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PubMed2000

Aprotinin in the management of life-threatening bleeding during extracorporeal life support.

Contact with the synthetic surfaces of an extracorporeal circuit induces alterations in vascular components, derangements of the coagulation cascade and a systemic inflammatory response. Aprotinin reduces intraoperative and postoperative bleeding in adults undergoing cardiopulmonary bypass; however, trials in children have not had similar favorable results. While there have been some anecdotal reports, there have been no prospective clinical trials exploring the utility of aprotinin in the prevention of or as a therapy for bleeding while on extracorporeal life support (ECLS). We present a case series on our experience utilizing aprotinin for the treatment of life-threatening bleeding during ECLS. The combination of a loading dose followed by a continuous infusion resulted in significant reduction in blood loss and blood product utilization. This suggests that aprotinin may have clinical efficacy in the management of massive blood loss while on ECLS; however, larger controlled trials will be essential to determine the efficacy and appropriate dosing regimens before widespread use in ECLS can be advocated.

Adolescent↗
PubMedDate not supplied

Process evaluation of an educational intervention to improve end-of-life care: the Education for Physicians on End-of-Life Care (EPEC) program.

Despite the growing importance of end-of-life care and the need to improve it, physicians receive little formal training in palliative care. The Education for Physicians on End-of-life Care (EPEC) project, developed by the American Medical Association and the Robert Wood Johnson Foundation, tested a train-the-trainer educational intervention to address this deficiency. This paper presents data from a process evaluation of the initial rollout of EPEC. By all accounts, EPEC provided a state-of-the-art curriculum covering important and clinically relevant topics to the care of the dying patient. It was less clear, however, if EPEC adequately prepared trainees to teach these new skills to other practicing physicians. Factors that may advance efforts to generalize EPEC to other settings and improve future applications of the program are discussed.

American Medical Association↗
PubMed2002

Life history and life cycles: production and behavior of trematode cercariae in relation to host exploitation and next-host characteristics.

Life history trade-offs affect trematode parasites reproducing inside their 1st intermediate hosts. Within the constraint of the effect on host survival, parasite production of cercariae is subject to a size-numbers trade-off. Within each cercaria, resources must be partitioned between host-seeking and subsequent developmental functions. Three species of microphallid trematodes with the same 1st intermediate host (the gastropod Littorina saxatilis) were investigated. Maritrema arenaria periodically released many small cercariae. Microphallus similis released fewer, 15% larger, cercariae without periodicity. Microphallus similis cercariae were strong swimmers, moving toward the dark and downward in turbulent water, whereas Ma. arenaria cercariae remained suspended. Maritrema arenaria cercariae, although smaller in body and tail size, were produced at an average daily volume nearly twice that of M. similis. These differences are interpreted as transmission adaptations related to mobility and predictability of the 2nd intermediate host. Microphallus similis, with a mobile and less predictable crab host, adopted a 'bethedging' prolonged production of fewer cercariae by less intensive host exploitation, each cercaria having a high allocation to host-seeking behavior. Maritrema arenaria, with predictable sessile barnacle hosts, produced less mobile but potentially longer-lived cercariae in larger numbers. Microphallus piriformes metacercariae remain in the gastropod host. The number of M. piriformes metacercariae increased in larger hosts. The 3 species differed in the number of sporocysts and (meta)cercariae per sporocyst within the gastropod but not in the within-host volume of parasites. Variation in host exploitation and life history appeared adaptive for transmission to the next host.

Animals↗
PubMed2006

Lack of emotional support from parents early in life and alcohol abuse later in life.

The purpose of this study is to examine the association between lacking emotional support from parents early in life and adult alcohol abuse. A series of logistic regression models were run with data collected from a nationally representative sample of over 2500 adults ages 25-74. The findings reveal a linear relationship between level of deficiency in early maternal support and odds of alcohol abuse during adulthood, with even moderate deficiencies being associated with elevated risk. Further examination suggests that this association persists throughout adulthood. This association does not appear to be explained by the early initiation of alcohol use, but poor psychological well-being during adulthood does account for a large portion of this association. These findings expand our understanding of the risks associated with poor parental support during childhood, and underscore the importance of adopting a life course perspective in studying the social determinants of alcohol problems among adults.

