Current Medical-Conditions News Results

Parental perspectives on influenza vaccination in children with asthma.

Pediatr Pulmonol. 2010 Sep 1;
Soyer OU, Hudaverdiyev S, Civelek E, Isik E, Karabulut E, Kocabas C, Sekerel BE

BACKGROUND: Influenza is an important cause of epidemic and pandemic disease leading to mortality and morbidity in children. Despite great efforts to increase influenza vaccination, many children with chronic medical conditions do not receive influenza vaccine. Our aim was to identify the demographic factors and asthma-associated characteristics related to vaccination, caregivers' attitudes and knowledge about influenza disease during the 2007-2008 influenza season. METHODS: Caregivers of children with asthma were surveyed via a self-administered questionnaire to document their knowledge about influenza disease and vaccine and factors influencing vaccination. RESULTS: We enrolled 311 children with asthma. The rate of lifetime influenza vaccination was 69.5%, whereas 51.8% of the patients had been vaccinated in the current season. There were no significant differences in demographic factors and asthma control parameters between the groups who received or did not receive influenza vaccine. Most of the parents whose children were vaccinated believed that influenza vaccination would decrease the prevalence and severity of asthma attacks (P < 0.05). The most important reason cited by parents for deciding on the influenza vaccine for their child was physician recommendation (80.1%). The major reasons for declining the vaccination were unawareness that the influenza vaccine was a requirement for their child (29.3%) and illness at the time of vaccination (20%). CONCLUSION: Physician recommendation is important in the influenza vaccination decision. Demographic factors and asthma control parameters had no influence on immunization uptake but parental beliefs and attitudes could be determinant. Greater effort is needed to increase influenza vaccination rates, in children with asthma. Pediatr. Pulmonol. (c) 2010 Wiley-Liss, Inc.

Mechanisms of distribution and targeting of neuronal ion channels.

Curr Opin Drug Discov Devel. 2010 Sep; 13(5): 559-67
Thayer DA, Jan LY

The discovery and development of pharmaceutical drugs targeting ion channels is important for treating a variety of medical conditions and diseases. Ion channels are expressed ubiquitously throughout the body, and are involved in many basic physiological processes. Neuronal ion channels are particularly appealing drug targets, and recent advances in screening ion channel function using optical-based and electrophysiological technologies have improved drug development in this field. Moreover, methods for the discovery of peptide-based neurotoxins and other natural products have proven useful in the pharmacological assessment of ion channel structure and function, while also contributing to the identification of lead molecules for drug development.

[Concepts of therapy for children with dyslexia.]

Z Kinder Jugendpsychiatr Psychother. 2010 Sep; 38(5): 329-39
von Suchodoletz W

Numerous methods based on very different concepts are available to treat children with dyslexia. Basically, symptomatic and causal principles can be distinguished. Among the symptomatic methods are systematic programmes based on learning theory, in which reading and spelling or precursors of these abilities are directly trained. Causal methods promise pronounced and persistent improvement of reading and spelling abilities through elimination of the postulated reason underlying the learning disabilities. Among the causal methods are treatment programmes that train low-level functions. Such training is based on the assumption that deficits of auditory, visual or kinesthetic perception, of motor skills or of the coordination of cerebral functional areas are at the bottom of specific learning disabilities. Concepts of other causal methods act on the assumption that learning processes are blocked or that abnormal medical conditions or psychiatric disorders constitute the background of dyslexia. Reviewed in the article are treatment concepts for children with dyslexia in the German-speaking countries and the methods of treatment derived from the different concepts. Results of evaluation studies are summarized and characteristics of effective treatment methods are listed. It is stressed that efficacy is proven only for symptomatic training programmes but not for causal methods.

Use of medication by nursing home residents nearing end of life: a preliminary report.

