Clinical Characteristics Of People Research Articles

Spatial dynamics and epidemiology for AIDS in remote areas in French Guiana

ABSTRACTAlthough AIDS care is generally improving in French Guiana, disparities among regions and certain key populations remain significant. The purpose of this study was to describe the spatial and clinical characteristics of people living with HIV (PLHIV) in remote areas in comparison to those followed in hospitals on the urban coast of French Guiana. The data presented were obtained from outpatient on primary care centers located in rural regions away from the urban coast. Data were compared with that from medical records of PLHIV treated in French Guiana's urban care. The evolution of the annual rate of discovery of HIV seropositivity indicates a lag in remote areas as compared to urban and coastal areas. In recent years, the epidemic appeared as particularly active in rural areas among Brazilian patients. The median age of PLHIV in remote areas was 43.8 years, the sex ratio (M/F) was 0.93. Nearly 37% of PLHIV were discovered with advanced disease (<200 CD4/mm3). The percentage of virological success after six months of HAART was 80% and 88% in remote areas and urban area, respectively. Efforts must be made to control and halt the spread of the HIV epidemic, as these remote sites represent strategic points.

The seizure precipitating effect of alcohol: A prospective observational cross-over study

PurposeThe aim of this study was to investigate the association between alcohol use and seizures in acutely hospitalized patients. We wished to study the extent of the problem as well as the clinical characteristics of people with various forms of alcohol-related seizures, including their drinking pattern. MethodAfter admission, a semi-structured interview took place with 134 consecutive patients (epilepsy 92, single seizures 42). Alcohol use was assessed by the Alcohol Use Disorders Identification Test (AUDIT) and by the number of alcohol units consumed during 6 days prior to the seizure. Sleep time was recorded during the previous 3 days and nights. A follow-up telephone interview covering the same weekdays was performed on a seizure-free day at least 4 weeks later. Results28% of patients had AUDIT scores ≥8 (hazardous drinking); 22% in epilepsy, 43% in single seizures (p = .012). Non-focal seizures were increased in single seizures, suggesting a withdrawal mechanism. In the 58 epilepsy patients with social drinking (excluded hazardous drinking or excessive binging), the alcohol intake was not different prior to seizure compared to follow-up, downgrading the role of modest alcohol intake as a seizure precipitant in epilepsy. On the other hand, a high percentage of binge drinkers had epilepsy (57%), and in the subgroup of Idiopathic Generalized Epilepsy (IGE) even social drinking was associated with seizures. Seizures peaked on Sundays and Mondays. Less sleep prior to the seizure was associated with hazardous drinking. ConclusionAlcohol is a major seizure precipitant in the context of hazardous drinking and withdrawal. In people with epilepsy, occasional binge drinking is associated with loss of seizure control. Social drinking is an uncommon cause of seizure breakthrough in predominantly focal epilepsy, but caution is warranted in IGE. Alcohol intake prior to a seizure is often accompanied by other triggers, such as sleep loss. Alcohol alone should not always be blamed.

Clinical Characteristics of People with Newly Diagnosed Type 2 Diabetes between 2015 and 2016: Difference by Age and Body Mass Index

BackgroundWe evaluated the clinical characteristics of insulin resistance and β-cell dysfunction in newly diagnosed, drug-naive people with type 2 diabetes by analyzing nationwide cross-sectional data.MethodsWe collected the clinical data of 912 participants with newly diagnosed diabetes from 83 primary care clinics and hospitals nationwide from 2015 to 2016. The presence of insulin resistance and β-cell dysfunction was defined as a homeostatic model assessment of insulin resistance (HOMA-IR) value ≥2.5 and fasting C-peptide levels <1.70 ng/mL, respectively.ResultsA total of 75.1% and 22.6% of participants had insulin resistance and β-cell dysfunction, respectively. The proportion of participants with insulin resistance but no β-cell dysfunction increased, and the proportion of participants with β-cell dysfunction but no insulin resistance decreased as body mass index (BMI) increased. People diagnosed with diabetes before 40 years of age had significantly higher HOMA-IR and BMI than those diagnosed over 65 years of age (HOMA-IR, 5.0 vs. 3.0; BMI, 28.7 kg/m2 vs. 25.1 kg/m2). However, the β-cell function indices were lower in people diagnosed before 40 years of age than in those diagnosed after 65 years of age (homeostatic model assessment of β-cell function, 39.3 vs. 64.9; insulinogenic index, 10.3 vs. 18.7; disposition index, 0.15 vs. 0.25).ConclusionWe observed that the main pathogenic mechanism of type 2 diabetes is insulin resistance in participants with newly diagnosed type 2 diabetes. In addition, young adults with diabetes are more likely to have higher insulin resistance with obesity and have higher insulin secretory defect with severe hyperglycemia in the early period of diabetes than older populations.

