Risk Of Medical Problems Research Articles

Türk Çocuklarında Baş Çevresinin Normal Değerleri

Objective: Measuring head circumference is a quick, simple, cheap, noninvasive and reliable procedure for determining underlying brain size and provides information about risk for medical problems. Growth percentages of head vary from one community to another.
 Methods: We aim to create head circumference growth curves for children aged 0-18 years in Turkish community. Measurements were performed by same person using a rigid and calibrated tape meter. In addition, the parents were asked to fill out a questionnaire with variables that could affect children's growth.
 Results: Data analysis has shown that there is no relationship between the children's head circumference and whether there exists someone with a large/small head circumference in their families, or the average monthly income of their families and the parent’s education level. Only the independent variables child’s school performance, birth weight, nutrition, smoking are significantly effective on the HC measures of boys at alpha=0.05 level. For girls, only the independent variables birth weight and nutrition form are significantly important in explaining the variability of HC at the level of alpha=0.05. One gram increase in birth weight causes a 0.001 cm increase in the HC of both genders. In addition, head circumference growth curves were created for both genders to include all children aged 0-18.
 Conclusions: Our study offers recent and gender-specific head circumference norms. These new values can be used more effectively in child follow-up.

Toxic reactions of skin

Skin is the most frequent target of drug reactions, possibly due to their easy identification. Up to 90 % of the symptoms are related to drug hypersensitivity. Medicinal rashes are caused by systemic drugs. Most drugs can induce erythematous rashes in almost 1 % of patients. Clinical manifestations of drug eruptions have a significant variability. Polypragmasy aggravates the risk of medical problems and worsens health.

Willingness to Engage in Health Behavior Change Interventions Among Primary Care Patients Positive For Tobacco Use and At-Risk Drinking.

To examine intervention preferences of primary care patients who recently screened positive for tobacco use and at-risk drinking. Primary care patients who screened positive for recent tobacco use and at-risk drinking were eligible to participate in a one-time telephone-based survey conducted from August 2015 to December 2015. The survey asked questions about how willingness to engage in an intervention in integrated primary care was influenced by the described format and focus of the intervention. Data from patients who smoked cigarettes and met criteria for at-risk drinking in the last 30 days (N = 53) were included in the analyses. Participants reported that they would be more willing to engage in an intervention focused on helping them reduce their risk of medical problems than in services focused specifically on discussing cigarette or alcohol use (P = .00). Participants did not indicate a preference related to whether the intervention was delivered during a primary care appointment, immediately following a primary care appointment, or as a scheduled follow-up (P = .693). Patients may be more willing to engage in a behavior intervention when general health is emphasized over a focus specifically on tobacco or alcohol use. Patients were equally receptive to receiving brief interventions in several different formats available within an integrated primary care setting.

Retinoblastoma survivors have an increased risk of medical problems as adults

Retinoblastoma survivors have an increased risk of medical problems as adults

Sex workers’ access to psychosocial health care in Flanders, Belgium

Background Sex workers (SW) are a socially vulnerable group. Due to stigma and exceptional working conditions, SW often cannot access the regular health care system. Not only do SW have a higher risk of medical problems such as sexually transmitted infections, psychosocial problems such as violence and drug use are also more common in this group. In Flanders, Belgium, non-profit organisations Ghapro and Pasop provide free of charge and anonymous preventive medical and social assistance to SW. …

Development and evaluation of a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence

Aims: To develop and evaluate a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence. Methods: A retrospective audit of attendances at a diabetes outpatient clinic at a public, teaching hospital over a 16-month period was conducted. Logistic regression was undertaken to examine risk factors associated with medication problems relating to hypoglycaemia and medication non-adherence and the most predictive set of factors comprise the Diabetes Medication Risk Screening Tool. Evaluating the tool involved assessing sensitivity and specificity, positive and negative predictive values, cut-off scores, inter-rater reliability, and content validity. Results: The Diabetes Medication Risk Screening Tool comprises seven predictive factors: Age, living alone, English language, mental and behavioural problems, comorbidity index score, number of medications prescribed, and number of high-risk medications prescribed. The tool has 76.5% sensitivity, 59.5% specificity, and has a 65.1% positive predictive value, and a 71.8% negative predictive value. A score of 27 or more out of 62 was associated with high-risk of a medication problem. The inter-rater reliability of the tool was high (κ = 0.79, 95% CI 0.75–0.84) and the content validity index was 99.4%. Conclusion: The Diabetes Medication Risk Screening Tool has good psychometric properties and can proactively identify people with diabetes at greatest risk of medication problems relating to hypoglycaemia and medication non-adherence.

Development and evaluation of a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence.

Abstract Aims: To develop and evaluate a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence. Methods: A retrospective audit of attendances at a diabetes outpatient clinic at a public, teaching hospital over a 16-month period was conducted. Logistic regression was undertaken to examine risk factors associated with medication problems relating to hypoglycaemia and medication non-adherence and the most predictive set of factors comprise the Diabetes Medication Risk Screening Tool. Evaluating the tool involved assessing sensitivity and specificity, positive and negative predictive values, cut-off scores, inter-rater reliability, and content validity. Results: The Diabetes Medication Risk Screening Tool comprises seven predictive factors: age, living alone, English language, mental and behavioural problems, comorbidity index score, number of medications prescribed, and number of high-risk medications prescribed. The tool has 76.5% sensitivity, 59.5% specificity, and has a 65.1% positive predictive value, and a 71.8% negative predictive value. A score of 27 or more out of 62 was associated with high-risk of a medication problem. The inter-rater reliability of the tool was high (κ = 0.79, 95% CI 0.75 - 0.84) and the content validity index was 99.4%. Conclusion: The Diabetes Medication Risk Screening Tool has good psychometric properties and can proactively identify people with diabetes at greatest risk of medication problems relating to hypoglycaemia and medication non-adherence.

Development and evaluation of a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence.

Abstract Aims: To develop and evaluate a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence. A retrospective audit of attendances at a diabetes outpatient clinic at a public, teaching hospital over a 16-month period was conducted. Logistic regression was undertaken to examine risk factors associated with medication problems relating to hypoglycaemia and medication non-adherence and the most predictive set of factors comprise the Diabetes Medication Risk Screening Tool. Evaluating the tool involved assessing sensitivity and specificity, positive and negative predictive values, cut-off scores, inter-rater reliability, and content validity. The Diabetes Medication Risk Screening Tool comprises seven predictive factors: Age, living alone, English language, mental and behavioural problems, comorbidity index score, number of medications prescribed, and number of high-risk medications prescribed. The tool has 76.5% sensitivity, 59.5% specificity, and has a 65.1% positive predictive value, and a 71.8% negative predictive value. A score of 27 or more out of 62 was associated with high-risk of a medication problem. The inter-rater reliability of the tool was high (κ = 0.79, 95% CI 0.75-0.84) and the content validity index was 99.4%. The Diabetes Medication Risk Screening Tool has good psychometric properties and can proactively identify people with diabetes at greatest risk of medication problems relating to hypoglycaemia and medication non-adherence.

General practitioners’ attitudes towards decision-supported prescribing: An analysis of the Dutch primary care sector

The use of multiple drugs by patients increases the risk of medical problems. Clinical decision support could assist general practitioners with prescribing but is underused. This article aims to investigate the attitudes of general practitioners towards using decision support systems. A survey was distributed among 500 Dutch general practitioners. Virtually all 184 respondents indicated having a clinical information system, while only 21 percent indicated having a decision support plug-in; this correlated with their use of medical formularies. Only use of one of the medical formularies correlated with the number of recognized underprescription problems. General practitioners' attitudes toward a newly proposed system aiding them with polypharmacy prescribing were mainly positive (57%); the perceived usefulness correlated with output quality (p = .000), time investment (p = .000), and financial stimuli (payability: p = .000 and reimbursement: p = .015) but not with job relevance. Dutch general practitioners are thus likely to adopt the proposed system under the conditions that it improves prescription quality and does not require extensive investments of time or money.

