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Severe lung disease is known to affect the lives of not only the sufferer but also his/her family. This qualitative phenomenological study identified seven patients with severe lung disease and studied the quality of life of their carers (five female, two male) who were not fully employed, living in the same house or nearby. In a semi-structured interview, the carers were asked about looking after their spouse or relative, whether they had support and the effect of caring on their health and finances. The findings showed the carers' lives to be severely restricted, all carrying a heavy emotional burden of frustration, depression and isolation: part-time jobs were important both financially and to reduce isolation. Family support was vital to their coping, but few had received professional help. All were affected by reduction in income, but claiming allowances was confusing; unpredictability of the disease complicated much-needed recreation and holidays. Findings were similar to previously published data.
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PMID:The quality of life of carers of patients with severe lung disease. 1536 1

These practice parameters are an update of the previously-published recommendations regarding the indications for polysomnography and related procedures in the diagnosis of sleep disorders. Diagnostic categories include the following: sleep related breathing disorders, other respiratory disorders, narcolepsy, parasomnias, sleep related seizure disorders, restless legs syndrome, periodic limb movement sleep disorder, depression with insomnia, and circadian rhythm sleep disorders. Polysomnography is routinely indicated for the diagnosis of sleep related breathing disorders; for continuous positive airway pressure (CPAP) titration in patients with sleep related breathing disorders; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep related symptoms; to assist in the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure related; in a presumed parasomnia or sleep related seizure disorder that does not respond to conventional therapy; or when there is a strong clinical suspicion of periodic limb movement sleep disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; for patients with seizures who have no specific complaints consistent with a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders; or to establish a diagnosis of depression.
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PMID:Practice parameters for the indications for polysomnography and related procedures: an update for 2005. 1617 Dec 94

Individuals use many non-religious coping (NRC) and religious coping (RC) strategies to cope with stress. In previous studies with lung transplant candidates, we found that NRC and RC predicted depression, anxiety, and disability. The present study aimed to (a) assess whether RC and NRC contributed uniquely to the prediction of distress and disability, or whether they were redundant and offered no additional information, and (b) evaluate the unique contribution of each subscale to determine the strongest associations with outcomes. Participants were 81 patients with end-stage lung disease being evaluated for lung transplant. Our findings suggest that RC and NRC are not functionally redundant. The best RC predictor was reappraising the situation as a punishment from God, and the best NRC predictors were mental disengagement and denial. Our findings suggest that NRC and RC are independent components of psychological functioning, and measuring both coping styles provides more information than studying each alone.
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PMID:Religious and non-religious coping in lung transplant candidates: does adding god to the picture tell us more? 1623 11

Dyspnea, the clinical term for shortness of breath, is the primary symptom and an important outcome measure in evaluations of patients with lung disease. It is a subjective symptom that has proved difficult to quantify. Many dyspnea measures are available, yet it is difficult, based on the existing literature, to determine the most reliable and valid. In this study, we evaluated 6 measures of dyspnea for reliability and validity: (a) Baseline Dyspnea Index (BDI) and Transition Dyspnea Index, (b) UCSD Shortness of Breath Questionnaire (SOBQ),(c) American Thoracic Society Dyspnea Scale, (d) Oxygen Cost Diagram, (e) Visual Analog Scale, and (f) Borg Scale. Subjects were 143 patients (74 women) and 69 men) with obstructive lung disease, ages 40 to 86, FEV(1.0) 0.36 to 3.53 L, FVC 1.07 to 5.74 L. Dyspnea measures were assessed for test-retest reliability internal consistency, interrater reliability, and construct validity (i.e., correlations among dyspnea measures and correlations of dyspnea measures with exercise tolerance, health-related quality of life, lung function, anxiety, and depression). Results suggest that the SOBQ and BDI demonstrated the highest levels of reliability and validity among the dyspnea measures examined.
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PMID:Reliability and validity of dyspnea measures in patients with obstructive lung disease. 1625 Jul 81

