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1.
Artigo em Inglês | MEDLINE | ID: mdl-38795241

RESUMO

The error-related negativity (ERN) and error positivity (Pe) are components of the event-related potential following an error that are potential mechanistic biomarkers of obsessive-compulsive disorder (OCD). The study examined the ERN, Pe, flanker task accuracy, and clinical measures in 105 OCD cases and 105 matched healthy controls (HC) ages 8-18 years. Higher flanker task accuracy in all participants was associated with an increased ERN amplitude and increased difference between Pe and correct positivity amplitudes (ΔPe). Compared to HC, OCD cases had an increased ERN but decreased ΔPe and flanker task accuracy. Those differences were also significant in tic-related and non-tic-related OCD cases compared to HC. A lower ΔPe was associated in cases with an earlier age at OCD symptom onset. The results support the hypothesis that OCD involves defects in an error monitoring system and suggest a reduced ΔPe may compromise error signaling and cause uncertainty about the correctness of a response.

2.
J Anat ; 240(1): 172-181, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34355792

RESUMO

Brachial plexus injury (BPI) occurs when the brachial plexus is compressed, stretched, or avulsed. Although rodents are commonly used to study BPI, these models poorly mimic human BPI due to the discrepancy in size. The objective of this study was to compare the brachial plexus between human and Wisconsin Miniature SwineTM (WMSTM ), which are approximately the weight of an average human (68-91 kg), to determine if swine would be a suitable model for studying BPI mechanisms and treatments. To analyze the gross anatomy, WMS brachial plexuses were dissected both anteriorly and posteriorly. For histological analysis, sections from various nerves of human and WMS brachial plexuses were fixed in 2.5% glutaraldehyde, and postfixed with 2% osmium tetroxide. Subsequently paraffin sections were counter-stained with Masson's Trichrome. Gross anatomy revealed that the separation into three trunks and three cords is significantly less developed in the swine than in human. In swine, it takes the form of upper, middle, and lower systems with ventral and dorsal components. Histological evaluation of selected nerves revealed differences in nerve trunk diameters and the number of myelinated axons in the two species. The WMS had significantly fewer myelinated axons than humans in median (p = 0.0049), ulnar (p = 0.0002), and musculocutaneous nerves (p = 0.0454). The higher number of myelinated axons in these nerves for humans is expected because there is a high demand of fine motor and sensory functions in the human hand. Due to the stronger shoulder girdle muscles in WMS, the WMS suprascapular and axillary nerves were larger than in human. Overall, the WMS brachial plexus is similar in size and origin to human making them a very good model to study BPI. Future studies analyzing the effects of BPI in WMS should be conducted.


Assuntos
Plexo Braquial , Animais , Plexo Braquial/anatomia & histologia , Mãos , Humanos , Ombro , Suínos , Porco Miniatura , Extremidade Superior
3.
Child Psychiatry Hum Dev ; 51(5): 827-838, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32656660

RESUMO

The error-related negativity (ERN) is a negative deflection in the event-related potential following a mistake that is a putative biomarker of anxiety. The study assessed the ERN as a diagnostic biomarker using receiver operating characteristic (ROC) analyses in 96 cases with anxiety disorders (AD) and 96 matched healthy controls (HC) ages 8 to 18 years. Forty-one cases had generalized anxiety disorder (GAD); 55 cases had other anxiety disorders (OAD) without GAD. ERN amplitude was significantly increased in AD cases compared to HC. The area under the curve (AUC) in the ROC analysis was 0.64, indicating the ERN is an inadequate diagnostic test for AD altogether. The ERN was significantly increased in cases with either GAD or OAD compared to HC. The AUC in ROC analyses with GAD and OAD was 0.75 and 0.56, respectively, suggesting the ERN provides an adequate diagnostic test for GAD but not for OAD.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/fisiopatologia , Potenciais Evocados/fisiologia , Adolescente , Biomarcadores , Criança , Eletroencefalografia , Feminino , Humanos , Masculino
4.
Child Psychiatry Hum Dev ; 51(6): 888-899, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32030629

