RESUMEN
BACKGROUND: Little is known about differences among hepatitis C virus (HCV) patients managed by generalists vs. specialists with respect to patient-centred outcomes, such as disease-specific knowledge, health-related quality of life (HRQoL) and satisfaction with care. AIM: To examine selected patient-centred outcomes of HCV-related care provided in primary care, specialty care or both. METHODS: A total of 629 chronic HCV patients completed a survey including an HCV knowledge assessment and validated instruments for satisfaction and HRQoL. Multivariable linear regression was used to compare outcomes between groups. RESULTS: Adjusted total HCV knowledge score was lower among patients who did not attend specialty care (P < 0.01). Primary care and specialty patients did not differ in adjusted general HRQoL or satisfaction. Sixty percent of specialty patients underwent formal HCV education, which was associated with 5% higher knowledge score (P = 0.01). General HRQoL and patient satisfaction did not differ between primary care and specialty groups. Disease-specific knowledge and care satisfaction were independent of mental illness, substance abuse, socio-economic variables, history of antiviral treatment, formal HCV education and duration of time between last visit and survey completion. CONCLUSIONS: Primary care patients with chronic HCV have lower adjusted disease-specific knowledge than specialty patients, but no difference in general HRQoL or patient satisfaction.
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Gastroenterología/normas , Hepatitis C Crónica/terapia , Educación del Paciente como Asunto/normas , Satisfacción del Paciente , Atención Primaria de Salud/normas , Calidad de la Atención de Salud/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Medicina/normas , Persona de Mediana Edad , Calidad de Vida/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
UNLABELLED: Urinary tract infections are quite frequent in children. Urinary tract obstruction combined with recurrent urinary tract infections increase the risk for renal impairment. Therefore prophylaxis of reinfection is an important nephroprotective procedure. The aim of this open, controlled, randomised pilot study was to compare the efficacy and tolerance of a low dose prophylaxis with Cefixime versus Nitrofurantoin. 60 girls aged 1 to 11 years with at least 2 urinary tract infections within the preceding year were included in the study. The minimum duration of therapy was 6 months and was extended to 12 months for most of the children. The number of recurrent infections was the main criteria for efficacy evaluation, whereas adverse events were analysed to evaluate tolerance. Statistical significant differences between the two treatment groups, regarding recurrence rates could not be demonstrated. Tolerance was comparable in both groups. The influence on gut flora of cefixime given as a low dose regimen over a long period of time corresponds with already published results and was not correlated with a higher number of gastrointestinal side effects. CONCLUSION: Low-dose Cefixime (2 mg/kg bodyweight) is effective and well tolerated in the prophylaxis of recurrent urinary tract infections. Efficacy and tolerance of cefixime were comparable to the results obtained with nitrofurantoin. Due to the small number of patients this study was only a pilot study. Low-dose cefixime, however, could become an alternative to standard regimens in the prophylaxis of recurrent urinary tract infections. This should be investigated in further studies.
Asunto(s)
Antibacterianos/uso terapéutico , Antiinfecciosos Urinarios/uso terapéutico , Cefixima/uso terapéutico , Nitrofurantoína/uso terapéutico , Infecciones Urinarias/prevención & control , Factores de Edad , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Antiinfecciosos Urinarios/administración & dosificación , Antiinfecciosos Urinarios/efectos adversos , Cefixima/administración & dosificación , Cefixima/efectos adversos , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Nitrofurantoína/administración & dosificación , Nitrofurantoína/efectos adversos , Proyectos Piloto , Recurrencia , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
This study explored the multidimensional outcome of three neurosurgical interventions for Parkinson's disease (PD): pallidotomy (N = 23), pallidal deep brain stimulation (DBS) (N = 9), and thalamic DBS (N = 7). All patients completed the Sickness Impact Profile (SIP) and the Beck Depression Inventory. Pallidotomy patients also completed the Profile of Mood States, the Beck Anxiety Inventory, and a disease-specific quality of life (QOL) measure, the Parkinson's Disease Questionnaire (PDQ-39). Three months after surgery, all neurosurgical groups showed significant improvements in mood and function, including physical, psychosocial, and overall functioning. Pallidal DBS and pallidotomy patients who completed additional QOL measures reported decreased anxiety and tension, increased vigor, improved mobility and ability to perform activities of daily living, and decreased perceived stigma. Psychosocial dysfunction scores from the SIP were related to depressed mood both at baseline (r = .42) and at followup (r = .45), but the physical dysfunction subscale was not related to mood at either time point, suggesting that disruption of social relationships due to PD may have more impact on affective distress than physical symptoms alone. Results suggest that neurosurgical interventions for PD improve disabling PD motor symptoms and also improve several domains of quality of life.
