 osteosarcoma and 1619 Ewing sarcoma cases, aged 0-49 years, diagnosed in Great Britain 1985-2008 and followed to 31/12/2009. Logistic regression models were used to calculate risk of dying within three months, six months, one year, three years and five years after diagnosis. Associations with Townsend deprivation score and its components were examined at small-area level. Urban/rural status was studied at larger regional level. For osteosarcoma, after age adjustment, mortality at three months, six months and one year was associated with higher area unemployment, OR = 1.05 (95% CI 1.00, 1.10), OR = 1.04 (95% CI 1.01, 1.08) and OR = 1.04 (95% CI 1.02, 1.06) respectively per 1% increase in unemployment. Mortality at six months was associated with greater household non-car ownership, OR = 1.02 (95% CI 1.00, 1.03). For Ewing sarcoma, there were no significant associations between mortality and overall Townsend score, nor its components for any time period. For both tumours increasing mortality was associated with less urban and more remote rural areas. This study found that for osteosarcoma, early mortality was associated with residence at diagnosis in areas of higher unemployment, suggesting risk of early death may be socio-economically determined. For both tumours, distance from urban centres may lead to greater risk of early death. Copyright © 2018 Elsevier Ltd. All rights reserved.

Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison.

PubMed

Halfon, Patricia; Eggli, Yves; Decollogny, Anne; Seker, Erol

2013-10-31

Pharmacy-based case mix measures are an alternative source of information to the relatively scarce outpatient diagnoses data. But most published tools use national drug nomenclatures and offer no head-to-head comparisons between drugs-related and diagnoses-based categories. The objective of the study was to test the accuracy of drugs-based morbidity groups derived from the World Health Organization Anatomical Therapeutic Chemical Classification of drugs by checking them against diagnoses-based groups. We compared drugs-based categories with their diagnoses-based analogues using anonymous data on 108,915 individuals insured with one of four companies. They were followed throughout 2005 and 2006 and hospitalized at least once during this period. The agreement between the two approaches was measured by weighted kappa coefficients. The reproducibility of the drugs-based morbidity measure over the 2 years was assessed for all enrollees. Eighty percent used a drug associated with at least one of the 60 morbidity categories derived from drugs dispensation. After accounting for inpatient under-coding, fifteen conditions agreed sufficiently with their diagnoses-based counterparts to be considered alternative strategies to diagnoses. In addition, they exhibited good reproducibility and allowed prevalence estimates in accordance with national estimates. For 22 conditions, drugs-based information identified accurately a subset of the population defined by diagnoses. Most categories provide insurers with health status information that could be exploited for healthcare expenditure prediction or ambulatory cost control, especially when ambulatory diagnoses are not available. However, due to insufficient concordance with their diagnoses-based analogues, their use for morbidity indicators is limited.

Cognitive Vulnerabilities and Depression versus Other Psychopathology Symptoms and Diagnoses in Early Adolescence

PubMed Central

Alloy, Lauren B.; Black, Shimrit K.; Young, Mathew E.; Goldstein, Kim E.; Shapero, Benjamin G.; Stange, Jonathan P.; Boccia, Angelo S.; Matt, Lindsey M.; Boland, Elaine M.; Moore, Lauren C.; Abramson, Lyn Y.

2012-01-01

Objective We examined the concurrent associations between multiple cognitive vulnerabilities to depression featured in Hopelessness Theory, Beck’s Theory, and Response Styles Theory and depressive symptoms and diagnoses in a sample of early adolescents. We also examined the specificity of these cognitive vulnerabilities to depression versus anxiety and externalizing psychopathology, controlling for co-occurring symptoms and diagnoses. Method Male and female, Caucasian and African-American, 12–13 year old adolescents were assessed in a cross-sectional design. Cognitive vulnerabilities of hopelessness, inferential style, rumination, and self-referent information processing were assessed with self-reports and behavioral tasks. Symptoms and diagnoses of depressive, anxiety, and externalizing disorders were assessed with self-report questionnaires and diagnostic interviews. Results Hopelessness exhibited the greatest specificity to depressive symptoms and diagnoses, whereas negative inferential styles, rumination, and negative self-referent information processing were associated with both depressive and anxiety symptoms and diagnoses and, in some cases, with externalizing disorders. Conclusions Consistent with cognitive theories of depression, hopelessness, negative inferential styles, rumination, and negative self-referent information processing were associated with depressive symptoms and diagnoses. However, with the exception of hopelessness, most of the remaining cognitive vulnerabilities were not specific to depression. With further maturation of our sample, these cognitive vulnerabilities may become more specific to depression as cognitive styles further develop and consolidate, the rates of depression increase, and individuals’ presentations of psychopathology become more differentiated. PMID:22853629

Multiple behaviour change intervention and outcomes in recently diagnosed type 2 diabetes: the ADDITION-Plus randomised controlled trial.

PubMed

Griffin, Simon J; Simmons, Rebecca K; Prevost, A Toby; Williams, Kate M; Hardeman, Wendy; Sutton, Stephen; Brage, Søren; Ekelund, Ulf; Parker, Richard A; Wareham, Nicholas J; Kinmonth, Ann Louise

2014-07-01

The aim of this study was to assess whether or not a theory-based behaviour change intervention delivered by trained and quality-assured lifestyle facilitators can achieve and maintain improvements in physical activity, dietary change, medication adherence and smoking cessation in people with recently diagnosed type 2 diabetes. An explanatory randomised controlled trial was conducted in 34 general practices in Eastern England (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care-Plus [ADDITION-Plus]). In all, 478 patients meeting eligibility criteria (age 40 to 69 years with recently diagnosed screen or clinically detected diabetes) were individually randomised to receive either intensive treatment (n = 239) or intensive treatment plus a theory-based behaviour change intervention led by a facilitator external to the general practice team (n = 239). Randomisation was central and independent using a partial minimisation procedure to balance stratifiers between treatment arms. Facilitators taught patients skills to facilitate change in and maintenance of key health behaviours, including goal setting, self-monitoring and building habits. Primary outcomes included physical activity energy expenditure (individually calibrated heart rate monitoring and movement sensing), change in objectively measured fruit and vegetable intake (plasma vitamin C), medication adherence (plasma drug levels) and smoking status (plasma cotinine levels) at 1 year. Measurements, data entry and laboratory analysis were conducted with staff unaware of participants' study group allocation. Of 475 participants still alive, 444 (93%; intervention group 95%, comparison group 92%) attended 1-year follow-up. There were no significant differences between groups in physical activity (difference: +1.50 kJ kg(-1) day(-1); 95% CI -1.74, 4.74), plasma vitamin C (difference: -3.84 μmol/l; 95% CI -8.07, 0.38), smoking (OR 1.37; 95% CI 0.77, 2.43) and

Social outcomes in mid- to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children.

PubMed

Howlin, Patricia; Moss, Philippa; Savage, Sarah; Rutter, Michael

2013-06-01

To describe current social functioning in a clinical sample of 60 adults with autism (mean age = 44 years) who were all of average nonverbal IQ (70+) when first diagnosed (mean age = 6.75 years). Outcome measures included standardized diagnostic and cognitive assessments and questionnaires on social functioning. Child and adult variables related to current outcomes were explored. All individuals continued to meet criteria for autism spectrum disorder (ASD) on the Autism Diagnostic Interview-Revised (ADI-R), but severity of autism symptoms declined over time. Nevertheless, only 10 individuals (17%) were rated as having a "good" or "very good" outcome; the majority (60%) were assessed as having "poor" or "very poor" outcomes. The strongest predictor of adult outcome was the Reciprocal Social Interaction domain score on the ADI at diagnostic confirmation. Change over time was further examined in a subgroup (n = 44) previously assessed 20 years ago earlier (mean age = 26 years). Although severity of autism had continued to decrease during the adult period, social outcomes were poorer than in younger adulthood. In this cohort of adults first diagnosed with autism, on average, 37 years previously, social inclusion remains very limited, despite general improvements in autism symptomatology with age. Whether these findings will be replicated in future generations of children with autism, who now have the benefits of earlier diagnosis and wider access to specialist provision, needs to be the focus of further longitudinal research. Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

The relative frequency of common neuromuscular diagnoses in a reference center.

PubMed

Cotta, Ana; Paim, Júlia Filardi; Carvalho, Elmano; da-Cunha-Júnior, Antonio Lopes; Navarro, Monica M; Valicek, Jaquelin; Menezes, Miriam Melo; Nunes, Simone Vilela; Xavier-Neto, Rafael; Baptista, Sidney; Lima, Luciano Romero; Takata, Reinaldo Issao; Vargas, Antonio Pedro

2017-11-01

The diagnostic procedure in neuromuscular patients is complex. Knowledge of the relative frequency of neuromuscular diseases within the investigated population is important to allow the neurologist to perform the most appropriate diagnostic tests. To report the relative frequency of common neuromuscular diagnoses in a reference center. A 17-year chart review of patients with suspicion of myopathy. Among 3,412 examinations, 1,603 (46.98%) yielded confirmatory results: 782 (48.78%) underwent molecular studies, and 821 (51.21%) had muscle biopsies. The most frequent diagnoses were: dystrophinopathy 460 (28.70%), mitochondriopathy 330 (20.59%), spinal muscular atrophy 158 (9.86%), limb girdle muscular dystrophy 157 (9.79%), Steinert myotonic dystrophy 138 (8.61%), facioscapulohumeral muscular dystrophy 99 (6.17%), and other diagnoses 261 (16.28%). Using the presently-available diagnostic techniques in this service, a specific limb girdle muscular dystrophy subtype diagnosis was reached in 61% of the patients. A neuromuscular-appropriate diagnosis is important for genetic counseling, rehabilitation orientation, and early treatment of respiratory and cardiac complications.

Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders.

PubMed

Barrera, Terri L; Mott, Juliette M; Hundt, Natalie E; Mignogna, Joseph; Yu, Hong-Jen; Stanley, Melinda A; Cully, Jeffrey A

2014-01-01

This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization. This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization. Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29). Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings. Published by Elsevier Inc.

26 CFR 1.451-6 - Election to include crop insurance proceeds in gross income in the taxable year following the...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 6 2010-04-01 2010-04-01 false Election to include crop insurance proceeds in... (CONTINUED) INCOME TAXES Taxable Year for Which Items of Gross Income Included § 1.451-6 Election to include... or damage. (a) In general. (1) For taxable years ending after December 30, 1969, a taxpayer reporting...

Epidemiological profile of patients diagnosed with athletic pubalgia.

PubMed

Oliveira, Anderson Luiz de; Andreoli, Carlos Vicente; Ejnisman, Benno; Queiroz, Roberto Dantas; Pires, Osvaldo Guilherme Nunes; Falótico, Guilherme Guadagnini

2016-01-01

To evaluate the clinical and epidemiological characteristics of pubalgia in patients from a Sports Medicine Center. Data analysis from medical records of patients with athletic pubalgia attended to from January 2007 to January 2015. The diagnosis was made by an experienced hip surgeon, complemented with pelvic X-ray, abdominal wall ultrasound, and magnetic resonance imaging of the pelvis. Among 43 patients, 42 were men, with mean age of 33 years. As for sports, 25 (58.1%) athletes were soccer players and 13 (30.2%) were runners; 37.2% were professional athletes. Inguinal hernia was diagnosed in 20.9% of patients, showing the importance of its routine search in these patients. Treatment duration ranged from 1 to 12 months and 95.2% of the patients returned to sport. This study presented the epidemiological characteristics of patients diagnosed with athletic pubalgia attended to in a reference medical center and demonstrated the prevalence of this lesion in male patients, soccer players and runners. It also disclosed a high success rate of the nonoperative treatment, and high rate of return to sport after treatment.

[Comparative effects of nebivolol and valsartan on atrial electromechanical coupling in newly diagnosed stage 1 hypertensive patients].

PubMed

Altun, Burak; Acar, Gürkan; Akçay, Ahmet; Sökmen, Abdullah; Kaya, Hakan; Köroğlu, Sedat

2011-10-01

Hypertension is an important cardiovascular risk factor for the development of atrial fibrillation (AF). Increased atrial electromechanical coupling time interval measured by tissue Doppler is accepted as an important factor for prediction of AF development in hypertensive patients. The aim of this study was to compare the effects of valsartan, an angiotensin receptor blocker, and nebivolol, a beta-blocker, on atrial electromechanical coupling in newly diagnosed stage 1 hypertensive patients. The study included 60 newly diagnosed stage 1 hypertensive patients with no other systemic disease. The patients were randomized to receive nebivolol 5 mg (30 patients; 21 women, 9 men; mean age 48.4 ± 11.4 years) and valsartan 160 mg (30 patients; 21 women, 9 men; mean age 49.8 ± 11.3 years). All the patients underwent tissue Doppler echocardiographic examination before and three months after treatment to compare the effects of the two drugs on atrial electromechanical coupling. Baseline blood pressures, electrocardiographic and echocardiographic findings, and atrial electromechanical coupling were similar in both groups (p>0.05). Both drugs significantly reduced blood pressure after treatment, with similar efficacy (p>0.05). Atrial electromechanical coupling time intervals showed significant decreases in both groups. Prolonged interatrial electromechanical time intervals in hypertensives are improved with antihypertensive treatment.

Country of Birth of Children With Diagnosed HIV Infection in the United States, 2008-2014.

PubMed

Nesheim, Steven R; Linley, Laurie; Gray, Kristen M; Zhang, Tianchi; Shi, Jing; Lampe, Margaret A; FitzHarris, Lauren F

2018-01-01

Diagnoses of HIV infection among children in the United States have been declining; however, a notable percentage of diagnoses are among those born outside the United States. The impact of foreign birth among children with diagnosed infections has not been examined in the United States. Using the Centers for Disease Control and Prevention National HIV Surveillance System, we analyzed data for children aged <13 years with diagnosed HIV infection ("children") in the United States (reported from 50 states and the District of Columbia) during 2008-2014, by place of birth and selected characteristics. There were 1516 children [726 US born (47.9%) and 676 foreign born (44.6%)]. US-born children accounted for 70.0% in 2008, declining to 32.3% in 2013, and 40.9% in 2014. Foreign-born children have exceeded US-born children in number since 2011. Age at diagnosis was younger for US-born than foreign-born children (0-18 months: 72.6% vs. 9.8%; 5-12 years: 16.9% vs. 60.3%). HIV diagnoses in mothers of US-born children were made more often before pregnancy (49.7% vs. 21.4%), or during pregnancy (16.6% vs. 13.9%), and less often after birth (23.7% vs. 41%). Custodians of US-born children were more often biological parents (71.9% vs. 43.2%) and less likely to be foster or nonrelated adoptive parents (10.4% vs. 55.1%). Of 676 foreign-born children with known place of birth, 65.5% were born in sub-Saharan Africa and 14.3% in Eastern Europe. The top countries of birth were Ethiopia, Ukraine, Uganda, Haiti, and Russia. The increasing number of foreign-born children with diagnosed HIV infection in the United States requires specific considerations for care and treatment.

Can autism be diagnosed accurately in children under 3 years?

PubMed

Stone, W L; Lee, E B; Ashford, L; Brissie, J; Hepburn, S L; Coonrod, E E; Weiss, B H

1999-02-01

This study investigated the reliability and stability of an autism diagnosis in children under 3 years of age who received independent diagnostic evaluations from two clinicians during two consecutive yearly evaluations. Strong evidence for the reliability and stability of the diagnosis was obtained. Diagnostic agreement between clinicians was higher for the broader discrimination of autism spectrum vs. no autism spectrum than for the more specific discrimination of autism vs. PDD-NOS. The diagnosis of autism at age 2 was more stable than the diagnosis of PDD-NOS at the same age. Social deficits and delays in spoken language were the most prominent DSM-IV characteristics evidenced by very young children with autism.

Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years.

PubMed

Tonni, Gabriele; Granese, Roberta; Martins Santana, Eduardo Félix; Parise Filho, José Pedro; Bottura, Isabela; Borges Peixoto, Alberto; Giacobbe, Annamaria; Azzerboni, Andrea; Araujo Júnior, Edward

2017-02-01

The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes. PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used. A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility. After 445 articles were excluded for specified reasons, 111 studies met the research criteria and were included for qualitative analysis. Overall, 306 cases of fetal tumors of the head and neck were reviewed. Maternal age was an independent factor. The mean maternal age was 28.2 years and gestational age at prenatal diagnosis was 27.1 weeks. Conventional 2D ultrasound was the standard diagnostic procedure in 27.9% of cases and was implemented in 27.3% of cases by 3D ultrasound and fetal magnetic resonance imaging (MRI). Diagnostic evaluation of intracranial spreading and high-airway obstructions was greatly enhanced by fetal MRI. The more common type of fetal tumor was hemangioma/lymphangioms (42.1%), followed by teratomas (29.7%), tumors of the gingiva (10.1%) and lymphatic venous malformations (9.1%), respectively. Fetal karyotyping was performed only in 9.8% of cases; within fetuses undergoing karyotype, chromosomal abnormalities accounted for 20% of cases. The most common pregnancy complication was polyhydramnios (26.3%). Ex utero intrapartum treatment (EXIT) procedure was performed in 30.1% of cases while surgical excision was used in 22.9% during postnatal life. The survival rate was 35.35%. Fetal tumors of the head and neck are rare congenital malformations. Two-dimensional ultrasound is diagnostic in almost all cases; however, MRI may be an important diagnostic adjunct in targeted cases and help patient selection for immediate intubation at the time of delivery. EXIT procedure and surgical removal of the tumor was associated with good

Infectious shock and toxic shock syndrome diagnoses in hospitals, Colorado, USA.

PubMed

Smit, Michael A; Nyquist, Ann-Christine; Todd, James K

2013-11-01

In Colorado, USA, diagnoses coded as toxic shock syndrome (TSS) constituted 27.3% of infectious shock cases during 1993-2006. The incidence of staphylococcal TSS did not change significantly overall or in female patients 10-49 years of age but increased for streptococcal TSS. TSS may be underrecognized among all ages and both sexes.

Meanings of well-being from the perspectives of youth recently diagnosed with psychosis.

PubMed

Lal, Shalini; Ungar, Michael; Malla, Ashok; Frankish, Jim; Suto, Melinda

2014-02-01

The phenomenon of well-being has attracted a surge of attention in mental health policy, clinical practice and research internationally. Yet, the definitions of well-being remain elusive, and there is limited understanding on its meanings from the perspectives of youth mental health service users. This study explored the meanings of well-being from the perspectives of youth mental health service users diagnosed with psychosis in the past 3 years. Using a qualitative approach, we conducted semi-structured interviews and participant-photography elicited focus groups with 17 youth recruited from an early intervention program for psychoses and a mental health program specializing in the delivery of psychiatric services to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. The findings illustrate five key themes in participants' conceptualizations of well-being: multidimensionality; active oriented states; social environment; identity; and normality. Dimensions of well-being identified in participants' accounts include: psychological, physical, emotional, moral/virtuous, financial/material, spiritual, and social aspects. Our heuristic framework for conceptualizing well-being, grounded in the narrative accounts of youth participants, can inform the future planning and design of interventions, research, and outcome measures pertaining to the well-being of youth recently diagnosed with psychosis.

Xp11.2 Translocation Renal Cell Carcinoma Diagnosed by Immunohistochemistry and Cytogenetics.

PubMed

Dey, Biswajit; Badhe, Bhawana; Govindarajan, Krishna Kumar; Ramesh, Ranjith Arumbakkam

2016-01-01

Xp11.2 translocation renal cell carcinomas (TRCCs) are a group of neoplasms with distinct clinical, histopathological appearance, immunohistochemical, and cytogenetic profile. We report a case of Xp11.2 translocation TRCC in an 11-year-old male diagnosed based on immunohistochemistry and fluorescence in situ hybridization.

Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients; a population-based register study.

