Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: UMLS:C0018799 (heart disease)
34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Low back pain (LBP) poses an economic burden to society, mainly in terms of the large number of work days lost by a small percentage of patients who develop chronic LBP. The object of this review is to gain a better understanding of the societal costs of LBP and to see whether current clinical management follows evidence-based guidelines and is economically attractive, by reviewing studies on LBP with economic implications. To this end, the Medline database was searched between 1996 and 2001 using appropriate keywords, broadly defined. A total of 372 abstracts were screened and paper copies of 73 potentially relevant articles were obtained. It was found that the cost of LBP illness was high and was comparable to other disorders such as headache, heart disease, depression or diabetes, but actual cost estimates varied depending on the costing methodology employed. A small percentage of patients with chronic LBP accounts for a large fraction of the costs. Excessive and inappropriate use of diagnostic or therapeutic services can be documented but varied by region and provider type. Management according to evidence-based guidelines was not necessarily economically attractive. Interventions for acute or chronic LBP failed to show economic benefits, but demonstrated modest clinical benefits, which suggested a weak relationship between clinical and economic outcomes. The conclusion was that common definitions and costing methodologies need to be found to gain a better understanding of the true costs to society and to make studies comparable. A better definition is needed for the type for patient with LBP for whom therapeutic management is most likely to have a long-lasting economic benefit.
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PMID:The economic burden of low back pain: a review of studies published between 1996 and 2001. 1198 29

Many countries in Asia, Africa, Latin America, and the Caribbean offer substantial tax breaks to foreign corporations that set up shops in free-trade zones and waive environmental regulations and repress trade unions to further induce this practice. Workers in these shops--mainly women--perform repetitive machine-based motions, are exposed to toxic chemicals and unsafe equipment, and face dangerously high production quotas. Health problems caused by these working conditions include headache and dizziness, fatigue, anemia, forgetfulness, stomach pains, respiratory problems, hypertension, heart disease, and allergies. Water and air pollution and dumping of hazardous waste affect the health of entire communities. Since free-trade zones are a permanent feature of the global economy, organizing to protect workers and communities assumes critical importance. Groups such as the Border Committee of Women Workers in Mexico are providing workers with skills and support to make demands such as better treatment of pregnant workers. International labor, environmental, and public health advocates can support such efforts by providing assistance to worker-controlled organizations and pressuring governments to enforce laws intended to protect workers and their communities.
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PMID:Globalization causes a world of health problems. 1234 7

Those of us with chronic Lyme disease are not at all confused, as suggested by Sigal and Hassett (2002). We know from years of experience that we have real, specific symptoms that are usually painful and disabling and include severe headaches, crippling arthritis, and heart palpitations, which lead to serious heart disease. Many of us know that our symptoms are kept in check while we are on antibiotics, but they painfully reappear when the antibiotics are withdrawn. Just because the medical community cannot detect a specific causative bacterium and managed health care companies want to maximize profits doesn't mean that those of us afflicted with this terrible condition are delusional and not truly benefiting from antibiotic treatment. We are not all crazy; we are sick and we should not be required to prove it to get medical care.
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PMID:Chronic Lyme disease: it's not all in our heads. 1219 94

We performed an observational analysis of prospectively collected data on 1,474 adult patients who were hospitalized for community-acquired pneumonia; 1,169 patients were under 80 years of age and 305 (21%) patients were over 80 years ("very elderly"). Mean patient ages were 60 years in the former group and 85 years in the latter group. Severely immunosuppressed patients and nursing-home residents were not included. Comorbidities significantly associated with older age were chronic obstructive pulmonary disease, chronic heart disease, and dementia. The most common causative organism was Streptococcus pneumoniae (23% in both groups). Aspiration pneumonia was more frequent in the very elderly (5% in younger patients versus 10% in the very elderly); Legionella pneumophila (8% in younger patients versus 1% in the very elderly) and atypical agents (7% in younger patients versus 1% in the very elderly) were rarely recorded in the very elderly. While very elderly patients complained less frequently of pleuritic chest pain, headache, and myalgias, they were more likely to have absence of fever and altered mental status on admission. No significant differences were observed between groups as regards incidence of classic bacterial pneumonia syndrome (60% versus 59%) in 343 patients with pneumococcal pneumonia. The development of inhospital complications (26% in younger versus 32% in very elderly patients) as well as early mortality (2% in younger versus 7% in very elderly patients) and overall mortality (6% in younger versus 15% very elderly patients) were significantly higher in very elderly patients. Acute respiratory failure and shock/multiorgan failure were the most frequent causes of death, especially of early mortality. Factors independently associated with 30-day mortality in the very elderly were altered mental status on admission (odds ratio, 3.69), shock (odds ratio, 10.69), respiratory failure (odds ratio, 3.50), renal insufficiency (odds ratio, 5.83), and Gram-negative pneumonia (odds ratio, 20.27).
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PMID:Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. 1279 2

