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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To explore some determinants of physicians' decisions to change practice habits, we posed three questions: To what extent are some particular innovations diffused among office-based primary care physicians? What characterizes the physicians who have adopted these innovations? And, what caused them to change their behavior and adopt the innovations? Three "markers," recent innovation in medical practice, were chosen using an expert consensus technique. A telephone survey of 200 office-based pediatricians was conducted, and the physicians were asked whether or not they used the following three innovations in medical practice: continuous rather than intermittent phenobarbital for the prevention of febrile seizures, glycosylated hemoglobin measurement in the management of diabetes, and slow release theophylline in the management of asthma. The questionnaire was completed by 156 pediatricians. Of the 110 pediatricians who cared for diabetics, 73% used glycosylated hemoglobin measurement; of the 145 who saw patients with febrile seizures, 77% prescribed the continuous use of phenobarbital (if they used it at all); and, of the 152 pediatricians who cared for asthmatics, 86% reported using slow-release theophylline. The characteristics significantly associated with using the innovations were board certification, group rather than solo practice, teaching, medically related publications, academic appointment, younger age, and caring for a greater number of patients per week. For two of the innovations, discussion with a colleague was the most important source of information leading to a change of practice. The subjects cited local specialists as the colleagues who most often sparked the adoption of an innovation.
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PMID:Changing patient management: what influences the practicing pediatrician? 233 Feb 41

The relation of ventilatory impairment and chronic mucus hypersecretion to death from all causes and death from obstructive lung disease (chronic bronchitis, emphysema and asthma) was studied in 13,756 men and women randomly selected from the general population of the City of Copenhagen. During the 10 year follow up 2288 subjects died. In 164 subjects obstructive lung disease was considered to be an underlying or a contributory cause of death (obstructive lung disease related death); in 73 subjects it was considered to be the underlying cause of death (obstructive lung disease death). Forced expiratory volume in one second, expressed as a percentage of the predicted value (FEV1% pred), and the presence of chronic phlegm were used to characterise ventilatory function and chronic mucus hypersecretion respectively. For mortality analysis the proportional hazards regression model of Cox was used; it included age, sex, pack years, inhalation habit, body mass index, alcohol consumption, and the presence or absence of asthma, heart disease, and diabetes mellitus as confounding factors. By comparison with subjects with an FEV1 of 80% pred or more, subjects with an FEV1 below 40% pred had increased risk of dying from all causes (relative risk (RR) = 5.0 for women, 2.7 for men), a higher risk of obstructive lung disease related death (RR = 57 for women, 34 for men), and a higher risk of obstructive lung disease death (RR = 101 for women, 77 for men). Chronic mucus hypersecretion was associated with only a slightly higher risk of death from all causes (RR = 1.1 for women, 1.3 for men). The association between chronic mucus hypersecretion and obstructive lung disease death varied with the level of ventilatory function, being weak in subjects with normal ventilatory function (for an FEV1 of 80% pred the RR was 1.2), but more pronounced in subjects with reduced ventilatory function (for an FEV1 of 40% pred the RR was 4.2). A similar though statistically non-significant trend was observed with regard to obstructive lung disease related death. This study shows that impaired lung function is very strongly related to total mortality, obstructive lung disease related mortality, and obstructive lung disease mortality and suggests that chronic mucus hypersecretion, in those with impaired ventilatory function, is also a significant risk factor for death from obstructive lung disease.
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PMID:Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes. 240 19

The reasons for the frequent mutual exclusion in the same patient of asthma and diabetes and the fact that dextran anaphylactoid reaction does not occur in diabetic rats remain unknown. The mortality induced by the compound 48/80 and its histamine releasing effect from peritoneal mast cells have been tested in alloxan diabetic rats. The effect of acetylcholine on isolated airways from these animals has also been investigated. It is suggested that the lower quantity of peritoneal mast cells found in diabetic animals (and not the histamine released from its mast cells or airway hyporeactivity to acetylcholine) contributes to the protective effect of diabetes mellitus to the anaphylactoid reaction consequences.
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PMID:Bronchial asthma and diabetes mellitus. Experimental evidences of mutual exclusion. 247 12