Zinc gluconate glycine lozenges are an over-the-counter homeopathic remedy that significantly reduced the duration and severity of common colds in adults in 2 independent clinical trials. To evaluate the safety of zinc gluconate glycine lozenges in elderly individuals with 1 or more health conditions, with or without a cold. This randomized, double-blind, placebo-controlled, parallel-group trial enrolled men and women between 60 and 91 years of age, who self-administered 1 zinc gluconate glycine or placebo lozenge every 3 to 4 hours for 6 days. One or more of the following conditions was present in the study population: arthritis, cancer, depression, heart disease, hypertension, lung disease, osteoporosis, prostate disease, and stroke. Assessments were performed at baseline and at 7 (+/-1 day) and 14 days. The safety evaluation considered physical examinations, clinical laboratory tests, vital signs, adverse events, and concomitant medications. Of 75 persons enrolled, 66 completed the study. Safety assessments demonstrated no clinically significant differences between treatment groups. Four participants taking zinc tablets and 3 participants taking placebo tablets reported mild adverse events. Of those participants taking zinc tablets, 6 adverse events were possibly related to the study product and 2 adverse events were probably related to the study product. Of those participants taking placebo tablets, 3 adverse events were reported that were possibly related to the study product. No serious or clinically significant adverse events were noted. Zinc gluconate glycine lozenges are safe and well tolerated by a geriatric population and are suitable for prophylactic or therapeutic use to reduce the duration or severity of the common cold.
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PMID:Safety of zinc gluconate glycine (Cold-Eeze) in a geriatric population: a randomized, placebo-controlled, double-blind trial. 1628 Jun 56

The gratifying results of lung transplantation in terms of survival and quality of life stimulate the referral of an ever-increasing number of patients with end-stage lung disease. This in turn compounds the organ shortage, which is the limiting factor in the transplantation rate. In the absence of good alternative treatment modalities, an evidence-based pretransplant screening process is a prerequisite to determine which patients will benefit most from transplantation. Within this evidence-based screening process, medical selection criteria are well established. There is a growing awareness that psychosocial and behavioural factors may determine outcome after transplantation as well. This paper reviews the available evidence for psychosocial and behavioural factors in the screening process for lung transplantation. The relation of various factors with post-transplant outcome was explored. Psychosocial characteristics before transplantation consist of 1) anxiety and depression, 2) personality disorders, 3) neurocognitive problems, and 4) lack of social support. Pretransplant behavioural factors include 1) noncompliance with medication, 2) alcohol abuse or dependence, 3) smoking, 4) noncompliance with dietary guidelines, and 5) noncompliance with monitoring of vital parameters and infections. It appears that the lack of rigorous studies limit the feasibility of an evidence-based screening process. Prospective studies are crucial to this further investigation of the relationship between psychosocial and behavioural determinants before transplantation and outcomes after transplantation, in terms of compliance, morbidity, and mortality. Identification of modifiable risk factors for poor outcome before transplantation is a first step in developing interventions.
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PMID:To transplant or not? The importance of psychosocial and behavioural factors before lung transplantation. 1650 76

Test the hypothesis that depressed hospitalized patients with congestive heart failure (CHF) and/or chronic pulmonary disease (CPD) are no different from depressed patients with other medical disorders, and so can be treated similarly. Consenting patients aged 50 or over consecutively admitted to the medical services at Duke University Medical Center and three community hospitals were screened for depressive disorder using the Structured Clinical Interview for Depression (SCID-IV). Characteristics of patients reflecting vulnerability, stressors, and coping resources were assessed. CHF/CPD patients with major (n = 413) and minor (n = 587) depression were compared to depressed patients with other medical disorders (n = 63). Among those with major depression, patients with CHF/CPD differed from those with other medical disorders in having less severe depression and less severe cognitive impairment, but greater physical illness severity. Among those with minor depression, CHF/CPD patients tended to be older and, as with major depression, had less severe depression and more severe medical illness. These findings were largely confirmed when CHF and CPD patients were examined separately. Depressive disorders in CHF/CPD patients are similar to those in patients with other medical disorders. However, they may be associated with less severe depressive symptoms and more severe physical illness than depressed patients with other medical disorders. These findings help to identify the unique ways in which depressive disorder manifests itself in hospitalized patients with chronic heart and lung disease that may impact their management.
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PMID:Comparison of older depressed hospitalized patients with and without heart failure/pulmonary disease. 1679 25

