Patients In Other Age Groups Research Articles

Incidence and characteristics of the 2009 influenza (H1N1) infections in inflammatory bowel disease patients

BackgroundIn 2009, influenza A (H1N1) infections spread worldwide. Because the use of immunomodulators is associated with an increased risk of infection, inflammatory bowel disease (IBD) patients who are on immunomodulators might be concerned about H1N1 influenza infections. The aim of this study was to investigate the age distribution and risk factors associated with H1N1 influenza of IBD patients in 2009–2010. MethodsA multicenter, prospective study was conducted, and 570 IBD patients were enrolled. Patients were followed up for 10months to identify any new infections. The incidence and age distribution of the H1N1 influenza infections were analyzed. IBD patients with H1N1 influenza infections and 2 matched, noninfected IBD patients were selected to assess the effect of specifying the medication on the incidence of infections. ResultsA total of 38 patients (6.7%) developed H1N1 influenza infections. The incidence of H1N1 influenza infections in patients aged less than 20years was significantly higher than that among patients in other age groups (p<0.01). The age distribution for H1N1 influenza infections in IBD patients was comparable to those in the general population. No patients needed hospitalization due to influenza infection. A total of 29 patients (76%) recovered from the H1N1 influenza symptoms within 7days and 20 patients (53%) received antiviral treatment. The percentage of patients who used steroids or thiopurine was comparable between the cases of H1N1 influenza infection and the control group. ConclusionOur prospective study showed that younger IBD patients were frequently infected with the influenza A (H1N1) virus as well as general population. Admission and fatal cases due to H1N1 influenza infections were not observed.

Epidemiology of pediatric hand injuries presenting to United States emergency departments, 1990 to 2009

The goal of this study is to describe the epidemiology of hand injuries among children treated in US emergency departments (EDs), including the consumer products and activities most commonly associated with these injuries. A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System for patients younger than 18 years, who were treated in an ED for hand injuries from 1990 through 2009. Sample weights were applied to calculate national estimates, and US Census Bureau data were used to determine injury rates. An estimated 16,373,757 (95% confidence interval: 14,082,965-18,664,551) children younger than 18 years were treated in EDs for hand injuries from 1990 through 2009 with a mean annual injury number of 818,688 and rate of 11.6 per 1,000 population. There was a statistically significant decrease in the annual number (by 20.5%) and rate (by 31.5%) of hand injuries during the 20-year study period. Males accounted for 65.3% of hand injuries. Injuries most commonly occurred in the home (57.7%) and were most frequently diagnosed as lacerations (31.3%). Patients aged 10 years to 14 years were most frequently diagnosed with fractures (26.7%) and were 1.71 (95% confidence interval: 1.68-1.75) times more likely to be diagnosed with a fracture than patients in other age groups. Hand injuries commonly occurred with products/activities associated with sports/recreational activities (36.4%). Hand injuries are a common and preventable source of pediatric morbidity. Prevention efforts should target the home environment and sport/recreational activities. Epidemiological study, level III.

P02-256 - Prevalence of mental disorders in late life

In late life patients considerably more seldom than patients of other age groups reach attention of psychiatrists due to obliteration of symptoms of mental suffering, their masked by somatic symptoms manifestation, not seldom - negative attitude of relatives toward psychiatric assistance etc.Study of patients of elder and older age at units of somatic hospital of another profile (therapeutic, cardiologic, neurological, traumatologic) has shown that mental disturbances are revealed in 74,4 % of them. Non-psychotic forms of disorders are basic (73,8 %), more seldom psychoses are found (18,6 %) and dementias of various nature (7,6 %). Of most prevalence in this contingent were disorders related with cerebral-vascular diseases (42,6 %), including those with acute disturbances of brain blood circulation (20,5 %). Somatogenic mental disorders occupy more modest place counting 8,8%. Neuroses including nosogenias are observed in 9,2 % of cases. Endogenous diseases are rarely found in patients of a somatic institution (6,7 %).In recent years significant growth of organic mental disorders in Russian Federation occurs predominantly at the expense of the elderly. In structure of this pathology as selective epidemiological investigations show the first place according to incidence rate is occupied by cerebral-vascular diseases (34,1 %); the second place is occupied by neurotic disturbances (26,0 %); the third one - affective disorders (15,4 %).Differences in sickness rate and morbidity in such conditions identified by researchers in different populations may reflect more particularly their diagnostic approaches than the true differences in incidence and prevalence.

What Should the Age Range Be for AYA Oncology?

What Should the Age Range Be for AYA Oncology?