Adult↗
PubMed2000

Emotional experience in everyday life across the adult life span.

Age differences in emotional experience over the adult life span were explored, focusing on the frequency, intensity, complexity, and consistency of emotional experience in everyday life. One hundred eighty-four people, age 18 to 94 years, participated in an experience-sampling procedure in which emotions were recorded across a 1-week period. Age was unrelated to frequency of positive emotional experience. A curvilinear relationship best characterized negative emotional experience. Negative emotions declined in frequency until approximately age 60, at which point the decline ceased. Individual factor analyses computed for each participant revealed that age was associated with more differentiated emotional experience. In addition, periods of highly positive emotional experience were more likely to endure among older people and periods of highly negative emotional experience were less stable. Findings are interpreted within the theoretical framework of socioemotional selectivity theory.

Adolescent↗
PubMed2000

[Life-threatening echovirus 11 infection during first month of life].

Infection with Echovirus 11 is mostly asymptomatic, but it may cause a wide variety of clinical diseases, from gastroenteritis to serious diseases such as meningitis and myocarditis. In small infants, especially during the first days of life, echovirus infection may appear as a sepsis-like illness, and cause disseminated intravascular coagulopathy and shock. We present 2 infants with severe Echovirus 11 infections. A 3.5-month-old died within 24 hours of shock and probably myocarditis. The other, 6-days old, presented with meningitis, hepatitis and disseminated intravascular coagulopathy. It recovered after treatment with intravenous immunoglobulin. Echovirus 11 may cause life-threatening infections in small infants. Pediatricians should be alert to the special characteristics of this disease.

Disseminated Intravascular Coagulation↗
PubMed1999

The Life Rope: a transactional approach to exploring worker and life role development.

The Model of Human Occupation offers a framework for analyzing occupational roles including that of worker; however, it does not describe the dynamics of role change after a traumatic injury. This paper reports a qualitative study of sixteen individuals who experienced a traumatic spinal cord injury in the midst of their occupational career development. The study examined their role change processes involved in redeveloping the worker role. Data were collected across 24 months of the participant's lives and triangulated via participant observations, guided interviews, mapping, and archival document review. Results showed that individuals formed multiple strands within their role repertoires at any point in time. After a traumatic injury, the worker role became an optional, elective role strand, one that often unraveled first as they encountered breakdowns in more basic survival roles, such as home manager, assistive technology user and attendant care employer. The metaphor of a Life Rope emerged as a useful conceptual framework for explaining life role development, including that of worker.

Journal Article↗
PubMed1988

[Life and freedom as a compulsion? Considerations of the relation of the phenomenology of life and analysis of existence].

The phenomenon of compulsion, unless it is seen as purely pathological, discloses in a peculiar way by an analysis of the situation in connexion with the immanence of life. Challenged by a given situation man must react immediately whereas the first origin of human existence is a state of passivity without any possible escapes. In so far freedom rests on a inevitableness, that reactualizes with every challenge by the daily situation. This "compulsion" to answer permits at the same time real freedom; for the clever and synthesic questions to life give way to the real tasks, that have to be settled at the moment.

Adaptation, Psychological↗
PubMed1999

Quality of life in depression: daily life determinants and variability.