J Nurs Res. 2010 Sep; 18(3): 199-205
Chen IC, Liu ML, Twu FC, Yuan CH

BACKGROUND:: Nursing home residents usually suffer from a variety of medical conditions and are prescribed a wider variety of medications than any other subpopulation. Polypharmacy is associated with the occurrence of adverse events. PURPOSE:: The purposes of this study were to describe the medication prescription patterns of residents who died in a nursing home, to examine how this pattern changed as residents progressed toward death, and to identify correlates of increased medication prescriptions. METHODS:: Thirty-one residents who had lived at one nursing home for more than 6 months before death were included in the study. Medication records for participants were obtained at four data collection points: on admission, 6 months before death, 3 months before death, and at death. RESULTS:: The mean number of medications prescribed immediately before death was 7.90 (SD = 3.27), and there was an upward trend in number of prescriptions written as patients neared death. The most frequent prescription was for medication for constipation, pulmonary care, and hypertension. There was a significant correlation between residents with heart disease and increased medication use. Medication prescribed for pulmonary care and hypertension increased from admission to death, but a decreased use of medication for pain relief in the time before death in these cases was found. CONCLUSIONS/IMPLICATIONS FOR PRACTICE:: This study surveyed and described the pattern of medication use in nursing home residents from admission to the end of life. Results can be used to reinforce clinician and nursing staff awareness of prescription frequency, amounts of medication, and change over time for elderly residents under their care. In addition to safer prescribing practices for the older people, nonpharmacological strategies (e.g., lifestyle modification and physiotherapy for function training) may be used to address common symptoms and complaints during chronic care.

Postmortem findings in eight cases of influenza A/H1N1.

Mod Pathol. 2010 Aug 27;
Rosen DG, Lopez AE, Anzalone ML, Wolf DA, Derrick SM, Florez LF, Gonsoulin ML, Hines MO, Mitchell RA, Phatak DR, Haden-Pinneri K, Sanchez LA

In March and early April 2009, cases of a new swine-origin influenza A (H1N1) virus were diagnosed in Mexico and the United States. Influenza virus presents as a respiratory infection with high morbidity and mortality. We describe the postmortem findings of eight confirmed cases of influenza A/H1N1 in a medical examiner setting. The eight cases falling under the jurisdiction of the Harris County Medical Examiner (Houston, TX, USA) with confirmed influenza A/H1N1 infection between June and September 2009 were included in this study. All cases were males between 6 months and 54 years of age. All adult patients had a body mass index from 31 to 49.8 kg/m(2). Five cases had comorbid conditions including one case with sleep apnea and mental retardation, three cases with chronic ethanolism, and one case with thymoma, sarcoidosis, and myasthenia gravis. The remaining three cases had no pre-existing medical conditions. All patients presented with severe flu-like symptoms; yet, only five were febrile. Rapid influenza diagnostic tests were performed in three cases by primary-care physicians, two of which were negative. None of the patients received antiviral medication. The average disease duration time was 8.2 days (3-14 days). A wide range of histopathological findings including tracheitis, necrotizing bronchiolitis, alveolitis, intra-alveolar hemorrhage, and hyaline membranes, both in a focal and in a diffuse distribution, were identified. Influenza A/H1N1 viral infection presents with a wide range of histological findings in a diffuse or focal distribution; most consistently with tracheitis, necrotizing bronchiolitis, and alveolitis with extensive alveolar hemorrhage. These histopathological findings at autopsy along with a clinical history of flu-like symptoms should raise suspicion for influenza A/H1N1 infection, and postmortem analysis by the reverse transcription-polymerase chain reaction (RT-PCR) is recommended for an accurate diagnosis.Modern Pathology advance online publication, 27 August 2010; doi:10.1038/modpathol.2010.148.

Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors.

Clin Neurol Neurosurg. 2010 Aug 25;
Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA

BACKGROUND: Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinico-radiologic diagnosis associated with numerous medical conditions including hypertension, immunosuppressant medications, and eclampsia. It is characterized by headache, altered mental status, seizures, visual disturbance, and neuroimaging consistent with posterior-predominant vasogenic edema. The objective of this study was to characterize the clinical spectrum and outcomes in a large series of RPLS patients, and to compare the presentation of patients taking calcineurin inhibitors (CNIs) to that of other RPLS patients. METHODS: We reviewed records of patients seen by the neurology and transplant services over an 18-year period. Comorbid conditions, medications, blood pressure, laboratory testing, clinical outcomes, and radiographic findings were collected. RESULTS: 84 episodes of RPLS were identified in 79 patients. Etiologies included CNIs (43%), hypertension (29%), renal disease (12%), preeclampsia/eclampsia (7%), and chemotherapy (5%). Patients on CNIs had lower blood pressures (p=0.002) and a lower prevalence of headache (p=0.02) compared to RPLS patients with other etiologies. Clinical recovery occurred in 65% of episodes, and radiographic resolution occurred in 67%. CONCLUSIONS: Patients with CNI-induced RPLS have lower blood pressure than other RPLS patients, but otherwise present similarly. RPLS typically occurs within days to weeks of CNI initiation in patients without elevated medication levels. Clinical and radiographic recovery occurred in the majority of patients in this series, but one-third suffered residual neurologic deficits or death. These findings highlight the importance of prompt recognition and treatment of RPLS triggers to prevent permanent sequelae.