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Globo Pálido/cirugía , Estado de Salud , Enfermedad de Parkinson/cirugía , Calidad de Vida , Actividades Cotidianas , Anciano , Ansiedad/diagnóstico , Ansiedad/psicología , Encéfalo/fisiología , Depresión/diagnóstico , Depresión/psicología , Estimulación Eléctrica/métodos , Globo Pálido/fisiología , Humanos , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Trastornos Psicomotores/diagnóstico , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate short-term effects of unilateral thalamic deep brain stimulation (DBS) on cognition, mood state, and quality of life in patients with essential tremor (ET). BACKGROUND: Unilateral thalamotomy and thalamic DBS are effective in alleviating refractory tremor contralateral to the side of surgery. Thalamotomy can lead to cognitive morbidity, and DBS might be a preferable surgical intervention given potential avoidance or reversibility of such morbidity. Although unilateral thalamic DBS is cognitively safe and leads to quality of life improvement in PD, its neurobehavioral effects in ET are unknown. METHODS: Forty patients with ET were administered a broad neuropsychological test battery, measures of mood state, and generic and disease-specific quality of life measures approximately 1 month before and 3 months after surgery (left hemisphere, 38 patients). RESULTS: Unilateral thalamic DBS was associated with significant improvements in tremor and dominant-hand fine visuomotor coordination. Statistically significant but clinically modest gains were observed on tasks of visuoperceptual and constructional ability, visual attention, delayed word list recognition, and prose recall. Only lexical verbal fluency declined significantly after surgery. Patients rated themselves as less anxious after surgery, and they perceived their quality of life as improved significantly. In particular, patients reported improved quality of life with respect to activities of daily living, stigma, emotional well-being, and communication. CONCLUSIONS: Unilateral thalamic DBS for ET is cognitively safe and associated with improvements in anxiety and quality of life in the near term and in the absence of operative complications. Patients were better able to carry out activities of daily living after surgery, and they reported improvement in several psychosocial domains of quality of life.
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Terapia por Estimulación Eléctrica , Calidad de Vida , Núcleos Talámicos/fisiopatología , Temblor/psicología , Temblor/terapia , Anciano , Anciano de 80 o más Años , Ansiedad/psicología , Humanos , Cuidados Intraoperatorios , Pruebas Neuropsicológicas , Periodo Posoperatorio , Resultado del Tratamiento , Temblor/fisiopatología , Temblor/cirugíaRESUMEN
160 children aged 1 to 12 years with clinical diagnosis of bacterial pharyngitis and/or tonsillitis were treated either with cefixime ready-to-use-suspension or penicillin V in an open, controlled and randomized multicenter study. Before treatment a rapid antigen detection test was accomplished and throat swabs were taken. After randomization, the children were either treated for 5 days with 8 mg cefixime/kg bodyweight ready-to-use suspension once daily or with 20,000 I.U. penicillin V/kg bodyweight t.i.d. also administered as suspension. The data of 151 children could be evaluated for clinically efficacy. In the cefixime-group 86.7% of the children were cured and 9.3% significantly improved. After initial improvement, in one child (1.3%) a relapse occurred and in the two remaining children (2.7%) therapy failed. 90.8% of the patients treated with penicillin V were cured, 6.6% improved and in one child each a relapse was registered resp. therapy failed. Complete microbiological data were available in 137 patients. In the cefixime-group in 82.6% of the patients the pathogens were eradicated. The elimination rate in the penicillin-group was 88.2%. At the follow-up 3-4 weeks after end of treatment 6 relapses were seen in the cefixime-group, and 8 in the patients treated with penicillin. Both regimes were safe. Mild to moderate adverse events at least possibly related to the study medication were seen in only 4 children treated with cefixime and in 5 treated with penicillin. A 5 day treatment of bacterial pharyngitis and tonsillitis with cefixime was as effective as a ten day treatment with penicillin V.
