Quality of life and psychosocial high risk factors in adolescents with Cooleys Anaemia

2007 ◽  
Author(s):  
Yen-hwa, Colinette Kwong
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
High Risk ◽  
High Risk Factors

scholarly journals Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features

2018 ◽  
Vol 36 (34) ◽  
pp. 3361-3369 ◽  
Author(s):  
Anna L. Godfrey ◽  
Peter J. Campbell ◽  
Cathy MacLean ◽  
Georgina Buck ◽  
Julia Cook ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Platelet Count ◽  
High Risk ◽  
Vascular Events ◽  
End Point ◽  
High Risk Factors ◽  
Patient Reported

Purpose Cytoreductive therapy is beneficial in patients with essential thrombocythemia (ET) at high risk of thrombosis. However, its value in those lacking high-risk features remains unknown. This open-label, randomized trial compared hydroxycarbamide plus aspirin with aspirin alone in patients with ET age 40 to 59 years and without high-risk factors or extreme thrombocytosis. Patients and Methods Patients were age 40 to 59 years and lacked a history of ischemia, thrombosis, embolism, hemorrhage, extreme thrombocytosis (platelet count ≥ 1,500 × 109/L), hypertension, or diabetes requiring therapy. In all, 382 patients were randomly assigned 1:1 to hydroxycarbamide plus aspirin or aspirin alone. The composite primary end point was time to arterial or venous thrombosis, serious hemorrhage, or death from vascular causes. Secondary end points were time to first arterial or venous thrombosis, first serious hemorrhage, death, incidence of transformation, and patient-reported quality of life. Results After a median follow-up of 73 months and a total follow-up of 2,373 patient-years, there was no significant difference between the arms in the likelihood of patients reaching the primary end point (hazard ratio, 0.98; 95% CI, 0.42 to 2.25; P = 1.0). The incidence of significant vascular events was low, at 0.93 per 100 patient-years (95% CI, 0.61 to 1.41). There were also no differences in overall survival; in the composite end point of transformation to myelofibrosis, acute myeloid leukemia, or myelodysplasia; in adverse events; or in patient-reported quality of life. Conclusion In patients with ET age 40 to 59 years and lacking high-risk factors for thrombosis or extreme thrombocytosis, preemptive addition of hydroxycarbamide to aspirin did not reduce vascular events, myelofibrotic transformation, or leukemic transformation. Patients age 40 to 59 years without other clinical indications for treatment (such as previous thrombosis or hemorrhage) who have a platelet count < 1,500 × 109/L should not receive cytoreductive therapy.

How I Treat High-risk Multiple Myeloma

Blood ◽  
2021 ◽  
Author(s):  
Elena Zamagni ◽  
Simona Barbato ◽  
Michele Cavo
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
High Risk ◽  
Tumor Biology ◽  
Treatment Strategies ◽  
Specific Drug ◽  
Improve Quality

Survival of multiple myeloma (MM) has significantly improved over the last decade; however, a composed group of patients (15-20%), named high-risk (HR) MM, still experience reduced survival. Both tumor biology and suboptimal/absent responses to therapy may underlie HR definition and a clear uniform identification of risk factors is crucial for a proper management of these patients. In biologic-HRMM, MRD negativity attainment and sustain, inside and outside BM, should be the primary goal and therapy should be adapted in patients with frailty to reduce toxicity and improve quality of life. MM treatment has traditionally been tailored on age and more recently frailty or comorbidities, but very rarely on the biology of the disease, mainly because of the lack of a clear benefit derived from a specific drug/combination, inhomogeneity in HR definition and lack of data coming from prospective, properly designed clinical trials. Some attempts have been successfully made recently in this direction. In this review, we are discussing the current different definitions of HR and the need for a consensus, the results of available trials in HR patients and the way through risk-adapted treatment strategies. For this purpose, we are proposing several clinical cases of difficult-to-treat patients throughout different treatment phases.

scholarly journals Pathogenesis and prevention strategies for equine tendinopathy