Sleep: A Good Investment in Health and Safety

ABSTRACT Sleep management is critical to both good health and safety. Most people do not know how much sleep is needed and place themselves and sometime others at risk for medical problems and increased risk for injuries or fatal accidents. Sleep need is discussed and the amount of sleep required as a function of age is provided. Agriculture is a high-risk industry with many injury-related or fatal accidents. SLEEP Model, a Web-based simulation model, was used to predict increase in odds ratio for injuries for farmers and other professionals who tend to work with a buildup of sleep debt because of the nature of their work. Results are given for working the day after a night of no sleep with and without use of caffeine and for a gradual buildup of sleep debt for daily sleep amounts of 0, 2, 4, 5, and 5.5 hours of sleep for a 58-year-old person with predicted sleep need of 6.2 hours per day. Results were also compared to some measurements reported in the literature. Odds ratio of about 10 times normal for average of caffeine and non-caffeine use are associated with working a day after no sleep and no previous sleep debt or with a gradual buildup of sleep debt typical of farmers involved in planting and harvesting seasons. Generally, caffeine use can reduce risks by about 70 times but may have little benefit for a night of no sleep after a buildup of severe sleep debt.

An Interdisciplinary Medication Management Program for Seniors in the Community

Background: The call for medication management programs (MMPs) is growing, as evidence of inappropriate prescribing and medication use in seniors accumulates. Seniors in social and supportive housing programs are likely at high risk of medication problems by virtue of their socioeconomic status and/or frailty. Yet there are few published reports of MMPs in such settings. Aim: To assess the need for medication management support for seniors in a supportive housing setting; to profile a pharmacist's medication management interventions; and to evaluate the costs, barriers, facilitators, and impact of a MMP. Method: Eleven seniors' apartment buildings in Peel region, served by 1 supportive housing provider, were randomized to experimental or control groups. Seniors in experimental buildings were referred to the MMP by supportive housing supervisors, health care professionals, or themselves. A pharmacist conducted in-home medication reviews. Her drug therapy assessment and recommendations were faxed to the family physician, and shared with other health care providers and caregivers as appropriate. Medication counselling and management aids were provided as needed. On average, clients received 1.7 follow-up visits or phone calls. Medication regimen complexity, adherence, and costs will be compared between groups at 3 months. Additional measures in the experimental group include number of pharmacist-identified medication problems and interventions, acceptance of prescribing recommendations, client and health care provider satisfaction, and service cost. Results: Almost 100 clients have received the service. Of the first 50 clients, 83% were female, with a mean age of 77.7 years and an average of 8 prescription drugs and 2 nonprescription medicines each. The pharmacist identified 2.5 medication problems per client and made 1.7 prescriber interventions and 1.1 client interventions. The most common medication problem (31%) was needing an additional drug and 67% of prescribing recommendations were known to be adopted or accepted. The service required 3.9 hours of pharmacist time per client. Data analysis is in progress. Implications for pharmacists: In-home medication management reviews improve seniors' drug therapy. Opportunities exist for pharmacists to provide this service in nontraditional settings, such as supportive housing or home care programs, thus increasing access and integrating primary care and community care providers in a coordinated medication support system for seniors.

Are Cesareans Performed Too Often on Older, Nulliparous Infertility Patients?

Risk for medical problems during pregnancy and risk for cesarean section both increase with age. These authors studied whether infertility treatment

Pathophysiology of obesity.