RESUMO

The study assessed the ability of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) to detect pediatric obsessive-compulsive disorder (OCD) using receiver operating characteristic analyses. The sample consisted of 114 cases with current OCD, 340 cases with other psychiatric disorders (OPD), and 301 healthy controls (HC) ages 7 to 18 years. All 755 participants were assessed with two semi-structured interviews and seven rating scales. In a comparison of current OCD cases and all other participants, the optimal OCI-CV cut-score was 11 with an area under the curve (AUC) of .88. In a comparison of current OCD cases and OPD cases, the optimal OCI-CV cut-score was 11 with an AUC of .82. In a comparison of current OCD cases and HC, the optimal OCI-CV cut-score was 10 with an AUC of .94. The results indicate that the OCI-CV provides an effective screen for pediatric OCD using empirically derived cut-scores.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Transtorno Obsessivo-Compulsivo/diagnóstico , Inventário de Personalidade/estatística & dados numéricos , Adolescente , Criança , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Psicometria/estatística & dados numéricos , Curva ROC , Reprodutibilidade dos Testes
5.
Res Sq ; 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38410467

RESUMO

The error-related negativity (ERN) and error positivity (Pe) are components of the event-related potential following an error that are potential mechanistic biomarkers of obsessive-compulsive disorder (OCD). The study examined the ERN, Pe, flanker task accuracy, and clinical measures in 105 OCD cases and 105 matched healthy controls (HC), ages 8 to 18 years, with 21 cases having a tic disorder history. Higher flanker task accuracy in all participants was associated with an increased ERN amplitude and increased difference between Pe and correct positivity amplitudes (ΔPe). Compared to HC, OCD cases had an increased ERN but decreased flanker task accuracy and ΔPe. Those differences were also significant in tic-related and non-tic-related OCD cases compared to HC. A lower ΔPe was associated in OCD cases with an earlier age at OCD symptom onset. The results support the hypothesis that OCD involves defects in an error monitoring system and suggest a reduced ΔPe may compromise error signaling and cause uncertainty about the correctness of a response.

7.
Surg Neurol Int ; 14: 411, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38213422

RESUMO

Background: The median nerve anatomy and its clinical presentation are crucial for surgeons to consider avoiding iatrogenic injury and performing effective surgical interventions. Case Description: An atypical presentation of median nerve anatomy proximal to the carpal tunnel was found during cadaveric dissection. The median nerve was located deep to a uniquely double-headed flexor carpi radialis and curved medially around the tendons of the forearm to enter the carpal tunnel superficially. Conclusion: The atypical presentation of median nerve anatomy can assist surgeons in adverse event reduction during surgeries such as carpal tunnel and pronator teres syndrome releases.

8.
Int J Occup Saf Ergon ; 28(4): 2173-2182, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34704533

RESUMO

Offshore industry has always been a risky working place, and therefore there has always been a strong focus on maintaining the highest safety standards. The present research aims to ascertain the effects of a new safety mindset from both individual employee and organizational angles, and is based on two surveys conducted in 2010 and 2014 on Danish oil production platforms in the North Sea and qualitative data from interviews, observations and documentary analysis. The participating offshore oil company introduced a new safety mindset at the beginning of 2010 to all of their employees and subcontractors. The results indicate that there were some significant, positive changes both in individual employee attitudes towards safety and in strong organizational commitment to work closely with employees to ensure the highest workplace safety status on oil platforms. However, the results also show that it is important to maintain a campaign to ensure these positive effects.


Assuntos
Gestão da Segurança , Local de Trabalho , Humanos , Seguimentos , Inquéritos e Questionários , Dinamarca , Cultura Organizacional
9.
Artigo em Inglês | MEDLINE | ID: mdl-35162395

RESUMO

Analog space missions were created to study the human factor in extraordinary conditions that would occur in future space habitats. Isolation has been shown to cause stress and disrupt individuals' daily routine, which can also affect their oral hygiene and lead to an increased risk of dental caries and gingivitis. The astronauts' specific freeze-dried diet is associated with "lazy" chewing, potential dehydration and vitamin A deficiency, which may adversely affect their saliva. The aim of this study is to investigate the influence of the freeze-dried diet on selected oral hygiene indicators in analog astronauts (AA) enduring strict isolation conditions during six consecutive analog space missions at the LunAres Research Station. During the experiment the oral hygiene and gingival inflammation status measurements were conducted on the group of AAs at the beginning and at the end of each mission. Measurements included four oral hygiene indicators: API, sOHI, PI by Silness and Loe and GBI by Ainamo and Bay. Each AA's individual scores were noted and analyzed. Statistically significant reduction in the amount of plaque and intensity of gingival bleeding was observed over the course of the study, which could indicate positive results of applied oral hygiene procedures despite unfavorable dietary and stressful isolation conditions.


