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PubMed2004

Is graded exercise better than cognitive behaviour therapy for fatigue? A UK randomized trial in primary care.

BACKGROUND: Patients frequently present with unexplained fatigue in primary care, but there have been few treatment trials in this context. We aimed to test cognitive behaviour therapy (CBT) and graded exercise therapy (GET) for patients presenting to their family doctor with fatigue. Secondly, we described the outcome for a cohort of patients who presented to the same doctors with fatigue, who received standard care, plus a booklet. METHOD: This was a randomized trial, followed by a prospective cohort study. Twenty-two practices in SE England referred 144 patients aged 16 to 75 years with over 3 months of unexplained fatigue. Self-rated fatigue score, the hospital anxiety and depression rating scale, functional impairment, physical step-test performance and causal attributions were measured. In the trial six sessions of CBT or GET were randomly allocated. RESULTS: In the therapy groups the mean fatigue score decreased by 10 points (95% confidence interval (CI) = -25 to -15), with no significant difference between groups (mean difference = -1.3; CI = -3.9 to 1.3). Fewer patients attended for GET. At outcome one-half of patients had clinically important fatigue in both randomized groups, but patients in the group offered CBT were less anxious. Twenty-seven per cent of the patients met criteria for CFS at baseline. Only 25% of this subgroup recovered, compared to 60% of the subgroup that did not meet criteria for CFS. CONCLUSIONS: Short courses of GET were not superior to CBT for patients consulting with fatigue of over 3 months in primary care. CBT was easier 'to sell'. Low recovery in the CFS subgroup suggests that brief treatment is too short.

Adolescent↗

PubMed2004

Prescribing viagra in an ethically responsible fashion.

Sildenafil citrate (Viagra) and other newly released pharmaceuticals that assist erectile dysfunction may be one of the most important categories of drugs released in the past decade. Sildenafil is distinctive because it creates a new therapeutic relationship not only between patient and physician, but also with sexual partner(s). Physicians must first evaluate the patient comprehensively, addressing not only erectile function and sexual performance, but overall physical and mental health. Since the drug does impact others, an expanded model for informed consent needs to be considered. Three models to consider include the public health one, ethically justified limits on confidentiality, and a biopsychosocial one. The biopsychosocial model may be preferred because it expands the patient-physician dyad to directly include others. Physicians also need to distinguish between professional, role-related obligations and personal conscience when treating patients whose sexual beliefs and practices differ from their own. Other ethical issues include inappropriate prescribing over the Internet, dealing with unrealistic patient expectations, and fairness in paying for treatment for sexual conditions in both men and women. With these proposed guidelines, physicians can continue to provide steady, reliable guidance for patients while working with yet another scientific advance in medicine.

Counseling↗

PubMed2002

Health examination and chromosome aberration analysis of residents living in 60Co-contaminated rebar buildings.

PURPOSE: To elucidate the results of health examination and chromosome aberration analysis of residents living in (60)Co-contaminated rebar buildings. MATERIAL AND METHODS: Medical surveillance including peripheral blood analysis, urine analysis, chest X-ray, blood biochemical analysis, electrocardiography, thyroid function test and physical examination was performed on 189 residents within 6 months after disclosure of radiation exposure. The annual dose for this group of residents varied from 2 to 95 mSv year(-1) (mean+/-1 SD = 18+/-21 mSv year(-1)) above the background exposure of the Taiwanese population. For chromosome analysis, 500-671 lymphocytes were scored for 136 residents, and the numbers of dicentrics and rings were counted and analysed. RESULTS: Medical surveillance showed that the most frequent abnormalities were elevation of the erythrocyte sedimentation rate occurring in 14.8% of those examined. Reduction of the negative charge on erthrocytes by ionizing radiation may cause an elevation of erythrocyte sedimentation rate. Statistical analysis of chromosome aberration data showed that the mean dicentric frequency for radiation-contaminated building residents (0.69+/-0.93 SD) was significantly higher than those for controls (0.33+/-0.49) (p <0.01). CONCLUSIONS: No radiation effects were found in the preliminary health examination. However, lymphocyte chromosome analysis of the radiation-contaminated building residents showed that prolonged low-dose-rate gamma exposure induced cytogenetic changes in humans.