External electrocardiographic loop recording permits extended cardiac rhythm monitoring and ECG storage before and after device activation. The purpose of the study was to assess the diagnostic yield of external loop recorders in patients with more than two syncopal events within the last 6 months and a negative tilt table test. Twenty-four consecutive patients (51 +/- 14 years, male n = 9) were enrolled with 3 +/- 4 recurrent syncopal events within the last 6 months and no overt structural heart disease. The loop recorder CardioCall continuously records a two-channel ECG via skin electrodes. When activated, up to 4.5 minutes of the ECG preceding activation is stored. The time between tilt table testing and monitoring was 5 +/- 4 weeks. The average monitoring period covered 50 +/- 22 days. Recording was either unsuccessful or terminated prematurely in 5 patients. The reasons were skin irritation secondary to the electrodes in two patients, cable damage in one patient, and two patients inadvertently erased the stored data when replacing the batteries. Fourteen patients activated the loop recorder at least once. Symptoms leading to device activation were syncope (n = 1), dizziness (n = 11), feeling unwell (n = 7), palpitations (n = 5), headaches (n = 1), and chest pain (n = 1). The loop recorder documented sinus tachycardia during the syncopal event. Sinus tachycardia was also observed in 7 other patients, and atrial flutter in two patients. Eight patients had recurrent syncope with two patients experiencing syncope prior to the monitoring period, one syncope occurred in a patient who inadvertently erased the stored data, one event coincided with sinus tachycardia, and 4 (17%) patients had syncope during 15 +/- 10 months after termination of loop monitoring. The external loop recorder was not very useful for arrhythmia detection in patients with syncopal events, no overt heart disease, and a negative tilt table test because the cardiac rhythm was stored in only 1 of 8 (13%) patients with recurrent syncope. Reasons for the low diagnostic yield of external loop recorders were infrequent syncopal events after the baseline evaluation, with rare events during the limited monitoring period in particular, and premature termination or unsuccessful recording in 21% of patients.
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PMID:Diagnostic yield of external electrocardiographic loop recorders in patients with recurrent syncope and negative tilt table test. 1293 Apr 97

Arterial ischemic stroke is being recognized more commonly in the pediatric population. The etiologies differ greatly from those seen in adults. The most common etiologies are congenital heart disease and sickle cell disease. Children may present with or without hemiparesis and may have fever, headache, and depressed level of consciousness. A high index of suspicion is needed to diagnose stroke. Although clinical studies are scarce in children, besides early diagnosis, early specialized care with careful attention to detail ensuring adequate oxygenation and ventilation, prevention of hyperthermia and seizures, and maintenance of blood pressure and metabolic balance are important and likely improve outcome in these children. Selective children may also benefit from anticoagulant therapy, and, as the interval to diagnosis decreases, thrombolytic therapy may become an option although safety data are required. Children with acute stroke should be rapidly transported to and cared for in a pediatric center with a specialized stroke team or access to acute stroke protocols.
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PMID:Cerebrovascular disorders. 1525 67

Azimilide is an investigational Class III antiarrhythmic that has been developed for treating both supraventricular and ventricular tachyarrhythmias. Similar to other Class III antiarrhythmics, azimilide prolongs myocardial repolarization in a dose-dependent manner by increasing the action potential duration, QT interval, and effective refractory period. The most frequent reported side effect is headache, with rare serious adverse events of early reversible neutropenia and Torsades de Pointes. In long-term follow up, the patient withdrawal rate has been low. Azimilide has very predictable pharmacokinetics, is predominantly hepatically metabolized, and has no significant drug interactions with digoxin or warfarin. In animal models, azimilide has been shown to be very effective in suppressing both atrial and ventricular tachyarrhythmias, decreasing the defibrillation energy requirement, and preventing post-myocardial infarction ventricular tachycardia and fibrillation. Clinically, in a series of 4 double-blind, randomized, placebo-controlled trials, the Azimilide Supraventricular Arrhythmia Program which included over 1000 patients and approximately 70% with structural heart disease, azimilide showed a significant prolongation in the time to first recurrence of paroxysmal supraventricular tachycardia or atrial fibrillation/flutter. With respect to ventricular tachyarrhythmias, the AzimiLide post-Infarct surVival Evaluation Trial was a large randomized, multinational, prospective, placebo-controlled study in recent survivors of myocardial infarction at high risk for sudden cardiac death. After 1 year of follow-up, this study showed no statistical difference in all-cause mortality between placebo and azimilide. However, azimilide did statistically reduce the incidence of new atrial fibrillation. Further trials are necessary to evaluate the efficacy of azimilide in patients with symptomatic ventricular arrhythmias.
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PMID:Azimilide, a novel oral class III antiarrhythmic for both supraventricular and ventricular arrhythmias. 1572 Feb 25

