Conceptual models of psychological distress among low-income patients in an inner-city primary care clinic

Although depression and anxiety syndromes are common in primary care, many depressed and anxious patients fail to receive effective treatment. Little attention has been given to the role of illness beliefs in shaping these patients' treatment preferences and decisions. Using semistructured interviews, this study examined conceptual models of depressive symptoms among patients in an inner-city clinic. A theoretical taxonomy of patients' conceptual models of distress was developed: each category was associated with a unique pattern of treatment preferences. We conclude that patients' models of distress may play an important role in treatment-seeking decisions, and deserve further investigation.     

BASIS: The blood pressure awareness and insight scale

Impaired illness awareness or not accepting that one has hypertension (HTN) may be an important predictor of treatment adherence and optimal blood pressure control. The purpose of this study was to perform a systematic review of available instruments to evaluate HTN awareness, and subsequently present a novel scale that measures the core domains of subjective illness awareness in HTN. Based on the absence of any validated HTN specific measure identified through our review, the Blood Pressure Awareness and Insight Scale (BASIS) was developed ( www.illnessawarenessscales.com ). An online survey platform was used to collect data on 100 participants. BASIS showed good concurrent (r(98) = .65, P < 0.001) and discriminant validity, internal consistency (Cronbach's α = .75), and 1‐month test‐retest reliability (ICC = 0.77). BASIS is a comprehensive, easy‐to‐use instrument specifically designed to measure subjective HTN awareness. BASIS may be used in research studies and clinical practice to assess the impact of HTN awareness on treatment adherence and clinical outcomes.     

Biologic response modifiers: relevance & repercussions

Biologic response modifiers (BRMs) are substances that occur naturally in the body. They can also be manufactured in the laboratory and then administered as targeted therapy. Undoubtedly BRMs will find expanded role in terminal illness like cancer where other therapies have failed. However, great caution must be exercised in prescribing these agents in chronic indolent diseases where potential for ultimate harm might outweigh short-term benefits.     

The identification of psychiatric illness by primary care physicians

Objective:This study tested several hypotheses about why women are more likely than men to have psychiatric disorders noted by their primary care physicians. Design:Patients were screened for mental disorders using the General Health Questionnaire. A stratified sample was assessed using the Schedule for Affective Disorders and Schizophrenia. Information on utilization and identification of mental bealth problems was abstracted from the medical records. Setting:The study was conducted at a multispecialty group practice in a semirural area of Wisconsin. Patients:Study participants consisted of a stratified probability sample of 247 patients seeking primary care. Results:Patients with a psychiatric illness who were relatively frequent users of the clinic were most likely to be identified by a physician as having a mental health problem. When psychiatric illness and utilization rates were statistically controlled, men and women had comparable identification rates. Supported in part by a contract (DBE-77-0071) and grant from the National Institute of Mental Health (MH-33940) and a grant from the Robert Wood Johnson Foundation.     

Psychological, Academic, and Work Functioning in College Students with Childhood-Onset Asthma

This study investigated differences in psychological, academic, and work functioning between college students with and without asthma and identified predictors of functioning. Both participants with asthma (n = 121) and age-and gender-matched healthy control subjects (n = 121) completed measures of psychological distress, provided information on missed school and work days, and consented to have their grade point averages released from the registrar. College students with asthma also completed measures of illness uncertainty and illness intrusiveness. Participants with asthma reported greater anxiety, general psychological distress, and more missed school and work days compared to healthy control subjects. Within the asthma group, both illness uncertainty and illness intrusiveness independently predicted anxious and depressive symptoms and general psychological distress; illness intrusiveness also predicted missed school days. Although enrollment in college implies resilient functioning, college students with asthma remain at risk for problems with psychological and academic functioning.     

年龄对合并非甲状腺疾病综合征老年危重病患者的临床意义

目的研究年龄对非甲状腺疾病综合征(NTIS)老年危重病患者的临床意义。方法回顾性分析2010年1月至2016年5月吉化集团公司总医院重症监护室危重病患者341例,其中甲状腺激素水平正常者152例,NTIS患者189例。按年龄进行二分类处理,比较在60岁、60~69岁、70~79岁及≥80岁年龄段间NTIS总发生率的差异,并比较NTIS组在上述4个年龄段间相关临床指标差异。采用SPSS 17.0统计软件对数据进行分析,根据数据类型,组间比较采用t检验或χ2检验。结果我院ICU危重病患者NTIS总发生率为55.42%(189/341),60岁、60~69岁、70~79岁及≥80岁组的NTIS发生率依次为42.67%(32/75)、47.47%(47/99)、55.32%(52/94)及79.45%(58/73),组间比较,差异有统计学意义(P0.05)。70~79岁组与≥80岁组NTIS患者低三碘甲状原氨酸(T3)和(或)低游离三碘甲状原氨酸(FT3)变异型均显著低于60岁与60~69岁组,70~79岁组与≥80岁组患者低T3和(或)低FT3且低甲状腺素(T4)变异型占比均显著高于60岁与60~69岁组,差异均有统计学意义(P0.01)。随着年龄增加,NTIS患者B型脑钠肽前体(pro-BNP)及胱抑素C(Cys C)水平显著升高,前白蛋白(PA)水平显著下降,差异有统计学意义(P0.01)。与60岁组患者(12.50%,4/32)比较,≥80岁组(39.66%,23/58)患者28 d死亡率显著升高(P0.05),其余年龄组间28 d死亡率比较,差异无统计学意义(P0.05)。结论老年危重病患者出现NTIS时提示病情较重,预后较差,≥80岁的高龄危重病患者NTIS发生率明显增高,死亡率明显增高。     

