Number Of Medical Problems Research Articles

A Wine a Day …: Medical Experts and Expertise in Plutarch’s Table Talk

Abstract This contribution examines the important role that medical experts and expertise played at convivial networking events in the High Roman Empire, as imagined by a non-specialist in the field, viz. the famous Platonist intellectual Plutarch of Chaeronea (ca. 45–120 CE). An analysis of a number of medical problems discussed in his Table Talk will yield fresh insights into the social and intellectual role which doctors, as members of the educated elite, were expected to play in convivial community contexts and also how popular or common had become certain theories, concepts and beliefs relating to health and healing in the High Imperial era. At the same time, it will give a clearer idea of what was the place of medical experts and expertise in Plutarch’s intellectual programme, and how this interest ties in with his (natural) philosophical endeavours more generally.

Risk factors and machine learning model for predicting hospitalization outcomes in geriatric patients with dementia.

IntroductionGeriatric patients with dementia incur higher healthcare costs and longer hospital stays than other geriatric patients. We aimed to identify risk factors for hospitalization outcomes that could be mitigated early to improve outcomes and impact overall quality of life.MethodsWe identified risk factors, that is, demographics, hospital complications, pre‐admission, and post‐admission risk factors including medical history and comorbidities, affecting hospitalization outcomes determined by hospital stays and discharge dispositions. Over 150 clinical and demographic factors of 15,678 encounters (8407 patients) were retrieved from our institution's data warehouse. We further narrowed them down to twenty factors through feature selection engineering by using analysis of variance (ANOVA) and Glmnet. We developed an explainable machine‐learning model to predict hospitalization outcomes among geriatric patients with dementia.ResultsOur model is based on stacking ensemble learning and achieved accuracy of 95.6% and area under the curve (AUC) of 0.757. It outperformed prevalent methods of risk assessment for encounters of patients with Alzheimer's disease dementia (ADD) (4993), vascular dementia (VD) (4173), Parkinson's disease with dementia (PDD) (3735), and other unspecified dementias (OUD) (2777). Top identified hospitalization outcome risk factors, mostly from medical history, include encephalopathy, number of medical problems at admission, pressure ulcers, urinary tract infections, falls, admission source, age, race, anemia, etc., with several overlaps in multi‐dementia groups.DiscussionOur model identified several predictive factors that can be modified or intervened so that efforts can be made to prevent recurrence or mitigate their adverse effects. Knowledge of the modifiable risk factors would help guide early interventions for patients at high risk for poor hospitalization outcome as defined by hospital stays longer than seven days, undesirable discharge disposition, or both. The interventions include starting specific protocols on modifiable risk factors like encephalopathy, falls, and infections, where non‐existent or not routine, to improve hospitalization outcomes of geriatric patients with dementia.Highlights A total 15,678 encounters of Geriatrics with dementia with a final 20 risk factors.Developed a predictive model for hospitalization outcomes for multi‐dementia types.Risk factors for each type were identified including those amenable to interventions.Top factors are encephalopathy, pressure ulcers, urinary tract infection (UTI), falls, and admission source.With accuracy of 95.6%, our ensemble predictive model outperforms other models.

THE USE OF THE PRP THERAPY TO ACTIVATE FOLLICULOGENESIS IN WOMEN OF THE LATE REPRODUCTIVE AGE IN PROGRAMS OF ASSISTED REPRODUCTIVE TECHNOLOGIES

The rate of infertility in married couples of reproductive age in this country makes up from 10 to 15%, in some regions this value is close to 20% - acritical level that has a negative impact on demographic figures. The rate of pregnancy depends directly on the women’s age and decreases by 3.3times starting from the age of 19 and by the age of 48. The decrease in the ability to conceive is accounted for by subtle mechanisms related to thedeterioration of the quality of oocytes. The patients who are prepared for an extracorporeal fertilization program (ECF) and do not respond tocontrolled ovarian hyperstimulation protocols are considered to be poor respondents. Many studies focused on the development of an optimaltreatment method. However, none of the approaches seems to be effective enough to guarantee a successful use. Platelet-rich plasma is a new andpromising method that is successfully used in the reproductive science to solve a number of medical problems. All the patients whose commonfeatures were low oocyte output and poor embryo quality as well as failed ECF attempts were offered a treatment method of autologous PRP therapyafter their written consent. Three months later, one obtained astonishing results, which by the markers of biochemical infertility alone could beclassified as a complete biological phenomenon and are also characterized by improved embryo quality. The results of hormonal homeostasis show adecrease in the level of the follicle-stimulating hormone by 67.33% while the level of the anti-muellerian hormone is 75.18% higher.Thus, the use of the PRP therapy in poor respondents helps them to overcome their problematic reproductive barrier.