Identifying daily influences on subjective well-being can be helpful in understanding the burden of depression. This study used experience sampling methodology (ESM) to examine the contribution of mood states, physical complaints and enjoyment of activities to a momentary measure of quality of life (mQoL), assessed by responses to the question 'In general, how is it going with you right now?' Sixty-three depressed and 22 healthy control subjects completed ESM self-reports during daily activities, 10 times per day for 6 days. In comparison to control subjects, depressed subjects had lower levels of mQoL, positive mood, and enjoyment of activity, higher negative mood, and more frequent and severe complaints. Depressed subjects were more likely than control subjects to be doing nothing and less likely to be engaged in work. Multilevel regression analysis showed that positive mood and enjoyment of the current activity were associated with higher mQoL, whereas negative mood and complaints were associated with lower mQoL. In depressed subjects, mQoL was more variable over time than in control subjects. In contrast to the ESM results, only negative mood and depression were significant predictors of global measures of QoL. We conclude that QoL has important situational determinants that can in part explain the impact of depression on daily functioning and well-being.

Adolescent↗
PubMed2000

Assessing health-related quality of life in cataract patients: the relationship between utility and health-related quality of life measurement.

The relationship between health-related quality of life (HQL) measures and patient preference for their health status was studied. Study subjects consisted of 132 patients at four hospitals who were scheduled for cataract surgery. Generic and disease-specific health status measures were determined in study subjects. The Medical Outcomes Study Short-form 36 (SF-36) item health status instrument was used to measure generic health status and the Visual Function 14 (VF-14) item visual health status instrument was used as the disease-specific health measure. Preference for general health and visual health was measured by assessing utilities assigned by patients to certain health states. Utilities assigned for general health were correlated with all categories of the SF-36 and VF-14 scores. Utilities assigned for visual health were correlated with four categories of the SF-36 (role limitation due to emotional health, general health, physical functioning, and vitality) and VF-14 scores. Utilities assigned for visual health were more strongly correlated with VF-14 scores than generic measures of health. Verbal ratings for visual health were correlated with Snellen visual acuity (SVA) (r = 0.20), utilities assigned for visual health (r = 0.58), VF-14 scores (r = 0.74), all categories of the SF-36 (r values ranging from 0.21 to 0.28), utilities assigned for general health (r = 0.19), and verbal ratings for general health (r = 0.29). Utility measures and verbal ratings for general and visual health were shown to be appropriate HQL measures. These measures were strongly correlated with other established generic and disease-specific health measures and should be included in the array of health status measures.

Activities of Daily Living↗
PubMed1990

Health status and life style in elderly Japanese men with a long life expectancy.

The Japanese population in Hawaii has one of the longest life expectancies of any large population subgroup in the U.S. and the world. Cross-sectional data on 1,379 elderly, noninstitutionalized, male Japanese American survivors of a population-based cohort study indicated the most common health problems were hypertension (43%), arthritis (33%), diabetes (13%), and gout (9%). For cancer and hypertension there is a trend toward higher prevalence in older age groups. For coronary heart disease, stroke, and angina the oldest age group (75-81 years) has a higher prevalence than that seen in younger age groups. Other relatively common diseases such as diabetes, gout, peptic ulcer, and arthritis do not have higher prevalence in older age groups. Drugs reported to be used frequently by study participants were for hypertension, gout, CHD, and diabetes. The prevalence rates of major limitations of mobility and of living alone appear to be relatively low in this population. Less than one percent of the current population rate their health status as poor. The prevalence of normal serum cholesterol and smoking are similar to those seen in U.S. White males, while the rates of hypertension appear lower. Prevalence rates for stroke and heart attack also appear to be somewhat lower in these long-lived individuals than those seen in U.S. Whites.

Activities of Daily Living↗
PubMed1987

Life prospects and quality of life in patients with Crohn's disease.