Cognitive Impairment and 7-Year Mortality in Dialysis Patients.

Am J Kidney Dis. 2010 Aug 25;
Griva K, Stygall J, Hankins M, Davenport A, Harrison M, Newman SP

BACKGROUND:: Although dementia has predicted mortality in large dialysis cohorts, little is known about the relationship between less pronounced cognitive deficits and mortality in patients with end-stage renal disease. This study assessed whether cognitive impairment without dementia was an independent predictor of 7-year survival in dialysis patients after controlling for other risk factors. STUDY DESIGN:: Prospective single-cohort study. SETTING & PARTICIPANTS:: 145 prevalent dialysis patients from 2 units in London, UK, were followed up for 64.3 +/- 27.4 months and censored at the time of change to a different treatment. PREDICTORS:: Cognitive impairment, defined as performance 1 standard deviation less than normative values on 2 or more cognitive tests within a neurocognitive battery assessing attention/concentration, memory, and psychomotor function domains. Depression, quality-of-life, and clinical measures also were obtained. OUTCOMES & MEASUREMENTS:: All-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical and psychological measures and cognitive impairment to mortality. RESULTS:: 98 (67.6%) patients were cognitively impaired at baseline. At follow-up, 56 (38.6%) patients had died, 29 of cardiac causes. Unadjusted Kaplan-Meier analysis showed higher mortality in cognitively impaired patients, in whom 7-year survival was 49% versus 83.2% in those with no cognitive impairment (P < 0.001). Mortality risk associated with cognitive impairment remained significant in adjusted analysis controlling for sociodemographic, clinical, and psychological factors (adjusted HR, 2.53; 95% CI, 1.03-6.22; P = 0.04). LIMITATIONS:: Small sample size and number of events. CONCLUSIONS:: Cognitive impairment is an independent predictor of mortality in dialysis patients. Although the implications of early recognition and treatment of cognitive impairment for clinical outcomes are unclear, these results suggest that patient management protocols should attempt to ensure prevention of cognitive decline in addition to managing coexisting medical conditions.

Effect of Pre-existing Medical Conditions on In-Hospital Mortality: Analysis of 20,257 Trauma Patients in Japan.

J Am Coll Surg. 2010 Sep; 211(3): 338-346
Shoko T, Shiraishi A, Kaji M, Otomo Y

BACKGROUND: The average life expectancy of Japanese individuals is the longest in the world. The mortality rate from injury is increasing among older people. There have been no detailed reports on the relationship between pre-existing medical conditions (PMCs) and mortality from trauma among elderly people in Japan. STUDY DESIGN: We conducted a retrospective analysis using 20,257 cases recorded in the Japan Trauma Data Bank from 2004 to 2007. The subjects were 11,590 hospital inpatients (57.2%) 16 years of age or older. A logistic regression analysis was conducted for the relation between 23 PMCs and in-hospital mortality. RESULTS: Overall in-hospital mortality was 10.8%, and for people 75 years of age and older, was 17.7%. The incidence of PMC was 4,752 (41.0%). Patients with PMCs of cirrhosis, active cancer, chronic obstructive pulmonary disease, hematologic disorders, anticoagulation drugs, dementia or mental retardation, or other conditions had higher in-hospital mortality. The existence of a single PMC did not increase mortality, but with 2 or more PMCs, mortality significantly increased. The existence of 2 or more PMCs in the 50- to 74-year-old age group and in the minor injury group strongly affected the odds ratio for mortality. CONCLUSIONS: The existence of certain PMCs or of 2 or more PMCs increases in-hospital mortality from injury. This effect is particularly conspicuous in middle-aged patients and people with minor injuries, but was not found to be a problem among elderly people. The increased mortality from injury in elderly people in Japan is therefore not affected by the existence of PMCs.

