RESUMO
BACKGROUND: Occupational short-latency respiratory disease (SLRD; predominantly asthma, rhinitis, hypersensitivity pneumonitis, and occupational infections) prevalence is difficult to determine but certain occupations may be associated with increased susceptibility. AIMS: This study aimed to examine which occupations and industries are currently at high risk for SLRD and determine their respective suspected causal agents. METHODS: SLRD cases reported to the SWORD scheme between 1999 and 2019 were analysed to determine directly standardized rate ratios (SRR) by occupation against the average rate for all other occupations combined. RESULTS: 'Bakers and flour confectioners' and 'vehicle spray painters' showed significantly raised SRR for SLRD in general, mostly due to occupational rhinitis (234.4; 95% CI 200.5-274.0) and asthma (63.5; 95% CI 51.5-78.3), respectively. Laboratory technicians also showed significantly raised SRR for occupational rhinitis (18.7; 95% CI 15.1-23.1), primarily caused by laboratory animals and insects. Metal machining setters and setter-operators showed increased SRR for occupational hypersensitivity pneumonitis (42.0; 95% CI 29.3-60.3), largely due to cutting/soluble oils. The occupation mostly affected by infectious disease was welding trades (12.9; 95% CI 5.7-29.3), mainly attributable to microbial pathogenicity. CONCLUSIONS: This study identified the occupational groups at increased risk of developing an SLRD based on data recorded over a recent two-decade period in the UK. Occupational asthma and rhinitis were identified as the prevailing conditions and hypersensitivity pneumonitis as a potentially rising respiratory problem in the metalworking industry.
RESUMO
BACKGROUND: People diagnosed with intestinal failure (IF) as a result of short bowel syndrome are dependent on home parenteral nutrition (HPN). Measuring nutritional status is essential for monitoring treatment. The present study aimed to determine the agreement and feasibility of three methods bioelectrical impedance analysis (BIA), ultrasound and air displacement plethysmography (ADP) for measuring body composition in people receiving HPN. METHODS: Body composition data were collected from patients attending an IF clinic. RESULTS: There were 50 participants recruited and data were collected for BIA (n = 46), ultrasound (n = 49) and ADP (n = 9). Numbers for ADP were much lower because of a lack of participant uptake. Fat-free mass (FFM) measured by BIA and ultrasound in comparison to ADP was found to have good intraclass correlation (ICC) 0.791 (95% confidence interval (CI) CI -0.21 to 0.96) and a moderate ICC 0.659 [95% (CI) -0.27 to 0.92], respectively. Fat mass (FM) measured by both BIA and ultrasound in comparison to ADP was found to have moderate ICC 0.660 (95% CI -0.28 to 0.92) and poor ICC -0.005 (95% CI -0.73 to 0.65), respectively. CONCLUSIONS: Compared to ADP, BIA indicated moderate to good agreement for measuring body composition, whereas ultrasound indicated far less agreement, particularly when measuring FM. The lack of uptake of ADP suggests that participants found the Bodpod (COSMED Srl, Shepperton, UK) unfavourable. Considering that ultrasound has limited agreement and ADP was not the preferred option for participants, BIA shows some potential. However, the difference between ADP and BIA was larger for FM compared to FFM, which needs to be considered in the clinical setting.