Toxoplasmosis can be a severe infection in immunosuppressed patients. In these patients it can present as collected encephalitis, diffuse hypoxemic pneumopathy, or disseminated infection with fatal outcome. These presentations are observed mainly in HIV-infected patients, and less frequently in bone-marrow transplanted, or heart or heart and lung transplanted patients, or in patients given long term steroids or immunosuppressive therapy. The disease is due most often to the reactivation of latent persistent forms of the parasite at a moment of depression of host defense mechanisms, with local reactivation, and/or hematogenous dissemination. In some cases, the disease is favored by an insufficient protective response after primary infection. Treatment, based on the pyrimethamine-sulfadiazine combination should be continued as long as a profound immunosuppression is present. Prevention is based on recommendations to avoid acquisition of the parasite for seronegative patients, and on chemoprophylaxis, using cotrimoxazole as first line regimen, in patients already infected with Toxoplasma gondii.
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PMID:[Toxoplasmosis in immunosuppressed patients. Contribution to the knowledge of toxoplasmic infection.]. 1729 16

While depression is a common co-morbid condition among patients with COPD, little is known about predictors or health impact of depression among these patients. To address these gaps in knowledge we conducted a cross-sectional survey of 207 patients with COPD cared for in a network of primary care clinics affiliated with an urban academic health center. A standardized questionnaire was used to measure demographic characteristics, smoking status, co-morbid medical conditions, current medications, self-efficacy, social support, illness intrusiveness, and self-reported health care utilization during the previous 6 months. Depressive symptoms were assessed using the Centers for Epidemiologic Studies-Depression scale. Overall, the prevalence of moderate to high levels of depressive symptoms was 60.4%. In a multivariate analysis independent predictors of depressive symptoms were being a former smoker (OR = 0.41 (95% CI 0.19-0.89)), higher self-efficacy (OR = 0.42 (0.28-0.64)), higher social support (OR = 0.72 (0.52-0.99)), and higher perceived illness intrusiveness (OR = 1.05 (1.02-1.08)). Depressive symptoms were associated with increased physician visits, emergency room visits, and hospitalizations for lung disease. In conclusion, depressive symptoms are common among patients with COPD and associated with an increase in healthcare utilization. These findings suggest that the identification of risk factors for depressive symptoms (e.g., continued smoking) may increase detection and improve management of depression and health outcomes among patients with COPD.
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PMID:Predictors of depressive symptoms in patients with COPD and health impact. 1736 74

There is growing concern about long-term neurodevelopmental outcomes after neonatal corticosteroid treatment for chronic lung disease (CLD). Here, we use a protocol with tapering doses of dexamethasone (DEX) or hydrocortisone (HC) proportional to those used in preterm infants to examine the long-term consequences of these treatments on hippocampal synaptic plasticity and associative memory in later life. We found that neonatal DEX, but not HC, treatment impairs long-term potentiation (LTP) but enhances long-term depression (LTD) induction in adolescent rats. The effects of neonatal DEX treatment on LTP and LTD were prevented when the animals were given glucocorticoid receptor antagonist, RU38486, before DEX administration. We also found that neonatal DEX, but not HC, treatment induces a profound increase in the autophosphorylation of a isoform of Ca2+/calmodulin-dependent protein kinase II at threonine-286 and a decrease in the protein phosphatase 1 expression. In addition, only neonatal DEX treatment disrupts memory retention in rats subjected to passive avoidance learning tasks. These results demonstrate that only neonatal DEX treatment alters the hippocampal synaptic plasticity and associative memory formation in later life and thus suggest that HC may be a safer alternative to DEX for the treatment of CLD in the neonatal period.
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PMID:Effects of neonatal corticosteroid treatment on hippocampal synaptic function. 1762 55


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