PubMed

Brenner, Philip; Alexanderson, Kristina; Björkenstam, Charlotte; Hillert, Jan; Jokinen, Jussi; Mittendorfer-Rutz, Ellenor; Tinghög, Petter

2014-01-01

Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on disability pension. The aims of this study were to chart the prevalences of psychiatric diagnoses and medications among MS patients of working ages, and to investigate their association with the risk for future disability pension. This nationwide, population-based prospective cohort study includes 10,750 MS patients and 5,553,141 non-MS individuals who in 2005 were aged 17-64 years. Psychiatric diagnoses and medications were identified using nationwide registers. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated adjusting for socio-demographics. Furthermore, a survival analysis with five-year follow-up was performed among the 4,571 MS patients not on disability pension in 2005, with psychiatric diagnoses and medication as risk factors, and disability pension as the outcome. Among MS patients, 35% had been prescribed psychiatric medication compared to 10% of non-MS individuals, adjusted OR 3.72 (95% CI 3.57 to 3.88). Ten percent of MS patients had received a psychiatric diagnosis, compared to 5.7% of non-MS individuals, OR 1.82 (95% CI 1.71 to 1.94). Serotonin reuptake inhibitors (SSRIs), were the most commonly prescribed drugs (17%) among MS patients, while depression (4.8%) was the most common psychiatric diagnosis. In the survival analysis, MS patients with any psychiatric diagnosis had a hazard ratio (HR) of 1.83 (95% CI 1.53 to 2.18) for disability pension compared to other MS patients. MS patients with any psychiatric drug prescription had a HR for disability pension of 2.09 (95% CI 1.84 to 2.33). Psychiatric diagnoses and medications are common among MS patients and adversely affect risk for disability pension. This highlights the importance of correct diagnosis and management of psychiatric comorbidity, in a clinical as well as in a societal perspective.

Increase in migraine diagnoses and guideline-concordant treatment in veterans, 2004-2012.

PubMed

Altalib, H H; Fenton, B T; Sico, J; Goulet, J L; Bathulapalli, H; Mohammad, A; Kulas, J; Driscoll, M; Dziura, J; Mattocks, K; Kerns, R; Brandt, C; Haskell, S

2017-01-01

Background and aim Health administrators, policy makers, and educators have attempted to increase guideline adherence of migraine medications while reducing inappropriate use of opioid- and barbiturate-containing medications. We evaluated the burden of migraine and proportion of guideline-concordant care in a large, national health care system over time. Methods We conducted a time-series study using data from the Veterans Health Administration (VHA) electronic health record. Veterans with migraines were identified by ICD-9 code (346.X). Prescriptions and comorbid conditions were evaluated before and after migraine diagnosis. Chi-square tests and logistic regression were performed. Results A total of 57,064 veterans were diagnosed with migraine headache (5.3%), with women significantly more likely diagnosed (11.6% vs. 4.4%, p < 0.0001). The number of veterans diagnosed with migraine has significantly increased over the years. By 2012, triptans were prescribed to 43% of people with migraine, with no difference by gender. However, triptan prescriptions increased from 2004 to 2012 in men, but not women, veterans. Preventive medicines showed a significant increase with the year of migraine diagnosis, after controlling for age, sex, race, and for comorbidities treated with medications used for migraine prevention. Conclusions The burden of migraines is increasing within the VHA, with a corresponding increase in the delivery of guideline-concordant acute and prophylactic migraine-specific medication.

Work-Home Interference, Perceived Total Workload, and the Risk of Future Sickness Absence Due to Stress-Related Mental Diagnoses Among Women and Men: a Prospective Twin Study.

PubMed

Svedberg, Pia; Mather, Lisa; Bergström, Gunnar; Lindfors, Petra; Blom, Victoria

2018-02-01

Work-home interference has been proposed as an important explanation for sickness absence (SA). Previous studies show mixed results, have not accounted for familial factors (genetics and shared everyday environment), or investigated diagnosis specific SA. The aim was to study whether work-home interference and perceived total workload predict SA due to stress-related mental diagnoses, or SA due to other mental diagnoses, among women and men, when adjusting for various confounders and familial factors. This study included 11,916 twins, 19-47 years (49% women). Data on work-to-home and home-to-work conflicts, perceived total workload, and relevant confounders were derived from a 2005 survey, and national register data on SA spells until 2013 were obtained. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Discordant twin pair design was applied to adjust for familial factors. Each one unit increase in work-to-home and home-to-work conflicts, and perceived total workload was associated with higher odds for SA due to stress-related mental diagnoses and to SA due to other mental diagnoses among women, when adjusting for sociodemographic factors (ORs 1.15-1.31). Including health or familial factors, no associations remained. For men, each one unit increase in work-to-home conflicts was associated with higher odds for SA due to stress-related diagnoses (ORs 1.23-1.35), independently of confounders. Work-to-home conflict was independently associated with future SA due to stress-related diagnoses among men only. Health- and work-related factors seem to be important confounders when researching work-home interference, perceived total workload, and SA. Not including such confounders involves risking drawing incorrect conclusions. Further studies are needed to confirm sex differences and whether genetic factors are important for the associations studied.

USE OF A NOVEL BOARD GAME IN A CLINICAL ROTATION FOR LEARNING THORACIC DIFFERENTIAL DIAGNOSES IN VETERINARY MEDICAL IMAGING.

PubMed

Ober, Christopher P

2017-03-01

When confronted with various findings on thoracic radiographs, fourth-year veterinary students often have difficulty generating appropriate lists of differential diagnoses. The purpose of this one-group, pretest, posttest experimental study was to determine if a game could be used as an adjunct teaching method to improve students' understanding of connections between imaging findings and differential diagnoses. A novel board game focusing on differential diagnoses in thoracic radiography was developed. One hundred fourth-year veterinary students took a brief pretest, played the board game, and took a brief posttest as a part of their respective clinical radiology rotations. Pretest results were compared to posttest results using a paired t-test to determine if playing the game impacted student understanding. Students' mean scores on the posttest were significantly higher than mean pretest scores (P < 0.0001). Thus, results indicate that playing the board game resulted in improved short-term understanding of thoracic differential diagnoses by fourth-year students, and use of the board game on a clinical rotation seems to be a beneficial part of the learning process. © 2016 American College of Veterinary Radiology.

Histological Diagnoses of Military Personnel Undergoing Lung Biopsy After Deployment to Southwest Asia.

PubMed

Madar, Cristian S; Lewin-Smith, Michael R; Franks, Teri J; Harley, Russell A; Klaric, John S; Morris, Michael J

2017-08-01

The current understanding of associations between lung disease and military deployment to Southwest Asia, including Iraq and Afghanistan, is both controversial and limited. We sought to clarify the relation between military deployment and biopsy-proven lung disease. Retrospective data were analyzed for military personnel with non-neoplastic lung biopsies evaluated at the Armed Forces Institute of Pathology or Joint Pathology Center (January 2005 to December 2012). Of 391 subjects, 137 (35.0%) had deployed to Southwest Asia prior to biopsy. Compared to non-deployed subjects, those deployed were younger (median age 37 vs. 51 years) with higher representation of African Americans (30.0 vs. 16.9%). Deployed patients were more likely diagnosed with non-necrotizing granulomas (OR 2.4). Non-deployed subjects had higher frequency of idiopathic interstitial pneumonias, particularly organizing pneumonia. Prevalence of small airways diseases including constrictive bronchiolitis was low. This study provides a broader understanding of diversity of biopsy-proven non-neoplastic lung disease as it relates to military deployment to Southwest Asia and importantly did not show an increased prevalence of small airway disease to include constrictive bronchiolitis.

Therapeutic experience of vincristine/cyclophosphamide/melphalan or mitoxantrone/prednisone combination therapy plus thalidomide as first-line induction therapy for newly diagnosed multiple myeloma in a single institution of China.

PubMed

Wang, Xiaoning; He, Pengcheng; Guo, Caili; Sun, Chunhong; Zhang, Mei

2017-10-01

To investigate the safety and efficacy of the combination regimen vincristine, cyclophosphamide, melphalan or mitoxantrone and prednisone (VCMP) plus thalidomide as first-line induction therapy for newly diagnosed multiple myeloma (MM). Three hundred and ninety-six symptomatic, newly diagnosed MM patients were treated with VCMP plus thalidomide in our hospital for the past 11 years, and clinical data of these patients were retrospectively analyzed. Of the 396 patients enrolled, the total response rate was 77.3%. Forty-three patients relapsed after sCR and CR. Mean cycles to first response were six cycles (range 1-16 cycles). A total of 53% of patients achieved at least a PR within the first cycle of therapy. The actuarial 1-year, 3-year and 5-year overall survival of all patients were 89.4%, 29.5% and 10.6%, respectively. The probabilities of 1-year, 3-year and 5-year progression-free survival of all patients were 84.0%, 23.1% and 8.4%, respectively. The major adverse events were gastrointestinal symptoms, electrolytes and glucose metabolism disorders, hypertension, infection, peripheral nerve disease and hematological adverse events, which were mostly below grade 3 and could be alleviated by symptomatic treatment. We concluded that VCMP plus thalidomide is an effective regimen with manageable side effects in the treatment of symptomatic, newly diagnosed MM including elderly patients and patients with renal failure. © 2016 John Wiley & Sons Australia, Ltd.

Cognitive and psychosocial effects of oxcarbazepine monotherapy in newly diagnosed partial epilepsy.

PubMed

Kim, Daeyoung; Seo, Ji-Hye; Joo, Eun Yeon; Lee, Hyang Woon; Shin, Won Chul; Hong, Seung Bong

2014-01-01

The aim of this study was to assess the effects of oxcarbazepine (OXC) on cognition and psychosocial difficulties in patients with new-onset partial epilepsy. Cognitive and psychosocial assessments were performed before and after 6 to 12 months of OXC monotherapy in 52 drug-naive patients (25 women; mean age, 31.1 years; SD, 12.1 years). Cognitive functions were evaluated with well-structured and validated tools. Mood, psychological distress, subjective handicap, and quality of life were also evaluated. Differences between baseline and after-treatment evaluation were compared and adjusted for possible confounders such as age, sex, seizure control, duration of epilepsy, assessment interval, and epileptogenic region. Mean assessment interval was 231.8 (range, 182-348) days, and mean (SD) OXC dose at retest was 693.8 (208.9) mg. The OXC was found to have no significant adverse effect on cognition. Furthermore, OXC monotherapy was not found to affect psychosocial difficulties, including psychological distress and subjective handicap. The results suggest that OXC monotherapy could be used to treat newly diagnosed partial epilepsy without adversely affecting cognitive and psychosocial functions.

Bronchoscopic modalities to diagnose sarcoidosis.

PubMed

Benzaquen, Sadia; Aragaki-Nakahodo, Alejandro Adolfo

2017-09-01

Several studies have investigated different bronchoscopic techniques to obtain tissue diagnosis in patients with suspected sarcoidosis when the diagnosis cannot be based on clinicoradiographic findings alone. In this review, we will describe the most recent and relevant evidence from different bronchoscopic modalities to diagnose sarcoidosis. Despite multiple available bronchoscopic modalities to procure tissue samples to diagnose sarcoidosis, the vast majority of evidence favors endobronchial ultrasound transbronchial needle aspiration to diagnose Scadding stages 1 and 2 sarcoidosis. Transbronchial lung cryobiopsy is a new technique that is mainly used to aid in the diagnosis of undifferentiated interstitial lung disease; however, we will discuss its potential use in sarcoidosis. This review illustrates the limited information about the different bronchoscopic techniques to aid in the diagnosis of pulmonary sarcoidosis. However, it demonstrates that the combination of available bronchoscopic techniques increases the diagnostic yield for suspected sarcoidosis.

[Subclinical and established kidney disease in recently diagnosed hypertensive patients].

PubMed

Gómez-Marcos, Manuel Angel; Martínez-Salgado, Carlos; Grandes, Gonzalo; Recio-Rodríguez, José Ignacio; Castaño Sánchez, Yolanda; Rodríguez Sánchez, Emiliano; García-Ortiz, Luis

2010-03-06

To estimate renal disease in recently diagnosed hypertensive patients, and to identify factors related to renal disease. Cross-sectional study, with 425 hypertensive patients recently diagnosed in primary health care; renal disease was estimated with serum creatinine, albumin/creatinine index and glomerular filtration rate (GFR). We analyzed cardiovascular risk factors (CRF), subclinical organ injury and cardiovascular disease following the criteria of the 2007 European Guide of Hypertension. Average age: 58,96 +/- 12,73 years old, 63,3% male. We found dyslipemia in 80%, abdominal obesity in 49% and metabolic syndrome in 36% patients. These patients showed increased serum creatinine 3,3%, a reduction in GFR 9,6%, hidden renal disease 6,4%, microalbuminuria 7,5% and nephropathy 2,4%. Hypertensive patients with renal disease (17,88%) were older, with higher systolic pressure, higher incidence of metabolic syndrome, abnormal carotid intima-media thickness and ankle-arm index, and presence of cardiovascular disease. Variables associated with renal disease were metabolic syndrome (odds ratio = 11,12) and ankle-arm index (odds ratio = 17,55). Variables related to creatinina were sex, ankle-arm index and metabolic syndrome; variables related to GFR were sex, age, ankle-arm index, metabolic syndrome and body mass index (BMI); variables related with albumin/creatinine index included diabetes mellitus. Renal disease is detected in about 2 out of 10 hypertensive patients, when, besides serum creatinina, we analyze albumin/creatinine index and GFR. Metabolic syndrome and ankle-arm index are the main variables associated with renal disease. Copyright 2009 Elsevier España, S.L. All rights reserved.

Diagnosing Abiotic Degradation

EPA Science Inventory

The abiotic degradation of chlorinated solvents in ground water can be difficult to diagnose. Under current practice, most of the “evidence” is negative; specifically the apparent disappearance of chlorinated solvents with an accumulation of vinyl chloride, ethane, ethylene, or ...

Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji.

PubMed

Engelman, Daniel; Mataika, Reapi L; Kado, Joseph H; Ah Kee, Maureen; Donath, Susan; Parks, Tom; Steer, Andrew C

2016-12-01

Echocardiographic screening for rheumatic heart disease (RHD) can detect subclinical cases; however, adequate adherence to secondary antibiotic prophylaxis (SAP) is required to alter disease outcomes. We aimed to investigate the adherence to SAP among young people with RHD diagnosed through echocardiographic screening in Fiji and to investigate factors associated with adherence. Patients diagnosed with RHD through echocardiographic screening in Fiji from 2006 to 2014 were included. Dates of benzathine penicillin G injections were collected from 76 health clinics nationally from December 2011 to December 2014. Adherence was measured using the proportion of days covered (PDC). Multivariate logistic regression analysis was used to identify characteristics associated with any adherence (≥1 injection received) and adequate adherence (PDC ≥0.80). Of 494 patients, 268 (54%) were female and the median age was 14 years. Overall, 203 (41%) had no injections recorded and just 33 (7%) had adequate adherence. Multivariate logistic regression showed increasing age (OR 0.93 per year, 95% CI 0.87-0.99) and time since diagnosis ≥1.5 years (OR 0.53, 95% CI 0.37-0.79) to be inversely associated with any adherence. Non-iTaukei ethnicity (OR 2.58, 95%CI 1.04-6.33) and urban residence (OR 3.36, 95% CI 1.54-7.36) were associated with adequate adherence, whereas time since diagnosis ≥1.5 years (OR 0.38, 95%CI 0.17-0.83) was inversely associated with adequate adherence. Adherence to SAP after screening in Fiji is currently inadequate for individual patient protection or population disease control. Secondary prevention should be strengthened before further screening can be justified. © 2016 John Wiley & Sons Ltd.

Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

PubMed

Liu, Danyang; Gan, Rongchang; Zhang, Weidi; Wang, Wei; Saiyin, Hexige; Zeng, Wenjiao; Liu, Guoyuan

2018-01-01

Emergency medicine is a 'high risk' specialty. Some diseases develop suddenly and progress rapidly, and sudden unexpected deaths in the emergency department (ED) may cause medical disputes. We aimed to assess discrepancies between antemortem clinical diagnoses and postmortem autopsy findings concerning emergency medicine dispute cases and to figure out the most common major missed diagnoses. Clinical files and autopsy reports were retrospectively analysed and interpreted. Discrepancies between clinical diagnoses and autopsy diagnoses were evaluated using modified Goldman classification as major and minor discrepancy. The difference between diagnosis groups was compared with Pearson χ 2 test. Of the 117 cases included in this study, 71 of cases (58 class I and 13 class II diagnostic errors) were revealed as major discrepancies (60.7%). The most common major diagnoses were cardiovascular diseases (54 cases), followed by pulmonary diseases, infectious diseases and so on. The difference of major discrepancy between the diagnoses groups was significant (p<0.001). Aortic dissection and myocardial infarction were the most common cause of death (15 cases for each disease) and the most common missed class I diagnoses (80% and 66.7% for each), higher than the average 49.6% of all class I errors of the study patients. High major disparities between clinical diagnoses and postmortem examinations exist in emergency medical disputes cases; acute aortic dissection and myocardial infarction are the most frequently major missed diagnoses that ED clinicians should pay special attention to in practice. This study reaffirmed the necessity and usefulness of autopsy in auditing death in EDs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Vital Signs: Trends in HIV Diagnoses, Risk Behaviors, and Prevention Among Persons Who Inject Drugs - United States.

PubMed

Wejnert, Cyprian; Hess, Kristen L; Hall, H Irene; Van Handel, Michelle; Hayes, Demorah; Fulton, Paul; An, Qian; Koenig, Linda J; Prejean, Joseph; Valleroy, Linda A

2016-12-02

Persons who inject drugs (PWID) are at increased risk for poor health outcomes and bloodborne infections, including human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus infections. Although substantial progress has been made in reducing HIV infections among PWID, recent changes in drug use could challenge this success. CDC used National HIV Surveillance System data to analyze trends in HIV diagnoses. Further, National HIV Behavioral Surveillance interviews of PWID in 22 cities were analyzed to describe risk behaviors and use of prevention services among all PWID and among PWID who first injected drugs during the 5 years before their interview (new PWID). During 2008-2014, HIV diagnoses among PWID declined in urban and nonurban areas, but have leveled off in recent years. Among PWID in 22 cities, during 2005-2015, syringe sharing decreased by 34% among blacks/African Americans (blacks) and by 12% among Hispanics/Latinos (Hispanics), but remained unchanged among whites. The racial composition of new PWID changed during 2005-2015: the percentage who were black decreased from 38% to 19%, the percentage who were white increased from 38% to 54%, and the percentage who were Hispanic remained stable. Among new PWID interviewed in 2015, whites engaged in riskier injection behaviors than blacks. Decreases in HIV diagnoses among PWID indicate success in HIV prevention. However, emerging behavioral and demographic trends could reverse this success. Access to comprehensive prevention services is essential for all PWID. Syringe services programs reduce syringe sharing and can help PWID access prevention and treatment services for HIV and other bloodborne diseases, such as hepatitis C and hepatitis B.

Increase in transmitted drug resistance in migrants from sub-Saharan Africa diagnosed with HIV-1 in Sweden.

PubMed

Andersson, Emmi; Nordquist, Agnes; Esbjörnsson, Joakim; Flamholc, Leo; Gisslén, Magnus; Hejdeman, Bo; Marrone, Gaetano; Norrgren, Hans; Svedhem, Veronica; Wendahl, Suzanne; Albert, Jan; Sönnerborg, Anders

2018-04-24

To study the trends of transmitted drug resistance (TDR) in HIV-1 patients newly diagnosed in Sweden, 2010-2016. Register-based study including all antiretroviral therapy-naive patients ≥18 years diagnosed with HIV-1 in Sweden 2010-2016. Patient data and viral pol sequences were extracted from the national InfCareHIV database. TDR was defined as the presence of surveillance drug resistance mutations (SDRMs). A CD4 T-cell decline trajectory model estimated time of infection. Phylogenetic inference was used for cluster analysis. Chi-square tests and logistic regressions were used to investigate relations between TDR, epidemiological and viral factors. One thousand, seven hundred and thirteen pol sequences were analyzed, corresponding to 71% of patients with a new HIV-1 diagnosis (heterosexuals: 53%; MSM: 34%). The overall prevalence of TDR was 7.1% (95% CI 5.8-8.3%). Nonnucleoside reverse transcriptase inhibitor (NNRTI) TDR increased significantly from 1.5% in 2010 to 6.2% in 2016, and was associated to infection and/or origin in sub-Saharan Africa (SSA). An MSM transmission cluster dating back to the 1990s with the M41L SDRM was identified. Twenty-five (1.5%) patients exhibited TDR to tenofovir (TDF; n = 8), emtricitabine/lamivudine (n = 9) or both (n = 8). NNRTI TDR has increased from 2010 to 2016 in HIV-1-infected migrants from SSA diagnosed in Sweden, mirroring the situation in SSA. TDR to tenofovir/emtricitabine, used in preexposure prophylaxis, confirms the clinical and epidemiological need for resistance testing in newly diagnosed patients.

Study protocol for Young & Strong: a cluster randomized design to increase attention to unique issues faced by young women with newly diagnosed breast cancer.