Epidemiological and clinical characteristics of people with venous ulcers attended at municipal health units

Objectives: To describe the sociodemographic and health data of individuals with venous ulcers treated at health services in Ribeirao Preto (Sao Paulo, Brazil) and to identify aspects of lower limbs and lesions and therapies used in treatment. Method: Quantitative descriptive study developed through the review of medical records, interview with users and evaluation of lower limbs. The data collection was done in the period of four months after the approval of the Institutional Committee of Ethics in Research. Results: 53 individuals with active or healed venous ulcer participated in the study. There was a predominance of individuals older than 60 years(73.5%), women (64.2%) and chronic diseases (73.6%), especially systemic arterial hypertension. Thirty-seven (69.8%) individuals had 72 active ulcers and 16 (30.2%) had 23 healed ulcers. Ulcers were in the lower third of the leg (97.2%), in an area < 49 cm2 (80.6%), with predominance of devitalized tissue (61.1%). Several treatment options were used to protect the wound bed, debridement or absorption of the exudate. Conclusion: The study enabled possible to identify the profile of users with venous ulcer and the assistance provided to them.

The accuracy of a non-invasive glucose monitoring device does not depend on clinical characteristics of people with type 2 diabetes mellitus

Objective: GlucoTrack is a non-invasive device that indirectly measures glucose fluctuation in the earlobe tissue. Thus, its accuracy may be subjected to a time lag between glucose concentration in blood and tissue. This time lag was shown to depend on individual characteristics related to microvascular complications, such as diabetes duration, HbA1c level, and smoking history. Therefore, the current study investigated the effects of these factors on GlucoTrack performance.Research design and methods: Clinical trials were conducted on 114 people with type 2 diabetes. Device performance was clinically evaluated using Clarke error grid (CEG) analysis and numerically evaluated using the distribution of absolute relative difference (ARD) values.Results: CEG analysis revealed that 98.0% of glucose readings were within the clinically acceptable CEG A + B zones. Total mean ARD was 22.7%. Clinical and numerical accuracies were comparable between never smokers and former/current smokers, but slightly reduced in the HbA1c ≥ 7.5% group and in the diabetes duration ≥15 years group. Yet, likelihood ratio and parametric bootstrap tests statistically demonstrated that ARD values did not depend on diabetes duration, HbA1c level, or smoking history.Conclusions: GlucoTrack performance does not depend on diabetes duration, HbA1c level, and smoking history, indicating the device is suitable for various people with type 2 diabetes.

Caregivers' resilience is independent from the clinical symptoms of dementia.

Resilience is the capacity for successful adaptation when faced with the stress of adversity. We aimed to investigate the relationship between caregivers' resilience and the sociodemographic and clinical factors of people with dementia. Cross-sectional assessment of 58 people with dementia and their caregiver dyads showed that most caregivers were female adult children. The caregivers reported moderate to higher levels of resilience, lower levels of anxiety and depressive symptoms and moderate levels of burden. Resilience was not related to the caregiver's gender (p = 0.883), nor clinical (p = 0.807) or emotional problems (p = 0.420). The regression showed that resilience was related to the caregiver's quality of life (p < 0.01) and inversely associated with their depressive symptoms (p < 0.01). There was no relationship between caregivers' resilience and the sociodemographic and clinical characteristics of people with dementia. We can assume that resilience is an individual characteristic. Support groups should also focus on the factors that may increase resilience among caregivers.

