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At least 325 records · Page 18Linked to original sources
PubMed2002

Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint.

Mandibular repositioning splints (MRSs) and continuous positive airway pressure (CPAP) are used to treat the sleep apnea/hypopnea syndrome (SAHS). There are some data suggesting that patients with milder symptoms prefer MRS, but there are few comparative data on outcomes. Therefore, we performed a randomized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new outpatients diagnosed with SAHS (apnea/hypopnea index [AHI] >or= 5/hour, and >or= 2 symptoms including sleepiness). Assessments at the end of both limbs comprised home sleep study, subjective ratings of treatment value, sleepiness, symptoms, and well-being, and objective tests of sleepiness and cognition. Forty-eight of 51 recruited patients completed the trial (12 women; age [mean +/- SD], 46 +/- 9 years; Epworth 14 +/- 4; median AHI, 22/hour; interquartile ratio [IQR], 11-43/hour). Significant (p <or= 0.01) differences between MRS and CPAP were observed for 7 of 21 variables (effect sizes, 0.3-0.6 SDs), all favoring CPAP, including AHI (15 +/- 16 and 8 +/- 6/hour, respectively), effectiveness rating, symptoms, Epworth (12 +/- 5 and 8 +/- 5, respectively), functional outcomes of sleepiness questionnaire, short-form 36 health survey mental component, and health transition scores. Objective sleepiness, cognitive performance, and preference for treatments were not different. In patients experiencing a mild form of the syndrome (AHI < 15, n = 18), symptoms, treatment efficacy and satisfaction, and subjective sleepiness were also better with CPAP than with MRS (effect sizes, 0.7-1.1 SDs). These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS.

Adolescent↗
PubMed2003

Gabapentin in the prophylaxis of chronic daily headache: a randomized, placebo-controlled study.

OBJECTIVE: To compare efficacy and safety of gabapentin (GPT) versus placebo for prophylaxis of chronic daily headache (CDH) (headache at least 15 days/month of greater than 4 hours duration over preceding 6 months). METHODS: This is a multicenter randomized placebo-controlled crossover study. After 4-week baseline, subjects, aged 18 to 65, were randomized to GPT 2,400 mg/day or placebo. There was 2 weeks titration, 6-week stable dosage, and 1 week washout period between treatment arms. The primary efficacy measure was the difference between the percentage of headache-free days per treatment period. Secondary efficacy measures included headache duration and severity, degree of disability, associated symptoms, concomitant medications, Visual Analogue Scale (VAS) scores, and quality of life (QOL). RESULTS: A total of 133 patients were enrolled (41 men, 92 women, mean age 43 years). All were eligible for safety analysis. Ninety-five received sufficient treatment to allow evaluation of efficacy. There was a 9.1% difference in headache-free rates favoring GPT over placebo (p = 0.0005). Benefits for GPT were also demonstrated for headache-free days/month (p = 0.0005), severity (p = 0.03), VAS (p = 0.0006), headache-associated symptoms of nausea (p = 0.03) and photophobia/phonophobia (p = 0.04), disability affecting normal activities (p = 0.02), attacks requiring bed rest (p = 0.001), and QOL related to bodily function (p = 0.01), health/vitality (p = 0.0001), social function (p = 0.006), and health transition (p = 0.0002). Reduction in headache days/month was seen across the spectrum of prerandomization headache frequencies. CONCLUSION: Gabapentin represents a therapeutic option for chronic daily headache.

Acetates↗
PubMed1995

Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with COPD.