Encouraging CPAP Adherence: It Is Everyone's Job.

Respir Care. 2010 Sep; 55(9): 1230-9
Bollig SM

Obstructive sleep apnea (OSA) is a chronic disease treated effectively with the use of continuous positive airway pressure (CPAP) therapy. Patient adherence to prescribed CPAP is variable, however, leaving the undertreated OSA patient at risk of development or worsening of comorbid medical conditions, including hypertension and cardiovascular disease. The severity of disease and the presence of daytime sleepiness appear to have some predictive quality for subsequent adherence, though a search for consistent predictive factors related to CPAP adherence has proven elusive. Other influences, such as sex, age, socioeconomic status, and personality traits are less robust predictors. The use of sophisticated therapy modalities such as auto-titration or bi-level PAP units has been shown to improve adherence in certain subsets of OSA patients. Adverse effects such as nasal congestion, dry mouth, or skin irritation occur in approximately 50% of CPAP users, and addressing these adverse effects may improve adherence in some patients. More encouraging, studies on the use of intensive patient education and behavioral interventions have shown more positive effects on adherence, leading to the conclusion that improvement in patient adherence to CPAP therapy requires a multi-layered approach, using combined technological, behavioral, and adverse-effect interventions.

Common complications in the surgical intensive care unit.

Crit Care Med. 2010 Sep; 38(9 Suppl): S483-93
Sawyer RG, Leon CA

Surgical and trauma intensive care units provide the facilities, resources, and personnel needed to care for patients who have been severely injured, present with acute surgical emergencies, require prolonged and complex elective surgical procedures, or have severe underlying medical conditions. Correcting the immediately evident physiologic derangement is only the first step in the care of these patients, because in many cases their prognosis and ultimate outcome will depend on whether additional insults accrued during their intensive care unit and hospital stay will prevent them from a full recovery. The nature, number, and complexity of the interventions used to provide advanced support requires a unique attention to the concept of patient safety, particularly when the population involved is that most vulnerable to injury and with the least amount of physiologic reserve to recover from it. The medical community, the public, and even regulatory agencies have focused on specific preventable complications that are common in surgical and injured patients, such as medical errors, healthcare-associated infections, and venous thromboembolism. Enough scientific knowledge has been obtained through well-conducted clinical trials to generate detailed evidence-based guidelines for the prevention and management of some of these pathologies, but still there are outstanding questions in terms of the applicability of the recommendations to the critically ill. In addition to clinical and technical expertise, performance improvement and quality monitoring activities provide direction for system solutions required to properly address many complications that are not provider specific.

Pretransplant cardiovascular evaluation and posttransplant cardiovascular risk.

Kidney Int. 2010 Sep; 78 Suppl 118: S1-7
Young JB, Neumayer HH, Gordon RD

Modern immunosuppression has expanded access to kidney transplantation by limiting the risk of rejection. However, cardiovascular disease (CVD) remains the principal cause of death with a functioning graft, threatening the long-term survival of transplant recipients. The article reviews the leading risk factors for cardiovascular morbidity both before and after kidney transplantation. Evidence linking poor renal function to CVD is discussed. The function of immunosuppression in exacerbating the risk of both nephrotoxicity and CVD is explored through means of a clinical case study. Underlying kidney disease, hypertension, hyperlipidemia, and diabetes are recognized risk factors for CVD both before and after kidney transplantation. Worsening kidney function and posttransplant immunosuppression exacerbate the risk. Although underlying medical conditions and demographic factors are not easily modifiable, immunosuppression has been recognized as a suitable target. Multiple risk factors converge to increase the risk of cardiovascular events and cardiovascular mortality after kidney transplantation. Clinicians are charged with isolating and treating modifiable risk factors to reduce the risk to long-term survival.

New national health program against dementia in Japan: the medical center for dementia.

