Current Medical Conditions Research Articles

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Psychosocial disorders and lifestyle trends have become more important in dermatology. Lifestyle diseases are a biopsychosocial phenomenon that can only be diagnosed and treated by paying attention to the quickly changing sociocultural aspects. The naming and popularization of the particular lifestyle diseases takes place by the media, but there is only an imprecise medical classification of these phenomena. This article gives an overview of the current situation and medical conditions of lifestyle diseases and try to assign them to an established psychosomatic diagnosis, based on the clinical symptomatic. Most often somatoform disorders, somatization disorders with a repeated presentation of physical symptoms which cannot be medically objectified or depressive disturbances are found.

Levels of Trauma Among Women Inmates with HIV Risk and Alcohol Use Disorders: Behavioral and Emotional Impacts

SUMMARY An increasing number of women are involved in the criminal justice system. Women in corrections are often of low socio-economic status, medically underserved and exposed to a variety of traumatic events. Programs and services provided in correctional settings should be informed by the unique profiles and needs of these women. This study sought to identify distinct sub-groups (classes) of incarcerated women based on differences in their qualitative (types of trauma) and quantitative (number of) trauma experiences. Demographics, psychosocial and behavioral characteristics were measured in 149 women entering jail, who reported recent hazardous drinking and HIV sexual risk behavior. Two classes based on trauma exposure of women were identified through latent class analysis. The classes did not differ with respect to qualitative differences in trauma exposure (both classes reported all forms of trauma), but did differ with respect to quantitative differences (Class 2 reported more exposure to trauma in all categories than Class 1). The classes also differed significantly on current psychological functioning, alcohol treatment, problems, and consequences, drug histories, sexual risk, medical conditions, and social group characteristics. In all areas, members of Class 2 were significantly more likely to report higher levels of measured variables. Nearly all women in our sample reported levels of trauma exposure, suggesting a need for intervention and attention. Through identifying these separate classes, limited resources for trauma survivors in the correctional setting could be most appropriately allocated.

Economic and ethical impact of extrarenal findings on potential living kidney donor assessment with computed tomography angiography

To determine the prevalence and spectrum of extrarenal findings in a screening population of potential living kidney donors undergoing renal Computed tomography angiography (CTA) and evaluate their impact on subsequent patient management and imaging costs. Two radiologists retrospectively reviewed 175 consecutive renal CTA's performed for assessment of potential living kidney donors. Extrarenal radiological findings were recorded and classified according to high, medium, or low importance based on clinical relevance and the need for further investigations and/or treatment. The cost of additional imaging examinations was calculated using 2002 Canadian (British Columbia) reimbursements. There were 73 extrarenal findings in 71/175 (40.6%) of the potential kidney donors in the study population. Findings were categorized as of high clinical importance in 18 (10.3%) cases, including lung lesions, bowel tumors, and liver tumors and as medium importance in 31 (17.7%). Twenty-two (12.6%) individuals had findings categorized as low importance, probably of no clinical significance and requiring no follow-up. Further potential evaluation of the 49 patients (28%) with highly and moderately significant extrarenal findings may require an additional $6137 (mean $35.1 per each case of all the screened patients). Transplantation of a kidney from a living donor is an excellent alternative to cadaveric allografts. Potential living kidney donors are a highly selected population of healthy individuals, screened for significant past or current medical conditions before undergoing CTA. Despite this screening, potentially significant extrarenal findings (classified as high or medium importance) were revealed in 28% of patients. These patients may require further investigations and/or treatment. The referring physician and patient should be aware of such potentially high probability, which may require further nontransplant related evaluation and treatment. This has medical, legal, economic, and ethical implications.