The rapidly rising prevalence of obesity, worldwide, has prompted re-evaluations of the definitions and diagnostic criteria, and of the extent of the burden it contributes to health care services. Although categorized arbitrarily for epidemiological purposes according to BMI > 25 kg/m2 ('overweight') and BMI > 30 kg/m2 ('obese'), the disease itself (ICD code E.66) is the process of excess fat accumulation. It leads to multiple organ-specific pathological consequences, particularly if there is a tendency to intra-abdominal fat accumulation. The simplest field method to identify obesity and risk of medical problems is the waist circumference, and this method has found a special role in health promotion. Risks begin with waist > 80 cm (women) or > 94 cm (men). As a broad generalization, obesity produces few symptoms below the age of 40 years, but then several symptoms often develop; tiredness, breathlessness, back pain, arthritis, sweatiness, poor sleeping, depression and menstrual disorders all being common. The symptoms are often attributed to diseases in other body systems. Metabolic diseases like diabetes, hyperlipidaemia and, hypertension develop later, but the mean BMI at diagnosis of diabetes is 28 kg/m2. Ultimately, obesity increases the likelihood of myocardial infarction, stroke and several major cancers, but its biggest impact on health, especially in the elderly, is probably the multiplicity of effects on other body systems. The greatest challenge for public health is to develop effective preventive measures, recognizing that BMI > 25 kg/m2 before the age of 20 years is a very strong predictor of obesity and ill health in adulthood.

THE FEMALE ATHLETE TRIAD

The opportunities for girls and women to play soccer has rapidly grown and gained acceptance in recent years. The benefits of involvement in soccer, both physically and psychologically, are overwhelmingly positive. Despite the benefits, girls and women involved in soccer are also at risk for medical problems as a result of their sports participation. Amenorrhea, disordered eating, and premature osteoporosis are entities known together as The Female Athlete Triad. The triad occurs in all sports and is associated with significant short- and long-term health consequences, and thus remains a concern for all involved in the care of the soccer athlete.

The clinical chemistry and immunology of long-duration space missions

Clinical laboratory diagnostic capabilities are needed to guide health and medical care of astronauts during long-duration space missions. Clinical laboratory diagnostics, as defined for medical care on Earth, offers a model for space capabilities. Interpretation of laboratory results for health and medical care of humans in space requires knowledge of specific physiological adaptations that occur, primarily because of the absence of gravity, and how these adaptations affect reference values. Limited data from American and Russian missions have indicated shifts of intra- and extracellular fluids and electrolytes, changes in hormone concentrations related to fluid shifts and stresses of the missions, reductions in bone and muscle mass, and a blunting of the cellular immune response. These changes could increase susceptibility to space-related illness or injury during a mission and after return to Earth. We review physiological adaptations and the risk of medical problems that occur during space missions. We describe the need for laboratory diagnostics as a part of health and medical care in space, and how this capability might be delivered.

The Pill: A Closer Look

This article summarizes the major risks and benefits of oral contraceptive (OC) use for specific categories of users. Major risks associated with OC use include vascular and circulatory disorders, hypertension, cancer, and other conditions such as gallbladder disease. There are also numerous minor side effects, e.g., breast tenderness, weight changes, yeast infections. Most of these side effects are attributed either to estrogen or progestin, which mimic excesses or deficiencies in the natural hormonal balance. These symptoms can often be reversed through alterations in the hormonal content of the OC. There have been numerous recent reports regarding the protective effect of OC use against conditions such as benign breast disease, ovarian and endometrial cancer, pelvic inflammatory disease, ectopic pregnancy, and rheumatoid disease. The risks and benefits for potential users can only be evaluated through reference to data from the relevant population group, taking into account factors such as age, race, heredity, potential predisposition for disease, and social habits. Information about the risk of medical problems in specific population groups must be weighed against the risk for those problems in the same population when combined with OC treatment. The benefits of the drug must also be weighed against the number and degree of risks found for the specific user. The convenience and efficacy associated with OCs can far outweigh the risks, inconveniences, and less impressive efficacy of other contraceptive methods in many cases. However, women over age 35 years, especially smokers, should use alternative methods of contraception. New hormonal contraceptive formulations and different modes of drug delivery are currently under development. However, several years of scientific investigation will be required to evaluate the longterm advantages or disadvantages of the newer experimental drugs compared with present OCs.