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Archive for the ‘diseases and conditions’ Category

NIH-commissioned Census Bureau report highlights effect of aging boomers

July 28, 2014 Comments off

NIH-commissioned Census Bureau report highlights effect of aging boomers
Source: National Institutes of Health/U.S. Census Bureau

While rates of smoking and excessive drinking have declined among older Americans, prevalence of chronic disease has risen, and many older Americans are unprepared to afford the costs of long-term care in a nursing home, according to a report from the U.S. Census Bureau commissioned by the National Institutes of Health.

The report highlights those trends and others among America’s older population, now over 40 million and expected to more than double by mid-century, growing to 83.7 million people and one-fifth of the U.S. population by 2050. Population trends and other national data about people 65 and older are presented in the report, 65+ in the United States: 2010 (PDF, 12.0M). It documents aging as quite varied in terms of how long people live, how well they age, their financial and educational status, their medical and long-term care and housing costs, where they live and with whom, and other factors important for aging and health.

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Uterine Pathology in Women Undergoing Minimally Invasive Hysterectomy Using Morcellation

July 23, 2014 Comments off

Uterine Pathology in Women Undergoing Minimally Invasive Hysterectomy Using Morcellation
Source: Journal of the American Medical Association

Our data demonstrate that uterine cancers occurred in 27 per 10 000 women undergoing morcellation. Other malignancies and precancerous abnormalities were also detected. Although morcellators have been in use since 1993, few studies have described the prevalence of unexpected pathology at the time of hysterectomy.2- 4 Prevalence information is the first step in determining the risk of spreading cancer with morcellation. Although data are limited, women with apparent uterine-confined neoplasms at the time of morcellation have been found to have intraperitoneal tumor dissemination at the time of reexploration.3,6

We recognize a number of limitations including the inability to verify pathological findings, possible misclassification of pathology, potential undercapture of morcellation, and the fact that our findings may not be generalizable to all hospitals. Last, we lack data on long-term follow-up, and the outcome of women with pathological abnormalities who underwent morcellation requires further study. Patients considering morcellation should be adequately counseled about the prevalence of cancerous and precancerous conditions prior to undergoing the procedure.

Census Bureau Updates Interactive HIV/AIDS Database; New Prevalence Estimates from More Than 100 Countries

July 22, 2014 Comments off

Census Bureau Updates Interactive HIV/AIDS Database; New Prevalence Estimates from More Than 100 Countries
Source: U.S. Census Bureau

The U.S. Census Bureau today released its annually updated interactive global resource on the prevalence of HIV infection and AIDS cases and deaths. First developed in 1987, the database now holds more than 164,000 statistics, an increase of approximately 5,900 new estimates in the last year, and is the most comprehensive resource of its kind in the world.

The Census Bureau database is maintained with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).

The tool consists of a library of statistics from more than 14,900 sources in international scientific and medical journals, individual countries’ annual HIV/AIDS surveillance reports, and papers and posters presented at international conferences. China represents 28 percent of the new records in the database, the largest increase by a single country.

The menu-driven access tool enables users to search for statistical information in countries and territories across the world, as well as by subpopulation, geographic subarea (such as urban and rural), age, sex and year from the 1960s to 2013.

Continuity of Care and the Cost of Treating Chronic Disease

July 21, 2014 Comments off

Continuity of Care and the Cost of Treating Chronic Disease
Source: RAND Corporation

Strengthening coordination of care in the U.S. health care system is a priority for policymakers and the medical community. Poor coordination of care can drive up costs and harm patient health, especially for patients with chronic illnesses who see many different providers across many different settings. Some new models of care, such as the patient-centered medical home, focus on improving coordination as a way to provide affordable, high-quality care. Are these new models having the desired effect?

To answer this question, RAND researchers studied one important aspect of care coordination: continuity of care — the extent to which a patient’s care visits occur with the same provider. Researchers reviewed insurance claims data to gauge the association between continuity of care, costs, and patient outcomes during episodes of care for Medicare patients with one or more of three chronic diseases: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and type 2 diabetes mellitus (DM).

