Sought Medical Attention Research Articles

Self-reported acute injury and chronic pain in American equestrian athletes

Abstract The use of trauma databases for epidemiological study of equestrian injuries is well established. However, such databases fail to capture minor injuries or injuries when medical attention is not sought. Additionally, concerns about chronic pain in equestrians have only been explored in small samples. The current study is the first nationwide survey of American equestrians 12 years and older participating in all equestrian disciplines. This study aimed to evaluate the patterns of self-reported acute injuries, behaviours of seeking medical attention for acute injuries, and chronic pain. A convenience sample of 2,573 American equestrians completed an anonymous online survey with questions on acute injury anatomical region, type, and if they sought medical attention. Additional questions identified frequency and location of chronic pain. In total, 2,049 survey responses were complete, with 96% female and representation from all regions of the United States. Participation status (PS) was categorised as professionals (19%), amateurs (43%), and recreational (38%). PS was associated with acute injury and chronic pain frequency. Only 3.9% had never experienced an acute injury from equestrian activity. Of all injuries, foot injuries were most reported (13% of all injuries; 52% of participants) with only 39% seeking medical attention. Professionals had higher odds of experiencing acute injuries in most anatomical regions. 42% indicated they had encountered a concussion; of those, 71% sought medical assistance due to a suspected concussion. Chronic back pain frequency was reported at 27.5%. This study is the first to evaluate self-reported injury in a large convenience sample of American equestrians. The current study found a higher rate of lower extremity injuries in equestrians than previously captured in trauma databases. Prior concussion and acute injury increased the odds of individuals experiencing regional chronic pain, suggesting that future studies and interventions should focus on improving preventative and rehabilitative care.

Bone parameters of elite athletes with oligomenorrhea and prevalence seeking medical attention: a cross-sectional study

Since the definition of secondary amenorrhea is cessation of regular menses for more than 3 months, it is likely that athletes with irregular menstrual cycles, including oligomenorrhea, do not consider the condition as serious. However, the consequences of untreated oligomenorrhea have not been investigated in elite track and field athletes. The cohort consisted of 91 elite-level track and field athletes. Body compositions, including bone parameters and bone turnover markers (BTMs), were measured. Among the 91 participants, 52 were eumenorrheic and 33 were oligomenorrheic. The eumenorrheic athletes had significantly higher bone mineral density (BMD) and bone mineral content (BMC) of the lumbar spine, lower extremities, and whole body than had the oligomenorrheic athletes (p < 0.01). There were no significant differences in BTMs between the two groups, but oligomenorrheic athletes had significantly lower percent body fat. More than 40% of the elite-level female track and field athletes in this study reported menstrual disorders with oligomenorrhea as the most common. However, none sought medical attention. As compared to the eumenorrheic athletes, the oligomenorrheic athletes had lower BMC and BMD. Hence, if an athlete is oligomenorrheic, bone parameter measurements are considerably important.

Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis

SummaryBackgroundDiagnosis of transient ischaemic attacks (TIAs) can be difficult. There is consensus on classic symptoms (eg, motor weakness, dysphasia, hemianopia, monocular visual loss) but no consensus on several monosymptomatic events with sudden-onset, non-progressive, focal negative symptoms (eg, isolated diplopia, dysarthria, vertigo, ataxia, sensory loss, and bilateral visual disturbance), with much variation in investigation and treatment.MethodsWe prospectively ascertained and investigated all strokes and sudden onset transient neurological symptoms in a population of 92 728 people (no age restrictions) from Oxfordshire, UK, who sought medical attention at nine primary care practices or at the John Radcliffe Hospital, Oxford, UK (Oxford Vascular Study). Patients classified at baseline with minor ischaemic stroke (National Institutes of Health Stroke Score <5), classic TIA, or non-consensus TIA were treated according to secondary prevention guidelines. Risks of stroke (7-day, 90-day, and 10-year risks) and risks of all major vascular events (from the time of first event, and from the time of seeking medical attention) were established by face-to-face follow-up visits and were compared with the risk expected from age and sex-specific stroke incidence in the underlying study population.FindingsBetween April 1, 2002, and March 31, 2018, 2878 patients were identified with minor ischaemic stroke (n=1287), classic TIA (n=1021), or non-consensus TIA (n=570). Follow-up was to Oct 1, 2018 (median 5·2 [IQR 2·6–9·2] years). 577 first recurrent strokes after the index event occurred during 17 009 person-years of follow-up. 90-day stroke risk from time of the index event after a non-consensus TIA was similar to that after classic TIA (10·6% [95% CI 7·8–12·9] vs 11·6% [95% CI 9·6–13·6]; hazard ratio 0·87, 95% CI 0·64–1·19; p=0·43), and higher than after amaurosis fugax (4·3% [95% CI 0·6–8·0]; p=0·042). However, patients with non-consensus TIA were less likely to seek medical attention on the day of the event than were those with classic TIA (336 of 570 [59%] vs 768 of 1021 [75%]; odds ratio [OR] 0·47, 95% CI 0·38–0·59; p<0·0001) and were more likely to have recurrent strokes before seeking attention (45 of 570 [8%] vs 47 of 1021 [5%]; OR 1·77, 95% CI 1·16–2·71; p=0·007). After excluding such recurrent strokes, 7-day stroke risk after seeking attention for non-consensus TIA (2·9% [95% CI 1·5–4·3]) was still considerably higher than the expected background risk (relative risk [RR] 203, 95% CI 113–334), particularly if the patient sought attention on the day of the index event (5·0% [2·1–7·9]; RR 300, 137–569). 10-year risk of all major vascular events was similar for non-consensus and classic TIAs (27·1% [95% CI 22·8–31·4] vs 30·9% [27·2–33·7]; p=0·12). Baseline prevalence of atrial fibrillation, patent foramen ovale, and arterial stenoses were also similar for non-consensus TIA and classic TIA, although stenoses in the posterior circulation were more frequent with non-consensus TIA (OR 2·21, 95% CI 1·59–3·08; p<0·0001).InterpretationPatients with non-consensus TIA are at high early and long-term risk of stroke and have cardiovascular pathological findings on investigation similar to those of classic TIA. Designation of non-consensus TIAs as definite cerebrovascular events will increase overall TIA diagnoses by about 50%.FundingWellcome Trust, National Institute for Health Research Oxford Biomedical Research Centre, Wolfson Foundation, Masonic Charitable Foundation, and British Heart Foundation.

Relationship between impaired work function and coping behaviors in workers with low back pain.

ObjectivesThe aim of the present study was to clarify the relationship between work functional impairment levels and three coping behaviors of workers with low back pain, which were about seeking medical attention, taking over‐the‐counter drugs, and taking self‐care.MethodsWe conducted a cross‐sectional study on 14 Japanese companies in 2016. Work function impairment was measured using the Work Functioning Impairment Scale. Logistic regression analyses were conducted for the three coping behaviors and odds ratios (ORs) calculated for work functional impairment levels.ResultsWe analyzed 2232 subjects; 226 were women and 790 worked on production lines. 688 workers had sought medical attention, 436 had taken over‐the‐counter medication, and 1225 had engaged in self‐care. Those seeking medical attention were associated with severe work function impairment compared with no work function impairment (adjusted OR = 2.84, 95% confidence interval: 1.82–4.45, p < .001). We observed a trend for the association between over‐the‐counter drug use with high levels of work function impairment (adjusted OR: 1.19 for low, 1.35 for moderate, 1.65 for severe). There was no apparent relationship between self‐care and the degree of work functional impairment.ConclusionIn workers with low back pain, severe work functional impairment may promote medical attention and over‐the‐counter medication use, but it would not encourage self‐care, such as stretching or exercise. Therefore, workplaces need to provide special support to help them take care of themselves. Therefore, it is desirable to provide good support for self‐care in the workplace.

The unusual experience of managing a severe COVID-19 case at home: what can we do and where do we go?