2019 ◽  
Vol 37 (3) ◽  
pp. 18-19
Author(s):  
Roger K.W. Smith
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Flexor Tendon ◽  
High Impact ◽  
Prevention Strategies ◽  
Suspensory Ligament ◽  
High Risk Factors ◽  
Superficial Digital Flexor Tendon ◽  
External Trauma

Equine tendinopathy arises through two main mechanisms – external trauma or overstrain injury. The pathogenesis of the former is straight forward and prevention relies on avoiding risk factors for palmar/plantar lacerations and protecting the tendons through the use of boots. For over-strain injuries, these mostly arise from overloading of the distal limb resulting in mid-substance tearing of the digital flexor tendons or borders tears of the deep digital flexor tendon within the confines of the digital sheath and navicular bursa. While some of these injuries may be spontaneous injuries associated solely with overload (such as the intra-thecal injuries of the deep digital flexor tendon), it is widely accepted that most overstrain injuries of the superficial digital flexor tendon (and suspensory ligament) occur as a result of accumulated microdamage which predisposes the tendon to over-strain injury. The mechanisms of this accumulated microdamage are poorly understood but probably relate to the effect of high impact loading of the tendon, sustained during normal exercise, which drives degradative changes in the tendon fascicles (Dudhia et al. 2007) and, in particular, the interfascicular matrix (endotenon) that allows the fascicles to slide past one another as a mechanism for the spring-like extension of the tendon under load (Thorpe et al. 2013). This is compounded by the lack of adaptive remodelling in adult tendon (Smith et al. 2002). This subclinical damage makes the tendon prone to sudden tearing of the tendon matrix during normal exercise, the risk of which is increased by factors such as the firmness of the ground, weight, speed, and fatigue. Strategies for prevention of injury rely on identifying at risk individuals through more sensitive monitoring of tendon health, maximising the quality of tendon during growth using carefully tailored ‘conditioning’ exercise regimes (Smith & Goodship 2008), reducing the degeneration induced by normal training and competition, and avoiding high risk factors for the initiation of the clinical injury.

scholarly journals Stroke risk and its association with quality of life: a cross-sectional study among Chinese urban adults

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Huiqing Yao ◽  
Juhua Zhang ◽  
Yanmei Wang ◽  
Qingqing Wang ◽  
Fei Zhao ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Relative Risk ◽  
High Risk ◽  
Psychosocial Factors ◽  
Stroke Risk ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background Stroke is a leading cause of mortality and disability worldwide. Most stroke risk studies focused on more established biological and pathophysiological risk factors such as hypertension and smoking, psychosocial factors such as quality of life are often under-investigated and thus less reported. The current study aims to estimate stroke risk and explore the impact of quality of life on stroke risk among a community sample of urban residents in Shanghai. Methods This cross-sectional study was conducted in Fengxian District of Shanghai City from December 2018 to April 2019. 4030 representative participants were recruited through a multistage, stratified, probability proportional to size sampling method and completed the study. Stroke risk was assessed using the Rapid Stroke Risk Screening Chart that included 8 risk factors for stroke. Quality of life was measured using the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Results One-third of residents were at risk for stroke, including 14.39% at high risk, and 18.68% at middle risk. The top three most commonly reported risk factors were physical inactivity (37.30%), hypertension (25.38%), and smoking (17.32%). Quality of life and its four domains were all independently and significantly associated with stroke risk. Multinominal logistic regressions showed that a one-unit increase in the quality of life was associated with a decreased relative risk for middle-risk relative to low-risk of stroke by a factor of 0.988 (95% CI:0.979, 0.997, P = 0.007), and a decreased relative risk for high-risk relative to low-risk of stroke by a factor of 0.975 (95% CI:0.966, 0.984, P < 0.001). Conclusions Our findings showed an alarmingly high prevalence of stroke risk among the sample, which may require future intervention programs to focus on improving both biological and behavioral risk factors such as increasing physical activity, early diagnosis and treatment of hypertension, and smoking cessation, as well as improving psychosocial factors such as quality of life.

scholarly journals KUSTA DI PROVINSI LAMPUNG: STUDI EKOLOGI BERDASARKAN TREN WAKTU