PubMed

Greaney, Mary L; Sprunck-Harrild, Kim; Ruddy, Kathryn J; Ligibel, Jennifer; Barry, William T; Baker, Emily; Meyer, Meghan; Emmons, Karen M; Partridge, Ann H

2015-01-31

Each year, approximately 11% of women diagnosed with breast cancer in the United States are 45 years of age or younger. These women have concerns specific to or accentuated by their age, including fertility-related concerns, and have higher rates of psychosocial distress than women diagnosed at older ages. Current guidelines recommend that fertility risks be considered early in all treatment plans; however, the extant research indicates that attention to fertility by the healthcare team is limited. Importantly, attention to fertility may be a proxy for whether or not other important issues warranting attention in younger women with breast cancer are addressed, including genetic risks, psychosocial distress, sexual functioning, and body image concerns. The Young & Strong study tests the efficacy of an intervention designed for young women recently diagnosed with breast cancer and their oncologists with the intention to: 1) increase attention to fertility as an important surrogate for other issues facing young women, 2) educate and support young women and their providers, and 3) reduce psychosocial distress among young women with breast cancer. The study employs a cluster randomized design including 14 academic institutions and 40 community sites across the U.S. assigned to either the study intervention arm or contact-time comparison intervention arm. Academic institutions enroll up to 15 patients per site while community sites enroll up to 10 patients. Patient eligibility requirements include: an initial diagnosis of stage I-III invasive breast cancer within three months prior, without a known recurrence or metastatic breast cancer; 18-45 years of age at diagnosis; ability to read and write in English. The primary outcome is oncologists' attention to fertility concerns as determined by medical record review. Secondary outcomes include differences in patient satisfaction with care and psychosocial distress between the two study arms. Study findings will provide

Immune checkpoint inhibitors and radiosurgery for newly diagnosed melanoma brain metastases.

PubMed

Robin, Tyler P; Breeze, Robert E; Smith, Derek E; Rusthoven, Chad G; Lewis, Karl D; Gonzalez, Rene; Brill, Amanda; Saiki, Robin; Stuhr, Kelly; Gaspar, Laurie E; Karam, Sana D; Raben, David; Kavanagh, Brian D; Nath, Sameer K; Liu, Arthur K

2018-06-16

Brain metastases are common in metastatic melanoma and radiosurgery is often utilized for local control. Immune checkpoint inhibitors (CPIs) play a central role in contemporary melanoma management; however, there is limited data exploring outcomes and potential toxicities for patients treated with CPIs and radiosurgery. We retrospectively identified all consecutive cases of newly diagnosed melanoma brain metastases (MBM) treated with Gamma Knife radiosurgery at a single institution between 2012 and 2017, and included only patients that initiated CPIs within 8 weeks before or after radiosurgery. Thirty-eight patients were included with a median follow-up of 31.6 months. Two-year local control was 92%. Median time to out-of-field CNS and extra-CNS progression were 8.4 and 7.9 months, respectively. Median progression-free survival (PFS) was 3.4 months and median overall survival (OS) was not reached (NR). Twenty-five patients (66%) received anti-CTLA4 and 13 patients (34%) received anti-PD-1+/-anti-CTLA4. Compared with anti-CTLA4, patients that received anti-PD-1+/-anti-CTLA4 had significant improvements in time to out-of-field CNS progression (p = 0.049), extra-CNS progression (p = 0.015), and PFS (p = 0.043), with median time to out-of-field CNS progression of NR vs. 3.1 months, median time to extra-CNS progression of NR vs. 4.4 months, and median PFS of 20.3 vs. 2.4 months. Six patients (16%) developed grade ≥ 2 CNS toxicities (grade 2: 3, grade 3: 3, grade 4/5: 0). Excellent outcomes were observed in patients that initiated CPIs within 8 weeks of undergoing radiosurgery for newly diagnosed MBM. There appears to be an advantage to anti-PD-1 or combination therapy compared to anti-CTLA4.

Diagnosing smallpox: would you know it if you saw it?

PubMed

Woods, Ryan; McCarthy, Tara; Barry, M Anita; Mahon, Barbara

2004-01-01

The intentional release of anthrax in the United States in 2001 and other recent acts of terrorism have highlighted the possibility of intentional release of smallpox by terrorists. Little is known about physicians' ability to diagnose smallpox, especially in the critical first days, when the potential for rapid control of transmission is greatest. During December 2002 and January 2003, primary care and emergency physicians at a large urban academic medical center were surveyed regarding the diagnosis and management of patients who present with vesicular rash illness. In addition to demographic and training-related questions, the questionnaire included items about perceived comfort in diagnosing and evaluating rashes, knowledge of the key differential diagnostic characteristics of chickenpox and smallpox, and the diagnostic interpretation of color photographs of patients with smallpox or chickenpox. Responses were summarized as a perceived comfort score, a differential diagnosis score, and a picture score. Of 266 eligible physicians, 178 (67%) responded. Of these, 95% thought clinicians need more education about bioterrorism; only 17% reported comfort in diagnosing smallpox. Although most physicians recognized pictures of smallpox and chickenpox, only 36% correctly answered 3 of 4 questions regarding differential diagnosis, an important aspect of identifying cases early. Those who were comfortable diagnosing rash illnesses had higher differential diagnosis scores. Strategies for bioterrorism-related training could take advantage of physicians' awareness of their own knowledge deficits.

Longitudinal associations between different dementia diagnoses and medication use jointly accounting for dropout.

PubMed

Agogo, George O; Ramsey, Christine M; Gnjidic, Danijela; Moga, Daniela C; Allore, Heather

2018-04-18

ABSTRACTBackground:Longitudinal studies of older adults are characterized by high dropout rates, multimorbid conditions, and multiple medication use, especially proximal to death. We studied the association between multiple medication use and incident dementia diagnoses including Alzheimer's disease (AD), vascular dementia (VD), and Lewy-body dementia (LBD), simultaneously accounting for dropout. Using the National Alzheimer's Coordinating Center data with three years of follow-up, a set of covariate-adjusted models that ignore dropout was fit to complete-case data, and to the whole-cohort data. Additionally, covariate-adjusted joint models with shared random effects accounting for dropout were fit to the whole-cohort data. Multiple medication use was defined as polypharmacy (⩾ five medications), hyperpolypharmacy (⩾ ten medications), and total number of medications. Incident diagnoses were 2,032 for AD, 135 for VD, and 139 for LBD. Percentages of dropout at the end of follow-up were as follows: 71.8% for AD, 81.5% for VD, and 77.7% for LBD. The odds ratio (OR) estimate for hyperpolypharmacy among those with LBD versus AD was 2.19 (0.78, 6.15) when estimated using complete-case data and 3.00 (1.66, 5.40) using whole-cohort data. The OR reduced to 1.41 (0.76, 2.64) when estimated from the joint model accounting for dropout. The OR for polypharmacy using complete-case data differed from the estimates using whole-cohort data. The OR for dementia diagnoses on total number of medications was similar, but non-significant when estimated using complete-case data. Reasons for dropout should be investigated and appropriate statistical methods should be applied to reduce bias in longitudinal studies among high-risk dementia cohorts.

Infectious Shock and Toxic Shock Syndrome Diagnoses in Hospitals, Colorado, USA

PubMed Central

Smit, Michael A.; Nyquist, Ann-Christine

2013-01-01

In Colorado, USA, diagnoses coded as toxic shock syndrome (TSS) constituted 27.3% of infectious shock cases during 1993–2006. The incidence of staphylococcal TSS did not change significantly overall or in female patients 10–49 years of age but increased for streptococcal TSS. TSS may be underrecognized among all ages and both sexes. PMID:24188357

Genetic and Environmental Influences on Disability Pension Due To Mental Diagnoses: Limited Importance of Major Depression, Generalized Anxiety, and Chronic Fatigue.

PubMed

Narusyte, Jurgita; Ropponen, Annina; Alexanderson, Kristina; Svedberg, Pia

2016-02-01

Previous research indicates that liability to disability pension (DP) due to mental diagnoses is moderately influenced by genetic factors. This study investigates whether genetic contributions to the liability to DP due to mood and neurotic diagnoses overlap with the genetic influences on major depression (MD), generalized anxiety disorder (GAD), or chronic fatigue (CF). A prospective cohort study including 9,985 female twins born in Sweden 1933-1958. The presence of MD, GAD, and CF was assessed by computer-assisted telephone interviews conducted in 1998-2002. Data on DP due to mood and neurotic diagnoses were obtained from nationwide registers for the years 1998-2010. Common genetic and environmental influences on the phenotypes were estimated by applying structural equation modeling. The prevalence of MD/GAD was 30%, CF 8%, and DP due to mood and neurotic diagnoses 3% in 2010. Genetic effects on MD/GAD explained 31% of the total genetic variation in DP, whereas genetic contributions in common with CF were small and not significant. The majority of the total non-shared environmental variance in DP (85%) was explained by the factors that were unique to DP. Large proportions of genetic and non-shared environmental influences in DP due to mood and neurotic diagnoses were not explained by the contributions from MD/GAD or CF. The results suggest that the process leading to DP is complex and influenced by factors other than those related to the disorder underlying DP.

Fuzzy expert system for diagnosing diabetic neuropathy.

PubMed

Rahmani Katigari, Meysam; Ayatollahi, Haleh; Malek, Mojtaba; Kamkar Haghighi, Mehran

2017-02-15

To design a fuzzy expert system to help detect and diagnose the severity of diabetic neuropathy. The research was completed in 2014 and consisted of two main phases. In the first phase, the diagnostic parameters were determined based on the literature review and by investigating specialists' perspectives ( n = 8). In the second phase, 244 medical records related to the patients who were visited in an endocrinology and metabolism research centre during the first six months of 2014 and were primarily diagnosed with diabetic neuropathy, were used to test the sensitivity, specificity, and accuracy of the fuzzy expert system. The final diagnostic parameters included the duration of diabetes, the score of a symptom examination based on the Michigan questionnaire, the score of a sign examination based on the Michigan questionnaire, the glycolysis haemoglobin level, fasting blood sugar, blood creatinine, and albuminuria. The output variable was the severity of diabetic neuropathy which was shown as a number between zero and 10, had been divided into four categories: absence of the disease, (the degree of severity) mild, moderate, and severe. The interface of the system was designed by ASP.Net (Active Server Pages Network Enabled Technology) and the system function was tested in terms of sensitivity (true positive rate) (89%), specificity (true negative rate) (98%), and accuracy (a proportion of true results, both positive and negative) (93%). The system designed in this study can help specialists and general practitioners to diagnose the disease more quickly to improve the quality of care for patients.

Fuzzy expert system for diagnosing diabetic neuropathy

PubMed Central

Rahmani Katigari, Meysam; Ayatollahi, Haleh; Malek, Mojtaba; Kamkar Haghighi, Mehran

2017-01-01

AIM To design a fuzzy expert system to help detect and diagnose the severity of diabetic neuropathy. METHODS The research was completed in 2014 and consisted of two main phases. In the first phase, the diagnostic parameters were determined based on the literature review and by investigating specialists’ perspectives (n = 8). In the second phase, 244 medical records related to the patients who were visited in an endocrinology and metabolism research centre during the first six months of 2014 and were primarily diagnosed with diabetic neuropathy, were used to test the sensitivity, specificity, and accuracy of the fuzzy expert system. RESULTS The final diagnostic parameters included the duration of diabetes, the score of a symptom examination based on the Michigan questionnaire, the score of a sign examination based on the Michigan questionnaire, the glycolysis haemoglobin level, fasting blood sugar, blood creatinine, and albuminuria. The output variable was the severity of diabetic neuropathy which was shown as a number between zero and 10, had been divided into four categories: absence of the disease, (the degree of severity) mild, moderate, and severe. The interface of the system was designed by ASP.Net (Active Server Pages Network Enabled Technology) and the system function was tested in terms of sensitivity (true positive rate) (89%), specificity (true negative rate) (98%), and accuracy (a proportion of true results, both positive and negative) (93%). CONCLUSION The system designed in this study can help specialists and general practitioners to diagnose the disease more quickly to improve the quality of care for patients. PMID:28265346

Xp11.2 Translocation Renal Cell Carcinoma Diagnosed by Immunohistochemistry and Cytogenetics

PubMed Central

Dey, Biswajit; Badhe, Bhawana; Govindarajan, Krishna Kumar; Ramesh, Ranjith Arumbakkam

2016-01-01

Xp11.2 translocation renal cell carcinomas (TRCCs) are a group of neoplasms with distinct clinical, histopathological appearance, immunohistochemical, and cytogenetic profile. We report a case of Xp11.2 translocation TRCC in an 11-year-old male diagnosed based on immunohistochemistry and fluorescence in situ hybridization. PMID:27365924

Web GIS in practice II: interactive SVG maps of diagnoses of sexually transmitted diseases by Primary Care Trust in London, 1997 – 2003

PubMed Central

Boulos, Maged N Kamel; Russell, Chris; Smith, Michael

2005-01-01

Background The rates of Sexually transmitted diseases (STDs) in England have been rising steadily since the mid 1990s, making them a major public health concern. In 2003, 672,718 people were diagnosed with an STD in England, and around one third of those cases were diagnosed in London. Results Using GeoReveal v1.1 for Windows, we produced Web-based interactive choropleth maps of diagnoses of STDs by Primary Care Trust (PCT) in London for the years from 1997 to 2003 . These maps are in Scalable Vector Graphics (SVG) format and require a freely available Adobe SVG browser plug-in to be displayed. They are based on data obtained from the House of Commons Hansard Written Answers for 15 October 2004. They show steadily rising rates of STDs in London over the covered seven-year period. Also, one can clearly see on the maps that PCTs located in central London had the highest numbers of STD diagnoses throughout the mapped seven years. A companion bar chart allows users to instantly compare the STD figure of a given PCT for a given year against the average figure for all 25 mapped PCTs for the same year, and also compare those figures across all seven years. The maps offer users a rich set of useful features and functions, including the ability to change the classification method in use, the number of ranges in the map, and the colour theme, among others. Conclusions Wizard-driven tools like GeoReveal have made it very easy to transform complex raw data into valuable decision support information products (interactive Web maps) in very little time and without requiring much expertise. The resultant interactive maps have the potential of further supporting health planners and decision makers in their planning and management tasks by allowing them to graphically interrogate data, instantly spot trends, and make quick and effective visual comparisons of geographically differentiated phenomena between different geographical areas and over time. SVG makes an ideal format for such

A 10-year follow-up of a child with mild case of xeroderma pigmentosum complementation group D diagnosed by whole-genome sequencing.

PubMed

Ono, Ryusuke; Masaki, Taro; Mayca Pozo, Franklin; Nakazawa, Yuka; Swagemakers, Sigrid M A; Nakano, Eiji; Sakai, Wataru; Takeuchi, Seiji; Kanda, Fumio; Ogi, Tomoo; van der Spek, Peter J; Sugasawa, Kaoru; Nishigori, Chikako

2016-07-01

Most patients with xeroderma pigmentosum complementation group D (XP-D) from Western countries suffer from neurological symptoms, whereas Japanese patients display only skin manifestations without neurological symptoms. We have previously suggested that these differences in clinical manifestations in XP-D patients are attributed partly to a predominant mutation in ERCC2, and the allele frequency of S541R is highest in Japan. We diagnosed a child with mild case of XP-D by the evaluation of DNA repair activity and whole-genome sequencing, and followed her ten years. Skin cancer, mental retardation, and neurological symptoms were not observed. Her minimal erythema dose was 41 mJ/cm(2) , which was slightly lower than that of healthy Japanese volunteers. The patient's cells showed sixfold hypersensitivity to UV in comparison with normal cells. Post-UV unscheduled DNA synthesis was 20.4%, and post-UV recovery of RNA synthesis was 58% of non-irradiated samples, which was lower than that of normal fibroblasts. Genome sequence analysis indicated that the patient harbored a compound heterozygous mutation of c.1621A>C and c.591_594del, resulting in p.S541R and p.Y197* in ERCC2: then, patient was diagnosed with XP-D. Y197* has not been described before. Her mild skin manifestations might be attributed to the mutational site on her genome and daily strict sun protection. c.1621A>C might be a founder mutation of ERCC2 among Japanese XP-D patients, as it was identified most frequently in Japanese XP-D patients and it has not been found elsewhere outside Japan. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Comparison of gastro-oesophageal reflux disease and heartburn diagnoses in UK primary care.

PubMed

Ruigómez, Ana; García Rodríguez, Luis Alberto; Wallander, Mari-Ann; Johansson, Saga; Dent, John

2006-09-01

It is unclear how gastro-oesophageal reflux disease (GORD) is diagnosed in primary care. The aim of this study is to compare patients given a diagnosis of GORD with those diagnosed with heartburn. Data from the UK General Practice Research Database were extracted for patients newly diagnosed with heartburn (n = 1841) or GORD (n = 5318) in 1996. Patient characteristics, morbidity, healthcare use and prescribed treatments were compared using unconditional logistic regression analysis. GORD was diagnosed more frequently than heartburn (3.2 vs. 1.1 per 1000 patient-years). A diagnosis of GORD was less likely among females (odds ratio (OR): 0.8; confidence interval (CI): 0.7-0.9), smokers (OR: 0.8; CI: 0.7-0.9) and patients who consulted their physician frequently (OR: 0.8; CI: 0.7-0.9). There was a wide distribution in the ratio of GORD-to-heartburn diagnoses between primary care practices (mean 2.9; range 0-infinity). GORD patients were more likely to receive proton pump inhibitors (OR: 2.9; CI: 2.6-3.4), but 24% of GORD patients and 40% of heartburn patients received no acid-suppressive treatment in the month after diagnosis. Several factors influenced the diagnosis of gastro-oesophageal reflux symptoms by primary care physicians. Further research is needed to aid the diagnosis of GORD in primary care.

Squamous cell carcinoma of the oral cavity in patients aged 45 years and under: a descriptive analysis of 116 cases diagnosed in the South East of England from 1990 to 1997.

PubMed

Llewellyn, C D; Linklater, K; Bell, J; Johnson, N W; Warnakulasuriya, K A A S

2003-02-01

there is, currently, much anecdotal and some epidemiological evidence for a rise in oral cancer rates amongst younger individuals, many of whom have had no exposure to traditional risk factors such as tobacco and heavy alcohol use, or at least not the exposure over decades usually associated with this disease. The probity of this assertion and the presence or absence of traditional risk factors needs further evidence. this paper describes the demography and the exposure to potential risk factors amongst a cohort aged 45 years and younger, diagnosed with squamous cell carcinoma of the oral cavity between 1990 and 1997 from the South East of England. eligible patients registered with a cancer registry were included in this retrospective study. Information was accessed from the database and by a postal questionnaire survey. The self-completed questionnaire contained items about exposure to the following risk factors: tobacco; alcohol; diet; frequency of dental visits and familial cancer. this is the largest UK epidemiological study so far to be undertaken on young subjects diagnosed with oral cancer. One-hundred and sixteen cases were recruited representing a response rate of 59%. Slightly over 90% of this cohort were classified as white European. A large proportion of cases (40%) were from social classes I & II suggesting either a true social class difference in young cases versus older oral cancer cases or a possible bias in responders or survivors. Risk factors of tobacco use and excessive alcohol consumption were present in the majority (75%) of patients. Significant differences in the pattern of alcohol consumption were found in female subjects, who were less likely to consume over the recommended amounts of alcohol compared with male subjects. Daily regular fresh fruit and vegetable consumption during the ten year period before cancer diagnosis was recorded to be low. There was a distinct subgroup of cases, 26% of the group, that showed little, if any, exposure

Coverage of HIV prevention components among people with long-standing diagnosed HIV infection in El Salvador.

PubMed

Jacobson, Jerry O; Creswell, Jacob; Guardado, Maria Elena; Lee, Janet C; Isabel Nieto, Ana; Paz-Bailey, Gabriela

2012-09-01

There is scarce information on prevention coverage and management of sexually transmitted infections (STIs) in people with HIV in resource-limited settings. Six hundred eighty nine sexually active people diagnosed with HIV ≥12 months before the study, including 110 men who have sex with men, 237 heterosexual men, and 342 women, were recruited from HIV support groups and hospitals in El Salvador and completed self-administered computer-assisted questionnaires and STI testing. Logistic models identified correlates of exposure to posttest counseling (POC) and subsequent prevention interventions (PIs). Past-year transmission risk factors included unprotected sex with noncommercial partners (28.7%), having multiple sex partners (76.4%), a casual sex partner (31.4%), selling (3.5%) and purchasing sex (6.4%), herpes simplex virus type 2 (86.3%), and treatable STIs (18.6%). Men who have sex with men reported more recent casual partners, sex work, and alcohol and drug use than other subgroups. POC (22.8%), PIs (31.3%), and access to advice and information regarding HIV at the point of HIV care (24.1%) were limited. Of subjects with past-year STI symptoms (N = 267), 44.1% had sought medical attention. In multivariate analysis, POC was negatively associated with multiple partners. PI was associated with self-initiated testing, treatable STIs, and female sex. Both outcomes were associated with HIV-related discrimination outside of the health services context. Coverage of POC, PIs, and treatment-seeking for STI symptoms was low among individuals with diagnosed HIV infection, although most were in regular contact with care and treatment. Prevention programs at testing and treatment sites should be intensified and should incorporate risk behavior screening to improve targeting.