Researchers used a continuity of care (COC) index to measure the number of providers and/or practices involved in a patient’s care during a 365-day episode of care. The index ranges from 0 (each visit involved a unique provider) to 1 (all visits were billed by a single provider). An increase in the COC index reflects either fewer providers involved in a patient’s care or a concentration of visits among fewer providers.

Findings from this study show that modest improvements in continuity of care correlate with sizable reductions in service use, complications, and costs:

  • Higher levels of care continuity for CHF, COPD, and DM patients were consistently associated with lower rates of hospitalizations, emergency room visits, and complications.
  • An 0.1-unit increase in the COC index (which ranges from 0 to 1) was associated with episode-of-care costs for CHF, COPD, and DM patients that were on average 5 percent lower.

UNAIDS report shows that 19 million of the 35 million people living with HIV today do not know that they have the virus

July 17, 2014 Comments off

UNAIDS report shows that 19 million of the 35 million people living with HIV today do not know that they have the virus
Source: Joint United Nations Programme on HIV/AIDS (UNAIDS)

A new report by UNAIDS shows that 19 million of the 35 million people living with HIV globally do not know their HIV-positive status.

The UNAIDS Gap report shows that as people find out their HIV-positive status they will seek life-saving treatment. In sub-Saharan Africa, almost 90% of people who tested positive for HIV went on to access antiretroviral therapy (ART). Research shows that in sub-Saharan Africa, 76% of people on ART have achieved viral suppression, whereby they are unlikely to transmit the virus to their sexual partners. New data analysis demonstrates that for every 10% increase in treatment coverage there is a 1% decline in the percentage of new infections among people living with HIV.

The report highlights that efforts to increase access to ART are working. In 2013, an additional 2.3 million people gained access to the life-saving medicines. This brings the global number of people accessing ART to nearly 13 million by the end of 2013. Based on past scale-up, UNAIDS projects that as of July 2014 as many as 13 950 296 people were accessing ART.

Update on findings in the FDA cold storage area on the NIH campus

July 17, 2014 Comments off

Update on findings in the FDA cold storage area on the NIH campus
Source: U.S. Food and Drug Administration

As previously reported, on July 1, 2014, biological samples were found in the cold storage area of U.S. Food and Drug Administration laboratories on the National Institutes of Health campus. The FDA has since acquired additional information from the federal investigative agencies regarding inventories of the materials.

The investigation found 12 boxes containing a total of 327 carefully packaged vials labeled with names of various biological agents such as dengue, influenza, Q fever, and rickettsia. Upon the discovery of these vials on July 1, 2014, FDA employees followed standard protocol and turned them all over to the appropriate NIH safety program officials, who in turn transferred them to the appropriate investigative agencies, as per standard protocols.

Reducing Dysfunctional Beliefs about Sleep Does Not Significantly Improve Insomnia in Cognitive Behavioral Therapy

July 17, 2014 Comments off

Reducing Dysfunctional Beliefs about Sleep Does Not Significantly Improve Insomnia in Cognitive Behavioral Therapy
Source: PLoS ONE

The present study examined to examine whether improvement of insomnia is mediated by a reduction in sleep-related dysfunctional beliefs through cognitive behavioral therapy for insomnia. In total, 64 patients with chronic insomnia received cognitive behavioral therapy for insomnia consisting of 6 biweekly individual treatment sessions of 50 minutes in length. Participants were asked to complete the Athens Insomnia Scale and the Dysfunctional Beliefs and Attitudes about Sleep scale both at the baseline and at the end of treatment. The results showed that although cognitive behavioral therapy for insomnia greatly reduced individuals’ scores on both scales, the decrease in dysfunctional beliefs and attitudes about sleep with treatment did not seem to mediate improvement in insomnia. The findings suggest that sleep-related dysfunctional beliefs endorsed by patients with chronic insomnia may be attenuated by cognitive behavioral therapy for insomnia, but changes in such beliefs are not likely to play a crucial role in reducing the severity of insomnia.