MALOCCLUSION: MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT

The article presents an overview of modern approaches to the identification and justification of the choice of management tactics for patients with malocclusion and crowding of teeth. The questions of the etiology and pathogenesis of malocclusion that occurred both in early childhood and in older age are highlighted. There is a high prevalence of malocclusion in the population, which creates a number of medical problems (tooth erasability and mobility, changes in the upper-mandibular joint, abnormalities of the biomechanics of the lower jaw), but also a number of aesthetic and psychological problems. The classification of malocclusion anomalies is given. The article describes the currently relevant visualization methods for diagnosing malocclusion, which allow us to assess the severity of changes and adequately select the optimal method of correction, including orthopantomography and telerentgenography. The application of the calculation method is justified, which allows to establish the fact of a lack of space in the dental arch and to identify the need for its increase in case of crowding of teeth. Indications for extraction of teeth for correction of malocclusion have been determined. The factors determining the success of corrective treatment and the stability of the achieved results are listed.

Health status in 1040 adults with disorders of sex development (DSD): a European multicenter study.

ObjectiveThe knowledge about health status in adults with disorder of sex development (DSD) is scarce.Design and methodsA cross-sectional observational study in 14 European tertiary centers recruited 1040 participants (717 females, 311 males, 12 others) with DSD. Mean age was 32.4 ± 13.6 year (range 16–75). The cohort was divided into: Turner (n = 301), Klinefelter (n = 224), XY-DSD (n = 222), XX-DSD (excluding congenital adrenal hyperplasia (CAH) and 46,XX males) (n = 21), 46,XX-CAH (n = 226) and 45,X/46,XY (n = 45). Perceived and objective health statuses were measured and compared to European control data.ResultsIn DSD, fair to very good general health was reported by 91.4% and only 8.6% reported (very) bad general health (controls 94.0% and 6.0%, P < 0.0001). Longstanding health issues other than DSD and feeling limited in daily life were reported in 51.0% and 38.6%, respectively (controls 24.5% and 13.8%, P < 0.0001 both). Any disorder except DSD was present in 84.3% (controls 24.6%, P < 0.0001). Males reported worse health than females. In the subgroup analysis, Klinefelter and 46,XX-DSD patients reported bad general health in 15.7% and 16.7%, respectively (Turner 3.2% and CAH 7.4%). Comorbidities were prevalent in all DSD subgroups but Klinefelter and Turner were most affected. Early diagnosis of DSD and a healthy lifestyle were associated with less comorbidities.ConclusionsOverall, general health appeared to be good but a number of medical problems were reported, especially in Klinefelter and Turner. Early diagnosis of DSD and a healthy lifestyle seemed to be important. Lifelong follow-up at specialized centers is necessary.

Parental Alcohol-Impact on Children

Alcohol consumption has been identified as a risk factor for many health problems affecting socio-economic status of individual, family and society worldwide. Alcoholism is a chronic, progressive disease affecting millions of Indians. It can cause number of medical problems, violence in person, and even death. Drinking may be responsible for the disruption of family life in an alcoholic home, causing trauma and shaping each individual's development, yet family members will work hard to cover this reality. Alcoholism is a growing problem with society today and many people who suffer from it do not even realize it.

Characteristics of urban male homeless veterans and non-veterans in Omaha, Nebraska

ABSTRACTThe current study examined differences between urban homeless veterans and non-veterans on sociodemographics, housing, clinical characteristics, and psychosocial factors. We recruited a sample of 196 homeless men (101 veterans, 95 non-veterans) from the Omaha, Nebraska metropolitan area. Structured interviews were conducted by research staff. The results showed that the two groups were similar in most respects, though there were several notable differences. Homeless veterans were found to be older and more educated than non-veterans, more likely to have married, and reported having fewer non-adult children. Multivariable models controlling for age further showed that veterans reported a higher number of medical problems and were more likely to report being diagnosed with major depression or PTSD than non-veterans. Comparison with previous studies suggests changes in certain characteristics of homeless veterans over the past few decades that may reflect the growing proportion of veterans from the all-volunteer force, initiated after the draft ended in 1975. Findings from this study were consistent with previous comparative studies suggesting limited changes in recent decades in the characteristics of homeless veterans as compared to non-veterans, although the high prevalence of major depression and PTSD merit special treatment for these disorders.