Assuntos
Composição Corporal , Impedância Elétrica , Avaliação Nutricional , Pletismografia/estatística & dados numéricos , Síndrome do Intestino Curto/fisiopatologia , Ultrassonografia/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Pacientes Ambulatoriais/estatística & dados numéricos , Nutrição Parenteral no Domicílio , Pletismografia/métodos , Reprodutibilidade dos Testes , Síndrome do Intestino Curto/terapia , Ultrassonografia/métodosRESUMO
BACKGROUND: Evidence suggests that the medical profession is reluctant to report mental ill-health despite its high prevalence. AIMS: To compare differential reporting patterns in the incidence of work-related mental ill-health (WRMIH) affecting doctors with selected comparison occupational groups, as determined by surveillance by general practitioners (GPs), specialist psychiatrists and occupational physicians (OPs). METHODS: New cases of medically reported WRMIH were reported prospectively between 2006 and 2009 by GPs, psychiatrists and OPs as part of The Health and Occupation Research (THOR) network. For GP and psychiatry reporting schemes, incidence rates (IRs) for doctors, nurses, teachers, corporate managers and protective service workers were calculated using information from the Labour Force Survey as the denominator. In OP surveys, participating reporters provided denominator information to calculate IRs for doctors, nurses and teachers. RESULTS: Average annual IRs expressed per 100000 person/years employed as reported by GPs, psychiatrists and OPs, respectively, were: doctors (309, 971, 430), nurses (891, 208, 670), teachers (1040, 136, 210) and for GPs and psychiatrists, respectively, were: protective service workers (1432, 721) and corporate managers (428, 90). Psychiatrists reported a higher incidence of WRMIH in doctors, whereas GPs reported higher incidences of WRMIH in other occupations (chi-squared test, P < 0.001). CONCLUSIONS: The distribution of the incidence of new cases reported across different schemes suggests a differential reporting pattern of WRMIH in doctors. The higher IR for doctors in psychiatrist-reported WRMIH could be due to factors such as disease severity and bypassing formal referral channels.
Assuntos
Clínicos Gerais/psicologia , Notificação de Abuso , Transtornos Mentais/diagnóstico , Saúde Ocupacional/normas , Médicos/psicologia , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Incidência , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Vigilância da População/métodos , Estudos Prospectivos , Fatores Sexuais , Reino Unido/epidemiologiaRESUMO
BACKGROUND: There is accumulating evidence that early-onset psoriasis (EOP; presenting at or before 40 years of age) and late-onset psoriasis (LOP; presenting after 40 years of age) are different diseases. OBJECTIVES: We aimed to identify potential clinical and immunocytochemical differences between EOP and LOP. METHODS: We assessed immunocytochemistry in involved (PP) skin and uninvolved skin (n = 31) and demographics, psoriasis phenotype and psychological parameters (n = 340) in a cross-sectional study. RESULTS: Immunocytochemistry revealed (17 EOP, 14 LOP) a greater lymphocytic infiltrate in PP skin of EOP compared with LOP (P = 0·03), with a higher epidermal CD4+ : CD8+ ratio in LOP (1·3) compared with EOP (0·5) (P = 0·002). In 340 patients with psoriasis (278 EOP, 62 LOP), we found an association with a positive first or second degree family history of psoriasis [62·0% vs. 35·6%, adjusted odds ratio (OR) 8·32, 95% confidence interval (CI) 1·90-36·52] and a higher likelihood of having parents with EOP (adjusted OR 10·34, 95% CI 1·32-81·83) in the EOP group. Patients with EOP were more likely to have received biological therapy (13·3% EOP vs. 3·5% LOP, P = 0·042), while patients with LOP had a higher likelihood of having type 2 diabetes (adjusted OR 3·43, 95% CI 1·004-11·691) and autoimmune thyroiditis (adjusted OR 5·05, 95% CI 1·62-15·7). Patients with LOP also had greater anxiety than patients with EOP (mean Hospital Anxiety and Depression Scale-A score LOP 8 ± 5, EOP 5 ± 5; P = 0·006). CONCLUSIONS: Our findings provide further evidence for the difference between EOP and LOP.
Assuntos
Psoríase/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Relação CD4-CD8 , Contagem de Células , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Psoríase/patologia , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: In 2010, the fit note replaced the sick note to help focus on what people are capable of doing, rather than signing patients 'off sick'. AIMS: To compare proportions of work-related ill-health issued with sickness certification pre- and post-fit note introduction and assess sickness absence trends. METHODS: General practitioners (GPs) report data on work-related ill-health and sickness absence via The Health and Occupation Research network in General Practice. The proportion of cases issued with sickness certification 4 years before and 3 years after the fit note introduction were compared. Changes in certification incidence rate ratios were measured over time. RESULTS: Participating GPs reported 5517 cases of work-related ill-health. Pre-fit note introduction 50% of cases were certified sick. There was no change in the proportion of cases certified sick in the first year post-fit note, despite 13% of cases classified as 'maybe fit'. However, in the second year, the proportion of cases certified sick had reduced significantly (41%) and a larger proportion (19%) was advised on workplace adjustments. In the third year post-introduction, there was a slight rise in the proportion of cases certified sick; therefore, although there was a fall of 2% per annum in certification rates, this was not significant. CONCLUSIONS: In the first year post-fit note introduction, modifications to work were recommended for people who would previously have been declared fit. Trends analyses showed a slight decrease in the certification rate, possibly indicating GPs will become more practised in advising on workplace adjustments.