Quality of life and comorbid medical and psychiatric conditions in temporal lobe epilepsy

Patients with epilepsy frequently report dissatisfaction with their quality of life (QOL), and there is considerable interest in understanding the factors and mechanisms associated with this perception. To date, investigation has focused on the potential contribution of seizure variables (e.g., seizure control) and psychiatric conditions to QOL, but there has not been an examination of the potential role of comorbid medical conditions. Information was gathered concerning current medical and psychiatric conditions for 93 patients with temporal lobe epilepsy, and their relationship with QOL was examined. The numbers of medical and psychiatric conditions were distinct and significant predictors of QOL satisfaction, and both were stronger correlates than seizure-related factors and demographic variables. The implications of these findings for the treatment and management of patients with epilepsy are discussed.

Clinical differences among depressed patients with and without a history of suicide attempts: Findings from the STAR ⁎D trial

Background This study sought to determine whether a history of suicide attempts among outpatients diagnosed with nonpsychotic major depressive disorder (MDD) is correlated with any difference in clinical presentation that should influence patient care. Methods Baseline data from the Sequenced Treatment Alternatives to Relieve Depression (STAR ⁎D) trial on outpatients with MDD treated in primary and specialty care settings were used to model significant demographic and clinical correlates of suicide attempter status. Results Altogether, 16.5% of participants ( n = 667) reported prior suicide attempts. Controlling for age, gender, and depressive symptom severity, previous attempters had more current general medical conditions ( μ = 3.2 vs. 2.9, p < .0001), more current alcohol/substance abuse ( p < .0001), and more work hours missed in the past week (26.2% vs. 18.2%, p < .0001) than non-attempters. On average, for the previously suicidal, the onset of MDD occurred 8.9 years earlier in life ( p < .0001) and had included 1.2 additional depressive episodes ( p = 0.001) compared to those without prior suicidal behavior. Previous attempters also reported more current suicidal ideation (61.3% of previous attempters, adjusted OR 1.6, vs. 45.5% of nonattempters, p < .0001). Limitations Presence or absence of a history of suicide attempts was determined only through self report. Conclusions Those with a history of suicidal behavior suffer a greater burden of depressive illness. Earlier intervention and ongoing, aggressive care, including maintenance-phase pharmacotherapy, may be critical to mitigating the long-term consequences associated with this increased disease burden.

Military deployment to the Gulf War as a risk factor for psychiatric illness among US troops

Several studies document an excess of psychiatric symptoms among veterans of the the 1991 Gulf War. However, little is known about the prevalence of psychiatric disorders in those who were deployed to that conflict. To compare the 12-month prevalence and associated risk factors for DSM Axis I psychiatric diagnoses between random samples of Gulf War-deployed veterans and veterans of the same era not deployed to the Persian Gulf (era veterans). Interview data from 967 Gulf War veterans and 784 era veterans were examined to determine current health status, medical conditions, symptoms and Axis I psychiatric disorders. Logistic regression models evaluated risk factors for psychiatric disorder. Gulf War veterans had a significantly higher prevalence of psychiatric diagnoses, with twice the prevalence of anxiety disorders and depression. Lower rank, female gender and divorced or single marital status were significant independent predictors of psychiatric disorder. Deployment to the Gulf War is associated with a range of mental health outcomes more than 10 years after deployment.

Assessing pain associated with activities of daily living in older adults

Chronic pain is a major problem for many older adults, and it has been suggested that pain can significantly restrict a person’s ability to perform activities of daily living (ADL’s). The relationship between pain and limitations in ADL’s, however, is not well understood, thus, the primary purpose of this pilot study was to examine which ADL’s are impacted the most by pain. A secondary purpose was to compare various pain rating (PR) scales to assess pain associated with ADL’s. Twenty-six older adults living independently in the community (mean age = 74.5 yrs) completed questionnaires assessing current pain and medical conditions. Also, participants rated the intensity of pain associated with the following ADL’s: dressing, bathing, standing, bending, walking, transferring in & out of bed, lifting & lowering objects, and climbing stairs using five different PR scales (VAS, NRS, VDS, BS-21, GBS). Results indicated that 62% were currently experiencing chronic pain with mild to moderate pain most often reported in the hands/fingers, knees, and hip joints. Pain was reported to be most severe in the lower back and shoulder joints. Participants reported experiencing the least amount of pain for dressing and bathing with higher levels of pain reported for walking, climbing stairs, and lifting & lowering objects. Significant correlations were found between all five PR scales (r = 0.57–0.99) for the various ADL’s. It is concluded that chronic pain in older adults is associated with mild to moderate interference in ADL’s, particularly activities involving walking, climbing stairs, and lifting & lowering objects.

