Biomedical subjects
A Valdini
Publications and source records attributed to A Valdini.
Loneliness as a predictor of hospital emergency department use.
BACKGROUND: Recent studies indicate that loneliness is a significant risk factor for many ailments from colds to heart disease. If lonely patients are at greater risk for illness, then we might expect that they would use the emergency department (ED) more often and incur greater medical costs than those who are not lonely. Our goal was to determine the prevalence of loneliness in patients in an ED and to evaluate it as a predictor of ED use, hospital admission, and chronic illness. METHODS: We evaluated a convenience sample of 164 ED patients with the University of California-Los Angeles Loneliness Scale, Version 3 and a survey of patient characteristics. Using medical record review and patient self-report, we determined total ED visits, the presence of chronic illness, and discharge diagnoses during a 1-year retrospective period. We evaluated data with least mean square regression and a 2-tailed t test. RESULTS: We found a statistically significant correlation between loneliness score and total hospital ED visits (P <.001). The mean loneliness score (39) was equal to that of normal populations. Patients scoring higher than the mean used the ED 60% more per year than patients who scored lower (P = .008). There was no association between a patient's loneliness score and baseline chronic illness or severity of current illness (P = .56). Spanish-speaking patients had higher loneliness scores than English-speaking patients (P = .001). CONCLUSION: Loneliness is a predictor of hospital ED use independent of chronic illness and is potentially very expensive to society. We recommend further studies be done to examine if allocating resources for preventing, diagnosing, and treating loneliness would be cost effective.
Norplant utilization in a Latina inner-city population.
This study was a consecutive-case series of 138 Latinas (age 16 to 36) who received levonorgestrel implants (Norplant) in a community health center between September 1, 1992, and December 31, 1994, and were observed through September 30, 1997. Continuation rate at one year was 70 percent, and 43, 28, and 22 percent at two, three, and four years, respectively. Average observation time was 32 months. Most frequent reasons for removal were excessive bleeding (34 percent), weight gain (26 percent), hair loss (16 percent), amenorrhea (13 percent), desire for pregnancy (11 percent), and headaches (9 percent). Five women discontinued due to fear of ill effects, four to undergo sterilization. No pregnancies occurred while using the method. Norplant is an effective contraceptive for inner-city Latinas; removal rate was higher than in previous reports. Side effects or fear of side effects led to removal in more than half the patients by two years' use.
Access and barriers to mammography in New England community health centers.
BACKGROUND: Historically, screening measures for poor patients have been underemployed. As a result, diagnosis of breast cancer is more likely made at later stages in underserved and minority populations. Regular care in community health centers (CHCs) can mitigate this screening inequity. The purpose of this study was to determine the barriers to and frequency of breast cancer screening in New England CHC women, and to compare our findings with the Healthy People 2000 goal of screening 60% of women aged 50 years and older with mammography every 2 years. METHODS: A consecutive series survey of 3176 women aged 40 years and older was performed between April 1 and August 31, 1995, at 32 CHCs in six states. RESULTS: Completed questionnaires were returned on 2943 patients, including 200 African-American, 2222 white, 370 Hispanic, and 56 Asian women; 932 (32%) were aged 40 to 49 years, and 2011 (68%) were aged 50 and older. Within the preceding 2 years, 2072 (70%) had had a breast examination by a provider. Eighty-seven percent reported that mammography was recommended. More women aged 50 years and older (55%) had had mammography during the last 2 years than women in the 40- to 49-year-old group (45%) (P < .004). The most common reason for not having a mammogram was that the patient thought "the test was not important"; expense and lack of insurance was second. Hispanics had the lowest rates of mammography. CONCLUSIONS: Progress is being made toward Healthy People 2000 goals in New England CHC women. Despite low income status, 55% of women aged > or = 50 years had had mammograms within the past 2 years. Once cost is removed as the greatest barrier, improving patient acceptance promises the largest increase in the use of mammography screening.
Body mass index is increasing at reservation high schools.
Explore the source record for details and available documents.
Xerostomia in diabetes mellitus.
OBJECTIVE: To determine the prevalence of xerostomia in a group of ambulatory diabetic patients and to compare the following in patients with and without xerostomia: 1) flow rates of saliva and lacrimal fluid, 2) the presence of other symptoms suggestive of oral and extraoral dryness, 3) indexes of glycemic control, and 4) noninvasive measures of cardiovagal autonomic nervous system function. RESEARCH DESIGN AND METHODS: Forty adult diabetic patients and an equal number of age- and sex-matched healthy nondiabetic control subjects were studied. Subjects who consumed xerogenic drugs or had other significant diseases were excluded from the study. A questionnaire was administered to all patients, and the following tests were performed: resting and stimulated flow rates on whole saliva; Schirmer's test (lacrimal fluid), serum glucose and HbA1, expiration-inspiration ratio, 30:15 ratio, Valsalva ratio, and the systolic blood pressure response to standing. RESULTS: Forty-three percent of diabetic patients complained of xerostomia, of which 82% were women. The oral dryness was not related to age or the type and duration of diabetes. Symptoms of water loss and oropharyngeal, ocular, and vaginal dryness were much more common in the xerostomic than the nonxerostomic diabetic patients. The salivary flow rates of the diabetic subjects was consistently lower than those of healthy, nondiabetic control subjects. The mean, resting, and whole-saliva flow rate was abnormally low in the diabetic patients who complained of xerostomia; no significant differences were observed for the stimulated salivary and the lacrimal flow rates. Significant inverse relationships were shown between salivary flow and the level of HbA1; none were shown between flow and autonomic function. CONCLUSIONS: Dry mouth is a common complaint among ambulatory diabetic patients. It is strongly associated with objective measurements of poor salivary flow and with other oral and extraoral symptoms of desiccation. The oral dryness is not associated with cardiovagal autonomic system dysfunction but may be due to disturbances in glycemic control.