The drug treatment of mild hypertension has been shown to afford protection against fatal and nonfatal strokes, congestive heart failure, progression to more severe levels of hypertension, and all-cause mortality, but not against the complications of coronary artery disease. The lack of benefit against coronary artery disease may result from failure to reduce other risk factors or because the drugs employed increased coronary risk. It can be taken as axiomatic that effective preventive antihypertensive therapy is more likely with drugs with mechanisms and sites of action that are focused on the underlying pathophysiology than with drugs that lower blood pressure by means unrelated to the hypertensive process. Adrenergic predominance plays a major role in the initiation and maintenance of essential hypertension and, consequently, the alpha-adrenergic receptor inhibitors were among the first substances to receive serious consideration as antihypertensive agents. However, since these drugs are nonselective, feedback control of transmitter norepinephrine was lost and, consequently, the clinical expectations of the early alpha-adrenergic receptor inhibitors in the treatment of high blood pressure were not fulfilled. The discovery of selective postjunctional alpha 1-adrenergic-receptor inhibitors, such as prazosin and doxazosin, which preserve feedback control of transmitter norepinephrine release, was the crucially important step in the development of specific drugs to combat the hyperactivity of adrenergic vasoconstrictor nerves in hypertension. These drugs have been shown to normalize hemodynamics in hypertensive patients. They lower blood pressure through a reduction in peripheral resistance at rest and during exercise, independent of changes in heart rate and blood pressure, with minimal reflex activation or tolerance development. Alpha 1-adrenergic-receptor inhibitors, such as prazosin and doxazosin, represent an attractive choice for initial therapy in all grades of hypertension and are especially appropriate in hypertensive patients with congestive heart failure, asthma and chronic obstructive airways disease, renal impairment, diabetes mellitus, hyperlipidemia, benign prostatic hyperplasia, or gout, and in those involved in vigorous work, sports, or exercise. There are no known contraindications to these drugs, except in patients who are sensitive to quinazolines.
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PMID:Pharmacologic basis for the use of doxazosin in the treatment of essential hypertension. 256 23

Lists of patients receiving repeat prescriptions for epilepsy, diabetes, thyroid disease and asthma were compared with chronic disease registers stored on seven practice computers. Diabetes was the most accurately recorded disease: the names of 72% of patients receiving medication for this condition appeared on the relevant disease registers. Agreement between the two data sources was 68% for thyroid disease, 58% for asthma and 49% for epilepsy. The levels of accuracy are not yet high enough for the computerised chronic disease registers to provide an accurate estimate of the prevalence of these conditions, but new system developments suggest a more optimistic outlook for the future.
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PMID:Computer held chronic disease registers in general practice: a validation study. 259 87

Empathy, emotional responsiveness, depression, aggression, and self-concept in 80 chronically ill and 40 well school-age children (9-11 years) were examined in a quasi-experimental study. The ill children had either diabetes or asthma. Results suggested a similarity of emotional functioning for empathy, emotional responsiveness, and depression in the ill children. The ill children had significantly higher levels of these behaviors than the well children. The groups of ill children did not significantly differ from each other in these areas. The diabetic and asthmatic children significantly differed in aggression and self-concept. The diabetic children, however, did not differ from the well children in self-concept. The asthmatic children had the lowest self-reported aggression while the diabetic children had the highest. Neither ill group differed from the well children in aggression.
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PMID:Emotional behaviors in chronically ill children. 260 57