Idiopathic thrombocytopenic purpura diagnosed during the second decade of life.

PubMed

Lowe, Eric J; Buchanan, George R

2002-08-01

To retrospectively review our institutional experience of adolescents with idiopathic thrombocytopenic purpura (ITP). Medical record review of all patients diagnosed with ITP between the ages of 10 and 18 years seen at our center from January 1976 to March 2000. Data were collected from 126 patients. Of the evaluable 110 cases, 63 (57%) satisfied the criteria for chronic ITP, 30 (27%) for acute ITP, and 17 (15%) were uncertain. Sex distribution and mean ages were similar in all 3 groups. Platelet count at presentation was higher in patients with chronic ITP. Splenectomy was performed in 24 patients, with 17 (77%) of 22 having normal platelet counts at last follow-up. Outcome for the nonsplenectomized patients with chronic ITP included normalization of platelet count (n = 4), minimal or no bleeding without treatment (n = 29), treatment for ongoing symptoms (n = 5), and unknown (n = 1). Two patients died, 1 from intracranial hemorrhage and 1 from Escherichia coli sepsis and pulmonary hemorrhage. Patients 10 to 18 years of age with ITP are more likely than younger children to have chronic disease. Many patients with ITP recover without drug therapy or need for splenectomy. ITP in adolescents shares features of both childhood and adult ITP.

Quantifying the changes in survival inequality for Indigenous people diagnosed with cancer in Queensland, Australia.

PubMed

Baade, Peter D; Dasgupta, Paramita; Dickman, Paul W; Cramb, Susanna; Williamson, John D; Condon, John R; Garvey, Gail

2016-08-01

The survival inequality faced by Indigenous Australians after a cancer diagnosis is well documented; what is less understood is whether this inequality has changed over time and what this means in terms of the impact a cancer diagnosis has on Indigenous people. Survival information for all patients identified as either Indigenous (n=3168) or non-Indigenous (n=211,615) and diagnosed in Queensland between 1997 and 2012 were obtained from the Queensland Cancer Registry, with mortality followed up to 31st December, 2013. Flexible parametric survival models were used to quantify changes in the cause-specific survival inequalities and the number of lives that might be saved if these inequalities were removed. Among Indigenous cancer patients, the 5-year cause-specific survival (adjusted by age, sex and broad cancer type) increased from 52.9% in 1997-2006 to 58.6% in 2007-2012, while it improved from 61.0% to 64.9% among non-Indigenous patients. This meant that the adjusted 5-year comparative survival ratio (Indigenous: non-Indigenous) increased from 0.87 [0.83-0.88] to 0.89 [0.87-0.93], with similar improvements in the 1-year comparative survival. Using a simulated cohort corresponding to the number and age-distribution of Indigenous people diagnosed with cancer in Queensland each year (n=300), based on the 1997-2006 cohort mortality rates, 35 of the 170 deaths due to cancer (21%) expected within five years of diagnosis were due to the Indigenous: non-Indigenous survival inequality. This percentage was similar when applying 2007-2012 cohort mortality rates (19%; 27 out of 140 deaths). Indigenous people diagnosed with cancer still face a poorer survival outlook than their non-Indigenous counterparts, particularly in the first year after diagnosis. The improving survival outcomes among both Indigenous and non-Indigenous cancer patients, and the decreasing absolute impact of the Indigenous survival disadvantage, should provide increased motivation to continue and enhance

Sporotrichal Tenosynovitis Diagnosed Helpfully by Musculoskeletal Ultrasonography

PubMed Central

Shimizu, Takashi; Akita, Shosuke; Harada, Yoshinori; Oguro, Eri; Okita, Yasutaka; Shigesaka, Minoru; Matsuoka, Hidetoshi; Nii, Takuro; Teshigawara, Satoru; Kudo-Tanaka, Eriko; Tsuji, Soichiro; Matsushita, Masato; Ohshima, Shiro; Hoshida, Yoshihiko; Hashimoto, Jun; Saeki, Yukihiko

2017-01-01

A 72-year-old man presented with persistent oligoarthritis and positive results for rheumatoid factor and was suspected of having rheumatoid arthritis (RA). However, the musculoskeletal ultrasonography (MSUS) findings were not consistent with those of typical RA. He had undergone surgery for carpal tunnel syndrome, which allowed both histopathological and microbiological examinations to be performed. A synovial tissue culture was positive for Sporothrix schenckii, and he was diagnosed with sporotrichal tenosynovitis. He received anti-fungal therapy, and the sporotrichal tenosynovitis resolved. This case suggests that MSUS is a useful modality, and sporotrichal tenosynovitis, though rare, should be considered in the differential diagnosis of RA. PMID:28502945

Non-contrast magnetic resonance imaging for diagnosing shoulder injuries.

PubMed

Arnold, Heino

2012-12-01

To compare preoperative non-contrast magnetic resonance imaging (MRI) with arthroscopy findings in diagnosing labral and rotator cuff tears. 86 men and 60 women aged 21 to 70 (mean, 52) years underwent non-contrast MRI before arthroscopic operations on the glenohumeral joint. Slices were made in a transverse, parasagittal, and paracoronar orientation. The sequences used were T2- and proton-weighted for paracoronar imaging, T1- and T2-weighted for transverse and parasagittal imaging, and T2-weigthed sequences with fat suppression and short tau inversion recovery sequences. MRI was evaluated with the surgeon to eliminate interobserver bias. Arthroscopic surgery was performed by a single surgeon. If a labral or rotator cuff tear was found, surgery was performed using corkscrew anchors. For full thickness rotator cuff tears, MRI and arthroscopy detected them in 76 and 82 patients, respectively. One such tear found by MRI could not be confirmed by arthroscopy. MRI missed 4 subscapularis and 3 supraspinatus tears. The sensitivity and specificity of MRI in diagnosing full thickness rotator cuff tears were 0.90 and 0.91, respectively. For labral tears, MRI and arthroscopy detected them in 16 and 31 patients, respectively. One anterior labral tear detected by MRI could not be verified by arthroscopy. All 16 labral tears detected by MRI were Bankart type-I tears (of the anterior glenoid) except for one superior labral tear from anterior to posterior (SLAP tear). All 13 SLAP tears (10 type 2 and 3 type 3) except for one could be found by arthroscopy only. The sensitivity and specificity of MRI in diagnosing labral tears were 0.52 and 0.89, respectively. Non-contrast MRI is reliable only for diagnosing full thickness rotator cuff tears and anterior labral tears. Direct or indirect contrast enhancement is recommended for more differentiation. Special scan orientation is necessary for SLAP tears.

Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002–2008

PubMed Central

Metzler, Thomas J.; Gima, Kristian S.; Bertenthal, Daniel; Maguen, Shira; Marmar, Charles R.

2009-01-01

Objectives. We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans. Methods. We determined the prevalence and predictors of mental health diagnoses among 289 328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data. Results. Of 289 328 Iraq and Afghanistan veterans, 106 726 (36.9%) received mental health diagnoses; 62 929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD. Conclusions. Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness. PMID:19608954

Diagnosing Students' Understanding of Energy and Its Related Concepts in Biological Context

ERIC Educational Resources Information Center

Chabalengula, Vivien Mweene; Sanders, Martie; Mumba, Frackson

2012-01-01

This study diagnosed the understanding about energy and biological-context energy concepts held by 90 first-year South African university biology students. In particular, students' explanations of energy in a biological context, how energy is involved in different biological situations and whether energy is present and what types of energy are…

Health care experiences among women diagnosed with gestational breast cancer.

PubMed

Hammarberg, K; Sullivan, E; Javid, N; Duncombe, G; Halliday, L; Boyle, F; Saunders, C; Ives, A; Dickinson, J E; Fisher, J

2018-03-01

Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi-structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were "communication" and "comprehensive care." "Communication" had two sub themes: "interdisciplinary communication" (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and "patient communication" (how they communicated this to the woman). The "comprehensive care" theme incorporated three sub themes: "the spirit" (psychological care); "the mind" (information provision); and "the body" (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care; offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised; and inform the development of resources to assist women and their families. © 2017 John Wiley & Sons Ltd.

Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore.

PubMed

Kaur, Palvinder; Saxena, Nakul; You, Alex Xiaobin; Wong, Raymond C C; Lim, Choon Pin; Loh, Seet Yoong; George, Pradeep Paul

2018-05-20

Multimorbidity in patients with heart failure (HF) results in poor prognosis and is an increasing public health concern. We aim to examine the effect of multimorbidity focusing on type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) on all-cause and cardiovascular disease (CVD)-specific mortality among patients diagnosed with HF in Singapore. Retrospective cohort study. Primary and tertiary care in three (out of six) Regional Health Systems in Singapore. Patients diagnosed with HF between 2003 and 2016 from three restructured hospitals and nine primary care polyclinics were included in this retrospective cohort study. All-cause mortality and CVD-specific mortality. A total of 34 460 patients diagnosed with HF from 2003 to 2016 were included in this study and were followed up until 31 December 2016. The median follow-up time was 2.1 years. Comorbidities prior to HF diagnosis were considered. Patients were categorised as (1) HF only, (2) T2DM+HF, (3) CKD+HF and (4) T2DM+CKD+HF. Cox regression model was used to determine the effect of multimorbidity on (1) all-cause mortality and (2) CVD-specific mortality. Adjusting for demographics, other comorbidities, baseline treatment and duration of T2DM prior to HF diagnosis, 'T2DM+CKD+HF' patients had a 56% higher risk of all-cause mortality (HR: 1.56, 95% CI 1.48 to 1.63) and a 44% higher risk of CVD-specific mortality (HR: 1.44, 95% CI 1.32 to 1.56) compared with patients diagnosed with HF only. All-cause and CVD-specific mortality risks increased with increasing multimorbidity. This study highlights the need for a new model of care that focuses on holistic patient management rather than disease management alone to improve survival among patients with HF with multimorbidity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Brain-derived neurotrophic factor (BDNF) plasma concentration in patients diagnosed with premature ovarian insufficiency (POI).

PubMed

Czyzyk, Adam; Filipowicz, Dorota; Podfigurna, Agnieszka; Ptas, Paula; Piestrzynska, Malgorzata; Smolarczyk, Roman; Genazzani, Andrea R; Meczekalski, Blazej

2017-05-01

Premature ovarian insufficiency (POI) is defined as a cessation of function of ovaries in women younger than 40 years old. Brain-derived neurotrophic factor (BDNF) is a protein critically involved in neuronal growth and metabolism. BDNF also has been shown to be important regulator of oocyte maturation. Recent data show that BDNF can be potentially involved in POI pathology. The aim of the study was to assess the BDNF plasma concentrations in patients diagnosed with idiopathic POI. 23 women diagnosed with POI (age 31 ± 7 years) and 18 (age 31 ± 3) controls were included to the study, matched according to age and body mass index. The BDNF concentrations were measured using competitive enzyme-linked immunosorbent assay (ELISA). Hormonal and metabolic parameters were measured in all individuals, in controls in late follicular phase. The POI group demonstrated lower mean plasma concentrations of BDNF (429.25 ± 65.52 pg/ml) in comparison to healthy controls (479.75 ± 34.75 pg/ml, p = 0.0345). The BDNF plasma concentration correlated negatively (R = -0.79, p < 0.001) with number of months since last menstrual period. There was a positive correlation between BDNF and progesterone in controls. In conclusion, POI patients show significantly lower BDNF plasma concentration and it correlates with the duration of amenorrhea. This observation brings important potential insights to the pathology of POI.

Recurrent intracranial solitary fibrous tumor initially diagnosed as hemangiopericytoma.

PubMed

Hori, Emiko; Kurimoto, Masanori; Fukuda, Osamu; Takahashi, Chiaki; Nagai, Shoichi; Oya, Takeshi; Endo, Shunro

2007-01-01

We describe a case of an intracranial solitary fibrous tumor that recurred three times consecutively in an 11-year period. A 72-year-old man presented with a headache and gait disturbance. Magnetic resonance imaging (MRI) revealed a dumbbell tumor at the left tentorium. The tumor was removed but recurred. The first diagnosis was hemangiopericytoma, but all specimens showed a "patternless pattern" and few reticulin fibers, which features were not compatible with hemangiopericytoma. All tumors showed immunoreactivity for CD34 and bcl-2. These results point to a solitary fibrous tumor (SFT) and not to hemangiopericytoma. We present here a hypercellular spindle-cell tumor that was very similar to hemangiopericytoma but is better diagnosed as SFT.

The validity and reliability of diagnoses of work-related mental ill-health.

PubMed

O'Neill, E; McNamee, R; Agius, R; Gittins, M; Hussey, L; Turner, S

2008-11-01

To establish the reliability and validity of work-related mental ill-health diagnoses. A UK-based surveillance scheme for work-related ill-health involving occupational physicians (OPs) reporting suggests that mental ill-health incidence is increasing by around 13% per year, with anxiety, depression and "other work-related stress" being the most common diagnoses. There have been no studies of the validity and reliability of such diagnoses. Given the existence of a large network of psychiatrists (PSYs) also involved in surveillance of work-related ill-health, an opportunity arose to measure the concurrent validity and reliability of work-related mental ill-health diagnoses. 100 anonymised summaries of cases previously reported by OPs or PSYs were collected; each was sent to 5 PSYs and 5 OPs, who assigned a diagnosis and judged whether the case was work-related. Concurrent validity of the ill-health aspect of the diagnoses, and of the opinion as to work-relatedness, was assessed by comparing the overall classifications of cases by OPs and PSYs. Reliability of the diagnostic classification was measured by kappa matrices. Diagnostic proportions for PSYs and OPs demonstrated good agreement for anxiety, depression, anxiety plus depression and "stress" (11%, 34%, 27%, 14%) and (14%, 30%, 27%, 17%), respectively. In both groups, kappa coefficients were high for a psychotic diagnosis (0.78, 95% CI: 0.74 to 0.83), but not as high for anxiety (0.27, 95% CI: 0.23 to 0.32), depression (0.34, 95% CI: 0.29 to 0.38) and "stress" (0.15, 95% CI: 0.10 to 0.19). The odds ratio of classifying a case as work-related among PSYs compared to OPs was 2.39 (95% CI: 1.68 to 3.38), p<0.001. The overall agreement between OPs and PSYs on mental ill-health diagnoses suggests that OP diagnoses are valid for epidemiological purposes. However, the within-group reliability of the diagnosis "stress" is low. Given differences in judgements about work-relatedness, further research is needed to

Tinea capitis in Campania, Italy: a 9-year retrospective study.

PubMed

Calabrò, G; Patalano, A; Fiammenghi, E; Chianese, C

2015-08-01

The present work was carried out to study the prevalence of Tinea capitis (TC) in Campania over a 9-year period and also to delineate the prevalence of the causative fungus responsible and the clinical forms of tinea capitis. This retrospective study included all the cases of TC occurring between January 2004 and December 2012 to the Mycology Laboratory at the University of Naples "Federico II" and mycologically confirmed. Samples for potassium hydroxide 20% mounts and fungal cultures were collected. Sabouraud dextrose agar were inoculated with the samples. TC was diagnosed by direct microscopy and culture in 143 patients. TC was found to be most common in the group including patients aged between 1-18 years; 13% of patients were over 18 years old. Non-inflammatory clinical forms were the most common type (80.4%). M. canis was the dermatophyte most frequently isolated (64.1%). Microscopic examination revealed an ectothrix pattern of hair invasion to be more common (72% cases). TC was clinical and mycologically diagnosed in 143 patients. It was prevalent in patients aged 1-18 years old; 73.2% of adults affected by TC had possible risk factors and in these patients TC often presented in atypical forms; atypical forms were also observed in children. M. canis was the most common dermatophyte species isolated in children, T. rubrum in adults. We noticed a significant increase of anthropophilic dermatophytes possibly linked to the immigration from African countries. For the diagnosis of TC, mycological examinations are essential.

Influence of frailty-related diagnoses, high-risk prescribing in elderly adults, and primary care use on readmissions in fewer than 30 days for veterans aged 65 and older.

PubMed

Pugh, Jacqueline A; Wang, Chen-Pin; Espinoza, Sara E; Noël, Polly H; Bollinger, Mary; Amuan, Megan; Finley, Erin; Pugh, Mary Jo

2014-02-01

To determine the effect of two variables not previously studied in the readmissions literature (frailty-related diagnoses and high-risk medications in the elderly (HRME)) and one understudied variable (volume of primary care visits in the prior year). Retrospective cohort study using data from a study designed to examine outcomes associated with inappropriate prescribing in elderly adults. All Veterans Affairs (VA) facilities with acute inpatient beds in fiscal year 2006 (FY06). All veterans aged 65 and older by October 1, 2005, who received VA care at least once per year between October 1, 2004, and September 30, 2006, and were hospitalized at least once during FY06 on a medical or surgical unit. A generalized linear interactive risk prediction model included demographic and clinical characteristics (mental health and chronic medical conditions, frailty-related diagnoses, number of medications) in FY05; incident HRME in FY06 before index hospitalization or readmission; chronic HRME in FY05; and FY05 emergency department (ED), hospital, geriatric, palliative, or primary care use. Facility-level variables were complexity, rural versus urban, and FY06 admission rate. The mean adjusted readmission rate was 18.3%. The new frailty-related diagnoses variable is a risk factor for readmission in addition to Charlson comorbidity score. Incident HRME use was associated with lower rates of readmission, as were higher numbers of primary care visits in the prior year. Frailty-related diagnoses may help to target individuals at higher risk of readmission to receive more-intensive care transition services. HRME use does not help in this targeting. A higher number of face-to-face primary care visits in the prior year, unlike ED and hospital use, correlates with fewer readmissions and may be another avenue for targeting prevention strategies. Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.

High-Resolution Methods for Diagnosing Cartilage Damage In Vivo

PubMed Central

Novakofski, Kira D.; Pownder, Sarah L.; Koff, Matthew F.; Williams, Rebecca M.; Potter, Hollis G.; Fortier, Lisa A.

2016-01-01

Advances in current clinical modalities, including magnetic resonance imaging and computed tomography, allow for earlier diagnoses of cartilage damage that could mitigate progression to osteoarthritis. However, current imaging modalities do not detect submicrometer damage. Developments in in vivo or arthroscopic techniques, including optical coherence tomography, ultrasonography, bioelectricity including streaming potential measurement, noninvasive electroarthrography, and multiphoton microscopy can detect damage at an earlier time point, but they are limited by a lack of penetration and the ability to assess an entire joint. This article reviews current advancements in clinical and developing modalities that can aid in the early diagnosis of cartilage injury and facilitate studies of interventional therapeutics. PMID:26958316

Hospital-Diagnosed Dementia and Suicide: A Longitudinal Study Using Prospective, Nationwide Register Data

PubMed Central

Erlangsen, Annette; Zarit, Steven H.; Conwell, Yeates

2013-01-01

Objective The current study aims to examine the risk of suicide in persons diagnosed with dementia during a hospitalization and its relationship to mood disorders. Design Event-history analysis using time-varying covariates. Setting Population-based record linkage. Participants All individuals aged 50+ living in Denmark (N = 2,474,767) during January 1, 1990 through December 31, 2000. Measurements Outcome of interest is suicide. Relative risks are calculated based on person-days spent in each stratum. Results A total of 18,648,875 person-years were observed during the 11-year study period. During this period, 136 persons who previously had been diagnosed with dementia died by suicide. Men and women aged 50–69 years with hospital presentations of dementia have a relative suicide risk of 8.5 (95% confidence interval: 6.3–11.3) and 10.8 (95% confidence interval: 7.4–15.7), respectively. Those who are aged 70 or older with dementia have a threefold higher risk than persons with no dementia. The time shortly after diagnosis is associated with an elevated suicide risk. The risk among persons with dementia remains significant when controlling for mood disorders. As many as 26% of the men and 14% of the women who died by suicide died within the first 3 months after being diagnosed whereas 38% of the men and 41% of the women died more than 3 years after initial dementia diagnosis. Conclusions Dementia, determined during hospitalization, was associated with an elevated risk of suicide for older adults. Preventive measures should focus on suicidal ideation after initial diagnosis but also acknowledge that suicides can occur well after a dementia diagnosis has been established. PMID:18310552

Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis.