Use of Aspirin for Primary and Secondary Cardiovascular Disease Prevention in the United States, 2011–2012

July 16, 2014 Comments off

Use of Aspirin for Primary and Secondary Cardiovascular Disease Prevention in the United States, 2011–2012
Source: Journal of the American Heart Association

Background
Aspirin use has been shown to be an effective tool in cardiovascular disease (CVD) prevention among high‐risk patients. The patient‐reported physician recommendation for aspirin as preventive therapy among high‐ and low‐risk patients is unknown.

Methods and Results
We conducted an analysis of the National Health and Nutrition Examination Survey 2011–2012 to examine the use of aspirin for CVD prevention. Patients without previously diagnosed CVD were classified into high and low risk based on their Framingham Risk Score (10‐year coronary heart disease risk). Among patients without previously diagnosed CVD, 22.5% were classified as high risk. Of the high‐risk individuals, 40.9% reported being told by their physician to take aspirin, with 79.0% complying. Among those who were at low risk, 26.0% were told by their physician to take aspirin, with 76.5% complying. Logistic regression analysis indicated that age, access to a regular source of care, education, and insurance status were significant predictors of patient‐reported physician recommendations for aspirin use for primary prevention. Among high‐risk patients, age, race, and insurance status were significant predictors of reported recommendations for aspirin use. Among low‐risk patients, age, education, obesity, and insurance status were significant predictors of reported recommendations for aspirin use.

Conclusions
Patient reports indicate nonideal rates of being told to take aspirin, for both high‐ and low‐risk patients for primary prevention. Clinical decision support tools that could assist physicians in identifying patients at risk may increase patient reports of physician recommendations for aspirin use.

Psychiatric Aspects of Infectious Diseases

July 16, 2014 Comments off

Psychiatric Aspects of Infectious Diseases
Source: Open Journal of Psychiatry

Psychiatric symptoms can be associated with several systemic and central nervous system infections and they can be the initial presenting symptoms, occurring in the absence of neurological symptoms in some disorders as in some cases of viral encephalitis. They could also be part of the clinical picture in other cases such as psychosis or mood symptoms secondary to brucellosis or toxoplasmosis. Late-onset neuropsychiatric complications may also occur several years following the infection such as in the case of subacute sclerosing panencephalitis due to measles. Some Infectious diseases may have possible etiological role for major psychiatric disorders, based on yet unconfirmed reports for viral infectious diseases (e.g. Influenza virus and HSV-1) which are thought to have risk for developing schizophrenia and psychosis. Neuropsychiatric adverse effects can occur due to drugs (e.g. mefloquine, interferon-alpha) that are used for treatment of infectious diseases. Psychiatric symptoms can also be reactivated resulting from chronic, complicated and serious infections such as HIV that can lead to depression, anxiety or adjustment disorders, although CNS involvement can also be a possible etiological factor. Patients suffering from primary and severe psychiatric disorders are at increased risk of contracting infection; that is mainly related to high risk behaviors in patients with mania or schizophrenia. It is also important to consider that the co-occurrence of psychiatric symptoms and infection can be incidental (i.e. infectious diseases can occur in psychiatric patients regardless of the above mentioned factors). Early identification of the underlying etiology for organic/secondary psychiatric symptoms is essential for appropriate intervention and early treatment of the primary condition that could be the etiology of psychiatric symptoms so as to avoid unnecessary long-term psychiatric treatment and to avoid complications of possible misdiagnosis or delayed diagnosis of the primary condition.

Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis

July 14, 2014 Comments off

Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis
Source: Environmental Health Perspectives

Background:
Particulate matter (PM) in outdoor air pollution was recently designated a Group I carcinogen by the International Agency for Research on Cancer (IARC). This determination was based on the evidence regarding the relationship of PM2.5 and PM10 to lung cancer risk; however, the IARC evaluation did not include a quantitative summary of the evidence.

Objective:
To provide a systematic review and quantitative summary of the evidence regarding the relationship between PM and lung cancer.

Methods:
We conducted meta-analyses of studies examining the relationship of exposure to PM2.5 and PM10 with lung cancer incidence and mortality. In total, 18 studies met inclusion criteria and provided the information necessary to estimate the change in lung cancer risk per 10-μg/m3 increase in exposure to PM. We used random effects analyses to allow between study variability to contribute to meta-estimates.