Clinical features of women with Turner syndrome experiencing transition period in Japan.

Turner syndrome results from the entire or partial loss of the second X chromosome, and is associated with a number of medical problems. Affected women require long-term medical follow-up. This study investigated the status of medical follow-up focusing on the transition for young adult women with Turner syndrome (TS). The clinical profiles of 63 women with TS over the age of 16 were retrospectively examined. Thirty-three women are continuously followed by pediatric endocrinologists at our pediatric division. Twenty women were transferred to gynecologists as primary care physicians. Eight young adult women dropped out of the regular health check-up from our pediatric division even though 7 women were undergoing estrogen replacement therapy. We further reviewed the complications and management of the 33 women who were continuously followed at our pediatric division. A high incidence of obesity and liver dysfunction were observed in this age group (23.5±8.7). Nineteen out of 33 women consulted a cardiologist in the adult care division for cardiovascular complications. In the analysis of 20 women who were transferred to gynecologists, mainly two gynecologists accepted the transfer and have become accustomed to clinical care for TS. Seven women who were followed by the gynecologist in our facility were adequately managed for lifelong complications. Since there is no clear framework for transition in Japan, coordination with other specialists, especially gynecologists, is essential for the successful management of adult women with TS. Patient education and provision of information are required for establishing self-advocacy, which will prevent drop-out.

Quantitative determination of dimethyl fumarate in silica gel by solid-phase microextraction/gas chromatography/mass spectrometry and ultrasound-assisted extraction/gas chromatography/mass spectrometry.

Dimethyl fumarate (DMF) is a chemical compound which has been added to silica gel bags used for preserving leather products during shipment. DMF has recently been singled out due to its ability to induce a number of medical problems in people which touch products contaminated by it. Its use as a biocide has been recently made illegal in Europe. Two different extraction techniques, namely ultrasound-assisted extraction (UAE) and solid-phase microextraction (SPME), both coupled with gas chromatography/mass spectrometry were applied to the quantitative determination of DMF in silica gel. Linearity of the methods, reproducibility and detection limits were determined. The two methods were applied to the quantification of DMF in thirty-four silica gel samples used as anti-mould agents in different leather products sold in Italy, and the obtained results were statistically compared.

Medication Treatment Complexity and Adherence in Children with CKD

The complexity of CKD management in children is increased by the number of comorbid conditions. This study assessed the prevalence of comorbidities in pediatric CKD and the frequency with which multiple comorbidities present together by assessing prevalent medication use by CKD stage and diagnosis and their association with clinical or sociodemographic factors. The association between number and frequency of dosing of medications prescribed and self-report of nonadherence was also assessed. In this cross-sectional analysis of the Chronic Kidney Disease in Children study, medication use at study entry grouped by indication was examined by CKD stage, diagnosis, age, race, ethnicity, income, and CKD duration. Multivariate adjusted predictors of medication use and clustering were examined. Nonadherence was assessed by self-report of missed medications in the past 7 days. The 558 eligible participants had a median age of 11 years and median GFR of 44 ml/min per 1.73 m(2); 62% of participants were male and 78% had nonglomerular kidney disease. The number of medications for treatment of CKD comorbidities increased with advanced CKD stage (2.5-fold for stages IV versus II; P<0.001) and glomerular disease (1.4-fold versus nonglomerular; P<0.001). Three distinct medication clusters were identified that corresponded to treatment of glomerular disease, advanced renal tubular dysfunction, and proteinuric complications, respectively. Nonadherence was associated with increased medication dosing frequency (administration >2 times/d; P<0.001) but not the number of medications. Medical therapy for children with CKD is complex and is affected by glomerular diagnosis, CKD stage, and medication frequency. The need for CKD-related medication treatment cannot be easily predicted by CKD staging alone. Poorer adherence was associated with increased medication frequency, but not with the number of medical problems needing treatment. Consolidating medical treatment and reducing medication frequency may improve adherence rates in children with CKD.