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Cefotaxima/análogos & derivados , Cefalosporinas/administración & dosificación , Penicilina V/administración & dosificación , Penicilinas/administración & dosificación , Faringitis/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes , Tonsilitis/tratamiento farmacológico , Cefixima , Cefotaxima/administración & dosificación , Cefotaxima/efectos adversos , Cefalosporinas/efectos adversos , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Lactante , Masculino , Penicilina V/efectos adversos , Penicilinas/efectos adversos , Streptococcus pyogenes/efectos de los fármacos , Resultado del TratamientoRESUMEN
In this paper, we examine social and psychological characteristics of 60 HIV+ women and gay men, matched on age and stage of HIV infection. A discriminant function analysis was performed using measures of life adversity, psychological distress, and psychosocial resources. The best combination of predictors for distinguishing between HIV+ women and gay men was comprised of satisfaction with emotional support, network size, use of avoidant coping, Hamilton depression, and loneliness scores [chi 2(7) = 14.8, p < .05]. Women reported more satisfaction with emotional support, although gay men had larger social networks. Gay men used more avoidant coping and had higher lonelines scores as compared to women, although women reported more depressive symptoms. Utilizing this set of psychosocial variables, we correctly classified 73% of the HIV+ women and 67% of the HIV+ men. These findings suggest the importance of considering subgroup differences in the design of counseling programs for HIV+ individuals.
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Infecciones por VIH/psicología , Homosexualidad Masculina , Calidad de Vida , Salud de la Mujer , Adaptación Psicológica , California , Estudios Transversales , Depresión , Análisis Discriminante , Familia , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Análisis Multivariante , Satisfacción Personal , Aislamiento Social , Apoyo Social , Estrés PsicológicoRESUMEN
LIFE stress, mood, and other psychosocial factors may help to explain variability in HIV (human immunodeficiency virus) disease progression. Attempts to support this notion empirically have produced mixed findings; several studies report a positive relationship between psychosocial factors and various indicators of disease progression or immune function (e.g., Evans et al. 1992; Goodkin et. al. 1992), whereas others have failed to detect any association (e.g., Perry et. al. 1992).
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Recuento de Linfocito CD4 , Linfocitos T CD8-positivos/inmunología , Depresión/psicología , Infecciones por VIH/psicología , VIH-1/inmunología , Acontecimientos que Cambian la Vida , Microglobulina beta-2/análisis , Adaptación Psicológica , Adulto , Nivel de Alerta/fisiología , Mecanismos de Defensa , Depresión/inmunología , Anticuerpos Anti-VIH/sangre , Infecciones por VIH/inmunología , Humanos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Determinación de la PersonalidadRESUMEN
In an open, controlled, randomized multicenter study, 160 children suffering from pharyngitis and/or tonsillitis were treated with either 8 mg cefixime/kg body weight once daily for 5 days or 20,000 I.U. penicillin V/kg body weight t.i.d. for 10 days. One hundred fifty-one children were evaluable for clinical efficacy. In the cefixime group, 65 (86.7%) children were cured, seven (9.3%) were significantly improved, one (1.3%) relapsed and in two (2.7%) therapy failed. Of the patients treated with penicillin V, 69 (90.8%) were cured, five (6.6%) improved, one (1.3%) relapsed and in one (1.3%) therapy failed. Elimination of initial pathogens occurred in 57 (82.6%) patients treated with cefixime and in 60 (88.2%) treated with penicillin V. At 3 to 4 weeks after the end of treatment, six relapses were seen in the cefixime group and eight in the penicillin V group. Mild-to-moderate adverse events that were possible related to the medication were seen in four children treated with cefixime and in five treated with penicillin V.