Assuntos
Cárie Dentária , Gengivite , Cárie Dentária/complicações , Dieta , Humanos , Higiene Bucal
10.
Depress Anxiety ; 28(6): 501-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21538726

RESUMO

OBJECTIVE: This study examined the comorbidity of obsessive-compulsive disorder (OCD) with major depressive disorder (MDD) in a family study of OCD with pediatric probands. METHOD: This study assessed the lifetime prevalence of MDD in 141 first-degree relatives (FDR) and 452 second-degree relatives (SDR) of pediatric probands with OCD and healthy controls, and identified variables associated with MDD in case FDR. All available FDR were directly interviewed blind to proband status; parents were also interviewed to assess the family psychiatric history of FDR and SDR. Best-estimate diagnoses were made using all sources of information. Data were analyzed with logistic regression and robust Cox regression models. RESULTS: Lifetime MDD prevalence was significantly higher in case than in control FDR (30.4 versus 15.4%). Lifetime MDD prevalence was significantly higher in FDR of case probands with MDD than in FDR of case probands without MDD or control FDR (46.3 versus 19.7 versus 15.4%, respectively). MDD in case FDR was significantly associated with MDD in case probands and with age and OCD in those relatives. Lifetime MDD prevalence was similar in case and control SDR. However, lifetime MDD prevalence was significantly higher in SDR of case probands with MDD than in SDR of case probands without MDD or control SDR (31.9 versus 16.8 versus 15.4%, respectively). CONCLUSIONS: MDD prevalence was significantly higher in both FDR and SDR of case probands with MDD than in relatives of case probands without MDD or control relatives, suggesting that pediatric OCD comorbid with MDD is a complex familial syndrome.


Assuntos
Transtorno Depressivo Maior/genética , Predisposição Genética para Doença/genética , Transtorno Obsessivo-Compulsivo/genética , Adolescente , Estudos de Casos e Controles , Criança , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Predisposição Genética para Doença/psicologia , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologia , Determinação da Personalidade/estatística & dados numéricos , Modelos de Riscos Proporcionais , Psicometria , Fatores de Risco
11.
Front Cell Dev Biol ; 9: 737426, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34722519

RESUMO

Adenosine receptors (AR) are widely expressed in a variety of tissues including the retina and brain. They are involved in adenosine-mediated immune responses underlying the onset and progression of neurodegenerative diseases. The expression of AR has been previously demonstrated in some retinal cells including endothelial cells and retinal pigment epithelial cells, but their expression in the choroid and choroidal cells remains unknown. Caffeine is a widely consumed AR antagonist that can influence inflammation and vascular cell function. It has established roles in the treatment of neonatal sleep apnea, acute migraine, and post lumbar puncture headache as well as the neurodegenerative diseases such as Parkinson and Alzheimer. More recently, AR antagonism with caffeine has been shown to protect preterm infants from ischemic retinopathy and retinal neovascularization. However, whether caffeine impacts the development and progression of ocular age-related diseases including neovascular age-related macular degermation remains unknown. Here, we examined the expression of AR in retinal and choroidal tissues and cells. We showed that antagonism of AR with caffeine or istradefylline decreased sprouting of thoracic aorta and choroid/retinal pigment epithelium explants in ex vivo cultures, consistent with caffeine's ability to inhibit endothelial cell migration in culture. In vivo studies also demonstrated the efficacy of caffeine in inhibition of choroidal neovascularization and mononuclear phagocyte recruitment to the laser lesion sites. Istradefylline, a specific AR 2A antagonist, also decreased choroidal neovascularization. Collectively, our studies demonstrate an important role for expression of AR in the choroid whose antagonism mitigate choroidal inflammatory and angiogenesis activities.