Psychogeriatrics. 2010 Jun; 10(2): 102-6
Awata S

Herein, the Medical Center for Dementia, which was introduced in 2008 as a new national health program in Japan, is reviewed from the perspective of the recent history of the national provision against dementia and the findings of a series of studies on the current status of medical care for dementia. The Medical Center for Dementia was developed to provide special medical services for dementia and connect with other community resources in order to contribute to building a comprehensive support network for demented patients. Specifically, the Medical Center for Dementia provides the following: (i) special medical consultation; (ii) differential diagnosis and early intervention; (iii) medical treatment for the acute stage of behavioral and psychological symptoms of dementia and concurrent medical conditions; (iv) education for general practitioners and other community professionals; (v) network meetings for the establishment of medical-medical and medical-care connection; and (vi) provision of information regarding dementia to the public. Special Medical Consultation Rooms would play an important role in the efficient functioning of the Medical Center for Dementia. In cooperation with municipal governments, the Medical Center for Dementia is also expected to play an important role in policy making and to improve the local status of medical care for people with dementia.

Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire.

Cancer. 2010 Aug 24;
Thekkumpurath P, Walker J, Butcher I, Hodges L, Kleiboer A, O'Connor M, Wall L, Murray G, Kroenke K, Sharpe M

BACKGROUND:: Systematic screening for depression has been recommended for patients who have medical conditions like cancer. The 9-item Patient Health Questionnaire (PHQ-9) is becoming widely used, but its diagnostic accuracy has not yet been tested in a cancer patient population. In this article, the authors report on the performance of the PHQ-9 as a screening instrument for major depressive disorder (MDD) in patients with cancer. METHODS:: Data obtained from a depression screening service for patients who were attending clinics of a Regional Cancer Centre in Edinburgh, United Kingdom were used. Patients had completed both the PHQ-9 and a 2-stage procedure to identify cases of MDD. Performance of the PHQ-9 in identifying cases of MDD was determined using receiver operating characteristic (ROC) analysis. RESULTS:: Data were available on 4264 patients. When scored as a continuous measure, the PHQ-9 performed well with an area under the ROC curve of 0.94 (95% confidence interval [CI], 0.93-0.95). A cutoff score of >/=8 provided a sensitivity of 93% (95% CI, 89%-95%), a specificity of 81% (95% CI, 80%-82%), a positive predictive value (PPV) of 25%, and a negative predictive value (NPV) of 99% and could be considered optimum in a screening context. The PHQ-9 did not perform as well when it was scored using an algorithm with a sensitivity of 56% (95% CI, 55%-57%), a specificity of 96% (95% CI, 95%-97%), a PPV of 52%, and an NPV of 97%. CONCLUSIONS:: The PHQ-9 scored as a continuous measure with a cutoff score of >/=8 performed well in identifying MDD in cancer patients and should be considered as a screening instrument in this population. Cancer 2010. (c) 2010 American Cancer Society.

Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.

Singapore Med J. 2010 Jul; 51(7): 599-607
Lee BW, Aw M, Chiang WC, Daniel M, George GM, Goh EN, Han WM, Lee ML, Leong KP, Liew WK, Phuah KY, Shek L, Van Bever H

The Academy of Medicine, Singapore (AMS) and the Ministry of Health (MOH) publish clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on the Management of Food Allergy, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Academy of Medicine website: http://www.ams.edu.sg/guidelines.asp#foodallergy. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

A Canadian population-based study of vision problems: assessing the significance of socioeconomic status.

Can J Ophthalmol. 2010 Oct; 45(5): 1-7
Perruccio AV, Badley EM, Trope GE

Objective: To examine the relationship between age, gender, socioeconomic status, and 3 chronic conditions (glaucoma, cataracts, and diabetes) and corrected and uncorrected vision problems, and to document the prevalence of visual problems in Canada across the adult age range.Design: Cross-sectional, representative, population-based study.Participants: Health survey respondents (n = 113 212, aged ≤20 years).Methods: Data are from a 2000-2001 Canadian health survey. Self-reported data included sociodemographic/economic characteristics, vision problems, eye care professional consultations, and medical conditions. Prevalence estimates were calculated; multinomial logistic regression examined the relationship between indicated variables and vision problems, generally and by type.Results: Fifty-seven percent of adults reported some form of vision problem, the majority corrected by lenses. Blindness was reported by 0.09% of adults. Increasing age, being female, and having a low income and lower educational attainment were significantly associated with reported vision problems. However, age and gender were not significant determinants of the type of vision problem. Cataracts, diabetes, and glaucoma in particular, were significantly associated with reported vision problems.Conclusions: Socioeconomic characteristics may underscore the socioeconomic burden of visual impairments in the population and highlight obstacles to eye service utilization among subgroups. This information is essential to establishing the need for treatment and management services, developing targeted screening programmes, and identifying priority areas of research.