What Makes Institutional Long-Term Care the Most Appropriate Setting for People With Dementia? Exploring the Influence of Client Characteristics, Decision-Maker Attributes, and Country in 8 European Nations

ObjectivesTo explore the extent to which client characteristics, decision-maker attributes, and country influence judgments of institutional long-term care (ILTC) appropriateness for people with dementia. Design, setting, and participantsA total of 161 experts in dementia care from 8 European countries reviewed a series of 14 vignettes representing people with dementia on the cusp of ILTC admission and indicated the most appropriate setting in which to support each case in a simple discrete choice exercise: own home, very sheltered housing, residential home, or nursing home. At least 16 experts participated in each country (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the United Kingdom). MeasurementsDescriptive statistics were used to characterize the experts and their placement preferences. Logistic regression modeling was used to explore the extent to which the sociodemographic and clinical characteristics of people with dementia, and the profession, workplace, and country of decision-makers were associated with ILTC recommendation. ResultsClient characteristics, decision-maker attributes, and country all seemed to play a part in influencing professionals' perceptions of the appropriateness of ILTC for people with dementia. Expert decision-makers were more likely to recommend ILTC for individuals who required help with mobility or had multiple care needs, and appeared to give more weight to carers' than clients’ wishes. Community-based social workers were less likely than other professional groups to favor ILTC placement. Experts in Finland, Germany, and the United Kingdom were less likely to recommend ILTC than experts in France, the Netherlands, and Estonia; experts in Sweden and Spain took an intermediate position. ConclusionThis study provides new understanding of the factors that shape professionals' perceptions of ILTC appropriateness and highlights the need to construct multifaceted models of institutionalization when planning services for people with dementia. It also has several important clinical implications (including flagging interventions that could decrease the need for ILTC), and provides a basis for enhancing professionals’ decision-making capabilities (including the greater involvement of clients themselves).

Clinical characteristics of people with early-onset Alzheimer's disease: A Clinical Research Center for Dementia of South Korea study

Clinical characteristics of people with early-onset Alzheimer's disease: A Clinical Research Center for Dementia of South Korea study

The characteristics of inhabitants suffering from migraine in the general urban population

Objective. The objective of this paper is to present sociodemographic and clinical characteristics of people with migraine in the population of Belgrade citizens. Methods. Study data were collected during the epidemiological survey performed on about 2000 respondents aged between 16-82 years, of both genders, in accordance with the standard predefined questionnaire. The field study has been performed, with personalized interview, during May 2006, in Belgrade. Results. Migraine frequency in the population of analyzed subjects (772 males, 1228 females) was 11% (for females 12.8%, for males 8%). The distribution of people with migraine in age groups was the following: 59 7%. The symptoms of aura were present in 3.2% of subjects. The most common migraine attack triggers were: stress (in 14.5% patients), weather changes (10%), tiredness (6.3%) and menstrual period (5.9%). The most common symptoms of migraine attack were: photophobia (in 14.9% sufferers) and nausea (11.8%). The majority of migraineurs had formal education: 54.3% college/university, 43.4% high school, and 2.3% elementary school degree. The people with low monthly income had less frequent migraine (4.5%), compared to those who earn more (44.3%). Stress was the most important provoking factor, in comparison with either income level or education degree. Conclusion. In accordance with the produced results, significant differences of values of the evaluated parameters were not found in comparison to similar studies performed in Europe and USA. Better educated and richer population more frequently suffers of migraine.

Pessoas com úlceras vasculogênicas em atendimento ambulatorial de enfermagem: estudo das variáveis clínicas e sociodemográficas

Objetivou-se analisar características sociodemográficas e clínicas de pessoas com úlceras vasculogênicas e investigar a associação entre estas variáveis. Realizou-se um estudo clínico observacional transversal, em salas de curativo de serviços municipais de saúde, de fevereiro a agosto de 2009. Realizou-se entrevista, exame clínico, aplicação da escala Pressure Ulcer Scale Healing (PUSH) e registro fotográfico das lesões. Participaram 42 indivíduos, com média de 60 anos (± 12), 73,8% do sexo masculino, com lesões únicas (66,7%), decorrentes de alteração da circulação venosa (90,5%), duração de até um ano (55,5%). Houve associação entre o escore da PUSH (p=0,019) e profundidade da lesão (p=0,027) com exercício de atividade ocupacional na atualidade, assim como entre o histórico de tabagismo e o gênero (p=0,049). As características sociodemográficas evidenciadas são semelhantes às de outros, com exceção do gênero masculino, o que indica a necessidade de maiores investigações na população goianiense.

Suicide on the Isle of Wight: A Case-study of 35 Suicides among Mental Health Service Users Between 2006 and 2008.

