“They treated me like a leper”

OBJECTIVE: Hepatitis C virus is the most prevalent chronic blood-borne infection in the United States, typically acquired through contaminated blood products or needle sharing. We hypothesized that patients with chronic hepatitis C infection experience stigmatization independent of mode of acquisition and that it negatively affects quality of life. DESIGN: Cross-sectional observation study. SETTING: Specialty clinic in a tertiary referral hospital. PATIENTS: Two hundred and ninety outpatients diagnosed with chronic hepatitis C infection and seen in a hepatology clinic. Thirty participants were excluded because of missing data. MEASUREMENTS AND MAIN RESULTS: Patients were asked to complete a demographic profile, a semistructured interview, the Sickness Impact Profile, and the Hospital Anxiety Depression Scale. A team of two blinded coders analyzed the interviews. A total of 147 of the 257 study patients experienced stigmatization that they attributed to the disease. Women were more likely to report perceived stigmatization than men (P <.05). Age, education, professional status, and mode of infection did not influence the likelihood of stigmatization. Stigmatization was associated with higher anxiety (P <.01) and depression (P <.01), worsened quality of life (P <.01), loss of control (P <.01), and difficulty coping (P <.01). Individuals who experienced stigmatization also mentioned problems in their health care (P <.01) and work environment (P <.01) as well as with family members (P <.01). CONCLUSION: Stigmatization is a very common emotionally burdensome experience for patients with hepatitis C, which can erode social support. As it penetrates even into the health care environment, physicians and other care providers should be aware of the existence and impact of such negative stereotyping.     

“They Don't Come to Listen”: The Experience of Loneliness Among Older People in Kwahu, Ghana

This article describes life conditions of elderly people in a rural community of Ghana. It deals with the paradoxical situation of elderly people who are still engaged in social activities and yet experience loneliness. It is argued that in spite of the respect given to them, elderly people are denied what they regard as the most valuable proof of respect and companionship: listening to their wisdom and advice. Their loss of that ultimate respect constitutes an experience of loneliness. The article is part of broader anthropological study on social and cultural meanings of growing old in a rural Ghanaian community.     

The “return” of hepatitis B

INTRODUCTION Hepatitis B virus (HBV) infection is a global health problem. This infection is especially endemic in Asia, South Pacific Region, sub-Saharan Africa and South America[1]. It is estimated that over 350 million people worldwide are chronically …     

The treatment of the “untreatable” patient-revisited

The limits of medicine have not yet been reached. Numerous human illnesses initially thought to be incurable are reversible under unique and unpredictable individual circumstances.This paper, and the preceding companion publication,describes instances of the successful treatment of patients previously labeled as untreatable, including instances of severe ulcerative colitis and Crohn‘s disease.     

The “Choosing Wisely” initiative in infectious diseases

Objective

“Choosing Wisely” is a growing international campaign aiming at practice changes to improve patient health and safety by both, conduct of essential and avoidance of unnecessary diagnostic, preventive and therapeutic procedures. The goal is to create an easily recognizable and distributable list (“Choosing Wisely items”) that addresses common over- and underuse in the management of infectious diseases.

Methods

The German Society of Infectious Diseases (DGI) participates in the campaign “Klug Entscheiden” by the German Society of Internal Medicine. Committee members of the (DGI) listed potential ‘Choosing Wisely items’. Topics were subjected to systematic evidence review and top ten items were selected for appropriateness. Five positive and negative recommendations were approved via individual member vote.

Results

The final recommendations are: (1) Imperatively start antimicrobial treatment and remove the focus in Staphylococcus aureus bloodstream infection. (2) Critically ill patients with signs of infection need early appropriate antibiotic therapy. (3) Annual influenza vaccination should be given to individuals with age >60 years, patients with specific co-morbidities and to contact persons who may spread influenza to others. (4) All children should receive measles vaccine. (5) Prefer oral formulations of highly bioavailable antimicrobials whenever possible. (6) Avoid prescribing antibiotics for uncomplicated upper respiratory tract infections. (7) Do not treat asymptomatic bacteriuria with antibiotics. (8) Do not treat Candida detected in respiratory or gastrointestinal tract specimens. (9) Do not prolong prophylactic administration of antibiotics in patients after they have left the operating room. (10) Do not treat an elevated C-reactive protein (CRP) or procalcitonin with antibiotics for patients without signs of infection.

Conclusions

Physicians will reduce potential harm to patients and increase the value of health care when implementing these recommendations.