Nonpsychiatric Illness Among Primary Care Patients With Trauma Histories and Posttraumatic Stress Disorder

The authors examined the relationship between posttraumatic stress disorder (PTSD), trauma, and self-reported nonpsychiatric medical conditions in a sample of 502 primary care patients with one or more anxiety disorders. Primary care patients with one or more DSM-IV anxiety disorders were assessed for comorbid psychiatric and substance use problems and for a history of trauma. These individuals also completed a self-report measure of current and lifetime medical conditions, lifetime tobacco use, and current regular exercise. Of 502 participants with at least one anxiety disorder, 84 (17 percent) reported no history of trauma, 233 (46 percent) had a history of trauma but no PTSD, and 185 (37 percent) met DSM-IV criteria for PTSD. Patients with PTSD reported a significantly greater number of current and lifetime medical conditions than did participants with other anxiety disorders but without PTSD. Primary care patients with PTSD were more likely to have had a number of specific medical problems, including anemia, arthritis, asthma, back pain, diabetes, eczema, kidney disease, lung disease, and ulcer. Possible explanations for the greater rates of medical conditions among participants with PTSD were examined as predictors in multiple regression. PTSD was found to be a stronger predictor of reported number of medical problems than trauma history, physical injury, lifestyle factors, or comorbid depression. These findings suggest that PTSD is associated with a higher rate of general medical complaints.

Factors Influencing Serum Neopterin Concentrations in a Population of Blood Donors

Neopterin, a product of interferon-γ-activated monocytes/macrophages is a sensitive indicator of cell-mediated immune activation (1). In humans, increased concentrations of neopterin in serum and urine have been found during allograft rejection episodes and in various malignant disorders, autoimmune diseases, and viral infections, including HIV type 1 (HIV-1) (2)(3)(4)(5)(6)(7)(8). To improve the safety of blood donations, additional neopterin testing of blood donations became mandatory for all Austrian blood-transfusion services in addition to testing for HIV-1 and -2 antibodies, hepatitis C virus (HCV) antibodies, hepatitis B virus (HBV) surface antigen, alanine aminotransferase (ALT), and Treponema pallidum antibodies (9). In the Austrian Tyrol, ∼900 000 voluntary blood donations have been routinely screened for increased neopterin concentrations since 1986. According to the results of previous studies, the cutoff for neopterin concentrations was set to the 98th percentile, thus tolerating a donation loss of 2% (9). Although the behavior of neopterin concentrations during the course of acute viral infections, for example, is well known, there are fewer data regarding the association of neopterin concentrations and physiologic findings in a healthy population. In this study, we looked for associations between neopterin concentrations and other laboratory tests that are routinely performed on blood donations at our institute. Associations between neopterin concentrations and physiologic conditions of blood donors obtained during the blood-donation procedure were also investigated. Blood samples from 1156 consecutive blood donors from the Austrian Tyrol (693 males and 463 females) were collected in January 2001. A questionnaire was administered, which asked about current smoking habits, medical conditions, and use of medications. Of the blood donors, 262 (22.7%) reported being smokers (range of cigarettes smoked daily, 1–50), 56 (4.8%) were taking antihypertensive drugs, and 52 (4.5%) reported using antiinflammatory drugs, such as acetylsalicylic acid. …