Fleas and canine dermatology

The cat flea, Ctenocephalides felis felis, is the flea most commonly found on dogs in the UK. The adult flea is a small, wingless, laterally flattened insect. Female fleas can lay up to 50 eggs a day. The cat flea life cycle involves the development from egg to adult via three larval stages and one pupal stage. Fleas are associated with a number of medical problems in their canine hosts, including irritation, flea allergy dermatitis, anaemia, tapeworm infestation and transmission of infectious agents. Pruritus is the principal manifestation of flea allergy dermatitis, the most common dermatological condition in dogs. Please note: Wiley-Blackwell are not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Frequent Use of Emergency Medical Services by the Elderly: A Case-Control Study Using Paramedic Records

To identify the factors that lead to increased use of emergency medical services (EMS) by patients 65 years of age and older in an urban EMS system. Retrospective, case-control study of frequent EMS use among elderly patients transported during one year in an urban EMS system. Three distinct groups were examined for transports that took place in 1999: (1) 1-3 transports per year (low use); (2) 4-9 times per year (high use); and (3) those transported 10+ times (very high use). This frequency-use indicator variable is the primary outcome measurement. Predictors included age, gender, preexisting medical diseases, ethnicity, number of medications, number of medical problems, primary physician, psychiatric diagnosis, and homelessness. Analysis of predictors was done using ordinal logistic regression model, and a global test of interaction terms. Male gender, black ethnicity, homelessness, and a variety of types of medical problems were associated with increased use of EMS resources. The strongest single predictor of case status remained homelessness, which was nearly eight times as commonly associated with frequent EMS use than for the controls. The number of medical problems and medications also were significantly associated with EMS use in this patient population. There was a lack of association of alcohol, substance abuse, and psychiatric disorders with EMS use. Patients with asthma who did not have a primary care physician were more likely to use EMS services than were those who had a physician. This analysis highlights homelessness as being strongly associated with frequent EMS use among the elderly and downplays other associated factors, such as psychiatric disease and substance use. Medical illness severity, particularly asthma when no primary care physician is available, also appears to drive frequent EMS use. Both findings have implications in terms of targeting of public resources; providing housing to medically ill elderly and primary care to asthmatics in particular, may provide dividends not only in terms of social welfare and medical care, but in preventing frequent EMS use by the elderly.

Neurohospitalists: Challenges for the Integration of a New Field: A Neurointensivist's Perspective

A new field of Neurohospitalist medicine is developing. The roots of this field are firmly in the field of Neurology. The development of the field however, may follow the path of its predecessor hospitalist medicine. It is therefore important to study the history of Internal Medicine and hospitalist medicine in order to understand where the field may be headed. The field of Internal Medicine and medical education has undergone a metamorphosis over the past several decades. Historically, patients would be admitted to a hospital for medical evaluation. During this evaluation teams of residents with the attending physician would admit, evaluate, diagnose, and embark on an extensive treatment strategy. As average life expectancy increased, and newer technologies developed, the cost of caring for patients in an in-patient hospital setting became increasingly burdensome. Nationally, increasing health costs became a serious strain on the economic health of most industrial countries. Subsequently, the inpatient evaluation and treatment of most medical diseases became cost prohibitive and moved toward a more cost effective outpatient setting. The movement of medical evaluations to the outpatient setting provided a challenge to internal medicine education. Residencies needed to mirror practice to appropriately prepare residents for their eventual post training place in internal medicine. Subsequently, internal medicine residencies have increased their outpatient requirements over the past few decades. This, however, has occurred during a time of mandated decreasing residency work hours and increasing in-patient volume and acuity. A solution for many of these residencies was the development and implementation of medical hospitalist programs and fellowship. The development of Neurohospitalist programs appears to be following a similar path as internal medicine. Dr. Meschia has noted similar erosion in the in-patient experience of neurology residencies compared to changes that occurred in internal medicine programs (Meschia, 2010). Practice patterns have also shown parallels to Internal Medicine. Today many neurological diseases are evaluated and managed in the outpatient setting. Neurology inpatient services have also displayed a greater number of medical problems and complications. In addition to these findings, the development and expansion of “acute neurology” and more specifically, the use of intravenous tissue plasminogen activator and the development of interventional procedures has increased the need for immediate neurological expertise. This need has superseded financial models to compensate and accommodate the necessary people and resources to adequately treat this patient population. The development of the field of hospital neurology may provide a solution to this problem. The neurohospitalist can provide timely care for acutely ill neurological patients and can relieve neurology practices the need to cover an emergency room or a sick hospital population. Thus, there is a strong economic incentive for the development of the field. This rosy scenario for the neurohospitalists, however, has many potential pitfalls and questions. How will neurohospitalists be organized? What skills will be needed or required for practice? Dr. Likosky's survey of neurohospitalists found that the majority of these physicians do not see patients in an outpatient setting (Likosky et al., 2010). Who will follow the patient once they have left the hospital? How will neurohospitalists be reimbursed? These are only a few of the questions a young field will need to address as it develops. Each of these questions and issues has potential difficulties. One model for Neurohospitalist development is to have the neurohospitalist hired by a group practice. Reimbursement would be established by the group and patient follow up would be covered by the group. However, what if the neurohospitalists are hired and salaried by the hospital? as is the growing trend in medicine. Coordination with outside practices will take considerable skill. Inevitably “turf issues” will arise. Similarly what will happen when a neurologic emergency occurs when a patient is not covered by the neurohospitalists practice? Who will the emergency room physicians call when an outside neurologist or physician is unavailable or delayed? Most neurologists and physicians may be grateful for this help; however, so may patients who may wish to leave the outpatient neurologists practice to join the practice of the physician who cared for them during their crisis who may or may not have an outpatient practice. A majority of neurohospitalists in Likosky's survey came from either a stroke or neurocritical care background (Likosky et al., 2010). This may represent selection bias of the survey or of individuals who chose to spend their time in the hospital. However, neurohospitalists should be able to provide consultative roles in all areas of the hospital including the intensive care units (ICUs). The neurohospitalists may be able to complement both the general neurologists and neurointensivists by dividing services, procedures, or consultations when necessary. Again a certain level of political skill may be needed to navigate these areas.

