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At least 343 records · Page 19Linked to original sources
PubMed2001

[Multicenter study of children's compliance to antibiotic treatment in primary care].

OBJECTIVES: To evaluate the degree of children's adherence to prescription of antibiotics and to determine factors linked to this adherence. DESIGN: Cross-sectional study, conducted through a telephone survey of parents of the children under study ten to fifteen days after the prescription of the antibiotic. SETTING: Thirty primary care centres in 6 Spanish provinces. PATIENTS AND OTHER PARTICIPANTS: Parents or guardians of children from 0 to 10 who attended the primary care centres between October 1998 and January 1999 for treatment of an acute infection and who were prescribed an oral antibiotic treatment with two or more daily doses. Interventions. The measuring instrument was the Morisky-Green test. MEASUREMENTS AND MAIN RESULTS: 2244 cases were studied. 1043 of them complied adequately (46.5%; 95% CI, 44.4-48.5). The factors associated with adherence were children's school situation, the age of parents or carers and the number of daily doses. CONCLUSIONS: Only half the children complied correctly with the treatment indicated. Pre-school children, those with parents or carers over 40 and those with a prescription of under three daily doses followed the treatment better. These factors need to be borne in mind by paediatricians when they prescribe an antibiotic.

Adult↗
PubMed2003

[Do our asthma patients still use inhalers incorrectly?].

AIM: To determine how skilled our patients with asthma are in performing different steps in the use of different inhalation devices, and to identify variables that may influence correct inhalation technique (IT). DESIGN: Descriptive, cross-sectional study. SETTING: An urban primary care center. PARTICIPANTS: 141 patients with asthma. MAIN OUTCOME MEASURES: Performance of a practical test to evaluate each step in IT for different devices according to SEPAR-semFYC guidelines. One point was scored for each step that was performed correctly, and the technique was considered correct if the total score was >9. The main outcome variable was the percentage of patients who performed the IT correctly. RESULTS: About three-fourths of the participants (77.3%) were women; mean age was 56.08 +/- 18.99 years. Inhalation technique was incorrect in 53.9% of the patients (51.06% of those who used a pressurized canister inhaler, 59.1% of those who used a PCI+spacer, 38.5% of those who used a Turbuhaler, and 37.5% of those who used an Accuhaler). The highest error rates were seen in exhaling completely before beginning the inhalation (63.78%), holding the breath after inhalation for as long as possible (65.94%), and breathing out slowly after the inhalation (64.86%). Better IT was seen in younger patients with higher levels of education (P=.007). There were no statistically significant differences in the rest of the variables. CONCLUSIONS: A large percentage of patients performed inhalations incorrectly. We cannot conclude that any given device is superior. The variables related with correct IT were age and level of education. Greater health education efforts are needed to teach patients how to use inhalation systems correctly.

Asthma↗
PubMed2004

[Do we forget asthma as a chronic illness in our primary care consultations?].

OBJECTIVE: To describe the characteristics of the asthmatic population at our centre through the information gathered from clinical records, the morbidity caused by asthma and the health education given. DESIGN: Retrospective, descriptive study. SETTING: Urban primary care team. PARTICIPANTS: Asthma sufferers over 14 registered at the centre (n=284). MAIN MEASUREMENTS: Review of the clinical records and analysis of data on diagnosis, follow-up and control of the illness. RESULTS: Prevalence of asthmatics at our centre ran at 1.8%. 73.6% (68.5-78.7) were women, whose average age was 51.25 (21.57). 19% were illiterate. The most common kind of asthma was intermittent (14.1%, 10-18.1). Respiratory infections sparked off acute attacks in 15% (11.3-19.7) of cases. 39.8% (31.4-45.5) (n=113) were diagnosed at the health centre. Spirometry was used as a diagnostic test in 23% (15.2-30.8) (n=26) of these 113 patients. The PC doctor participated in monitoring 81.7% (77.2-86.2) of asthma cases. Spirometry was used in the previous 3 years on 45.4% (39.6-51.2). 95% of spirometry tests were conducted at the hospital. As to health education, there was no record of explanations about the concept of asthma or of breathing techniques in 90.1% (86.1-93.4) and 81% (76.4-85.5) of clinical records, respectively. CONCLUSIONS: High percentage of asthmatics monitored by PC doctors. Under-recording in clinical records of asthma-related action taken. Few additional monitoring tests were conducted. There were few data on health education.

Adult↗
PubMed2003

Safety and immunogenicity of respiratory syncytial virus purified fusion protein-2 vaccine in pregnant women.