Health-Related Quality of Life in Persian Gulf War Veterans

The objective of this investigation is to describe the health-related quality of life of Persian Gulf War (GW) veterans and to examine the effects of current chronic medical conditions and psychiatric status on physical functioning. To measure health-related quality of life, the Medical Outcomes Short Form Survey (SF36) was administered approximately 4 years after the GW to a stratified, random sample of New England-area GW-deployed veterans and a group of military personnel deployed to Germany during the GW. The SF36 scores for the GW-deployed study population (N = 141) were compared with those for the Germany-deployed group (N = 46) and with published U.S. population norms. Multiple linear regression analyses were performed to identify risk factors associated with lower physical health functioning in the GW-deployed study group. Functional health status was significantly lower in the GW-deployed group compared with the Germany-deployed group for each of the SF36 subscales and the two summary scores (Physical Component Summary [PCS] and Mental Component Summary). Compared with the general U.S. population, the GW-deployed group median was between the 25th and 50th percentile for the Physical Functioning subscale and the PCS score. Within the GW-deployed group, lower education, psychological symptomatology, and a higher number of chronic self-reported medical conditions were significant predictors of the PCS score. GW-deployed veterans report lower functional health status compared with a group of Germany-deployed veterans and published general U.S. population norms. Within the group of GW-deployed veterans, several current medical and psychological conditions predictive of lower physical functioning levels were identified.

Epidemiological study on sleep habits and insomnia of new outpatients visiting general hospitals in Japan.

A large scale epidemiological survey of sleep habits, specifically for insomnia, was conducted using 6277 new outpatients from 11 general hospitals in Japan. They were requested to answer a questionnaire newly designed for this study, which consisted of 34 questions concerning sociodemographic characteristics, current medical conditions, sleep habits, current or past sleep complaints, symptoms of parasomnia, use of hypnotics/anxiolytics and other aspects of daily life. Insomnia was the focus of analysis using chi2 statistics and, additionally, logistic regression to explore the predictors of insomnia. Bedtime was 23:30 and wake-up time was 6:35 on average, with a mean sleep time of 6.77 h on weekdays. The number of subjects with current sleep complaints was 1276, of which 735 (11.7% of the total sample) had insomnia lasting for 1 month or more. Only 37.6% of those were taking hypnotics and/or anxiolytics. Old age, female sex, neurology, psychiatry, early bedtime, late wake-up time, living alone and dissatisfaction with the bedroom environment for sleep were found to be associated with long-term insomnia. This study helps to provide a framework for further studies using the general population.

Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military.

To profile differences in current physical symptoms and medical conditions among women users of Veterans Administration (VA) health services with and without a self-reported history of sexual assault sustained during military service, we conducted a cross-sectional analysis of a nationally representative, random sample of women veterans using VA outpatient services (n = 3632). A self-administered, mailed survey asked whether women had sustained sexual assault while in the military and requested information about a spectrum of physical symptoms and medical conditions. A history of sexual assault while in the military was reported by 23% of women VA users and was associated with current physical symptoms and medical conditions in every domain assessed. For example, women who reported sexual assault were more likely to indicate that they had a "heart attack" within the past year, even after adjusting for age, hypertension, diabetes, and smoking history (OR 2.3, 95% CI 1.3-4.0). Among women reporting a history of sexual assault while in the military, 26% endorsed > or = 12 of 24 symptoms/conditions, compared with 11% of women with no reported sexual assault while in the military (p < 0.001). Clinicians need to be attuned to the high frequency of sexual assault occurring while in the military reported by women VA users and its associated array of current physical symptoms and medical conditions. Clinicians should consider screening both younger and older patients for a sexual violence history, especially patients with multiple physical symptoms.

Latino parents' perception of their children's health status

Descriptive and multivariate analyses of the Hispanic health and nutrition examination survey were undertaken to describe Mexican American and Puerto Rican parents' perceptions of the health status of their young children, and to test a model of perceived health. Results suggest that ratings of poor health are substantially higher than reports for children from the general population and that the two ethnic groups differed from each other in the apparent basis for their ratings. Key predictors of health ratings for both populations were children's functional limitations, current and resolved medical conditions, and educational attainment of the head of household. Mexican-American ratings were also predicted by current and resolved developmental conditions, acculturation, and family income.