Results:
The meta-relative risk (95% CI) for lung cancer associated with PM2.5 was 1.09 (95% CI: 1.04, 1.14). The meta-relative risk of lung cancer associated with PM10 was similar, but less precise: 1.08 (95% CI: 1.00, 1.17). Estimates were robust to restriction to studies that considered potential confounders, as well as sub-analyses by exposure assessment method. Analyses by smoking status showed that lung cancer risk associated with PM2.5 was greatest for former smokers, 1.44 (95% CI: 1.04, 1.22) followed by never smokers, 1.18 (95% CI: 1.00, 1.39), and then current smokers, 1.06 (95% CI: 0.97, 1.15). In addition, meta-estimates for adenocarcinoma associated with PM2.5 and PM10 were 1.40 (95% CI: 1.07, 1.83) and 1.29 (95% CI: 1.02, 1.63), respectively.

Conclusion:
The results of these analyses, and the decision of the IARC working group to classify PM and outdoor air pollution as carcinogenic (Group 1), further justify efforts to reduce exposures to air pollutants that can arise from many sources.

Daily Mean Temperature and Clinical Kidney Stone Presentation in Five U.S. Metropolitan Areas: A Time-Series Analysis

July 10, 2014 Comments off

Daily Mean Temperature and Clinical Kidney Stone Presentation in Five U.S. Metropolitan Areas: A Time-Series Analysis
Source: Environmental Health Perspectives

Background:
High ambient temperatures are a risk factor for nephrolithiasis, but the precise relationship between temperature and kidney stone presentation is unknown.

Objectives:
Our objective was to estimate associations between mean daily temperature and kidney stone presentation according to lag time and temperatures.

Methods:
Using a time series design and distributed lag non-linear models, we estimated the relative risk (RR) of kidney stone presentation associated with mean daily temperatures, including cumulative RR for a 20-day period, and RR for individual daily lags through 20 days. Our analysis used MarketScan data for 60,433 patients who presented for evaluation or treatment of kidney stones from 2005–2011 in Atlanta, Chicago, Dallas, Los Angeles, and Philadelphia.

Results:
Associations between mean daily temperature and kidney stone presentation were not monotonic, and there was variation in the exposure-response curve shapes and the strength of associations at different temperatures. However, in most cases RRs increased for temperatures above the reference value of 10°C. The cumulative RR for a daily mean temperature of 30°C versus 10°C was 1.38 in Atlanta (95% CI: 1.07, 1.79), 1.37 in Chicago (95% CI: 1.07, 1.76), 1.36 in Dallas (95% CI: 1.10, 1.69), 1.11 in Los Angeles (95% CI: 0.73, 1.68), and 1.47 in Philadelphia (95% CI: 1.00, 2.17). Kidney stone presentations also were positively associated with temperatures < 2°C in Atlanta, and < 10°C in Chicago and Philadelphia. In 4 cities, the strongest association between kidney stone presentation and a daily mean temperature of 30 versus 10°C was estimated for lags ≤ 3 days.

Conclusions:
In general, kidney stone presentations increased with higher daily mean temperatures, with the strongest associations estimated for lags of only a few days. These findings further support an adverse effect of high temperatures on nephrolithiasis.

HHS — Elder Justice Roadmap Project Report

July 10, 2014 Comments off

Elder Justice Roadmap Project Report (PDF)
Source: U.S. Department of Health and Human Services (National Center on Elder Abuse)

The Top Five Priorities critical to understanding and reducing elder abuse and to promoting health, independence, and justice for older adults, are:
1. Awareness: Increase public awareness of elder abuse, a multi-faceted problem that requires a holistic, well-coordinated response in services, education, policy, and research.
2. Brain health: Conduct research and enhance focus on cognitive (in)capacity and mental health – critical factors both for victims and perpetrators.
3. Caregiving: Provide better support and training for the tens of millions of paid and unpaid caregivers who play a critical role in preventing elder abuse.
4. Economics: Quantify the costs of elder abuse, which is often entwined with financial incentives and comes with huge fiscal costs to victims, families and society.
5. Resources: Strategically invest more resources in services, education, research, and expanding knowledge to reduce elder abuse.