2019 ◽  
Vol 18 (2) ◽  
pp. 88-98
Author(s):  
Nurhalina Sari ◽  
Eliza Eka Nurmala
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Data Analysis ◽  
Spatial Analysis ◽  
High Risk ◽  
Ecological Study ◽  
Secondary Data ◽  
Poor People ◽  
Study Designs

ABSTRACT  Leprosy is a disease that can cause pain and disability, which in the end can affect a person's quality of life. Through the 2013 Bangkok Declaration, Indonesia declared itself that 2020 was a leprosy-free country. However, until 2015, there were still reports of leprosy cases, including in Lampung Province. This study aims to analyze spatial leprosy and its risk factors to get priority areas for leprosy handling in Lampung Province. The study used ecological study designs. The sources of leprosy data and risk factors came from secondary data at the Central Statistics Agency and Health Office in Lampung for the year 2011 to 2015. Data analysis using spatial analysis. The analysis shows that leprosy cases are divided into two categories, namely paucibacillary and multibacillary. Spatial analysis results for 5 years indicate that leprosy cases are dominant in Central Lampung and East Lampung Districts. Based on population density, number of poor people, sanitation, nutritional status, and health facilities, several districts have a high risk of leprosy. The conclusion of this study is the priority in handling leprosy cases should be focused in the Central Lampung District and East Lampung District. Keywords: Leprosy, Lampung, spatial analysis, ecological study   ABSTRAK Kusta merupakan penyakit yang dapat menyebabkan kesakitan dan kecacatan,  yang pada akhirnya dapat mempengaruhi kualitas hidup seseorang. Melalui Deklarasi Bangkok 2013, Indonesia menyatakan bahwa tahun 2020 menjadi negara bebas kusta. Namun, hingga 2015 masih terdapat laporan kasus kusta, termasuk di Provinsi Lampung. Penelitian ini bertujuan menganalisis secara spasial  kusta dan faktor risikonya untuk mendapatkan prioritas penanganan kusta di Provinsi Lampung dengan desain studi ekologi. Sumber data kusta dan faktor risiko berasal dari data sekunder di Badan Pusat Statistik dan Dinas Kesehatan di Lampung 2011 sampai dengan 2015. Analisis data menggunakan analisis spasial. Hasil analisis menunjukkan bahwa kasus kusta terbagi dalam dua kategori yaitu pausibasiler (PB) dan multibasiler (MB).Hasil analisis spasial selama 5 tahun menunjukkan bahwa kasus kusta dominan di Kabupaten Lampung Tengah dan Kabupaten Lampung Timur. Berdasarkan kepadatan penduduk, jumlah orang miskin, sanitasi, status gizi, dan fasilitas kesehatan, beberapa kabupaten memiliki risiko tinggi terhadap kasus kusta. Kesimpulan penelitian ini adalah prioritas penanganan kasus kusta sebaiknya difokuskan di wilayah Kabupaten Lampung Tengah dan Kabupaten Lampung Timur. Kata kunci: Kusta, Lampung, analisis spasial, studi ekologi

Postsurgical Neuralgia

2018 ◽  
pp. 73-80
Author(s):  
John P. Kenny ◽  
Dalia Elmofty
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
High Risk ◽  
Healthcare Costs ◽  
Mechanism Of Injury ◽  
Profound Impact ◽  
Risk Patients ◽  
Collaborative Efforts ◽  
Preventative Approach

The development of post-surgical neuralgia (PSN) is multi-factorial and many questions still remain unanswered. PSN results from traumatic nerve injury during a surgical procedure. Little is known about the correlation between the mechanism of injury and the clinical presentation. PSN is often unrecogonized and misdiagnosed. It can be severely debilitating. The consequences of postsurgical neuralgia not only affect a patient’s quality of life, but also have a profound impact on healthcare costs. Identifying predisposing risk factors, utilizing a preventative approach, proper and timely detection, enhancing awareness amongst physicians and early pain management referral are imperative steps in the treatment of PSN. Surgeons and anesthesiologist have a crucial role in the prevention of PSN. Identifying high risk patients and high risk surgery types along with collaborative efforts to implement a multimodal perioperative analgesic plan is recommended.