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Cefotaxima/análogos & derivados , Cefalosporinas/uso terapéutico , Penicilina V/uso terapéutico , Penicilinas/uso terapéutico , Faringitis/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico , Tonsilitis/tratamiento farmacológico , Cefixima , Cefotaxima/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
This research describes major stressors in the lives of women who have been infected with the human immunodeficiency virus (HIV). Thirty-one HIV antibody positive (HIV+) women infected primarily through heterosexual contact participated in a two hour semi-structured interview detailing the circumstances, context, and consequences of all stressful life events and difficulties experienced within the preceding six months. Qualitative methods of data analyses were utilized (Miles & Huberman, 1984). HIV-related life events and difficulties were classified into primary and secondary stressors based on the stress process model (Pearlin et al., 1981). Problems arising directly from one's seropositivity were defined as primary stressors. Stressful life events and difficulties occurring in other role areas were defined as secondary stressors. Six categories of HIV-related stressors were identified and quantified. Primary stressors were health-related, and included both gynecological problems (e.g., amenorrhea) and general symptoms of HIV infection (e.g., fatigue). Secondary stressors related to child and family (e.g., future guardianship of children), marital/partner relations (e.g., disclosure of HIV+ status), occupation (e.g., arranging time-off for medical appointments), economic problems (e.g., insurance "hassles"), and social network events (e.g., death of friends from AIDS). This research indicates that HIV-positive women are exposed to multiple stressors; some may be viewed as unique to women, whereas others may be considered common to both sexes. Identification of stressors has implications for the design of medical and psychiatric interventions for women.
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Seropositividad para VIH/psicología , Estrés Psicológico/etiología , Salud de la Mujer , Adulto , Estudios de Cohortes , Familia , Femenino , Seropositividad para VIH/economía , Seropositividad para VIH/epidemiología , Humanos , Estudios Longitudinales , Matrimonio , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología , Mujeres TrabajadorasRESUMEN
Twenty full term neonates with suspected bacterial infection were randomly assigned to a once daily or a twice daily dosage regimen with gentamicin (4 mg/kg/day). Concomitantly all patients were treated with ampicillin (200 mg/kg/day). The gentamicin concentration time curves were analysed by an open two compartment model under steady state conditions on day 4 of treatment. The mean theoretical maximum serum concentration in the group taking gentamicin once daily (10.9 micrograms/ml) was significantly higher than in the group taking it twice daily (7.4 micrograms/ml). Potentially toxic serum concentrations were never reached. Mean trough concentrations were comparable in both groups (once daily 0.8 micrograms/ml; twice daily 1.0 micrograms/ml). Urinary alanine aminopeptidase excretion increased during and even two days after end of treatment in both groups without any significant differences. The results of the dynamic in vitro model revealed that both dosage schedules showed comparable bactericidal effects on pathogens inhibited by low concentrations of gentamicin like Escherichia coli and Staphylococcus aureus. However the once daily regimen was significantly superior in isolates with high minimal inhibitory concentrations.
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Antibacterianos/farmacocinética , Infecciones Bacterianas/tratamiento farmacológico , Gentamicinas/farmacocinética , Aminopeptidasas/orina , Ampicilina/uso terapéutico , Infecciones Bacterianas/sangre , Infecciones Bacterianas/orina , Antígenos CD13 , Esquema de Medicación , Gentamicinas/administración & dosificación , Gentamicinas/sangre , Gentamicinas/uso terapéutico , Humanos , Recién NacidoRESUMEN
In a prospective, open clinical study, 50 urological patients with acute pyelonephritis were treated with the oral cephalosporin cefixime. The medication (2 x 200 mg/day) was given for seven to ten days. Clinical, bacteriological as well as hematological examinations were carried out prior to, during and immediately after therapy. A late check-up was performed five to nine days after the end of therapy. 46 of the 50 cases were evaluable for efficacy, and all 50 patients were included in safety evaluation. The most frequent pathogens isolated prior to therapy were Escherichia coli (34 times), Proteus mirabilis (six times), Klebsiella pneumoniae (twice) and coagulase-negative staphylococci (twice). Immediately after the end of therapy the pathogens were eradicated in 44 (97.5%) patients. At the late check-up the urine was sterile in 29 (63%) patients. A relapse was observed in 11 patients, a reinfection in four and the initially isolated pathogens had persisted in two. Immediately after the end of therapy 44 (95.7%) patients were clinically cured and two patients had improved. At the late check-up 41 patients were classified as clinically cured, three showed improvement, and two improvement with relapse. Adverse reactions (one case nausea and exanthem, and one case of meteorism) occurred in two patients. No changes in the blood counts or in the liver and kidney functions were observed. In the study described here cefixime proved to be an effective and well tolerated antibiotic for the treatment of upper urinary tract infections; it is of particular interest that 16 of the 50 patients presented with underlying disease favoring infection.