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PubMed1992

[Self-treatment and self-monitoring in patients with bronchial asthma].

Regular assessment of the peak expiratory flow (PEF), which after proper instruction, the patient can do himself is important for evaluation of the activity of bronchial asthma. It is, however, essential to assess the optimal PEF values of every individual. For control of self-treatment it is important to know the daily variations of PEF and the degree of reversibility of bronchospasm after inhalation of a beta 2-adrenergic substance. Inadequate reversibility of bronchial obstruction despite repeated inhalation of a beta 2-adrenergic substance is usually caused by inflammation. Depending on the clinical status and changes of PEF the patient can, if properly instructed, start corticosteroid treatment in case of acute deterioration or increase the corticosteroid doses in case of subacute deterioration of the condition. Follow-up of PEF is important also for self-management in case of clinically latent deterioration and during maintenance treatment.

Acute Disease↗
PubMed1992

Acquisition and retention of skills training methods in chronic schizophrenic outpatients.

Forty-one DSM-III-R schizophrenic subjects on constant, low-dose maintenance neuroleptic drug therapy (5-10 mg of fluphenazine decanoate intramuscularly every 2 weeks) were randomly assigned to structured and modularized skills training or to supportive group psychotherapy. The skills training was designed by using cognitive and behavioral methods to compensate for the learning disabilities that plague many schizophrenic patients. Skill acquisition was assessed by using quantified performance on standardized role-play tests. Subjects who received skills training made significant gains in each of the areas taught, whereas those who participated in the control psychotherapy group did not. The knowledge and skills learned during training were retained without significant erosion over a 1-year followup period. These results suggest that the use of structured principles of learning and cognitive therapy can effectively train schizophrenics in skill areas pertinent to the self-management of their illness.

Adult↗
PubMed1992

Randomized controlled study of a retiree health promotion program. The Bank of American Study.

The initial results of a 12-month controlled trial of a health promotion program in 5686 Bank of America retirees, randomized into full program, questionnaire only, and insurance claims only groups, were analyzed to determine whether the health promotion program was effective. Comparisons were between program and questionnaire only groups for self-reported health habit changes, health risk scores, medical care utilization, and days confined to home, and between all groups for insurance claims data. The intervention, or full program, included health habit questionnaires administered every 6 months, individualized time-oriented health risk appraisals, personal recommendation letters, self-management materials, and a health promotion book. Twelve-month changes in health habits, health status, and economic variables favored the full program group in 31 of 32 comparisons and were statistically significant at the .05 level in two-tailed tests in 19 comparisons and at the .01 level in two-tailed tests in 13 comparisons. Over 12 months, overall computed health risk scores decreased by 4.3% in the full program experimental group and increased by 7.2% in the questionnaire only control group. Total direct and indirect costs decreased by 11% in the experimental group and increased by 6.3% in the questionnaire only control group. Analysis of claims data confirmed these trends. A low-cost health promotion program for retirees was effective in changing health behaviors and has potential to decrease health care utilization.

Aged↗
PubMed1991

Current management of acute severe asthma.

Most attacks of acute severe asthma represent a failure of asthma management. The factors underlying each attack should be identified and determined attempts made to improve the assessment of asthma severity and self-management by the patient so that future attacks can be aborted or prevented.

Acute Disease↗
PubMed1992

[Clinical course in poor grade patients with ruptured intracranial aneurysms and extensive subarachnoidal clot].