Assessing Statewide All-Cause Future One-Year Mortality: Prospective Study With Implications for Quality of Life, Resource Utilization, and Medical Futility (Preprint)

2018 ◽  
Author(s):  
Yanting Guo ◽  
Gang Zheng ◽  
Tianyun Fu ◽  
Shiying Hao ◽  
Chengyin Ye ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
High Risk ◽  
Information Exchange ◽  
Elderly Population ◽  
Validation Cohort ◽  
Health Information Exchange ◽  
Risk Group ◽  
Futile Treatment

BACKGROUND For many elderly patients, a disproportionate amount of health care resources and expenditures is spent during the last year of life, despite the discomfort and reduced quality of life associated with many aggressive medical approaches. However, few prognostic tools have focused on predicting all-cause 1-year mortality among elderly patients at a statewide level, an issue that has implications for improving quality of life while distributing scarce resources fairly. OBJECTIVE Using data from a statewide elderly population (aged ≥65 years), we sought to prospectively validate an algorithm to identify patients at risk for dying in the next year for the purpose of minimizing decision uncertainty, improving quality of life, and reducing futile treatment. METHODS Analysis was performed using electronic medical records from the Health Information Exchange in the state of Maine, which covered records of nearly 95% of the statewide population. The model was developed from 125,896 patients aged at least 65 years who were discharged from any care facility in the Health Information Exchange network from September 5, 2013, to September 4, 2015. Validation was conducted using 153,199 patients with same inclusion and exclusion criteria from September 5, 2014, to September 4, 2016. Patients were stratified into risk groups. The association between all-cause 1-year mortality and risk factors was screened by chi-squared test and manually reviewed by 2 clinicians. We calculated risk scores for individual patients using a gradient tree-based boost algorithm, which measured the probability of mortality within the next year based on the preceding 1-year clinical profile. RESULTS The development sample included 125,896 patients (72,572 women, 57.64%; mean 74.2 [SD 7.7] years). The final validation cohort included 153,199 patients (88,177 women, 57.56%; mean 74.3 [SD 7.8] years). The c-statistic for discrimination was 0.96 (95% CI 0.93-0.98) in the development group and 0.91 (95% CI 0.90-0.94) in the validation cohort. The mortality was 0.99% in the low-risk group, 16.75% in the intermediate-risk group, and 72.12% in the high-risk group. A total of 99 independent risk factors (n=99) for mortality were identified (reported as odds ratios; 95% CI). Age was on the top of list (1.41; 1.06-1.48); congestive heart failure (20.90; 15.41-28.08) and different tumor sites were also recognized as driving risk factors, such as cancer of the ovaries (14.42; 2.24-53.04), colon (14.07; 10.08-19.08), and stomach (13.64; 3.26-86.57). Disparities were also found in patients’ social determinants like respiratory hazard index (1.24; 0.92-1.40) and unemployment rate (1.18; 0.98-1.24). Among high-risk patients who expired in our dataset, cerebrovascular accident, amputation, and type 1 diabetes were the top 3 diseases in terms of average cost in the last year of life. CONCLUSIONS Our study prospectively validated an accurate 1-year risk prediction model and stratification for the elderly population (≥65 years) at risk of mortality with statewide electronic medical record datasets. It should be a valuable adjunct for helping patients to make better quality-of-life choices and alerting care givers to target high-risk elderly for appropriate care and discussions, thus cutting back on futile treatment.