Selections from current literature: chronic fatigue syndrome.
Explore the source record for details and available documents.
Xerostomia. Part II: Relationship to nonoral symptoms, drugs, and diseases.
Five hundred twenty-nine adult outpatients were studied to determine the relationship of xerostomia to other oral symptoms and salivary flow (reported in part I) and to nonoral symptoms, drugs, and select diseases (reported here in Part II). It was observed that dry throat, blurred vision, dry eyes, dry skin, and vaginal itching and fungal infections are prominently associated with oral dryness. These nonoral symptoms were positively correlated with the oral symptoms cited in part I of this study and were inversely related to the flow of resting, but not stimulated, whole saliva. Several classes of drugs were associated with dry mouth. In addition, diabetes mellitus and hypertension were significantly associated with it. Approximately half of the diabetic and hypertensive patients complained of dry mouth. Although a majority of them were taking medications, the association between xerostomia and these diseases cannot be completely attributed to drugs, since many of these patients did not take any xerogenic medicaments. The data show that xerostomia and several other oral symptoms are valid indicators of salivary gland hypofunction. They suggest, moreover, that select nonoral symptoms are an indicator of generalized xerosis.
Usefulness of a standard battery of laboratory tests in investigating chronic fatigue in adults.
Twenty-two adults with chronic fatigue were studied to determine the clinical usefulness of commonly applied laboratory tests. Subjects with the chief complaint of fatigue persisting for more than one year were followed for an average of seven months at a university family health centre. During this time a group of commonly recommended tests were carried out and the patients had repeated physical examinations. Physical diseases and laboratory abnormalities were few, and patients with abnormal values and active problems were followed until their fatigue resolved or their abnormalities reverted to normal following therapy. The study demonstrated that the presence of an abnormal laboratory result in a fatigued individual does not necessarily indicate the cause of fatigue. A psychiatric history was also performed and patients were tested with the symptom check list 90-R (SCL-90-R), a 90-item psychological symptom check list. Seven patients were receiving psychotherapy when they enrolled in the study. Two additional subjects entered therapy after the start of the study. Results on the symptom check list for the study group were largely abnormal, with a majority scoring in the highest quartile for depression, paranoid ideation and psychoticism. It is concluded that the investigation of patients with fatigue which has lasted for longer than one year should focus on psychological causes. In this group of patients laboratory abnormalities are not useful in guiding evaluation or treatment for their fatigue.
Xerostomia. Part I: Relationship to other oral symptoms and salivary gland hypofunction.
The prevalence of xerostomia and nine other oral symptoms was studied in 529 subjects (18 years or older) in a family health center. The findings show that (1) dry mouth and several other symptoms are common in an outpatient population and (2) they are a valid indicator of salivary gland hypofunction.
Xerostomia. A neglected symptom.
Xerostomia, the subjective feeling of dry mouth caused by a severe reduction in the flow of saliva, is a common problem that is particularly prevalent among the aged. It has become increasingly evident that dry mouth is associated with a number of serious systemic conditions and diseases. Among these are the intake of commonly prescribed medications, autoimmune diseases, and irradiation to the head and neck. The diminution in the flow of saliva may profoundly affect oral health, disturb digestion and speech, and seriously impair the patient's quality of life. Food avoidance, nonabsorption of sublingually placed drugs, and noncompliance with medication may also result. Sialometry can be used to confirm the presence of dry mouth. Treatment is aimed at increasing the flow of saliva, when possible, or providing oral moisture by other means.
Incidence and evaluation of an AGUS Papanicolaou smear in primary care.
BACKGROUND: The category atypical glandular cells of undetermined significance (AGUS) occurs in about 0.5% of Papanicolaou smears. Although recent case series report a great many dysplastic, cancerous, and precancerous lesions of the cervix and endometrium associated with AGUS, little attention has been focused on this issue in primary care literature. METHODS: We report a case series of 52 women with AGUS Papanicolaou smears in a family health center during 2 years (1997 to 1998), along with colposcopy and biopsy results and 18 months of follow-up findings. These results were compared with findings of recent reports. RESULTS: The incidence of AGUS was 0.5%, 52 of 10,564 Papanicolaou smears. Colposcopy was performed in 45. Biopsy (n = 46) showed 2 adenocarcinomas of the endometrium, and 6 high-grade dysplastic lesions, including 1 squamous cell carcinoma in situ. Nineteen women had cervical intraepithelial neoplasia stage I-changes of human papillomavirus effect, and 4 had endocervical polyps. Three women were lost to follow-up. The frequency of dysplastic and cancerous lesions in our population (17.4%) is consistent with series findings from cytology and obstetrics and gynecology literature, reporting that 19.5% of women with AGUS have either cancer--adenocarcinoma of the endometrium, squamous cell carcinoma, or extrauterine (8%)--or high-grade lesions--cervical intraepithelial neoplasia II-III, carcinoma in situ, or cervical adenocarcinoma in situ, (11.5%). CONCLUSIONS: A relatively large percentage of women with AGUS on Papanicolaou smears have cancerous and dysplastic squamous and glandular lesions of the exocervix, endocervix, and endometrium. Clinical practice guidelines recommend patients with AGUS should be evaluated with colposcopy and endocervical curettage. Consensus supports endometrial sampling in women 35 years and older and in those with a laboratory report of AGUS, favors neoplasia or suggests an endometrial source.