Three hundred and eight cases with ruptured intracranial aneurysms and variable amounts of subarachnoidal clot were evaluated clinically with special emphasis on the natural course of poor grade patients. Clinical severity was classified according to the Glasgow Coma Scale (GCS); severe cases (score 3-8) and mild cases (score 9-15). Patients were further divided into four groups based on the preoperative clinical course, and on whether radical surgery was performed or not. Group A, severe cases without radical surgery (17 patients, mean GCS score 4.2); group B, severe cases (which had undergone) radical surgery (24 cases, mean GCS score 5.5); group C, patients considered as severe cases on admission that had improved to mild cases before radical surgery (3 patients, mean GCS score 11.7); group D, mild cases which had undergone radical surgery (254 cases, mean GCS score 14.3). CT findings after their last bleeding episode were evaluated in each group using subarachnoid hemorrhage (SAH) score from "0"-"3" according to the severity of SAH. In addition, the SAH-B (brainstem) score ("0"-"9") was also evaluated. In this score, the amount of SAH in each perimesencephalic cistern (a. prepontine or interpeduncular cistern, b. ambient cistern, c. quadrigeminal cistern) was considered with a possible score of "0"-"3" for each cistern. (No patient had a concurrent intracerebral or intraventricular hematoma causing a mass effect on CT scan). All cases in group A died except one patient that remained in a vegetative state. All of them had severe subarachnoidal clot (mean SAH score 2.9, SAH-B score 8.2). In group B, in patients with same scores (mean SAH score 2.8, mean SAH-B score 7.3), the outcome was as follows: 6 patients (33.3%) had full recovery or were capable of self-management, 6 patients (33.3%) were partially or fully dependent, and 12 patients (50%) were either in vegetative state or died. Patients in groups C and D with good outcome had significantly less amount of SAH, especially in the perimesencephalic cistern (group C--mean SAH score 2.3, mean SAH-B score 3.7, group D--mean SAH score 1.9, mean SAH-B score 3.3). It is concluded that duration and level of unconsciousness in the cases of SAH without concurrent hematoma causing mass effect, has a good correlation with the severity of SAH in the perimesencephalic cisterns.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

[Occupational health care as a basis of occupational medicine monitoring in small companies. Common occupational medicine/ergonomic approach to prevention].

Set out from various specific angles, the concept concerning a modern common industrial medicine/safety/ergonomics approach can be fitted into the present legal framework. Adapted according to specific needs, this approach can equally be applied in all areas--health promotion, prevention, cure, rehabilitation. Those involved in the current debate about industrial health policies start out from the premise that industrial medicine could contribute strongly in this respect. While the workmen's compensation scheme, together with the industrial medical profession, is to a considerable extent involved in the subject as a whole on the basis of the industrial safety Act, its competencies are however limited, being in actual fact confined to the field of health maintenance in the occupational context. The examinations they effect in this framework cannot be based on a holistic medical orientation, because our constitution has expressly excluded the private sphere of the individual (self-management domain). Hence, there are very little chances of success for any attempt of changing current health care practice solely via the workmen's compensation administrations. It currently is, rather, the health and pension insurance schemes who hold the potential for influence. The common approach of industrial medicine, safety and ergonomics outlined may be of considerable use also in view of their goals, and holds sufficient justification for their intervening favourably in the ongoing debate about quality and quantity of industrial medical service provision with the ministries in charge.

Ergonomics↗
PubMed1991

Reversing disability of irreversible lung disease.

Pulmonary rehabilitation is a comprehensive multifaceted team approach for integrating medical management, coping skills, self-management techniques, and exercise reconditioning. It provides patients with chronic lung disease the ability to adapt and live full and nearly normal lives. These changes are possible because the overall disability includes significant reversible components: Patients have bronchospasm, infection, and cor pulmonale; they respond to progressively impaired lungs by progressive inactivity, leading to physical deconditioning. Both factors contribute to dyspnea. Because patients naturally fear dyspnea, they panic easily. During panic, their work of breathing may increase and respiratory failure may result. Pulmonary rehabilitation provides good medical management; provides exercises to increase strength, endurance, and tolerance to dyspnea; and trains patients in panic control. These programs have not been shown to lengthen life span or improve static lung function. They increase exercise performance and render patients functional, independent, and subject to fewer hospital admissions. Pulmonary rehabilitation is the only approach to chronic lung disease short of lung transplantation that improves the long-term outlook for these patients.

Activities of Daily Living↗
PubMedDate not supplied

[The evolution of a comprehensive community service system].

The evolution of psychiatric care in the United States is still strongly influenced by the consequences of deinstitutionalisation. In some cases the process has generated a sort of transinstitutionalisation: at present, there are more intermediate public structures than a few years ago, whereas small residential units, experimentally self-managed by chronic patients, are also being established. With regard to the State of Illinois, current efforts are focused on the reduction of the number of psychosocial disabilities and the setting up of a wider range of rehabilitative programs. A comprehensive community service, connecting short-term and prolonged-stay hospital wards with community-based facilities seems to represent the most promising combination.

Community Mental Health Services↗
PubMed1991

[Treatment for serious cases of ruptured intracranial aneurysms with severe subarachnoid clot].