BackgroundThe speed and reach of the COVID-19 pandemic has created special scenarios to be considered, such as those in where patients who meet criteria for hospitalization due to moderate/severe disease cannot be hospitalized due to economic constraints and saturation of national health systems. The aim of this report is to present an unusual case of a severe COVID-19 patient managed at home in a developing country, and to discuss some of the available guidelines and potential therapeutic options for this type of cases.Case presentationA 60-year-old female seeking medical attention through teleconsultation presents with profound dyspnea, oppressive chest pain, fatigue, episodic hallucinations, and difficulty sleeping, for what she originally sought medical attention at an ER but could not be admitted due to saturation of the health system. A positive PCR test for COVID-19, and a CT scan of the chest showing bilateral consolidations with ground-glass opacities confirmed the diagnosis. The patient was managed at home, with corticosteroids, nitazoxanide and a single dose of 40 mg of subcutaneous enoxaparin. Colchicine was added at the third day of treatment. Standard oxygen therapy through nasal cannula was also recommended. Daily follow-ups were established to monitor for signs of clinical improvement. Two weeks later from the initial consultation the patient presents marked improvement in her symptoms, as well as in her CT scan, which prompted in discontinuation of the medications and the oxygen therapy.ConclusionsThere are several limitations in this report regarding the clinical data and the management, but such limitations do also reflect the state of emergency and the chaos that resides in the health care systems of developing nations. For the ambulatory care of COVID-19 patients, several aspects of disease management may differ from current guidelines and basic requirements may represent a huge challenge to cover. Further research is needed to assist physicians in the daily clinical decision making, to optimize patient outcomes, and to reduce the probability of adverse scenarios of patients with COVID-19 managed in the ambulatory setting.

Medical Attention Seeking After Transient Ischemic Attack and Minor Stroke Before and After the UK Face, Arm, Speech, Time (FAST) Public Education Campaign

Risk of major stroke is high during the hours and days after transient ischemic attack (TIA) and minor stroke but is substantially reduced by urgent medical treatment. Public education campaigns have improved the response after major stroke, but their association with behavior after TIA and minor stroke is uncertain. The number of potentially preventable early recurrent strokes in patients who delay or fail to seek medical attention is unknown. To investigate the association of public education with delays and failure in seeking medical attention after TIA and minor stroke. Prospective population-based study of all patients with TIA or stroke who sought medical attention between April 1, 2002, and March 31, 2014, registered at 9 general practices in Oxfordshire, United Kingdom. Data analysis took place from July 1, 2013, to March 2, 2015. Face, Arm, Speech, Time (FAST) public education campaign in the United Kingdom. Number of early recurrent strokes in patients who delayed or failed to seek medical attention, as well as the odds of seeking urgent attention after TIA and minor stroke before vs after initiation of the public education campaign. Among 2243 consecutive patients with first TIA or stroke (mean [SD] age, 73.6 [13.4] years; 1126 [50.2%] female; 96.3% of white race/ethnicity), 1656 (73.8%) had a minor stroke or TIA. After the FAST campaign, patients with major stroke more often sought medical attention within 3 hours (odds ratio [OR], 2.56; 95% CI, 1.11-5.90; P = .03). For TIA and minor stroke, there was no improvement in use of emergency medical services (OR, 0.79; 95% CI, 0.50-1.23; P for interaction = .03 vs major stroke) or time to first seeking medical attention within 24 hours (OR, 0.75; 95% CI, 0.48-1.19; P for interaction = .006 vs major stroke). Patient perception of symptoms after TIA and minor stroke was associated with more urgent behavior, but correct perception declined after the FAST campaign (from 37.3% [289 of 774] to 27.6% [178 of 645]; OR, 0.64; 95% CI, 0.51-0.80; P < .001). One hundred eighty-eight patients had a stroke within 90 days of their initial TIA or stroke, of whom 93 (49.5%) followed unheeded TIAs for which no medical attention was sought, similar before and after the FAST campaign (43 of 538 [8.0%] before vs 50 of 615 [8.1%] after, P = .93). This study suggests that in contrast to major stroke, extensive FAST-based public education has not improved the response to TIA and minor stroke in the United Kingdom, emphasizing the need for campaigns that are tailored to transient and less severe symptoms.