A regional prevalence group of 106 patients with Crohn's disease were interviewed about their familial, social, and professional conditions. The results were compared with results from similar interviews of an age and sex matched control group of 75 previously healthy patients admitted to the hospital for acute diseases of less than 28 days' duration. An equal percentage of the patients and the controls were married (67% vs 71%) and had become parents (68% vs 79%). The number of children was slightly lower among Crohn's disease patients. The occurrence of familial problems and sexual problems did not differ among patients and controls. The intake of sedatives was low in both groups and no difference was found in alcohol and tobacco intake between patients and controls. A combined score for social activities comprising cultural, sporting, educational and private social arrangements showed that about one-third of patients and controls had high social activity and about half of both groups had moderately high social activity. A similar physical activity score showed no difference between the two groups. The socioeconomic level of the Crohn's disease patients was slightly, but significantly higher than that of the controls. Sixty five per cent of Crohn's disease patients were employed, 64% of controls; 6% and 7% respectively unemployed. Three per cent of Crohn's disease patients had disablement pension. Of Crohn's disease patients employed, a higher percentage (77%) had remained in the same job for more than five years (64% of controls). The number of sick leave days during previous year was less than 11 in 72/69% of patients and controls. In spite of these objectively good results 54% of patients with Crohn's disease felt exacerbations of their disease strained their professional and personal life. During the previous year 23% reported decreased working capacity and 21% reported decreased leisure activities, compared with their own expectations.

Adult↗
PubMed2002

Life expectancy and quality of life in adult patients with congenital heart disease.

The survival and quality of life of patients with congenital heart disease have significantly improved in the last 20 years. This is due to more effective medical and surgical care. The new community of grown-up congenital heart patients consists of a few natural survivors with trivial congenital lesions or very rare complex cardiac abnormalities which are naturally compensated, and of more than 75% of patients who had been submitted to cardiac surgery during infancy or childhood. Clinical follow-up is however mandatory for many of them with scheduled times and types of exams to control the effects of sequelae and late complications, and to prevent deterioration and premature death because cardiac surgery may not have resulted in normality. Moreover, these patients have many needs and even more, many questions. Not giving a correct answer to each specific question reduces the entity of surgical success.

Adult↗
PubMed1996

Chemical and physical context for life in terrestrial hydrothermal systems: chemical reactors for the early development of life and hydrothermal ecosystems.

The diversity of terrestrial hot spring systems, resulting from the large scale coupled transfer of heat and mass in the Earth's crust, maximizes opportunities for evolving ecosystems by the continuous supply of nutrients (P, N, C, S) together with the metals (e.g. K, Mg, Mo, Zn) essential to biogenesis. Cyclic, evaporative micro-environments are common, and potentially catalytic mineral surfaces are also continually created through rock alteration and mineral deposition in and around hot springs. These dynamical systems constitute highly interactive, open, chemical environments capable of establishing complex biochemical microreactors. Volcanic collapse settings on oceanic islands, provide a highly dynamic scenario for the initiation of life and development of diverse ecosystems at the earliest stages of development of the Earth's crust.

Archaea↗
PubMed2006

Does condition-specific quality of life correlate with generic health-related quality of life and objective incontinence severity in women with stress urinary incontinence?

AIMS: We examined the impact of stress urinary incontinence (SUI) on health-related quality of life (QOL) and evaluated the relationships between incontinence-specific QOL and objective disease severity. METHODS: A total of 158 women (mean age 49.9) suffering from SUI were included in the study. The Medical Outcomes Study Short Form-36 (SF-36) and the King's Health Questionnaire (KHQ) were used to assess QOL in the patient and control groups. RESULTS: The SF-36 scores did not show any significant differences between the two groups except for one domain (physical functioning, P = 0.005). The patient KHQ scores were significantly lower than those of the controls (P < 0.001 for all domains). The scores of the KHQ domains correlated with those of the SF-36 domains, but the relationship was low to moderate, ranging from -0.033 to -0.686. However, they did not correlate with Valsalva leak point pressure (VLPP). When patients were divided into the low VLPP group (n = 60) and the higher VLPP group (n = 98), statistically significant differences were found between the groups for general health domains of the SF-36 (P = 0.010) and of the KHQ (P = 0.027). No statistically significant differences were found in other domains of both questionnaires. CONCLUSIONS: The generic QOL instrument is not a sensitive tool for measuring QOL in women with SUI. In addition, our findings suggest that objective disease severity is not associated with generic or incontinence-specific QOL.

Adult↗
PubMed1997

Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis.

