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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty clients with chronic obstructive pulmonary disease (COPD) and their spouses were interviewed to examine differences in the relationships among loneliness, depression, and social support. Data were collected during structured in-home interviews using the UCLA loneliness scale, the Center for Epidemiological Studies depression scale, and the social support questionnaire. The clients and spouses did not differ significantly on measures of loneliness and depression, with mean scores for both groups higher than those in other comparable groups. Spouses, however, tended to be a little lonelier than clients, and clients tended to be a little more depressed than spouses. The two groups were also similar with respect to the number of people in their social networks but different as to network composition. Spouses were less satisfied with their networks than clients. Social support satisfaction was linked to loneliness and depression for clients but not for spouses. Results of the study suggest that community nurses working in home settings must be sensitive to clients' and spouses' psychologic reactions to COPD, which may be expressed in feelings of loneliness and depression.
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PMID:Loneliness, depression, and social support of patients with COPD and their spouses. 830 92

Changes in physical competence, respiratory symptoms, well-being, emotional state, level of depression, every-day coping skills, and general activity and independence were studied in 40 chronic obstructive pulmonary disease patients participating in an intensive 3-week rehabilitation program. Both patient and staff ratings were used. Expectations and attitudes prior to rehabilitation were also measured. The study design included a 3-week basal period, a 3-week rehabilitation period and a 6-month follow-up. The immediate effects of rehabilitation on the variables which described subjective experiences were positive: well-being, emotional state and respiratory symptoms improved significantly (p < 0.001, p < 0.01 and p < 0.01, respectively). By the end of the follow-up period, however, all the treatment effects had dissipated. No significant effects of rehabilitation could be seen in every-day coping skills, general activity and independence or level of depression. It was not possible to predict the rehabilitation response on the basis of the patients' attitudes, expectations, level of depression or age. We conclude that pulmonary rehabilitation causes transient improvement in respiratory symptoms and some subjectively characterized psychosocial variables and that this improvement is unpredictable by attitude and expectation variables.
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PMID:Psychosocial changes in patients participating in a chronic obstructive pulmonary disease rehabilitation program. 834 61

Patients with chronic obstructive pulmonary disease (COPD) can have an accompanying depression that interferes with nursing management and reduces patients' quality of life. Nurses need to understand more about that depression, how depression can be manifested and measured in older adults, and how depression in those with COPD differs from that seen in other chronic diseases. Self-report questionnaires can be used to identify depression initially and determine the need for further assessment. The DSM III-R criteria is recommended for those who wish to use a clinical evaluation tool. Treatment for the depression seen in COPD can include pharmacologic therapy and life changes, as well as individual and family therapies.
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PMID:Depression in patients with COPD. 836 62

Physicians need to weigh the efficacy, adverse effects and cost of first-line antihypertensive agents. Calcium channel blockers lower blood pressure, improve coronary blood flow and depress cardiac contractility by relaxing smooth muscle and cardiac muscle. They have beneficial or neutral effects in hypertensive patients with angina, asthma, chronic obstructive pulmonary disease, postural hypotension, peripheral vascular disease, depression, sexual dysfunction, diabetes and hyperlipidemia. The major adverse effect of some calcium channel blockers is that they may worsen congestive heart failure in some patients. Because calcium channel blockers are metabolized in the liver, the dosage must be lowered in the elderly and in patients with hepatic disease. Diltiazem, verapamil and nifedipine represent prototypes of the three classes of calcium channel blockers, each with slightly different effects.
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PMID:Calcium channel blockers in the treatment of hypertension. 836 95

Smoking tobacco contributes to and exacerbates many chronic diseases of aging, including hypertension, stroke, COPD, heart disease, and atherosclerosis. It is also associated with an increased risk of peptic ulcers and of cancers of the lungs and oral cavity. Older patients generally continue to smoke because of physiologic and psychological addiction to nicotine. Nicotine administration through gum or patch eases the symptoms of nicotine withdrawal for highly-tolerant patients. Detecting and treating alcohol abuse, depression, or life stress may then make it easier to motivate the patient to quit smoking. Physician advice combined with follow-up visits and phone calls has been shown to be one of most effective methods of getting patients to stop smoking.
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PMID:Smoking cessation: clinical steps to improve compliance. 838 53

Hydroxyzine is frequently used to tranquilize chronic obstructive pulmonary disease patients, who may be concomitantly receiving narcotic analgesics. Therefore, its effect alone and in combination with meperidine on arterial blood gases and ventilation at rest were evaluated in 44 patient volunteers, who gave informed consent. Hydroxyzine, 1.5 mg/kg i.v. caused no significant decrease in PaO2 and pH, no increase in PaCO2 at 5, 10, 20, 30 and 60 min post-infusion (n = 13, mean age = 63.4 years). Meperidine, 1.5 mg/kg i.v. caused a significant (p < 0.001) reduction in PaO2 for 20 min with concomitant increase in PaCO2 (n = 14; mean age = 49.4 years). The combination of the same doses of hydroxyzine with meperidine i.v. caused no greater decrease in PaO2 or in pH or increase in PaCO2 than did meperidine alone (n = 17; mean age = 52.6 years), indicating no greater ventilatory depression with the combination than with meperidine alone. The lack of significant pH decreases at 30 and 60 min further corroborates no potentiation of meperidine by hydroxyzine. In conclusion, hydroxyzine, even when given through the i.v. route in excess of the maximum i.m. therapeutic dose, caused no changes in PaO2, PaCO2 or pH in chronic obstructive pulmonary disease patients. Therefore, its i.m. administration resulting in lower blood levels than i.v., is not likely to cause ventilatory depression. Furthermore, hydroxyzine caused no potentiation of the ventilatory depression induced by meperidine, hence hydroxyzine may be safely employed in combination with meperidine.
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PMID:Effect of hydroxyzine and meperidine on arterial blood gases in patients with chronic obstructive pulmonary disease. 846 9