Adolescent↗

PubMed1995

Health care outcomes case study: anemia in end-stage renal disease.

Outcomes goals in managing anemia in end-stage renal disease (ESRD) with epoetin alfa and other therapies are illustrated with a case study. Anemia is common in patients with ESRD undergoing hemodialysis; the cause is primarily a reduction in the secretion of erythropoietin. Multiple coexisting factors, such as iron deficiency and blood loss, also contribute. Outcomes goals include decreasing blood transfusions, increasing physical performance, improving cardiovascular and cognitive function, enhancing overall well-being, and achieving self-sufficiency. The potential to achieve these goals has been linked to the attainment of an optima, hematocrit and hemoglobin concentration with epoetin alfa therapy. Once epoetin alfa is begun, safety and effectiveness should be monitored and attainment of outcomes goals assessed. Supplemental iron, folate, and cyanocobalamin may be necessary, as may management of the underlying inflammatory process. The pharmacist can help optimize outcomes by conducting drug-use evaluations, monitoring laboratory test values and drug dosages, assessing drug effectiveness, and counseling patients. A case study of a 67-year-old woman with diabetes mellitus and ESRD who was placed on hemodialysis is presented as an example of how the pharmacist can help optimize outcomes. Opportunities for pharmacists in outcomes management in patients with ESRD-associated anemia include monitoring epoetin alfa therapy, counseling patients, and working with the renal team.

Aged↗

PubMed2005

Late-life anemia is associated with increased risk of recurrent falls.

OBJECTIVES: To examine whether anemia is associated with a higher incidence of recurrent falls. DESIGN: Prospective cohort study. SETTING: Community-dwelling sample in The Netherlands. PARTICIPANTS: Three hundred ninety-four participants aged 65 to 88 from the Longitudinal Aging Study Amsterdam. MEASUREMENTS: Anemia was defined according to World Health Organization criteria as a hemoglobin concentration less than 12 g/dL in women and less than 13 g/dL in men. Falls were prospectively determined using fall calendars that participants filled out weekly for 3 years. Recurrent fallers were identified as those who fell at least two times within 6 months during the 3-year follow-up. RESULTS: Of the 394 persons, 11.9% (18 women and 29 men) had anemia. The incidence of recurrent falls was 38.3% of anemic persons versus 19.6% of nonanemic persons (P=.004). After adjustment for sex, age, body mass index, and diseases, anemia was significantly associated with a 1.91 times greater risk for recurrent falls (95% confidence interval=1.09-3.36). Poor physical function (indicated by muscle strength, physical performance, and limitations) partly mediated the association between anemia and incidence of recurrent falls. CONCLUSION: Late-life anemia is common and associated with twice the risk of recurrent falls. Muscle weakness and poor physical performance appear to partly mediate this association.

Accidental Falls↗

PubMed1988

The relationship of presenting complaints to the use of psychiatric services in a low-income group.

The presenting complaints of 503 subjects who contacted a mental health clinic serving an inner-city, low-income group were classified into mental state, physical functioning, social relations, and social performance. The authors examined the relationship between type of presenting complaint and race ethnicity, gender, age, marital status, DSM-III diagnosis, source of referral, and previous use of psychiatric services. Diagnostic group, source of referral, previous use of services, and type of presenting complaint were the four best predictors of number of outpatient visits. The increment in prediction produced by type of presenting complaint, however, was relatively modest.

Adult↗

PubMed1986

The matrix of care: a heuristic for assessment and placement.

Policymakers and practioners have attempted to enhance the quality of long-term care, and thereby provide appropriate care, by using the notion of levels of care. This approach assumes that the needs of those requiring long-term care can be easily ordered along a single continuum. This conceptual position, however, has led to confusion with the diagnosis of patient needs and conflicting approaches to assessments of those needs. Invariably problems of patient placement and alternative levels of care result. A more productive approach to the issue of providing appropriate care is to separate physical from psychosocial needs when performing functional assessment and to rearrange them into a matrix. By examining each need separately, and the point at which they overlap in the matrix, more direct assessment can be performed, and specified interventions can be designed.