Commentary on Supramaximal Verification of Peak Oxygen Uptake in Adolescents With Cystic Fibrosis

“How can I apply this information in adolescents with cystic fibrosis in my clinical practice?” Aerobic capacity and exercise testing are important tools within pediatric physical therapy practice, but often not a content area of comfort for the practicing pediatric physical therapist. Whereas cystic fibrosis (CF), a common pediatric disorder, requires a multidisciplinary approach, exercise testing and training, which has a critical role in the management of adolescents with CF, has received little attention. Studies have shown that higher peak VO2 and the time-dependent decline in peak VO2 assist in predicting survival in CF.1,2 Additionally, exercise training has been shown to improve aerobic fitness and is an important adjunct for mucociliary clearance.3-5 Physical therapists must continue to develop their expertise in the area of exercise testing and training, and this article describes a relatively simple means of determining exercise capacity in adolescents with CF. The accurate determination of O2 peak is critical in exercise testing and exercise prescription, yet the inconsistency between heart rate and VO2 raises some concerns that are addressed by this study. This study clarifies that O2 peak measured by traditional exercise testing does appear to reflect the true O2 peak. “What should I be mindful about in applying this information?” Pediatric therapists must continue to develop competence and expertise in the area of aerobic capacity and exercise testing. Clearly the authors are experienced with the technical aspects of exercise testing and metabolic analysis. This study specifically focused on stable adolescents with mild to moderate involvement. The clinician must be cautious to not generalize the findings to patients in other age groups or with different disease severities, including those with exercise induced hypoxemia, dysrhythmias, or patients being treated for a CF exacerbation. Whereas it is tempting to use the Steep Ramp test (SRT) as a measure of exercise capacity, additional validation of the SRT must be completed as noted by the authors. Until then, standard cardiopulmonary exercise testing (CPET) based on heart rate and work load increments should remain the standard of care.

Pain and Other Side Effects after MR Arthrography: Prospective Evaluation in 1085 Patients

To prospectively evaluate pain and other side effects after magnetic resonance (MR) arthrography. Institutional review board approval and patient informed consent were obtained. MR arthrography was performed in 1085 patients. In 1011 patients, 2 mmol/L gadopentetate dimeglumine was injected. In patients whose wrists were examined, 5 mmol/L gadoterate dimeglumine was injected. Pain was measured directly after injection, 4 hours after injection, 1 day [18-30 hours] after injection, and 1 week [6-8 days] after injection and compared with pain at baseline (before contrast material was injected). A visual analogue scale or verbal rating scale (score range, 0-10) was used to measure pain. When increased pain persisted at the end of the observation period, additional assessment was performed to exclude infection. Evaluated factors with a potential effect on pain were time after injection, joint type, contrast agent volume, patient age and sex, and radiologist experience. Repeated measures analysis of variance was used. Mean pain increase was most pronounced 4 hours after injection (P < .0001). This increase was most pronounced in the hip, followed by the elbow, knee, wrist, ankle, and shoulder. (Differences between joints were not significant [P = .26].) Pain scores returned to baseline levels 1 week after injection. Patients younger than 30 years had more pronounced pain than did patients in other age groups at all time points (P = .044). Joint type, contrast agent volume (P = .44), patient sex (P = .29), and radiologist experience (P = .10) did not significantly affect pain scores. No patient had infection or any other severe side effect. Besides joint pain, minor side effects included pressure, headache, muscle ache, swollen hand, fatigue, vertigo, increased blood glucose level, and pruritus. MR arthrography temporarily increases joint-related pain. Such pain depends on patient age but not on joint type, contrast material volume, patient sex, or radiologist experience.

The challenges of clinical trials for adolescents and young adults with cancer

In the United States, Europe, and Australia, and probably all countries of the world, older adolescents and young adults with cancer are under-represented in clinical trials of therapies that could improve their outcome. Simultaneously, the survival and mortality rates in these patients have mirrored the clinical trial accrual pattern, with little improvement compared with younger and older patients. This suggests that the relative lack of participation of adolescent and young adult patients in clinical trials has lessened their chances for as good an outcome as that enjoyed by patients in other age groups. Thus, increased availability of and participation in clinical trials is of paramount important if the current deficits in outcome in young adults and older adolescents are to be eliminated. Regardless of whether there is a causal relationship, the impact of low clinical trial activity on furthering our scientific knowledge and management of cancer during adolescence and early adulthood is detrimental.

Caring for the New Uninsured: Hospital Charity Care for Older People without Coverage

Despite near-universal coverage through Medicare, a number of elderly residents in the United States do not have health insurance coverage. To the author's knowledge, this study is the first to document trends in the use of hospital charity care by uninsured older people. Data from the New Jersey Charity Care Program, which subsidizes hospitals for services provided to low-income uninsured people, were used to analyze trends in charity care utilization by older people from 1999 to 2004. Charity care charges are standardized to uniform Medicaid reimbursement rates and inflation adjusted using the Medical Care Consumer Price Index. From 1999 to 2004, use of charity care by older people grew much faster than it did for younger patients. As a result, older people now account for a greater share of hospital charity care in New Jersey than children. Elderly users of charity care generated higher costs per patient than their younger counterparts. Cost differences were especially salient at the upper end of the distribution, where high-cost elderly patients used significantly more resources than high-cost patients in other age groups. These results highlight an emerging source of strain on the healthcare safety net and point to a growing population of uninsured residents who have costly and complex medical needs. Similar experiences are likely to be found in other states, especially those that have growing populations of elderly immigrants who are likely to lack health insurance.