STUDY OBJECTIVE: To evaluate the short-form 36-item questionnaire (SF-36) as an instrument for measuring health-related quality of life (HRQL) in patients with symptomatic COPD. DESIGN: Observational data at a single point in time. SETTING: Outpatient pulmonary clinic. PATIENTS: Fifty male patients with COPD and no significant comorbidity. MEASUREMENTS AND RESULTS: HRQL was assessed with the SF-36, which consists of 36 questions that cover nine health domains. Clinical ratings of dyspnea were measured by the multidimensional baseline dyspnea index (BDI). Pulmonary function tests included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and maximal inspiratory mouth pressure (PImax). The mean (+/- SD) age of the patients was 72 +/- 8 years. The BDI focal score was 5.6 +/- 2.3, FEV1 was 1.32 +/- 0.60 L (48 +/- 22% pred), and PImax was 62 +/- 23 cm H2O. The BDI focal score was significantly correlated with seven of nine components of the SF-36 (range of r, 0.42 to 0.91; p < 0.05). The FEV1 percent of predicted and PImax were significantly correlated with five of nine health components (range of r, 0.30 to 0.65 and 0.31 to 0.61, respectively). Using linear regression model analysis with the different SF-36 components as the dependent variable and BDI, FVC, FEV1, and PImax as independent variables, the BDI score was the only significant predictor of social and physical functioning, role-physical, vitality, pain, health perceptions, and health transition (p < 0.05). CONCLUSIONS: The SF-36 is a valid instrument to measure HRQL in patients with COPD. The severity of dyspnea but not respiratory function was a significant predictor of various components of HRQL.

Adult↗
PubMed2003

[Emerging infectious diseases in the realm of complexity: implications for scientific and technological policies].

The current emergence and global dissemination of some new and resurgent infectious diseases have surpassed national frontiers, increasingly affecting developing and also developed countries. This study stresses that this outburst is affecting the predictability of dominant health transition approaches. This paper analyses, from epistemological and policy viewpoints, alternative approaches in order to confront these new global epidemiological trends.

English Abstract↗
PubMed2006

[Clinical efficacy of treatment for regulating Pi and protecting Xin in treating patients after coronary artery bypass grafting and its effect on patients' quality of life].

OBJECTIVE: To evaluate the clinical efficacy of treatment for regulating Pi and protecting Xin (abbr. as CHM) and its effect on quality of life (QOL) in patients after coronary artery bypass grafting (CABG). METHODS: One hundred and six patients, who were planned to undergo CABG were assigned into two groups, the 51 patients in the control group were treated with conventional Western medicinal treatment (WM) and the 55 patients in the experimental group were treated by WM with additional medication of CHM constituted mainly by modified Huxin Recipe. The changes of symptoms and heart function were observed and the patients' QOL was evaluated by SF-36 Scale. RESULTS: After being treated for 3 months, the total scores of symptoms in the experimental group was significantly improved in comparing with that in the control group (P < 0.01), the clinical efficacy on symptoms of TCM and improvement of heart function were superior to those in the control group (P < 0.05) respectively. The scores in terms of pain, vitality, role of emotion, mental health, health transition of patients in the experimental group according to SF-36 scale were significantly higher than those in the control group (P < 0.05 or P < 0.01). CONCLUSION: Treatment for regulating Pi and protecting Xin by modified Huxin Recipe can improve the recovery process of patients after CABG, elevate patients' heart function, symptoms and QOL.

Aged↗
PubMed1989

Cardiac rhythm responses. 1. An important phenomenon for nursing practice, science, and research.

The human responses to actual or potential health problems that are of interest to nursing encompass physiologic, psychologic, and sociocultural responses. Measurement of cardiac rhythm responses provides a unique opportunity to look at the complex interplay of physiologic, emotional, and environmental factors at a particular time. A model depicting the relationships between cardiac rhythm responses and the central nursing domain concepts of individual, environment, health, transitions, and nursing therapeutics is presented. Measurement of cardiac rhythm responses provides an objective, quantifiable, noninvasive, inexpensive, readily accessible, reliable, and valid tool for measuring human responses. Study of the phenomenon holds promise for nursing practice, science, and research fostering links among the three. Study of cardiac rhythm responses will have direct applicability to practice with the potential for narrowing the research-practice gap. Moreover, study of the phenomenon will contribute to nursing knowledge and foster advancement of nursing science by the development of theory.