Activities of Daily Living↗

PubMed2005

Gait disorders: search for multiple causes.

Gait disorders predict functional decline in older adults. They are often the result of multiple causes, so a full assessment should consider different sensorimotor levels and should include a focused physical examination and evaluation of functional performance. Exercise and medical and surgical interventions are effective and can reduce the degree of gait disorder, but usually not without some residual impairment. Orthoses and mobility aids are also important interventions to consider.

Age Factors↗

PubMed2000

Health-related quality of life predictors of survival and hospital utilization.

The health-related quality of life (HRQOL) of 103 end-stage renal disease (ESRD) patients on hemodialysis was studied for prediction of 1-year survival and hospital days in the context of other predictors. Higher HRQOL physical functioning, higher provider-reported functional performance, fewer private religious activities, living with family, black race, and having a diagnosis of hypertension predicted survival. Lower HRQOL energy, higher pain, and not living with family predicted more hospital days. Patients living with family reported more social support and better HRQOL general health, emotional well-being, social health, and quality of social interactions than other patients.

Aged↗

PubMed2001

Pathophysiology, diagnosis, and current management strategies for chest pain in patients with normal findings on angiography.

Chest pain syndromes in patients with normal angiographic findings represent a multifactorial pathophysiologic state, which may range from abnormalities in pain perception to abnormalities in endothelial- and non-endothelial-dependent coronary flow reserve associated with myocardial ischemia. Treatment begins with an accurate diagnosis by obtaining a comprehensive history and performing a physical examination, followed possibly by performing functional angiography in those who continue to have symptoms. This approach may help to determine appropriate treatment.

Angina Pectoris↗

PubMedDate not supplied

[The evaluation of the quality of life among professional soldiers with diagnosed alcohol addiction syndrome].

Presented paper is the first estimation probe in Poland of the "quality of life" of alcohol addicted people. The group of 70 professional soldiers that had been undergo treatment in Military Hospital the Section of Psychiatric Clinic in Cracow in years 1996-1998 has been investigated as alcohol addicted syndrome. For the research it has been used: the questionnaire with sociodemographis and epidemiological data, Polish version questionnaire SF-36 for "quality of life" research and Michigan Alcoholism Screening Test (MAST)--the questionnaire for estimation alcohol problems. The main aim of investigation was to recognise the influence of alcohol addicted syndrome that impact on "quality of life" estimation, range changes and their dynamics that depend on alcohol addicted syndrome degree, in age, military degree. The exploration aim was some sociodemographis and epidemiological data analysis. Results confirm the lower "quality of life" within estimated group. All ingredients Q1 have decreased, and the highest differences related such ingredients as: "physical limits in role perform", "social function", "emotion limits in role perform" so that "social activity sphere" creation ingredients. The estimation hypothesis related to QL decrease together with addiction degree (numbers of MAST) and decrease of "quality of life" together with age within estimated group have been not confirmed. The analysis of chosen sociodemographis variables has shown the significant variation, relative to QL and: "sexual live", "alone drinking" and "conflict". The differences between peoples who are alcohol addicted and non habitual drinking alcohol peoples has been confirmed within range; "frequency of alcohol drinking", "quantity of single drinking alcohol", "frequency to be drunk", "reasons of drinking", "behaviour after drinking", "suffering after drinking", "continuos drinking" or "alcohol tolerance".

Adult↗

PubMed2002

[Subjective quality of life of children and adolescents with psychiatric disorders: development and validation of a new assessment scale].