Hat tip: PW

Prevalence of Incontinence Among Older Americans

July 9, 2014 Comments off

Prevalence of Incontinence Among Older Americans (PDF)
Source: National Center for Health Statistics

Objective
This report presents national estimates of incontinence prevalence in the United States using data source-specific definitions of incontinence among persons aged 65 and over by sociodemographic characteristics during 2007–2010.

Methods
Data are from the 2007–2010 National Health and Nutrition Examination Survey (NHANES), the 2010 National Survey of Residential Care Facilities (NSRCF), the 2007 National Home and Hospice Care Survey (NHHCS), and the 2009 Long Term Care Minimum Data Set (MDS). Findings are based on in-home interviews with 2,625 noninstitutionalized respondents (NHANES) and reports provided by designated facility or agency staff members for 6,856 residential care facility (RCF) residents (NSRCF), 3,226 current home health care patients (NHHCS), 3,918 hospice discharges (NHHCS), and 2,416,705 nursing home residents (MDS). Response rates for incontinence questions were 84% among noninstitutionalized persons (NHANES), 98% among RCF residents and home health and hospice care patients (NSRCF and NHHCS), and 99% for nursing home residents (MDS).

Results
This is the first report presenting national estimates on incontinence for subpopulations of older persons sampled in the Centers for Disease Control and Prevention’s National Center for Health Statistics surveys and the Centers for Medicare & Medicaid Services’ Long Term Care Minimum Data Set. Because a different definition of incontinence is used by each data collection system, it is not possible to make data comparisons between them or to summarize results across all surveys. Accordingly, only survey-specific results are presented. Including recent data from all of these data collection systems facilitates a multidimensional picture of incontinence, while underscoring the need for a standardized definition.

Circumlocution in Diagnostic Medical Queries

July 9, 2014 Comments off

Circumlocution in Diagnostic Medical Queries
Source: Microsoft Research

Circumlocution is when many words are used to describe what could be said with fewer, e.g., “a machine that takes moisture out of the air” instead of “dehumidifier”. Web search is a perfect backdrop for circumlocution where people struggle to name what they seek. In some domains, not knowing the correct term can have a significant impact on the search results that are retrieved. We study the medical domain, where professional medical terms are not commonly known and where the consequence of not knowing the correct term can impact the accuracy of surfaced information, as well as escalation of anxiety, and ultimately the medical care sought. Given a free-form colloquial health search query, our objective is to find the underlying professional medical term. The problem is complicated by the fact that people issue quite varied queries to describe what they have. Machine-learning algorithms can be brought to bear on the problem, but there are two key complexities: creating high-quality training data and identifying predictive features. To our knowledge, no prior work has been able to crack this important problem due to the lack of training data. We give novel solutions and demonstrate their efficacy via extensive experiments, greatly improving over the prior art.

Modulation of Age- and Cancer-Associated DNA Methylation Change in the Healthy Colon by Aspirin and Lifestyle

July 9, 2014 Comments off

Modulation of Age- and Cancer-Associated DNA Methylation Change in the Healthy Colon by Aspirin and Lifestyle
Source: Journal of the National Cancer Institute

Background
Aberrant DNA methylation in gene promoters is associated with aging and cancer, but the circumstances determining methylation change are unknown. We investigated the impact of lifestyle modulators of colorectal cancer (CRC) risk on the stability of gene promoter methylation in the colonic mucosa.

Methods
We measured genome-wide promoter CpG methylation in normal colon biopsies (n = 1092) from a female screening cohort, investigated the interaction of lifestyle factors with age-dependent increase in methylation with log-linear multivariable regression, and related their modifying effect to hypermethylation in CRC. All statistical tests were two-sided.