Relationship Between Patient Age and Duration of Physician Visit in Ambulatory Setting: Does One Size Fit All?

To determine whether patient age, the presence of comorbid illness, and the number of prescribed medications influence the duration of a physician visit in an ambulatory care setting. A cross-sectional study of ambulatory care visits made by adults aged 45 and older to primary care physicians. A probability sample of outpatient follow-up visits in the United States using the National Ambulatory Medical Care Survey (NAMCS) 2002 database. Of 28,738 physician visits in the 2002 NAMCS data set, there were 3,819 visits by adults aged 45 and older included in this study for analysis. The primary endpoint was the time that a physician spent with a patient at each visit. Covariates included for analyses were patient characteristics, physician characteristics, visit characteristics, and source of payment. Visit characteristics, including the number of diagnoses and the number of prescribed medications, the major diagnoses, and the therapeutic class of prescribed medications, were compared for different age groups (45-64, 65-74, and > or =75) to determine the complexity of the patient's medical conditions. Endpoint estimates were computed by age group and were also estimated based on study covariates using univariate and multivariate linear regression. The mean time+/-standard deviation spent with a physician was 17.9+/-8.5 minutes. There were no differences in the duration of visits between the age groups before or after adjustment for patient covariates. Patients aged 75 and older had more comorbid illness and were prescribed more medications than patients aged 45 to 64 and 65 to 74 (P<.001). Patients aged 75 and older were also prescribed more medications that require specific monitoring and counseling (warfarin, digoxin, angiotensin-converting enzyme inhibitors, diuretics, and levothyroxine) than were patients in other age groups (P<.001). Hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, cerebrovascular disease, and transient ischemic attack were more common in patients aged 75 and older than in other age groups (P<.001). Despite these differences, there were no differences in unadjusted or adjusted duration of physician visit between the age groups. Although patients aged 75 and older had more medical conditions and were at higher risk for drug-related problems than younger patients, the duration of physician visits was similar across the age groups. These findings suggest that elderly patients may require a multidisciplinary approach to optimize patient care in the ambulatory setting.

Young adults with cancer: parents' interactions with health care professionals.

This paper examines the relationship between medical professionals and parents of young adults who are being treated by them for cancer. This study aims to discover what practices and procedures make the cancer journey easier or more difficult to manage for parents in the medical setting. Many studies of carers focus on spouses, little attention has been paid to parents of young adults in this context. Self-selected parents responded to an appeal for narratives about their adult son or daughter's cancer experience. A narrative correspondence method was used relying on contributions of a qualitative nature submitted in written form and analysed through the identification of emerging themes. Interactions with health professionals have a far-reaching effect on parents' experience. A clear understanding needs to be established at an early stage with agreement by all parties on how information and decision making should be shared. If parents feel excluded or uninformed about procedures, or believe that their son or daughter is receiving less than optimum care, this results in feelings of helplessness and frustration. While many of the issues identified in this paper might apply to relatives of cancer patients in other age groups, the effect of life stage during young adulthood exacerbates the complexities of the medical setting.

11p15 translocations involving theNUP98 gene in childhood therapy-related acute myeloid leukemia/myelodysplastic syndrome

In a survey of childhood therapy-related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) in Japan, we found 11p15 translocations in 5 (6%) of 81 children with t-AML/MDS. t(11;17)(p15;q21), t(11;12)(p15;q13), t(7;11)(p15;p15), inv(11)(p15q22), and add(11)(p15) were each found in one patient. Southern blotting and/or RT-PCR analyses revealed rearrangements of the NUP98 gene in tumor samples of all five patients. Rearrangements of DDX10 were detected in t-AML/MDS cells with inv(11), and rearrangements of HOXA9 were detected in t-AML cells with t(7;11). The 17q21 breakpoint of t(11;17) and the 12q13 breakpoint of t(11;12)(p15;q13) coincided with the loci of the HOXB and HOXC gene families, respectively. Therefore, it is reasonable to speculate that one of the HOXB genes and one of the HOXC genes were fused to NUP98 by t(11;17) and t(11;12), respectively, in t-AML/MDS cells. We propose that NUP98 may be a target gene for t-AML/MDS, and that t-AML/MDS with a fusion of NUP98 and HOX or DDX10 genes may be more frequent in children than in patients of other age groups.