Forty-one serious cases of ruptured intracranial aneurysms with severe subarachnoid clot were clinically analyzed, with special emphasis on the prognosis, pathophysiology, and surgical indications. All cases had thick subarachnoid clot without concurrent intracerebral hematoma and/or intraventricular hematoma causing mass signs on the CT scan. In this series, 23 cases underwent radical surgery while in the acute stage, 18 cases were treated conservatively (including 5 cases treated only by continuous ventricular drainage). The criterion for determining the degree of severity was defined as either a "semicoma" or "coma" state just prior to radical surgery for the radically-operated group, with the same designations for the conservative group at their time of admission. All patients except two in the conservatively-treated group died due to primary brain damage caused by massive subarachnoid hemorrhage. The two remaining cases died from other complications. On the other hand, the outcome for the 23 surgically-treated patients was as follows: Three (13%) fully recovered; three (13%) were capable of self-management; eight (34.8%) were partially or fully dependent. Nine (39.1%), died. In the radically-treated group, pre-operative factors that might predict clinical outcome were investigated. Those factors were the neurological grade, the brain-stem response, the response after the rapid administration of 20% Mannitol (300-900 ml), and the length of time from the last bleeding episode to the time that radical surgery was performed. It was recognized that there was no relationship between the neurological grade just prior to radical surgery and the outcomes in the serious cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Food records: a predictor and modifier of weight change in a long-term weight loss program.

Overriding concerns about the accuracy of self-reported food records have overshadowed discussion of their practical value as a self-management, intervention tool. This study examined the relationship between keeping food records and subsequent weight loss in a large-scale, conservative weight loss program. Keeping food records was a better predictor of weight loss than were baseline body mass index, exercise, and age. Monthly as well as cumulative weight loss was directly related to the number of days in which food records were kept. The strong, linear relationship between food record patterns and weight loss suggests that in spite of legitimate concern about the accuracy and representativeness of self-reported food records, they have considerable power as a predictor of success in achieving weight loss.

Adult↗
PubMedDate not supplied

[Development and evaluation of an instrument to assess the psychosocial environment].

It is an instrument to explore the psico-social environment that carries out a thorough inventory of the elements in such environment, it groups them in general categories that, from the process of stress (taken as the point of the departure), are the following: stressing situations, psicosocial support and facing conducts. And they are expressed in four levels or spheres of action: society, family, occupation and individual. It was intended to satisfy the need to count on relatively simple material, self-managable, widely applicable, standardized and that describes in an integral way the environment. The validity of contents and concepts was estimated through the Delphos technique. Though the concurrent validity is established by its application with another similar instrument, when this late was not available, some scales that could work as standards were use. The t Student test was used to evaluate the discrimination capacity among subgroups. In this, statistical differences were noticed for the same items with a significant value of 0.01. It was observed that the older they were there was an increasing set of stressing situations in the society and occupation spheres (correlation quotient of 0.80). According to sex, there were more stressing family situations in women. According to income, it was found that the bigger number of stressing situations and fewer psicosocial supports pertained to a higher income (correlation quotient of 0.91). It is deduced that the instrument, though it has some limitations, can be widely used. The only requirement is that it should be applied to individuals over 18 years old, of any sex and socio-economical class, and they should be literate.

Humans↗
PubMed1990

[Possibilities of cognitive behavior therapy in general practice].

Cognitive behavior therapy has achieved an important standing among the various approaches in psychotherapy. The article gives a short overview over the history of cognitive behavior therapy and delineates its applications in psychotherapy, especially in the treatment of mild to moderate depressions. Further indications include the treatment of anxiety disorders, as well as in the skills training and self-management of schizophrenic patients. Therapeutic experience underscores the importance of a multimodal concept, embedded in a trusting therapeutic relationship. Cognitive behavior therapy must not be viewed as mere therapeutic technique but rather as a therapeutic attitude with the goal of helping the patient achieve better self-efficacy.

Cognitive Behavioral Therapy↗
PubMed1990

Promoting adherence to low-fat, low-cholesterol diets: review and recommendations.