Results
Of 20025 promoter-associated CpGs analyzed, 1713 showed statistically significant age-dependent methylation gains. Fewer CpGs acquired methylation in users of aspirin (≥2 years) and hormonal replacement therapy (HRT age ≥50 years) compared with nonusers (43 vs 1355; 1 vs1377, respectively), whereas more CpGs were affected in smokers (≥20 years) and individuals with a body mass index (BMI) of 25kg/m2 and greater compared with control groups (180 vs 39; 554 vs 144, respectively). Fifty percent of the CpGs showing age-dependent methylation were found hypermethylated in CRC (odds ratio [OR] = 20; 95% confidence interval [CI] = 18 to 23; P < 2×10–16). These loci gained methylation with a higher median rate compared with age-only methylated sites (P = 2×10–76) and were enriched for polycomb regions (OR = 3.67). Importantly, aspirin (P < .001) and HRT use (P < .001) reduced the methylation rate at these cancer-related genes, whereas smoking (P < .001) and high BMI (P = .004) increased it.

Conclusions
Lifestyle, including aspirin use, modulates age-associated DNA methylation change in the colonic epithelium and thereby impacts the evolution of cancer methylomes.

See: Cancer risk: Aspirin and smoking affect aging of genes (Science Daily)

Mind and Body Practices for Fibromyalgia

July 8, 2014 Comments off

Mind and Body Practices for Fibromyalgia
Source: National Center for Complementary and Alternative Medicine

Fibromyalgia syndrome is a common and chronic disorder characterized by widespread pain, diffuse tenderness, fatigue, and a number of other symptoms that can interfere with a person’s ability to carry out daily activities. It is estimated that fibromyalgia affects 5 million American adults. Most people with fibromyalgia—between 80 and 90 percent—are women. However, men and children also can have the disorder, which is often associated with other syndromes. The causes of fibromyalgia are unknown, but there are probably a number of factors involved. Recently, researchers have focused on abnormalities in processing of pain by the central nervous system.

Fibromyalgia can be difficult to diagnose and treat. Current diagnostic criteria are available from the American College of Rheumatology. Treatment often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) and nonpharmacologic interventions such as exercise, muscle strength training, cognitive behavioral therapy, movement/body awareness practices, massage, acupuncture, and balneotherapy.

Drowsy Driving and Risk Behaviors — 10 States and Puerto Rico, 2011–2012

July 8, 2014 Comments off

Drowsy Driving and Risk Behaviors — 10 States and Puerto Rico, 2011–2012
Source: Morbidity and Mortality Weekly Report (CDC)

Findings in published reports have suggested that drowsy driving is a factor each year in as many as 7,500 fatal motor vehicle crashes (approximately 25%) in the United States (1,2). CDC previously reported that, in 2009–2010, 4.2% of adult respondents in 19 states and the District of Columbia reported having fallen asleep while driving at least once during the previous 30 days (3). Adults who reported usually sleeping ≤6 hours per day, snoring, or unintentionally falling asleep during the day were more likely to report falling asleep while driving compared with adults who did not report these sleep patterns (3). However, limited information has been published on the association between drowsy driving and other risk behaviors that might contribute to crash injuries or fatalities. Therefore, CDC analyzed responses to survey questions regarding drowsy driving among 92,102 respondents in 10 states and Puerto Rico to the 2011–2012 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The results showed that 4.0% reported falling asleep while driving during the previous 30 days. In addition to known risk factors, drowsy driving was more prevalent among binge drinkers than non-binge drinkers or abstainers and also more prevalent among drivers who sometimes, seldom, or never wear seatbelts while driving or riding in a car, compared with those who always or almost always wear seatbelts. Drowsy driving did not vary significantly by self-reported smoking status. Interventions designed to reduce binge drinking and alcohol-impaired driving, to increase enforcement of seatbelt use, and to encourage adequate sleep and seeking treatment for sleep disorders might contribute to reductions in drowsy driving crashes and related injuries.