Within paediatric disciplines and in particular in child and adolescent psychiatry very little work is available regarding the quality of life (QoL) of patients. After using literature search and interviews for identifying the relevant QoL domains, a set of self report questionnaires (for the parents: proxy rating) was developed (C-version: children 10 to 14 years, A-version: adolescents 14 to 18 years, P-version: parental proxy rating about child/adolescent). It was aimed at an almost identical wording within each questionnaire version in regard to the different QoL domains. The questionnaires should not primarily address symptomatology (like e.g. the Child Behaviour Checklist by Achenbach and Edelbrock 1983). After a pilot phase ensuring adequacy and appropriateness of the forms, the questionnaires were field tested in a consecutive series of nearly 700 patients which were referred to the Cologne university department of child and adolescent psychiatry for diagnosis and treatment between 1996 and 2000. The intended structure of the questionnaire system with symptom and functioning scales concerning the domains: "physical performance, fatigue, anxiety, depression, peer group, school, family, beliefs, general QoL" and some further single questions was confirmed by psychometric testing (validity and reliability). Interscale correlations were in general moderate, exhibiting the expected pattern. Analyses of variances using the method of "known groups comparisons" showed e.g. age, sex, and diagnosis related effects hinting towards clinically meaningful differences. The questionnaire forms were well accepted and understood by patients and parents and the wording of the addressed topics was reported to be adequate. Further work will include the psychopathological findings and will focus on specific subgroups of patients (e.g. different diagnoses) as well as on the longitudinal observation of special patient groups, e.g. patients with eating disorders. It can be concluded that the new QoL instruments were successfully employed in a consecutive series of patients and showed very sufficient psychometric properties.

Adolescent↗

PubMed2002

Work-related symptoms among furniture factory workers in Lublin region (eastern Poland).

48 woodworkers employed in the furniture factory were examined. The control group consisted of 41 office workers with no exposure to organic dust. The examination included: interview on work-related symptoms, physical examination, and lung function test performed before and after the working-day. 38 out of 48 (79.2%) woodworkers reported work-related symptoms. The most common complaint was dry cough reported by 25 workers (52.1%), followed by general malaise -- reported by 17 (35.45%), conjunctivitis -- by 16 (33.3%), rhinitis - by 16 (33.3%), and skin symptoms by 16 (33.3%). Other symptoms such as headache, shortness of breath and chest pain occurred less frequently. Subjects working in initial processing and board processing departments had a higher prevalence of cough compared to workers employed in the varnishing department (p < 0.01). The prevalence of skin symptoms was significantly higher in board processing and varnishing departments compared to initial processing department (p < 0.05). Occupational asthma and allergic alveolitis were recorded in 3 out of 48 (6.2%) and 2 out of 48 (4.2%) workers, respectively. Baseline FVC and FEV(1) values were lower in woodworkers compared to controls (p < 0.01). The increased lung function parameters (FVC, FEV(1)) were observed in woodworkers who smoked compared to non-smokers. The difference was not statistically significant. There was a significant over-shift decrease of all measured spirometric values: FVC, FEV(1)), FEV(1)) /VC, PEF among woodworkers (p < 0.001). There was a significant pre-shift, post-shift decline in FVC, FEV(1)), FVC/FEV(1)), and PEF among workers under 30 years of age (p < 0.001). The same tendency was seen for FVC and FEV(1)) in subjects over 30. The percentage changes in FVC and FEV(1)) were greater in the group of younger workers (15.1% and 17.6%) respectively, than in the group of older subject (6.2%, 7.1%). The difference was not statistically significant.

Adult↗

PubMedDate not supplied

[Effect of normobaric hypoxia and physical load on the functional indices of cardiorespiratory system in overweight people].

Changes in the cardiorespiratory function in obese persons exposed to different combinations of normobaric hypoxia and physical exercise were studied. The results show a positive effect of combined use of normobaric hypoxic exercise on functional reserves of cardiorespiratory system, physical performance and aerobic potentialities in obese patients. The highest effect is achieved in combination of physical exercise with hypoxic gas mixtures breathing.

Adolescent↗

PubMed2004

Measuring and improving health outcomes in Medicare: the Medicare HOS program.

The Medicare Health Outcomes Survey (HOS) (originally called the Health of Seniors Survey) was developed as a longitudinal performance measure to assess the physical functioning and mental well being of Medicare beneficiaries over time. The survey was implemented nationally in Medicare managed care organizations (MCOs) as part of Medicare HEDIS, 3.0/1998 and continues today. In 1998, a pilot test of the HOS in Medicare FFS was conducted; the pilot test concluded in 2001. This overview discusses the importance of functional status assessment, reviews the goals of the HOS, and explains how researchers and quality improvement professionals are using the data to explore functional status measurement issues, describe policy and programmatic implications for CMS, and identify opportunities to improve health care practice.