Determinants of morbidity in late preterm infants.

Early Hum Dev. 2010 Aug 20;
Dimitriou G, Fouzas S, Georgakis V, Vervenioti A, Papadopoulos VG, Decavalas G, Mantagos S

OBJECTIVE: To assess the effect of selected maternal medical conditions and complications of pregnancy on the risk for morbidity among late preterm neonates. DESIGN: Prospective cohort study. MATERIAL AND METHODS: A total of 548 late preterm neonates (34(0/7) to 36(6/7)weeks' gestation) delivered from August 2006 to July 2009, were included. Information regarding demographics, gestational age, mode of delivery, maternal age and parity, pre-existing medical conditions and complications of pregnancy were obtained and associated with neonatal morbidity, both independently and as joint exposures. Newborn morbidity was defined by combining specific diagnoses, length of hospital stay, and transfer to the Neonatal Intensive Care Unit. RESULTS: Overall, 165 (30.1%) of the late preterm infants suffered from morbidity. The morbidity rates were 16.8% at 36weeks' gestation, and then approximately doubled from 38.2% at 35weeks to 59.7% at 34weeks. The joint effect of gestational age (OR 8.43 for 34weeks and 3.60 for 35weeks' gestation), small for gestational age (SGA) (OR 4.18), multiple gestation (OR 3.68) and lack of antenatal steroid administration (OR 4.03), was greater than the independent effect of each of these factors, and greater than additive. Emergency caesarean section (OR 1.43) and antepartum haemorrhage (OR 3.07) were also associated with a significant impact on neonatal morbidity. CONCLUSIONS: The risk for morbidity among late preterm infants, changes with each passing week of gestation. This risk seems to be intensified, when other exposures such as SGA, multiple gestation, emergency caesarean section, lack of antenatal steroid administration and antepartum haemorrhage, are also present.

A Shift to Randomness of Brain Oscillations in People with Autism.

Biol Psychiatry. 2010 Aug 21;
Lai MC, Lombardo MV, Chakrabarti B, Sadek SA, Pasco G, Wheelwright SJ, Bullmore ET, Baron-Cohen S, , Suckling J

BACKGROUND:: Resting-state functional magnetic resonance imaging (fMRI) enables investigation of the intrinsic functional organization of the brain. Fractal parameters such as the Hurst exponent, H, describe the complexity of endogenous low-frequency fMRI time series on a continuum from random (H = .5) to ordered (H = 1). Shifts in fractal scaling of physiological time series have been associated with neurological and cardiac conditions. METHODS:: Resting-state fMRI time series were recorded in 30 male adults with an autism spectrum condition (ASC) and 33 age- and IQ-matched male volunteers. The Hurst exponent was estimated in the wavelet domain and between-group differences were investigated at global and voxel level and in regions known to be involved in autism. RESULTS:: Complex fractal scaling of fMRI time series was found in both groups but globally there was a significant shift to randomness in the ASC (mean H = .758, SD = .045) compared with neurotypical volunteers (mean H = .788, SD = .047). Between-group differences in H, which was always reduced in the ASC group, were seen in most regions previously reported to be involved in autism, including cortical midline structures, medial temporal structures, lateral temporal and parietal structures, insula, amygdala, basal ganglia, thalamus, and inferior frontal gyrus. Severity of autistic symptoms was negatively correlated with H in retrosplenial and right anterior insular cortex. CONCLUSIONS:: Autism is associated with a small but significant shift to randomness of endogenous brain oscillations. Complexity measures may provide physiological indicators for autism as they have done for other medical conditions.

Nursing care, delirium, and pain management for the hospitalized older adult.