Estudio retrospectivo: tendencia diagnóstica y perfil epidemiológico en la consulta otoneurológica en pacientes pediátricos, Hospital Británico de Buenos Aires, 2013-2016

Objective : Balance disorders in patients during pediatric ages are a diagnostic and therapeutic challenge for pediatricians and otorhinolaryngologists due to the difficulty of symptom description. In Latin America, there are few studies on the epidemiological profile of pediatric patients with balance disorders. The aim of this study is to describe the trends in vestibular pathology in pediatric patients seen over the last three years at Hospital Britanico de Buenos Aires. Methodology: Observational, descriptive, retrospective study. We reviewed the medical history of patients under 16 who sought medical attention due to balance disorders from 2013 to 2016. Results: Study participants had a mean age of 9.07, of whom more patients were female. The main symptoms were vertigo and dizziness in girls and dizziness in boys. The main diagnosis for both girls and boys was vestibular migraine. For patients (both boys and girls) whose main symptom was vertigo, final diagnosis was infant paroxysmal positional vertigo and vestibular migraine. Conclusions: In the population studied, the symptom most commonly leading to seeking medical attention was vertigo. More girls sought medical attention than boys, and the mean age of the total population studied was 9.07. The most frequent diagnosis, both in girls and boys, was vestibular migraine.

Risk factors for injuries in a high-altitude ultramarathon

BackgroundRisk factors for ultramarathon injuries are poorly understood.ObjectiveEffects of human and environmental factors on predicting injuries.DesignObservational study using electronic surveys prior and 10-days post-race.SettingLeadville-100 is a difficult high-altitude trail ultramarathon...

Fatal ischemic stroke in a patient receiving lenalidomide for multiple myeloma

Lenalidomide is a novel treatment that significantly increases urvival time in patients with relapsed or refractory multiple yeloma [1]. Known side effects include neutropenia, thromboytopenia and venous thromboembolism [1]. Recently, a 54-year-old female was admitted to our hospital ith a previous history of multiple myeloma. She was treated with enalidomide (25mg PO) in combination with the usual regimen f dexamethasone 40mg PO once a week. Other actual medication ncluded paracetamol, pregabaline and fentanyl patches for neuopathic pain. One week later, she was found on the floor by her on in an unconscious state. It could be reconstructed that she had een unconscious for approximately one day when she was found. ater, her brother reported that twodaysprior to admission shehad xperienced a sudden weakness on the right side of the body, for hich she had not soughtmedical attention. Besides suffering from ultiplemyeloma, hermedical historywas unremarkable. She had o previous history of smoking, vascular disease, diabetes, or any ther known risk factors for stroke. Six months previously, under uspicion of cardiac amyloidosis, she had undergone an extensive nalysis by a cardiologist which had revealed no abnormalities. Upon admission to the hospital, she was comatose (E1M4V1), ith a pathological extension of the right arm and flexion of the eft arm on a painful stimulus. Hyperreflexia and a Babinski’s sign n the right side were present. A cerebral CT-scan revealed large ypodense areas in the vascular territories of both middle cereral arteries (Fig. 1). Apart from an elevated serum creatine kinase 1499 IU/l), presumably from prolonged immobilization on the oor, laboratory investigations revealed no abnormalities. The limted options for treatmentwere discussedwith the patient’s family, ho agreed to wait and see. The patient was admitted to the eurology ward where she died the following day. No additional

Clear cell sarcoma of the nuchal region with metastasis in stomach

Clear cell sarcoma/malignant melanoma of soft parts is a rare malignant tumor that originates from the neural crest. It is most common in young men in the lower limbs, grows slowly in the form of deep localized nodes around the tendons, fascia, and aponeurosis. Prognosis is poor, local recurrences and metastases are common. We present a case of a 53-year-old patient who sought medical attention due to the presence of a tumefaction in the nuchal neck region, followed by pain, heightened sensitivity, and numbness in his right hand. After excision, histological examination, and application of immunohistochemical and histochemical methods, malignant melanoma of soft tissues was diagnosed. Fourteen months after the excision of the neck tumor, a metastatic stomach disease was diagnosed. Larger tumors with necrosis, expressed pleomorphisam, and increased mitotic activity give metastases before local recurrence. Diagnosis is set using immunohistochemical methods after surgical excision of the tumor and the prognosis of the disease depends on the size of tumor and complete surgical excision.