P5546The benefit of one week immersion in lifestyle-based program for sustainable improvements in cardiovascular risk factors over time

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Schwartz ◽  
J George ◽  
S Stoll ◽  
A Jain ◽  
D Desai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
High Risk ◽  
Nutrition Education ◽  
Mediterranean Diet ◽  
Functional Capacity ◽  
Average Weight ◽  
Short Term ◽  
Dietary Compliance

Abstract Background Hypertension (HTN), hyperlipidemia (HLD) and obesity are traditional risk factors for cardiovascular disease (CVD). Lifestyle measures for prevention of CVD include exercise, dietary changes such as reducing saturated fats, increasing fruits and vegetables, and limiting sugar intake but most people are not successful at making meaningful changes without support. Purpose To demonstrate the feasibility of a short-term lifestyle-based immersion in improving anthropomorphic measurements, blood pressure (BP) and lipids after one week, and its ability to create sustainable change in a high risk cohort. Methods This was a one-week lifestyle immersion for employees of their company and a significant other who were considered high risk for CVD. Eighty participants went through a one-week, in-house, lifestyle-based program that included daily nutrition education, 100% plant-based food that was sugar, salt and oil free, exercise classes and stress management. Anthropomorphic measurements, BP and lipids were checked at onset and on day 6. Dietary survey (validated 14-point Mediterranean diet survey), functional capacity survey (DASI survey) and quality of life (QOL) survey (SF-36) were administered at day 0 and 3-months post immersion. Results Of the 80 participants, 64% were female, mean age was 47 years (range 21–71), mean weight was 194.95 lbs. and average BMI was 30.47 kg/m2. Risk factors for CVD were prevalent as 71.25% of the participants had HTN, 27.5% had HbA1c >6%, and there were 35% former and 7.5% active smokers. After one-week lifestyle immersion, average BMI improved by 0.50±0.38 kg/m2 (p<0.001), average weight improved by 3.28±2.62 lbs. (p<0.001) and average waist size improved with a loss of 0.73±1.20 inches (p<0.001). Average systolic BP (SBP) decreased by 6.67±15.17 mmHg (p<0.001) and diastolic BP (DBP) by 5.00±9.82 mmHg (p<0.001). Average total cholesterol improved by 20.40±15.44 mg/dL (p<0.001), triglycerides by 31.78±44.06 mg/dL (p<0.001), HDL by 3.13±5.83 mg/dL (p<0.001) and LDL by 11.71±15.92 mg/dL (p<0.001). In participants who had HTN at the start of the study, average SBP dropped by 10.91±14.30 mmHg (p<0.001) and average DBP by 8.02±8.84 mmHg (p<0.001). DASI and Mediterranean diet surveys were completed by 66% at day 0 and three months. Over the 3 months, there was a significant improvement in both functional capacity (7.03±11.17 points, p<0.001) and average diet score (1.38±2.40 points, p<0.001). The QOL survey was completed by 56% participants with an improvement in quality of life score of 22.02±17.68 points (p<0.001). Conclusion Short term intensive lifestyle interventions can lead to immediate and significant improvements in BP, weight and lipid profiles and importantly can have longer lasting effects on exercise capacity, dietary compliance and QOL. Further research to assess benefits of immersion programs with access to larger populations and for longer durations is warranted. Acknowledgement/Funding Whole Foods, Inc via Total Health Immersions, LLC

scholarly journals Features of pharmacotherapy at elderly and senile patients

2021 ◽  
Vol 2 (4) ◽  
pp. 6-15
Author(s):  
A. V. Safronenko ◽  
E. V. Gantsgorn ◽  
V. A. Safronenko ◽  
I. I. Kuznetsov ◽  
N. V. Sukhorukova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
High Risk ◽  
Drug Interactions ◽  
Adverse Drug Reactions ◽  
Drug Reactions ◽  
Clinical Practices ◽  
Low Level ◽  
Level Of Knowledge

The high risk of developing adverse drug reactions (ADRs) among elderly and senile patients is caused several reasons. Firstly, the age‑associated changes organs and system cause certain changes in pharmacodynamics and pharmacokinetics of drugs and, as a consequence, atypical ADRs. Secondly, polymorbidity, which is often present in this category of patients, causes the phenomenon of polypharmacy, thereby exacerbating the aspect of drug‑drug interactions – one of the risk factors for the development of ADRs. Finally, low level of knowledge in this area healthcare practitioners causes reason developing of «pharmacological cascades». The active applying of geriatric pharmacology in clinical practices gives the chance do better live the quality of life and the prediction of diseases for elderly and senile patients.

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