Clinical evaluation of the BTA trak assay and comparison to voided urine cytology and the bard BTA test in patients with recurrent bladder tumors

Objectives To assess the clinical performance of the BTA TRAK assay and to compare it with that of voided urine cytology (VUC) and the Bard BTA test (BTA) in the detection of recurrent bladder cancer (BC). Methods The study was performed on randomly selected archival voided urine samples for many of which VUC and/or BTA information was available. Sensitivity was determined in samples from patients with histologically confirmed recurrent BC. Specificity was determined in samples from healthy volunteers, patients with three categories of current medical conditions, and patients with a history of BC but no current evidence of disease. Results The TRAK assay was positive in 156 of 216 samples for patients diagnosed with BC, for an overall sensitivity of 72%. Mean values increased with progressing grade and stage of disease. In the comparison between TRAK and VUC, the overall sensitivities were 68% and 25%, respectively ( P < 0.001 ). For Stages Ta and T1 and for all tumor grades, the sensitivity of the TRAK assay was significantly greater than that of VUC ( P < 0.001 ). TRAK sensitivity was also significantly better than that of BTA (73% versus 58%, P = 0.005). The specificity of the TRAK assay ranged from 75% in samples from patients with genitourinary disease to 97% in healthy volunteers. Conclusions The TRAK assay is superior to VUC and the original BTA test in the detection of BC. The results of the study indicate that the TRAK assay may be a useful adjunct to cystoscopy in the management of patients with recurrent BC.

Balance screening of an inner city older adult population

Objective: Until recently, studies of balance abilities were conducted on nursing home residents or volunteers in a clinical laboratory setting. Little is known about balance abilities of older adults living independently in large urban cities or who represent different ethnic backgrounds. The purpose of this study was to describe balance abilities in these individuals. Subjects: Older adults ( n = 251) ranging in age from 60 to 95 years of age (X̄= 74.3, SD = 7.7) participated. The majority of individuals (85.7%) were African-American or Hispanic. Procedure: The elders were screened for past and current medical conditions, activity level, and confidence in performing interactions with the environment (instrumental activities of daily living), and were administered the Berg Balance Scale, Timed Up and Go, and Reach in Four Directions Test. Results: The mode on the Berg Balance Scale was 53 (maximum 56). Mean on the Timed Up and Go was 15 seconds, and Reach in Four Directions Test was: forward, 8.9in; backward, 4.6in; right, 6.8in; and left 6.6in. Multiple regression analysis revealed that the frequency of performing activities and the comfort in performing activities without fear of falling significantly contributed to the scores on the balance tests. The results of this study can serve as norms for balance testing in urbandwelling older adult populations from diverse backgrounds and may be useful for clinicians who are developing health promotion and fall prevention programs.

Anxiety, relaxation and anaesthesia for day-case surgery

Obesity is a significant public health issue with no consensus regarding optimal medical management. Integrative medicine (IM) may help to fill this gap.(1) To characterize the sociodemographics, psychosocial functioning, health behaviors, and current medical conditions across BMI classifications in patients seeking IM; and (2) to examine how patients’ reasons for seeking IM care, treatment goals, services sought, and services provided differ based on BMI.Survey data were collected from patients seeking care at nine BraveNet IM centers. Sociodemographics, psychosocial health, lifestyle behaviors, and reasons for seeking specific IM services were compared across BMI categories using Chi-square test, Fisher's exact test, or one-way analysis of variance. Logistical regression was used to compare reasons for seeking IM care, treatment goals, and services sought and provided across BMI categories.2015 patients were included in this study; 300 (14.9%) were obese and 580 (28.8%) were overweight. Obese patients were more likely to be non-White, unmarried, and uninsured, and have lower education, lower income, and at least one chronic disease (p < 0.05). They also had the lowest rates of aerobic activity (67.4% exercise < 3×/week, p < 0.01), and greater depression (CESD-10 score 10.1 ± 6.6, p < 0.01), stress (PSS score 6.3 ± 3.5, p < 0.01), fatigue (avg 5.5 ± 2.4 on scale 1–10, p < 0.01), and pain (avg 3.6 ± 2.5 on scale 1–10, p < 0.01). Obese patients were more likely to seek manipulative/body-based services (OR = 1.46, 95% CI = 1.10–1.93, p < 0.05) and to seek and receive energy therapies (seek: OR = 1.49, 95% CI = 1.07–2.07; receive: OR = 2.56, 95% CI = 1.28–5.10), but less likely to seek IM care for greater compatibility with their beliefs and culture (OR = 0.72, 95% CI = 0.53–0.97). There were no significant differences between BMI categories for IM treatment goals.Obese adults seeking IM care may represent a unique patient population with potential unmet health needs. IM may provide approaches to more effectively address the multifaceted complexities of obesity.