Arrhythmias, Cardiac↗
PubMed1998

Generic surgical priority criteria scoring system: the clinical reality.

AIMS: To assess the 'generic surgical priority criteria' (GSPC) introduced into Auckland Hospital by the Northern Division of the Transitional Health Authority in 1997 and compare it with a score based on clinical judgement obtained using a linear analogue scale (LAS). METHODS: From the time of introduction in June 1997 all patients being placed on the general surgical waiting list have been scored using both the GSPC and the LAS. After two months the scores given to 209 patients were reviewed and compared. Correlation and limits of agreement analysis were performed for grouped data, cancer and benign groups. RESULTS: The data showed wide variation and poor agreement between the surgeons' clinical judgement in assessing priority for surgery and the score patients obtained using the GSPC. CONCLUSION: The GSPC has poor diagnostic discrimination as it failed to identify reliably a cancer diagnosis as high priority, with benign diagnoses scoring consistently higher. This highlights the need for clinical involvement in designing priority criteria and for formal validation of such tools.

Elective Surgical Procedures↗
PubMedDate not supplied

Physician workforce planning and the transition to primary health care in former socialist countries.

With the collapse of the Soviet Union, countries in Eastern Europe and the Newly Independent States inherited a physician workforce that was often too large, dominated by specialists, and poorly prepared for the transition to primary health care and the addition of the family/general practice specialty. We examine attempts in selected countries to plan the future physician workforce, while attempting to reduce the size of the workforce and train physicians to lead the transition to primary health care (PHC). We look the impact these efforts have had on the current workforce and will have on the future physician workforce. With few exceptions, the first move after independence was to reduce the inputs into the physician workforce in an attempt to reduce the size of the workforce, considered large by western standards, in 1990 between 350 and 400 per 100, 000 population compared to the EU average of 299. These reductions often did not result from planning and ignored the lengthy physician training process, leading to concerns for the future supply of physicians and the conclusion that many other factors were influencing the number of physicians. At the same time, two methods were being employed to rapidly prepare physicians for PHC, retraining of existing physicians for the short-term and the establishment of training programs in the faculties of medicine to train family/general practitioners (GPs) for the long-term. GPs per 100,000 population remained at about 102 throughout the period in the original EU countries, but in the new EU countries went from 51 in 1991 to 63 in 2002. The success of the programs was varied and often depended on the overall organization of the physician workforce, the status of the new family physician within the workforce and the commitment at the national level to the transition to PHC. After over a decade of independence, there is still a struggle to have a physician workforce with the right numbers, the right specialty mix, and practicing in the right locations.

Education, Medical, Graduate↗
PubMed2005

Marital transitions and mental health: are there gender differences in the short-term effects of marital status change?

Although there has been evidence to suggest that women exhibit more vulnerability to psychological distress than men when they lose a spouse or remarry, knowledge about the process by which men and women adjust to marital change remains fragmentary. This is due in part to the length of time between observations in longitudinal studies on marital change, with the result that mental health status is typically assessed long after a marital status transition has occurred. The purpose of the current study is to test for gender differences in the short-term mental health effects of a marital status transition using three waves of data collected at two year intervals in a Canadian population health survey (N=11,155). Growth curve analyses confirm the mental health advantage of marriage and reveal that the short-term effects of moving into and out of marriage on psychological distress are similar for men and women. We discuss the implications of these findings for resolving competing explanations regarding psychological adjustment to marital change.

Adolescent↗
PubMed2002

Diet, health and the nutrition transition: some impacts of economic and socio-economic factors on food consumption patterns in the Kingdom of Tonga.