12.
Scand J Public Health ; 38(2): 177-83, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20133340

RESUMO

BACKGROUND: Level of education is in many fields of research used as an indicator of social status. METHODS: Using Statistics Denmark's register for education and employment of the population, we examined highest completed education with a birth-cohort perspective focusing on people born between 1930 and 1974. RESULTS: Irregularities in the educational data were found for both men and women born from 1951 to 1957. For the birth cohorts born from 1951 to 1954, a sudden increase in the proportion of persons with basic school education only was seen, and a following decrease in this proportion was seen for the birth cohorts born from 1955 to 1957. For the same birth cohorts, a reverse curve was found for the proportion with vocational training as highest completed education. Using proportion of women with at least one child at the age of 30, our analysis illustrated that spurious patterns may emerge when other social phenomena are analysed by partly misclassified educational groups. CONCLUSIONS: Our findings showed that register data are not always to be taken at face value and that thorough analysis may unravel unexpected irregularities. Although such data errors may be remedied in analyses of population trends by use of extrapolated values, solutions are less obvious in epidemiological research using individual level data.


Assuntos
Escolaridade , Emprego , Sistema de Registros/normas , Idoso , Estudos de Coortes , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa , Fatores Socioeconômicos
13.
J Brachial Plex Peripher Nerve Inj ; 15(1): e1-e4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32055253

RESUMO

Median nerve anatomy is of great interest to clinicians and scientists given the importance of this nerve and its association with diseases. A rare anatomical variant of the median nerve in the distal forearm and wrist was discovered during a cadaveric dissection. The median nerve was deep to the flexor digitorum superficialis (FDS) in the carpal tunnel. It underwent a 360-degree spin before emerging at the lateral edge of FDS. The recurrent motor branch moved from medial to lateral on the deep surface of the median nerve, as it approached the distal carpal tunnel. This variant doesn't fall into any of Lanz's four groups of median nerve anomalies. We propose a fifth group that involves variations in the course of the median nerve. This report underscores the importance of recognizing variants of the median nerve anatomy in the forearm and wrist during surgical interventions, such as for carpal tunnel syndrome.

14.
Brain Sci ; 10(2)2020 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-32024242

RESUMO

The pathophysiology of attention-deficit/hyperactivity disorder (ADHD) involves deficits in performance monitoring and adaptive adjustments. Yet, the developmental trajectory and underlying neural correlates of performance monitoring deficits in youth with ADHD remain poorly understood. To address the gap, this study recruited 77 children and adolescents with ADHD and 77 age- and gender-matched healthy controls (HC), ages 8-18 years, who performed an arrow flanker task during electroencephalogram recording. Compared to HC, participants with ADHD responded more slowly and showed larger reaction time variability (RTV) and reduced post-error slowing; they also exhibited reduced error-related negativity (ERN) and error positivity effects, and reduced N2 and P3 congruency effects. Age effects were observed across groups: with increasing age, participants responded faster, with less variability, and with increased post-error slowing. They also exhibited increased ERN effects and increased N2 and P3 congruency effects. Increased RTV and reduced P3 amplitude in incongruent trials were associated with increased ADHD Problems Scale scores on the Child Behavior Checklist across groups. The altered behavioral and ERP responses in ADHD are consistent with the pattern associated with younger age across groups. Further research with a longitudinal design may determine specific aspects of developmental alteration and deficits in ADHD during performance monitoring.

15.
Sci Rep ; 9(1): 9700, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31273232

RESUMO

B-cell lymphoma 2 (Bcl-2) protein is the founding member of a group of proteins known to modulate apoptosis. Its discovery set the stage for identification of family members with either pro- or anti-apoptotic properties. Expression of Bcl-2 plays an important role during angiogenesis by influencing not only vascular cell survival, but also migration and adhesion. Although apoptosis and migration are postulated to have roles during vascular remodeling and regression, the contribution of Bcl-2 continues to emerge. We previously noted that the impaired retinal vascularization and an inability to undergo pathologic neovascularization observed in mice globally lacking Bcl-2 did not occur when mice lacked the expression of Bcl-2 only in endothelial cells. To further examine the effect of Bcl-2 expression during vascularization of the retina, we assessed its contribution in pericytes or astrocytes by generating mice with a conditional Bcl-2 allele (Bcl-2Flox/Flox) and Pdgfrb-cre (Bcl-2PC mice) or Gfap-cre (Bcl-2AC mice). Bcl-2PC and Bcl-2AC mice demonstrated increased retinal vascular cell apoptosis, reduced numbers of pericytes and endothelial cells and fewer arteries and veins in the retina. Bcl-2PC mice also demonstrated delayed advancement of the superficial retinal vascular layer and aberrant vascularization of the deep vascular plexus and central retina. Although pathologic neovascularization in oxygen-induced ischemic retinopathy (OIR) was not affected by lack of expression of Bcl-2 in either pericytes or astrocytes, laser-induced choroidal neovascularization (CNV) was significantly reduced in Bcl-2PC mice compared to littermate controls. Together these studies begin to reveal how cell autonomous modulation of apoptosis in vascular cells impacts development and homeostasis.