Increase in serum haptoglobin and apolipoprotein M in patients with obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is a common syndrome, which is associated with a number of medical problems that impact morbidity and mortality. Although the precise mechanisms that underlie these associations are not fully understood, previous studies have suggested that patients with OSA show elevations of several biomarkers that are associated with cardiovascular risk. This study was undertaken to identify serum proteins associated with OSA by using a proteomics technique and to examine changes in identified protein levels after continuous positive airway pressure treatment. The study participants consisted of 40 male patients (aged 40-49 years) with severe OSA and 34 male control subjects matched for age and body mass index. All subjects underwent polysomnography. Using a proteomics approach, we identified nine proteins that were differentially expressed in patients with severe OSA and controls. Three of these nine proteins, haptoglobin, paraoxonase-1 and apolipoprotein M, were quantified by using enzyme-linked immunosorbent assays, kinetic assays and by using Western blotting. Multiple regression analysis showed that haptoglobin and apolipoprotein M levels are independently related to apnoea-hypopnoea index (P < 0.01). A further study is required to determine the nature of associations between these identified proteins and OSA in a large population.

Health Beliefs and Help Seeking for Depressive and Anxiety Disorders Among Urban Singaporean Adults

Health Beliefs and Help Seeking for Depressive and Anxiety Disorders Among Urban Singaporean Adults

Personality Type of the Glaucoma Patient

To characterize the personality profile of glaucoma subjects. One hundred eight subjects including 56 open-angle glaucoma (OAG) and 52 controls were given the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test and all performed automated perimetry. Clinical and demographic information which could relate to personality type was collected. OAG subjects had significantly higher Hypochondriasis (Hs; P=0.0082), Hysteria (Hy; P=0.0056), and Health Concerns (HEA; P=0.0025) mean scores than the control group. OAG subjects also had a significantly greater frequency of clinically abnormal score for hysteria (P=0.0262), and health concerns (P=0.0018). Multivariate analysis of variance revealed that Hypochondriasis, Hysteria, and Health Concerns scores were related to number of systemic medications used and to diagnostic group. Other potential explanatory variables such as sex, ethnicity, number of medical problems, length of glaucoma diagnosis, occurrence of glaucoma surgery, intraocular pressure, and visual status (logMAR, visual field indices) were not related to these personality scores. Patients with a diagnosis of OAG had more abnormal MMPI-2 scores in areas that focus upon concerns of somatic complaints and poor health. The use of systemic medications, which may be a constant reminder of illness, is a factor that may contribute to higher MMPI-2 scores.