Assuntos
Certificação/estatística & dados numéricos , Comunicação em Saúde/métodos , Retorno ao Trabalho , Licença Médica/tendências , Atitude do Pessoal de Saúde , Medicina Geral/métodos , Humanos , Relações Médico-Paciente , Pesquisa Qualitativa , Reino Unido , Local de Trabalho/normasRESUMO
BACKGROUND: Clinicians' prognoses in patients with advanced cancer are imprecise. The aim of this study was to compare doctors', nurses' and patients' survival predictions and to identify factors which influence accuracy. PATIENTS AND METHODS: Some 1018 patients with advanced cancer were recruited. Survival estimates were obtained from the attending doctor, nurse, multidisciplinary team (MDT) and patient (n = 829, 954, 987 and 290 estimates, respectively) and were compared with actual survival. Clinician and patient characteristics were recorded. RESULTS: MDTs', doctors' and nurses' predictions were accurate 57.5%, 56.3% and 55.5% of occasions, respectively. Nurses were less accurate than the MDT (P = 0.007) but were no worse than doctors (P = 0.284). Estimates of clinicians and patients were more optimistic (doctors: 31%; nurses: 34%; MDT: 31.1%; patients: 45.1%) than pessimistic (12.7%, 11%, 11.4% and 2.7%). Nurses' accuracy increased if they had reviewed the patient within 24 h. Most patients (61.4%) wanted to know their prognosis. Only 37.1% were willing to offer an estimate regarding their own survival. Patients' prognostic estimates were less accurate than health care professionals' (P < 0.001). CONCLUSIONS: MDTs were better at predicting survival than doctors' or nurses' alone. Patients were substantially worse. Among nurses, recency of review was related to improved prognostic accuracy.
Assuntos
Neoplasias/mortalidade , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Prognóstico , Taxa de Sobrevida , Assistência TerminalRESUMO
AIMS: To compare the renal effects of low- vs. high-dose atorvastatin in patients with Type 2 diabetes mellitus and optimally managed early renal disease. METHODS: We compared the 2-year progression of nephropathy in a double-blind randomized controlled trial of atorvastatin 80 mg/day (n = 60) vs. 10 mg/day (n = 59) in patients with Type 2 diabetes with microalbuminuria or proteinuria [mean (sd): age 64 years (10 years); HbA(1c) 7.7% (1.3%), 61 mmol/mol (10 mmol/mol); blood pressure 131/73 mmHg; renin-angiotensin system blocker use > 80%; dual blockade > 67%] recruited from diabetes clinics in Greater Manchester. RESULTS: Over (mean) 2.1 years of follow-up, the Modification of Diet in Renal Disease estimated glomerular filtration rate declined by 3 ml min(-1) 1.73 m(-2) in the combined group. The mean (95% CI) between-group difference during follow-up was not significant [2.2 ml min(-1) 1.73 m(-2) (-1.1 to 5.4 ml min(-1) 1.73: m(-2) ), P = 0.20] after adjusting for baseline differences in renal function; positive difference favours 80 mg dose. Similarly, there was no significant difference in creatinine clearance by Cockcroft and Gault [2.5 ml/min (-2.4 to 7.3 ml/min), P = 0.32]; serum creatinine/24-h urine collections [4.0 ml/min (-4.8 to 12.7 ml/min), P = 0.38]; cystatin C (P = 0.69); or 24-h urine protein or albumin excretion (P = 0.92; P = 0.93). We recorded no significant between-group differences in deaths or adverse events. CONCLUSIONS: In patients with Type 2 diabetes with early renal disease, we found no statistical difference in renal function between those taking high- or low-dose atorvastatin over 2 years. We cannot exclude a beneficial effect of < 1.6 ml min(-1) 1.73 m(-2) year(-1) on Modification of Diet in Renal Disease estimated glomerular filtration rate, or if blood pressure management or if renin-angiotensin system blocker use had not been optimized.