Assuntos
Astrócitos/patologia , Neovascularização de Coroide/patologia , Endotélio Vascular/patologia , Neovascularização Patológica/patologia , Pericitos/patologia , Proteínas Proto-Oncogênicas c-bcl-2/fisiologia , Doenças Retinianas/patologia , Animais , Apoptose , Proliferação de Células , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/metabolismo , Feminino , Isquemia/etiologia , Isquemia/metabolismo , Isquemia/patologia , Masculino , Camundongos , Camundongos Knockout , Neovascularização Patológica/etiologia , Neovascularização Patológica/metabolismo , Oxigênio/toxicidade , Doenças Retinianas/etiologia , Doenças Retinianas/metabolismo , Vasos Retinianos/patologia
16.
Obes Surg ; 17(4): 465-9, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17608258

RESUMO

BACKGROUND: Some investigators have postulated that a history of being the victim of childhood sexual abuse may impact outcome of bariatric surgery. METHODS: In this retrospective chart review, we examined the electronic medical records of 152 adults with morbid obesity who underwent Roux-en-Y gastric bypass and who had a weight recorded in their medical record or reported in a follow-up surgery at 2 years after the RYGBP. The purpose of this retrospective chart review was to examine the relationship between psychosocial factors assessed preoperatively and the percent of excess weight lost (%EWL) at 2 years after bariatric surgery. RESULTS: We found a high prevalence of being the victim of childhood sexual abuse (27%), adult sexual trauma (9%), and/or physical abuse (19%) at the initial evaluation. There was no association between these factors and %EWL at 2 years. However, when we examined participants' medical records for post-operative psychiatric hospitalizations at our medical center, 8 of 11 hospitalized patients reported a history of childhood sexual abuse (73%). CONCLUSIONS: History of being the victim of childhood sexual abuse is reported frequently by patients seeking bariatric surgery. Our finding that having been the victim of childhood sexual abuse may be associated with increased risk of psychiatric hospitalization after RYGBP has several clinical implications. First, we recommend that clinicians assess carefully for a history of sexual or physical abuse, and secondly, abuse survivors may need to be told that there is an increased risk of psychiatric morbidity after bariatric surgery. Finally, perhaps close monitoring of these patients may prevent psychiatric difficulties after surgery. Further research to verify these preliminary findings is clearly needed.


Assuntos
Abuso Sexual na Infância/psicologia , Derivação Gástrica , Hospitalização/estatística & dados numéricos , Obesidade/psicologia , Obesidade/cirurgia , Redução de Peso , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Seguimentos , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
J Neurosurg ; 136(3): 927-930, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34678776
18.
JAMA Intern Med ; 176(3): 310-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26857383