PubMed

Kwee, Robert M; Broos, Wouter Am; Brans, Boudewijn; Walenkamp, Geert Him; Geurts, Jan; Weijers, René E

2018-05-01

Background The diagnosis of infected hip prosthesis is frequently not straightforward yet very important as it changes treatment. Purpose To retrospectively investigate the added value of 18F-FDG PET/CT to conventional tests including radiography, erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) testing, and joint aspiration, in diagnosing infected hip prosthesis. Material and Methods Seventy-eight hip prostheses of 78 patients (55% men; mean age = 66.5 years; age range = 30-85 years) with non-specific clinical presentation, i.e. no abscess or sinus tract communicating with the joint space at clinical examination, were analyzed. Cultures of intra-articular fluid and peri-implant tissues after revision surgery or clinical follow-up ≥6 months served as gold standard. Areas under the receiver operating characteristic curves (AUCs) of radiography, ESR/CRP testing, aspiration culture, and white blood cell (WBC) count without and with the addition of 18F-FDG PET/CT were compared. Results The addition of 18F-FDG PET/CT increased AUCs: for radiography with 0.212, P = 0.001; for ESR/CRP testing with 0.076, P = 0.072; for aspiration culture with 0.126, P = 0.032; and for aspiration WBC count with 0.191, P = 0.035. Conclusion This study shows that 18F-FDG PET/CT adds to individual conventional tests in diagnosing infected hip prosthesis. It may improve the preoperative planning and should therefore be considered in the diagnostic work-up. Future studies should define the exact place of 18F-FDG PET/CT in the diagnostic work-up of periprosthetic joint infection.

Trends in work disability with mental diagnoses among social workers in Finland and Sweden in 2005-2012.

PubMed

Rantonen, O; Alexanderson, K; Pentti, J; Kjeldgård, L; Hämäläinen, J; Mittendorfer-Rutz, E; Kivimäki, M; Vahtera, J; Salo, P

2017-12-01

Aims Social workers report high levels of stress and have an increased risk for hospitalisation with mental diagnoses. However, it is not known whether the risk of work disability with mental diagnoses is higher among social workers compared with other human service professionals. We analysed trends in work disability (sickness absence and disability pension) with mental diagnoses and return to work (RTW) in 2005-2012 among social workers in Finland and Sweden, comparing with such trends in preschool teachers, special education teachers and psychologists. Records of work disability (>14 days) with mental diagnoses (ICD-10 codes F00-F99) from nationwide health registers were linked to two prospective cohort projects: the Finnish Public Sector study, years 2005-2011 and the Insurance Medicine All Sweden database, years 2005-2012. The Finnish sample comprised 4849 employees and the Swedish 119 219 employees covering four occupations: social workers (Finland 1155/Sweden 23 704), preschool teachers (2419/74 785), special education teachers (832/14 004) and psychologists (443/6726). The reference occupations were comparable regarding educational level. Risk of work disability was analysed with negative binomial regression and RTW with Cox proportional hazards. Social workers in Finland and Sweden had a higher risk of work disability with mental diagnoses compared with preschool teachers and special education teachers (rate ratios (RR) 1.43-1.91), after adjustment for age and sex. In Sweden, but not in Finland, social workers also had higher work disability risk than psychologists (RR 1.52; 95% confidence interval 1.28-1.81). In Sweden, in the final model special education teachers had a 9% higher probability RTW than social workers. In Sweden, in the final model the risks for work disability with depression diagnoses and stress-related disorder diagnoses were similar to the risk with all mental diagnoses (RR 1.40-1.77), and the probability of RTW was 6% higher in

Prevalence of Chronic Diabetic Complications in Newly Diagnosed versus Known Type 2 Diabetic Subjects in a Sample of Alexandria Population, Egypt.

PubMed

Khalil, Samir Assaad; Megallaa, Magdy Helmy; Rohoma, Kamel Hemida; Guindy, Myriam AbouSeif; Zaki, Adel; Hassanein, Mohamed; Malaty, Amin Helmy; Ismael, Hanaa Mohamed; Kharboush, Ibrahim Fahmy; El Kafash, Dalal Nasr-Eldein; Sallam, Hassan Nooman; Desouky, Iman Abdelkareem

2018-01-24

In Egypt, data on the prevalence of chronic diabetic complications, which are essential for the adjustment of policies and practices related to diabetes care, are scarce. Therefore, the aim of this study was to determine the frequency of chronic complications of diabetes; namely neuropathy, diabetic kidney disease (DKD), retinopathy and peripheral arterial disease (PAD) in newly-diagnosed versus known type 2 diabetic patients. This is a cross-sectional study that is based on a previous household survey conducted on a representative sample of the population of Alexandria, Egypt. This study included 506 consecutive subjects with type 2 diabetes; 323 patients with previously known T2DM and 183 patients with newly diagnosed T2DM (discovered during the survey). For each participant, a focused history was taken. Comprehensive clinical examination was done including fundus examination, foot examination and assessment of ankle brachial index. Laboratory tests included HbAlc, lipids profile, serum creatinine and urinary albumin creatinine ratio (UACR). Peripheral neuropathy was detected in 20% of the studied patients; 29.4% of known patients and 3.3% of newly diagnosed patients (p<0.001). Diabetic kidney disease was detected in 33.2% of the studied patients; 46.1% of known patients and 10.4% of newly diagnosed patients (p<0.001). Diabetic retinopathy was detected in 34.6% of the studied patients; 48.3% of known patients and 10.4% of newly diagnosed patients (p<0.001). Peripheral arterial disease was detected in 32.6% of the studied patients; 45.5% of known patients and 9.8% of newly diagnosed patients (p<0.001). In patients with known diabetes, the presence of any of the studied complications (neuropathy, diabetic kidney disease, retinopathy or PAD) was significantly associated with the presence of all other complications (p< 0.001). In patients with newly-diagnosed diabetes, the presence of diabetic kidney disease was significantly associated with the presence of

Trends in sports-related concussion diagnoses in the USA: a population-based analysis using a private-payor database.

PubMed

Amoo-Achampong, Kelms; Rosas, Samuel; Schmoke, Nicholas; Accilien, Yves-Dany; Nwachukwu, Benedict U; McCormick, Frank

2017-09-01

To describe recent epidemiological trends in concussion diagnosis within the United States (US) population. We conducted a retrospective review of PearlDiver, a private-payor insurance database. Our search included International Classification of Disease, Ninth Revision codes for sports-related concussions spanning 2010 through 2014. Overall study population included patients aged 5 to 39 with subgroup analysis performed on Cohort A (Youth), children and adolescents aged 5 to 19, and Cohort B (Adults), adults aged 20 to 39. Incidence was defined as the number of individuals diagnosed normalized to the number of patients in the database for each demographic. Our search returned 1,599 patients diagnosed during the study period. The average (±SD) annual rate was 4.14 ± 1.42 per 100,000 patients for the overall population. Youth patients were diagnosed at a mean annual rate of 3.78 ± 1.30 versus 0.36 ± 0.16 per 100,000 in Adults. Concussion normalized incidence significantly increased from 2.47 to 3.87 per 100,000 patients (57%) in the Youth cohort (p = 0.048). In Adults, rate grew from 0.34 to 0.44 per 100,000 patients (29%) but was not statistically significant (p = 0.077). Four-year compound annual growth rates for Youth and Adults were 26.3% and 20.4%, respectively. Youth patients comprised 1,422/1,599 (90.18%) of all concussion diagnoses and were predominantly male (75%). Adults also constituted 138/1,599 (8.63%) of the sample and were also largely male (80%). Midwestern states had highest diagnostic rates (Cohort A:19 per 100,000 and Cohort B:1.8 per 100,000). Both cohorts had the most total diagnoses made in the fourth quarter followed by the second quarter. Sports-related concussion diagnostic rates have grown significantly in the youth population. Quarterly, regional and gender distributions appear consistent with participation in concussion-prone sports. Utilization of individualized and multifaceted approaches are recommended to advance

Autologous hematopoietic stem cell transplantation and conventional insulin therapy in the treatment of children with newly diagnosed type 1 diabetes: long term follow-up.

PubMed

Gu, Yi; Gong, Chunxiu; Peng, Xiaoxia; Wei, Liya; Su, Chang; Qin, Miao; Wang, Xi'ou; Li, Fengting

2014-01-01

It has been indicated that autologous hematopoietic stem cell transplantation (AHST) is a promising treatment to adults with type 1 diabetes, however, the application of AHST therapy to children with type 1 diabetes still needs more data. The aim of this study was to assess the clinical effect of immune intervention combined with AHST and conventional insulin therapy in the treatment of children with newly diagnosed type 1 diabetes. This 1:2 matched case-control study was comprised of 42 children who were newly diagnosed with type 1 diabetes in the Department of Endocrinology, Beijing Children's Hospital from 2009-2010. The case group included 14 patients, who were treated with AHST within the first 3 months after being diagnosed with diabetes at request of their parents during 2009-2010. The control group included 28 patients with newly diagnosed type 1 diabetes at the same period of hospitalization. We compared the baseline and follow-up data of them, including ketoacidosis onset, clinical variables (glycosylated hemoglobin (HbA1c), insulin dosage and serum C-peptide). The clinical characteristics of the patients was comparable between the case group and the control group. At 6-12 months ((10.7±4.2) months) after AHST treatment, we found 11 patients in the case group did not stop the insulin therapy, three cases stopped insulin treatment for 2, 3 and 11 months, respectively. No diabetic ketoacidosis (DKA) occurred after transplantation in all the patients in the case group. HbA1c in the control group was significant lower than that in the case group (P < 0.01), while the insulin dosage and serum C-peptide were not significant different between the two groups (P > 0.05). In order to eliminate the honeymoon effect, we performed final follow-up at the 3-5 years ((4.2±1.8) years) after AHST treatment, and found that HbA1c in the control group was still lower than that in the case group (P < 0.01); however, the insulin dosage and serum C-peptide were not

CT angiography in the setting of suspected acute mesenteric ischemia: prevalence of ischemic and alternative diagnoses.

PubMed

Henes, Frank Oliver; Pickhardt, Perry J; Herzyk, Andrzej; Lee, Scott J; Motosugi, Utaroh; Derlin, Thorsten; Lubner, Meghan G; Adam, Gerhard; Schön, Gerhard; Bannas, Peter

2017-04-01

The purpose of the study was to determine the prevalence of ischemic and alternative diagnoses and the diagnostic accuracy of CT angiography (CTA) in the setting of suspected acute mesenteric ischemia (AMI). We included 959 patients undergoing CTA for the evaluation of suspected AMI. The final clinical diagnosis was used to determine the prevalence of ischemic and alternative diagnoses and to calculate the diagnostic accuracy of CTA. Prevalence of diagnoses by age, sex, and admission status was compared using Cochran-Armitage and χ 2 tests. Prevalence was 18.8% (180/959) for AMI and 61.2% (587/959) for specific alternative diagnoses. In the remaining 20.0% (192/959), no clear clinical diagnosis was established. The most frequent alternative diagnoses were small-bowel obstruction (10.4%; 61/587), infectious colitis (8.7%; 51/587), pneumonia (6.5%; 38/587), cholecystitis (6.1%; 36/587), and diverticulitis (5.6%; 33/587). Prevalence of specific alternative diagnoses varied significantly according to both age (p < .013) and admissions status (p < 0.001). CTA had a sensitivity and specificity for diagnosing AMI of 89.4%/99.5% and for alternative diagnoses of 86.7%/96.9%, respectively. In the setting of suspected AMI, the prevalence of ischemic and alternative diagnoses varies significantly by age, sex, and admission status. CTA provides for rapid and non-invasive assessment of ischemic and alternative diagnoses with high diagnostic accuracy.

Clinical profiles and trend analysis of newly diagnosed lung cancer in a tertiary care hospital of East China during 2011-2015.

PubMed

Wang, Pingli; Zou, Jixia; Wu, Jingni; Zhang, Chengyan; Ma, Chengxi; Yu, Juan; Zhou, You; Li, Baizhou; Wang, Kai

2017-07-01

More than one-third of lung cancer worldwide occurring in China. However, the clinical profiles of lung cancer patients in the mainland of China are rarely reported and largely unknown. The objective of this study is to analyze the characteristics and time trends of newly diagnosed lung cancer cases during the past 5 years in East China. The data came from an academic tertiary care hospital of East China. Patients who were newly diagnosed as lung cancer from 2011 to 2015 were enrolled. All new cases got pathological supports by lung biopsy or surgery. Tumor staging was performed according to the seventh edition of the tumor node metastasis (TNM) classification of malignant tumors. The patients' disease information was collected from the database of the hospital information system (HIS). From 2011 to 2015, aggregately 5,779 patients, including 3,719 males and 2,060 females, were diagnosed as lung cancer. The major histologic subtypes of lung cancer were adenocarcinoma (ADC, 60.0%), squamous cell carcinoma (SCC, 25.6%), small cell lung cancer (SCLC, 8.5%), large cell carcinoma (0.6%), adenosquamous carcinoma (1%), other non-small cell carcinoma (1.6%) and unclassified or rare carcinoma (2.8%). ADC proportion of female was much higher than that of male. A higher proportion of advanced stage (stage IIIB, IV) of lung cancer existed in patients who were admitted to hospital due to respiratory or cancer related symptoms (RCRS) than those without RCRS. Smoking rate in male patients reached 80.2%, while it was only 2.7% in females. EGFR mutation existed in 66% of female and 37% of male patients with ADC. This study demonstrates the clinicopathologic characteristics of lung cancer patients from East China, including histologic composition, staging proportion, smoking prevalence and gene mutation status. During the past 5 years, the proportion of ADC has increased gradually whereas SCC decreased.

Sexually transmitted diseases diagnosed among travelers returning from the tropics.

PubMed

Ansart, Séverine; Hochedez, Patrick; Perez, Lucia; Bricaire, François; Caumes, Eric

2009-01-01

Data are lacking on the spectrum of sexually transmitted diseases (STDs) diagnosed in returning travelers. All consecutive travelers consulting our tropical unit between November 1, 2002 and October 31, 2003 were included if they presented within 1 month after their return from the tropics, with mucocutaneous signs suggesting STDs. Forty-nine patients (12 women and 37 men; median age 36.4 y, 35 heterosexuals) were included. Four patients had traveled with their usual sexual partner and 45 patients had casual sex while abroad (31 with locals and 14 with other tourists). The main diagnoses were gonococcal urethritis (n = 18), herpes simplex virus 2 infection (n = 12), urethritis of undetermined origin (n = 9), Chlamydia trachomatis infection (n = 4), primary syphilis (n = 4), and primary human immunodeficiency virus infection (n = 2). These results illustrate the broad spectrum of STDs contracted by travelers to the tropics. They suggest the need to also inform travelers of the risks of STD and to promote the use of condoms in case of casual sex while abroad.

Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics.

PubMed

Moy, Ernest; Barrett, Marguerite; Coffey, Rosanna; Hines, Anika L; Newman-Toker, David E

2015-02-01

An estimated 1.2 million people in the US have an acute myocardial infarction (AMI) each year. An estimated 7% of AMI hospitalizations result in death. Most patients experiencing acute coronary symptoms, such as unstable angina, visit an emergency department (ED). Some patients hospitalized with AMI after a treat-and-release ED visit likely represent missed opportunities for correct diagnosis and treatment. The purpose of the present study is to estimate the frequency of missed AMI or its precursors in the ED by examining use of EDs prior to hospitalization for AMI. We estimated the rate of probable missed diagnoses in EDs in the week before hospitalization for AMI and examined associated factors. We used Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases for 2007 to evaluate missed diagnoses in 111,973 admitted patients aged 18 years and older. We identified missed diagnoses in the ED for 993 of 112,000 patients (0.9% of all AMI admissions). These patients had visited an ED with chest pain or cardiac conditions, were released, and were subsequently admitted for AMI within 7 days. Higher odds of having missed diagnoses were associated with being younger and of Black race. Hospital teaching status, availability of cardiac catheterization, high ED admission rates, high inpatient occupancy rates, and urban location were associated with lower odds of missed diagnoses. Administrative data provide robust information that may help EDs identify populations at risk of experiencing a missed diagnosis, address disparities, and reduce diagnostic errors.

The effect of start and stop age at screening on the risk of being diagnosed with prostate cancer

PubMed Central

Arnsrud Godtman, Rebecka; Carlsson, Sigrid; Holmberg, Erik; Stranne, Johan; Hugosson, Jonas

2016-01-01

Purpose The aim of this study was to investigate the effect of age and number of screens on the risk of prostate cancer (PCa) diagnosis. Materials and Methods The Göteborg randomized population-based PCa screening trial has, since 1995, invited men biennially for prostate-specific antigen (PSA)-testing, until the upper age limit 70 years. Men with a PSA-level above the threshold ≥2.5 ng/ml were recommended further work-up including 10-core biopsy (sextant before 2009). The present study comprises 9,065 men born 1930–43 (1944 excluded due to different screening algorithm). Complete attendees were defined as men who accepted all screening invitations (maximum 3–9 invitations). Cumulative incidence of PCa was calculated using standard methods. Results Of the 3,488 (38%) complete attendees, 667 were diagnosed with PCa (follow-up 1995–30 Jun 2014). At the age 70, there was no significant difference in PCa risk between those who started screening at the age of 52 (9 screens), 55 (7 screens) or 60 (5 screens) years. However, the cumulative risk of PCa diagnosis increased dramatically with age and was 7.9% at age 60, 15% at age 65 and 21% at age 70, for men who had been screened ≥4 times. Conclusion There was no clear association between risk of PCa and the number of screens. Starting screening at an early age appears to advance the time of PCa diagnosis but does not seem to increase the risk of being diagnosed with the disease. Age at termination of screening is strongly associated with the risk of being diagnosed with PCa. PMID:26678954

Low-Dose CT for Evaluation of Suspected Urolithiasis: Diagnostic Yield for Assessment of Alternative Diagnoses.

PubMed

Weinrich, Julius Matthias; Bannas, Peter; Regier, Marc; Keller, Sarah; Kluth, Luis; Adam, Gerhard; Henes, Frank Oliver

2018-03-01

The purpose of this study is to assess the diagnostic yield of low-dose (LD) CT for alternative diagnoses in patients with suspected urolithiasis. In this retrospective study, we included 776 consecutive patients who underwent unenhanced abdominal CT for evaluation of suspected urolithiasis. All examinations were performed with an LD CT protocol; images were reconstructed using iterative reconstruction. The leading LD CT diagnosis was recorded for each patient and compared with the final clinical diagnosis, which served as the reference standard. The mean (± SD) effective dose of CT was 1.9 ± 0.6 mSv. The frequency of urolithiasis was 82.5% (640/776). LD CT reached a sensitivity of 94.1% (602/640), a specificity of 100.0% (136/136), and an accuracy of 95.1% (738/776) for the detection of urolithiasis. In 93 of 136 patients (68.4%) without urolithiasis, alternative diagnoses were established as the final clinical diagnoses. Alternative diagnoses were most commonly located in the genitourinary (n = 53) and gastrointestinal (n = 18) tracts. LD CT correctly provided alternative diagnoses for 57 patients (61.3%) and was false-negative for five patients (5.4%). The most common clinical alternative diagnoses were urinary tract infections (n = 22). Seven diagnoses missed at LD CT were located outside the FOV. For 43 of all 776 patients (5.5%), neither LD CT nor clinical workup could establish a final diagnosis. The sensitivity, specificity, and accuracy of LD CT for the detection of alternative diagnoses were 91.9% (57/62), 95.6% (43/45), and 93.5% (100/107), respectively. LD CT enables the diagnosis of most alternative diagnoses in the setting of suspected urolithiasis. The most frequent alternative diagnoses missed by LD CT are urinary tract infections or diagnoses located outside the FOV of the abdominopelvic CT scan.

Study protocol: Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer (RESPECT).