Humans↗

PubMed1994

Smoking, alcohol, and neuromuscular and physical function of older women. Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To determine the associations of current and lifetime smoking and alcohol use with physical function in an older population. DESIGN: Survey. SETTING: Four clinic centers in the United States. PARTICIPANTS: A total of 9704 community-dwelling, ambulatory white women 65 years or older recruited from four areas of the United States. MAIN OUTCOME MEASURES: Twelve performance tests of muscle strength, agility and coordination, gait and balance, and self-reported functional status. RESULTS: Compared with women who never smoked, current smokers had significantly poorer function on all of the performance measures except grip strength after adjusting for age, history of stroke, body mass index, clinic site, physical activity, and alcohol use (P < .05). This decrease in function was 50% to 100% as great as that associated with a 5-year increase in age, and most measures worsened with increasing numbers of pack-years. Compared with current moderate drinkers, nondrinkers had significantly poorer function on all of the performance measures except tandem walk (P < .05). Evaluation of a dose effect with alcohol was limited by the small number of heavy drinkers in the study. CONCLUSIONS: In this population, women who currently smoke are weaker and have poorer balance and poorer performance on measures of integrated physical function than nonsmokers. Smoking is associated with a decline in physical function. Current moderate drinkers have better physical function compared with nondrinkers, but associations of function with heavy drinkers could not be assessed.

Activities of Daily Living↗

PubMed1992

Rehabilitation and Parkinson's disease.

In this study we evaluated the efficacy of physical therapy together with drug therapy in a group of parkinsonian patients, compared with a group of patients treated using drug therapy only. The physical therapy program lasted four months and included passive and active mobilization exercises, adopted for postural control and equilibrium, walking and prevention of contractures and ankylosis. The assessment was accomplished by means of clinical rating scales and motor performance tests. Patients treated by means of physiotherapy showed an improvement at the end of the study in both clinical scales and motor performance tests. This improvement was noted in both patients with less severe and more severe symptoms as well as in those with shorter and longer disease duration. It is not easy to assess the role played by physical therapy due to the difficulty of an objective evaluation; our results, however, show an improvement in the functional performance of patients and suggest the usefulness of physical therapy associated with drug therapy in a comprehensive treatment for Parkinson's disease.

Aged↗

PubMed2002

Change in physical performance over time in older women: the Women's Health and Aging Study.

BACKGROUND: Although lower and upper extremity performance measures are widely used and represent validated physical function measures in older adults, there is limited information regarding the magnitude of changes in these measures over time. This study (i) assesses prospective changes in physical performance measures, (ii) defines a summary score that demonstrates a significant amount of change over time, and (iii) examines rates of decline according to age and baseline performance levels. METHODS: Data from the Women's Health and Aging Study (WHAS) were analyzed to assess change in the one third most disabled older women living in the community. Lower extremity function was assessed using walking speed, balance, and chair stands tests. The putting-on-blouse test, the lock and key test, the Purdue Pegboard test, and grip strength were used to gauge upper extremity function. Continuous and categorical summary performance scores were calculated using continuous and categorical data of lower and upper performance measures. RESULTS: After 3 years, lower extremity performance measures declined by 16%-27%, while upper extremity performance measures declined less (7%-24%). For lower extremity function, the continuous summary performance score showed a slightly greater 3-year decline from baseline (decline vs baseline mean: 23%; decline vs SD of the baseline mean: 59%) than the categorical score (22% and 41%, respectively). Older age and intermediate level of baseline performance were associated with the greatest decline, especially for lower extremity function. CONCLUSIONS: In moderately to severely disabled women aged 65 or older, lower extremity measures show more change over 3 years than upper extremity measures. Among the lower extremity summary scores, the continuous score changes more over time than the categorical score with respect to the baseline SD. The lower extremity continuous summary performance score may be a useful outcome measure for clinical studies of physical performance in older women.

Aged↗