Connecting Social,Clinical, and Home Care Services for Persons with Serious Illness in the Community

The medical, psychological, cognitive, and social needs of older adults with serious illness are best met by coordinated and team‐based services and support. These services are best provided in a seamless care model anchored by integrated biopsychosocial assessments focused on what matters to older adults and their social determinants of health; individualized care plans with shared goals; care provision and management; and quality measurement with continuous improvement. This model requires (1) racially and ethnically diverse healthcare professionals, including mental health and direct service workers, with training in aging and team collaboration; (2) an integrated network of community‐based organizations (CBOs) providing in‐home services; (3) an electronic communication platform that spans the system of providers and organizations with skilled technology staff; and (4) payment models that incentivize team‐based care across the continuum of services, including CBOs, with adequate salaries and academic loan forgiveness to recruit and retain high‐quality team members. Assuring that this model is effective requires ongoing quality assurance measures that include not only quality of care and utilization data to demonstrate cost offsets of service integration, but also quality of life for both the older adults and the family members caring for them. Although this may seem a lofty ideal in comparison with our current fragmented system, we review models that provide the key elements effectively and cost efficiently. We then propose an Essential Care Model that defines best practice in meeting the needs of older adults with serious illness and their families. J Am Geriatr Soc 67:S412–S418, 2019.     

Chronic Illness with Complexities: Mental Illness and Substance Use Among Veteran Clinic Users with Diabetes

Objective: Create a taxonomy and examine the predictors of the often co-occurring conditions of substance use disorders and mental illness in veterans with diabetes. Design: Merged Veteran Health Administration and Medicare fee-for-service claims data (N = 485,893). Results: Thirty-one percent of patients with diabetes were diagnosed with either mental illness or substance use and had higher rates of diabetes-related complications. Women were more likely to have serious mental illness; African Americans and Latinos more likely to have drug and/or alcohol use. Conclusion: Prevalence of substance use disorder and mental illness differed by socio-demographics, suggesting the need for tailored diabetes management interventions.     

Vitamin D deficiency: Implications for acute care in the elderly and in patients with chronic illness

There is evidence that the vast majority of hospitalized patients have vitamin D deficiency. Vitamin D deficiency is a poorly recognized pandemic with evidence to indicate inadequate testing and monitoring of response to treatment in high‐risk populations. Vitamin D receptors are ubiquitous in the human body and while the endocrine effects of vitamin D are well recognized, the autocrine and paracrine effects of this steroid hormone are less well appreciated. These functions include antimicrobial and immunomodulation effects as well benefits on cardiovascular health, autoimmune disease, cancer and metabolism. Vitamin D deficiency increases mortality and even a modest amount of vitamin D may enhance longevity. Emerging evidence suggests that a vitamin D replete state carries significant health benefits in acute illness. In this review, we discuss the role of vitamin D deficiency and potential benefits in treating this deficiency focusing on the implications for managing acute illness in elderly patients and those with an underlying chronic illness. Geriatr Gerontol Int 2011; 11: 395–407.     

The central nervous system in systemic lupus erythematosus

Summary Management of central nervous system (CNS) involvement is one of the most challenging problems in systemic lupus erythematosus. This article reviews the spectrum of CNS manifestations present in this disease, their diagnosis and pathogenesis, as well as an approach to their treatment and prognostic implications.     

Health-related Quality of Life in College Students with and without Childhood-Onset Asthma

Objective. The current study investigated whether differences existed in health-related quality of life between individuals who self-identified as having childhood-onset asthma and individuals without a chronic illness. Additionally, the relationship between perceived illness intrusiveness and illness uncertainty to health-related quality of life was explored. Methods. College undergraduates at least 18 years of age who self-identified as having childhood asthma were randomly matched by age and gender to healthy control participants. Participants completed a demographic form, the Mishel Uncertainty in Illness Scale-Community Form, the Illness Intrusiveness Scale, and the SF-36 Health Survey, a measure of health-related quality of life. Results. Participants with asthma had significantly lower scores on the total and mental health-related quality of life scales than did healthy control subjects. There were no significant differences between self-identified participants with asthma and matched healthy control subjects on physical health-related quality of life scales. Illness intrusiveness was not related to either the physical (e.g., physical functioning, general health) or mental health-related quality of life. Higher levels of illness uncertainty were significantly related to higher levels of mental health-related quality of life (e.g., vitality, mental health). In addition, participants with asthma scored significantly lower than healthy controls on the social functioning and role-emotional subscales. Conclusion. The current study adds to the extant literature by examining the relationships between illness intrusiveness, illness uncertainty, and health-related quality of life among a young adult population. College students with asthma appear to be at risk for diminished quality of life compared to a healthy comparison group. Further examination of various domains of health-related quality of life among older adolescents and young adults with childhood asthma is needed.     