Assuntos
Anticolesterolemiantes/administração & dosagem , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Ácidos Heptanoicos/administração & dosagem , Rim/efeitos dos fármacos , Pirróis/administração & dosagem , Albuminúria/metabolismo , Atorvastatina , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Nefropatias Diabéticas/induzido quimicamente , Nefropatias Diabéticas/metabolismo , Método Duplo-Cego , Esquema de Medicação , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/metabolismo , Falência Renal Crônica/induzido quimicamente , Falência Renal Crônica/metabolismo , Masculino , Pessoa de Meia-Idade , Placebos , Resultado do Tratamento , Reino UnidoRESUMO
OBJECTIVES: To establish the reliability and validity of work-related mental ill-health diagnoses. BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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 investigate this aspect of a diagnosis.
Assuntos
Transtornos Mentais/diagnóstico , Doenças Profissionais/diagnóstico , Adulto , Competência Clínica , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Variações Dependentes do Observador , Doenças Profissionais/epidemiologia , Vigilância da População/métodos , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Reino Unido/epidemiologiaRESUMO
Objectives To measure the feasibility and effectiveness of interventions to increase cervical screening uptake amongst young women. Methods A two-phase cluster randomized trial conducted in general practices in the NHS Cervical Screening Programme. In Phase 1, women in practices randomized to intervention due for their first invitation to cervical screening received a pre-invitation leaflet and, separately, access to online booking. In Phase 2, non-attenders at six months were randomized to one of: vaginal self-sample kits sent unrequested or offered; timed appointments; nurse navigator; or the choice between nurse navigator or self-sample kits. Primary outcome was uplift in intervention vs. control practices, at 3 and 12 months post invitation. Results Phase 1 randomized 20,879 women. Neither pre-invitation leaflet nor online booking increased screening uptake by three months (18.8% pre-invitation leaflet vs. 19.2% control and 17.8% online booking vs. 17.2% control). Uptake was higher amongst human papillomavirus vaccinees at three months (OR 2.07, 95% CI 1.69-2.53, p < 0.001). Phase 2 randomized 10,126 non-attenders, with 32-34 clusters for each intervention and 100 clusters as controls. Sending self-sample kits increased uptake at 12 months (OR 1.51, 95% CI 1.20-1.91, p = 0.001), as did timed appointments (OR 1.41, 95% CI 1.14-1.74, p = 0.001). The offer of a nurse navigator, a self-sample kits on request, and choice between timed appointments and nurse navigator were ineffective. Conclusions Amongst non-attenders, self-sample kits sent and timed appointments achieved an uplift in screening over the short term; longer term impact is less certain. Prior human papillomavirus vaccination was associated with increased screening uptake.
Assuntos
Detecção Precoce de Câncer , Infecções por Papillomavirus/prevenção & controle , Participação do Paciente , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Inglaterra , Feminino , Humanos , Lactente , Pessoa de Meia-Idade , Papillomaviridae/imunologia , Infecções por Papillomavirus/diagnóstico , Vacinas contra Papillomavirus/administração & dosagem , Medicina Estatal , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico , Adulto JovemRESUMO
Tension in an anterior cruciate ligament graft is greater with the knee in flexion when the angle of the tibial tunnel in the coronal plane is vertical or more perpendicular to the medial joint line of the tibia; however, the relationship of the angle of the tibial tunnel to knee function has not been studied. Greater graft tension may limit knee flexion or stretch the graft and increase anterior laxity. Five surgeons treated 119 subjects by reconstructing a torn anterior cruciate ligament using a double-looped semitendinosus and gracilis graft and a standardized technique. The femoral tunnel was drilled through the tibial tunnel. Radiographs were analyzed for tibial tunnel placement and a clinical evaluation was made 4 months postoperatively. Knees were assigned to subgroups according to the angle of the tibial tunnel in the coronal plane (65 degrees to 69 degrees, 70 degrees to 74 degrees, 75 degrees to 79 degrees, 80 degrees to 84 degrees, and 85 degrees to 89 degrees), with the angle of the latter subgroup being most vertical. Loss of flexion increased significantly from 0.5 degrees to 6.5 degrees and anterior laxity increased significantly from 0.5 to 2.2 mm as the tunnel angle was increased. The average angle of the tibial tunnel varied significantly, 11 degrees between surgeons (range, 69 degrees to 80 degrees). We found a tibial tunnel angle of 75 degrees or more is associated with greater loss of flexion and anterior laxity. Surgeons do not drill the angle of the tibial tunnel in the coronal plane accurately. We now routinely drill the tibial tunnel at an angle of 65 degrees to 70 degrees in the coronal plane because it may reduce loss of flexion and anterior laxity.