A randomized, double-blind, placebo controlled study was carried out to determine the safety and immunogenicity of RSV PFP-2 vaccine (Wyeth-Lederle Vaccines, NY) in 35 healthy women in the third trimester of pregnancy and their offspring. Infants were followed during their first RSV season for occurrence and severity of respiratory illnesses. RSV-PFP-2 vaccine was safe and well tolerated by pregnant women. Mild pain at the site of injection occurred in 65% of PFP-2 and 13% of placebo recipients (P=0.005). There were no systemic reactions, fever, or serious adverse events associated with vaccine administration in mothers. All 35 infants were born healthy, and there were no differences among the groups in perinatal or neonatal outcomes, growth and development in the first year of life. During the RSV season, there was no increase in the frequency or morbidity associated with respiratory tract illnesses in infants of vaccine recipients. 15/20 (75%) vaccine recipients had a response to PFP-2 by Western blot vs. 0/15 placebo recipients (P<0.01). 19/20 (95%) vaccine recipients had a > or =4 fold rise in IgG ELISA Ab after immunization with PFP-2 vs. 0/15 placebo recipients (P<0.01). Geometric mean concentrations of IgG ELISA Ab were 4 fold higher in infants of vaccine recipients at birth, 2 and 6 months after delivery than in infants of placebo recipients (P<0.01). A modest (0.5log2) increase in neutralization Ab was observed in vaccine recipients and their infants. The half-life of maternal antibodies in infants was > or =3 weeks. There was no evidence of enhanced T-cell or cytokine activity in infants of vaccine recipients vs. infants of placebo recipients. Vaccine specific anti-F IgA and IgG concentrations in breast milk were higher in mothers who received RSV-PFP-2.

Adult↗
PubMed2003

Comparison of the reactogenicity and immunogenicity of a combined diphtheria, tetanus, acellular pertussis, hepatitis B, inactivated polio (DTPa-HBV-IPV) vaccine, mixed with the Haemophilus influenzae type b (Hib) conjugate vaccine and administered as a single injection, with the DTPa-IPV/Hib and hepatitis B vaccines administered in two simultaneous injections to infants at 2, 4 and 6 months of age.

An open, randomised, multicentre trial was performed to compare the reactogenicity and safety profile of the administration of a hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated polio (DTPa-HBV-IPV) vaccine administered in one injection mixed with Haemophilus influenzae type b (Hib) conjugate vaccine (Group 1) with that of a pentavalent DTPa-IPV vaccine mixed with a Hib vaccine (DTPa-IPV/Hib), simultaneously administered with HBV (Group 2) in two injections in opposite thighs, as a primary vaccination course, to healthy infants at 2, 4 and 6 months of age. A total of 235 completed the study, 120 from Group 1 and 115 from Group 2. Blood samples (pre-vaccination and 1 month after the third dose) were obtained from a subset of infants (Group 1: 40; Group 2: 31) to assess the immune response to vaccination. Local and general solicited symptoms were recorded by parents on diary cards. Seven hundred and five diary cards (Group 1: 360; Group 2: 345) were collected. The clinically relevant and most commonly reported local reaction was pain (infant cried when the limb was moved) in 2.5% (Group 1) and 1.2% (Group 2) of diary cards. Fever was more frequently reported in Group 1 (21% of diary cards) than in Group 2 (12% of diary cards). However only 3 and 2% of doses in Groups 1 and 2, respectively, were responsible for a rectal temperature between 38.6 and 39.5 degrees C and only one case (Group 2) had > or =39.5 degrees C. Other clinically relevant general symptoms were rarely recorded: irritability (2-2.8%), loss of appetite (0.3-0.6%) and drowsiness (0.3-0.3%). All subjects included in the immunogenicity analysis had seroprotective titres to diphtheria, tetanus, polio virus types 1 and 3, Hib. Almost all subjects were seroprotected for anti-polio type 2 and hepatitis B (with the exception of 1 subject in Group 1 for each antigen). The vaccines response rates to pertussis antigens were over 97 and 90% in Groups 1 and 2, respectively. This study shows that, from a clinical perspective, the DTPa-HBV-IPV/Hib vaccine given in a single injection has a similar reactogenicity and safety profile to that of two licensed vaccines (DTPa-IPV/Hib, HBV) given in two simultaneous injections to infants at 2, 4 and 6 months of age. This is a valuable advantage, since in some countries, such as Spain and the UK, an additional injection (for the administration of meningococcal C conjugate vaccine) has been recently included in the infants' vaccination calendars.