Glucose control in sepsis

Hyperglycemia is common during the course of critical illness and is associated with adverse clinical outcomes. Randomized controlled trials and large observational trials of insulin therapy titrated to achieve glucose values approximating the normal range (80 to 110 mg/dL) demonstrate improved morbidity and mortality in heterogeneous populations and have led to recommendations for improved glucose control. Patients who have septic shock, however, appear to be at higher risk for hypoglycemia, and a recent randomized trial focusing exclusively on patients who had severe sepsis did not show benefit. The recent Surviving Sepsis consensus statement recommends insulin therapy using validated protocols to lower glucose (less than 150 mg/dL) pending the results of adequately powered trials to determine if normalization (less than 110 mg/dL) of glucose is needed to optimize outcomes in patients who have severe sepsis.     

血液净化疗法在内科危重急症抢救中的作用

目的：评价血液净化技术在内科危重急症抢救中的治疗作用。方法：回顾性分析1987年以来应用血液净化技术抢救内科危重急症675例的效果。结果：总抢救成功率为89．5％（604／675）,其中急性肾功能衰竭（肾衰）、慢性肾衰合并严重并发症和其它非肾性内科危重急症的抢救成功率分别为80．2％（77／96）、92．3％（470／509）和81．4％（57／70）。结论血液净化技术在内科危重急症的抢救中有着十分重要的作用,其具体实施宜因人而异,重视综合治疗。     

Skeletal muscle in critical illness

Summary Skeletal muscle protein breakdown is a dominant feature of critical illness and is believed to be a useful biological response to injury. However the loss of muscle is accompanied by some major difficulties in medical management and complications for the patient. Protein turnover is difficult to study and the catabolic state is resistant to treatment, whether by nutritional or other strategies. This article provides an overview of the current physiological knowledge in this area, questions the usefulness of the catabolic response and highlights some new research worthy of further investigation. Received: 24 September 1998 Accepted: 20 April 1999     

Decline of influenza and respiratory syncytial virus detection in facility-based surveillance during the COVID-19 pandemic,South Africa,January to October 2020

BackgroundIn South Africa, COVID-19 control measures to prevent SARS-CoV-2 spread were initiated on 16 March 2020. Such measures may also impact the spread of other pathogens, including influenza virus and respiratory syncytial virus (RSV) with implications for future annual epidemics and expectations for the subsequent northern hemisphere winter.MethodsWe assessed the detection of influenza and RSV through facility-based syndromic surveillance of adults and children with mild or severe respiratory illness in South Africa from January to October 2020, and compared this with surveillance data from 2013 to 2019.ResultsFacility-based surveillance revealed a decline in influenza virus detection during the regular season compared with previous years. This was observed throughout the implementation of COVID-19 control measures. RSV detection decreased soon after the most stringent COVID-19 control measures commenced; however, an increase in RSV detection was observed after the typical season, following the re-opening of schools and the easing of measures.ConclusionCOVID-19 non-pharmaceutical interventions led to reduced circulation of influenza and RSV in South Africa. This has limited the country’s ability to provide influenza virus strains for the selection of the annual influenza vaccine. Delayed increases in RSV case numbers may reflect the easing of COVID-19 control measures. An increase in influenza virus detection was not observed, suggesting that the measures may have impacted the two pathogens differently. The impact that lowered and/or delayed influenza and RSV circulation in 2020 will have on the intensity and severity of subsequent annual epidemics is unknown and warrants close monitoring.     

Cost of severe asthma in Brazil—systematic review

Introduction: Severe asthma is characterized by frequent exacerbations, symptoms limiting daily activities and nocturnal symptoms. It requires the continuous use of medications, at high doses, and, sometimes, continuous use of oral corticosteroids, representing a significant burden to health system and society. This systematic review sought to address economic data related to severe asthma in Brazil. Method: In June 2014, electronic searches were conducted to identify relevant publications. Quality criteria were developed and applied to each selected study. In order to compare results across the selected studies, costs were refined to an annual basis, grouped according to the study perspective, inflated and converted to 2014 USD. Results: Cost analyses from the Brazilian public health system perspective were derived from two studies and showed an average annual hospital cost per patient of 135 USD and 733 USD, respectively. From the family perspective, average annual direct costs per patient varied from 764 USD to 929 USD. Conclusion: Hospitalizations and medications seem to be the most important resources funded by the Brazilian public health system and by patients and their families. Although further studies are necessary, as information on cost of this disease is scarce in Brazil, these findings suggest that there is a potential room for improving severe asthma care among Brazilian patients.