Adherence to Black Box Warnings for Prescription Medications in Outpatients

Few data are available regarding the prevalence of potentially dangerous drug-drug, drug-laboratory, and drug-disease interactions among outpatients. Our objectives were to determine how frequently clinicians prescribe drugs in violation of black box warnings for these issues and to determine how frequently such prescribing results in harm. In an observational study of 51 outpatient practices using an electronic health record, we measured the frequency with which patients received prescriptions in violation of black box warnings for drug-drug, drug-laboratory, and/or drug-disease interactions. We performed medical record reviews in a sample of patients to detect adverse drug events. Multivariate analysis was conducted to assess the relationship of prescribing in violation of black box warnings to patient and clinician characteristics, adjusting for potential confounders and clustering. Of 324 548 outpatients who received a medication in 2002, 2354 (0.7%) received a prescription in violation of a black box warning. After adjustment, receipt of medication in violation of a black box warning was more likely when patients were 75 years or older or female. The number of medications taken, the number of medical problems, and the site of care were also associated with violations. Less than 1% of patients who received a drug in violation of a black box warning had an adverse drug event as a result. About 7 in 1000 outpatients received a prescription violating a black box warning. Few incidents resulted in detectable harm.

Multiple Substance Dependence and Course of Alcoholism among Alaska Native Men and Women

Alcohol dependence among Native Americans and Alaska Natives is twice that found in the general population. Alaska Natives are 7 times more likely to die of alcohol-related problems. This study investigated differences in the course and consequences of alcoholism and co-occurring polysubstance dependence in a sample of 582 alcohol-dependent Alaska Natives undergoing inpatient lifetime treatment in Anchorage between 1994 and 1999. Mean age was 33.9 years. Information on lifetime psychiatric symptoms and disorders was collected by using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), a research diagnostic interview. Results indicate that in addition to alcohol dependence, the majority of subjects were dependent on other substances. Marijuana dependence was most common, followed by dependence on cocaine and opiates. Compared with subjects not dependent on any other drugs, subjects with co-occurring alcohol and opiate dependence showed significant differences in relation to age of first regular drink, intoxication, tolerance and withdrawal symptoms, number of medical problems, and number of psychological problems. More research and specific clinical interventions are needed for alcohol- and opiate-dependent Alaska Natives. Findings indicate the need for prevention and interventions in alcohol and illicit drug abuse in this population at an early age.

Construct Validity of the EQ-5D in Low-Income Chinese American Primary Care Patients

Although the EQ-5D has been used with increasing frequency to measure health-related quality of life, to date, the measure's validity has not been examined in Chinese American immigrants. We evaluated the construct validity of the EQ-5D by testing its performance with respect to sociodemographic and clinical characteristics of the population and comparing responses on the EQ dimensions with the SF-36 subscales. The study surveyed low-income Chinese patients attending a community health center in New York City's Chinatown. Participants received self-administered versions of the EQ-5D and SF-36 and additional questions regarding demographic and clinical information. 856 patients were approached and data were collected from 523 patients (61%). Analysis of the EQ-5D responses by sociodemographic and clinical variables found significant differences among categories of age, gender, marital status, number of medical problems, self-rated health, and specific medical problems. Correlations between similar dimensions and subscale scores were stronger between the two measures than dissimilar ones. Patients without impairments on a given EQ dimension tended to have higher SF-36 subscale scores than patients reporting 'any' impairment (i.e. some/moderate or severe). The results provide initial support for the construct validity of the EQ-5D in our sample. Further studies should compare the performance of the EQ-5D with other preference-based measures in Chinese persons and examine the valuations that both low-income and Chinese persons place on core aspects of health.

Hypokalemic Myopathy in Pregnancy Caused by Clay Ingestion

BACKGROUND We present a case of severe hypokalemic myopathy during pregnancy caused by clay ingestion. CASE A multigravida presented with fatigue, muscle weakness, and a 3-day history of extremity pain. Serum potassium levels were 1.5 mEq/L, requiring intravenous potassium replacement. The initial evaluation was unrewarding for the cause of the patient's hypokalemia until a family member reported that the patient frequently ate large quantities of clay. Discontinuation of clay ingestion led to normalization of potassium levels. CONCLUSION Pica, the persistent ingestion of nonnutritive substances, can cause a number of medical problems. Pica of clay, called geophagia, can bind potassium in the intestine, leading to severe hypokalemic myopathy. Clinicians caring for pregnant women with fatigue, muscle weakness, and hypokalemia should consider geophagia as a possible cause.