Psychiatric disorders occur frequently in patients with COPD, but therapy with psychotropic drugs is often limited by concomitant depression of ventilatory drive. We present a patient with COPD and major depression who developed hypercapnic respiratory failure while receiving nortriptyline and oxazepam. Because of known respiratory depressant effects of the latter drug, nortriptyline alone was resumed upon recovery. Depression of CO2 sensitivity and ventilatory load compensation with a concomitant increase in exercise tolerance with decreased dyspnea was observed while she was receiving nortriptyline. These results demonstrate a previously unreported depressant effect of nortriptyline on ventilatory control, and they suggest the need for further investigation of the ventilatory effects of this drug in patients with pulmonary disease.
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PMID:Nortriptyline-induced depression of ventilatory control in a patient with chronic obstructive pulmonary disease. 848 48

The objective of this study was to demonstrate the value of a planning model for the design and evaluation of community health services. The health status of Washtenaw County, Michigan was modeled. Data were obtained from the Michigan Department of Public Health, Medstat Systems, and the medical literature for 32 diseases or conditions, representing approximately 85% of causes of death and 56% of medical payments (excluding medication costs). An expanded life-table approach was used for 16 age-and sex-matched cohorts exposed to a disease attack rate, access-to-care rate, case fatality rate, morbidity, and costs. Rates can be modified to reflect changes due to treatment, secular trends, or prevention programs. Two alternative delivery methods were considered to show the potential impact of reducing cardiovascular deaths (worksite initiative), or increasing utilization of services (lay health promotion) on county health status and costs over time. Deaths, bed days, and annual medical payments were the main outcome measurements. Cardiovascular and cancer conditions are and will be the primary causes of death in this population. The most important causes of bed days are musculoskeletal conditions, chronic obstructive pulmonary disease, accidents, strokes, and depression. The major health-care payments are for angina pectoris and/or other cardiac conditions, musculoskeletal conditions, accidents, prenatal care, and/or childbirth, and depression. The two alternative scenarios illustrate how reductions in mortality are not necessarily equated with similar improvements in morbidity or costs. This model presents an overview of the current and projected health status of a community. With such a planning tool, a community can better understand the impact of potential prevention or intervention programs, and help design its health-care system within the constraints of available resources.
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PMID:A guide for planning community-oriented health care: the health sector resource allocation model. 862 45

Six-year predictors of successful aging were analyzed for 356 Alameda County Study men and women aged 65-95 years measured prospectively in 1984 and followed to 1990. Successful aging was defined as needing no assistance nor having difficulty on any of 13 activity/mobility measures plus little or no difficulty on five physical performance measures. After adjusting for baseline successful aging, sex, and age, the authors found that 1984 predictors of 1990 successful aging included income above the lowest quintile (odds ratio (OR) = 2.01, 95% confidence interval (CI) 0.99-4.11), > or = 12 years of education (OR = 1.67, 95% CI 0.98-2.84), white ethnicity (OR = 2.12, 95% CI 0.93-4.86), diabetes (OR = 0.10, 95% CI 0.01-0.79), chronic obstructive pulmonary disease (OR = 0.41, 95% CI 0.17-0.97), arthritis (OR = 0.43, 95% CI 0.26-0.71), and hearing problems (OR = 0.48, 95% CI 0.25-0.89). Adjusting for all variables, the authors found that behavioral and psychosocial predictors included the absence of depression (OR = 1.94, 95% CI 1.10-3.42), having close personal contacts (OR = 1.82, 95% CI 1.05-3.18), and often walks for exercise (OR = 1.77, 95% CI 1.00-3.12). Cross-sectional comparisons at follow-up revealed significantly higher community involvement, physical activity, and mental health for those aging successfully.
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PMID:Successful aging: predictors and associated activities. 867 44

A patient with a long-standing history of chronic obstructive pulmonary disease suffered a thermal injury over 20% of his total body surface area. He required opiates for pain management and benzodiazepines for anxiety associated with dressing changes. The narcotics compromised his pulmonary function and level of consciousness, and interfered with several attempts to wean him from ventilator support. Intravenous ketorolac instead of narcotics before dressing changes alleviated the respiratory depression and returned his partial pressure of carbon dioxide-mediated respiratory drive to normal. With these changes, including changes in respiratory rate to tidal volume, he was successfully weaned from ventilatory support. In addition, the patient's level of consciousness improved. These changes increased his participation in his daily physical therapy sessions.
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PMID:Intravenous ketorolac for pain management in a ventilator-dependent patient with thermal injury. 870 Jul 95


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