To identify the sociodemographic, clinical and service delivery risk factors for suicide in psychiatric patients in a limited geographic area. A retrospective case study of 35 patients who died as a result of suicide between January 2006 and December 2008. Male gender, unemployment, living alone, basic education and significant life events were identified as sociodemographic factors. A history of previous psychiatric admission, previous suicide attempt, suffering from depression, co-morbidity of another psychiatric disorder (mainly stress-related symptoms and alcoholism), and contacting the services prior to suicide were found as typical clinical factors. Hanging was the most common method of suicide in both men and women. Most men died in spring and summer, while the majority of females died in autumn. As in similar studies, mental disorders could be identified as the strongest risk factor for suicide. Almost 70% of suicides were conducted by people suffering from a mental disorder. Treating mental disorders and identifying certain sociodemographic and clinical characteristics of people suffering from mental disorders and addressing them is the key in suicide prevention strategies.

The foot‐related clinical characteristics of people with diabetes in an Australian regional setting

Methods A three-month prospective clinical audit of the podiatry services involved in the podiatric model of care was undertaken. Basic demographic variables were recorded in addition to the UT risk classification at baseline and incidence of ulceration. Statistical analysis was undertaken to explore the differences in the demographic variables with respect to both risk category at baseline and incidence of ulceration.

Demographic and Clinical Characteristics of People With Intellectual Disabilities With and Without Substance Abuse Disorders in a Medicaid Population

Little is known about the demographic and clinical characteristics of people with intellectual disabilities and substance abuse problems. Drawing on health care billing claims for people with Medicaid coverage aged 12-99 years, the characteristics of people with intellectual disability and a history of substance abuse (N=9,484) were explored and compared with people with intellectual disability but without substance abuse. Age- and/or gender-adjusted odds ratios were derived from logistic regression analyses to consider differences in demographic and clinical diagnoses. People with intellectual disability and substance abuse constituted 2.6% of all people with intellectual disability, most of whom had a diagnosis of mild or moderate intellectual disability. People with intellectual disability and substance abuse problems were, on average, 2 years older than the comparison group and less likely to be White. The sample was more likely than the comparison group to have serious mental illness or depression and substance abuse-related disorders were not prevalent. These data provide a comparison point for existing studies of mental health diagnoses as well as new information about substance abuse disorders. Implications relate to the identification of substance abuse among people with intellectual disabilities as well as the establishment of demographic and clinical correlates.

Clinical characteristics of people with head nodding in southern Tanzania

We have previously described a seizure disorder characterized by head nodding (HN). In a prospective study in southern Tanzania, we evaluated 62 patients with HN. Here, we report the patients' clinical characteristics and those of their seizures, which indicate high seizure frequency, unsatisfactory seizure control, a high burden of cognitive impairment and disease-associated barriers to education.

Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey

BackgroundSuicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received.MethodsWe carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death.ResultsThere were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward.ConclusionMeasures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.

P01-380 - Sociodemographical characteristics in gerontopsychiatric inpatients

ObjectivesEpidemiological issues have an special interest among gerontopsychiaty, because of the high prevalence of mental disorders and the increasing average age of the population. According to the National Statistic Institute in Spain, in 2002 almost 7 million of the people were over 65 years old and in 2020 there is expected to be 8 million of elder people. This question associated with the decrease of birthrate, will bring about a rise in the absolut number of elder people with a mental disorder.Our main objective in this work is to study the sociodemographil profile of inpatients over 60years old in a short stay unit.MethodsThis is a prospective, descriptive study. We have collected sociodemographical and clinical characteristics of people over 60 years old that entered short stay units of two hospitals in Vizcaya, Spain, during one year. Patients with dementia were excluded.Results60 patients entered the units. The average age was 71,2 (7,26). Education; illiterate 6,6%; just read and write 46,6%; primary/elementary education 38,3%; secondary education 3,33% and higher education 5%. Marital status: single 10%; married 51,6%; divorced 8,3%; widow/er 30%. Family life: 31,6% alone; 28,33% with a paretner; 21,66% with a partner and some else; 13,33%, with their children with a partner; 3,33% old people's home.Social relationship: 5% without any relation; 25% family and neighbours; 31,6% family, neigbours and frienda; 3,33% people in the old people's home.ConclusionsIt is assumed to be important to know the characteristics of this people to guarantee an optimum assistance.