PubMed

Thorsteinsson, Troels; Helms, Anne Sofie; Adamsen, Lis; Andersen, Lars Bo; Andersen, Karen Vitting; Christensen, Karl Bang; Hasle, Henrik; Heilmann, Carsten; Hejgaard, Nete; Johansen, Christoffer; Madsen, Marianne; Madsen, Svend Aage; Simovska, Venka; Strange, Birgit; Thing, Lone Friis; Wehner, Peder Skov; Schmiegelow, Kjeld; Larsen, Hanne Baekgaard

2013-11-14

During cancer treatment children have reduced contact with their social network of friends, and have limited participation in education, sports, and leisure activities. During and following cancer treatment, children describe school related problems, reduced physical fitness, and problems related to interaction with peers. The RESPECT study is a nationwide population-based prospective, controlled, mixed-methods intervention study looking at children aged 6-18 years newly diagnosed with cancer in eastern Denmark (n=120) and a matched control group in western Denmark (n=120). RESPECT includes Danish-speaking children diagnosed with cancer and treated at pediatric oncology units in Denmark. Primary endpoints are the level of educational achievement one year after the cessation of first-line cancer therapy, and the value of VO2max one year after the cessation of first-line cancer therapy. Secondary endpoints are quality of life measured by validated questionnaires and interviews, and physical performance. RESPECT includes a multimodal intervention program, including ambassador-facilitated educational, physical, and social interventions. The educational intervention includes an educational program aimed at the child with cancer, the child's schoolteachers and classmates, and the child's parents. Children with cancer will each have two ambassadors assigned from their class. The ambassadors visit the child with cancer at the hospital at alternating 2-week intervals and participate in the intervention program. The physical and social intervention examines the effect of early, structured, individualized, and continuous physical activity from diagnosis throughout the treatment period. The patients are tested at diagnosis, at 3 and 6 months after diagnosis, and one year after the cessation of treatment. The study is powered to quantify the impact of the combined educational, physical, and social intervention programs. RESPECT is the first population-based study to examine the

Relations between mental health diagnoses, mental health treatment, and substance use in homeless youth.

PubMed

Narendorf, Sarah Carter; Cross, Matthew B; Santa Maria, Diane; Swank, Paul R; Bordnick, Patrick S

2017-06-01

Youth experiencing homelessness have elevated rates of mental illness and substance use compared to the general population. However, the extent to which underlying mental health issues may contribute to substance use as a way to manage symptoms and whether mental health treatment may reduce risk for substance use is unclear. This paper investigated these relations in a community sample of homeless youth. Youth ages 13-24 (N=416) were interviewed as part of a community count and survey of homeless youth in Houston, Texas. A path analysis examined relations among lifetime diagnoses of ADHD, bipolar disorder, and depression; past-month marijuana, alcohol, and synthetic marijuana use, and hypothesized mediators of past-year mental health treatment and perceived unmet need for treatment. Rates of prior mental disorder diagnoses were high, with extensive comorbidity across the three diagnoses (n=114, 27.3% had all three diagnoses). Relations varied by diagnoses and substances. ADHD was positively related to current marijuana use (β=0.55 (0.16), p<0.001), a relation that mental health treatment did not mediate. Depression was positively related to synthetic marijuana use through unmet need (β=0.25 (0.09), p=0.004) and to alcohol use through unmet need (β=0.20 (0.10), p=0.04) CONCLUSIONS: This study provides new information about relations between prior mental health diagnoses and substance use in homeless youth. Findings support the need to consider prior mental disorder diagnoses in relation to current substance use and to assess for whether youth perceive they have unmet needs for mental health treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

How Is Paget's Disease of Bone Diagnosed?

MedlinePlus

... of Bone Diagnosed? How Is Paget’s Disease of Bone Diagnosed? Symptoms of Paget’s Disease Many people with ... Last Reviewed 2015-05 NIH Osteoporosis and Related Bone Diseases ~ National Resource Center 2 AMS Circle Bethesda, ...

Variability in the traditional Chinese medicine (TCM) diagnoses and herbal prescriptions provided by three TCM practitioners for 40 patients with rheumatoid arthritis.

PubMed

Zhang, Grant G; Lee, Wenlin; Bausell, Barker; Lao, Lixing; Handwerger, Barry; Berman, Brian

2005-06-01

To ascertain if previous findings of low levels of agreement of Traditional Chinese Medicine (TCM) pattern diagnoses made by TCM practitioners in patients with rheumatoid arthritis (RA) were a function of practitioner differences or would be replicated with a different sample of clinicians, and to examine the relationship between TCM diagnosis and herbal treatment plans. A prospective survey. General clinical research center, University of Maryland Hospital System, Baltimore, MD. Forty (40) patients with RA. PRACTITIONERS: Licensed acupuncturists with at least 5 years' experience and education in Chinese herbs. Three (3) TCM practitioners examined the same 40 RA patients separately, following the traditional Four Diagnostic Methods. Patients filled out questionnaires and physical examinations, including observations of the tongue and palpation of radial pulse, were conducted by the 3 practitioners. Each practitioner then provided both a TCM diagnosis and an herbal prescription. These diagnoses/prescriptions were examined with respect to the rate of agreement among the 3 practitioners. The average agreement with respect to the TCM diagnoses among the 3 TCM practitioners was 31.7 % (range, 27.5-35%). The degree to which the herbal prescriptions agreed with textbook recommended practice for each TCM diagnosis was 91.7% (range, 85-100%). The most commonly used TCM assessments in arriving at these diagnoses were inquiry about factors affecting pain and pulse diagnosis. No statistically significant differences were found between this study and our previous study regarding the level of agreement on TCM diagnosis. The average agreement of the diagnoses provided by 3 TCM practitioners was at the same low level as previously reported. No association was found between the diagnostic methods used and the consistency of diagnosis. Both studies, however, found a high degree of consistency between the TCM pattern diagnoses provided and the herbal treatment plans made as a result

Early Experience after Developing a Pathology Laboratory in Malawi, with Emphasis on Cancer Diagnoses

PubMed Central

Horner, Marie-Josephe; Shores, Carol G.; Alide, Noor; Kamiza, Steve; Kampani, Coxcilly; Chimzimu, Fred; Fedoriw, Yuri; Dittmer, Dirk P.; Hosseinipour, Mina C.; Hoffman, Irving F.

2013-01-01

Background Despite increasing cancer burden in Malawi, pathology services are limited. We describe operations during the first 20 months of a new pathology laboratory in Lilongwe, with emphasis on cancer diagnoses. Methods and Findings We performed a cross-sectional study of specimens from the Kamuzu Central Hospital pathology laboratory between July 1, 2011 and February 28, 2013. Patient and specimen characteristics, and final diagnoses are summarized. Diagnoses were categorized as malignant, premalignant, infectious, other pathology, normal or benign, or nondiagnostic. Patient characteristics associated with premalignancy and malignancy were assessed using logistic regression. Of 2772 specimens, 2758 (99%) with a recorded final diagnosis were included, drawn from 2639 unique patients. Mean age was 38 years and 63% were female. Of those with documented HIV status, 51% had unknown status, and 36% with known status were infected. Histologic specimens comprised 91% of cases, and cytologic specimens 9%. Malignant diagnoses were most common overall (n = 861, 31%). Among cancers, cervical cancer was most common (n = 117, 14%), followed by lymphoma (n = 91, 11%), esophageal cancer (n = 86, 10%), sarcoma excluding Kaposi sarcoma (n = 75, 9%), and breast cancer (n = 61, 7%). HIV status was known for 95 (11%) of malignancies, with HIV prevalence ranging from 9% for breast cancer to 81% for cervical cancer. Increasing age was consistently associated with malignancy [bivariable odds ratio 1.24 per decade increase (95% CI 1.19–1.29) among 2685 patients with known age; multivariable odds ratio 1.33 per decade increase (95% CI 1.14–1.56) among 317 patients with known age, gender, and HIV status], while HIV infection and gender were not. Conclusions Despite selection and referral bias inherent in these data, a new pathology laboratory in Lilongwe has created a robust platform for cancer care and research. Strategies to effectively capture clinical

Allocating provider resources to diagnose and treat restless legs syndrome: a cost-utility analysis.

PubMed

Padula, William V; Phelps, Charles E; Moran, Dane; Earley, Christopher

2017-10-01

Restless legs syndrome (RLS) is a neurological disorder that is frequently misdiagnosed, resulting in delays in proper treatment. The objective of this study was to analyze the cost-utility of training primary care providers (PCP) in early and accurate diagnosis of RLS. We used a Markov model to compare two strategies: one where PCPs received training to diagnose RLS (informed care) and one where PCPs did not receive training (standard care). This analysis was conducted from the US societal and health sector perspectives over one-year, five-year, and lifetime (50-year) horizons. Costs were adjusted to 2016 USD, utilities measured as quality-adjusted life-years (QALYs), and both measures were discounted annually at 3%. Cost, utilities, and probabilities for the model were obtained through a comprehensive review of literature. An incremental cost-effectiveness ratio (ICER) was calculated to interpret our findings at a willingness-to-pay threshold of $100,000/QALY. Univariate and multivariate analyses were conducted to test model uncertainty, in addition to calculating the expected value of perfect information. Providing training to PCPs to correctly diagnose RLS was cost-effective since it cost $2021 more and gained 0.44 QALYs per patient over the course of a lifetime, resulting in an ICER of $4593/QALY. The model was sensitive to the utility for treated and untreated RLS. The probabilistic sensitivity analysis revealed that at $100,000/QALY, informed care had a 65.5% probability of being cost-effective. A program to train PCPs to better diagnose RLS appears to be a cost-effective strategy for improving outcomes for RLS patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Novel Use of Ophthalmic pH Paper to Diagnose Malicious Caustic Ingestion in a Pediatric Patient

PubMed Central

Bruno, Eric C.

2018-01-01

Occult caustic ingestion in the pediatric population is a challenging diagnosis to make in the emergency department. Failure to suspect and diagnose a caustic ingestion can lead to potentially life-changing comorbidities. Historically, the diagnosis of caustic ingestion has been clinical without any suitable diagnostic tools to aid in the suspicion of occult cases. In this case, we describe a novel use of ophthalmic pH paper to diagnose caustic ingestion in a three-year-old.

Method and system for the diagnosis of disease using retinal image content and an archive of diagnosed human patient data

DOEpatents

Tobin, Kenneth W; Karnowski, Thomas P; Chaum, Edward

2013-08-06

A method for diagnosing diseases having retinal manifestations including retinal pathologies includes the steps of providing a CBIR system including an archive of stored digital retinal photography images and diagnosed patient data corresponding to the retinal photography images, the stored images each indexed in a CBIR database using a plurality of feature vectors, the feature vectors corresponding to distinct descriptive characteristics of the stored images. A query image of the retina of a patient is obtained. Using image processing, regions or structures in the query image are identified. The regions or structures are then described using the plurality of feature vectors. At least one relevant stored image from the archive based on similarity to the regions or structures is retrieved, and an eye disease or a disease having retinal manifestations in the patient is diagnosed based on the diagnosed patient data associated with the relevant stored image(s).

CT Pulmonary Angiography: Increasingly Diagnosing Less Severe Pulmonary Emboli

PubMed Central

Schissler, Andrew J.; Rozenshtein, Anna; Kulon, Michal E.; Pearson, Gregory D. N.; Green, Robert A.; Stetson, Peter D.; Brenner, David J.; D'Souza, Belinda; Tsai, Wei-Yann; Schluger, Neil W.; Einstein, Andrew J.

2013-01-01

Background It is unknown whether the observed increase in computed tomography pulmonary angiography (CTPA) utilization has resulted in increased detection of pulmonary emboli (PEs) with a less severe disease spectrum. Methods Trends in utilization, diagnostic yield, and disease severity were evaluated for 4,048 consecutive initial CTPAs performed in adult patients in the emergency department of a large urban academic medical center between 1/1/2004 and 10/31/2009. Transthoracic echocardiography (TTE) findings and peak serum troponin levels were evaluated to assess for the presence of PE-associated right ventricular (RV) abnormalities (dysfunction or dilatation) and myocardial injury, respectively. Statistical analyses were performed using multivariate logistic regression. Results 268 CTPAs (6.6%) were positive for acute PE, and 3,780 (93.4%) demonstrated either no PE or chronic PE. There was a significant increase in the likelihood of undergoing CTPA per year during the study period (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.04–1.07, P<0.01). There was no significant change in the likelihood of having a CTPA diagnostic of an acute PE per year (OR 1.03, 95% CI 0.95–1.11, P = 0.49). The likelihood of diagnosing a less severe PE on CTPA with no associated RV abnormalities or myocardial injury increased per year during the study period (OR 1.39, 95% CI 1.10–1.75, P = 0.01). Conclusions CTPA utilization has risen with no corresponding change in diagnostic yield, resulting in an increase in PE detection. There is a concurrent rise in the likelihood of diagnosing a less clinically severe spectrum of PEs. PMID:23776522

Spirometer-controlled cine magnetic resonance imaging used to diagnose tracheobronchomalacia in paediatric patients.

PubMed

Ciet, Pierluigi; Wielopolski, Piotr; Manniesing, Rashindra; Lever, Sandra; de Bruijne, Marleen; Morana, Giovanni; Muzzio, Pier Carlo; Lequin, Maarten H; Tiddens, Harm A W M

2014-01-01

Tracheobronchomalacia (TBM) is defined as an excessive collapse of the intrathoracic trachea. Bronchoscopy is the gold standard for diagnosing TBM; however it has major disadvantages, such as general anaesthesia. Cine computed tomography (CT) is a noninvasive alternative used to diagnose TBM, but its use in children is restricted by ionising radiation. Our aim was to evaluate the feasibility of spirometer-controlled cine magnetic resonance imaging (MRI) as an alternative to cine-CT in a retrospective study. 12 children with a mean age (range) of 12 years (7-17 years), suspected of having TBM, underwent cine-MRI. Static scans were acquired at end-inspiration and expiration covering the thorax using a three-dimensional spoiled gradient echo sequence. Three-dimensional dynamic scans were performed covering only the central airways. TBM was defined as a decrease of the trachea or bronchi diameter >50% at end-expiration in the static and dynamic scans. The success rate of the cine-MRI protocol was 92%. Cine-MRI was compared with bronchoscopy or chest CT in seven subjects. TBM was diagnosed by cine-MRI in seven (58%) out of 12 children and was confirmed by bronchoscopy or CT. In four patients, cine-MRI demonstrated tracheal narrowing that was not present in the static scans. Spirometer controlled cine-MRI is a promising technique to assess TBM in children and has the potential to replace bronchoscopy.

An Ethnographic Field Study of the Influence of Social Interactions during the School Day for Children Diagnosed with ADHD

ERIC Educational Resources Information Center

Feder, Kim Michéle; Bak, Carsten Kronborg; Petersen, Kirsten Schultz; Vardinghus-Nielsen, Henrik; Kristiansen, Tine Mechlenborg

2017-01-01

The aim of this ethnographic field study was to investigate the influence of school-day social interactions on the well-being and social inclusion of children diagnosed with ADHD. The empirical data consisted of participant observations and informal interviews over a three-month period at a Danish primary school. Two ADHD-diagnosed 11-year-old…

Predictors of posttraumatic stress in parents of children diagnosed with a disorder of sex development.

PubMed

Pasterski, Vickie; Mastroyannopoulou, Kiki; Wright, Deborah; Zucker, Kenneth J; Hughes, Ieuan A

2014-02-01

The aims of the current study were twofold: (1) to assess the prevalence/severity of posttraumatic stress symptoms (PTSS) as well as cognitive and emotional responses in parents whose children were diagnosed with a disorder of sex development (DSD); and (2) to assess factors which contributed to PTSS. We hypothesized that parents would show elevated levels of PTSS and that negative cognitive and/or emotional responses would be predictive. Participants were parents of children diagnosed with a DSD. Thirty-six mothers and 11 fathers completed a measure of posttraumatic stress and reported difficulties in the domains of cognition (e.g., confusion) and emotion (e.g., grief). Using multiple regression, we determined factors contributing to parental PTSS. Reported PTSS was high: 31 % of mothers and 18 % of fathers met the threshold for caseness for Posttraumatic Stress Disorder. Regression included: child sex, parent sex, child age at diagnosis, years since diagnosis, genital ambiguity, father occupation, cognitive confusion, and emotional distress. Only cognitive confusion contributed significantly to variance in PTSS. Parents of children with DSD may experience the diagnosis as traumatic, evidenced by high rates of PTSS in the current report. Assessment of reactions to their children's diagnoses revealed that cognitive confusion, and not emotional distress, predicted PTSS. In this case, direct cognitive interventions may be applicable. Though psychological support is widely recommended, no detailed intervention has been offered. Our findings suggest that we may directly apply models successful in other areas of pediatrics, such as pediatric oncology. Future studies may assess the usefulness of such an intervention.

Dose-dense temozolomide for newly diagnosed glioblastoma: a randomized phase III clinical trial.

PubMed

Gilbert, Mark R; Wang, Meihua; Aldape, Kenneth D; Stupp, Roger; Hegi, Monika E; Jaeckle, Kurt A; Armstrong, Terri S; Wefel, Jeffrey S; Won, Minhee; Blumenthal, Deborah T; Mahajan, Anita; Schultz, Christopher J; Erridge, Sara; Baumert, Brigitta; Hopkins, Kristen I; Tzuk-Shina, Tzahala; Brown, Paul D; Chakravarti, Arnab; Curran, Walter J; Mehta, Minesh P

2013-11-10

Radiotherapy with concomitant and adjuvant temozolomide is the standard of care for newly diagnosed glioblastoma (GBM). O(6)-methylguanine-DNA methyltransferase (MGMT) methylation status may be an important determinant of treatment response. Dose-dense (DD) temozolomide results in prolonged depletion of MGMT in blood mononuclear cells and possibly in tumor. This trial tested whether DD temozolomide improves overall survival (OS) or progression-free survival (PFS) in patients with newly diagnosed GBM. This phase III trial enrolled patients older than age 18 years with a Karnofsky performance score of ≥ 60 with adequate tissue. Stratification included clinical factors and tumor MGMT methylation status. Patients were randomly assigned to standard temozolomide (arm 1) or DD temozolomide (arm 2) for 6 to 12 cycles. The primary end point was OS. Secondary analyses evaluated the impact of MGMT status. A total of 833 patients were randomly assigned to either arm 1 or arm 2 (1,173 registered). No statistically significant difference was observed between arms for median OS (16.6 v 14.9 months, respectively; hazard ratio [HR], 1.03; P = .63) or median PFS (5.5 v 6.7 months; HR, 0.87; P = .06). Efficacy did not differ by methylation status. MGMT methylation was associated with improved OS (21.2 v 14 months; HR, 1.74; P < .001), PFS (8.7 v 5.7 months; HR, 1.63; P < .001), and response (P = .012). There was increased grade ≥ 3 toxicity in arm 2 (34% v 53%; P < .001), mostly lymphopenia and fatigue. This study did not demonstrate improved efficacy for DD temozolomide for newly diagnosed GBM, regardless of methylation status. However, it did confirm the prognostic significance of MGMT methylation. Feasibility of large-scale accrual, prospective tumor collection, and molecular stratification was demonstrated.

Dose-Dense Temozolomide for Newly Diagnosed Glioblastoma: A Randomized Phase III Clinical Trial

PubMed Central

Gilbert, Mark R.; Wang, Meihua; Aldape, Kenneth D.; Stupp, Roger; Hegi, Monika E.; Jaeckle, Kurt A.; Armstrong, Terri S.; Wefel, Jeffrey S.; Won, Minhee; Blumenthal, Deborah T.; Mahajan, Anita; Schultz, Christopher J.; Erridge, Sara; Baumert, Brigitta; Hopkins, Kristen I.; Tzuk-Shina, Tzahala; Brown, Paul D.; Chakravarti, Arnab; Curran, Walter J.; Mehta, Minesh P.