National Athletic Trainers’ Association (Nata) Advance Releases Executive Summary of Exertional Heat Illnesses Position Statement and Issues New Research on Heat and Hydration

July 7, 2014 Comments off

National Athletic Trainers’ Association (Nata) Advance Releases Executive Summary of Exertional Heat Illnesses Position Statement and Issues New Research on Heat and Hydration
Source: National Athletic Trainers’ Association

At NATA’s 65th Clinical Symposia & AT Expo in Indianapolis today, leading health care professionals advance released an executive summary of the association’s exertional heat illnesses position statement. This is an update to the original 2002 guidelines and will be published in its entirety in an upcoming issue of the Journal of Athletic Training, NATA’s scientific publication. A copy of the executive summary is available at http://www.nata.org/press-room.

In addition to the guidelines, the NATA Research & Education Foundation unveiled hot topics in heat illness as presented by study authors and as part of the convention’s Free Communications program.

“Exertional heat illnesses are largely preventable within the confines of organized sports when appropriate protocols are put into place,” said Douglas J. Casa, PhD, ATC, FACSM, FNATA, chief operating officer of the Korey Stringer Institute, director of Athletic Training Education, Department of Kinesiology at the University of Connecticut and chair of the position statement writing group.

“This includes heat acclimatization, body cooling, hydration, modifying of exercise based on environmental conditions, among other considerations. These guidelines are not just for athletes – they are also valuable for individuals exposed to warm weather environments such as those in the military or individuals whose work necessitates heat exposure.”

Exertional heat stroke is one of the three leading causes of death in sport (and the leading cause in the summer). The period of 2005 to 2009 had more heat stroke deaths than any other five year period in the 35 years prior. There were 18 deaths from 2005 to 2009; from 2010 to 2014 (still being tracked) there are now an estimated 20 to 22 deaths.

Overview of Emergency Department Visits in the United States, 2011

July 4, 2014 Comments off

Overview of Emergency Department Visits in the United States, 2011
Source: Agency for Healthcare Research and Quality

Emergency departments (EDs) provide a significant source of medical care in the United States, with over 131 million total ED visits occurring in 2011. Over the past decade, the increase in ED utilization has outpaced growth of the general population, despite a national decline in the total number of ED facilities. In 2009, approximately half of all hospital inpatient admissions originated in the ED. In particular, EDs were the primary portal of entry for hospital admission for uninsured and publicly insured patients (privately insured patients were more likely to be directly admitted to the hospital from a doctor’s office or clinic).

ED utilization reflects the greater health needs of the surrounding community and may provide the only readily available care for individuals who cannot obtain care elsewhere. Many ED visits are “resource sensitive” and potentially preventable, meaning that access to high-quality, community-based health care can prevent the need for a portion of ED visits.

This HCUP Statistical Brief presents data on ED visits in the United States in 2011. Patient and hospital characteristics for two types of ED visits are provided: ED visits with admission to the same hospital and ED visits resulting in discharge, which includes patients who were stabilized in the ED and then discharged home, transferred to another hospital, or any other disposition. The most frequent conditions treated by patient age group also are presented for both types of ED visits. All differences between estimates noted in the text are statistically significant at the .0005 level or better.

A Population-Based Investigation into the Self-Reported Reasons for Sleep Problems

July 3, 2014 Comments off

A Population-Based Investigation into the Self-Reported Reasons for Sleep Problems
Source: PLoS ONE

Typologies of sleep problems have usually relied on identifying underlying causes or symptom clusters. In this study the value of using the patient’s own reasons for sleep disturbance are explored. Using secondary data analysis of a nationally representative psychiatric survey the patterning of the various reasons respondents provided for self-reported sleep problems were examined. Over two thirds (69.3%) of respondents could identify a specific reason for their sleep problem with worry (37.9%) and illness (20.1%) representing the most commonly reported reasons. And while women reported more sleep problems for almost every reason compared with men, the patterning of reasons by age showed marked variability. Sleep problem symptoms such as difficulty getting to sleep or waking early also showed variability by different reasons as did the association with major correlates such as worry, depression, anxiety and poor health. While prevalence surveys of ‘insomnia’ or ‘poor sleep’ often assume the identification of an underlying homogeneous construct there may be grounds for recognising the existence of different sleep problem types particularly in the context of the patient’s perceived reason for the problem.

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