Does palliative home oxygen improve dyspnoea? A consecutive cohort study

Palliative oxygen for refractory dyspnoea is frequently prescribed, even when the criteria for long-term home oxygen (based on survival, rather than the symptomatic relief of breathlessness) are not met. Little is known about how palliative home oxygen affects symptomatic breathlessness. A 4 -year consecutive cohort from a regional community palliative care service in Western Australia was used to compare baseline breathlessness before oxygen therapy with dyspnoea sub-scales on the symptom assessment scores (SAS; 0–10) 1 and 2 weeks after the introduction of oxygen. Demographic and clinical characteristics of people who responded were included in a multi-variable logistic regression model. Of the study population (n = 5862), 21.1% (n = 1239) were prescribed oxygen of whom 413 had before and after data that could be included in this analysis. The mean breathlessness before home oxygen was 5.3 (SD 2.5; median 5; range 0–10). There were no significant differences overall at 1 or 2 weeks (P = 0.28) nor for any diagnostic sub-groups. One hundred and fifty people (of 413) had more than a 20% improvement in mean dyspnoea scores. In multi-factor analysis, neither the underlying diagnosis causing breathlessness nor the demographic factors predicted responders at 1 week. Oxygen prescribed on the basis of breathlessness alone across a large population predominantly with cancer does not improve breathlessness for the majority of people. Prospective randomised trials in people with cancer and non-cancer are needed to determine whether oxygen can reduce the progression of breathlessness compared to a control arm.

Caracterização da clientela das clínicas-escola de cursos de Psicologia da região metropolitana de Porto Alegre

São diversos os estudos sobre a caracterização da clientela de clínicas-escola de Psicologia no Brasil. Todavia, há escassez de pesquisas desta natureza no Rio Grande do Sul. Este trabalho se propõe a realizar uma pesquisa de levantamento das características sociodemográficas e clínicas da população que buscou atendimento em 2004 nas dez clínicas-escola da Região Metropolitana de Porto Alegre. É possível reconhecer a similaridade dos achados com a grande maioria dos estudos, permitindo-se a inferência de um perfil típico do paciente que busca atendimento em clínicas-escola no Brasil: crianças, do sexo masculino, encaminhadas por escolas devido a dificuldades de aprendizagem ou comportamento e mulheres jovens, que buscam atendimento espontaneamente devido a conflitos relativos ao comportamento afetivo. Também se destaca a dificuldade em pesquisar sobre o tema em função da ausência de registros padronizados, adequados e bem preenchidos pelas clínicas-escola.

Clinical characteristics of people with mental health problems who frequently attend an Australian emergency department

The objective of this study is to determine the clinical characteristics of people with mental health problems who frequently attend an Australian emergency department (ED). A retrospective clinical audit of presenter characteristics was conducted in a 550-bed tertiary referral metropolitan hospital with data reflecting 12 months of consecutive ED presentations between September 2002 and August 2003. A sample of 868 individuals accounted for 1076 presentations. Patients attending more than once accounted for 12.5% of the total sample. Significant variables associated with frequent attendance included: younger age; English speaking background; and mood and anxiety disorders. Lone arrival of a patient to the ED showed marginal significance. The significant associates of frequent attendance found in this study may be used to identify patients earlier to a multidisciplinary case review process and individual management planning involving clinicians, carers and patients.

Suicide in Schizophrenia: Findings from a National Clinical Survey

A reduction in suicide among individuals with mental illness is an international public-health priority. Approximately 10% of patients with schizophrenia will die by suicide. The goal of this study was to describe social and clinical characteristics of people with schizophrenia who completed suicide, including aspects of the clinical care they received. A national clinical survey was conducted based on a 4-year (1996-2000) sample of people in England and Wales who had died by suicide and had been in contact with mental health services in the previous 12 months. Of 20,927 individuals who committed suicide, 5,099 (24%) were known to have been in contact with mental health services in the year prior to death. Completed questionnaires were returned on 4,859 cases of suicide. Of these, 960 (20%) were diagnosed with schizophrenia. These suicides were characterized by more violent modes of death, with over a quarter (27%) jumping from a height or in front of a moving vehicle compared to 10% of the remaining sample. They were more likely than the other individuals in the sample to be young, male, unmarried, and from an ethnic minority with high rates of unemployment. Rates of previous violence and drug abuse were high and they were proportionally more likely to be inpatients at the time of death and to have been noncompliant with medication. Patients with schizophrenia and comorbid substance abuse showed particularly complex social and clinical morbidity. Measures that may prevent suicide among patients with schizophrenia include improved ward safety, closer supervision in both inpatient and community settings, particularly for those with poor medication compliance, and effective treatment of substance abuse.