The relationship between health and cognitive functioning in a sample of elderly people in the community.

The association between health status and cognitive performance was examined in a sample of 708 community dwelling elderly people aged 70 years or over. Cognitive performance declined significantly across the age groups 70-74, 75-79, 80-84, and 85-89 years on the Mini-Mental State Examination and on measures of fluid intelligence and memory, but not on measures of crystallized intelligence. Health status declined significantly across age for five of 49 past and current medical conditions, for measures of Activities of Daily Living (ADL) and for systolic blood pressure, but did not decline significantly for global self-ratings of health, diastolic blood pressure or reports of smoking. Weak but significant correlations between health and cognitive performance were found for self-reported global ratings of health and for self-reports of some physical symptoms but not for diastolic or systolic blood pressure, or for many other physical conditions. Both self- and informant-based ratings of ADL correlated with cognitive performance. Age differences remained after cognitive performance was adjusted for health variables such as ADL, self-ratings of health and current health problems. It is concluded that, at the population level, lower levels of cognitive performance in community-dwelling elderly subjects are not strongly mediated by ill health.

Patient-interactive Computer System for Obtaining Medication Histories

A portable, patient-interactive computerized system for obtaining medication histories is described. A comprehensive interview script modeling pharmacist-conducted medication-history interviews was written in lay language. The script contains sections on demographics, current medical conditions, medication regimen, medication compliance, symptoms, allergy history, dietary history, psychosocial history, and occupational and environmental exposure; it also asks the patient to evaluate the system. Some of the information requested is often not obtained by physicians during the history and physical examination. A program that conducts the interview by processing a computerized version of the script was developed with Microsoft QuickBASIC. The program was designed to be run on a personal computer microprocessor so that an interview can be conducted virtually anywhere by using a desktop or laptop computer. Summary reports suitable for inclusion in the medical record are generated after each interview. Patients using the system took an average of 40 minutes to complete an interview. They entered data easily and accurately, and they gave the system a high overall rating. The medication-history interviewing system described produces useful, comprehensive, and consistent reports and requires about the same amount of time to conduct an interview as a human interviewer.

Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders.

The authors studied the prevalence of eight chronic medical conditions in an adult population sample (N = 2,554) with and without psychiatric disorders. Adjusted for age and sex, the prevalence of any lifetime chronic medical condition for persons with any lifetime affective, anxiety, or substance use disorder was 61.4%, 57.1%, and 57.7%, respectively. Each of these percentages was significantly higher than that for persons with no lifetime psychiatric disorder (53.4%). Both lifetime affective and anxiety disorders were uniquely associated with a greater prevalence of any lifetime chronic medical condition, but the only psychiatric disorders uniquely associated with current (i.e., active) chronic medical conditions were anxiety disorders, suggesting that the association between anxiety disorders and chronic medical conditions develops more quickly than associations between medical conditions and other psychiatric disorders.

Maternal risk status and outcome measures: a three-stage study in Israel.

Maternal risk for child inadequate development and disturbed parentchild interaction was assessed in a sample of 262 Israeli mothers by considering maternal history, pregnancy situation, and current medical and psychosocial conditions. Outcome measures included the assessment of maternal perceptions of their infants characteristics and their perceptions of their families and themselves; infants' developmental status and weight/height gains; Bayley, Bates, and HOME scales; and wellbaby clinic data. Maternal risk was significantly differentiated between many of these outcome measures. The implications for predicting outcome measures from an early assessment of maternal risk for problems in child development are discussed.