Antibodies, Bacterial↗
PubMed2001

Perceptual phenomena after unilateral arm amputation: a pre-post-surgical comparison.

Painful and non-painful phantom phenomena occur frequently after amputations but are rarely investigated in the perioperative stage. The goal of the present study was the assessment of phantom phenomena, pain and changes in primary somatosensory cortex prior to and after upper limb amputation. Two patients who suffered from metastatic carcinoma were examined 2 days prior to and 7 days after the amputation of an arm using comprehensive psychometric assessments and neuroelectric source imaging. Both patients reported phantom limb pain that was similar to their pre-amputation pain. In one patient, reorganization of the mouth area into the deafferented hand area took place immediately after the amputation. In the other patient reorganization had occurred prior to the amputation possibly related to non-use of the arm several years prior to the amputation.

Aged↗
PubMed2001

Early activation of the primary somatosensory cortex without conscious awareness of somatosensory stimuli in tumor patients.

The primary sensory cortex has usually been regarded as a necessary step in the information processing stream leading to conscious awareness. Recently, it has been proposed that that higher order associative areas rather than the primary sensory areas are the neural basis of conscious perception. In two patients with tumors near the central region we recorded magnetic somatosensory evoked fields. Magnetic source imaging revealed early (40 ms) neural activation in primary somatosensory cortex and absence of later (>60 ms) neural activation in the primary and associative areas in these patients. None of the patients showed conscious awareness of somatosensory stimuli applied to the corresponding body site although the first component of the evoked field was within normal limits. The time course of the magnetic responses and additional evidence on intensity ratings of somatosensory stimuli suggest that early activity in the primary somatosensory cortex is not sufficient for conscious experience to emerge.

Adult↗
PubMed2002

Brain circuits involved in emotional learning in antisocial behavior and social phobia in humans.

While psychopaths (PP) lack anticipatory fear, social phobics (SP) are characterized by excessive fear. Criminal PP, SP and healthy controls (HC) participated in differential aversive delay conditioning with neutral faces as conditioned (CS) and painful pressure as unconditioned stimuli. Functional magnetic resonance imaging revealed differential activation in the limbic-prefrontal circuit (orbitofrontal cortex, insula, anterior cingulate, amygdala) in the HC. By contrast, the PP displayed brief amygdala, but no further brain activation. The SP showed increased activity to the faces in the amygdala and orbitofrontal cortex already during habituation. Thus, a hypoactive frontolimbic circuit may represent the neural correlate of psychopathic behavior, whereas an overactive frontolimbic system may underly social fear.

Adult↗
PubMed2002

Simultaneous electroencephalography and functional magnetic resonance imaging of primary and secondary somatosensory cortex in humans after electrical stimulation.

Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) measurements were performed in six healthy subjects to determine the representation of stimulation of the right thumb in somatosensory cortex. In all subjects EEG-based dipole locations could be determined in primary (S1) and secondary (S2) somatosensory cortex. The stimulus-induced blood oxygenation level dependent response of the fMRI showed deviations of 23.5 mm (standard deviation, SD = 6.9) for S1 and 15.7 mm (SD = 3.5) for S2 cortex. fMRI constrained dipole searches lead to higher residual variances. The data show that simultaneous EEG and fMRI measurements of somatosensory activity are feasible and yield reliable and valid results.

Adult↗
PubMed2003

A brief and unobtrusive instrument to detect simulation and exaggeration in patients with whiplash syndrome.

The objective of this study was to develop and test a brief and unobtrusive instrument to detect exaggeration and simulation in whiplash syndrome. The instrument consists of eight scenarios with ten response options that have to be ordered according to how easy a behavior is to perform. Twenty-five simulating and 25 non-simulating patients with whiplash syndrome of grades 2 and 3 according to the Quebec Task Force classification as well as 25 simulating and 25 non-simulating controls completed the instrument. In a cross-validation study 20 controls and 20 patients participated. Malingering and exaggeration scores were determined for each subject and patient. The scores were summed up and compared across malingering and exaggerating subjects and controls and cut-off values were determined to classify the patients. T-tests and a discriminant analysis were used to determine classification accuracy. The instrument correctly identified 94% of the simulators and 84% of the exaggerators in both samples. This brief and unobtrusive instrument can detect exaggeration and simulation in whiplash syndrome.

Adult↗
PubMed2003

Gender differences in the processing of standardized emotional visual stimuli in humans: a functional magnetic resonance imaging study.