The old get equal care: myth or reality.

A national ethics survey was conducted of all registered nurses participating in post-basic specialisation nursing courses in Israel over a one-year period (1994-95) to identify ethical situations which confront Israeli nurses caring for patients of different age groups and in different clinical settings. This study compares the responses of those nurses caring for elderly patients (60 years or older) with those caring for adult patients in other age groups. Nurses caring for the elderly reported encountering ethical dilemmas in 16 out of 37 situations presented to them, more than in the other adult patient age groups. The most frequent dilemmas were concerning mistaken or questionable treatment, patient-family conflict, patient referral to an institution or discharge to the home where the family is incapable of caring for him, offensive behaviour by caregivers and physical restraint of the patient for staff convenience. It is recommended that nursing ethics intervention programmes be established to promote ethical decision making and patients' rights.

Cardiac rehabilitation in the elderly: improving effectiveness.

Heart disease is a major cause of mortality and morbidity among adults who are older than 65 years of age. One-third of cardiac operations on adults in the United States are performed on patients who are more than 65 years old, and almost half of the hospitalized candidates for an outpatient cardiac rehabilitation programs are in the older patient population. Structured educational program that include exercise and modification of risk factors have been shown to reduce the risk of subsequent coronary events; however, studies show that older adults enroll in these programs at a significantly lower rate than do patients in other age groups. Nurses and other healthcare professionals must eliminate barriers to participation and adapt their programs to meet the needs of older adults with cardiac disease to reduce morbidity, enhance functioning, and improve quality of life. In this article, the authors describe current knowledge about the efficacy and use of cardiac education and rehabilitation in elderly patients and suggest implications for future practice and research.

ABC of one to seven. Services for children: primary care.

The general practitioner provides continuous care for the whole family, and his intimate knowledge of the fears and aspirations of each individual enables him to act as a trusted counsellor in both preventive and curative medicine. Specialists in the community or hospital provide the support he requests. About 25% of the work of the general practitioner concerns children, and he recognises that their needs are different from those of patients in other age groups because they are both dependent and developing. Unfortunately, the primary care of children is still divided: general practitioners provide a mainly treatment service (for those who seek it) while the clinical medical officers of the child health and school health services provide a surveillance, prevention, and health education service. General practitioners are performing an increasing amount of preventive work stimulated by the report Healthier Children? Thinking Prevention from the Royal College of General Practitioners in 1982.

Transfusion and alloimmunization in sickle cell disease. The Cooperative Study of Sickle Cell Disease

In 1,814 patients with sickle cell disease who had been transfused, the overall rate of alloimmunization to erythrocyte antigens was 18.6%. The rate of alloimmunization in this group appears to be an explicit function of the number of transfusions received because it increases exponentially with increasing numbers of transfusions. Alloimmunization usually occurred with less than 15 transfusions, although the rate of alloimmunization continued to increase when more transfusions were given. The rate of alloimmunization was less in patients with hemoglobin SC disease and sickle-beta+ thalassemia because these patients had received fewer transfusions. Children less than 10 years old had a slightly lower rate of alloimmunization than patients in other age groups even after correction for the number of transfusions given. Women were more frequently alloimmunized than men; this was largely due to the fact that women received more transfusions than men, but in the age group 16 to 20 years the increase may have been due in part to alloimmunization owing to pregnancy. Forty-five percent of those alloimmunized made antibodies of only one specificity; 17% made four or more antibodies reacting with different antigens. Antibodies to the C and E antigens of the Rh group, the Kell antigen, and the Lewis antigens were most commonly made. These findings may be important in formulating a rational transfusion policy in sickle cell disease.

Transfusion and Alloimmunization in Sickle Cell Disease

In 1,814 patients with sickle cell disease who had been transfused, the overall rate of alloimmunization to erythrocyte antigens was 18.6%. The rate of alloimmunization in this group appears to be an explicit function of the number of transfusions received because it increases exponentially with increasing numbers of transfusions. Alloimmunization usually occurred with less than 15 transfusions, although the rate of alloimmunization continued to increase when more transfusions were given. The rate of alloimmunization was less in patients with hemoglobin SC disease and sickle-beta+ thalassemia because these patients had received fewer transfusions. Children less than 10 years old had a slightly lower rate of alloimmunization than patients in other age groups even after correction for the number of transfusions given. Women were more frequently alloimmunized than men; this was largely due to the fact that women received more transfusions than men, but in the age group 16 to 20 years the increase may have been due in part to alloimmunization owing to pregnancy. Forty-five percent of those alloimmunized made antibodies of only one specificity; 17% made four or more antibodies reacting with different antigens. Antibodies to the C and E antigens of the Rh group, the Kell antigen, and the Lewis antigens were most commonly made. These findings may be important in formulating a rational transfusion policy in sickle cell disease.