2013-01-01

Purpose Radiotherapy with concomitant and adjuvant temozolomide is the standard of care for newly diagnosed glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status may be an important determinant of treatment response. Dose-dense (DD) temozolomide results in prolonged depletion of MGMT in blood mononuclear cells and possibly in tumor. This trial tested whether DD temozolomide improves overall survival (OS) or progression-free survival (PFS) in patients with newly diagnosed GBM. Patients and Methods This phase III trial enrolled patients older than age 18 years with a Karnofsky performance score of ≥ 60 with adequate tissue. Stratification included clinical factors and tumor MGMT methylation status. Patients were randomly assigned to standard temozolomide (arm 1) or DD temozolomide (arm 2) for 6 to 12 cycles. The primary end point was OS. Secondary analyses evaluated the impact of MGMT status. Results A total of 833 patients were randomly assigned to either arm 1 or arm 2 (1,173 registered). No statistically significant difference was observed between arms for median OS (16.6 v 14.9 months, respectively; hazard ratio [HR], 1.03; P = .63) or median PFS (5.5 v 6.7 months; HR, 0.87; P = .06). Efficacy did not differ by methylation status. MGMT methylation was associated with improved OS (21.2 v 14 months; HR, 1.74; P < .001), PFS (8.7 v 5.7 months; HR, 1.63; P < .001), and response (P = .012). There was increased grade ≥ 3 toxicity in arm 2 (34% v 53%; P < .001), mostly lymphopenia and fatigue. Conclusion This study did not demonstrate improved efficacy for DD temozolomide for newly diagnosed GBM, regardless of methylation status. However, it did confirm the prognostic significance of MGMT methylation. Feasibility of large-scale accrual, prospective tumor collection, and molecular stratification was demonstrated. PMID:24101040

Social and behavioural outcomes in children diagnosed with autism spectrum disorders: a longitudinal cohort study.

PubMed

Russell, Ginny; Golding, Jean; Norwich, Brahm; Emond, Alan; Ford, Tamsin; Steer, Colin

2012-07-01

  To compare social and behavioural outcomes between children formally diagnosed with autism spectrum disorders (ASD) with those of children who displayed autistic traits at preschool age, but remained undiagnosed as teenagers.   A secondary analysis of data from a birth cohort study, the Avon Longitudinal Study of Parents and Children (N = 13,944), in SW England. Children clinically diagnosed with ASD were identified from their medical records (n = 71). A comparison group, who displayed autistic traits at age 3-4, but without ASD diagnosis were also identified (n = 142). Social and behavioural outcomes in adolescence were compared between the two groups.   Children with ASD diagnoses were more impaired as teenagers that those in the comparison group on a range of measures of autistic-like behaviour. The developmental trajectory of prosocial behaviour showed that differences between the case and comparison groups increased dramatically in the preschool and early primary years, but that after 6 years the trajectories were similar.   The divergence of the clinically diagnosed group and the nondiagnosed group in measures of autistic-like behaviour increased with age. This study provides evidence that it may be difficult to distinguish preschool age children who exhibit autistic-like symptoms but improve, from those who go on to develop lifelong impairment. © 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental Health.

Antihypertensive medication prescription patterns and time trends for newly-diagnosed uncomplicated hypertension patients in Taiwan.

PubMed

Liu, Pang-Hsiang; Wang, Jung-Der

2008-06-18

Knowledge of existing prescription patterns in the treatment of newly-diagnosed hypertension can provide useful information for improving clinical practice in this field. The aims of this study are to determine the prescription patterns and time trends for antihypertensive medication in newly-diagnosed cases of uncomplicated hypertension in Taiwan and to compare these with current clinical guidelines. A total of 6,536 newly-diagnosed patients with uncomplicated hypertension, aged >/=30 years, were identified from the representative 200,000-person sample in the computerized reimbursement database of the National Health Insurance in Taiwan. These patients were followed from 1998 to 2004 with all diagnoses, prescription data and medication charges being retrieved for subsequent analysis. Prescription patterns varied by age, gender and clinical facilities, with mono-therapies being found to be dominant in the first year, albeit declining over time. Calcium channel blockers and beta-blockers were the most frequently prescribed antihypertensive drugs, either alone or in combinations. Although least expensive, the prescription rates of diuretics were low, at 8.3% for mono-therapies and 19.9% overall. The prescription rate for angiotensin receptor blockers (ARBs) was elevated considerably over time. After controlling for other related factors by multiple logistic regression analysis, ARBs were found to be prescribed mainly by medical centers or regional hospitals. These findings indicate the existence of a gap between current clinical practice and the desired goal of cost-effectiveness in antihypertensive treatment in Taiwan, which should be corrected.

Increased survival and decreased recurrence in colorectal cancer patients diagnosed in a screening programme.

PubMed

Mengual-Ballester, Mónica; Pellicer-Franco, Enrique; Valero-Navarro, Graciela; Soria-Aledo, Victoriano; García-Marín, José Andrés; Aguayo-Albasini, José Luis

2016-08-01

Population-based screening programmes for colorectal cancer (CRC) allow an early diagnosis, even before the onset of symptoms, but there are few studies and none in Spain on the influence they have on patient survival. The aim of the present study is to show that patients receiving surgery for CRC following diagnosis via a screening programme have a higher survival and disease-free survival rate than those diagnosed in the symptomatic stage. Prospective study of all the patients undergoing programmed surgery for CRC at the JM Morales Meseguer Hospital in Murcia (Spain) between 2004 and 2010. The patients were divided into two groups: (a) those diagnosed through screening (125 cases); and (b) those diagnosed in the symptomatic stage (565 cases). Survival and disease-free survival were analysed and compared for both groups using the Mantel method. The screen-detected CRC patients show a higher rate of survival (86.3% versus 72.1% at 5 years, p<0.05) and a lower rate of tumour recurrence (73.4% versus 88.3% at 5 years, p<0.05). Population-based screening for CRC is an effective strategic measure for reducing mortality specific to this neoplasia. Copyright © 2016. Published by Elsevier Ltd.

Diagnosing Behavior Problems: A Guide for Practitioners.

PubMed

Stelow, Elizabeth

2018-05-01

Clinicians play an important role in diagnosing problem behaviors as a precursor to treating them. This requires a protocol for gathering historical behavioral and health information, direct observation and examination of the animal, and a broad knowledge base of medical and behavioral differential diagnoses for those findings. Aggression and anxiety are the most commonly reported behavior problems in dogs. In cats, elimination problems and aggression are the most prevalent. Other important diagnoses for these species are cognitive dysfunction and abnormal repetitive behaviors. Copyright © 2017 Elsevier Inc. All rights reserved.

Helicobacter pylori status and associated gastroscopic diagnoses in a tertiary hospital endoscopy population in Rwanda.

PubMed

Walker, Timothy D; Karemera, Martin; Ngabonziza, Francois; Kyamanywa, Patrick

2014-05-01

The study was undertaken to document the prevalence of Helicobacter pylori and endoscopic diagnoses in Rwandans presenting for gastroscopy. We studied an endoscopic database containing 961 consecutive gastroscopy patients at the University Teaching Hospital, Butare, over 12 months. Patient characteristics, endoscopic diagnoses and H. pylori status (by modified rapid urease testing) were analysed. The overall H. pylori positivity rate was 75% (n=825), similar to that found elsewhere in sub-Saharan Africa. Common endoscopic diagnoses included duodenal ulceration (20%), duodenitis (9%), benign gastric outlet obstruction (6%) and malignancy (5%). Duodenal ulceration was strongly associated with H. pylori infection (OR 6.2 [3.1-12.6]; p<0.001).

Capturing Key NANDA-I Nursing Diagnoses From Actual Clinical Data for Patients With Heart Failure.

PubMed

Park, Hyejin; Tucker, Denise A

2017-01-01

The purpose of the study was to identify key nursing diagnoses with related factors and signs/symptoms using NANDA-I for patients with heart failure (HF). A retrospective descriptive design was used to address the research questions. Data were obtained from the records of patients discharged for 1 year with the medical diagnoses of HF from a Midwestern community hospital. A total of 272 inpatient records were analyzed to describe the frequency and percentage of NANDA-I diagnosis with related factors and signs/symptoms. The top 10 NANDA-I diagnoses associated with related factors and signs/symptoms were identified. Further research related to standardized nursing terminologies such as NANDA-I using large clinical databases from health information systems is needed to support evidence-based nursing diagnosis decision making. © 2015 NANDA International, Inc.

Using Nuclear Medicine Imaging Wisely in Diagnosing Infectious Diseases

PubMed Central

Censullo, Andrea

2017-01-01

Abstract In recent years, there has been an increasing emphasis on efficient and accurate diagnostic testing, exemplified by the American Board of Internal Medicine’s “Choosing Wisely” campaign. Nuclear imaging studies can provide early and accurate diagnoses of many infectious disease syndromes, particularly in complex cases where the differential remains broad. This review paper offers clinicians a rational, evidence-based guide to approaching nuclear medicine tests, using an example case of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia in a patient with multiple potential sources. Fluorodeoxyglucose-positron emission tomography (FDG-PET) with computed tomography (CT) and sulfur colloid imaging with tagged white blood cell (WBC) scanning offer the most promise in facilitating rapid and accurate diagnoses of endovascular graft infections, vertebral osteomyelitis (V-OM), diabetic foot infections, and prosthetic joint infections (PJIs). However, radiologists at different institutions may have varying degrees of expertise with these modalities. Regardless, infectious disease consultants would benefit from knowing what nuclear medicine tests to order when considering patients with complex infectious disease syndromes. PMID:28480283

Diagnoses have the greatest impact on variation in sick-leave certification rate among primary-care patients in Sweden: A multilevel analysis including patient, physician and primary health-care centre levels.

PubMed

Starzmann, Karin; Hjerpe, Per; Dalemo, Sofia; Ohlsson, Henrik; Björkelund, Cecilia; Bengtsson Boström, Kristina

2015-11-01

The aims of this study were to determine and evaluate simultaneously the importance of factors known to influence sick-leave certification such as the sick leave-related diagnoses, the patients' socio-economic status, and characteristics of the physicians. Computerised medical records from 24 public primary health-care centres (PHCC) were used in a multilevel logistic regression analysis at three levels: patients (n=64,354; sex, age, socio-economic status, workplace factors and diagnoses), physicians (n=574; sex and level of experience) and PHCC (n=24). The variation of sick-leave certification at each level was the outcome. Most of the variation was attributed to the patient level and only 3.5% to the physician and 1.2% to the PHCC levels. Among the patient characteristics, psychiatric diagnoses (mostly acute stress) had the highest odds ratio (OR) for sick leave (OR=16.0; 95% confidence interval [CI] 15-17.2), followed by musculoskeletal diagnoses (OR=6.1; 95% CI 5.8-6.5). Other factors with increased OR were low education (OR=1.7; 95% CI 1.6-1.8), use of social allowance (OR=1.4; 95% CI 1.2-1.7) and certain workplaces (manufacture and health and social care). Being older was not associated with increased certified sick leave. The greatest variation in sick-leave certification rate was seen at the patient level, specifically psychiatric diagnoses. Socio-economic factors increasing the risk for sick-leave certification were education, social allowance and occupations in manufacture and caregiving. Understanding the impact of the different factors that influence certified sick leave is important both for targeted interventions in order to facilitate patients' return to work. © 2015 the Nordic Societies of Public Health.

Role of Experience and Context in Learning To Diagnose Lyme Disease.

ERIC Educational Resources Information Center

Bakken, Lori L.

2002-01-01

Using grounded theory, the learning processes used by nine physicians to diagnose Lyme Disease were investigated. Repetition and counterexperiences served to frame the problem along a continuum of familiarity. Results suggest ways to prepare case studies that include variety, repetition, and counterexperiences to teach diagnosis. (Contains 28…

HIV Diagnoses and Care Among Transgender Persons and Comparison With Men Who Have Sex With Men: New York City, 2006-2011.

PubMed

Wiewel, Ellen Weiss; Torian, Lucia V; Merchant, Pooja; Braunstein, Sarah L; Shepard, Colin W

2016-03-01

We measured HIV care outcomes of transgender persons, who have high HIV infection rates but are rarely distinguished from men who have sex with men (MSM) in HIV surveillance systems. New York City's surveillance registry includes HIV diagnoses since 2000 and HIV laboratory test results for transgender persons since 2005. We determined immunological status at diagnosis, delayed linkage to care, and nonachievement of viral suppression 1 year after diagnosis for transgender persons diagnosed with HIV in 2006 to 2011 and compared transgender women with MSM. In 2006 to 2011, 264 of 23 805 persons diagnosed with HIV were transgender (1%): 98% transgender women and 2% transgender men. Compared with MSM, transgender women had similar CD4 counts at diagnosis and rates of concurrent HIV/AIDS and delayed linkage to care but increased odds of not achieving suppression (adjusted odds ratio = 1.56; 95% confidence interval = 1.13, 2.16). Compared with MSM, transgender women in New York City had similar immunological status at diagnosis but lagged in achieving viral suppression. To provide appropriate assistance along the HIV care continuum, HIV care providers should accurately identify transgender persons.

[Self-employed and small business owners diagnosed with cancer: effect on entrepreneurial survival].

PubMed

Ha-Vinh, Philippe; Régnard, Pierre; Huiart, Laetitia; Sauze, Laurent; Eisinger, François

2015-01-01

When self-employed andsmall business owners are diagnosed with cancer what is the effect on their small-firm survival duration? Data Sources: secondary data for 3,587 subjects, 18-65 years, working when diagnosed with cancer in 1995-2009 and a comparison group of 27,688 subjects matched for gender, age and occupation. Study design: a comprehensive population-based longitudinal study. A Cox model described time to failures of small businesses and terminations ofself-employment. Data Collection Methods: extraction from the statutory mandatory self-employed social security scheme database. Findings were that age, cancer prognosis and very intense physical workload occupation were independent predictors of enterprise failure for cancer-exposed subjects. Compared with unexposed subjects, their global hazard ratio was 1.59 (95% CI = 1.50 - 1.70). However, the difference atfiveyears after cancer diagnosis became non-significant: hazard ratio 1.11 (95% CI = 0.95 - 1.30). These findings demonstrate that beyond 5 years of maintenance of activity, the economic cost of cancer supported by very small businesses and self-employed is not important. However, support is required to pass through these first 5 years. The authors describe the various possible aids that could be implemented.

Decreased spontaneous attention to social scenes in 6-month-old infants later diagnosed with autism spectrum disorders.

PubMed

Chawarska, Katarzyna; Macari, Suzanne; Shic, Frederick

2013-08-01

The ability to spontaneously attend to the social overtures and activities of others is essential for the development of social cognition and communication. This ability is critically impaired in toddlers with autism spectrum disorders (ASD); however, it is not clear if prodromal symptoms in this area are already present in the first year of life of those affected by the disorder. To examine whether 6-month-old infants later diagnosed with ASD exhibit atypical spontaneous social monitoring skills, visual responses of 67 infants at high-risk and 50 at low-risk for ASD were studied using an eye-tracking task. Based on their clinical presentation in the third year, infants were divided into those with ASD, those exhibiting atypical development, and those developing typically. Compared with the control groups, 6-month-old infants later diagnosed with ASD attended less to the social scene, and when they did look at the scene, they spent less time monitoring the actress in general and her face in particular. Limited attention to the actress and her activities was not accompanied by enhanced attention to objects. Prodromal symptoms of ASD at 6 months include a diminished ability to attend spontaneously to people and their activities. A limited attentional bias toward people early in development is likely to have a detrimental impact on the specialization of social brain networks and the emergence of social interaction patterns. Further investigation into its underlying mechanisms and role in psychopathology of ASD in the first year is warranted. Copyright © 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Transbronchial biopsies safely diagnose amyloid lung disease

PubMed Central

Govender, Praveen; Keyes, Colleen M.; Hankinson, Elizabeth A.; O’Hara, Carl J.; Sanchorawala, Vaishali; Berk, John L.

2018-01-01

Background Autopsy identifies lung involvement in 58–92% of patients with the most prevalent forms of systemic amyloidoses. In the absence of lung biopsies, amyloid lung disease often goes unrecognized. Report of a death following transbronchial biopsies in a patient with systemic amyloidosis cautioned against the procedure in this patient cohort. We reviewed our experience with transbronchial biopsies in patients with amyloidosis to determine the safety and utility of bronchoscopic lung biopsies. Methods We identified patients referred to the Amyloidosis Center at Boston Medical Center with lung amyloidosis diagnosed by transbronchial lung biopsies (TBBX). Amyloid typing was determined by immunohistochemistry or mass spectrometry. Standard end organ assessments, including pulmonary function test (PFT) and chest tomography (CT) imaging, and extra-thoracic biopsies established the extent of disease. Results Twenty-five (21.7%) of 115 patients with lung amyloidosis were diagnosed by TBBX. PFT classified 33.3% with restrictive physiology, 28.6% with obstructive disease, and 9.5% mixed physiology; 9.5% exhibited isolated diffusion defects while 19% had normal pulmonary testing. Two view chest or CT imaging identified focal opacities in 52% of cases and diffuse interstitial disease in 48%. Amyloid type and disease extent included 68% systemic AL disease, 16% localized (lung limited) AL disease, 12% ATTR disease, and 4% AA amyloidosis. Fluoroscopy was not used during biopsy. No procedure complications were reported. Conclusions Our case series of 25 patients supports the use of bronchoscopic transbronchial biopsies for diagnosis of parenchymal lung amyloidosis. Normal PFTs do not rule out the histologic presence of amyloid lung disease. PMID:28393574

Do Mirrors Facilitate Acquisition of Motor Imitation in Children Diagnosed with Autism?

ERIC Educational Resources Information Center

Miller, Scott A.; Rodriguez, Nicole M.; Rourke, Ami J.

2015-01-01

We evaluated the efficacy of a procedure that incorporated a mirror to teach gross motor imitation with a 2-year-old boy who had been diagnosed with autistic disorder. Responses taught with a mirror were acquired more quickly than responses taught without the mirror and were maintained after the mirror was removed. These data indicate that a…

[An overview of neurometabolic diseases in Tunisia. a 3-year prospective study].

PubMed

Kraoua, I; Benrhouma, H; Rouissi, A; Youssef-Turki, I Ben; Zouari, B; Kaabachi, N; Gouider-Khouja, N

2009-01-01

Neurometabolic diseases are a large group of genetic diseases. In our country, the diagnostic and therapeutic approach to theses diseases is rather difficult. The aim of our study was to determine the frequency of neurometabolic diseases in the hospital population, to describe the problems in diagnosing these conditions and difficulties encountered during patient care. Our goal was to propose guidelines for a practical diagnostic and therapeutic approach to neurometabolic disorders in our country. We have conducted a prospective study over a 3-year period including all patients diagnosed with "metabolic disease" and followed at the Child and Adolescent Neurology Department of the National Institute of Neurology of Tunis. One hundred and thirty-six patients were included (2.4% of our patients). Mean age was 7.3 +/- 5.1 years. Mean age at onset was 4.3 years. There was a high consanguinity rate. Respiratory chain defects were the most frequently suspected diseases (16.9%), followed by lysosomal diseases (8.8%). Chromatography, initially systematically prescribed, became targeted with a higher diagnostic efficacy. Metabolic diseases diagnosed as certain, represented 22% of the studied cases. This can be explained by the insufficiency of available laboratory tests of confirmation. The prescription of specific treatment was insufficient, even for confirmed pathologies (14.7%) because of the high cost of these therapies. The diagnostic approach has to be rational, targeted, multidisciplinar and conducted within a care network. Diagnostic priority should focus on treatable neurometabolic diseases. The establishment of a systematized registry and neonatal screening for the main treatable neurometabolic diseases constitute the final objective of our work to prepare for biochemical and genetic studies.

Rural AIDS Diagnoses in Florida: Changing Demographics and Factors Associated With Survival

PubMed Central

Trepka, Mary Jo; Niyonsenga, Theophile; Maddox, Lorene M.; Lieb, Spencer

2012-01-01

Purpose To compare demographic characteristics and predictors of survival of rural residents diagnosed with acquired immunodeficiency syndrome (AIDS) with those of urban residents. Methods Florida surveillance data for people diagnosed with AIDS during 1993–2007 were merged with 2000 Census data using ZIP code tabulation areas (ZCTA). Rural status was classified based on the ZCTA’s rural-urban commuting area classification. Survival rates were compared between rural and urban areas using survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level socioeconomic and health care access factors. Findings Of the 73,590 people diagnosed with AIDS, 1,991 (2.7%) resided in rural areas. People in the most recent rural cohorts were more likely than those in earlier cohorts to be female, non-Hispanic black, older, and have a reported transmission mode of heterosexual sex. There were no statistically significant differences in the 3-, 5-, or 10-year survival rates between rural and urban residents. Older age at the time of diagnosis, diagnosis during the 1993–1995 period, other/unknown transmission mode, and lower CD4 count/percent categories were associated with lower survival in both rural and urban areas. In urban areas only, being non-Hispanic black or Hispanic, being US born, more poverty, less community social support, and lower physician density were also associated with lower survival. Conclusions In rural Florida, the demographic characteristics of people diagnosed with AIDS have been changing, which may necessitate modifications in the delivery of AIDS-related services. Rural residents diagnosed with AIDS did not have a significant survival disadvantage relative to urban residents. PMID:23802929

Diagnoses, infections and injuries in Northern Syrian children during the civil war: A cross-sectional study.