RESUMO

IMPORTANCE: It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization. OBJECTIVE: To evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF. DESIGN, SETTING, AND PARTICIPANTS: We randomized 1437 patients hospitalized for HF between October 12, 2011, and September 30, 2013, to the intervention arm (715 patients) or to the usual care arm (722 patients) of the Better Effectiveness After Transition-Heart Failure (BEAT-HF) study and observed them for 180 days. The dates of our study analysis were March 30, 2014, to October 1, 2015. The setting was 6 academic medical centers in California. Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF. INTERVENTIONS: The intervention combined health coaching telephone calls and telemonitoring. Telemonitoring used electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight. Centralized registered nurses conducted telemonitoring reviews, protocolized actions, and telephone calls. MAIN OUTCOMES AND MEASURES: The primary outcome was readmission for any cause within 180 days after discharge. Secondary outcomes were all-cause readmission within 30 days, all-cause mortality at 30 and 180 days, and quality of life at 30 and 180 days. RESULTS: Among 1437 participants, the median age was 73 years. Overall, 46.2% (664 of 1437) were female, and 22.0% (316 of 1437) were African American. The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge, which occurred in 50.8% (363 of 715) and 49.2% (355 of 722) of patients, respectively (adjusted hazard ratio, 1.03; 95% CI, 0.88-1.20; P = .74). In secondary analyses, there were no significant differences in 30-day readmission or 180-day mortality, but there was a significant difference in 180-day quality of life between the intervention and usual care groups. No adverse events were reported. CONCLUSIONS AND RELEVANCE: Among patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01360203.


Assuntos
Insuficiência Cardíaca , Monitorização Fisiológica , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Qualidade de Vida , Telemetria , Telefone , Idoso , Idoso de 80 Anos ou mais , Fatores de Confusão Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Razão de Chances , Modelos de Riscos Proporcionais , Estudos Prospectivos , Projetos de Pesquisa , Estados Unidos/epidemiologia
19.
J Pain Symptom Manage ; 30(5): 408-17, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16310615

RESUMO

Self-reports of 32 symptoms and their treatments were obtained from patients of three palliative care programs that provide services to seriously ill HIV patients (>or=95% AIDS) in Alabama (n=47), Baltimore (n=91), and New York City (n=117). On average, patients reported 10.9 (SD=7.6) to 12.7 (SD=6.2) symptoms. Pain, lack of energy, and worrying were reported by a majority of patients at all sites, often with a high level of associated distress. For only four symptoms (pain, nausea, difficulty swallowing, and mouth sores) did half or more of patients at all sites experiencing the symptom also report treatment. Less than a third of patients experiencing 12 symptoms (five of six comprising a psychological subscale) reported treatment. Results show that despite the availability of more efficacious treatments, many HIV/AIDS patients continue to experience significant physical and psychological symptomatology. Many of those experiencing symptoms, however, do not perceive their symptoms as being treated.


Assuntos
Infecções por HIV/complicações , Infecções por HIV/psicologia , Cuidados Paliativos , Adulto , Alabama , Baltimore , Feminino , Infecções por HIV/terapia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque
20.
AIDS Patient Care STDS ; 18(3): 145-58, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15104875

RESUMO

Despite prolonged survival and improved quality of life as a result of treatment advances for HIV/AIDS, thousands still suffer with the disease and 15-16,000 a year die in the United States alone. Little is known about those patients with HIV/AIDS who still require palliative care services or the types of services needed. This paper describes the program elements and clients of three programs providing palliative care to persons with HIV/AIDS in Alabama (n = 41), Baltimore, Maryland, (n = 55), and New York City (n = 52). Also presented are the prevalence of need for 27 services as assessed by clients and staff, the level of agreement found between client and staff assessments at each site, and services for which prevalence of need varied among programs. Interviews were conducted between June 2000 and October 2002. The majority of clients at all programs were socioeconomically disadvantaged, persons of color, and had a history of substance abuse, although significant differences were noted in the distributions of clients at each program with regard to these characteristics. Greater differences were observed among programs in the prevalence of need reported than were found between reports of clients and staff at the same program. Despite these differences, a common set of medical (ambulatory/outpatient care, laboratory testing, pharmacy) and ancillary (nutritional counseling, transportation) services was identified by at least 25% of clients and staff at each program. These findings suggest that need, beyond a core of medical and ancillary services, is relative and best conceptualized as a mixture of need, demand, and supply. The need for a mix of "care" and "cure" services identified reflect the erratic disease trajectory experienced by some clients who move in and out of treatment as well as the vulnerability and marginalized lives of the clients served by these programs.


Assuntos
Síndrome da Imunodeficiência Adquirida/terapia , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Avaliação das Necessidades , Cuidados Paliativos , Síndrome da Imunodeficiência Adquirida/economia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Alabama/epidemiologia , Análise de Variância , Baltimore/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , Cidade de Nova Iorque/epidemiologia , Populações Vulneráveis
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