Population-Based Study of Behavior Immediately After Transient Ischemic Attack and Minor Stroke in 1000 Consecutive Patients

Most guidelines now recommend that patients with minor stroke or high-risk transient ischemic attack (TIA) are assessed within 24 hours of their event, but the feasibility of this depends on patients' behavior. We studied behavior immediately after TIA and minor stroke according to clinical characteristics, patients' perception of the nature of the event, and their predicted stroke risk. In a population-based study in Oxfordshire, UK, with face-to-face interview of 1000 consecutive patients with TIA and minor stroke (National Institutes of Health Stroke Scale < or =5) from 2002 to 2007 (Oxford Vascular Study), we studied delay in seeking medical attention and identified patients who did not seek attention after an initial event and only presented after a recurrent stroke. Of 1000 patients (459 TIAs, 541 minor strokes), 300 (67%) with TIA and 400 (74%) with minor stroke sought medical attention within 24 hours and 208 (47%) and 234 (46%), respectively, sought attention within 3 hours. Most patients (77%) first sought attention through their primary care physician. In patients with TIA, incorrect recognition of symptoms, absence of motor or speech symptoms, shorter duration of event, lower ABCD(2) score, no history of stroke or atrial fibrillation, and weekend presentation were associated with significantly longer delays. However, age, sex, social class, and educational level were all unrelated to either correct recognition of symptoms or to delay in seeking attention. Of 129 patients with TIA or minor stroke who had a recurrent stroke within 90 days, 41 (31%) did not seek medical attention after their initial event. These patients were more likely to have had a TIA (P=0.003), shorter duration of event (P=0.02), and a history of TIA (P=0.09) and less likely to have had motor (P=0.004) or speech symptoms (P=0.04) compared with those patients who sought medical attention for their initial event. Approximately 70% of patients do not correctly recognize their TIA or minor stroke, 30% delay seeking medical attention for >24 hours, regardless of age, sex, social class, or educational level, and approximately 30% of early recurrent strokes occur before seeking attention. Without more effective public education of all demographic groups, the full potential of acute prevention will not be realized.

Patient Behavior Immediately After Transient Ischemic Attack According to Clinical Characteristics, Perception of the Event, and Predicted Risk of Stroke

Little research has been done on patients' behavior after transient ischemic attack (TIA). Recent data on the high early risk of stroke after TIA mean that emergency action after TIA is essential for effective secondary prevention. We therefore studied patients' behavior immediately after TIA according to their perceptions, clinical characteristics, and predicted stroke risk. Consecutive patients with TIA participating in the Oxford Vascular Study or attending dedicated hospital clinics in Oxfordshire, UK, were interviewed. Predicted stroke risk was calculated using 2 validated scores. Of 241 patients, 107 (44.4%) sought medical attention within hours of the event, although only 24 of these attended the emergency department. A total of 107 (44.4%) delayed seeking medical attention for > or =1 day. Correct recognition of symptoms (42.2% of patients) was not associated with less delay. However, patients with motor symptoms or duration of symptoms > or =1 hour were more likely to seek emergency attention (hazard ratio, 2.1; 95% CI, 1.4 to 3.2; P=0.00005), as were those at higher predicted stroke risk (P=0.001). The other main correlate with delay was the day of the week on which the TIA occurred (P<0.001), with greater delays at the weekend. Delay was unrelated to age, sex, or other vascular risk factors. Many patients delay seeking medical attention after a TIA irrespective of correct recognition of symptoms, although patients at higher predicted risk of stroke do act more quickly. Public education about both the urgency and nature of TIA is required.