Pain Manag Nurs. 2010 Sep; 11(3): 177-85
Schreier AM

Delirium is a reversible cognitive disorder that has a rapid onset. Delirium risk factors include older age, severity of illness, poorer baseline functional status, comorbid medical conditions, and dementia. There are adverse consequences of delirium, including increased length of stay and increased mortality. Therefore, it is important for nurses to identify clients at risk and prevent and manage delirium in the hospitalized older client. Once high-risk clients are identified, prevention strategies may be used to reduce the incidence. Examples of prevention strategies include providing glasses and working hearing aids and effective pain management. This article discusses various assessment instruments that detect the presence of delirium. With this information, nurses are better equipped to evaluate the best assessment options for their work setting. Early detection is crucial to reduce the adverse consequences of delirium. Once a client is found to be experiencing delirium, a treatment plan can be established using both nonpharmacologic and pharmacologic interventions. In addition, the identification and the correction of etiologies of delirium can shorten the course of delirium.

Incidence of and Risk Factors for Change in Urinary Incontinence Status in a Prospective Cohort of Middle-Aged and Older Women: The Reproductive Risk of Incontinence Study in Kaiser.

J Urol. 2010 Aug 18;
Thom DH, Brown JS, Schembri M, Ragins AI, Subak LL, Eeden SK

PURPOSE: Urinary incontinence is a dynamic condition that can progress and regress but few groups have examined risk factors for change in incontinence status. MATERIAL AND METHODS: We used stratified random sampling to construct a racially and ethnically diverse, population based cohort of 2,109 women 40 to 69 years old. Data were collected by questionnaires and medical record review. A second survey approximately 5 years later was completed by 1,413 women (67%) from the original cohort. The frequency of urinary incontinence was categorized as less than weekly, weekly and daily. Change in incontinence status was defined as new onset incontinence, incontinence progression or regression between frequency categories and resolution of incontinence. Predictor variables were demographics, body mass index and other medical conditions. We used logistic regression to estimate the adjusted OR and 95% CI. RESULTS: Compared to white nonHispanic women, black women were less likely to have incontinence progression (OR 0.46, 95% CI 0.24-0.88). New onset incontinence was more common in women with a higher body mass index at baseline (p = 0.006) and those who experienced increased body mass index (p = 0.03) or decreased general health (p = 0.007) during the study. Participants with chronic obstructive pulmonary disorder at baseline were more likely to report incontinence progression (OR 2.64, 95% CI 1.22-5.70). Baseline incontinence type was not significantly associated with the risk of change in continence status independent of frequency. CONCLUSIONS: Identifying risk factors for change in incontinence status may be important to develop interventions to decrease the burden of incontinence in the general population.

Chronic hepatitis caused by persistent parvovirus B19 infection.

BMC Infect Dis. 2010 Aug 20; 10(1): 246
Mogensen TH, Jensen JM, Hamilton-Dutoit S, Larsen CS

ABSTRACT: BACKGROUND: Human infection with parvovirus B19 may lead to a diverse spectrum of clinical manifestations, including benign erythema infectiosum in children, transient aplastic crisis in patients with haemolytic anaemia, and congenital hydrops foetalis. These different diseases represent direct consequences of the ability of parvovirus B19 to target the erythroid cell lineage. However, accumulating evidence suggests that this virus can also infect other cell types resulting in diverse clinical manifestations, of which the pathogenesis remains to be fully elucidated. This has prompted important questions regarding the tropism of the virus and its possible involvement in a broad range of infectious and autoimmune medical conditions. Case Presentation Here, we present an unusual case of persistent parvovirus B19 infection as a cause of chronic hepatitis. This patient had persistent parvovirus B19 viraemia over a period of more than four years and displayed signs of chronic hepatitis evidenced by fluctuating elevated levels of ALAT and a liver biopsy demonstrating chronic hepatitis. Other known causes of hepatitis and liver damage were excluded. In addition, the patient was evaluated for immunodeficiency, since she had lymphopenia both prior to and following clearance of parvovirus B19 infection. CONCLUSIONS: In this case report, we describe the current knowledge on the natural history and pathogenesis of parvovirus B19 infection, and discuss the existing evidence of parvovirus B19 as a cause of acute and chronic hepatitis. We suggest that parvovirus B19 was the direct cause of this patient's chronic hepatitis, and that she had an idiopathic lymphopenia, which may have predisposed her to persistent infection, rather than bone marrow depression secondary to infection. In addition, we propose that her liver involvement may have represented a viral reservoir. Finally, we suggest that clinicians should be aware of parvovirus B19 as an unusual aetiology of chronic hepatitis, when other causes have been ruled out.