Pictures from the International Affective Picture System were used in a functional magnetic resonance imaging study to assess gender differences in brain activation in ten male and ten female volunteers. The affectively positive, negative and neutral pictures were presented for 750 ms in a single event design and were carefully matched for arousal, valence and stimulus content. Men and women showed no significant difference in valence, arousal, skin conductance response and startle modulation. Only in men was amygdala activation observed in the pleasant condition. Furthermore, men showed a stronger brain activity for positive visual stimuli than women in the frontal lobe (inferior and medial frontal gyrus). In women, stronger brain activation for affectively negative pictures was observed in the anterior and medial cingulate gyrus. These results indicate that it is crucial to take gender differences into account when emotional paradigms are used in functional brain imaging.

Adult↗
PubMed1997

Enhanced dimensional complexity of the EEG during memory for personal pain in chronic pain patients.

Associative connections between cortical cell assemblies representing pain-related memories should be stronger and more extensive in subjects with chronic pain. To test this hypothesis, the dimensional complexity of the electroencephalograph (EEG) was examined during the actual experience as well as during memory for pain. Nine chronic pain patients and nine matched healthy controls participated in the study. During acute pain induction, acute pain recall, personal stress and pain recall, the EEG was recorded from 15 scalp sites. Non-linear analysis, based on the theory of deterministic chaos, revealed higher and more widespread EEG complexity in the patients compared to the healthy controls only during the recall of the personal pain scene. The personal stress scene was rated equally aversive but did not induce more EEG complexity. These more extensive and more readily accessible pain memories may be instrumental for the persistence of chronic pain.

Adult↗
PubMed1997

Extensive reorganization of primary somatosensory cortex in chronic back pain patients.

The hypothesis of reorganization of the primary somatosensory cortex in states of chronic pain was assessed in 10 low back pain patients and nine matched healthy controls. Intracutaneous electric stimuli were applied to the left back and index finger at a standard, a non-painful and a painful intensity. Magnetic fields were recorded by a 37-channel BTi biomagnetometer from the hemisphere contralateral to the site of stimulation. The power of the early evoked magnetic field (< 100 ms) elicited by painful stimulation of the painful back in very chronic patients was elevated relative to that elicited by painful back stimulation of healthy controls and showed a linear increase with chronicity (r = 0.74). The maximum activity elicited in primary somatosensory cortex was shifted more medially in the very chronic back pain subjects. These data suggest that chronic pain is accompanied by cortical reorganization and may serve an important function in the persistence of the pain experience.

Adult↗
PubMed2001

The effect of opioids on phantom limb pain and cortical reorganization.

The efficacy of oral retarded morphine sulphate (MST) was tested against placebo in a double-blind crossover design in 12 patients with phantom limb pain after unilateral leg or arm amputation. Two counterbalanced treatment phases of 4 weeks each were initiated with an intravenous test infusion of MST or Placebo. The titration phase was 2 weeks. The dose of MST was titrated to at least 70 mg/day and at highest 300 mg/day. Pain intensity was assessed hourly on visual analog scales during a 4-week treatment-free phase, both treatment phases and at two follow-ups (6 and 12 months). Reorganization of somatosensory cortex, electric perception and pain thresholds as well as selective attention were measured pre- and post-treatment. A significant pain reduction was found during MST but not during placebo. A clinically relevant response to MST (pain reduction of more than 50%) was evident in 42%, a partial response (pain reduction of 25-50%) in 8% of the patients. Neuromagnetic source imaging of three patients showed initial evidence for reduced cortical reorganization under MST concurrent with the reduction in pain intensity. Perception and pain thresholds were not significantly altered whereas attention was significantly lower under MST. Thus, opioids show efficacy in the treatment of phantom limb pain and may potentially influence also cortical reorganization. These data need to be replicated in larger patient samples.

Adult↗
PubMed2002

The role of operant conditioning in chronic pain: an experimental investigation.

The role of operant conditioning for the development and maintenance of chronic pain was examined in 30 chronic back pain patients (CBP) and 30 matched healthy controls. Half of each group was reinforced for increased, half for decreased pain reports while EEG, EOG, heart rate, skin conductance and muscle tension levels were recorded. Both groups showed similar learning rates, however, the CBP patients displayed slower extinction of both the verbal and the cortical (N150) pain response. In addition, the CBP group displayed prolonged elevated electromyogram levels to the task. These data suggest that CBP patients are more easily influenced by operant conditioning factors than healthy controls and this susceptibility may add to the maintenance of the chronic pain problem.

Adult↗