     

The “end-systolic” length-tension relation in mammalian myocardium

Summary Complete length-tension diagrams of myocardium were measured on isolated papillary muscles of cat right ventricle. These diagrams clearly demonstrate that irrespective of loading conditions there is no uniform maxima curve. As a function of preload the curves of afterloaded isotonic maxima obey totally separate nonlinear relations. Thus, for the heart muscle one should not assign a single linear regression line to the end-systolic length-tension points. Originally, its slope was supposed to be determined almost entirely by the contractile state of the heart muscle. Alteration in the contractile state of the heart muscle by varying the extracellular Ca⁺⁺ concentration is primarily expressed in a corresponding change in the distance between maxima curve and resting length-tension curve, and thereby in the myocardial working capacity, whereas the mean slope of the maxima curves reacts in a considerably less sensitive manner. These evidences annul the supposed physiological basis of the end-systolic pressurevolume concept, with E_max as index of contractility.Dedicated to Professor Dr. R. Jacob on the occasion of his 60th birthday.Presented at the Symposium Aktuelle Probleme der Herzdynamik (1984) supported by Fritz-Thyssen-Stiftung.     

Older Adults: The “Panini Sandwich” Generation

There are various reasons underlying why older adults find themselves in the role of a caregiver to their adult child, ranging from having a child born with a developmental disability, to having a child who suffers from a long term disability to having an adult child who has been diagnosed with a psychological disorder to raising one’s grandchildren in the absence of their adult children. The caregiving literature focuses almost entirely on care provided to the older adult, rather than by the older adult. Unlike the breadth of literature on these adult children or spouse caregivers, there is a dearth of literature about this cohort and the impact that care provision has on their mental health and well-being. This may be largely due to the lack of a framework for identifying and focusing on the needs of this cohort of caregivers. The only framework to date has focused on the bi-directionality of care when the adult child is at the center of care provision. As older adult caregivers age, they are pressed between their own physical and emotional aging needs and providing care to their adult children. The conceptualization of caregivers in this cohort as the Panini Sandwich Generation provides the needed lens by which mental health professionals can begin to explore and address the emotional and psychological needs and experiences of older adult caregivers.     

The first results of the “bevolkingsonderzoek” in the Zaanstreek region in The Netherlands

This short communication describes the results with respect to stage of colorectal cancer in people detected via screening and patients with clinical complaints.     

The Perceived Benefits of Participating in Voluntary Activities Among Older People: Do They Differ by Volunteer Characteristics?

Previous research has linked volunteering with a catalog of well-being indicators; however, it is unclear whether all volunteers derive the same benefit. The aim of this article is to examine the perceived benefits of volunteering among older people and to determine whether the benefits differ by volunteer characteristics. The study found that volunteers reported a wide range of benefits emerging from their volunteering, including increased socialization and self-worth. There was some evidence to suggest that benefits vary by volunteer characteristics with the older-old, the less educated, and the retired reporting the greatest benefit. In addition, different subgroups may benefit in different ways. Recognizing and responding to the potential benefits of volunteering to different groups is important in the recruitment and retention of volunteers.     

Do Physicians Do What They Say?: The Inclination to Test and Its Association with Coronary Angiography Rates

OBJECTIVE: Efforts to evaluate variations in cardiac procedures have focused on patient factors and differences in health care delivery systems. We wanted to assess how physicians' inclination to test patients with coronary artery disease influences utilization patterns. SETTING AND SUBJECTS: Physicians and the populations of Maine, New Hampshire, and Vermont. DESIGN: We conducted a survey of 263 family practitioners, internists, and cardiologists residing in 57 hospital service areas in Maine, New Hampshire, and Vermont. Using patient scenarios, we assessed the clinicians' inclinations to test during the evaluation of patients with coronary artery disease. Self-reported testing intensities were used to create three indices: a Catheterization Index, an Imaging Exercise Tolerance Test (ETT) Index, and a Nonimaging ETT Index. Using administrative data, age- and gender-adjusted population-based coronary angiography rates were calculated. Physicians were assigned to low (2.9/1,000), average (4.2/1,000), and high (5.8/1,000) coronary angiography rate areas, based on where they practice. Analysis of variance techniques were used to assess the relation of the index scores to the population-based coronary angiography rates and to physician specialties. RESULTS: There was a positive relationship between the population-based coronary angiography rates and the self-reported scores of the Catheterization Index (p < .005) and the Imaging ETT Index (p = .01), but none was found for the Nonimaging ETT Index (p = .10). These relationships were evident in subanalyses of cardiologists and internists, but not of family practitioners. CONCLUSIONS: Self-reported testing intensity by physicians is related to the population-based rates of coronary angiography. This relationship cuts across specialties, suggesting that there is a "medical signature" for the evaluation of patients with coronary artery disease.