PubMed

van Berlaer, Gerlant; Elsafti, Abdallah Mohamed; Al Safadi, Mohammad; Souhil Saeed, Saad; Buyl, Ronald; Debacker, Michel; Redwan, Atef; Hubloue, Ives

2017-01-01

The civil war in Syria including the deliberate targeting of healthcare services resulted in a complex humanitarian emergency, seriously affecting children's health. The objectives of this study are to document diagnoses and disease categories in Northern Syrian children after four years of conflict, and to document infectious diseases and injuries in this vulnerable population. In a prospective cross-sectional observational sample study conducted in May 2015, healthcare workers registered demographics, comorbidities, and diagnoses (categorised according to the International Classification of Diseases version 10) in children visited at home and in internally displaced persons camps in four Syrian governorates. Of 1080 filled-out records, 1002 were included. Children originated from Aleppo (41%), Idleb (36%), Hamah (15%) and Lattakia (8%). Median age was 6 years (0-15; IQR 3-11), 61% were boys, 40% were younger than 5 years old. Children suffered from respiratory (29%), neurological (19%), digestive (17%), eye (5%) and skin (5%) diseases. Clinical malnutrition was seen in 4%, accidental injury in 3%, intentional injury in 1%, and mental disorders in 2%. Overall, 64% had features of infectious diseases (OR 0.635; CI 0.605-0.665). Most common comorbidities were chronic respiratory diseases (14, malnutrition (5%), acute flaccid paralysis (5%), and epilepsy (4%). Logistic regression analysis indicated that the risk for children to have communicable diseases was higher in Aleppo than in Idleb (OR 1.7; CI 1.2-2.3), Hamah (OR 4.9; CI 3.3-7.5), or Lattakia (OR 5.5; CI 3.3-9.3). Children in Aleppo and Lattakia were more at risk to be injured than in Idleb (OR 5.6; CI 2.1-14.3), or in Hamah (OR 5.9; CI 1.4-25.6), but more often from intentional violence in Lattakia. Mental problems were more prominent in Hamah. Four years far in the conflict, 64% of the studied children in four Northern Syrian governorates suffer from infections, mostly from respiratory, neurological and

Prenatal Diagnosis of Transposition of the Great Arteries over a 20-Year Period: Improved but Imperfect

PubMed Central

Escobar-Diaz, Maria C; Freud, Lindsay R; Bueno, Alejandra; Brown, David W; Friedman, Kevin; Schidlow, David; Emani, Sitaram; del Nido, Pedro; Tworetzky, Wayne

2015-01-01

Objective To evaluate temporal trends in prenatal diagnosis of transposition of the great arteries with intact ventricular septum (TGA/IVS) and its impact on neonatal morbidity and mortality. Methods Newborns with TGA/IVS referred for surgical management to our center over a 20-year period (1992 – 2011) were included. The study time was divided into 5 four-year periods, and the primary outcome was rate of prenatal diagnosis. Secondary outcomes included neonatal pre-operative status and perioperative survival. Results Of the 340 patients, 81 (24%) had a prenatal diagnosis. Prenatal diagnosis increased over the study period from 6% to 41% (p<0.001). Prenatally diagnosed patients underwent a balloon atrial septostomy (BAS) earlier than postnatally diagnosed patients (0 vs. 1 day, p<0.001) and fewer required mechanical ventilation (56% vs. 69%, p=0.03). There were no statistically significant differences in pre-operative acidosis (16% vs. 26%, p=0.1) and need for preoperative ECMO (2% vs. 3%, p=1.0). There was also no significant mortality difference (1 pre-operative and no post-operative deaths among prenatally diagnosed patients, as compared to 4 pre-operative and 6 post-operative deaths among postnatally diagnosed patients). Conclusion The prenatal detection rate of TGA/IVS has improved but still remains below 50%, suggesting the need for strategies to increase detection rates. The mortality rate was not statistically different between pre- and postnatally diagnosed patients; however, there were significant pre-operative differences with regard to earlier BAS and less mechanical ventilation. Ongoing study is required to elucidate whether prenatal diagnosis confers long-term benefit. PMID:25484180

Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific.

PubMed

Mirabel, Mariana; Tafflet, Muriel; Noël, Baptiste; Parks, Tom; Axler, Olivier; Robert, Jacques; Nadra, Marie; Phelippeau, Gwendolyne; Descloux, Elodie; Cazorla, Cécile; Missotte, Isabelle; Gervolino, Shirley; Barguil, Yann; Rouchon, Bernard; Laumond, Sylvie; Jubeau, Thierry; Braunstein, Corinne; Empana, Jean-Philippe; Marijon, Eloi; Jouven, Xavier

2015-12-01

Rheumatic heart disease (RHD) remains the leading acquired heart disease in the young worldwide. We aimed at assessing outcomes and influencing factors in the contemporary era. Hospital-based cohort in a high-income island nation where RHD remains endemic and the population is captive. All patients admitted with newly diagnosed RHD according to World Heart Federation echocardiographic criteria were enrolled (2005-2013). The incidence of major cardiovascular events (MACEs) including heart failure, peripheral embolism, stroke, heart valve intervention and cardiovascular death was calculated, and their determinants identified. Of the 396 patients, 43.9% were male with median age 18 years (IQR 10-40)). 127 (32.1%) patients presented with mild, 131 (33.1%) with moderate and 138 (34.8%) with severe heart valve disease. 205 (51.8%) had features of acute rheumatic fever. 106 (26.8%) presented with at least one MACE. Among the remaining 290 patients, after a median follow-up period of 4.08 (95% CI 1.84 to 6.84) years, 7 patients (2.4%) died and 62 (21.4%) had a first MACE. The annual incidence of first MACE and of heart failure were 59.05‰ (95% CI 44.35 to 73.75) and 29.06‰ (95% CI 19.29 to 38.82), respectively. The severity of RHD at diagnosis (moderate vs mild HR 3.39 (0.95 to 12.12); severe vs mild RHD HR 10.81 (3.11 to 37.62), p<0.001) and ongoing secondary prophylaxis at follow-up (HR 0.27 (0.12 to 0.63), p=0.01) were the two most influential factors associated with MACE. Newly diagnosed RHD is associated with poor outcomes, mainly in patients with moderate or severe valve disease and no secondary prophylaxis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Mental health in the United States: parental report of diagnosed autism in children aged 4-17 years--United States, 2003-2004.

PubMed

2006-05-05

Autism is a lifelong neurodevelopmental disorder characterized by early onset of impairments in social interaction and communication and unusual, stereotyped behaviors. Autism (i.e., autistic disorder) often is classified with two related, although less severe, developmental disorders: Asperger disorder and pervasive developmental disorder--not otherwise specified. These three constitute the autism spectrum disorders (ASDs). Diagnosis of ASDs is based exclusively on developmental pattern and behavioral observation. Two population-based studies conducted by CDC in selected U.S. locations reported ASD prevalence of 3.4 and 6.7 per 1,000 children, respectively. CDC also conducts two nationally representative surveys, the National Health Interview Survey (NHIS) and the National Survey of Children's Health (NSCH), in which parents are asked whether their child ever received a diagnosis of autism. Because of similarities in methodology used by the two surveys, CDC analyzed 2003-2004 data from NHIS and data from the first-ever NSCH (collected during January 2003-July 2004) to 1) estimate the population-based prevalence of parental report of diagnosed autism in the United States and 2) assess parental reporting of child social, emotional, and behavioral strengths and difficulties and special-health care needs among children with and without reported autism. This report describes the results of that analysis, which indicated that the prevalence of parent-reported diagnosis of autism was 5.7 per 1,000 children in NHIS and 5.5 per 1,000 children in NSCH. Prevalence estimates in the two studies were similar across age, sex, and racial/ethnic populations. The consistency in estimates between the two surveys suggests high reliability for parental report of autism. These estimates suggest that, as of 2003-2004, autism had been diagnosed in at least 300,000 U.S. children aged 4-17 years. In addition, parental reports of autism were associated with reported social, emotional, and

Spontaneous complete regression of a brain stem glioma pathologically diagnosed as a high-grade glioma.

PubMed

Ishihara, Masahiro; Yamamoto, Kazumi; Miwa, Hideaki; Nishi, Masaya

2017-12-01

Spontaneous regressions of brain stem gliomas are extremely rare. Only six cases have been reported in the literature. We describe the case of a patient who was diagnosed with a pontomedullary dorsal brain stem glioma at the age of 15 years. An open biopsy showed the presence of an anaplastic glioma. Because the patient and her parents refused conventional therapies, including radiation and chemotherapy, we followed up the patient by performing magnetic resonance imaging scans on her every 3 months. At 3 months after biopsy, we observed the radiological disappearance of her tumor. One year after biopsy, the tumor retained the spontaneous complete regression observed earlier. In this case report, we present the first report of the spontaneous complete regression of a brain stem glioma that was histologically proven to be a high-grade glioma and we believe that this regression was the natural progression of this case, as may be the scenario in a few other cases of brain stem gliomas.

Comparison of patients diagnosed with gonorrhoea through community screening with those self-presenting to the genitourinary medicine clinic.

PubMed

Cook, Penny A; Evans-Jones, John; Mallinson, Harry; Wood, Martyn; Alloba, Fath; Jones, Kathy; Strodtbeck, Sara; Hanna-Bashara, Layla

2014-03-14

To compare the clinical, socioeconomic and demographic characteristics of individuals diagnosed with Neisseria gonorrhoeae (NG) in the community using a concomitant nucleic acid amplification test (NAAT, AptimaCombo2) as part of the (community-based) UK Chlamydia Screening Programme (CSP), with those diagnosed in hospital-based genitourinary medicine (GUM) services. A retrospective case note review of all 643 patients treated for NG at a GUM in north west England (January 2007-April 2009). All 643 treated for NG (including CSP cases, since all cases were referred to GUM for treatment). Limited data were available for 13 CSP cases who failed to attend GUM. Whether the case was detected in the community or GUM services. Predictors were demographics (age, gender, postcode for deprivation analysis), sexual history (eg, number of partners) and clinical factors (eg, culture positivity). 131 cases were diagnosed by CSP (13 of whom did not attend GUM). A further four cases were contacts of these. The GUM caseload was thus inflated by 23% (from 521 to 643). Community cases were overwhelmingly female (85% vs 27% in GUM, p<0.001) and younger (87% females were <25 years vs 70% GUM females, p=0.001). Logistic regression analysis restricted to the target age of the CSP (<25 years) revealed that CSP cases, compared with GUM cases, were more likely to reside in deprived areas (adjusted OR=5.6, 95% CI 1.4 to 21.8 and 5.3, CI 1.7 to 16.6 for the most and second most deprived group respectively, compared with the averagely deprived group, p=0.037) and be asymptomatic (adjusted OR=1.9, CI 1.1 to 3.4, p=0.02). Community screening for NG led to a 79% increase in the number of infections detected in women aged <25 years. Screening is targeted at young people, and tends to disproportionately attract young women, a group under-represented at GUM. Screening also contributed further to case detection in deprived areas.

Interventions for healthcare professionals, organizations and patients to enhance quality of life for people diagnosed with palliative esophagogastric cancer: a systematic review.

PubMed

Cowley, Alison; Bath-Hextall, Fiona; Cooper, Joanne

2017-03-01

Esophagogastric (EG) cancer is the fifth most common malignancy, and its incidence is increasing. The disease is fast paced, and five-year survival rates are poor. Treatment with palliative intent is provided for the majority of patients but there remains a lack of empirical evidence into the most effective service models to support EG cancer patients. The overall objective of this quantitative systematic review was to establish best practice in relation to interventions targeted at healthcare professionals or the structures in which healthcare professionals deliver care (i.e. models of care and practice) and patients (diagnosed with palliative EG cancer) to enhance the quality of life for people diagnosed with palliative EG cancer. The current review considered studies that included patients diagnosed with palliative EG cancer and any health professionals involved in the delivery of palliative care to this patient group in a hospital, home or community setting. The current review considered studies that evaluated any intervention or combination of intervention strategies aimed at healthcare professionals, organizations or patients to improve quality of life for people diagnosed with palliative EG cancer. The current review considered both experimental and epidemiological study designs. Studies were excluded that evaluated: screening programs, pharmacology alone, palliative oncology and palliative endoscopy. The primary outcome measure was objectively measured quality of life. A three-step search strategy was utilized. Sixteen databases were searched for papers from the year 2000 onward and followed by hand searching of reference lists. Methodological quality was not assessed as no articles were found that met the inclusion criteria. Data extraction was not possible as no articles were found that met the inclusion criteria. It was not possible to complete data synthesis as no articles were found that met the inclusion criteria. Comprehensive searching and study

Psychosocial diagnoses occurring after patients present with fatigue.

PubMed

MacKean, Peter Reagh; Stewart, Moira; Maddocks, Heather L

2016-08-01

To discover the frequency of psychosocial and other diagnoses occurring at the end of a visit when patients present to their FPs with concerns about fatigue. Cross-sectional study of patient-FP encounters for fatigue. Ten FP practices in southwestern Ontario. A total of 259 encounters involving 167 patients presenting to their FPs between March 1, 2006, and June 30, 2010, with concerns about fatigue. The frequency of psychological and social diagnoses made at the end of visits, and whether diagnoses were made by FPs at the end of the visits versus whether the code for fatigue remained. The associations between patient age, sex, fatigue presenting with other symptoms, or the presence of previous chronic conditions and the outcomes was tested. Psychosocial diagnoses were made 23.9% of the time. Among psychosocial diagnoses made, depressive disorder and anxiety disorder or anxiety state were diagnosed more often in women (P = .048). Slightly less than 30% of the time, the cause of patients' fatigue remained undiagnosed at the end of the encounter. A diagnosis was made more often in men. Causes of fatigue frequently remain undiagnosed; however, when there is a diagnosis, psychosocial diagnoses are common. Therefore, it would be appropriate for FPs to screen for psychosocial issues when their patients present with fatigue, unless some other diagnosis is evident. Depression and anxiety could be considered particularly among female patients with fatigue. Copyright© the College of Family Physicians of Canada.

Diagnoses of Early and Late Readmissions after Hospitalization for Pneumonia. A Systematic Review

PubMed Central

Sjoding, Michael W.; Iwashyna, Theodore J.

2014-01-01

Rationale: Pneumonia is a frequent cause of hospitalization, yet drivers of post-pneumonia morbidity remain poorly characterized. Causes of hospital readmissions may elucidate important sources of morbidity and are of particular interest given the U.S. Hospital Readmission Reductions Program. Objectives: To review the primary diagnoses of early (≤30 d) and late (≥31 d) readmissions after pneumonia hospitalization. Methods: Systematic review of MEDLINE, Embase, and CINAHL databases. We identified original research studies of adults aged 18 years or older, hospitalized for pneumonia, and for whom cause-specific readmission rates were reported. Two authors abstracted study results and assessed study quality. Measurements and Main Results: Of the 1,243 citations identified, 12 met eligibility criteria. Included studies were conducted in the United States, Spain, Canada, Croatia, and Sweden. All-cause 30-day readmission rates ranged from 16.8 to 20.1% across administrative studies; the weighted average for the studies using chart review was 11.6% (15.6% in United States–based studies). Pneumonia, heart failure/cardiovascular causes, and chronic obstructive pulmonary disease/pulmonary causes are the most common reasons for early readmission after pneumonia hospitalization. Although it was the single most common cause for readmission, pneumonia accounted for only 17.9 to 29.4% of all 30-day readmissions in administrative studies and a weighted average of 23.0% in chart review studies. After accounting for study population, there was no clear difference in findings between claims-based versus chart-review studies. Few studies assessed readmissions beyond 30 days, although the limited available data suggest similar primary diagnoses for early and late readmissions. No studies assessed whether reasons for readmission were similar to patients’ reasons for healthcare use before hospitalization. Conclusions: Pneumonia, heart failure/cardiovascular disease, and chronic

Diagnosing Dementia—Positive Signs

MedlinePlus

... test offers promise in the early detection of Alzheimer's. By Mary Best What if there were an easy, affordable blood test that could accurately diagnose Alzheimer's disease (AD)—even before symptoms began to show? ...

Diagnosing plant problems

Treesearch

Cheryl A. Smith

2008-01-01

Diagnosing Christmas tree problems can be a challenge, requiring a basic knowledge of plant culture and physiology, the effect of environmental influences on plant health, and the ability to identify the possible causes of plant problems. Developing a solution or remedy to the problem depends on a proper diagnosis, a process that requires recognition of a problem and...

Characteristics of newly diagnosed COPD patients treated with triple inhaled therapy by general practitioners: a real world Italian study.

PubMed

Di Marco, Fabiano; Santus, Pierachille; Terraneo, Silvia; Peruzzi, Elena; Muscianisi, Elisa; Ripellino, Claudio; Pegoraro, Valeria

2017-09-07

Factors predicting prescriptions of triple therapy were investigated in a large group of general practitioners in Italy. In the population treated by identified general practitioners, a cohort of newly diagnosed chronic obstructive pulmonary disease patients was extracted from IMS Health Longitudinal Database during the period 2010-2013. From the diagnosis, 1-year follow-up was evaluated. Thirty-two thousand forty-six newly diagnosed chronic obstructive pulmonary disease patients were evaluated (57.7% male, mean age 67 years). During 2 years prior to diagnosis less than 13% of patients were requested with a pulmonology evaluation and less than 5% with a spirometry; 65.1% cases were prescribed with a respiratory drug, which in 9.6% of cases was inhaled corticosteroid/long-acting β 2 -agonist fixed-dose combination. Two thousand and twenty eight patients (6.3% of the newly diagnosed chronic obstructive pulmonary disease patients) were treated with triple therapy during the first year of follow-up, whose 858 (42.3%) starting immediately, and 762 (37.6%) following an initial treatment with inhaled corticosteroid/long-acting β 2 -agonist fixed-dose combination. Being older, being requested with pulmonologist evaluation or spirometry, being prescribed with a inhaled corticosteroid/long-acting β 2 -agonist fixed-dose combination at diagnosis resulted independent predictors of triple therapy use. ENSURING CORRECT PRESCRIPTIONS FOR EARLY-STAGE DISEASE: An improved education program for doctors promoting correct use of medication for chronic lung disease is needed in Italy. Current guidelines state that inhaled corticosteroids (ICSs) should be reserved for patients with severe chronic obstructive pulmonary disease (COPD), but it appears that doctors do not always follow this advice. Fabiano Di Marco, at San Paolo Hospital-Università degli Studi di Milano, and co-workers analyzed data from 32,046 COPD patients newly-diagnosed by family doctors in Italy between 2010 and

[Effectiveness of heart tumor therapy in the cardiology department during 7 year follow-up].

PubMed

Dabek, Józefa; Twardowski, Romuald; Jakubowski, Daniel; Michniak, Barbara; Swiderski, Robert; Gasior, Zbigniew

2009-11-01

Neoplasms of the heart are rare. Usually asymptomatic on the early stage are diagnosed incidentally. Among primary heart neoplasms the most often benign tumors are diagnosed--mostly myxomas, whereas the majority of malignant heart tumors are sarcomas. The aim of this paper was to present heart tumors diagnosed in the cardiology department, their symptoms, used diagnostic tests and therapy and to show after therapy quality of life changes. There were 18 patients included to the study, whom during hospitalization in the cardiology department heart tumors were diagnosed. There were 11 women and 7 men, aged from 33- to 76-years-old (mean 60,5 years). To all of the patients medical interview, physical examination, EKG, UCG and laboratory test were performed. Additionally in some cases computed tomography or magnetic resonance imaging of the chest and coronary angiograms were done. Based on the diagnostic tests results the patients were qualified to conservative or surgical treatment. Among 18 heart tumor patients in 12 cases primary benign tumors were diagnosed (66,6%), 1 patient had primary malignant tumor (5,5%), there were 3 cases of metastatic tumors (16,6%) and 2 patients with non-neoplasmic tumors--clots (11,1%). From 18 subjects with heart tumor 3 patients died because of advanced stage of neoplasmic disease and presence of metastatic tumors in the heart. Results of the study show, that heart tumors, regardless of development of diagnostic tests, are still diagnosed too late. The study group follow-up proved, that early diagnosis and proper heart tumor treatment prevented complications and improved the quality of life. It is worth to emphasize, that coronary angiogram in some cases allowed to diagnose coronary artery disease, to treat heart tumor and to perform coronary artery by-pass grafting simultaneously.