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/etiologia , Articulação do Joelho/fisiopatologia , Procedimentos Ortopédicos/efeitos adversos , Tíbia/cirurgia , Adulto , Análise de Variância , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Instabilidade Articular/prevenção & controle , Articulação do Joelho/diagnóstico por imagem , Masculino , Procedimentos Ortopédicos/métodos , Estudos Prospectivos , Radiografia , Tíbia/diagnóstico por imagemRESUMO
Avulsion fractures of the anterior inferior iliac spine are a relatively uncommon injury. Their diagnosis is usually made based on history, findings of the clinical examination, and standard roentgenograms. In the patient described, the diagnosis of avulsion of the anterior inferior iliac spine was made with the assistance of a single photon emission computed tomography scan, a relatively new diagnostic tool.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Ílio/lesões , Tomografia Computadorizada de Emissão de Fóton Único , Criança , Humanos , Masculino , RadiografiaRESUMO
From November 1984 to February 1989, 13 extensor indicis proprius tendon transfers were performed for various reasons. Nine patients with a total of ten transfers were available for follow-up, at an average of 29 months. Active range of motion was measured (both dependently and independently) at the metacarpophalangeal joints of both the involved and the uninvolved index finger. There was no extensor lag of the metacarpophalangeal joint during dependent extension, and only an average of 2.1 degrees of extensor lag during independent extension. Measurement of total active motion showed that the dependent and independent range of motion of the involved index finger was 95% of that of the uninvolved index finger. The obvious concerns with using the extensor indicis proprius tendon for transfer is the possible theoretical loss of complete extension and independent extension of the index finger. We found these concerns not to be a problem.
Assuntos
Articulação Metacarpofalângica/fisiologia , Percepção de Movimento , Transferência Tendinosa , Doadores de Tecidos , HumanosRESUMO
Casting and splinting materials used in orthopedics have historically consisted of plaster of Paris and, more recently, fiberglass. Plaster is cost-effective and malleable enough to help to hold reductions. Fiberglass is stronger and lighter, but more expensive. The hybrid cast of plaster and fiberglass optimizes the advantages of both materials in fracture management; it is sufficiently strong, yet still cost-effective.
Assuntos
Sulfato de Cálcio , Moldes Cirúrgicos , Fraturas Ósseas/terapia , Vidro , Teste de Materiais , Fenômenos Biomecânicos , Humanos , Estresse MecânicoRESUMO
A retrospective clinical and radiographic review of 25 conventional cementless total hip replacements (THRs) and 25 cementless hydroxyapatite-coated THRs was performed to evaluate early postoperative results. The hydroxyapatite-coated group had a higher incidence of pain-free arthroplasties compared with the standard cementless group (72% v 44%, P = .045) at the 2-month postoperative evaluation. At the 6-month evaluation, 76% of hydroxyapatite-coated THRs were pain-free compared with 52% of conventional cementless THRs, although the statistical significance disappears (P greater than .05). No differences between groups existed in the 6-month Harris hip scores, average motion, use of external support, Trendelenberg gait, postoperative implant radiolucent lines. Adding a 50- to 75-mug hydroxyapatite coating to a proximal one-third porous femoral prosthesis and porous surface acetabular cup improved the early clinical results in cementless THR. Whether this improvement in pain scores reflects a more stable cementless prosthesis via increased rates and amount of osseus ingrowth or adjunctive bone hydroxyapatite chemical bonding remains unanswered. Long-term follow-up of femoral subsidence and THR revision is needed to indicate the durability and success of hydroxyapatite coating.