Angiotensin converting enzyme inhibitors are effective hypotensive agents, lowering blood pressure in patients with mild to moderate hypertension either alone or in combination with a low dose loop diuretic. They are generally well tolerated and score well in quality of life studies. However, in some patients they do cause cough, which may lead to their withdrawal, and their association with renal failure and death in elderly patients may reduce their usefulness in this age group. Nevertheless they have established a role as first line therapy in patients with asthma and diabetes.
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PMID:ACE inhibitors and strategies for managing hypertension. 269 11

Insulin-dependent diabetes mellitus (IDDM) may be caused by a combination of genetic predisposition and environmental insults. However, there are few solid leads concerning human diabetogenic environmental agents. A case-control study was carried out to investigate the possible relationships between IDDM and various biological, chemical, and psychological factors. All 161 cases of IDDM among children aged 0-17 yr occurring in Montreal from 1983 to 1986 were included. The parent of each newly diagnosed diabetic subject was asked to provide the names of two of the child's friends or neighbors who would be age and sex matched to serve as controls. For those unable to do so, matched controls were selected from a hospital emergency room. Parents of cases and controls were interviewed concerning many factors. There was little or no difference between cases and controls with regard to parental smoking habits, exposure to pets, and consumption of meat products high in nitrosamines. In univariate analyses, there was some indication of elevated risk for children who had not been breast-fed, who attended day care or nursery before age 5 yr, who lived in a crowded household at age 3 yr, or who had a history of asthma or eczema, although in multivariate analyses the only variables that had any effect were crowding and day-care attendance. In univariate and multivariate analyses, there was high risk of IDDM among children who had experienced selected stressful life events during the 12 mo preceding onset of IDDM or who had exhibited symptoms of social or psychological dysfunction during that time.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes Care 1989 Mar
PMID:Case-control study of IDDM. 270 13

A questionnaire investigation was undertaken to study the circumstances of life of 115 families with children aged 0-7 years suffering from asthma, diabetes and epilepsy. Their contacts with the authorized and alternative therapeutic systems were investigated. In addition, 317 families with healthy children matched for age and sex were also investigated. 89.8% of the families with sick children and 86.4% of the families with healthy children replied. The average percentage of replies was 87.2. The frequency of change of doctor was similar in the case and the control group. Among families with sick children, no association was found between change of doctor and the degree of satisfaction with medical treatment. One third of the sick children had received alternative treatment. The majority had consulted chiropractors. 73% of the parents reported that the treatment had been of benefit to their child. Among parents of asthmatic children who had received chiropractic treatment, 92% considered this treatment beneficial. Alternative treatment was more frequent among children from the higher social classes. A tendency was observed towards less satisfaction with medical treatment, information and general guidance concerning the illness among families who sought alternative treatment. The differences were not statistically significant, possibly because of the limited size of the study population investigated.
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PMID:[Contact between preschool children with chronic diseases and the authorized health services and forms of alternative therapy]. 277 88

While the association between Type A behaviour pattern and coronary heart disease (CHD) has been abundantly investigated, the question of the specificity of this association remains virtually unexplored. The present study addressed this question by examining, in a sample of 1949 male and female adults, the relationship between JAS Type A measurement and self-reported diseases (i.e. CHD, scarlatina, rheumatoid arthritis, asthma, diseases of the liver, diseases of the gall-bladder, thyroid troubles, tuberculosis, peptic ulcer, renal disease, hypertension and diabetes). Type A subjects were found to report not only more CHD, but also more peptic ulcers, thyroid problems, asthma and rheumatoid arthritis. Globally, more Type A than Type B subjects reported having been ill, and the average number of reported diseases per person was higher among Type As than among Type Bs. These results were obtained in spite of the fact that Type A subjects in this study were markedly younger than Type Bs, and in spite of the empirically based reputation of the former to be symptom deniers rather than symptom reporters. Overall, the data supported the view that Type A behaviour pattern is a general disease-prone condition rather than merely a specific coronary risk factor.
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PMID:Type A behaviour pattern: specific coronary risk factor or general disease-prone condition? 278 74


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