Evidence that lowering blood cholesterol levels reduces risk of coronary heart disease has prompted widespread recommendations that hyperlipidemic individuals undergo dietary therapy. However, the extent to which people can adopt and maintain diets to lower lipids is unclear. In our article, we review what is currently known regarding adherence to low-fat diets and present an approach to dietary counseling for lowering cholesterol that incorporates elements of behavioral self-management and social learning theory. We discuss specific recommendations for counseling hyperlipidemic patients based on the Dietary Alternatives Study. Recommendations include providing patients with an adequate knowledge base to make dietary changes, using goal setting and self-monitoring to help patients initiate dietary changes, enlisting support from the patient's family, and enhancing self-efficacy to promote long-term dietary maintenance.

Cholesterol, Dietary↗
PubMed1990

[Teaching and education of diabetic patients].

The instruction of the patient with diabetes mellitus, aimed at the mastery of technical elements in self-management, as well as his/her education to a coherent behavior respecting both the quality of metabolic control and the quality of life, are basic elements of diabetes treatment. To neglect them would be a professional error. The physician in charge of a diabetic patient must take into account the knowledge and the capabilities that have been acquired by the patient before, as well as his/her actual demand for information and instruction. Concepts and methods of learning and teaching for diabetic patients that have been developed and applied over the last decade may serve as reference for all levels of health education.

Diabetes Mellitus↗
PubMed1990

[Anterior cerebral artery occlusion clinical analysis of 27 self-experienced cases].

From the years 1977 through 1989, the author experienced 27 cases with only anterior cerebral artery (ACA) occlusion but without any other main cerebral arterial occlusions. These were proven by cerebral angiographies and verified by CT. Two patients showing large infarction in the left frontal lobe on CT but showing no evidence of arterial occlusion by cerebral angiography were also registered in this study because these patients were thought to have recanalized ACA. There were 15 males and 12 females with an age of 61.5 +/- 7.98 (mean +/- SD) and 66.1 +/- 6.45, respectively. Twenty two cases had cerebral thrombosis and 5 had cerebral embolism. There were 4 cases with bilateral ACA occlusions, 8 with right ACA occlusion and 15 with left ACA occlusion. Twenty two patients (81%) were alert on admission and this fact might explain their excellent ADL on discharge: full recovery in 9 patients (33%) and self-management in 12 patients (44%). Seventeen patients (63%) had a CT-proven infarcted area with a correlation to ACA occlusion (s), while 9 patients (33%) showed no correlation between an infarction on CT and an ACA occlusion. One patient showed no abnormal findings on CT. Four patients with right ACA occlusion were incidentally observed, even though their mode of onset was strokes. The symptoms of the other 23 patients were those of anterior cerebral artery syndromes: hemiparesis (74%), urinary incontinence (39%), forced grasping (39%), mutism (30%), indifference (26%) and apraxia (22%) etc.

Aged↗
PubMedDate not supplied

[Strategies to reduce morbidity and mortality caused by acute diarrhea in Latin America].

Following the World Health Organization guidelines, the Latin American Diarrheal Disease Control Programs have directed its efforts towards the promotion of Oral Hydration Therapy (OHT) and appropriate dietary management during the diarrheal episode and convalescent period, aimed at diminishing the mortality secondary to diarrhea. In developing countries, OHT is preventing, annually, one million of childhood deaths due to dehydration. Yet, only one fourth of the total population of children suffering diarrhea are being treated with this therapy. Among the strategies to decrease diarrhea morbidity, breast-feeding and hand washing are top priorities. The fundamental strategy has been to promote educational programs to train health personnel and community members. To continue these actions, we suggested the creation of more secondary and tertiary level hospitals and the installation of community units of OHT. They should become self-sufficient and self-manageable and include other programs of primary health care, such as immunization, growth and development surveillance, family planning and pregnancy control.

Acute Disease↗
PubMed1990

[Anxiety and illness behavior in bronchial asthma].

In 82 patients attending a one-week asthma self-management education program, asthma symptom anxiety, personality trait anxiety, and attack-related coping styles were correlated with attack frequency, medication regimen and pulmonary function parameters. In 21 patients, asthma symptoms anxiety was shown to influence illness behaviour at follow-up one year later: in patients with severe asthma, greater symptom anxiety was associated with more suitable illness behaviour. Moreover, suitable illness behaviour appears to be related to cognitive coping styles that take into account the asthmatic's feeling of dependency in attacks without denying them.

Adaptation, Psychological↗