We examined symptom experiences, symptom attributions, and causal attributions reported by patients hospitalized for a first-time myocardial infarction (MI). We also explored the roles of symptoms, negative affect, and risk factors in promoting stress and other causal attributions. Patients (N = 65) completed measures of symptom experiences and attributions, perceived causes of their MI, state and trait negative affect, and risk factors. Patients attributed most of their symptoms to the heart condition, although rates varied from 48% (headaches) to 97% (nausea). The most common causal attribution was stress, followed by high cholesterol, heredity, fat consumption, and hypertension. Stress attributions were positively associated with state anxiety and specific, stress-related symptoms (e.g., fatigue and breathlessness). Anxious mood and stress-related symptoms appear to enhance the plausibility of stress as a cause of MI. Risk factors were moderately correlated with associated causal attributions. For many patients, however, attributions to hypertension, cholesterol, and family history of heart disease were discordant with their clinical data. Causal attributions remained stable over the subsequent 6 months.
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PMID:Symptom experiences, symptom attributions, and causal attributions in patients following first-time myocardial infarction. 1574 34

Domestic violence (DV) is a serious risk for women's health. So far, little attention has been paid to this area in research and medical care in Germany. Acknowledging this deficit, the S.I.G.N.A.L.-Intervention Project has started to develop a program to improve the medical care for victimized women. For the first time in Germany, data on the health care needs of victimized women have been collected within the S.I.G.N.A.L.-Evaluation Research Project. This article presents the results of a female patient survey (n=806) on DV conducted in the emergency department (ED) of a university hospital in Berlin. The results demonstrate that 36.6% of women reported at least one episode of DV after the age of 16. A total of 4.6% were victims of DV over the past year, and 1.5% of women came to the ED for treatment of injuries caused by violence. A total of 57% of the victims of at least one episode of DV in their lifetime after the age of 16 described a negative impact on their health. The most frequently reported sequelae were head injuries, haematomas and fractures, gastrointestinal disorders, headache/migraine and heart disease. The psychological symptoms were anxiety, depression and suicide/self-mutilation attempts. Some 52% of the victims who reported health consequences had received medical care. In case of DV occurring, 67% of all women said that they would discuss it with their physicians. Approximately 80% of all respondents favoured a routine inquiry for DV as part of the medical history protocol of the ED.
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PMID:[Domestic violence against women and health care demands. Results of a female emergency department patient survey]. 1576 6

It is unclear whether physiologic hemoglobin targets lead to cardiac benefit in incident hemodialysis patients without symptomatic heart disease and left ventricular dilation. In this randomized, double-blind study, lower (9.5 to 11.5 g/dl) and higher (13.5 to 14.5 g/dl) hemoglobin targets were generated with epoetin alpha over 24 wk and maintained for an additional 72 wk. Major eligibility criteria included recent hemodialysis initiation and absence of symptomatic cardiac disease and left ventricular dilation. The primary outcome measure was left ventricular volume index (LVVI). The study enrolled 596 patients. Mean age, duration of dialysis therapy, baseline predialysis hemoglobin, and LVVI were 50.8 yr, 0.8 yr, 11.0 g/dl, and 69 ml/m2, respectively; 18% had diabetic nephropathy. Mean hemoglobin levels in the higher and lower target groups were 13.3 and 10.9 g/dl, respectively, at 24 wk. Percentage changes in LVVI between baseline and last value were similar (7.6% in the higher and 8.3% in the lower target group) as were the changes in left ventricular mass index (16.8 versus 14.2%). For the secondary outcomes, the only between-group difference was an improved SF-36 Vitality score in the higher versus the lower target group (1.21 versus -2.31; P = 0.036). Overall adverse event rates were similar in both target groups; higher (P < 0.05) rates of skeletal pain, surgery, and dizziness were seen in the lower target group, and headache and cerebrovascular events were seen in the higher target group. Normalization of hemoglobin in incident hemodialysis patients does not have a beneficial effect on cardiac structure, compared with partial correction.
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PMID:Double-blind comparison of full and partial anemia correction in incident hemodialysis patients without symptomatic heart disease. 1590 66


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