Women's Interpretation of their Coronary Heart Disease Symptoms

Men and women are known to delay in seeking medical attention when experiencing acute cardiac symptoms. However, women are more likely to have had chronic undifferentiated symptoms prior to an acute episode and then when experiencing an acute episode delay longer than do men. Studies have shown once women do present they tend to be further along the disease trajectory than men. The aim of this study was to explore women's own interpretation of the presenting symptoms they experienced. Twenty-nine women consented to take part in semi-structured interviews that focussed on their experience of coronary heart disease (CHD). The women's narrative around the initial disruption of their illness was analysed focusing on routine and reconstructed forms of narration. The results showed that many failed to recognise and act on their symptoms. Most only sought medical attention after family or friends intervened. None of the women had seen themselves at risk of developing coronary heart disease despite many have a strong family history. The women's early symptoms of coronary heart disease were often undifferentiated and difficult to interpret by the women themselves. There is a need for further research to understand and recognise early symptoms of coronary heart disease in women. This will allow women and health professionals to assess risk and identify women with coronary heart disease early on in their disease trajectory so therapy to prevent the morbidity associated with coronary heart disease and acute life threatening episodes will be reduced.

Anal incontinence after obstetric sphincter tears: incidence in a Norwegian county.

Anal sphincter tears during vaginal delivery are a major cause of anal incontinence. We wanted to assess the incidence in a Norwegian county where primary repairs are performed in four hospitals using similar per- and postoperative protocol for the treatment of such injuries. A postal questionnaire was distributed to all women who underwent primary repair of obstetric sphincter tears in the years 1999 and 2000 in the county of Möre and Romsdal. Symptoms of incontinence and fecal urgency were recorded. Incontinence was assessed using the Pescatori score system. Clinically detected sphincter tears occurred in 180 of 5123 vaginal deliveries (3.5%). The questionnaire was returned by 156 women (87%). Six women were excluded. Median follow-up was 25 months (range 4-39). Incontinence was reported by 88 women (59%), restricted to flatus incontinence in 53 cases (35%). Fecal urgency without incontinence was reported by 14 women (9%). Sixty-three women (42%) reported de novo moderate to severe symptoms. There was no difference in outcome whether the sphincter injury was partial or complete. Mean Pescatori score was 3.7 in women who felt disabled compared with 2.9 in women who did not feel disabled by their incontinence (P < 0.001). Of 29 women who felt disabled, only three had sought medical attention. Fifty-eight women (39%) had received no information about the sphincter tear before discharge. Anal incontinence is common after both partial and complete obstetric sphincter tears. Information before discharge is deficient, and women avoid seeking medical attention when incontinence develops.

Anal incontinence after obstetric sphincter tears: incidence in a Norwegian county

Background. Anal sphincter tears during vaginal delivery are a major cause of anal incontinence. We wanted to assess the incidence in a Norwegian county where primary repairs are performed in four hospitals using similar per- and postoperative protocol for the treatment of such injuries. Methods. A postal questionnaire was distributed to all women who underwent primary repair of obstetric sphincter tears in the years 1999 and 2000 in the county of Möre and Romsdal. Symptoms of incontinence and fecal urgency were recorded. Incontinence was assessed using the Pescatori score system. Results. Clinically detected sphincter tears occurred in 180 of 5123 vaginal deliveries (3·5%). The questionnaire was returned by 156 women (87%). Six women were excluded. Median follow-up was 25 months (range 4–39). Incontinence was reported by 88 women (59%), restricted to flatus incontinence in 53 cases (35%). Fecal urgency without incontinence was reported by 14 women (9%). Sixty-three women (42%) reported de novo moderate to severe symptoms. There was no difference in outcome whether the sphincter injury was partial or complete. Mean Pescatori score was 3·7 in women who felt disabled compared with 2·9 in women who did not feel disabled by their incontinence (P < 0·001). Of 29 women who felt disabled, only three had sought medical attention. Fifty-eight women (39%) had received no information about the sphincter tear before discharge. Conclusion. Anal incontinence is common after both partial and complete obstetric sphincter tears. Information before discharge is deficient, and women avoid seeking medical attention when incontinence develops.