An essential element of the "health transition" is the emergence of disease patterns associated with changes in dietary regimes. The consumption of nutritionally poor (imported) foods in the Pacific is associated with increasing rates of diet related non-communicable diseases (NCDs). An oft-made assumption is that changes in consumption patterns are related to food preference (specifically preferences for high fat and/or dense carbohydrate foods). Recent work in the Kingdom of Tonga suggests that the "common-sense" association between food preference and food consumption is incorrect. The results of a large survey (n=430) indicate availability is the key factor in consumption, and that food preference, knowledge of the nutritional values of foods, and frequency of consumption are not correlated. Further analysis shows there are significant differences in consumption patterns between persons of higher and lower socio-economic status; perception of availability and frequency of consumption are a function of economic and social position--specifically access to cash. These results underline the salience of economic factors; the rise in NCDs is correlated with the increasing importance of the cash economy (not cultural values or ignorance of nutritional issues). In the absence of economic solutions, current consumption patterns will continue.

Adolescent↗
PubMed2002

Wingecarribee Health Service model for transitional care.

The Wingecarribee Health Service (WHS) has developed a program of ambulatory care different from the commonly accepted models. The program provides a "whole service" approach to care, with integration of hospital, allied health and community services in partnership with other key stakeholders such as general practitioners (GPs) and non-government organisations (NGOs). It departs from the medical model and embraces the health service's commitment to a wellness approach to care. The program is focused on providing the most appropriate care, in the most appropriate location by the most appropriate provider.

Ambulatory Care↗
PubMed1998

The health care reform in Italy: transition or turmoil.

Health care reform in Italy is transforming its centrally planned, vertically integrated National Health Service into a market-oriented system in which public funders contract directly with individual providers. A model is envisaged in which a plurality of public and private care providers compete for contracts with capitated health agencies responsible for assuring uniform levels of services for geographically defined populations. The ultimate goal of the reform is to guarantee universal coverage and secure global spending limits while, at the same time, promoting efficiency in the delivery of care and enhancing responsiveness to consumers. The emphasis upon incentives for the individual provider which will be introduced should, however, be considered against the quest for equity in health care which was the central tenet of the 1978 reform and is yet to be attained. The fragmentation of the National Health Service into many separate, competing delivery units might well damage the ability to plan strategically for addressing the substantial inequities in health status, health care utilization, and health service availability which still exist across the country. Competition between a plurality of providers and fee-for-service payment schemes add additional concerns about unnecessary care and supplier-induced demand. It creates the need for developing rules to make competition manageable and providing sound clinical and financial information that make enforcement possible. The poor record scored in managing the contractual relationships between the LHUs and the strong private health sector suggests that massive investment in promoting managerial skills and developing appropriate clinical and financial information systems are required. Careful experimentation in implementing the reform and continuous monitoring of its impact on the health care system are, therefore, the imperatives of the next two years.

Capitation Fee↗
PubMed2005

Employment transitions and mental health: an analysis from the British household panel survey.

STUDY OBJECTIVE: To describe the impact of changes between employment and various forms of non-employment, and vice versa, on the psychological wellbeing of men and of women. DESIGN: Separate multivariate models for men and for women were constructed to study the association between employment transitions and episodes of psychological distress (general health questionnaire). PARTICIPANTS: 13,359 employment transitions from 5092 people aged 16-74 years in the British household panel survey from 1991 to 1998. MAIN RESULTS: Transitions from paid employment to either unemployment or long term sick leave were associated with increased psychological distress for both men and women. Starting maternity leave or staying home to look after the family were also associated with psychological distress for women. Transitions from these roles to formal employment resulted in an improvement in mental health. There was some evidence that the effects were felt most strongly within six months of the transition. CONCLUSIONS: This paper provides further evidence that movements between paid employment and various forms of non-employment, in addition to unemployment, have an impact on mental health. The emphasis on transitions between a full range of employment states for both men and women from a large population based longitudinal study and a comparison of the relative magnitude of effects are unique features of this analysis. Interventions are suggested to minimise the psychological distress associated with transitions.

Adaptation, Physiological↗