Assuntos
Prótese de Quadril/instrumentação , Hidroxiapatitas , Adulto , Idoso , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Desenho de Prótese , Radiografia , Estudos RetrospectivosRESUMO
BACKGROUND: In recent years a close association between anxiety and persecutory ideation has been established, contrary to the traditional division of neurosis and psychosis. Nonetheless, the two experiences are distinct. The aim of this study was to identify factors that distinguish the occurrence of social anxiety and paranoid thoughts in an experimental situation. METHOD: Two hundred non-clinical individuals broadly representative of the UK general population were assessed on a range of psychological factors, experienced a neutral virtual reality social environment, and then completed state measures of paranoia and social anxiety. Clustered bivariate logistic regressions were carried out, testing interactions between potential predictors and the type of reaction in virtual reality. RESULTS: The strongest finding was that the presence of perceptual anomalies increased the risk of paranoid reactions but decreased the risk of social anxiety. Anxiety, depression, worry and interpersonal sensitivity all had similar associations with paranoia and social anxiety. CONCLUSIONS: The study shows that social anxiety and persecutory ideation share many of the same predictive factors. Non-clinical paranoia may be a type of anxious fear. However, perceptual anomalies are a distinct predictor of paranoia. In the context of an individual feeling anxious, the occurrence of odd internal feelings in social situations may lead to delusional ideas through a sense of 'things not seeming right'. The study illustrates the approach of focusing on experiences such as paranoid thinking rather than diagnoses such as schizophrenia.
Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/etiologia , Transtorno da Personalidade Paranoide/diagnóstico , Transtorno da Personalidade Paranoide/etiologia , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/etiologia , Meio Social , Adulto , Transtornos de Ansiedade/psicologia , Cognição , Tomada de Decisões , Diagnóstico Diferencial , Feminino , Humanos , Acontecimentos que Mudam a Vida , Solidão , Masculino , Transtorno da Personalidade Paranoide/psicologia , Transtornos Fóbicos/psicologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Apoio Social , Inquéritos e Questionários , Interface Usuário-ComputadorRESUMO
BACKGROUND: Psoriasis, a chronic inflammatory skin disease, affects approximately 2% of the population worldwide. Although the aetiology of psoriasis is poorly understood, patients with disease of early onset (Type I, age of onsetAssuntos
Proteína Tirosina Fosfatase não Receptora Tipo 22/genética
, Psoríase/genética
, Adulto
, Idade de Início
, Estudos de Coortes
, Feminino
, Predisposição Genética para Doença
, Haplótipos
, Humanos
, Modelos Logísticos
, Masculino
, Polimorfismo de Nucleotídeo Único
RESUMO
A prospective study was conducted to investigate and compare the analgesic effect of morphine and bupivacaine injected intra-articularly following elective knee arthroscopy performed under general anesthesia without the use of a tourniquet. Cost-effectiveness of these agents was also evaluated. Patients in Group 1 (n = 41) received 30 cc of 0.25% bupivacaine with 1:200,000 epinephrine; while Group 2 (n = 40) received 2 mg morphine (1 mg/cc) in 28 cc normal saline (total volume 30 cc). Postoperative pain scores and the amount of supplemental analgesic agents used in a 24-hour period were recorded. Results showed that patients in Group 2 reported significantly less pain overall (P < .006) and significantly lower analgesic requirements (P < .0004) at a lower average patient cost than Group 1. We conclude that intra-articular morphine reduces postoperative pain and analgesic requirements more effectively and at a lower average patient cost than bupivacaine.
Assuntos
Analgesia , Artroscopia , Bupivacaína , Epinefrina , Articulação do Joelho/cirurgia , Morfina , Dor Pós-Operatória/tratamento farmacológico , Adulto , Análise Custo-Benefício , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Cuidados Pré-Operatórios , Estudos Prospectivos , Fatores de TempoRESUMO
A case of simultaneous traumatic bilateral anterior/posterior hip dislocations in a 28-year-old man is presented. The mechanism and treatment of this injury, as well as its complications, are discussed.
Assuntos
Luxação do Quadril/etiologia , Lesões do Quadril , Acidentes de Trânsito , Adulto , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/terapia , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , RadiografiaRESUMO
PURPOSE: We describe an unusual mechanism of action for a proximal tibial fracture in an adolescent. CASE SUMMARY: The patient injured his leg while jumping off a spring diving board and sustained a proximal tibial physeal fracture. DISCUSSION: The majority of these fractures occur when an athlete jumps up from a stationery platform, most commonly in basketball. RELEVANCE: This article describes an unreported cause of a proximal physeal fracture secondary to an athlete jumping off a spring diving board.