The morbidity of osteoporosis is caused by fractures. Vertebral fractures lead to pain and disability and a decrease in quality of life. A Working Party of the European Foundation for Osteoporosis has developed a specific questionnaire for patients with established vertebral osteoporosis. This questionnaire is intended for use in clinical trials. The questionnaire consists of questions and visual analogue scales in the following domains: pain, activities of daily living, jobs around the house, mobility, leisure and social activities, general health perception and mood. The questionnaire has been translated from English into French, German, Italian, Hebrew, Swedish and Dutch. The questionnaire is currently being validated in a multicentre study involving patients with stable osteoporosis and control subjects. Preliminary results indicate that the reproducibility is sufficient and that the questionnaire is able to discriminate between patients with vertebral osteoporosis and control subjects.

Activities of Daily Living↗
PubMed2002

Assessment of former ICU patients' quality of life: comparison of different quality-of-life measures.

OBJECTIVE: To compare three different measures to assess quality of life (QOL) after an Intensive Care Unit (ICU) stay: a standardized telephone interview, a satisfaction scale, and the Sickness Impact Profile (SIP). DESIGN: Prospective study, evaluating QOL 6 months after ICU discharge. SETTING: Medical ICU of a Swiss tertiary-care university hospital. PATIENTS AND METHODS: Patients admitted to the ICU between July and November 1998 for more than 24 h were included. Six months after ICU discharge overall QOL and health-related QOL were evaluated. Of the 118 patients approached, 85 returned valid questionnaires. RESULTS: The majority of patients indicated good QOL 6 months after ICU stay on each measure. A correlation for both overall and health-related QOL was found between the SIP and the satisfaction scales, between SIP and the telephone interviews, between the telephone interviews and satisfaction scales. The correlation between rating by scale or telephone interview and SIP in patients with cardiovascular disease differed from patients with other diagnoses. CONCLUSIONS: For the global assessment of overall or health-related QOL after ICU stay, long questionnaires such as SIP may be replaced by a short, structured telephone interview or, better, by a satisfaction scale. Quantitative measures such as SIP may be needed for comparison of therapeutic interventions or specific functional or psychosocial aspects.

Activities of Daily Living↗
PubMed1999

Development and validation of the mini-osteoporosis quality of life questionnaire (OQLQ) in osteoporotic women with back pain due to vertebral fractures. Osteoporosis Quality of Life Study Group.

The objective of the study was to evaluate a shortened osteoporosis quality of life questionnaire (OQLQ) in osteoporotic women with back pain due to vertebral fractures. From the longer 30-item OQLQ (four to nine items per domain) we created the mini-OQLQ by choosing the two items with the highest impact in each of five domains (symptoms, physical function, activities of daily living, emotional function, leisure). We administered the OQLQ, the Sickness Impact Profile, the SF-36 and the Brief Pain Index to patients at baseline, after 2 weeks and after 6 months. The intraclass correlations between baseline and the 2-week follow-up for the five mini-OQLQ domains ranged from 0.72 to 0.86. Cross-sectional correlations between the domains of the mini-OQLQ and other health instruments were moderate to large (0.35-0.80) and greater than predicted. The mini-OQLQ items showed moderate to large correlations with items omitted from the shortened questionnaire (0. 44-0.88). Correlations between the OQLQ domains and the other three instruments were greater than those of the mini-OQLQ, and partial correlations between OQLQ items omitted from the mini-OQLQ and the other three instruments after considering mini-OQLQ items were substantial (0.19-0.71) and statistically significant. Sample sizes of less than 200 per group should be required to detect minimally important differences in parallel-group clinical trials. Longitudinal correlations between the mini-OQLQ and the other measures were often significant but generally lower than predicted (0.10-0.49). The partial correlations revealed that the omitted items explained a significant portion of the longitudinal variance in each domain. We conclude that in a selected group of patients with back pain caused by vertebral fractures, the mini-OQLQ demonstrated good discriminative and adequate evaluative properties. The mini-questionnaire should be useful in clinical settings.

Aged↗